Showing papers in "BMC Psychiatry in 2021"

Effects of sources of social support and resilience on the mental health of different age groups during the COVID-19 pandemic.

Abstract: A pandemic is a very stressful event, especially for highly vulnerable people (e.g., older adults). The purpose of the current study was to investigate the main and interactive relationships of social support and resilience on individual mental health during the COVID-19 pandemic across three age groups: emerging adults, adults, and older adults. A survey was conducted with 23,192 participants aged 18–85. Respondents completed a questionnaire, including items on the COVID-19-related support they perceived from different sources, the abbreviated version of the Connor-Davidson Resilience Scale, and the Mental Health Inventory. Latent profile analysis identified five profiles of social support, and the patterns of potential profiles were similar in all groups. However, category distribution in the five profiles was significantly different among the age groups. Furthermore, analysis using the BCH command showed significant differences in mental health among these profiles. Lastly, interactive analyses indicated resilience had a positive relationship with mental health, and social support served as a buffer against the negative impact of low resilience on mental health. This study provides quantitative evidence for socioemotional selectivity theory (SST) and enables several practical implications for helping different age groups protecting mental health during pandemic.

A qualitative study of experiences of NHS mental healthcare workers during the Covid-19 pandemic.

Abstract: The Covid-19 pandemic has imposed extraordinary strains on healthcare workers. But, in contrast with acute settings, relatively little attention has been given to those who work in mental health settings. We aimed to characterise the experiences of those working in English NHS secondary mental health services during the first wave of the pandemic. The design was a qualitative interview-based study. We conducted semi-structured, remote (telephone or online) interviews with 35 members of staff from NHS secondary (inpatient and community) mental health services in England. Analysis was based on the constant comparative method. Participants reported wide-ranging changes in the organisation of secondary mental health care and the nature of work in response to the pandemic, including pausing of all services deemed to be “non-essential”, deployment of staff across services to new and unfamiliar roles, and moves to remote working. The quality of participants’ working life was impaired by increasing levels of daily challenge associated with trying to provide care in trying and constrained circumstances, the problems of forging new ways of working remotely, and constraints on ability to access informal support. Participants were confronted with difficult dilemmas relating to clinical decision-making, prioritisation of care, and compromises in ability to perform the therapeutic function of their roles. Other dilemmas centred on trying to balance the risks of controlling infection with the need for human contact. Many reported features of moral injury linked to their perceived failures in providing the quality or level of care that they felt service users needed. They sometimes sought to compensate for deficits in care through increased advocacy, taking on additional tasks, or making exceptions, but this led to further personal strain. Many experienced feelings of grief, helplessness, isolation, distress, and burnout. These problems were compounded by sometimes poor communication about service changes and by staff feeling that they could not take time off because of the potential impact on others. Some reported feeling poorly supported by organisations. Mental health workers faced multiple adversities during the pandemic that were highly consequential for their wellbeing. These findings can help in identifying targets for support.

A comparison of the Mini-Mental State Examination (MMSE) with the Montreal Cognitive Assessment (MoCA) for mild cognitive impairment screening in Chinese middle-aged and older population: a cross-sectional study.

Abstract: The Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) are the most commonly used scales to detect mild cognitive impairment (MCI) in population-based epidemiologic studies. However, their comparison on which is best suited to assess cognition is scarce in samples from multiple regions of China. We conducted a cross-sectional analysis of 4923 adults aged ≥55 years from the Community-based Cohort Study on Nervous System Diseases. Objective cognition was assessed by Chinese versions of MMSE and MoCA, and total score and subscores of cognitive domains were calculated for each. Education-specific cutoffs of total score were used to diagnose MCI. Demographic and health-related characteristics were collected by questionnaires. Correlation and agreement for MCI between MMSE and MoCA were analyzed; group differences in cognition were evaluated; and multiple logistic regression model was used to clarify risk factors for MCI. The overall MCI prevalence was 28.6% for MMSE and 36.2% for MoCA. MMSE had good correlation with MoCA (Spearman correlation coefficient = 0.8374, p < 0.0001) and moderate agreement for detecting MCI with Kappa value of 0.5973 (p < 0.0001). Ceiling effect for MCI was less frequent using MoCA versus MMSE according to the distribution of total score. Percentage of relative standard deviation, the measure of inter-individual variance, for MoCA (26.9%) was greater than for MMSE (19.0%) overall (p < 0.0001). Increasing age (MMSE: OR = 2.073 for ≥75 years; MoCA: OR = 1.869 for≥75 years), female (OR = 1.280 for MMSE; OR = 1.163 for MoCA), living in county town (OR = 1.386 and 1.862 for MMSE and MoCA, respectively) or village (OR = 2.579 and 2.721 for MMSE and MoCA, respectively), smoking (OR = 1.373 and 1.288 for MMSE and MoCA, respectively), hypertension (MMSE: OR = 1.278; MoCA: OR = 1.208) and depression (MMSE: OR = 1.465; MoCA: OR = 1.350) were independently associated with greater likelihood of MCI compared to corresponding reference group in both scales (all p < 0.05). MoCA is a better measure of cognitive function due to lack of ceiling effect and with good detection of cognitive heterogeneity. MCI prevalence is higher using MoCA compared to MMSE. Both tools identify concordantly modifiable factors for MCI, which provide important evidence for establishing intervention measures.

The psychological impact of the COVID-19 pandemic on adults and children in the United Arab Emirates: a nationwide cross-sectional study.

Abstract: The psychosocial impact of previous infectious disease outbreaks in adults has been well documented, however, there is limited information on the mental health impact of the COVID-19 pandemic on adults and children in the United Arab Emirate (UAE) community. The aim of this study was to explore anxiety levels among adults and children in the UAE and to identify potential risk and protective factors for well-being during the COVID-19 pandemic. Using a web-based cross-sectional survey we collected data from 2200 self-selected, assessed volunteers and their children. Demographic information, knowledge and beliefs about COVID-19, generalized anxiety disorder (GAD) using the (GAD-7) scale, emotional problems in children using the strengths and difficulties questionnaire (SDQ), worry and fear about COVID-19, coping mechanisms and general health information were collected. Descriptive analysis was carried out to summarize demographic and participant characteristics, Chi-square analysis to explore associations between categorical variables and anxiety levels and multivariable binary logistic regression analysis to determine predictors of anxiety levels in adults and emotional problems in children. The overall prevalence of GAD in the general population was 71% with younger people (59.8%) and females (51.7%) reporting highest levels of anxiety. Parents who were teachers reported the highest percentage of emotional problems in children (26.7%). Adjusted multivariable logistic regression for GAD-7 scores showed that being female, high levels of worry associated with COVID-19, intention to take the COVID-19 vaccine and smoking were associated with higher levels of anxiety. Adjusted multivariable logistic regression for SDQ showed that higher emotional problems were reported for children in lower and higher secondary education, and parents who had severe anxiety were seven times more likely to report emotional problems in their children. This study reports the psychological impact of COVID-19 among adults and children in the UAE and highlights the significant association between parental and child anxiety. Findings suggest the urgency for policy makers to develop effective screening and coping strategies for parents and especially children.

