Effects of the lockdown on the mental health of the general population during the COVID-19 pandemic in Italy: Results from the COMET collaborative network

Abstract Background The Coronavirus disease 2019 (COVID-19) pandemic is an unprecedented traumatic event influencing the healthcare, economic, and social welfare systems worldwide. In order to slow the infection rates, lockdown has been implemented almost everywhere. Italy, one of the countries most severely affected, entered the “lockdown” on March 8, 2020. Methods The COvid Mental hEalth Trial (COMET) network includes 10 Italian university sites and the National Institute of Health. The whole study has three different phases. The first phase includes an online survey conducted between March and May 2020 in the Italian population. Recruitment took place through email invitation letters, social media, mailing lists of universities, national medical associations, and associations of stakeholders (e.g., associations of users/carers). In order to evaluate the impact of lockdown on depressive, anxiety and stress symptoms, multivariate linear regression models were performed, weighted for the propensity score. Results The final sample consisted of 20,720 participants. Among them, 12.4% of respondents (N = 2,555) reported severe or extremely severe levels of depressive symptoms, 17.6% (N = 3,627) of anxiety symptoms and 41.6% (N = 8,619) reported to feel at least moderately stressed by the situation at the DASS-21. According to the multivariate regression models, the depressive, anxiety and stress symptoms significantly worsened from the week April 9–15 to the week April 30 to May 4 (p < 0.0001). Moreover, female respondents and people with pre-existing mental health problems were at higher risk of developing severe depression and anxiety symptoms (p < 0.0001). Conclusions Although physical isolation and lockdown represent essential public health measures for containing the spread of the COVID-19 pandemic, they are a serious threat for mental health and well-being of the general population. As an integral part of COVID-19 response, mental health needs should be addressed.

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The impact of the COVID-19 pandemic on mental health in the general population: a comparison between Germany and the UK

10.1101/2020.08.27.20182980 ◽

2020 ◽

Author(s):

Franziska Knolle ◽

Lisa Ronan ◽

Graham K Murray

Keyword(s):

Mental Health ◽

General Population ◽

Physical Health ◽

Mental Health Problems ◽

Well Being ◽

Work Place ◽

Financial Situation ◽

The Uk ◽

The Impact ◽

Mental And Physical Health

In March 2020 the SARS-CoV-2infection (COVID-19) was declared a pandemic. In response to its world-wide outbreak radical measures were taken by governments across the world including curfew, quarantine, travel bans, social distancing, work place and school closures, etc, to reduce the transmission of the virus. These measures led to dramatic social and economic changes for the general population, in addition to the fears and worries related to the disease and its contraction. First studies report the impact of the pandemic on mental well-being of the general population showing increased levels of anxiety, stress and depression. In this study, we compare the impact of the pandemic on two European countries: the UK and Germany, which reported their first cases within a week. 241 residents of the UK and 541 residents of Germany filled in an online survey, including questions on COVID-19 exposure, impact on financial situation and work, substance and media consumption, self-reported mental and physical health, as well as including two clinical questionnaires, the general mental health Symptom Check List-27 (SCL-27) and the Schizotypal Personality Questionnaire. Data collection was completed between 27/04/20-31/05/20. We found distinct differences between the two countries. UK responders reported a stronger direct impact on their health, financial situation and their families. UK responders had higher clinical scores on the SCL-27, with a higher percentage being above cut-off. Interestingly, however, we found that German responders were less hopeful for an end of the pandemic and more concerned about their life-stability. Generally, we found that a younger age, being female, lower education, poorer mental and physical health before the pandemic, as well as more social media and substance consumption was associated with a higher clinical risk. This research shows strong differences between two economically and culturally similar countries, but as 25% of both German and UK responders reported a subjective worsening of the general psychological symptoms and 20-50% of German and UK responders reached the clinical cut-off for depressive, dysthymic and anxieties, it specifically shows the need for health emergency tailored intervention systems to assist not only people vulnerable for mental health problems, but also large proportions of the general public.

