Depression,anxiety, and stress among Ugandan university students during the COVID-19 lockdown: an online survey

BackgroundCOVID19 pandemic forced most countries to lockdown, leading to the prolonged closure of many learning institutions. This dramatic shift led to increase of mental illness symptoms among university students.ObjectiveTo determine the prevalence and factors associated with symptoms of depression, anxiety, and stress among Uganda''s university students during the COVID-19 lockdown.MethodsWe conducted a one-month online survey using the Depression Anxiety and Stress Scale (DASS-21).ResultsParticipants n=321 were enrolled with mean age, 24.8(SD=5.1) years and 198(61.7%) were males. The prevalence of mental health symptoms among participants was 80.7%, 98.4%, and 77.9% for depression, high levels of anxiety, and stress, respectively. Statistically significant association between mental health symptoms on multi-logistic regression was found with Males (depression=2.97[1.61–5.48] and stress=1.90[1.07–3.35]), engagement in leisure activity (depression= 1.87[1.01–3.49] and stress=1.98[1.10–3.56]), and being finalist (stress=0.55[0.31- 0.97]). Use of addictive substances seem to potentially alleviate symptoms of depression, anxiety and stress in the short term.ConclusionsThe findings of this study suggest a high prevalence of symptoms of depression, anxiety and stress among university students during the COVID-19 lockdown. Students'' mental health should be monitored by all stakeholders, especially as the pandemic progresses.     

Prevalent,incident, and persistent insomnia in a population-based cohort tested before (2018) and during the first-wave of COVID-19 pandemic (2020)

Study ObjectivesHigh rates of sleep and mental health problems have been reported during the COVID-19 pandemic, but most of the evidence is retrospective without pre-pandemic data. This study documented rates of prevalent, incident, and persistent insomnia and psychological symptoms during the COVID-19 pandemic (2020) compared to pre-pandemic data (2018).MethodsData were derived from a longitudinal, population-based study of insomnia in Canada. When the first lockdown started in the province of Quebec, a subsample of participants who had completed the latest 2018 follow-up were surveyed (April to May 2020) about their sleep, insomnia, and psychological symptoms since the beginning of the pandemic. Prevalence, incidence, and persistence rates of insomnia, and severity of stress, anxiety, and depressive symptoms were estimated, as well as their associations with confinement, loneliness, social support, use of electronics, and other lifestyle changes occurring during the pandemic. A sleep/health survey and validated questionnaires of insomnia, sleep quality, stress, fatigue, anxiety, and depression were administered at both assessments.ResultsThe sample consisted of 594 adults (mean age: 48.3 ± 13.1 years; 64.0% women). Prevalence of insomnia increased from 25.4% to 32.2% (symptoms) and from 16.8% to 19% (syndrome) from 2018 to 2020, for an overall 26.7% increase in insomnia rates. Of those classified as good sleepers in 2018 (n = 343), 32.6% (n = 112) had developed new insomnia during the COVID-19 pandemic. Among participants who had insomnia in 2018, the persistence rate was 76.5% 2 years later. There was a significant worsening of sleep quality, fatigue, anxiety, and depression (all ps < .005) during the COVID-19 pandemic compared to 2018. Significant associations were found between sleep and psychological symptoms and with living alone and being in confinement, lower social support, increased time using electronic devices, reduced physical exercise, and higher financial stress.ConclusionsThe COVID-19 pandemic is associated with significant increases in insomnia and psychological symptoms compared to the pre-pandemic period. Large scale public sleep and mental health intervention programs should be prioritized during and after a pandemic such as the COVID-19.     

Impact of the COVID-19 Pandemic on the Mental Health of Adolescent Students in Daegu,Korea