Prevalence and correlates of anxiety and depression in frontline healthcare workers treating people with COVID-19 in Bangladesh.

Abstract: Healthcare workers (HCWs) who are in the frontline during the COVID-19 pandemic are often under significant pressures that may predispose them to symptoms of poor mental health. This study aimed to investigate the prevalence of anxiety and depression among HCWs and factors correlated with mental health concerns during the COVID-19 pandemic in Bangladesh. And, it also aimed to evaluate the psychometric properties of the Bangla version of the Hospital Anxiety and Depression Scale (HADS). A cross-sectional survey was conducted between July and August, 2020. A self-reported online questionnaire was utilized to collect data. The survey included questions concerning socio-demographic, lifestyle, and work setting, as well as the HADS. A confirmatory factor analysis (CFA) and multiple linear regression analysis were performed. Data from 803 HCWs (50.7% male; mean age: 27.3 [SD = 6.9]; age range: 18-58 years) were included in the final analysis. The Bangla HADS was psychometrically sound, and demonstrated good internal consistency and reliability (α = 0.83), and excellent construct validity. Prevalence estimates of anxiety and depression were 69.5%, and 39.5%, respectively, for less severe symptomology (at least borderline abnormal), and 41.2% and 15.7% for more severe (at least abnormal) symptomology. Regression analyses with the total HADS score as a dependent variable revealed significant (p < 0.05) associations with female gender, moderate and poor health status, infrequent physical exercising, smoking, having had regrets about one’s profession because of the pandemic and associated experiences, not updating on the latest COVID-19-related research, experiencing discrimination in the workplace, and facing social problems due to working in a lab or hospital during the COVID-19 pandemic. Symptoms of anxiety and depression are prevalent among HCWs during the COVID-19 pandemic in Bangladesh. The findings suggest a need for screening for mental health concerns, and employing early intervention to help these individuals.

Psychological distress associated with the COVID-19 pandemic and suppression measures during the first wave in Belgium.

Abstract: The COVID-19 pandemic and subsequent suppression measures have had health and social implications for billions of individuals. The aim of this paper is to investigate the risk of psychological distress associated with the COVID-19 pandemic and suppression measures during the early days of the lockdown. We compared the level of psychological distress at the beginning of that period with a pre-pandemic health survey and assessed the psychological effects of exposure to the COVID-19 pandemic and changes in social activity and support. An online survey was distributed to the general population in Belgium 3 days after the beginning of the lockdown. 20,792 respondents participated. The psychological distress of the population was measured using the GHQ-12 scale. Social activities and support were assessed using the Social Participation Measure, the Short Loneliness Scale, and the Oslo Social Support Scale. An index of subjective exposure to the COVID-19 pandemic was constructed, as well as a measure of change in occupational status. Measurements were compared to a representative sample of individuals extracted from the Belgian Health Interview Survey of 2018. Bootstrapping was performed and analyses were reweighted to match the Belgian population in order to control for survey selection bias. Half of the respondents reported psychological distress in the early days of the lockdown. A longer period of confinement was associated with higher risk of distress. Women and younger age groups were more at risk than men and older age groups, as were respondents who had been exposed to COVID-19. Changes in occupational status and a decrease in social activity and support also increased the risk of psychological distress. Comparing the results with those of the 2018 Belgian Health Interview shows that the early period of the lockdown corresponded to a 2.3-fold increase in psychological distress (95% CI: 2.16–2.45). Psychological distress is associated with the consequences of the COVID-19 pandemic and suppression measures. The association is measurable from the very earliest days of confinement and it affected specific at-risk groups. Authorities should consider ways of limiting the effect of confinement on the mental and social health of the population and developing strategies to mitigate the adverse consequences of suppression measures.

Mental health problems and social supports in the COVID-19 healthcare workers: a Chinese explanatory study.

Abstract: Coronavirus disease 2019 (COVID-19) has spread rapidly in China and other overseas areas, which has aroused widespread concern. The sharp increase in the number of patients has led to great psychological pressure on health care workers. The purpose of this study was to understand their mental health status and needs, so as to provide a scientific basis for alleviating the psychological pressure of health care workers. Using a cross-sectional study design, 540 health care workers were randomly selected from two designated tuberculosis medical institutions in Anhui Province. The basic situation, perceived social support, depression level, loneliness and COVID-19 related knowledge were collected and analyzed by questionnaire. A total of 511 valid questionnaires were finally retrieved. There were 139 people in epidemic prevention and control positions (27.20%). Depression level: People in isolation ward, fever clinic and pre-check triage were at the level of mild to moderate depression. Female was higher than male; nurse was higher than doctor; middle and junior job titles were higher than senior titles; junior college degree or below were higher than bachelor’s degree, master’s degree and above; isolation ward, fever clinic and pre-check triage were significantly higher than those of non-prevention and control positions (p < 0.05). Loneliness scores: Doctors were higher than that of medical technicians, and isolation ward, fever clinic and pre-check triage were higher than those of other medical departments (p < 0.05). Social support: Doctors were lower than that of medical technicians, and isolation ward, fever clinic and pre-check triage were significantly lower than those of other departments (p < 0.05). The score of social support was negatively correlated with depression and loneliness (p < 0.001), while depression was positively correlated with loneliness (p < 0.001). Health care workers most want to receive one-to-one psychological counseling (29.75%), and provide crisis management (24.07%). The awareness rate of health care workers on COVID-19’s knowledge was relatively high. The psychological problems of health care workers, especially women, nurses with low educational background, low professional title, and staff in the epidemic prevention and control positions are relatively serious.

Depression, risk factors, and coping strategies in the context of social dislocations resulting from the second wave of COVID-19 in Japan.

