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The 1995 Kikwit Ebola outbreak: lessons hospitals and physicians can apply to future viral epidemics
Abstract
This article looks at lessons learned from the 1995 Kikwit Ebola outbreak and suggests how modern hospitals should apply these lessons to the next lethal viral epidemic that occurs.
The 1995 Kikwit Ebola outbreak in the Democratic Republic of the Congo (formally Zaire) is one of the most well studied epidemics to have occurred to date. Many of the lessons learned from identifying, containing and treating that epidemic are applicable to future viral outbreaks, natural disasters and bioterrorist attacks. This is due to Ebola's highly contagious nature and high mortality rate.
When an outbreak occurs, it often produces fear in the community and causes the basic practice of medicine to be altered. Changes seen at Kikwit included limited physical examinations, hesitance to give intravenous medications and closure of supporting hospital facilities. The Kikwit Ebola outbreak also provided beneficial psychological insight into how patients, staff and the general community respond to a biological crisis and how this will affect physicians working in an epidemic.
General lessons from the outbreak include the importance of having simple, well-defined triage procedures; staff who are flexible and able to adapt to situations with unknowns; and the need to protect staff physically and emotionally to ensure a sustained effort to provide care.
... Insomnia was diagnosed using Insomnia Severity Index (ISI), a 7-item self-report questionnaire (yielding a total score ranging from 0 to 28) assessing the nature, severity, and impact of insomnia. The total score interpreted as: (0-7) absence of insomnia; (8)(9)(10)(11)(12)(13)(14) sub-threshold insomnia; (15-21) moderate insomnia; and (22-28) severe insomnia. PTSD was diagnosed using 22item Impact of Event Scale-Revised (IES-R) scale. ...
... Depression, panic attacks, PTSD and anxiety were the major mental health disorders reported and in some cases, psychosis and even suicidal attempts were observed. 10,11 In the present study, 63.3% participants were females. This is due to the fact that majority of study participants were nurses who, generally, are females in KSA. ...
Background: Since the outbreak of Covid-19, several studies have demonstrated that healthcare workers (HCWs) are at risk of developing mental health disorders. Objective: To survey Saudi healthcare workers exposed to Covid-19 patients for most commonly reported mental health disorders. Study type, settings & duration: A descriptive cross-sectional study carried out at King Fahd Armed Forces Hospital Jeddah, Kingdom of Saudi Arabia (KSA) during June 2020. Methodology: The population comprised of healthcare workers (physicians, nurses and paramedical staff). The mental health disorders explored were depression, anxiety, insomnia and post traumatic stress disorder (PTSD). Data analysis was performed using SPSS statistical software version 22.0 (IBM Corp). Results: The most frequent mental health disorder reported in the present study was anxiety (68.6%) followed by insomnia (30.3%), PTSD (15.7%) and clinically significant depression (11.1%). Frontline healthcare workers demonstrated significantly higher risk of developing anxiety and PTSD after adjustment for other factors (OR of 1.9, 95% CI: 1.13-3.15, p =0.015), and (OR of 2.7, 95% CI: 1.22-6.01, p =0.014) respectively. Conclusion: Frontline HCWs demonstrated approximately twofold increased risk of developing anxiety and approximately threefold risk of developing post-traumatic stress disorders after adjustment for other variables. We suggest launching a large scale health education program and screening for Saudi HCWs engaged in the management of Covid-19 patients.
... Individuals may experience the fear of becoming ill or dying. Additionally, they may feel helplessness or perceive stigma (Hall et al., 2008), experiencing which will naturally cause certain psychological or physical problems. Schredl et al. (2016) determined that waking concerns related to health also impact dream imagery. ...
This study investigated the “coronavirus pandemic dream” phenomenon in Chinese including residing in Wuhan city based on the continuity hypothesis, which states that dream contents reflect waking life. We analyzed the effects of lockdown due to coronavirus disease-2019 (COVID-19) on dream reported from Chinese university students and workers residing in inside and outside of Hubei province including Wuhan city, where the infection was initially detected in the world. The questionnaire on dreams, consisting of descriptions of the most striking dreams and classification of dream characteristics with reference to the Hall/Van de Castle Coding System, was administered to 943 participants via online survey over two periods. The recall rate of the COVID-19-related dreams among the participants of the Hubei province was high at 10.3%, while that in other provinces was 3.2%. Due to the different degrees of impact and quarantine policies, the Chinese in various regions have been affected differently by COVID-19. In the characteristic analysis of the dream contents, the biggest difference between the participants in Hubei and in other provinces was the emergence of words such as abandon and end during the lockdown, which are common in nightmarish pandemic dreams in many cultures. People in areas where the epidemic is severe or lockdown measures are strict may have more serious psychological problems, and needs more attention to psychological problems. In conclusion, analyzing the dream content could help identify specific people who may be the most at risk. It could allow researchers to direct appropriate help to specific populations in the pandemic.
... During the epidemic, individuals may experience fear of death, desperation, loneliness, and illness. During the epidemic, depression, anxiety, panic attacks, post-traumatic stress disorder, psychosis, and rarely can suicide be seen (11). SARS-CoV-2, an epidemic virus in which the first patients were seen in China in December 2019, spread worldwide and was declared a pandemic by the World Health Organization on March 11, 2020 (12). ...
The primary purpose of this study is to examine friendship relationships, which are the most critical element of adolescence, in adolescents attending 9th grade and to reveal the impact of the Covid-19 pandemic on these relationships. In this direction, phenomenology design, one of the qualitative research methods, was used. The research group was determined as 13 girls and 8 boys, 21 adolescents in 9th grade, and accepted to participate in the study, in line with the purposeful sample. In line with the purpose, online interviews were done with an interview form that included questions about demographic information, friendship relations, and pandemic lives. As a result of the research, it was seen that adolescents continued their education through different platforms during the pandemic process, spent most of their time with their phones during the pandemic process, and used it to follow lessons and social media while using it. It has been observed that online life, an outcome of the pandemic in the friendship relationships of adolescents, has effects such as getting away with friends, not meeting, not being able to make friends and a decrease in the number of friends. In this direction, it can be suggested to protect adolescents' friendship relationships, protect them from the possible dangers of online life, and ensure standardization of education or paste your abstract here as prescribed by the journal's instructions for authors.
... With the outbreak of the Covid-19 pandemic, communities around the world have been employing various tactics and measures to contain the spread of the virus in their respective locations. A Few of the most widespread intervention been implemented by countries around the world includes social distances, the closing of religious and educational institutions, and partial or full lockdown (Hall, Hall and Chapman, 2008;Xiang et al., 2020). With the outbreak of the virus in Nigeria and its substantial rise, A variety of measures where been implemented by the Nigerian government to control the spread of the virus. ...
The novel coronavirus (COVID19) pandemic and the subsequent lockdown has taken the world by storm and has forced dramatic alterations to daily living and generating a considerable degree of worry, fear, and concern among university students. The pandemic has disrupted the education of over one billion students in 129 countries around the world. As universities around the world have shifted to emergency remote teaching (ERT) via online platforms, this has further caused anxiety amongst the students. This study was conducted to assess the prevalence and associated factor of stress among Engineering students at Bells university in Nigeria during the pandemic. Four hundred engineering students were randomly selected from Bells university during the movement control order. A cross-sectional online survey, using Cohen's perceived stress scale questionnaire was distributed among the students to measure perception of stress during the COVID-19 pandemic and lockdown. The questionnaire comprised of sociodemographic characteristics and stress-related variables. It was found that of the 400 respondents, 13.8%, 74.8%, and 11.5% experienced a low, moderate, and high level of stress respectively. Female gender (p= 0.008), Igbo ethnicity (p= 001) and smoking (p= 001) were significantly associated with higher levels of stress. Age group, regular exercise, and average daily sleeping hours were not associated with stress levels. Negative changes were reported in family income status (44.3%), internet connection status (54.3%), and satisfaction with online classes (55.0%). Negative changes to family income, internet status, and online classes were not associated with higher stress levels. It was then concluded that there is a significant association between gender, ethnicity , smoking and stress among Bells university students during MCO.
... One of the most common emotional responses throughout the pandemic has been fear (De Los Santos, 2020; Khattak et al., 2020), since there is a limited understanding of Covid-19's biology, there is much uncertainty about how it spreads (Al-Hanawi et al., 2020). Prior research has shown that fear of infection results in tension, despair, and anxiety during a pandemic (Hall et al., 2008). Uninfected people are afraid of coming into contact with confirmed Covid-19 patients. ...
Mongolia remained one of the few countries with no registered cases of the COVID-19 virus for most of 2020. However, the number spiked after the first registered case, which was imported from abroad by a foreign individual. As a result, the Mongolian government implemented multiple lockdown restrictions, which impacted the overall mental health and well-being of the population. The purpose of this study was to investigate depression, anxiety and stress levels in the Mongolian population ( n = 344) during lockdowns using a Depression, Anxiety, Stress Scale (DASS-21) scale that included factors such as the health and well-being of loved ones, financial status and anhedonia. This study also aimed at establishing relationships between depression, anxiety, stress and the tendency to seek social support using an Oslo Social Support Scale (OSSS-3) scale. Participants who scored highest on depression, anxiety and stress tended to seek social support less. The findings increase understanding of the impact of social factors on mental well-being during global health crises and have implications for how governments can better approach the management of these issues.