BackgroundIn February 2020, as coronavirus disease 2019 (COVID-19) spread rapidly in Daegu, South Korea, students in that region experienced many emotional difficulties. In this study, we analyzed the stress and emotional crisis experienced by students during the COVID-19 pandemic, its causative factors, and the factors that affect negative emotions.MethodsWe identified the demographic information related to the experiences of unbearable stress and emotional crisis and their causal factors at three points in time: before the pandemic, during its peak, and at the time of the survey (2–3 months after the peak). In addition, we analyzed the factors related to depression and anxiety experienced by students during the COVID-19 pandemic. The Korean version of the Patient Health Questionnaire 9 and the Korean version of the Generalized Anxiety Disorder 7 was used to assess for depressive and anxiety symptoms in the subject students, respectively.ResultsA total of 8,177 students participated in the analysis, with 4,072 boys (49.8%), 4,105 girls (50.2%), and 4,463 middle school students (54.6%) and 3,177 high school students (45.4%). The percentage of students who experienced unbearable stress was 9% before the COVID-19 pandemic, increased to 16% at the peak of the COVID-19 pandemic, then decreased to 12.7% at the time of the survey. Stress was experienced more by girls (18.1% versus 13.8% in boys; χ² = 28.159, P < 0.001) and high school students (19.0% versus 13.5% in middle school students; χ² = 45.437, P < 0.001). Overall, 7.6% experienced emotional crises during the COVID-19 pandemic, which was more prevalent in girls (10.1% versus 5.2% in boys; χ² = 71.025, P < 0.001) and in high school students (8.8% versus 6.7% in middle school students; χ² = 12.996, P < 0.001). Depression and anxiety was seen in 19.8% and 12.3% of students during the COVID-19 pandemic, respectively. The risk factors for depression and anxiety included unbearable stress before the COVID-19 pandemic (P < 0.001), mental health (P = 0.044), and age (P = 0.040), whereas resilience was identified as a protective factor for depression and anxiety (P = 0.001).ConclusionStudents in Daegu experienced lots of mental difficulties since the COVID-19 pandemic. It will be necessary to improve stress management and resilience to improve students'' mental health in disasters such as the COVID-19 pandemic.     

Factors Related to Anxiety and Depression Among Adolescents During COVID-19: A Web-Based Cross-Sectional Survey

BackgroundThe coronavirus disease 2019 (COVID-19) outbreak and subsequent disease-containment measures (such as school closures) significantly affected the lives of adolescents. We evaluated the mental-health status and factors associated with anxiety and depression among South Korean adolescents.MethodsA nationwide online survey was conducted to evaluate the mental-health status of South Korean adolescents during the COVID-19 pandemic. In total, 570 adolescents aged 13–18 years were surveyed between May 27 and June 11, 2021. The participants completed the Generalized Anxiety Disorder Scale (GAD-7) and Patient Health Questionnaire (PHQ-9) to determine anxiety and depression symptoms, respectively. Stepwise logistic regression models were constructed to determine factors related to anxiety and depression.ResultsAmong the study participants, 11.2% and 14.2% had anxiety and depression, respectively. The results suggested that several factors, such as the experience of COVID-19 infection and quarantine of oneself, a family member or an acquaintance, physical and mental health problems, and fear of one’s local community being discriminated against as a COVID-19 area were related to anxiety and depression.ConclusionThe present study identified COVID-19-related factors associated with anxiety and depression among adolescents, and provides insights regarding potential interventions to improve the mental health of adolescents. To promote the mental health of adolescents during the COVID-19 pandemic, special attention should be paid to individuals with physical or mental-health problems, and efforts should be made to reduce the negative social and emotional impacts of infection-control measures.     

The Prevalence of Depression,Anxiety and Associated Factors among the General Public during COVID-19 Pandemic: a Cross-sectional Study in Korea

BackgroundSince its first case confirmed on January 20, 2020, Korea has been through three waves of the COVID-19 pandemic. Fears of the fourth wave persist as new cases continue to emerge. In such unpredictable times, the mental well-being of people is of crucial importance. This study examined the levels of depression and anxiety and their predictors among the Korean general public in Busan, Korea, during the COVID-19 pandemic.MethodsWe conducted a cross-sectional study via a self-reported questionnaire administered to 2,288 adult residents (aged 19–60 years) of Busan, Korea. Participants'' depression and anxiety were assessed using the Korean version of the Patient Health Questionnaire-4 (PHQ-4), which consists of PHQ-2 and Generalized Anxiety Disorder-2 (GAD-2), with the cutoff score of 3.ResultsThe mean age of the participants was 39.71 years. COVID-19 had several psychosocial impacts on people. It was revealed that 80.3% had restrictions in outside activities, 47.3% reported financial difficulties, and 53.6% had a fear of death or fatal outcome when infected with COVID-19. We performed logistic regression analysis to identify the factors associated with depression and anxiety. A total of 30.7% participants were classified as at risk of depression based on cutoff score of 3 on PHQ-2. Logistic regression analysis revealed that changes in sleep pattern due to COVID-19 were most strongly associated with depression, followed by restrictions in outside activities due to social distancing and increased family conflicts due to COVID-19. Also, 22.6% participants were classified as at risk of anxiety based on a cutoff score of 3 on GAD-2. Analysis revealed that changes in sleep pattern due to COVID-19 were most strongly associated with anxiety, followed by spending a lot of time searching for COVID-19-related information and having a fear of death or fatal outcome when infected with COVID-19.ConclusionThe results are alarming; 30.7% had a PHQ-2 score of 3 or higher, indicating depression, and 22.6% had a GAD-2 score of 3 or higher, indicating anxiety. Changes in sleep pattern had the strongest association with both depression and anxiety. Our results can be used to formulate mental health policies tailored to the context of the city. Our findings suggest the high prevalence of depression and anxiety in the society during the COVID-19 pandemic, which places growing importance on early intervention for mental health problems during these times.     