Abstract: Social dislocations resulting from coronavirus disease 2019 (COVID-19) pandemic have been prolonged, which has led to general population social suppression. The present study aimed to reveal risk factors associated with mental health problems and suggest concrete coping strategies in the context of COVID-19. A web-based survey was conducted in July when Japan was experiencing a second wave of COVID-19. Demographics, Patient Health Questionnaire-9 (PHQ-9), state anger, anger control, and the Brief Coping Orientation to Problems Experienced were measured. Multivariate logistic regression analysis on PHQ-9 scores by set variables was conducted. The participants were 2708 individuals, and 18.35% of them were depressed. Logistic regression analysis showed that in the order of odds ratios (ORs), underlying disease (OR = 1.96, 95% confidence interval (CI) = 1.32–2.92), not working (OR = 1.85, CI = 1.22–2.80), negative economic impact (OR = 1.33, CI = 1.01–1.77), state anger (OR = 1.17, CI = 1.14–1.21), anger control (OR = 1.08, CI = 1.04–1.13), age (OR = 0.97, CI = 0.96–0.98), high income (OR = 0.45, CI = 0.25–0.80), and being married (OR = 0.53, CI = 0.38–0.74) were predictors of depressive symptoms. Regarding coping strategies, planning (OR = 0.84, CI = 0.74–0.94), use of instrumental support (OR = 0.85, CI = 0.76–0.95), denial (OR = 0.88, CI = 0.77–0.99), behavioural disengagement (OR = 1.28, CI = 1.13–1.44), and self-blame (OR = 1.47, CI = 1.31–1.65) were associated with probable depression. During prolonged psychological distress caused by COVID-19 pandemic, the prevalence of depressive symptoms in Japan was two to nine times as high as before the COVID-19 pandemic, even though Japan was not a lockdown country. Although some coping strategies were useful for maintaining mental health, such as developing ways, alone or with others, to address or avoid social dislocations, the influence of demographics was more powerful than these coping strategies, and medical treatments are needed for high-risk individuals.

Network structure of depression and anxiety symptoms in Chinese female nursing students.

Abstract: Comorbidity between depressive and anxiety disorders is common. From network perspective, mental disorders arise from direct interactions between symptoms and comorbidity is due to direct interactions between depression and anxiety symptoms. The current study investigates the network structure of depression and anxiety symptoms in Chinese female nursing students and identifies the central and bridge symptoms as well as how other symptoms in present network are related to depression symptom “thoughts of death”. To understand the full spectrum of depression and anxiety, we recruited 776 Chinese female nursing students with symptoms of depression and anxiety that span the full range of normal to abnormal. Depression symptoms were measured by Patient Health Questionnaire-9 while anxiety symptoms were measured by Generalized Anxiety Disorder 7-Item Questionnaire. Network analysis was used to construct networks. Specifically, we computed the predictability, expected influence and bridge expected influence for each symptom and showed a flow network of “thoughts of death”. Nine strongest edges existed in network were from the same disorder. Four were between depression symptoms, like “sleep difficulties” and “fatigue”, and “anhedonia” and “fatigue”. Five were between anxiety symptoms, like “nervousness or anxiety” and “worry too much”, and “restlessness” and “afraid something will happen”. The symptom “fatigue”, “feeling of worthlessness” and “irritable” had the highest expected influence centrality. Results also revealed two bridge symptoms: “depressed or sad mood” and “irritable”. As to “thoughts of death”, the direct relations between it and “psychomotor agitation/retardation” and “feeling of worthlessness” were the strongest direct relations. The current study highlighted critical central symptoms “fatigue”, “feeling of worthlessness” and “irritable” and critical bridge symptoms “depressed or sad mood” and “irritable”. Particularly, “psychomotor agitation/retardation” and “feeling of worthlessness” were identified as key priorities due to their strongest associations with suicide ideation. Implications for clinical prevention and intervention based on these symptoms are discussed.

Assessment of depression, anxiety and stress levels in the Ecuadorian general population during social isolation due to the COVID-19 outbreak: a cross-sectional study.

Abstract: Coronavirus disease 2019 (COVID-19) has become a global pandemic with serious consequences that have led to the implementation of unprecedented social isolation measures. At the early stages of the pandemic, Ecuador was one of the most affected countries in Latin America. The objective of this study was to assess the levels of depression, anxiety and stress in the Ecuadorian general population during the social isolation period due to COVID-19. A web-based survey consisting of 31 short-answer and multiple-choice questions was administered to the general population from April 22–May 3, 2020. Mental health status was assessed through the Depression, Anxiety and Stress Scale-21 Items (DASS-21) questionnaire. Ordinal logistic analyses were used to identify potential risk factors associated with the severity of mental health issues. A total of 626 individuals were included. Most of them were females (60.5%), and their mean age was 29.6 ± 11.7 years. Approximately 17.7% of the respondents had moderate to very severe levels of depression, 30.7% had similar levels of anxiety, and 14.2% experienced stress. Female sex, younger age, student status, and having a relative diagnosed with COVID-19 were associated with significantly higher levels of depression, anxiety and stress. Ordinal regression models showed that being a student was a risk factor for having more severe levels of depression (OR = 3.67; 95% CI = 2.56–5.26, p: 0.0001), anxiety (OR= 1.86; 95% CI= 1.35–2.55, p: 0.0001), and stress (OR = 2.17; 95% CI= 1.47–3.19, p: 0.0001). Having a relative with COVID-19 was also found to be a risk factor only for depression (OR= 1.70; 95% CI= 1.03–2.80, p: 0.036) and anxiety (OR = 2.17; 95% CI= 1.35–3.47, p: 0.001). Additionally, male sex, older age, and having more children were found to be protective factors for the three conditions. Our findings suggest that social isolation due to the COVID-19 outbreak has impacted the mental health of the general population in Ecuador. We identified potential risk and protective factors that could serve as a foundation from which to develop psychological strategies to safeguard the mental health of our population during the current pandemic.

Psychological distress among Italians during the 2019 coronavirus disease (COVID-19) quarantine.