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The Impact of Social Support on Students’ Behavior in the Context of Iraqi Medical Education

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2021.7688 ◽

2021 ◽

Vol 9 (E) ◽

pp. 1553-1559

Author(s):

I. D. Al-Hasani ◽

H. S. Salih ◽

A. T. Abdul Wahid ◽

Mohammed Jabarah

Keyword(s):

Mental Health ◽

Social Support ◽

Medical Students ◽

Social Life ◽

Online Survey ◽

Mental Health Problems ◽

Well Being ◽

Depression And Anxiety ◽

Cross Sectional ◽

The Impact

BACKGROUND: Mental health problems are reflected and linked to human behavior in many aspects. Medical students are susceptible to a wide variety of events that compromise their mental well-being, social life as well as their academic achievements. AIM: This study aimed to find the impact of social support on medical students’ behavior in Iraq via assessing their depression, anxiety, and stress status. METHODS: A cross-sectional online survey-based study targeted all medical students in Iraq. The employed questionnaires covered mental health status of participants by evaluating their perceptions of depression, anxiety, and stress using. Data were analyzed using the Statistical Analysis System. RESULTS: The study revealed a significant influence of social support on students’ perceptions of depression and anxiety, but not of their perception of stress. CONCLUSION: Lending social support to medical student is crucial to improve their depression and anxiety with all the positive results that the support brings to their behavior and social life. However, they need more than the social support to keep them safe from academic and daily life stressors.

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The hidden crisis: COVID-19 and impact on mental health of medical students in Pakistan

Middle East Current Psychiatry ◽

10.1186/s43045-021-00123-7 ◽

2021 ◽

Vol 28 (1) ◽

Author(s):

Nazish Imran ◽

Imran Ijaz Haider ◽

Ali Burhan Mustafa ◽

Irum Aamer ◽

Zahid Kamal ◽

...

Keyword(s):

Mental Health ◽

Medical Students ◽

Online Survey ◽

Mental Health Problems ◽

Positive Impact ◽

Well Being ◽

Depression Symptoms ◽

Psychological Well Being ◽

The Impact ◽

Medical Colleges

Abstract Background Medical students have faced an enormous disruption to their lives due to the COVID-19 pandemic. The study aimed to assess the impact of COVID-19 on medical student’s psychological well-being in Pakistan. Following ethical approval, an online survey developed in collaboration with World Psychiatric Association (WPA) was distributed among medical students of 5 Medical colleges in the Punjab province of Pakistan between August and September 2020. Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7), and Risk Assessment Suicidality Scale (RASS) were used to assess psychological well-being. Data was analyzed using SPSS 26.0. Results Eleven hundred medical students responded, 756 (69%) being females. More than 2/3rd admitted that their emotional state got worse in relation to appearance of anxiety, insecurity, and sadness, compared to before the outbreak of COVID-19. Prevalence of anxiety and depressive symptoms were 48.6% and 48.1%, respectively. Female medical students, pre-clinical students, and those with a previous psychiatric history reported experiencing more anxiety and depression symptoms (P value < 0.001). One in five medical students thought that it would be better if they were dead, and 8% admitted to often think of committing suicide during the past 2 weeks. RASS and subscales (intention, life, and history) scores were higher in females and students with previous psychiatric problems. Conclusion Our findings underscore that the impact of COVID-19 on medical students has been significant; hence, it is crucial for medical colleges to employ strategies to maintain the student’s well-being with safeguards like reassurance, support, and confidential student-centered psychiatric services. The use of virtual platforms (websites, email) to educate and screen students by staff members can create a positive impact. The limitations of this study include cross-sectional design, the possibility of selective participation being web-based survey, response bias, and the possibility of reluctance of students to report mental health problems due to stigma.

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The Impact of the COVID-19 Pandemic on Mental Health and Psychological Well-Being of Young People Living in Austria and Turkey: A Multicenter Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17239111 ◽

2020 ◽

Vol 17 (23) ◽

pp. 9111

Author(s):

Türkan Akkaya-Kalayci ◽

Oswald D. Kothgassner ◽

Thomas Wenzel ◽

Andreas Goreis ◽

Anthony Chen ◽

...

Keyword(s):