Evening-types show highest increase of sleep and mental health problems during the COVID-19 pandemic—multinational study on 19 267 adults

Study ObjectivesIndividual circadian type is a ubiquitous trait defining sleep, with eveningness often associated with poorer sleep and mental health than morningness. However, it is unknown whether COVID-19 pandemic has differentially affected sleep and mental health depending on the circadian type. Here, the differences in sleep and mental health between circadian types are examined globally before and during the COVID-19 pandemic.MethodsThe sample collected between May and August 2020 across 12 countries/regions consisted of 19 267 adults with information on their circadian type. Statistical analyses were performed by using Complex Sample procedures, stratified by country and weighted by the number of inhabitants in the country/area of interest and by the relative number of responders in that country/area.ResultsEvening-types had poorer mental health, well-being, and quality of life or health than other circadian types during the pandemic. Sleep–wake schedules were delayed especially on working days, and evening-types reported an increase in sleep duration. Sleep problems increased in all circadian types, but especially among evening-types, moderated by financial suffering and confinement. Intermediate-types were less vulnerable to sleep changes, although morningness protected from most sleep problems. These findings were confirmed after adjusting for age, sex, duration of the confinement, or socio-economic status during the pandemic.ConclusionsThese findings indicate an alarming increase in sleep and mental health problems, especially among evening-types as compared to other circadian types during the pandemic.     

Digital cognitive behavioral therapy for insomnia promotes later health resilience during the coronavirus disease 19 (COVID-19) pandemic

Study ObjectivesStressful life events contribute to insomnia, psychosocial functioning, and illness. Though individuals with a history of insomnia may be especially vulnerable during stressful life events, risk may be mitigated by prior intervention. This study evaluated the effect of prior digital cognitive-behavioral therapy for insomnia (dCBT-I) versus sleep education on health resilience during the COVID-19 pandemic.MethodsCOVID impact, insomnia, general- and COVID-related stress, depression, and global health were assessed in April 2020 in adults with a history of insomnia who completed a randomized controlled trial of dCBT-I (n = 102) versus sleep education control (n = 106) in 2016–2017. Regression analyses were used to evaluate the effect of intervention conditions on subsequent stress and health during the pandemic.ResultsInsomnia symptoms were significantly associated with COVID-19 related disruptions, and those who previously received dCBT-I reported less insomnia symptoms, less general stress and COVID-related cognitive intrusions, less depression, and better global health than those who received sleep education. Moreover, the odds for resurgent insomnia was 51% lower in the dCBT-I versus control condition. Similarly, odds of moderate to severe depression during COVID-19 was 57% lower in the dCBT-I condition.ConclusionsThose who received dCBT-I had increased health resilience during the COVID-19 pandemic in adults with a history of insomnia and ongoing mild to moderate mental health symptoms. These data provide evidence that dCBT-I is a powerful tool to promote mental and physical health during stressors, including the COVID-19 pandemic.Clinical Trial Registration{"type":"clinical-trial","attrs":{"text":"NCT02988375","term_id":"NCT02988375"}}NCT02988375     

Mental Health of Adolescents and Subjective Economic Deterioration Caused by COVID-19 in Korea