Abstract: Quarantine as a preventive action to reduce people’s exposure to a contagious disease has substantial psychological impact. We aimed to collect information on psychologically distressing experiences of Italians living in quarantine during the COVID-19 pandemic. From 6 to 20 April 2020 participants filled out an online questionnaire. Demographic and physical symptoms data from the prior 14 days of quarantine were collected. Psychological impact of quarantine was assessed by the COVID-19 Peritraumatic Distress Index (CPDI). In all, 20,158 participants completed the online survey. Of these, 11,910 (59.1%) were from Lombardy, the region with 37.7% of positive cases identified during the survey period. 30.1% of responders were male. About half (55.9%) of responders were 18–50 years old, 54.3% had a tertiary level of education, 69.5% were workers, 84.1% were living in houses with ≥3 rooms, and 13.7% were living alone. 9.7% had had contact with COVID-19 positive people. Of all responders, 9978 (48.6%) reported a psychological impact, 8897 (43.4%) of whom reported mild or moderate and 1081 (5.2%) severe psychological impact. The multivariate analysis, after adjustments, showed that an increasing CPDI score was associated with gender (female), first-second educational level, being unemployed, living in a ≤2 room house, having had new health problems during the previous 14 days, and not having been out of the house in the previous week. Concerning the type of psychological distress, 2003 responders (9.9%) reported moderate to severe depressive symptoms, 1131 (5.5%) moderate to severe anxiety symptoms, and 802 (3.9%) moderate to severe physical symptoms. A positive correlation was found between responder rate (per 10.000 residents) and positive COVID-19 cases (per 10.000 residents) by region (rs = + 0.83, p = < 0.0001), and between responder rate and region latitude (rs = + 0.91, p = < 0.0001), with a greater response rate in the north. Considering Lombardy Region responders, a negative correlation between CPDI score and distance from place of residence to the red zone (Nembro-Alzano) was found. Higher prevalence of psychological distress was found up to 25 km away from the red zone and, in particular, severe distress up to 15 km. Policy makers and mental health professionals should be aware of quarantine’s adverse mental health consequences. Factors influencing the success of quarantine and infection control practices for both disease containment and community recovery should be identified and additional support to vulnerable persons at increased risk of adverse psychological and social consequences of quarantine should be guaranteed.

Stigma of mental illness and cultural factors in Pacific Rim region: a systematic review

Abstract: Although cultural factors play a crucial role in experience of stigma, there is scant review on the impact and importance of culture on stigma of mental illness across Pacific Rim Region. This study aims to investigate: 1) the cultural factors related to stigmatizing beliefs about mental illness in Pacific Rim region, and 2) culture-specific measures and interventions on stigma of mental illness. A systematic search of papers was conducted in the MEDLINE, Embase, CINAHL, Web of Science, PsycINFO, Scopus, Cochrane Library and Google scholar through January 2003 to April 2019. Forty-one studies in Pacific Rim region which met the inclusion criteria were included in the study. The rate of stigma of mental illness (e.g., public stigma: from 25.4 to 85.2%) was relatively high in Pacific Rim region. Culture factors (e.g., Collectivism, Confucianism, face concern and familism, religion and supernatural beliefs) contributed to people’s stigmatizing behaviors and attitudes toward persons with mental illness, their relatives and mental health professionals. Certain measurements were developed and employed to assess different type of cultural factors related to stigma of mental illness. Cultural factors play an important role in influencing the rate and performance of stigma of mental illness. Further research on stigma of mental illness and culture-specific interventions to reduce the stigma should be conducted in the Pacific Rim region.

Psychiatric emergency admissions during and after COVID-19 lockdown: short-term impact and long-term implications on mental health.

Abstract: Background The 'lockdown' measures, adopted to restrict population movements in order to help curb the novel coronavirus disease 2019 (COVID-19) pandemic, contributed to a global mental health crisis. Although several studies have extensively examined the impact of lockdown measures on the psychological well-being of the general population, little is known about long-term implications. This study aimed to identify changes in psychiatric emergency department (ED) admissions between two 8-week periods: during and immediately after lifting the lockdown. Methods Socio-demographic and clinical information on 1477 psychiatric ED consultations at the University Hospital of Geneva (HUG) were retrospectively analyzed. Results When grouped according to admission dates, contrary to what we expected, the post-lockdown group presented with more severe clinical conditions (as measured using an urgency degree index) compared to their lockdown counterparts. Notably, after the lockdown had been lifted we observed a statistically significant increase in suicidal behavior and psychomotor agitation and a decrease in behavior disorder diagnoses. Furthermore, more migrants arrived at the HUG ED after the lockdown measures had been lifted. Logistic regression analysis identified diagnoses of suicidal behavior, behavioral disorders, psychomotor agitation, migrant status, involuntary admission, and private resident discharge as predictors of post-lockdown admissions. Conclusions Collectively, these findings can have implications concerning the prioritization of mental health care facilities and access for patients at risk of psychopathological decompensation in time of confinement policies, but above all, provide a foundation for future studies focusing on the long-term impact of the pandemic and its associated sanitary measures on mental health. Trial registration Research Ethics Committee of Geneva, Registration number 2020-01510, approval date: 29 June 2020.

Temporal trends in annual incidence rates for psychiatric disorders and self-harm among children and adolescents in the UK, 2003-2018.

Abstract: There has been growing concern in the UK over recent years that a perceived mental health crisis is affecting children and adolescents, although published epidemiological evidence is limited. Two population-based UK primary care cohorts were delineated in the Aurum and GOLD datasets of the Clinical Practice Research Datalink (CPRD). We included data from 9,133,246 individuals aged 1–20 who contributed 117,682,651 person-years of observation time. Sex- and age-stratified annual incidence rates were estimated for attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) (age groups: 1–5, 6–9, 10–12, 13–16, 17–19), depression, anxiety disorders (6–9, 10–12, 13–16, 17–19), eating disorders and self-harm (10–12, 13–16, 17–19) during 2003–2018. We fitted negative binomial regressions to estimate incidence rate ratios (IRRs) to examine change in incidence between the first (2003) and final year (2018) year of observation and to examine sex-specific incidence. The results indicated that the overall incidence has increased substantially in both boys and girls in between 2003 and 2018 for anxiety disorders (IRR 3.51 95% CI 3.18–3.89), depression (2.37; 2.03–2.77), ASD (2.36; 1.72–3.26), ADHD (2.3; 1.73–3.25), and self-harm (2.25; 1.82–2.79). The incidence for eating disorders also increased (IRR 1.3 95% CI 1.06–1.61), but less sharply. The incidence of anxiety disorders, depression, self-harm and eating disorders was in absolute terms higher in girls, whereas the opposite was true for the incidence of ADHD and ASD, which were higher among boys. The largest relative increases in incidence were observed for neurodevelopmental disorders, particularly among girls diagnosed with ADHD or ASD. However, in absolute terms, the incidence was much higher for depression and anxiety disorders. The number of young people seeking help for psychological distress appears to have increased in recent years. Changes to diagnostic criteria, reduced stigma, and increased awareness may partly explain our results, but we cannot rule out true increases in incidence occurring in the population. Whatever the explanation, the marked rise in demand for healthcare services means that it may be more challenging for affected young people to promptly access the care and support that they need.