Mental Health ◽

Health Status ◽

Young People ◽

Online Survey ◽

Mental Health Problems ◽

Well Being ◽

Mental Health Status ◽

Health State ◽

Psychological Well Being ◽

The Impact

Little is known about the impact of the COVID-19 pandemic on the mental health and psychological well-being of young people. The aim of this study is to investigate the psychological well-being and changes in the mental-health state of young people living in Austria and Turkey. By using an anonymous online survey, we recruited 1240 people aged 15–25 years from these two countries. We used the “Psychological General Well-being” and a self-created questionnaire to capture individual experiences during the COVID-19 pandemic and quarantine period. The native Turks indicated higher “anxiety” (ps < 0.010), lower “vitality” (ps < 0.011), and lower “general health” (ps < 0.011) than native Austrians or Austrian migrants and increased “depression” (p = 0.005) and lower “self-control” (p = 0.022), than Austrian migrants. Moreover, 50.9% of native Turks reported a decrease in their mental health status, compared to 31.1% of native Austrians and 23.7% of Austrian migrants. Participants with financial problems (OR = 1.68) and prior mental health problems (i.e., already in treatment by the time of COVID-19, OR = 5.83) reported a higher probability for a worsening in their mental health status. Our results show that the COVID-19 pandemic impaired the psychological well-being and mental health of young people. Especially people in Turkey were most affected, probably due to the stringent policies to fight COVID-19.

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Patterns of mental health problems before and after easing COVID-19 restrictions: Evidence from a 105248-subject survey in general population in China

PLoS ONE ◽

10.1371/journal.pone.0255251 ◽

2021 ◽

Vol 16 (8) ◽

pp. e0255251

Author(s):

Depeng Jiang ◽

Jian Chen ◽

Yixiu Liu ◽

Jing Lin ◽

Kun Liu ◽

...

Keyword(s):

Mental Health ◽

High Risk ◽

General Population ◽

Mental Disorders ◽

Online Survey ◽

Latent Class ◽

Mental Health Problems ◽

General Health Questionnaire ◽

Well Being ◽

Before And After

Background The COVID-19 pandemic has alarming implications for individual and population level mental health. Although the future of COVID-19 is unknown at present, more countries or regions start to ease restrictions. The findings from this study have provided the empirical evidence of prevalence and patterns of mental disorders in Chinese general population before and after easing most COVID-19 restrictions, and information of the factors associated with these patterns. Methods A cross-sectional population-based online survey was carried out from February to March 2020 in the general population across all provinces in China. The 12-item General Health Questionnaire (GHQ-12) was incorporated in the survey. Latent class analyses were performed to investigate the patterns of mental disorders and multinomial logistic regressions were used to examine how individual and regional risk factors can predict mental disorder patterns. Results Four distinctive patterns of mental health were revealed in the general population. After the ease of most COVID-19 restrictions, the prevalence of high risk of mental disorders decreased from 25.8% to 20.9% and prevalence of being high risk of unhappiness and loss of confidence decreased from 10.1% to 8.1%. However, the prevalence of stressed, social dysfunction and unhappy were consistently high before and after easing restrictions. Several regional factors, such as case mortality rate and healthcare resources, were associated with mental health status. Of note, healthcare workers were less likely to have mental disorders, compared to other professionals and students. Conclusions The dynamic management of mental health and psychosocial well-being is as important as that of physical health both before and after the ease of COVID-19 restrictions. Our findings may help in mental health interventions in other countries and regions while easing COVID-19 restrictions.

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Embitterment as a Specific Mental Health Reaction during the Coronavirus Pandemic

Psychopathology ◽

10.1159/000517447 ◽

2021 ◽

pp. 1-10

Author(s):

Beate Muschalla ◽

Clio Vollborn ◽

Anke Sondhof

Keyword(s):

Mental Health ◽

Mental Illness ◽

Online Survey ◽

Mental Health Problems ◽

Affective State ◽

Well Being ◽

Health Problems ◽

Social Consequences ◽

High Rate ◽

Perceived Injustice

Introduction: Embitterment can occur as a reaction to perceived injustice. During the pandemic and restrictions in daily living due to infection risk management, a range of many smaller or severe injustices have occurred. Objective: The aim of this study is to investigate what characterizes persons with high embitterment, mental illness, embitterment and mental illness, and those without embitterment or mental health problems. Methods: We conducted an online survey including persons from the general population in November 2020 and December 2020, the phase during which a second lockdown took place, with closed shops, restaurants, cultural and activity sites. 3,208 participants (mean age 47 years) gave self-ratings on their present well-being, burdens experienced during the pandemic, embitterment, wisdom, and resilience. Results: Embitterment occurred among 16% of the sample, which is a high rate in comparison with 4% during pre-pandemic times. Embitterment was weakly correlated with unspecific mental well-being. There were more persons with embitterment than those with embitterment and a mental health problem. Persons with embitterment reported less coronavirus-related anxiety than persons without embitterment. However, embittered persons reported more social and economic burdens and more frequent experiences of losses (job loss and canceling of medical treatments). Embittered persons perceive their own wisdom competencies on a similar level as persons with mental health problems or persons without mental health problems. Conclusion: Embitterment is a specific potentially alone-standing affective state, which is distinguishable from general mental health and coping capacities (here: wisdom). The economic and social consequences of pandemic management should be carefully recognized and prevented by policy.