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic greatly impacted the health and economy worldwide. Children and adolescents are less affected by COVID-19 but are more vulnerable to secondary damage, such as mental health. We would like to evaluate the subjective economic changes caused by COVID-19 in Korea and adolescents’ mental health status.MethodsThe data are based on the Korea Youth Risk Behavior Survey, published by the Korea Center for Disease Control and Prevention in South Korea. It is an annual cross-sectional national representative survey of middle and high school students. There were 54,948 subjects, and the survey was conducted from August 3, 2020 to November 13, 2020. We investigated usual stress, loneliness, anxiety, sadness and hopelessness, and suicidal ideation.ResultsWe found that the odds ratio of adolescent mental health increased as the economic deterioration caused by COVID-19 increased. Overall, it was more severe in female students, and the greater the economic change, the worse the anxiety in boys and the worse the sadness and hopelessness in girls.ConclusionWe hope that it will be possible to prevent and intervene early in adolescents, considering not only the risk of infection from COVID-19 but also mental health, especially mental health related to the economic deterioration caused by COVID-19.     

COVID-19 and impairment of mental health: public health perspective

ObjectivesThe objective of the article is to understand the impact of COVID-19 on the mental health of the members of the general population.IntroductionThe coronavirus disease-2019 (COVID-19) pandemic has forced the public health authorities to implement unprecedented public health measures with an intention to control the spread of the infection.MethodsAn extensive search of all materials related to the topic was carried out in the PubMed search engine and World Health Organization website and a total of 27 articles were selected based upon the suitability with the current review objectives.ResultsIn order to reduce the caseload and interrupt the chain of transmission of the novel viral infection, it was envisaged that people should stay indoors unless it is extremely essential. This intervention did play its part in reducing the caseload, but significantly affected the daily routine of the people, which in turn accounted for a significant impact on the mental health of the people. Considering the ongoing development and the impact of COVID-19 infection on the mental health of people, there is an immense need to implement strategies to improve the lifestyle of the general population and the health care professionals.ConclusionTo conclude, the ongoing COVID-19 pandemic has created a state of public health emergency on the global scale. The infection has impacted people from all walks of life and is also responsible for precipitating a number of psychological and mental disorders. Thus, it is the need of the hour to identify those individuals who are prone to psychological disorders, and take urgent steps to ensure the preservation and improvement of the mental health of people.     

The impact of COVID-19 on cancer patients,their carers and oncology health professionals: A qualitative study

ObjectiveCancer patients, carers and oncology health professionals have been impacted by the COVID-19 pandemic in many ways, but their experiences and psychosocial responses to the pandemic are still being explored. This study aimed to document the experience of Australians living with cancer, family carers, and Oncology health professionals (HPs) when COVID-19 first emerged.MethodsIn this qualitative study, participants (cancer patients currently receiving treatment, family carers and HPs) completed a semi-structured interview exploring their experiences of COVID-19 and the impact it had on cancer care. Participants also completed the Hospital Anxiety and Depression Scale (patients) and the Depression, Anxiety and Stress Scale (carers and HPs) to assess emotional morbidity. Thematic analysis was undertaken on qualitative data.Results32 patients, 16 carers and 29 HPs participated. Qualitative analysis yielded three shared themes: fear and death anxiety, isolation, and uncertainty. For HPs, uncertainty incorporated the potential for moral distress and work-stress. Patients and carers scoring high on anxiety/depression measures were more likely to have advanced disease, expressed greater death anxiety, talked about taking more extreme precautionary measures, and felt more impacted by isolation.ConclusionCancer and COVID-19 can have compounding psychological impacts on all those receiving or giving care.Practice ImplicationsScreening for distress in patients, and burnout in HPs, is recommended. Increased compassionate access and provision of creative alternatives to face-to-face support are warrented.     

Self-Injurious Behavior Rate in the Short-Term Period of the COVID-19 Pandemic in Korea