It is envisioned that the COVID-19 pandemic has influenced the mental health of many individuals, especially those who have diabetes. The present study evaluated the effect of the COVID-19 pandemic on diabetics' mental health. A pretested online questionnaire was developed to assess the concern related to COVID-19, anxiety and depressive symptoms, and resilience to stress of people with diabetes during the COVID-19 pandemic. Data from 371 surveys was collected. The majority (71.2%) of the responders' aged between 41 to 64 years. Chronic disease was present in 69.3% of respondents, while 76.8% indicated overall good health. Most respondents (82.5%) were worried a lot or worried about the economic recession, whilst 53.9% of respondent were worried a lot or worried about frightening media messages. Around 35% of those surveyed were feeling depressed for at least three days a week for the previous two months, and 30.5% were fearful for at least three days a week for the previous two months. Approximately 60% of respondents agreed or strongly agreed that they had difficulty getting through stressful events. The current study revealed elevated rates of fear and depression symptoms, and noticeable difficulties in managing stressful situations associated with the COVID-19 pandemic within diabetes patients. These results highlight the importance of addressing the mental health issues within the chronic diseases patients at the time of crises. Which can be realized via specific interventions at the time of pandemics, which would reflect on the overall mental well-being and ability to adapt in stressful situations.
Introduction
The COVID-19 pandemic brought about an unprecedented number of people to be isolated and this negatively impacted on manifestations of various anxiety and depressive symptoms. Our study determined the prevalence of anxiety and depressive symptoms and the associated sociodemographic and clinical factors among discharged COVID-19 patients in North-Central, Nigeria.
Methods
One hundred and sixteen discharged COVID-19 patients were assessed in a cross-sectional study during the early phase of the COVID-19 outbreak in Jos, North-Central, Nigeria. The age, gender, educational level, length of stay in isolation, and presence of symptoms of COVID-19 were assessed with a semi-structured questionnaire designed by the authors. The Hopkins Symptom Checklist-25 was used to assess for the symptoms of anxiety and depression among participants.
Results
The mean age was 38.7 ± 14.6 years. More men (59%) were assessed with 67.2% of the participants “ever married,” and 43% had tertiary education. Voluntary admission was 62% and about 14% had symptoms of COVID-19. Forty-three percent had stayed for more than 10 days. The prevalence of symptoms of anxiety and depression was 17.2% and 9.5%, respectively, with 10.3% having combined symptoms. No significant association between the various sociodemographic and clinical factors, with symptoms of anxiety, except for the female gender which was significantly associated with depressive symptoms ( P = 0.026).
Conclusion
Isolation and COVID-19 impact on the manifestation of anxiety and depressive symptoms. Screening for anxiety and depressive symptoms should be integrated into the comprehensive psychological management of patients, especially for epidemic-prone diseases like COVID-19 that are associated with stigma.
BACKGROUND
A plethora of studies have reported the adverse psychiatric outcomes among the general masses during the COVID-19 pandemic; however, not much data is available in relation to the Indian population from this perspective. The aim of the present study was to investigate the impact of the COVID-19 pandemic on the mental health status among the general masses in the Indian population.
MATERIALS AND METHODS
The present study was planned in a cross-sectional study design between July 2020 and October 2021 in which a well-structured questionnaire, consisting of questions assessing the sociodemographic profile, while, also, specific questions related to the stress and anxiety-related variables, was used. The questionnaire was validated through intra-class correlation with a strong correlation of 0.84. The Chi-square test was used for statistical analysis to test the association between the studied variables, while P < 0.05 was considered statistically significant.
RESULTS
On comparison between the male and female participants using stress and anxiety-related variables, 43.81% of males as against 56.19% of the female participants reported that they felt horrified due to the pandemic with the results being statistically highly significant ( P = 0.0043). Similarly, 45.18% of male and 54.82% of female participants expressed apprehension due to the fear of the pandemic with the results being statistically significant ( P = 0.0217).
CONCLUSION
The research findings of the present study indicated that men and women responded to stress differently, with women experiencing greater sadness and anxiety and were found to be at a relatively greater risk for developing anxiety and depression than men.
Background
The COVID-19 global pandemic has led to a marked increase in anxiety levels, significantly affecting the well-being of individuals worldwide. In response to this growing concern, interventions aimed at enhancing social-emotional skills and promoting mental health are more crucial than ever.
Objective
This global study aimed to examine the effectiveness of a self-care program on anxiety, loneliness, and satisfaction with life in high school students and staff in a randomized, waitlist control trial with baseline and postintervention assessments.
Methods
The 4-week web-based self-care program, offered by the Heartfulness Institute, is designed to develop social-emotional skills through stress management and self-observation. The web-based program was a positive intervention that offered support to the students and staff to build specific skills, such as reflection, observation, positivity, time management, and goal setting. In this study, the sample consisted of a total of 203 high school students and staff randomized into a control waitlisted group (students: n=57 and staff: n=45) and a Heartfulness group (students: n=57 and staff: n=44) from 3 schools. Both the groups completed web-based surveys at weeks 0, 4, and 8, assessing their anxiety, loneliness, and satisfaction with life scores using Generalized Anxiety Disorder-7 Scale (GAD-7 and Severity Measure for Generalized Anxiety Disorder—Child Age 11-17), Satisfaction With Life scale (SWLS) and Satisfaction With Life Scale-Child (SWLS-C), and the University of California, Los Angeles (UCLA) Loneliness Scale. Survey responses were each individually analyzed using repeated measures ANOVA.
Results
The study received institutional review board approval on February 3, 2022. Participant recruitment lasted from the approval date until March 30, 2022. The 4-week program for the Heartfulness group started on April 4, 2024. There was a significant 3-way interaction among time, group, and school showing a decrease in anxiety and loneliness scores and an increase in satisfaction-with-life scores (P<.05). In students in the Heartfulness group, there was strong evidence to suggest a significant mean difference in GAD-7, SWLS, and UCLA scores between week 0 and week 4 at all schools (P<.001). In staff in the Heartfulness group, there was strong evidence to suggest a significant mean difference in GAD-7, SWLS, and UCLA scores between week 0 and week 4 at all schools (P<.001).
Conclusions
The pandemic brought severe educational and social changes that triggered a decline in mental health in schools. This study showed the effectiveness of noninvasive self-care tools used digitally to significantly decrease anxiety and loneliness scores and increase satisfaction of life scores in the participants.
Trial Registration
ClinicalTrials.gov NCT05874232; https://clinicaltrials.gov/ct2/show/NCT05874232
Myths, misinformation, facts like posts spread by social media during COVID-19 pandemic had an enormous effect on psychological health. This study aimed to investigate social media based COVID-19’s posts and the psychological health status of participants. A cross-sectional, online survey-based study was conducted in between April to October 2021 using a structured and semi-structured questionnaire, predominantly involving 1200 active social network users in Bangladesh. Depression, anxiety, and stress were assessed using the Depression, Anxiety, and Stress Scale (DASS-21), while the Insomnia Severity Index (ISI) measured insomnia severity for selected participants. Internal reliabilities were calculated with Cronbach’s alpha coefficients (cut-off point 0.70). Unrelated multivariate logistic regression explored correlations among outcome errors, with the model assessing the impact of selected independent variables on mental health. The findings demonstrated that 27.8% individuals spread facts whereas 7.4% spread myths and misinformation about COVID-19 on social networks. Furthermore, 28.1% and 36.7% shared obstinate and concerning posts respectively. The prevalence of depression, anxiety and stress symptoms, ranging from mild to extremely severe, were 43.9%, 30.9%, and 23.8% respectively. However, 2.8% had severe level of insomnia. Facts, myths, tour attending, and no mask group photos were significantly associated with anxiety, and less likelihood of experiencing anxiety. Interestingly, circulating such activities on social networks had no significant association with depression, stress, or insomnia. The spread of misinformation on social media undermines any efforts to contain COVID-19 infection. The findings hugely recommend of using fact checking facilities and adaptation to the pandemic situations to maintain lower prevalence of depression, anxiety, stress and insomnia.
BACKGROUND
The role of mental health is crucial in maintaining the dynamism and productivity of any given society. In contemporary times, a significant proportion of the workforce is comprised of women and mothers. Working in healthcare facilities, where exposure to pathogenic agents is an everyday nuisance, can have detrimental effects on mothers’ stress and anxiety levels. Furthermore, such exposure can also endanger the health of both the family and society. Conversely, the employment of mothers could positively impact their social well-being. The primary objective of this study is to assess and compare the stress, anxiety, and social well-being scores of mothers employed in healthcare facilities and stay-at-home mothers during the COVID pandemic.
MATERIALS AND METHODS
This study is a cross-sectional analysis of 246 mothers, equally divided into two groups: Mothers who work in health centers and stay-at-home mothers (123 individuals in each group). The study was conducted from 2021 to 2022, a multistage sampling method was utilized and two questionnaires were administered: The DASS 21 (21 questions) and the social well-being questionnaire (48 questions). The data were analyzed using SPSS 18, and descriptive and analytical tests (Independent Samples T-Test, Mann-Whitney) were employed.
RESULTS
The mean age was 35.7 ± 7.1 for working mothers and 34.3 ± 6.3 for stay-at-home mothers. The average stress score for employed mothers was 5.72 ± 4.7, and for stay-at-home mothers, it was 7.16 ± 4.3, which indicates a statistically significant difference in stress levels between the two groups ( P = 0.04). However, the two groups had no significant difference in the mean anxiety score ( P = 0.08). The mean score for social well-being was 165.5 ± 18.4 for working mothers and 162.17 ± 21.2 for stay-at-home mothers. This difference was not statistically significant ( P = 0.18). Except for the social acceptance dimension ( P = 0.003), no statistically significant differences were observed in the social well-being dimension between the two groups.
CONCLUSION
The social acceptance of working mothers appears to be greater than that of stay-at-home mothers. Higher social acceptance suggests that they hold a more positive outlook on people and are at ease in social situations, which may have helped to alleviate their stress and anxiety.