Development and psychometric testing of nursing students’ perceptions of clinical stressors scale: an instrument design study

Abstract: In clinical environments, nursing students experience a range of stressors that can affect their health, learning, and quality of patient care. This study aimed to develop a Nursing Students’ Perceptions of Clinical Stressors Scale (NSPCSS) and to evaluate its psychometric properties. This exploratory, sequential mixed-method study was conducted in 2 phases. In the qualitative (item generation) phase, NSPCSS items were generated using the data collected from semi-structured interviews and a literature review. In the quantitative (psychometric evaluation) phase, face, content, construct, convergent, and discriminant validity and reliability of the scale were tested. To evaluate construct validity, exploratory and confirmatory factor analyses were performed on the data collected from 430 nursing students. Reliability was also assessed through internal consistency and composite reliability. In this study, 6 factors were extracted from 30 itemes through exploratory factor analysis: (1) instructor’s limited competence in clinical environments, (2) inappropriate clinical environment, (3) inadequate knowledge and skills, (4) inefficient education in clinical planning, (5) instructor’s inappropriate conduct, and (6) concerns about the characteristics of nursing career. These factors accounted for 58.8% of the total variance. The results of the confirmatory factor analysis suggested the goodness-of-fit indices was acceptable. Furthermore, the internal consistency and composite reliability indices of all factors were greater than 0.7. The NSPCSS is a valid and reliable instrument for assessing clinical stressors among nursing students.

The effect of online multimedia psychoeducational interventions on the resilience and perceived stress of hospitalized patients with COVID-19: a pilot cluster randomized parallel-controlled trial.

Abstract: There is evidence suggesting that quarantine might have undesirable psychological impacts on the patients. Therefore, it is important to seek for ways to increase the resilience and alleviate the psychological pressure of the patients who are quarantined due to infection with COVID-19. The present study was conducted to assess an online multimedia psychoeducational intervention regarding the feasibility, adherence, patient satisfaction and effectiveness on resilience and perceived stress of patients hospitalized with confirmed COVID-19. This was a pilot cluster randomized parallel-controlled trial with hospital wards as the units of randomization. Participants in this fully online trial were 50 consecutive patients who were hospitalized in 2 hospitals in Shiraz, after being diagnosed with COVID-19. Before the beginning of the intervention, four inpatient wards inside two of the hospitals were randomly assigned to either intervention or control conditions. All eligible participants in the wards allocated to the intervention condition received online multimedia psychoeducational interventions during the 2 weeks, whilst the patients in the wards allocated to the control condition were offered the opportunity to receive telephone-based psychological counseling if needed. Psychoeducational interventions mainly included cognitive–behavioural techniques, stress management techniques, mindfulness-based stress reduction and positive psychotherapy. The patients were assessed regarding resilience and perceived stress at baseline and after two weeks. Of 27 patients starting multimedia psychoeducational interventions, 26 (96.29%) completed post-assessments. A high level of adherence (80.76%) and satisfaction (Mean = 29.42; SD = 4.18) with the online multimedia psychoeducational interventions was found. Compared with the control group, the patients who used online multimedia psychoeducational interventions reported greater resilience (Meanintervention = 81.74; Meancontrol = 72.86; adjusted t (46) = 2.10; p = 0.04; CI: 0.39 to 17.38; dppc2 = 0.83) and fewer perceived stress (Meanintervention = 22.15; Meancontrol = 29.45; adjusted t (46) = 2.66; p = 0.01; CI: − 12.81 to − 1.78; dppc2 = − 0.77) after 2 weeks. The findings of the present study provided a successful first attempt at implementing feasible online multimedia psychoeducational interventions to promote resilience and mitigate stress among the patients who were hospitalized due to infection with COVID-19. The present results could help mental health professionals to determine which psychological techniques should be emphasized to promote patients’ resilience in the context of COVID-19 disease. Iranian Registry of Clinical Trials, IRCT20201001048893N1 . Retrospectively registered, 29 Jan 2021.

Prevalence and its associated factors of depressive symptoms among Chinese college students during the COVID-19 pandemic.

Abstract: The COVID-19 pandemic has caused a mental health crisis around the world. The psychological health of college students also faces great challenges. This study aimed to investigate the prevalence and the related factors of depressive symptoms among Chinese college students. This online cross-sectional survey was conducted via Wenjuanxing platform from March 3–15, 2020 and received 1681 effective questionnaires. Each questionnaire contains the Center for Epidemiologic Studies Depression scale, the Multi-Dimensional Scale of Perceived Social Support, the Herth Hope Index, and the self-designed items. Multivariable logistic regression was conducted to determine the significantly associated factors of depressive symptoms. The prevalence of depressive symptoms among college students was 56.8%. Sleep problems (OR 2.678, 95%CI 2.094–3.424), family members’ going out (OR 1.775, 95%CI 1.089–2.894), perceived more stress for online education (OR 1.642, 95%CI 1.191–2.263), fear of COVID-19 (OR 1.450, 95%CI 1.121–1.876), influence on social interaction (OR 1.354, 95%CI 1.053–1.741) and higher grade (OR 1.378, 95%CI 1.046–1.816) were considered as risk factors of depressive symptoms. Perceived social support (OR 0.354, 95%CI 0.259–0.484), hope (OR 0.052, 95%CI 0.034–0.080), female (OR:0.557, 95%CI 0.427–0.725) and higher monthly disposable income (OR 0.666, 95%CI 0.447–0.993) were identified as protective factors against depressive symptoms. There was a high prevalence of depressive symptoms among Chinese college students during the COVID-19 pandemic. It is important to find ways to alleviate the pressure and fear of college students, to provide them with more social support, and to help them adapt to the changes in learning style and lifestyle.

Experiences and management of physician psychological symptoms during infectious disease outbreaks: a rapid review.