BackgroundThe objective of this study was to investigate the trend of self-injurious behavior (SIB) among persons who were directly impacted by coronavirus disease 2019 (COVID-19), especially those with pre-existing mental disorders.MethodsUsing the National Health Insurance Service-COVID-19 database cohort, the monthly SIB rate was calculated by COVID-19 subgroups (i.e., positive for COVID-19 test, negative for COVID-19 test, and non-COVID-19 test [control]). In addition, moderated regression analysis was utilized to examine the statistical difference of SIB (suicide attempt and non-suicidal self-injury using ICD-10 code) trend between COVID-19 subgroups and with and without pre-existing mental disorder.ResultsA total of 328,373 persons were included in the cohort study. Of these, 212,678 had been tested for COVID-19, and 7,713 of them were confirmed positive. During the pandemic peak, the “negative for COVID-19” group showed a large increase (P = 0.003) in SIB rates compared to the control group, the “positive for COVID-19” group showed a decreasing trend, but not significant (P = 0.314). Among those who were tested for COVID-19, those with pre-existing mental disorders showed an increasing trend of SIB compared to those without pre-existing mental disorders, however statistically insignificant (P = 0.137).ConclusionOur results suggest that people who are tested for COVID-19 are at a high risk of SIB during the peak COVID-19 pandemic. Therefore, screening for suicide risk and psychological interventions is needed for these high-risk groups.     

新型冠状病毒肺炎疫情下雅安市普通民众心理健康状况

目的:了解新型冠状病毒肺炎流行期雅安普通民众居家隔离期间的心理健康状况。方法:采用在线问卷调查,选取雅安市年龄≥15岁的居民537例,于2020年2月10-15日,采用12条目一般健康问卷(≥3分为心理健康状况不良)、自评焦虑量表(≥50分有焦虑症状)、匹兹堡睡眠质量指数量表(≥8分有睡眠障碍)评估。结果:537例居民中心理健康状况不良者79例(14.7%),有焦虑症状者50例(9.3%),有睡眠障碍者69例(12.8%)。Logistics回归分析显示,年龄≥65岁组更易出现心理健康状况不良、焦虑症状(OR=4.21、9.87,P<0.05),知道新冠肺炎疫情爆发后不太担心组更不易出现心理健康状况不良、焦虑症状、睡眠障碍(OR=0.08、0.06、0.24,P<0.05),居住地为乡村、对新冠肺炎传染性知道一点或不清楚组更易出现睡眠障碍(OR=2.99、2.97,P<0.05)。结论:新冠肺炎疫情下老年可能是雅安普通民众心理健康状况不良、焦虑症状的危险因素,居住地为乡村、对新冠肺炎传染性缺乏了解是睡眠障碍的危险因素。     

Parental Mental Health and Children's Behaviors and Media Usage during COVID-19-Related School Closures

BackgroundCoronavirus disease 2019 (COVID-19) is different from previous disasters in that it continues to the present and has affected all aspects of family life. During epidemics, psychosocial support is not less important than infection control. During COVID-19-related school closures, prolonged partial closures of schools could have detrimental social and health consequences for children and may increase the burden on the family. Based on a community sample in Korea, this study identified parental concerns, children''s media usage, other various factors and examined whether parental stress level or depression were positively associated with problem behaviors, media exposure, and sleep problems of the primary school children during school closure under COVID-19.MethodsParticipants were 217 parents residing in Suwon, South Korea, who had primary school children and responded to a web-based questionnaire on parental concerns from school closure under COVID-19, subjective stress, depression, whether having received mental health services, and family characteristics; children''s sleep patterns, problem behaviors, media usage during the online-only class period, and changes in activity level following the pandemic.ResultsDuring school closure, children gained body weight, spent less time in physical activities and more in media usage. Besides online learning content (97.2%), YouTube was highly used content (87.6%), and games followed (78.3%). Parental subjective stress index was highly associated with parental depression (Pearson correlation 0.439, P < 0.001), children''s sleep problems (0.283, P < 0.001), tablet time (0.171, P = 0.012) and behavior problems (0.413, P < 0.001). Parental depression was associated with children''s sleep problems (0.355, P < 0.001), TV time (0.153, P = 0.024), tablet time (0.159, P = 0.019), and behavior problems (0.524, P < 0.001). Parents who previously received mental services seemed to be more concerned about the problems their children already have getting worse because of COVID-19 than the disease itself. Children''s sleep problem was associated with tablet (0.172, P = 0.011) and smartphone time (0.298, P < 0.001), but not its frequency.ConclusionDuring COVID-19-related school closures, many parents and children had various difficulties relating to mental health. Ongoing monitoring of mental health of high-risk groups and multiple support systems may need to be expanded to cover those parents having difficulty in caring for their children.     