The outbreak and rapid spread of the novel coronavirus disease or COVID-19 had health, social and economic ramifications for people worldwide. Using the framework of Social Representation Theory, the present research attempts to understand how emerging adults (18–29 years) made sense of the COVID-19 outbreak, the role of collectives (organizations) in managing it, and the evolution of this understanding over time. The function of this theoretical perspective in the present study is to help make sense of the COVID-19 pandemic as a threatening event and in the process understand if responsibility or blame is attributed to specific collectives. Data was collected in two phases, from ten participants (four males and six females), aged 18–29 years residing in India. Semi-structured interviews were used to generate data. Findings have been discussed as ‘sociogenesis of COVID-19’, ‘role of collectives: heroes, villains, or on the fence’, ‘collective symbolic coping: making sense of collective threats’, and ‘the next normal: learnings from COVID-19). Finally, this study would have implications for research on social representation and its evolution, especially of emerging infectious diseases and the representation of collectives may also be used to reevaluate health policies and get better prepared for future emergencies.
Background
Since the outbreak of coronavirus disease 2019, it has had a serious impact on people's physical and mental health. However, in our clinical work, we have found that the erectile function of coronavirus disease 2019 patients with neurological decline was often seriously affected.
Objectives
To further explore the relationship between erectile dysfunction and neurological dysfunction caused by coronavirus disease 2019.
Materials and methods
We conducted a survey from August 2022 to February 2023 at the First Affiliated Hospital of Anhui Medical University and the Third People's Hospital of Linyi City. A total of 251 subjects with a history of coronavirus disease 2019 infection were included. Symptoms and changes in erectile function after the coronavirus disease 2019 infection were collected and assessed using the International Index of Erectile Function‐5 scale and several targeted questions.
Results
In this study, we found that in patients infected with novel coronavirus, the proportion of erectile dysfunction was higher in those with neurological manifestations such as olfactory and taste impairment or psychological symptoms such as anxiety.
Discussion
We found that neurological decline and psychological factors were independent and significant risk factors for erectile dysfunction caused by coronavirus disease 2019.
Conclusion
Patients with neurological damage or psychiatric symptoms are more likely to have erectile dysfunction, suggesting that the 2019 novel coronavirus may affect erectile function by damaging nerves. This provides a new insight into the mechanism of erectile dysfunction
The COVID-19 outbreak, as an international health emergency, led to uncertainty. Pandemics can be stressful and anxiety-producing for community individuals. Moreover, due to lockdown measures implemented to slow down the spread of the disease, an increase in the usage of social media was reported. Therefore, this study aims to find the prevalence of mental health problems and the level of social media usage during the outbreak of COVID-19 in the Kurdistan region, Iraq. Furthermore, the relationship between mental health problems (i.e., depression, anxiety, and stress) and social media usage is explored. The study was cross-sectional; the data was collected through a snowball sampling method in which 355 participants completed an online questionnaire. Social networking usage questionnaire, Hopkins Symptom Checklist-15 (HSCL-25), and Perceived Stress Scale (PSS) were used as measurement tools. The results showed that the level of social networking usage was moderate. As for mental health problems, 76.5% of the respondents showed moderate to high stress levels, 56.4% reported experiencing depression, and 37.4% reported experiencing anxiety. Significant gender differences were found in depression, anxiety, and stress, with females scoring higher in all categories. In the mental health problem domains, only depression scores positively correlated with social media usage. The findings also showed social networking usage is associated with higher depression and anxiety; however, the effect sizes were small. Therefore, more research into this matter is necessary in the cultural context of the Kurdistan region to reach conclusive results.
Bu çalışma, Covid-19 korkusunun yalnızlık üzerindeki etkisinde anksiyete bozukluğunun düzenleyici rolünü belirlemek amacıyla gerçekleştirilmiştir. Katılımcılara yüz yüze ve online olarak ulaştırılan anket formu, kişisel özelliklerin yanı sıra Yaygın Anksiyete Bozukluğu-7 (YAB-7) Ölçeği, Revize Edilmiş UCLA Yalnızlık Ölçeği (RULS-6) ve COVID-19 Korku Ölçeği'ni içermektedir. Araştırmanın örneklemi toplam 760 kişiden oluşmaktadır. Yaygın Anksiyete Bozukluğu-7 (YAB-7) Ölçeği toplam puan ortalaması 8.41; Revize edilmiş UCLA Yalnızlık Ölçeği (RULS-6) 15.19; COVID-19 Ölçeği Korkusu 16.68’dir. Covid-19 korkusunun yalnızlık üzerine etkisinde anksiyete bozukluğunun düzenleyici role sahip olduğu görüldü. Anksiyete bozukluğu arttıkça, covid-19 korkusunun yalnızlık üzerine etkisi azalmaktadır. Anksiyete bozukluğu yüksek olanlara, covid-19 korkusunun azaltılması noktasında çeşitli kanallar (sosyal medya gibi) aracılığıyla doğru bilginin aktarılması önem arz etmektedir. Böylece bireylerin yalnızlık duyguları da azalmış olacaktır.
Objective
To evaluate the influence of occupational and mental health variables, religiosity and posttraumatic stress (PTSD) on depression, anxiety and stress in front-line healthcare professionals during the COVID-19 pandemic.
Methods
An observational and cross-sectional study was conducted in a hospital in the state of Minas Gerais, Brazil, with 151 health professionals working on the front-line of COVID-19. Sociodemographic, occupational and mental health, religiosity (P-DUREL), PTSD (PCL-C) and screening for depression, anxiety and stress (DASS-21) questionnaires were used. Descriptive, bivariate and multiple linear regression were used.
Results
There was a predominance of female, white, Catholic, married, complete higher education, with children, sedentary and without a history of chronic or psychiatric diseases. The minority presented symptoms of COVID-19, tested positive for the virus or needed isolation. Most of them had deprivation of contact with family members and did not receive psychological/psychiatric support. Most professionals had mild or minimal symptoms of depression (68.2%), anxiety (64.9%) or stress (69.5%). The prevalence of PTSD symptoms was 17.2%. A previous history of psychiatric disorder and the presence of PTSD symptoms were associated with current symptoms of depression, anxiety, and stress. Low intrinsic religiosity scores were associated with high depression scores and females were associated with higher depression and stress scores.
Conclusions
During the pandemic, symptoms of depression, anxiety and stress were common in this sample of health professionals. The factors associated with these symptoms can be used to identify vulnerable professionals who need psychological/psychiatric support.
KEYWORDS
Health personnel; mental health; psychological stress; spirituality; COVID-19
This paper explores dynamics surrounding the Covid 19 pandemic which triggered a surge in cases of intimate partner violence. In the wake of the Covid 19 pandemic, Zimbabwe enacted a national lockdown and various protocols to contain the spread of the lethal virus. The impact of the Covid 19 pandemic was felt by many as the national lockdowns embroiled people's lives socially and economically. Using a descriptive interpretive design, the study reviewed reports on gender-based violence from the media and organisations dealing with gender-based violence pre and during the Covid 19 pandemic to gather data. The paper examines violence in intimate relationships from an intersectional feminist perspective which views gender-based violence as twofold and caused by patriarchy together with other repressive factors. The study revealed that economic challenges, limited access to support services and prolonged enclosure at home experienced during the Covid 19 pandemic were key factors fuelling relational violence amongst intimate partners. Therefore, the paper proposes vigorous campaign strategies against intimate partner violence and an increase in socioeconomic support services for citizens during the Covid 19 pandemic to curtail intimate partner violence.
Our study aims to examine the influence of COVID-19 on psychological and mental well-being, along with its impact on overall quality of life.
A cross-sectional study was conducted from July 24, 2020, to October 3, 2020, involving Indian adults residing in India. Participants were recruited using convenient and snowball sampling methods, reaching out through a Google form distributed via social media platforms. A total of 305 participants responded to the survey, providing socio-demographic information and answering 14 validated questions related to stress, anxiety, socioeconomic impact, and social support. Data was collected anonymously and analyzed confidentially.
The COVID-19 pandemic significantly impacted our sample, causing moderate to severe stress due to peak cases in India. Our findings highlight the need for increased mental health awareness, support for friends and family, and future research. Ongoing pandemic effects require confirmation in larger populations. Policymakers should prioritize positive attitude development and effective policy implementation.
The aim of the present study was to investigate the effects of home confinement/social isolation (i.e., lockdown), imposed to reduce large-scale spread of a disease in the population, on the mental health of individuals. Through an online survey during the lockdown (DL) related to COVID-19 (1085 respondents, 627 females, agerange: 18-82) (Italy, 23 April-2 May 2020), we revealed that situational factors, i.e., the presence of children at home and female gender, and psychological factors, i.e., a greater sense of isolation, lower perception of safety outside the home and higher trait anxiety, predicted higher levels of state anxiety (R 2 = 0.58). The same factors, but with young age instead of the presence of children, predicted higher levels of perceived stress (R 2 = 0.63). Then, these data were compared with those collected after the lockdown (AL) (174 respondents, 128 females, agerange: 19-78) (Italy, 1 July-31 October 2021). The results showed that along with a reduced sense of isolation (DL = 2.90 vs. AL = 2.10) and an increased perception of safety outside the home (DL = 2.63 vs. AL = 3.05), a reduction in state anxiety (DL = 45.76 vs. AL= 40.88) and stress appeared (DL = 18.84 vs. AL = 17.63). However, the situation was better for men than for women. Perceived self-efficacy emerged as a protective factor for mental health (R 2 range: 0.03-0.27). The results are discussed in light of the evidence on the effects of lockdown on individuals worldwide. These results may be used to make more educated decisions on targeted help for individuals who may be most adversely affected by the adoption of lockdowns in the future.