Abstract: Prior to the COVID-19 pandemic, physicians experienced unprecedented levels of burnout The uncertainty of the ongoing COVID-19 pandemic along with increased workload and difficult medical triage decisions may lead to a further decline in physician psychological health We searched Medline, EMBASE, and PsycINFO for primary research from database inception (Medline [1946], EMBASE [1974], PsycINFO [1806]) to November 17, 2020 Titles and abstracts were screened by one of three reviewers and full-text article screening and data abstraction were conducted independently, and in duplicate, by three reviewers From 6223 unique citations, 480 articles were reviewed in full-text, with 193 studies (of 90,499 physicians) included in the final review Studies reported on physician psychological symptoms and management during seven infectious disease outbreaks (severe acute respiratory syndrome [SARS], three strains of Influenza A virus [H1N1, H5N1, H7N9], Ebola, Middle East respiratory syndrome [MERS], and COVID-19) in 57 countries Psychological symptoms of anxiety (143–923%), stress (119–937%), depression (17–805%), post-traumatic stress disorder (132–752%) and burnout (147–76%) were commonly reported among physicians, regardless of infectious disease outbreak or country Younger, female (vs male), single (vs married), early career physicians, and those providing direct care to infected patients were associated with worse psychological symptoms Physicians should be aware that psychological symptoms of anxiety, depression, fear and distress are common, manifest differently and self-management strategies to improve psychological well-being exist Health systems should implement short and long-term psychological supports for physicians caring for patients with COVID-19

Mental disorder and PTSD in Syria during wartime: a nationwide crisis

Abstract: Syria has experienced war since 2011, leaving over 80% under the poverty line and millions displaced. War and its retaliations have significantly impacted the mental health of Syrians. This study evaluates the post-traumatic stress disorder (PTSD), and the severity of the mental distress caused by war and other factors such as low social support. This study also evaluates other variables and compares the findings with those of multiple studies on Syria and refugees. This is a cross-sectional study that included people who lived in Syria in different governorates. Online surveys were distributed into multiple online groups and included the Kessler 10 (K10) scale which screens for anxiety and depression, the Screen for Posttraumatic Stress Symptoms (SPTSS) tool, the Multidimensional Scale of Perceived Social Support, and questionnaires on demographic and war-related factors. Our study included 1951 participants, of which, 527 (27.0%) were males and 1538 (78.8%) between the age of 19 and 25. Among participants, 44% had likely severe mental disorder, 27% had both likely severe mental disorder and full PTSD symptoms, 36.9% had full PTSD symptoms, and only 10.8% had neither positive PTSD symptoms nor mental disorder on the K10 scale. Around 23% had low overall support. Half of the responders were internally displaced, and 27.6% were forced to change places of living three times or more due to war. Around 86.6% of the responders believed that the war was the main reason for their mental distress. Those with high SPTSS and K10 scores were found to take more days off from work or school due to negative feelings and having somatic symptoms. Moreover, the number of times changing places of living due to war, educational level, and being distressed by war noise were the most prominent factors for more severe PTSD and mental distress. No differences in PTSD and mental disorder prevalence were noted in participants living in different governorates or among different types of jobs. A strong significant correlation (r = 0.623) was found between SPTSS and K10 scores. The conflict in Syria has left the population at great risk for mental distress which was higher compared to Syrian refugees elsewhere. Many measures with an emphasis on mental health are needed to help the people against a long-term avoidable suffering.

Prevalence and predictors of posttraumatic stress disorder, depression and anxiety among hospitalized patients with coronavirus disease 2019 in China.

Abstract: Coronavirus disease 2019 (COVID-19) has affected more than 5 million people around the world and killed more than 300,000 people; thus, it has become a global public health emergency. Our objective was to investigate the mental health of hospitalized patients diagnosed with COVID-19. The PTSD checklist for DSM-5 (PCL-5), Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7), Trauma Exposure Scale, abbreviated version of the Connor–Davidson Resilience Scale (CD-RISC-10), Perceived Social Support Scale (PSSS) and Demographic Questionnaire were used to examine posttraumatic stress disorder (PTSD), depression, anxiety, trauma exposure, resilience and perceived social support among 898 patients who were hospitalized after being diagnosed with COVID-19 in China. The data were analyzed with t tests, one-way ANOVA and multivariable logistic regression analysis. The results showed that the prevalence of PTSD, depression and anxiety was 13.2, 21.0 and 16.4%, respectively. Hospitalized patients who were more impacted by negative news reports, had greater exposure to traumatic experiences, and had lower levels of perceived social support reported higher PTSD, depression and anxiety. Effective professional mental health services should be designed to support the psychological wellbeing of hospitalized patients, especially those who have severe disease, are strongly affected by negative news and have high levels of exposure to trauma.

Depressive symptoms among Peruvian adult residents amidst a National Lockdown during the COVID-19 pandemic.

Abstract: Population health and well-being in Latin America, the current epicenter of the COVID-19 pandemic, has been severely affected during the past semester. Despite the growing evidence about the link between the pandemic, its control measures, and mental health worldwide, there is still no regional evidence of the potential mental health impact. We describe the prevalence and distribution of depressive symptoms across demographic and socioeconomic risk factors in the Peruvian population amidst a national lockdown during the COVID-19 pandemic. Cross-sectional study conducted during the community transmission phase and national lockdown in Peru (May 4th–16th, 2020). We recorded 64,493 responses from adult Peruvian residents through an opt-in online questionnaire. All analyses were weighted using raking based on proportions of sociodemographic variables from the last Peruvian census in 2017. The prevalence of depressive symptoms was calculated using the Patient Health Questionnaire (PHQ-9) score of 10 or more. We identified associated demographic and socioeconomic factors by prior mental health diagnosis. Sensitivity analysis considered an alternative cut-off point for depressive symptoms of PHQ-9 ≥ 14. A total of 57,446 participants were included in the analytical sample. A third of the participants (n = 23,526, unweighted) showed depressive symptoms in the 2 weeks prior to the study. Participants who reported a previous mental health diagnosis doubled the sample prevalence of depressive symptoms (59, 95%CI 56.7, 61.4%) of those without a prior diagnosis. Psychosocial and functioning reactions were largely more prevalent among females and young adults. A dose-response relationship was found between household income and depressive symptoms across previous mental health diagnosis strata, being as low as 32% less in the wealthiest than the most impoverished group (PR: 0.68, 95%CI 0.58,0.79). Other critical factors associated with a higher burden of depressive symptoms were lower education level, single, unemployed, and chronic comorbidity. An increased burden of depressive symptoms and psychosocial reactions has emerged during the COVID-19 pandemic in Peru compared to previous years. The mental health burden disproportionately affects women, the younger population, and those with low income and education. As the country eases the social distancing measures, it is crucial to use local evidence to adjust public health policies and mental health services to the renewed population needs.

The impacts of coping style and perceived social support on the mental health of undergraduate students during the early phases of the COVID-19 pandemic in China: a multicenter survey.