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COVID-19 pandemic related long-term chronic stress on the prevalence of depression and anxiety in the general population

BMC Psychiatry ◽

10.1186/s12888-021-03385-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Tian Qi ◽

Ting Hu ◽

Qi-Qi Ge ◽

Xiao-Na Zhou ◽

Jia-Mei Li ◽

...

Keyword(s):

Mental Health ◽

General Population ◽

Chronic Stress ◽

Protective Factor ◽

Mental Health Problems ◽

Anxiety Symptoms ◽

Binary Logistic Regression Analysis ◽

Depression And Anxiety ◽

Factors Associated

Abstract Background The COVID-19 pandemic has lasted for more than 1 year, causing far-reaching and unprecedented changes in almost all aspects of society. This study aimed to evaluate the long-term consequences of the COVID-19 pandemic on depression and anxiety, and explore the factors associated with it. Methods A cross-sectional study using an online survey was conducted to assess mental health problems from February 2 to February 9, 2021 by using patient health questionnaire-9 (PHQ-9) and generalized anxiety disorder-7 (GAD-7). The insomnia severity index (ISI), demographic data and COVID-19 related variables were measured by a self-designed questionnaire. The factors associated with depressive and anxiety symptoms were identified by Pearson chi-square test and binary logistic regression analysis. Results In the study that 1171 participants enrolled, the overall prevalence of depressive and anxiety symptoms among general people was 22.6 and 21.4% respectively in the present study. Living alone was a potential risk factor for depressive symptoms, while regular exercises was a potential protective factor. The prevalence of depressive and anxiety symptoms was significantly associated with the severity of insomnia symptoms and the negative feelings about pandemic. Conclusion COVID-19 pandemic- related chronic stress has brought about profound impacts on long-term mental health in the general population. The level of insomnia and a negative attitude towards the pandemic are significantly correlated with unfavorable mental health. However, we failed to found a significant association of age and gender with the mental health symptoms, although they were recognized as well-established risk factors during the outbreak by some other studies. This discrepancy may be because the acute and chronic effects of the pandemic are influenced by different factors, which reminds that more attention should be paid to the intrinsic psychological factors and physical reactions towards COVID-19.

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Leveraging Twitter Using Artificial Intelligence to Explore Mental Health Insights in the UK During the COVID-19 Pandemic (Preprint)

10.2196/preprints.32449 ◽

2021 ◽

Author(s):

Christopher Marshall ◽

Kate Lanyi ◽

Rhiannon Green ◽

Georgie Wilkins ◽

Fiona Pearson ◽

...

Keyword(s):

Mental Health ◽

Artificial Intelligence ◽

Language Processing ◽

Mental Health Problems ◽

Well Being ◽

Research Activity ◽

Health Crisis ◽

Key Topics ◽

The Uk ◽

The Impact

BACKGROUND There is increasing need to explore the value of soft-intelligence, leveraged using the latest artificial intelligence (AI) and natural language processing (NLP) techniques, as a source of analysed evidence to support public health research activity and decision-making. OBJECTIVE The aim of this study was to further explore the value of soft-intelligence analysed using AI through a case study, which examined a large collection of UK tweets relating to mental health during the COVID-19 pandemic. METHODS A search strategy comprising a list of terms related to mental health, COVID-19, and lockdown restrictions was developed to prospectively collate relevant tweets via Twitter’s advanced search application programming interface over a 24-week period. We deployed a specialist NLP platform to explore tweet frequency and sentiment across the UK and identify key topics of discussion. A series of keyword filters were used to clean the initial data retrieved and also set up to track specific mental health problems. Qualitative document analysis was carried out to further explore and expand upon the results generated by the NLP platform. All collated tweets were anonymised RESULTS We identified and analysed 286,902 tweets posted from UK user accounts from 23 July 2020 to 6 January 2021. The average sentiment score was 50%, suggesting overall neutral sentiment across all tweets over the study period. Major fluctuations in volume and sentiment appeared to coincide with key changes to any local and/or national social-distancing measures. Tweets around mental health were polarising, discussed with both positive and negative sentiment. Key topics of consistent discussion over the study period included the impact of the pandemic on people’s mental health (both positively and negatively), fear and anxiety over lockdowns, and anger and mistrust toward the government. CONCLUSIONS Through the primary use of an AI-based NLP platform, we were able to rapidly mine and analyse emerging health-related insights from UK tweets into how the pandemic may be impacting people’s mental health and well-being. This type of real-time analysed evidence could act as a useful intelligence source that agencies, local leaders, and health care decision makers can potentially draw from, particularly during a health crisis.