Background:
The global COVID-19 lockdown restricted daily routines due to the psychological fear of infection, which imposed an unknown universal threat on female college students, affecting physiological health and well-being. However, scant information concerning the efficacy of yogic practice on female college students during the stressful COVID-19 pandemic situation is available.
Methods:
In a randomized controlled trial (n = 74, age = 21.65 [4.05] y), a study was conducted with a well-conceptualized yogic module for 5 days/week for 3 months (40 min daily in the morning) among yogic volunteers. Pre-post analysis of anthropometric, physiological, and biochemical indices in pandemic-stressed female college students was done for the control and yoga groups.
Results:
After 3 months of yogic practice, significant reduction (P < .05) in heart rate (d = 0.64, meandiff = 5.43), systolic blood pressure (d = 0.59, meandiff = 5.32), cortisol (d = 0.59, meandiff = 6.354), and triglycerides (P < .01, d = 0.45, meandiff = 13.95) was observed. After yogic follow-up significant improvement (P < .01) in high-frequency (d = 0.56, meandiff = -7.3), total power (d = 0.46, meandiff = -1150) and time domain parameters of heart rate variability led to ameliorate the stress index. Superoxide dismutase (P < .01, d = 0.78, meandiff = 0.69), catalase (P < .05, d = 0.48, meandiff = -7.37), glutathione (P < .001, d = 0.83, meandiff = -4.15), high-density lipoprotein (P < .05, d = 0.48, meandiff = -11.07), and dopamine (P < .001, d = 0.97, meandiff = -135.4) values along with inflammatory markers (P < .001) significantly improved among yogic volunteers after regular practice.
Conclusions:
Our findings suggest that a 3-month well-conceptualized yogic intervention during COVID-19 may be considered as a prophylactic tool to improve female college students' universal psychophysiological health by ameliorating autonomic functions, cardiometabolic risk factors, and immune metabolisms in an economical and environment-friendly manner.
The objective of this study is to assess the prevalence of anxiety, depression, stress and burnout in the health staff of an Intensive Care Unit - ICU. This is a study with an exploratory, descriptive, and longitudinal design, with a quantitative approach. The sample consisted of 90 health professionals. The reduced version of the Depression, Anxiety and Stress Scale-21 (DASS-21) and the Oldenburg Burnout Inventory (OBLI) scale were used. In order to apply statistical tests, the free statistical software R, version 3.6.1, was used. The institution's professionals showed higher levels of stress and exhaustion regardless of the provision of adequate training and guaranteed access to personal protective equipment. Efforts must be made to reduce the burnout on professionals. It is hoped that the results of the study will contribute to the provision of evidence to assist in the construction of intervention strategies to mitigate adverse responses to the COVID-19 pandemic in health professionals.
BACKGROUND: The psychosocial impacts of the COVID-19 pandemic are mainly focused on the general population, while pandemics do not impact the mental health of the entire population uniformly, especially vulnerable populations with underlying health conditions. This study aimed to investigate diabetes psychosocial comorbidities among Iranians with type 1 diabetes (T1D) during the COVID-19 pandemic.
MATERIALS AND METHODS: This was a cross-sectional study of 212 adults with T1D in different cities in Iran. Study participants completed an online survey in April–June 2020. The survey collected self-reported data on diabetes psychosocial comorbidities (i.e. diabetes burnout, diabetes distress, and depressive symptoms). Demographic and COVID-19 data before and during the pandemic were also collected. Responses were analyzed using ordinary least squares and logistic regression methods.
RESULTS: Around 17.5% reported being tested for COVID-19 virus, 8% were diagnosed positive, 10.8% were hospitalized, and 92.9% followed precaution recommendations during the pandemic. Participants had high levels of diabetes distress (57.1%), depressive symptoms (60.8%), and diabetes burnout (mean score = 3.1 out of 5). During the pandemic, trouble paying for the very basic needs was a consistent factor increasing the risk of diabetes distress, diabetes burnout, and depressive symptoms. Lack of access to diabetes care was only associated with diabetes burnout, while diabetes hospitalization/emergency department (ED) visit was associated with diabetes distress. Existing diabetes disparities before the pandemic were also associated with higher scores of diabetes psychosocial comorbidities [accessing diabetes supplies and medications (P < 0.0001) and places for physical exercise (P < 0.0333)].
CONCLUSION: The negative impact of the COVID-19-related changes on individuals with diabetes, as one of the most vulnerable populations, must be recognized alongside the physical, financial, and societal impact on all those affected. Psychological interventions should be implemented urgently in Iran, especially for those with such characteristics.
Bu araştırma COVID-19 tanısı alan bireylerin yaşadıkları psikolojik semptomları ve kendilerini toparlama düzeylerini belirlemek amacıyla yapıldı. Tanımlayıcı-kesitsel tipte yapılan bu araştırmanın örneklemini Haziran 2021-Aralık 2021 tarihleri arasında araştırma kriterlerine uyan ve araştırmaya katılmayı kabul eden 823 kişi oluşturdu. Veriler online olarak Bilgi Formu, Depresyon Anksiyete Stres Ölçeği ve Kendini Toparlama Gücü Ölçeği ile toplandı. Çalışmaya katılan bireylerin %69,9’u kadın, %57,4’ü ise bekardır. %66,3’ü üniversite mezunu, %81,2’si geniş ailede ve %65,1’i ilde yaşamaktadır. Katılımcıların %57,5’inin birlikte yaşadığı kişiler COVID-19 tanısı almıştır. Depresyon Anksiyete Stres ölçeği alt boyut puanları da kadınlarda ve bekarlarda daha yüksek bulundu (p
Background:
Quality of life and marital satisfaction are important components of reproductive-age women's health. This study aimed to compare the quality of life and marital satisfaction in women of reproductive age in Iran and Afghanistan before and after the COVID-19 pandemic.
Methods:
This was a cross-sectional study on a sample of Iranian and Afghan women of reproductive age. To collect the data, the 12-item short-form health survey (SF-12) and the Enrich marital satisfaction scale were used to assess the quality of life and marital satisfaction, respectively. In addition, the Global Rating of Change (GRC) was used in order to evaluate the quality of life and marital satisfaction compared to before the COVID-19 pandemic. Data were evaluated descriptively through statistics including sing t-test, and chi-square, Logistic regression was performed to assess the relationship between outcome variables and independent variables.
Results:
In all 599 reproductive-age women (300 Iranian, and 299 Afghan) were studied. After adjusting for demographic variables, no significant difference was observed between the two groups for the physical component (P = 0.05) and mental component summary scores of quality of life (P = 0.166) as measured by the SF-12. The majority of Iranian women reported that their quality of life was worsened compared to before the pandemic (57.2%), while in the Afghan group, a higher percentage declared that it was unchanged (58.9%). The mental component of quality of life had no significant relationship with any of the independent variables including nationality. In contrast, the physical component quality of life had a significant relationship with nationality (P = 0.01). Iranian women had more marital satisfaction than Afghan women (P<0.001) and marital satisfaction had a significant relationship with nationality (P<0.001). Most women in both groups (70% of Iranian and 60% of Afghan women) declared that their marital satisfaction unchanged compared to before the COVID-19 pandemic.
Conclusion:
The results showed that the quality of life of Iranian and Afghan women of reproductive age was almost the same before and after the pandemic. However, Iranians scored lower on the mental component summary and Afghans reported lower scores on the physical component summary. Marital satisfaction of Afghan women was much lower than that of Iranian women. The findings suggest the need for serious attention by health care authorities. Providing a supportive environment might be considered a primary step towards a better quality of life for these populations.
Background
To investigate the physical and psychological effects of five-element music therapy combined with Baduanjin qigong treatment on inpatients with mild coronavirus disease 2019 (COVID-19) in Wuhan.
Methods
A mixed-methods study was used. In the quantitative study, a randomized controlled trial was performed on 40 study participants divided into a control group ( n = 20) and an intervention group ( n = 20). The Self-rating Anxiety Scale, Self-rating Depression Scale and Pittsburgh Sleep Quality Index were compared. For qualitative analysis, it adopted purposive sampling method, 13 patients of different ages from 18 to 60 years old and different exercise behavior were selected as the participants from the intervention group. A semi-structured interview method was used to collect data, and the content analysis method was used for data analysis. An interview outline was developed to assess the psychological condition and personal functional-exercise behavior of patients.
Results
In the quantitative study, the anxiety self-scores and depression self-scores of patients in intervention group were significantly lower compared with control group after treatment ( p < .05). The sleep quality of intervention group was significantly improved compared with control group ( p < .001). Participants in the qualitative study responded to questions posed through semi-structured interviews. The effect of intervention was good, which has been supported and recognized by patients.
Conclusion
The treatment of five-element music therapy combined with Baduanjin qigong on patients with mild COVID-19 alleviated anxiety and depression, and improved sleep quality, which was beneficial to the patients’ physical and psychological recovery.
Purpose
Healthcare workers’ (HCWs’) job-related high exposure to Covid-19 virus arouses fear of Covid-19 among them. Based on the Theory of Mind (ToM), the study predicts that fears will lead to negative psychological (psychological distress) and behavioral (withdrawal intentions) outcomes. ToM is also used to identify social intelligence as a means to counter fear of Covid-19 on heightened psychological distress and increased withdrawal intentions.
Design/methodology/approach
To investigate the study design, a sample of 262 HCWs, including doctors, nurses and technicians, were surveyed using standardized questionnaires.
Findings
As predicted, Covid-19 fear led to increased withdrawal intentions with heightened psychological distress partially mediating the relationship. The alleviating role of social intelligence on the effects of Covid-19 was supported as high social intelligence reduced HCWs’ turnover intentions, with decreased psychological distress partially mediating the relationship.