Abstract: An increasing number of undergraduate students in China have been reported to have psychological problems. In response to the COVID-19 pandemic, a series of preventive and control measures were implemented, which undoubtedly worsened their psychological health. Coping style and social support were probably important factors that affected the psychological well-being of undergraduate students during the pandemic. This study aimed to explore the effects of coping style and perceived social support on the psychological well-being of college students and relevant risk factors. This cross-sectional study was performed in February and March of 2020 by distributing an online questionnaire among undergraduate students from seven geographical regions across China. The questionnaire included sociodemographic information; the 21-item Depression, Anxiety and Stress Scale (DASS-21); the Perceived Social Support Scale (PSSS); and the Simplified Coping Style Questionnaire (SCSQ). For the analyses, t-tests, one-way analysis of variance (ANOVA), the Kruskal–Wallis test and multiple linear regression were utilized. The level of significance was set at P < 0.05. Among 3113 college students, the rates of anxiety, depression and stress symptoms were 13.3, 15.4 and 6.8%, respectively. Increased rates of current smoking and drinking (5.5 and 25.2%, respectively) among undergraduates were identified. The results indicated that the PSSS subscales and SCSQ subscales were significantly associated with DASS-21 scores (P < 0.001). Multiple linear regression analysis showed that active coping style and family support were protective factors while passive coping style could aggravate psychological problems among participants (P < 0.001). A remarkable number of college students adopted passive coping strategies to cope with negative feelings, such as smoking and drinking, which were detrimental to their mental health. In contrast, active coping strategies helped improve their psychological well-being. Moreover, family support was particularly important for maintaining their mental health and ameliorating mental health challenges in this major health crisis. Consequently, suitable psychointervention, routine screening for risk behaviors, and provision of further social support are needed for undergraduate students in the COVID-19 pandemic or other emergency public health events.

A longitudinal study of changes in smart phone addiction and depressive symptoms and potential risk factors among Chinese college students.

Abstract: The current study aims to track the changes in the levels of smart phone addiction (SPA) and depressive symptoms between pre and during COVID-19 and potential risk factors of among Chinese college students in a four-wave longitudinal study. The participants were recruited from a Chinese university (n = 195; 58.5% females). The first three-wave surveys were conducted before COVID-19 (during December of Year 1, June of Year 1, and December of Year 2 of their college study; Time 1, Time 2, Time 3), while the fourth survey (Time 4; during June of Year 2 of their college study) was conducted in June 2020 during COVID-19. COVID-19-related factors, including quarantine, lockdown, boredom, emotional loneliness, and social loneliness, were investigated. The results showed a significant increase in the levels of depressive symptoms and prevalence of probable depression during COVID-19 (69.2%) compared to those 18 months, 12 months and 6 months before COVID-19 (41.5, 45.6, 48.2%) but non-significant changes in SPA. Boredom and emotional loneliness were positively associated with both SPA and depressive symptoms during COVID-19. Social loneliness was also positively associated with depressive symptoms during COVID-19. Quarantine and lockdown were not significantly associated with SPA or depressive symptoms. The results highlight that the study population may be a high risk group of probable depression. Future studies should continue to track these mental and behavioral status with the progression of the epidemic. The identified emotional factors could be used to reduce depressive symptoms during COVID-19 and prevent the potential risk of SPA.

Metacognition, social cognition, and mentalizing in psychosis: are these distinct constructs when it comes to subjective experience or are we just splitting hairs?

Abstract: Research using the integrated model of metacognition has suggested that the construct of metacognition could quantify the spectrum of activities that, if impaired, might cause many of the subjective disturbances found in psychosis. Research on social cognition and mentalizing in psychosis, however, has also pointed to underlying deficits in how persons make sense of their experience of themselves and others. To explore the question of whether metacognitive research in psychosis offers unique insight in the midst of these other two emerging fields, we have offered a review of the constructs and research from each field. Following that summary, we discuss ways in which research on metacognition may be distinguished from research on social cognition and mentalizing in three broad categories: (1) experimental procedures, (2) theoretical advances, and (3) clinical applications or indicated interventions. In terms of its research methods, we will describe how metacognition makes a unique contribution to understanding disturbances in how persons make sense of and interpret their own experiences within the flow of life. We will next discuss how metacognitive research in psychosis uniquely describes an architecture which when compromised - as often occurs in psychosis - results in the loss of persons' sense of purpose, possibilities, place in the world and cohesiveness of self. Turning to clinical issues, we explore how metacognitive research offers an operational model of the architecture which if repaired or restored should promote the recovery of a coherent sense of self and others in psychosis. Finally, we discuss the concrete implications of this for recovery-oriented treatment for psychosis as well as the need for further research on the commonalities of these approaches.

Prevalence and associated factors of psychosocial distress among seafarers during COVID-19 pandemic.

Abstract: In the context of growing concerns about seafarers’ mental health during the COVID-19 pandemic, this study aimed to assess the prevalence and associated factors of psychosocial distress among seafarers of ocean-going vessels during the current health emergency. This cross-sectional study was conducted among 470 multinational seafarers working on two oil tanker international shipping companies. Psychosocial distress was assessed by using Depression-Anxiety-Stress Scale (DASS-21). General Health Questionnaire-12 (GHQ-12) and Zung Self-Rating Anxiety Scale (SAS) were used to assessed genral psychiatry disorders and self-rate anxiety. Perceived health status was assessed by a single-item question. Multivariate logistic regression was used to determine the association between demographic and work-related variables with mental health outcomes. Overall, 439 out of 470 invited seafarers with a mean age of 34.5 (SD: 8.05) participated in this study (participation rate: 93.4%). The prevalence (95% confidence interval) of depression, anxiety, stress, self-rated anxiety, general psychiatric disorders, and poor perceived health status was 12.3% (9.4–15.7), 11.6% (8.7–15.0), 5.9% (3.9–8.5), 2.1% (0.9–3.8), 42.6% (38.0–47.4), and 4.3% (2.6–6.6), respectively. In the multivariate model, by increasing the duration of stay (per month) on board, the odds of depression increased by 20% (OR: 1.20 (95% CI: 1.02–1.40)). Also, non-officer seafarers experienced significantly lower psychosocial distress such as anxiety and stress levels than officers. High prevalence of depression, anxiety, and general psychiatric disorders among seafarers during COVID-19 was observed. Our findings also highlight the factors that need to be considered to protect seafarers’ mental well-being. Further studies to evaluate the impact of COVID-19 on psychological health issues at sea are recommended.

A systematic review and meta-analysis of group peer support interventions for people experiencing mental health conditions.