Effects of Depression and Resilience of Public Workers on Work-related Stress and Anxiety in Response to the COVID-19 Pandemic

BackgroundThis study explored the clinical variables related to public workers'' stress and anxiety regarding the viral epidemic, and the mediating effect of resilience on the relationship between their depression and anxiety in response to coronavirus disease 2019 (COVID-19) pandemic.MethodsA total of 938 public workers answered anonymous questionnaires in May 2020. The survey included rating scales such as the Stress and Anxiety to Viral Epidemics-9 (SAVE-9), Patients Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Connor-Davidson Resilience Scale 2 items (CD-RISC 2), and subjects also answered whether they were employed in COVID-19 related fields.ResultsMarried, female, junior, public workers reported a higher level of stress and anxiety in response to the viral epidemic. Furthermore, high levels of stress and anxiety toward the epidemic are defined by high PHQ-9, high GAD-7, and low CD-RISC 2 scores. It could also be seen that resilience mediated the effect of depression in public workers and their stress and anxiety levels toward the epidemic.ConclusionIt is important to reduce the psychological burden of public workers and manage their mental health to help them cope with the epidemic wisely and efficiently. Among many mental health factors, psychological resilience represents an essential target for psychological intervention among public workers.     

Posttraumatic stress disorder symptoms and coping with the lockdown among help-seeking veterans before and during the COVID-19 pandemic

AimsTo compare the severity of posttraumatic stress disorder (PTSD) symptoms and of particular PTSD clusters among help-seeking veterans before and during the COVID-19 lockdown. The second aim was to identify the main coping strategies used.MethodsMale war veterans (N = 176) receiving outpatient treatment at the Referral Center for PTSD were assessed at baseline (12-18 months before the pandemic declaration in March 2020) and during the COVID-19 pandemic lockdown (March-June 2020). The Life Events Checklist for DSM-5, PTSD Checklist for DSM-5, and The Brief COPE were used.ResultsDirect exposure to the virus in our sample was low, and the majority of participants followed the preventive measures. The severity of the overall PTSD symptoms and of clusters of symptoms significantly decreased compared with the first assessment. At the second assessment, all participants still fulfilled the PTSD diagnosis criteria. During the lockdown, the participants used emotion-focused and problem-focused coping rather than dysfunctional coping.ConclusionThe severity of PTSD symptoms decreased during the lockdown. Further research is needed to study the trajectories of long-term psychopathology.

The COVID-19 pandemic has severely threatened the physical and mental health of individuals around the world. Stressors have included isolation, self-isolation or quarantine, restricted movement and physical contact, infection fears, loss of loved ones, lack of supplies, inadequate information (“infodemic”), financial loss, and social stigma (1-3). During emergencies, mental health requires special consideration due to increased rates of stress-related mental health problems and limited availability of mental health services (2-5).Depending on the emergency context, particular groups of people are at an increased risk of experiencing social and psychological problems (6), and ex-combatants have been repeatedly shown to be one of them (7).Exposure to a new traumatic or stressful life event might affect posttraumatic stress disorder (PTSD) symptoms. A growing body of research shows that such exposure is a risk factor for worsening of the condition in various groups of PTSD patients (8,9). This mainly happens if the subsequent event is of the same type as the initial stressors, serving as a reminder and as an additional traumatic factor with a “wear and tear” effect on the exposed person (10-13).Regarding the coping strategies used among PTSD patients, combat veterans with PTSD report a more ineffective and dysfunctional coping style, with the avoidance coping style as a predictive factor of the overall PTSD symptom severity (14-16). PTSD patients try to avoid confrontation with trauma-reminders, intrusive memories, and trauma-related thoughts and emotions (17,18). Some authors emphasize the importance of differentiating between coping strategies with PTSD symptoms and coping strategies with actual traumatic or stressful events as they depend on various factors related to the specific traumatic exposure (19).Twenty-five years after the Homeland War in Croatia (1991–1995), veterans still suffer from numerous health problems and have been highly prevalent among the users of the health facilities for PTSD treatment (20-22). The same is true for PTSD patients treated in the Referral Center of the Ministry of Health of the Republic of Croatia (RCPTSD) at the Clinical Hospital Center (CHC) Rijeka. A recent study revealed high rates of overall symptoms and severe posttraumatic symptoms (ie, complex PTSD) in this population years after the war ended (23).The COVID-19 pandemic lockdown in Croatia started on March 19, 2020. According to Oxford University, Croatia introduced the world''s strictest restrictions in relation to the number of the infected (24,25). On March 21, 2020, mental health experts from RCPTSD recommended self-help strategies for staying in good mental health and advice for front-liners on how to deliver psychological first aid (26,27). On the same day, the Croatian Psychiatric Association Expert Group released recommendations for the organization of psychiatric care, psychiatric interventions, and psychopharmacological treatment of mental conditions during the COVID-19 pandemic, and for de-escalation and appropriate communication techniques with aggressive patients (28-30). In RCPTSD, mental health service was restructured to be delivered via the internet or hotlines during the pandemic, with a possibility for urgent outpatient and inpatient treatment. On April 27, 2020, the lifting of restrictions began.To our knowledge, no study worldwide has examined the psycho-social correlates of the COVID-19 pandemic lockdown in veterans with PTSD. Therefore, we aimed to compare the severity of PTSD symptoms and of particular PTSD symptom clusters before and during the COVID-19 pandemic lockdown. Second, we identified the main coping strategies that veterans used during the lockdown.     