Originality/value
Given the universality of the Theory of Mind (ToM), the findings of this study are likely to be generalizable to all pandemics. The study results support the increased application of ToM in organizational settings and have both theoretical and practical implications for health administrators. Based on study results, health administrators are exhorted to develop ToM-based mental models to understand and deal with the fear of contagious diseases. Health administrators can also increase HCWs’ social intelligence to deal with the negative perceptual and behavioral outcomes arising from the emotions aroused by the nature of their work.
Introduction:
COVID-19 is a disease that may cause anxiety, depression, and stress. Bladder pain syndrome (BPS) is a disease in which stress and psychological factors might negatively affect its course. In this study, we aimed to examine the possible clinical aggregation of the pandemic period on BPS patients.
Materials and methods:
A total of 35 BPS patients diagnosed between 2010 and 2018 were included. All patients were using medical treatment, and the follow-up period was at least 6 months. According to our clinical follow-up protocol, the BPS patients were given the King's Health Questionnaire (KHQ), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Overactive Bladder Form V8 (OAB-V8), and Visual Analog Score (VAS) in every visit. In the sixth month of the pandemic, the clinical course of the patients was questioned by telephone or video interview, and their treatment continuities were questioned. Information was received about the delays in their follow-up and the difficulties in accessing healthcare opportunities. The same questionnaires were filled out and compared with pre-pandemic scores.
Results:
The mean age of the patients included in the study was 50.2 ± 13.32 (min:20, max:74), 11 were males and 24 were females. The mean follow-up periods were 71.8 ± 35.6 months. All questionnaire scores showed an increase compared to the pre-pandemic period. A statistically significant increase was detected during the pandemic in all sub-units of the KHQ. The VAS and OAB-V8 scores of 16 patients who requested hospital admission were significantly higher than before the pandemic. However, there was no statistically significant difference in the increase in VAS and OAB-V8 scores of the 19 patients who refused to come to the hospital.
Conclusion:
BPS patients have been negatively affected by the emotional effects of the COVID-19 pandemic. Due to the fear, stress, anxiety, and depression, the symptoms of BPS patients exacerbated, and the patients could not receive the necessary support due to a lack of regular follow-ups.
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Context
COVID-19 patients undergo myriad of psychological problems such as mood swings, depression, fear of isolation, fear of dying, feeling helpless, insomnia, anxious forebodings, and nervousness. These are commonly seen among isolated and quarantined patients who experience notable levels of anxiety, uncertainty, anger, confusion, stress and insecurity.
Aims
This study aims to determine the prevalence of anxiety and depression among these infected patients admitted to tertiary care center.
Settings and Design
This cross-sectional study was conducted on 100 COVID-19 patients admitted to DMC&H, Ludhiana.
Subjects and Methods
The data were collected on sociodemographic parameters and assessment was done using Hamilton Depression Rating Scale (HDRS) and Hamilton Anxiety Rating Scale (HARS) at the time of discharge from the hospital.
Statistical Analysis Used
SPSS 21 version for Microsoft Windows.
Results
Majority of the patients were males and in the age group of 31–50 years. 48% patients had comorbid depression. Moderate-to-severe levels of depression were found more in males (25%) as compared to females (15%). Comorbid anxiety was seen commonly in females (60%) than male patients (28.75%), though the moderate-to-severe level of anxiety was more in males (71.25%) as compared to females (40%). On symptom checklist of HDRS and HARS, patients had high scores on insomnia (75%), psychic anxiety (45%–50%), somatic symptoms (gastrointestinal [50%], muscular [56%], and respiratory [81%]) and loss of weight (40%).
Conclusions
COVID-19 patients score higher on comorbid anxiety and depression. Moderate-to-severe level of anxiety and depression is commonly seen among male patients than female patients.
The research aims at examining the influence of loneliness and stress on anxiety and depression. The role of optimism bias in regulating anxiety and depression dimensions among 726 students in India is investigated. Partial least squares-structural equation modelling (PLS-SEM) approach is used to study the relationships between constructs. According to the data, optimism bias significantly moderates the association among stress and anxiety & between loneliness and anxiety. The research enables understanding of the consequences of Covid-19 upon the psychology of the students while providing an insight into the behavioural implications of loneliness, stress and optimism bias on the anxiety level and depression of students. The study enables the academicians and management in formulating communication and management strategies for students. Limited studies have been found on stress and depression in Indian student's context. It is the first study to employ an optimistic bias scale to investigate the behaviour of students in India and its impact on the students’ mental health using anxiety and depression as variables.
Background
The COVID-19 pandemic and its prevention and control measures, such as social distancing, self-isolation, and quarantine, have a negative impact on the population’s mental health. This study aimed to determine the prevalence of anxiety and stress among the general population during the outbreak of COVID-19 and assess their associated factors.
Methods
We carried out a cross-sectional study in Erbil governorate, Iraqi Kurdistan Region, from July 18 to September 12, 2020. We used an online survey questionnaire to collect data from a sample of Erbil population. The 10-items Perceived Stress Scale and the 7-item Generalized Anxiety Disorder scale were used to measure the levels of stress and anxiety.
Results
A total of 851 persons responded to the survey. The prevalence of moderate and high perceived stress was 59.6% and 16.6%, respectively. The prevalence of moderate and severe anxiety was 24.7% and 22.7%, respectively. Age, gender, economic level, having contact with COVID-19 patients, and following COVID-19 news were independent variables significantly associated with stress levels. Age, gender, economic level, employment status, having symptoms of COVID-19, having contact with COVID-19 patients, and following COVID-19 news were independent variables significantly associated with anxiety levels.
Conclusion
A high proportion of people experienced stress and anxiety during the COVID-19 outbreak in Erbil, Iraqi Kurdistan Region. Females, younger age, poor, and unemployed reported significantly higher stress and anxiety levels. There is a need to establish mechanisms at the population level to decrease the stress and anxiety risks and provide mental health coping measures in times of crisis, such as education about positive thinking, stress management programs, and the role of social support.
The COVID-19 pandemic has had a massive and unprecedented impact on the mental health of individuals worldwide. Quarantine hotel employees not only endured enormous upheavals when providing service to quarantine guests during obligatory quarantine periods, but also experienced the high mental stress that comes with the risk of exposure and contagion of themselves, their friends, and their families. This study investigated the impact of the fear of COVID-19 on mental health problems. The moderating roles of self-compassion and psychological resilience were also examined. Data was collected from 360 employees from thirteen "Alternative State Quarantine" hotels in Thailand. The results suggested that fear of COVID-19 positively influenced mental health problems. Self-compassion and psychological resilience at work buffered the detrimental impact of fear of COVID-19 on mental health. This three-way interaction demonstrated that employees with high self-compassion and high resilience coped better. The theoretical and practical implications for hospitality managers are discussed.
Background
The COVID-19 pandemic impacted the psychosocial well-being of the United Arab Emirates [UAE] population like other communities internationally.
Objectives
We aimed to identify the factors associated with psychological distress, fear, and coping amongst community members across the UAE.
Methods
We conducted a cross-sectional online survey across the UAE during November 2020. Adults aged ≥18 years, living in the UAE who were able to respond to an online questionnaire in English or Arabic were considered eligible to participate in the study. We used standard validated tools to measure psychological distress, fear and coping. Kessler Psychological Distress Scale [K10] was used to assess psychological distress, Fear of COVID-19 Scale [FCV-19S] was used to assess the level of fear, and Brief Resilient Coping Scale [BRCS] was used to assess the coping strategies.
Results
A total of 417 individuals participated in this study with a mean age of 29 [± 10.7] years. More than half of the participants experienced high to very high levels of psychological distress [55%] and a quarter experienced high levels of fear of COVID-19 [23.3%] with almost a third of them [36.2%] having low resilient coping. About 37.4% of the participants had work-related mental health impacts and 32.4% were perceived to have moderate to a great deal of distress due to a change of employment status during the pandemic. One in ten participants [9.4%] reported increased smoking. Increased smoking [AOR 8.66, 95% CIs 1.08–69.1,], increased alcohol drinking [AOR 2.39, 95% CIs 1.05–5.47] and higher levels of fear of COVID-19 [AOR 2.93, 95% CIs 1.83–4.67] were associated with moderate to very high levels of psychological distress. Being female [AOR 1.82, p = 0.030], having a pre-existing mental health condition [AOR 9.88, 95% p = 0.027], engaging in high-risk behaviors such as increased smoking [AOR 21.14, p = 0.003], increased alcohol drinking [AOR 1.48, p = 0.359] in the previous four weeks, and higher levels of fear of COVID-19 [AOR 4.18, p <0.001] were associated with moderate to very high levels of psychological distress. Also, being a smoker [AOR, 0.840, p = 0.011], and having a high level of fear [AOR 0.372, p = 0.001] were found to be associated with low resilient coping.
Conclusion
Community members in the UAE are at a higher risk of psychosocial distress and fear during the COVID-19 pandemic. Thus, healthcare providers and policymakers would need to be more alert to provide specific mental health support strategies for their wellbeing.
Objectives:
Shelter hospital was an alternative way to provide large-scale medical isolation and treatment for people with mild coronavirus disease 2019 (COVID-19). Due to various reasons, patients admitted to the large shelter hospital was reported high level of psychological distress, so did the healthcare workers. This study aims to introduce a comprehensive and multifaceted psychosocial crisis intervention model.
Methods:
The psychosocial crisis intervention model was provided to 200 patients and 240 healthcare workers in Wuhan Wuchang shelter hospital. Patient volunteers and organized peer support, client-centered culturally sensitive supportive care, timely delivery of scientific information about COVID-19 and its complications, mental health knowledge acquisition of non-psychiatric healthcare workers, group activities, counseling and education, virtualization of psychological intervention, consultation and liaison were exhibited respectively in the model. Pre-service survey was done in 38 patients and 49 healthcare workers using the Generalized Anxiety Disorder 7-item (GAD-7) scale, the Patient Health Questionnaire 2-item (PHQ-2) scale, and the Primary Care PTSD screen for the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (PC-PTSD-5). Forty-eight healthcare workers gave feedback after the intervention.