Abstract: Peer support is being integrated within mental health services to further the development of a recovery approach. However, the most effective models and formats of intervention delivery are unknown. We conducted this systematic review and meta-analysis to determine the effectiveness of peer support for improving outcomes for people with lived experience of mental health conditions, when delivered as group interventions. Studies reporting randomised controlled trials of group peer support interventions for people experiencing mental health conditions were identified by searching MEDLINE, PsycINFO, Embase and Cochrane CENTRAL, from inception until July 12th 2019 and undertaking supplementary searches. Included studies were assessed for risk of bias and meta-analyses were conducted if three or more trials provided usable data. Eight trials met eligibility criteria, providing data from 2131 participants. Six trials had either high or unclear risk of bias. Interventions were categorised as mutual support groups, or peer support groups, sub-categorised as anti-stigma or self-management interventions. Meta-analyses were only possible for peer support groups and five outcomes. We found evidence that group peer support may make small improvements to overall recovery but not hope or empowerment individually, or to clinical symptoms. Evidence for effectiveness for outcomes which could not be meta-analysed was mixed. Findings from the few eligible trials suggest group peer support interventions may be specifically effective for supporting personal recovery and have a limited impact on other outcomes, though there were some risks of bias to study findings. Interventions were heterogeneous and most social outcomes were absent in the literature, highlighting further limitations to the current evidence-base. There is insufficient evidence available from trials of group peer support torecommend the routine implementation of these interventions across mainstream mental health services at present. More high-quality trials of peer-developed, group peer support interventions are needed in order tomake firm conclusions about intervention effectiveness.

Socioeconomic inequality in psychological distress among older adults in India: a decomposition analysis

Abstract: Older people coming from a lower wealth gradient are more vulnerable to have stressful life events further adding more risk for common mental health disorders and psychological distress situations. The present study explores the associations between socioeconomic and health-related variables and psychological distress among older adults in India and the contribution of such factors to the inequalities in psychological distress. A cross-sectional survey of 9181 older adults conducted as ‘Building a Knowledge Base on Population Ageing in India’ was assessed. Logistic regression and decomposition models were used to analyze the data. Psychological distress was measured from General Health Questionnaire (GHQ-12). The value of Cronbach's alpha was 0.90. It was having a scale of 0 to 12 on the basis of experiencing stressful symptoms and was re-coded as 0 (representing 6+ stressful symptoms) and 1 (representing 5 and fewer symptoms). Older adults from the poorest wealth quintile, having no source of income, not working for the last one year period, suffering from multi-morbidity, disabled, with low activities of daily living and low instrumental activities of daily living and poor cognitive ability were suffering from high psychological distress in India. Further, factors such as religion, caste, education, living arrangements, and self-worth in the family were major contributors to the concentration of psychological distress in older adults from poor households (concentration index: − 0.23). The study suggests that among older people, there is a wide disparity of experiencing psychological distress across different socio-economic groups with significant factors being responsible for inequality in psychological distress. There is a need to build a “win-win” circumstance across sectors, including a broad spectrum of health, social and economic benefits to the vulnerable older population.

Symptoms of anxiety/depression during the COVID-19 pandemic and associated lockdown in the community: longitudinal data from the TEMPO cohort in France.

Abstract: Background To cope with the COVID-19 pandemic, social distancing restrictions where implemented in France, which could have led to social isolation. This is expected to have affected the mental health situation, including increasing risk of symptoms of anxiety and depression in the general population. Persons with prior mental health difficulties could be an especially vulnerable group, however, few studies have tested this empirically considering preexisting mental health difficulties. We examine the association between preexisting symptoms of anxiety/depression and anxiety/depression during lockdown due to the COVID-19 pandemic in a longitudinal community sample. Methods A longitudinal follow-up during lockdown (data collection March-June 2020) was implemented among participants of the TEMPO cohort. Prior knowledge of anxiety/depression was included from prior waves of data collection. Generalized estimation equations models were used to estimate the association between preexisting symptoms of anxiety/depression and symptoms of anxiety/depression during lockdown among 662 mid-aged individuals. Results Individuals with symptoms of anxiety/depression measured prior to lockdown had 6.73 higher odds [95% CI = 4.45-10.17] of symptoms of anxiety/depression during lockdown. Additionally, the likelihood of symptoms of anxiety/depression during lockdown was elevated among women (OR = 2.07 [95% CI = 1.32-3.25]), subjects with low household income (OR = 2.28 [1.29-4.01]) and persons who reported being lonely (OR = 3.94 [95% CI = 2.47-6.28]). Conclusions Our study underlines the role of preexisting symptoms of anxiety/depression as a vulnerability factor of anxiety/depression during lockdown. Interventions focusing on individuals with mental health difficulties as well as people feeling lonely should be considered, to reduce the psychological impact of the COVID-19 pandemic.

Psychiatric symptoms and moral injury among US healthcare workers in the COVID-19 era.

Abstract: Emerging cross-sectional data indicate that healthcare workers (HCWs) in the COVID-19 era face particular mental health risks. Moral injury – a betrayal of one’s values and beliefs, is a potential concern for HCWs who witness the devastating impact of acute COVID-19 illness while too often feeling helpless to respond. This study longitudinally examined rates of depression, generalized anxiety disorder (GAD), posttraumatic stress disorder (PTSD), and moral injury among United States HCWs in the COVID-19 era. We anticipated finding high levels of clinical symptoms and moral injury that would remain stable over time. We also expected to find positive correlations between clinical symptoms and moral injury. This three-wave study assessed clinical symptoms and moral injury among 350 HCWs at baseline, 30, and 90 days between September and December 2020. Anxiety, depression, PTSD, and moral injury were measured using the Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Primary Care PTSD Screen (PC-PTSD), and Moral Injury Events Scale (MIES). Of the 350 HCWs, 72% reported probable anxiety, depression, and/or PTSD disorders at baseline, 62% at day 30, and 64% at day 90. High level of moral injury was associated with a range of psychopathology including suicidal ideation, especially among healthcare workers self-reporting COVID-19 exposure. Findings demonstrate broad, persisting, and diverse mental health consequences of the COVID-19 pandemic among United States HCWs. This study is the first to longitudinally examine the relationships between moral injury and psychopathology among HCWs, emphasizing the need to increase HCWs’ access to mental healthcare.

Locus of control moderates the association of COVID-19 stress and general mental distress: results of a Norwegian and a German-speaking cross-sectional survey.

Abstract: The Norwegian part of the study was financed by Innlandet Hospital Trust, Norway. The German speaking part was conducted in the absence of financial funding