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What Is the Role of Resilience and Coping Strategies on the Mental Health of the General Population during the COVID-19 Pandemic? Results from the Italian Multicentric COMET Study

Brain Sciences ◽

10.3390/brainsci11091231 ◽

2021 ◽

Vol 11 (9) ◽

pp. 1231

Author(s):

Gaia Sampogna ◽

Valeria Del Del Vecchio ◽

Vincenzo Giallonardo ◽

Mario Luciano ◽

Umberto Albert ◽

...

Keyword(s):

Mental Health ◽

General Population ◽

Coping Strategies ◽

Mental Health Problems ◽

Poor Mental Health ◽

Adaptive Coping ◽

Current Increase ◽

Stress Symptoms ◽

Low Levels

The effects of the COVID-19 pandemic on mental health are now well documented, however, few studies have been focused on the role of coping strategies and resilience in counterbalancing these detrimental effects. Data are derived from the COvid Mental hEalth Trial (COMET), a national multicentric trial carried out in the Italian general population. The final sample consisted of 20,720 participants, 53.1% (n = 11,000) of the sample reported low levels of resilience. Adaptive coping strategies and resilience levels did not have any significant protective impact on the levels of depressive, anxiety, and stress symptoms. Only self-distraction was a risk factor for poor mental health (Beta Coefficient, B = 0.1, 95% Confidence Interval, CI: 0.003 to 0.267 for stress symptoms; B = 0.2; 95% CI: 0.077 to 0.324 for anxiety symptoms and B = 0.2, 95% CI: 0.105 to 0.382 for depressive symptoms). High levels of resilience were predicted by adaptive coping strategies, such as acceptance (B = 1.8, CI 95% = 1.4–2.7). Exposure to the different weeks of lockdown, being infected by COVID-19, and being a healthcare professional did not influence the levels of resilience. Our findings should be carefully considered, since the low levels of resilience may represent the missing link between the pandemic and the current increase in mental health problems.

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Relationship between self-care activities, stress and well-being during COVID-19 lockdown: a cross-cultural mediation model

BMJ Open ◽

10.1136/bmjopen-2020-048469 ◽

2021 ◽

Vol 11 (12) ◽

pp. e048469

Author(s):

Elkin Luis ◽

Elena Bermejo-Martins ◽

Martín Martinez ◽

Ainize Sarrionandia ◽

Cristian Cortes ◽

...

Keyword(s):

General Population ◽

Online Survey ◽

Self Care ◽

Well Being ◽

Active Role ◽

Total Sample ◽

Cross Sectional ◽

Psychological Well Being ◽

Sociodemographic Variables ◽

The Impact

ObjectivesTo examine the mediation role of self-care between stress and psychological well-being in the general population of four countries and to assess the impact of sociodemographic variables on this relationship.DesignCross-sectional, online survey.ParticipantsA stratified sample of confined general population (N=1082) from four Ibero-American countries—Chile (n=261), Colombia (n=268), Ecuador (n=282) and Spain (n=271)—balanced by age and gender.Primary outcomes measuresSociodemographic information (age, gender, country, education and income level), information related to COVID-19 lockdown (number of days in quarantine, number of people with whom the individuals live, absence/presence of adults and minors in charge and attitude towards the search of information related to COVID-19), Perceived Stress Scale-10, Ryff’s Psychological Well-Being Scale-29 and Self-Care Activities Screening Scale-14.ResultsSelf-care partially mediates the relationship between stress and well-being during COVID-19 confinement in the general population in the total sample (F (3,1078)=370.01, p<0.001, R2=0.507) and in each country. On the other hand, among the evaluated sociodemographic variables, only age affects this relationship.ConclusionThe results have broad implications for public health, highlighting the importance of promoting people’s active role in their own care and health behaviour to improve psychological well-being if stress management and social determinants of health are jointly addressed first. The present study provides the first transnational evidence from the earlier stages of the COVID-19 lockdown, showing that the higher perception of stress, the less self-care activities are adopted, and in turn the lower the beneficial effects on well-being.

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