Results:
The psychosocial crisis intervention model was successfully implemented by 10 mental health professionals and was well-accepted by both patients and healthcare workers in the shelter hospital. In pre-service survey, 15.8% of 38 patients were with anxiety, 55.3% were with stress, and 15.8% were with depression; 16.3% of 49 healthcare workers were with anxiety, 26.5% were with stress, and 22.4% were with depression. In post-service survey, 62.5% of 48 healthcare workers thought it was very practical, 37.5% thought more practical; 37.5% of them thought it was very helpful to relief anxiety and insomnia, and 27.1% thought much helpful; 37.5% of them thought it was very helpful to recognize patients with anxiety and insomnia, and 29.2% thought much helpful; 35.4% of them thought it was very helpful to deal with patients' anxiety and insomnia, and 37.5% thought much helpful.
Conclusions:
Psychological crisis intervention is feasible, acceptable, and associated with positive outcomes. Future tastings of this model in larger population and different settings are warranted.
The purpose of this study was to determine the stress, anxiety and eating conditions of health personnel working in COVID-19 clinics, to evaluate how they interact with each other with a holistic approach, and to examine the role of variables such as gender and BMI in these relationships. It was determined that 1-unit increase in the TFEQ-18 score decreased stress and anxiety levels 1.09 and 1.028 times, respectively. We were able to show that stress and anxiety levels of participants negatively affect their eating behavior and anxiety levels of health personnel negatively affect their eating behavior.
Background
The coronavirus disease 2019 (COVID-19) outbreak has had a widespread and profound impact on people’s mental health. The factors associated with mental symptoms among men diagnosed with infertility, a disease closely related to psychological conditions, remain unclear. The aim of this study is to investigate the risk factors associated with mental symptoms among infertile Chinese men during the pandemic.
Results
A total of 4,098 eligible participants were recruited in this cross-sectional, nationwide study, including 2,034 (49.6%) with primary infertility and 2,064 (50.4%) with secondary infertility. The prevalence of mental health conditions was 36.3%, 39.6%, and 6.7% for anxiety, depression, and post-pandemic stress, respectively. Sexual dysfunction is associated with a higher risk with adjusted odds ratios (ORs) of 1.40 for anxiety, 1.38 for depression, and 2.32 for stress. Men receiving infertility drug therapy displayed a higher risk for anxiety (adjusted OR, 1.31) and depression (adjusted OR, 1.28) symptoms, while those receiving intrauterine insemination had a lower risk of anxiety (adjusted OR, 0.56) and depression (adjusted OR, 0.55) symptoms.
Conclusion
The COVID-19 pandemic has had a significant psychological impact on infertile men. Several psychologically vulnerable populations were identified, including individuals with sexual dysfunction, respondents receiving infertility drug therapy, and those experiencing control measures for COVID-19. The findings provide a comprehensive profile of the mental health status of infertile Chinese men during the COVID-19 outbreak and provide potential psychological intervention strategies.
Purpose
Coronavirus disease (COVID-19) was declared as a pandemic since COVID-19's widespread outbreak and the hospitality industry has been the hardest hit due to lockdown. Consequently, hospitality workers are suffering from the negative aspects of mental health. In the event of such a crisis, this study aims to explore the link between unemployment and home isolation to the willingness to choose electronic consultation (e-consultation) by exploiting psychological ill-being and behavioural intention (BI) with marital status as a moderator.
Design/methodology/approach
A quantitative methodology is applied to primary data collected from 310 workers from the hospitality industry through an online survey.
Findings
Findings of this study suggest that the usage of the e-consultation service can be adopted using three levels. There are valid reasons to conclude unemployment and home isolation are linked to higher rates of psychological health behaviours, which can result in stigma, loss of self-worth and increased mortality. The adverse effect is higher for single individuals than for married people.
Originality/value
The study focussed on e-consultation, BI coupled with the Fishbein scale and a classification model for the prediction of willingness to choose e-consultation with the extension of Theory of Planned Behaviour (TPB).
This article hopes to offer some guidance regarding remote working with people with Intellectual Disabilities (ID) during the Covid-19 pandemic. This includes offering individual therapy, managing risk, working indirectly and in consultative capacities.
The aim of the study is to investigate the experiences of elderly individuals regarding stigma and anxiety during the COVID 19 pandemic. This study is a study conducted with a hermeneutic approach, one of the qualitative methods and phenomenology models. After obtaining ethical permission, the document and interview data of 10 elderly individuals selected through criterion sampling were analyzed with descriptive analysis. Findings consist of a theme, seven categories and forty-eight codes. Participants emphasized that the pandemic process caused anxiety and that they felt stigmatized in this process. The participants stated that the lethality of the COVID 19 disease and the high rate of transmission caused them anxiety. In addition, they stated that the restrictive measures taken for the elderly made them feel like a source of illness and this caused them to feel stigmatized. In conclusion, it was observed that the participants had high anxiety and stigmatized feelings in this process. They stated that they pay attention to the mask, distance and hygiene rules, which are the methods of protection from the virus, to cope with anxiety, and that they have a spiritual orientation. However, they did not have any statements about the feelings of anxiety and stigmatization they experienced in this process to share with their relatives or health workers and to get help. Accordingly, it is thought that it would be beneficial for healthcare professionals working with elderly individuals to encourage these individuals to share their feelings. In addition, healthcare professionals should take part in activities to raise awareness of the community about the COVID 19 process and the measures taken to prevent stigma.
College students’ mental health has been seriously impacted during the global COVID-19 lockdown. There is evidence that dispositional mindfulness is beneficial to mental health. However, few studies have looked at the relationship between dispositional mindfulness and mental health from the standpoint of self-compassion. Furthermore, it is unclear under what circumstances dispositional mindfulness is linked to mental health during COVID-19 lockdown. To fill this gap, the current study investigated self-compassion as a possible mediating factor and gender as a possible moderating effect between dispositional mindfulness and mental health. The sample included 1,018 Chinese university students during the COVID-19 lockdown (M age = 20.12; SD age = 1.17) who had completed self-report questionnaires on dispositional mindfulness, self-compassion, and mental health. According to the findings of mediation analysis, self-compassion partially mediated the relationship between dispositional mindfulness and mental health. The moderating analysis also revealed significant moderating effects of dispositional mindfulness, self-compassion, and mental health. Male college students’ mental health was significantly better protected, and the buffering effects of dispositional mindfulness and self-compassion on their mental health were significantly stronger than those of female college students. These findings advance our understanding of the process and mechanism between dispositional mindfulness and mental health, broadened and deepened the understanding of the relationship between dispositional mindfulness and mental health, as well as the mediating role of self-compassion and the moderating role of gender, and offer practical guidance for improving college students’ mental health during the COVID-19 lockdown.
Summary This study describes experiences of the survivors of the 1995 Ebola epidemic in Kikwit, Democratic Republic of Congo. Most of the survivors in our sample had cared for a sick family member before becoming ill themselves, and most had never heard of Ebola before they developed symptoms and therefore did not suspect that they were infected by the virus. Fear, denial and shame were their principal initial feelings. After release from hospital, survivors were abandoned by family or friends more often than they had expected. Belief in god was an important aid to all of them. Their most negative experiences were witnessing other people dying in the isolation ward of the Kikwit General Hospital, and the reluctance of hospital personnel to treat them. During Ebola outbreaks more attention should be given to the psychosocial implications of such an epidemic. Information campaigns should include antidiscrimination messages and more psychosocial support should be given to patients and their families.
In contrast with procedures in previous Ebola outbreaks, patient care during the 1995 outbreak in Kikwit, Democratic Republic
of the Congo, was centralized for a large number of patients. On 4 May, before the diagnosis of Ebola hemorrhagic fever (EHF)
was confirmed by the Centers for Disease Control and Prevention, an isolation ward was created at Kikwit General Hospital.
On 11 May, an international scientific and technical committee established as a priority the improvement of hygienic conditions
in the hospital and the protection of health care workers and family members; to this end, protective equipment was distributed
and barrier-nursing techniques were implemented. For patients living far from Kikwit, home care was organized. Initially,
hospitalized patients were given only oral treatments; however, toward the end of the epidemic, infusions and better nutritional
support were given, and 8 patients received blood from convalescent EHF patients. Only 1 of the transfusion patients died
(12.5%). It is expected that with improved medical care, the case fatality rate of EHF could be reduced.
The Ebola epidemic in Kikwit, Democratic Republic of the Congo, was recognized because of a nosocomial outbreak in Kikwit
General Hospital. Initially, a diagnosis of shigella infection was suspected because many patients presented with bloody diarrhea.
On 4 May 1995, blood samples from 14 acutely ill patients were sent to the Centers for Disease Control and Prevention (Atlanta),
and on 9 May, a diagnosis of Ebola hemorrhagic fever was confirmed. The major disease control measures that were undertaken
were the isolation of patients in a quarantine ward at Kikwit General Hospital, the distribution of protective equipment to
health care workers and family members caring for Ebola patients, the use of barrier nursing techniques, the distribution
of health education material, active and passive case finding, and the burying of the deceased in plastic bags by a trained
team of Red Cross volunteers who wore gloves and protective clothing.