Examining the impact of employment status on sleep quality during the COVID-19 pandemic in two low-income neighborhoods in Pittsburgh,PA

Study ObjectivesAfrican Americans have faced disproportionate socioeconomic and health consequences associated with the COVID-19 pandemic. The current study examines employment and its association with sleep quality during the initial months of the pandemic in a low-income, predominantly African American adult sample.MethodsIn the early months of COVID-19 (March to May 2020), we administered a survey to an ongoing, longitudinal cohort of older adults to assess the impact of COVID-related changes in employment on self-reported sleep quality (N = 460; 93.9% African American). Participants had prior sleep quality assessed in 2018 and a subset also had sleep quality assessed in 2013 and 2016. Primary analyses focused on the prevalence of poor sleep quality and changes in sleep quality between 2018 and 2020, according to employment status. Financial strain and prior income were assessed as moderators of the association between employment status and sleep quality. We plotted trend lines showing sleep quality from 2013 to 2020 in a subset (n = 339) with all four waves of sleep data available.ResultsAll participants experienced increases in poor sleep quality between 2018 and 2020, with no statistical differences between the employment groups. However, we found some evidence of moderation by financial strain and income. The trend analysis demonstrated increases in poor sleep quality primarily between 2018 and 2020.ConclusionsSleep quality worsened during the pandemic among low-income African American adults. Policies to support the financially vulnerable and marginalized populations could benefit sleep quality.     

Prospective examination of adolescent sleep patterns and behaviors before and during COVID-19

Study ObjectivesTo prospectively examine changes in adolescent sleep before and during the COVID-19 pandemic in adolescents with and without ADHD.MethodsParticipants were 122 adolescents (ages 15–17; 61% male; 48% with ADHD). Parents reported on adolescents’ sleep duration and difficulties initiating and maintaining sleep (DIMS); adolescents reported on sleep patterns, sleep duration, delayed sleep/wake behaviors, and daytime sleepiness before (September 2019 to February 2020) and during (May–June 2020) COVID-19. Adolescents also reported on their health behaviors, COVID-19-related negative affect, and difficulties concentrating due to COVID-19.ResultsParents reported adolescents had more DIMS during COVID-19 than before COVID-19, with clinically elevated rates increasing from 24% to 36%. Both bedtimes and waketimes shifted later during COVID-19, and adolescents reported more delayed sleep/wake behaviors. Adolescents also reported less daytime sleepiness and longer school night sleep duration during COVID-19. In considering differences between adolescents with and without ADHD, adolescents with ADHD did not experience an increase in school night sleep duration and were less likely to obtain recommended sleep duration during COVID-19. In the full sample, controlling for ADHD status, COVID-19-related sadness/loneliness was associated with increases in DIMS, and spending less time outside and more COVID-19-related worries/fears were associated with increases in delayed sleep/wake behaviors during COVID-19.ConclusionsCOVID-19 had negative and positive impacts on adolescent sleep. Adolescents with ADHD did not experience the benefit of increased school night sleep duration during COVID-19 like adolescents without ADHD. Negative affect and health behaviors may be useful intervention targets for reducing negative impacts of COVID-19 for adolescent sleep.     