From May to July 1995, a serologic and interview survey was conducted to describe Ebola hemorrhagic fever (EHF) among personnel
working in 5 hospitals and 26 health care centers in and around Kikwit, Democratic Republic of the Congo. Job-specific attack
rates estimated for Kikwit General Hospital, the epicenter of the EHF epidemic, were 31% for physicians, 11% for technicians/room
attendants, 10% for nurses, and 4% for other workers. Among 402 workers who did not meet the EHF case definition, 12 had borderline
positive antibody test results; subsequent specimens from 4 of these tested negative. Although an old infection with persistent
Ebola antibody production or a recent atypical or asymptomatic infection cannot be ruled out, if they occur at all, they appear
to be rare. This survey demonstrated that opportunities for transmission of Ebola virus to personnel in health facilities
existed in Kikwit because blood and body fluid precautions were not being universally followed.
In 1995, 316 people became ill with Ebola hemorrhagic fever (EHF) in Kikwit, Democratic Republic of the Congo. The exposure
source was not reported for 55 patients (17%) at the start of this investigation, and it remained unknown for 12 patients
after extensive epidemiologic evaluation. Both admission to a hospital and visiting a person with fever and bleeding were
risk factors associated with infection. Nineteen patients appeared to have been exposed while visiting someone with suspected
EHF, although they did not provide care. Fourteen of the 19 reported touching the patient with suspected EHF; 5 reported that
they had no physical contact. Although close contact while caring for an infected person was probably the major route of transmission
in this and previous EHF outbreaks, the virus may have been transmitted by touch, droplet, airborne particle, or fomite; thus,
expansion of the use of barrier techniques to include casual contacts might prevent or mitigate future epidemics.
Between 6 and 22 June 1995, 8 patients in Kikwit, Democratic Republic of the Congo, who met the case definition used in Kikwit
for Ebola (EBO) hemorrhagic fever, were transfused with blood donated by 5 convalescent patients. The donated blood contained
IgG EBO antibodies but no EBO antigen. EBO antigens were detected in all the transfusion recipients just before transfusion.
The 8 transfused patients had clinical symptoms similar to those of other EBO patients seen during the epidemic. All were
seriously ill with severe asthenia, 4 presented with hemorrhagic manifestations, and 2 became comatose as their disease progressed.
Only 1 transfused patient (12.5%) died; this number is significantly lower than the overall case fatality rate (80%) for the
EBO epidemic in Kikwit and than the rates for other EBO epidemics. The reason for this low fatality rate remains to be explained.
The transfused patients did receive better care than those in the initial phase of the epidemic. Plans should be made to prepare
for a more thorough evaluation of passive immune therapy during a new EBO outbreak.
During the 1995 outbreak of Ebola hemorrhagic fever in the Democratic Republic of the Congo, a series of 103 cases (one-third
of the total number of cases) had clinical symptoms and signs accurately recorded by medical workers, mainly in the setting
of the urban hospital in Kikwit. Clinical diagnosis was confirmed retrospectively in cases for which serum samples were available
(n = 63,61% of the cases). The disease began unspecifically with fever, asthenia, diarrhea, headaches, myalgia, arthralgia,
vomiting, and abdominal pain. Early inconsistent signs and symptoms included conjunctival injection, sore throat, and rash.
Overall, bleeding signs were observed in <45% of the cases. Typically, terminally ill patients presented with obtundation,
anuria, shock, tachypnea, and normothermia. Late manifestations, most frequently arthralgia and ocular diseases, occurred
in convalescent patients. This series is the most extensive number of cases of Ebola hemorrhagic fever observed during an
outbreak.
The outbreak of severe acute respiratory syndrome (SARS) in Toronto, which began on Mar. 7, 2003, resulted in extraordinary public health and infection control measures. We aimed to describe the psychological and occupational impact of this event within a large hospital in the first 4 weeks of the outbreak and the subsequent administrative and mental health response.
Two principal authors met with core team members and mental health care providers at Mount Sinai Hospital, Toronto, to compile retrospectively descriptions of the experiences of staff and patients based on informal observation. All authors reviewed and analyzed the descriptions in an iterative process between Apr. 3 and Apr. 13, 2003.
In a 4-week period, 19 individuals developed SARS, including 11 health care workers. The hospital's response included establishing a leadership command team and a SARS isolation unit, implementing mental health support interventions for patients and staff, overcoming problems with logistics and communication, and overcoming resistance to directives. Patients with SARS reported fear, loneliness, boredom and anger, and they worried about the effects of quarantine and contagion on family members and friends. They experienced anxiety about fever and the effects of insomnia. Staff were adversely affected by fear of contagion and of infecting family, friends and colleagues. Caring for health care workers as patients and colleagues was emotionally difficult. Uncertainty and stigmatization were prominent themes for both staff and patients.
The hospital's response required clear communication, sensitivity to individual responses to stress, collaboration between disciplines, authoritative leadership and provision of relevant support. The emotional and behavioural reactions of patients and staff are understood to be a normal, adaptive response to stress in the face of an overwhelming event.
The outbreak of SARS in 2003 had a dramatic effect on the health care system in Toronto. The main objective of this study was to investigate the psychosocial effects associated with working in a hospital environment during this outbreak.
Questionnaires were distributed to all willing employees of Sunnybrook and Women's College Health Sciences Centre between Apr. 10 and 22, 2003. The survey included questions regarding concern about SARS, precautionary measures, personal well-being and sociodemographic characteristics; a subsample also received the 12-item version of the General Health Questionnaire (GHQ-12).
Of the 4283 questionnaires distributed, 2001 (47%) were returned, representing 27% of the total hospital employee population of 7474. The proportions of respondents who were allied health care professionals, nurses and doctors and who worked in areas other than patient care were representative of the hospital staff population as a whole. Of the 2001 questionnaires, 510 contained the GHQ-12. Two-thirds of the respondents reported SARS-related concern for their own or their family's health. A total of 148 respondents (29%) scored above the threshold point on the GHQ-12, indicating probable emotional distress; the rate among nurses was 45%. Masks were reported to be the most bothersome infection control precaution. Logistic regression analysis identified 4 factors as being significantly associated with increased levels of concern for personal or family health: perception of a greater risk of death from SARS (adjusted odds ratio [OR] 5.0, 95% confidence interval [CI] 2.6-9.6), living with children (adjusted OR 1.8, 95% CI 1.5-2.3), personal or family lifestyle affected by SARS outbreak (adjusted OR 3.3, 95% CI 2.5-4.3) and being treated differently by people because of working in a hospital (adjusted OR 1.6, 95% CI 1.2-2.1). Four factors were identified as being significantly associated with the presence of emotional distress: being a nurse (adjusted OR 2.8, 95% CI 1.5-5.5), part-time employment status (adjusted OR 2.6, 95% CI 1.2-5.4), lifestyle affected by SARS outbreak (adjusted OR 2.2, 95% CI 1.4-3.5) and ability to do one's job affected by the precautionary measures (adjusted OR 2.9, 95% CI 1.9-4.6).
Our findings indicate that the SARS outbreak had significant psychosocial effects on hospital staff. These effects differed with respect to occupation and risk perception. The effect on families and lifestyle was also substantial. These findings highlight the need for interventions to address psychosocial distress and concern and to provide support for employees during such crises.
To identify anxiety levels among front-line health care workers during the 2003 severe acute respiratory syndrome outbreak.
Questionnaire survey.
Regional hospital, Hong Kong.
All hospital staff were given a questionnaire; administrative staff who had not had any patient contact served as controls.
Levels of contact with patients who had severe acute respiratory syndrome were measured and correlated with anxiety levels as determined by the State-Trait Anxiety Inventory.
Of 4252 questionnaires distributed between May and June 2003, 2040 (48.0%) were returned and 1926 (45.3%) were valid for analysis. Overall, 534 (27.7%) respondents had had contact with patients with severe acute respiratory syndrome. Anxiety scores ranged from 20 to 80, and mean (standard deviation) scores were higher among staff who had had contact with patients with severe acute respiratory syndrome than among those who had not (52.6 [10.5] versus 49.8 [10.1], respectively; P<0.01). Mean anxiety levels were higher among workmen, health care assistants, and nurses than among administrative staff controls or doctors (P<0.01). Anxiety scores were correlated with burnout scores (Pearson's correlation coefficient, 0.52-0.59) and with discomfort from wearing protective gear (0.21-0.32).
Severe acute respiratory syndrome has likely stressed the public health care system. Prediction and early identification of adverse factors in a crisis situation would allow early implementation of interventions to reduce and counteract the impact of this stress.
Haemorrhagic fever viruses (HFVs) are a diverse group of viruses that cause a clinical disease associated with fever and bleeding disorder. HFVs that are associated with a potential biological threat are Ebola and Marburg viruses (Filoviridae), Lassa fever and New World arenaviruses (Machupo, Junin, Guanarito and Sabia viruses) (Arenaviridae), Rift Valley fever (Bunyaviridae) and yellow fever, Omsk haemorrhagic fever, and Kyanasur Forest disease (Flaviviridae). In terms of biological warfare concerning dengue, Crimean-Congo haemorrhagic fever and Hantaviruses, there is not sufficient knowledge to include them as a major biological threat. Dengue virus is the only one of these that cannot be transmitted via aerosol. Crimean-Congo haemorrhagic fever and the agents of haemorrhagic fever with renal syndrome appear difficult to weaponise. Ribavirin is recommended for the treatment and the prophylaxis of the arenaviruses and the bunyaviruses, but is not effective for the other families. All patients must be isolated and receive intensive supportive therapy.
Singapore was affected by an outbreak of severe acute respiratory syndrome (SARS) from 25 February to 31 May 2003, with 238 probable cases and 33 deaths.
To study usage of personal protective equipment (PPE) among three groups of healthcare workers (HCWs: doctors, nurses, and administrative staff), to determine if the appropriate PPE were used by the different groups and to examine the factors that may determine inappropriate use.