Impact of the coronavirus pandemic on mental health and health care in adults with neurofibromatosis: Patient perspectives from an online survey

The coronavirus pandemic increased anxiety and stress and prevented access to health care worldwide; it is unclear how COVID-19 affected adults with a multisystem genetic disorder such as neurofibromatosis (NF). An anonymous online survey was distributed through an international registry and foundations to adults with NF (June–August 2020) to assess the impact of the pandemic on mental health and NF health care. Six hundred and thirteen adults (18–81 years; M = 45.7) with NF1 (77.8%), NF2 (14.2%), and schwannomatosis (7.8%) provided complete responses. Respondents rated moderate-to-high amounts of worry about the impact of COVID-19 on their emotional (46.3%) and physical health (46.7%), and 54.8% endorsed moderate-to-high pandemic-related stress. Adults with diagnosed/suspected mental health disorders or moderate-to-severe NF symptom impact as well as females endorsed higher COVID-19 stress (ps < 0.01). Less than half who missed a doctor's appointment for their NF care (43.4%) used telehealth. Of these, 33.3% and 46.2% reported that telehealth met their needs to a moderate or high degree, respectively. Results indicated that subgroups of adults with NF experience higher COVID-19-related worries and stress and may need additional support. Furthermore, telehealth is under-utilized and could help NF providers connect with patients, although improved delivery and patient training may facilitate expanded use of these services.     

Perceived Physical and Mental Health and Healthy Eating Habits During the COVID-19 Pandemic in Korea

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has disrupted the lives of people around the world since 2020. This study aims to reveal perceived impact of the coronavirus pandemic on physical and mental health and eating behaviors among people with disabilities and without disabilities in South Korea, as compared to other countries.MethodsA secondary analysis of a prospective cross-sectional study which was conducted with a web-based global survey.ResultsAmong the 3,550 responses from 65 countries, 2,621 responses with nation information were set as full data, 189 for South Korea and 2,432 for other countries. In Korea, there was no significant difference in healthy lifestyle behaviors between people with and without disabilities before the COVID-19 pandemic. Perceived physical and mental health and changes in eating habits during the COVID-19 pandemic showed no significant difference between people with and without disabilities in Korea. There were significant differences in physical health and dietary habits, but no differences in its effect on mental health between people living in Korea and other countries in both people with and without disabilities groups. In other words, more than 60% of people in all groups (disability vs. non-disability, Korea vs. non-Korea) reported worse mental health than before the COVID-19 pandemic.ConclusionIn Korea and other countries, mental health showed a tendency to deteriorate regardless of the presence or absence of disability during the COVID-19 pandemic. In terms of healthy eating habits, Koreans were relatively less affected than people from other countries.     

Pre-pandemic sleep reactivity prospectively predicts distress during the COVID-19 pandemic: The protective effect of insomnia treatment

The COVID-19 pandemic is a rare stressor that has precipitated an accompanying mental health crisis. Prospective studies traversing the pandemic's onset can elucidate how pre-existing disease vulnerabilities augured risk for later stress-related morbidity. We examined how pre-pandemic sleep reactivity predicted maladaptive stress reactions and depressive symptoms in response to, and during, the pandemic. This study is a secondary analysis of a randomised controlled trial from 2016 to 2017 comparing digital cognitive behavioural therapy for insomnia (dCBT-I) against sleep education (N = 208). Thus, we also assessed whether dCBT-I moderated the association between pre-pandemic sleep reactivity and pandemic-related distress. Pre-pandemic sleep reactivity was measured at baseline using the Ford Insomnia Response to Stress Test. In April 2020, participants were recontacted to report pandemic-related distress (stress reactions and depression). Controlling for the treatment condition and the degree of COVID-19 impact, higher pre-pandemic sleep reactivity predicted more stress reactions (β = 0.13, ± 0.07 SE, p = 0.045) and depression (β = 0.22, ± 0.07 SE, p = 0.001) during the pandemic. Further, the odds of reporting clinically significant stress reactions and depression during the pandemic were over twice as high in those with high pre-pandemic sleep reactivity. Notably, receiving dCBT-I in 2016–2017 mitigated the relationship between pre-pandemic sleep reactivity and later stress reactions (but not depression). Pre-pandemic sleep reactivity predicted psychological distress 3–4 years later during the COVID-19 pandemic, and dCBT-I attenuated its association with stress reactions, specifically. Sleep reactivity may inform prevention and treatment efforts by identifying individuals at risk of impairment following stressful events.