A self-administered questionnaire survey of 14,554 HCWs in nine healthcare settings, which included tertiary care hospitals, community hospitals, and polyclinics, was carried out in May-July 2003. Only doctors, nurses, and clerical staff were selected for subsequent analysis.
A total of 10 236 valid questionnaires were returned (70.3% response); 873 doctors, 4404 nurses, and 921 clerical staff were studied. A total of 32.5% of doctors, 48.7% of nurses, and 77.1% of the administrative staff agreed that paper and/or surgical masks were "useful in protecting from contracting SARS". Among this group, 23.6% of doctors and 42.3% of nurses reported working with SARS patients. The view that a paper and/or surgical mask was adequate protection against SARS was held by 33.3% of doctors and 55.9% of nurses working at the A&E unit, 30.5% of doctors and 49.4% of nurses from medical wards, and 27.5% of doctors and 37.1% of nurses from intensive care units. Factors which predicted for agreement that paper and/or surgical masks were protective against SARS, included HCW's job title, reported contact with SARS patients, area of work, and Impact Events Scale scores.
A variety of factors determine appropriate use of personal protective equipment by HCWs in the face of a major SARS outbreak.
Patients who have refused to provide blood samples has meant that there have been significant delays in confirming outbreaks of Ebola virus hemorrhagic fever (EVHF). During the 2 EVHF outbreaks in the Republic of Congo in 2003, we assessed the use of oral fluid specimens versus serum samples for laboratory confirmation of cases of EVHF.
Serum and oral fluid specimens were obtained from 24 patients with suspected Ebola and 10 healthy control subjects. Specimens were analyzed for immunoglobulin G antibodies by enzyme-linked immunosorbent assay (ELISA) and for Ebola virus by antigen detection ELISA and reverse-transcriptase polymerase chain reaction (RT-PCR). Oral fluid specimens were collected with a commercially available collection device.
We failed to detect antibodies against Ebola in the oral fluid specimens obtained from patients whose serum samples were seropositive. All patients with positive serum RT-PCR results also had positive results for their oral fluid specimens.
This study demonstrates the usefulness of oral fluid samples for the investigation of Ebola outbreaks, but further development in antibodies and antigen detection in oral fluid specimens is needed before these samples are used for filovirus surveillance activities in Africa.
The elderly experience a higher physical morbidity and a more complicated hospital course post-injury when affected by terrorism due to physiological changes associated with aging, the presence of comorbidities, decreased mobility, and a lack of physiological reserve. Psychiatrically, the elderly face different challenges than the general population due to their past experiences, a potential for reduced independence, and restricted access to services. Part I of this two-part series on the effects of terrorism on the elderly addresses specific data as it relates to the medical impact of biological, chemical, nuclear, and bombing attacks. Part II, to be published in the September issue of Clinical Geriatrics, will review the literature as it relates to the occurrence of psychiatric disorders in the elderly following terrorist attacks.
The lived experience of waiting-to-know: Ebola at Mbarara, Uganda – hoping for life, anticipating death
Purpose of the study. The purpose of the study was to describe the phenomenon of ‘waiting to know’. It is a phenomenon uniquely experienced by persons who had been exposed to patients with Ebola Hemorrhagic Fever (Ebola) but who have not yet exhibited signs and symptoms of the disease.
Research method/analysis. The phenomenological human science approach was used using the four life worlds as guides for reflection. These are spatiality, corporeality, temporality, and relationality.
Participants. Seven health care personnel were selected through professional networking. They were preferred because of their exposure to patients with Ebola during the epidemic at Mbarara, Uganda.
Results/findings. Written descriptions of the experience of ‘waiting to know’ whether exposure to patients with Ebola causes these participants to be infected, were obtained and analysed. Through immersion with the written descriptions, the following themes emerged: helplessness in anticipation and fear of dying or premature death; agonizing and languishing over losing relatives, friends, and loved ones; trusting no one, and; helplessness and hopelessness with the persistence of time.
Objectives:
A survey was conducted to measure psychological stress in hospital workers and measure factors that may have mediated acute traumatic responses.
Methods:
A self-report survey was completed by 1557 healthcare workers at three Toronto hospitals in May and June 2003. Psychological stress was measured with the Impact of Event Scale. Scales representing attitudes to the outbreak were derived by factor analysis of 76 items probing attitudes to severe acute respiratory syndrome. The association of Impact of Event Scale scores to job role and contact with severe acute respiratory syndrome patients was tested by analysis of variance. Between-group differences in attitudinal scales were tested by multivariate analysis of variance. Attitudinal scales were tested as factors mediating the association of severe acute respiratory syndrome patient contact and job role with total Impact of Event Scale by linear regression.
Results:
Higher Impact of Event Scale scores are found in nurses and healthcare workers having contact with patients with severe acute respiratory syndrome. The relationship of these groups to the Impact of Event Scale score is mediated by three factors: health fear, social isolation, and job stress.
Conclusions:
Although distress in response to the severe acute respiratory syndrome outbreak is greater in nurses and those who care for patients with severe acute respiratory syndrome, these relationships are explained by mediating variables that may be available for interventions to reduce stress in future outbreaks. In particular, the data suggest that the targets of intervention should include job stress, social isolation, and health fear.
The outbreak of Ebola hemorrhagic fever in Kikwit, Democratic Republic of the Congo, clearly signaled an end to the days when
physicians and researchers could work in relative obscurity on problems of international importance, and it provided many
lessons to the international public health and scientific communities. In particular, the outbreak signaled a need for stronger
infectious disease surveillance and control worldwide, for improved international preparedness to provide support when similar
outbreaks occur, and for accommodating the needs of the press in providing valid information. A need for more broad-based
international health regulations and electronic information systems within the World Health Organization also became evident,
as did the realization that there are new and more diverse partners able to rapidly respond to international outbreaks. Finally,
a need for continued and coordinated Ebola research was identified, especially as concerns development of simple and valid
diagnostic tests, better patient management procedures, and identification of the natural reservoir.
On 6 May 1995, the Médecins sans Frontières (MSF) coordinator in Kinshasa, Democratic Republic of the Congo (DRC), received
a request for assistance for what was believed to be a concurrent outbreak of bacillary dysentery and viral hemorrhagic fever
(suspected Ebola hemorrhagic fever [EHF]) in the town of Kikwit, DRC. On 11 May, the MSF intervention team assessed Kikwit
General Hospital. This initial assessment revealed a nonfunctional isolation ward for suspected EHF cases; a lack of water
and electricity; no waste disposal system; and no protective gear for medical staff. The priorities set by MSF were to establish
a functional isolation ward to deal with EHF and to distribute protective supplies to individuals who were involved with patient
care. Before the intervention, 67 health workers contracted EHF; after the initiation of control measures, just 3 cases were
reported among health staff and none among Red Cross volunteers involved in body burial.
A 3-month ecologic investigation was done to identify the reservoir of Ebola virus following the 1995 outbreak in Kikwit,
Democratic Republic of the Congo. Efforts focused on the fields where the putative primary case had worked but included other
habitats near Kikwit. Samples were collected from 3066 vertebrates and tested for the presence of antibodies to Ebola (subtype
Zaire) virus: All tests were negative, and attempts to isolate Ebola virus were unsuccessful. The investigation was hampered
by a lack of information beyond the daily activities of the primary case, a lack of information on Ebola virus ecology, which
precluded the detailed study of select groups of animals, and sample-size limitations for rare species. The epidemiology of
Ebola hemorrhagic fever suggests that humans have only intermittent contact with the virus, which complicates selection of
target species. Further study of the epidemiology of human outbreaks to further define the environmental contact of primary
cases would be of great value.
The surviving members of 27 households in which someone had been infected with Ebola virus were interviewed in order to define
the modes of transmission of Ebola hemorrhagic fever (EHF). Of 173 household contacts of the primary cases, 28 (16%) developed
EHF. All secondary cases had direct physical contact with the ill person (rate ratio [RR], undefined; P < .001), and among those with direct contact, exposure to body fluids conferred additional risk (RR, 3.6; 95% confidence
interval [CI], 1.9–6.8). After adjusting for direct contact and exposure to body fluids, adult family members, those who touched
the cadaver, and those who were exposed during the late hospital phase were at additional risk. None of the 78 household members
who had no physical contact with the case during the clinical illness were infected (upper 95% CI, 4%). EHF is transmitted
principally by direct physical contact with an ill person or their body fluids during the later stages of illness.
The filoviruses, Marburg and Ebola, are classified as Category A biowarfare agents by the Centers for Disease Control. Most known human infections with these viruses have been fatal, and no vaccines or effective therapies are currently available. Filoviruses are highly infectious by the airborne route in the laboratory, but investigations of African outbreaks have shown that person-to-person spread requires direct contact with virus-containing material. In consequence, filovirus epidemics can be halted by isolating patients and instituting standard infection control and barrier nursing procedures. The filovirus disease syndrome resembles that caused by other hemorrhagic fever viruses, necessitating studies in a biocontainment laboratory to confirm the diagnosis. Some progress has been made in developing vaccines and antiviral drugs, but efforts are hindered by the limited number of maximum containment laboratories. Terrorists might have great difficulty acquiring a filovirus for use as a weapon, but my attempt to do so because of the agents' ability to inspire fear. Accurate information is the best tool to prevent panic in the event of an attack.
Viral haemorrhagic fevers (VHF) have attracted the attention of the medical world and general public for many reasons, some based in reality and more on misinformation. They are amongst the highest profile infections in the public mind, because they are thought to be highly infectious and to kill most of their victims in a dramatic way (1,2). To add to the intrigue, mysteries remain about the source of some of the viruses involved. They emerge and re-emerge in many countries, most recently Ebola in Uganda in 2000 (3) and Gabon in 2001/02 (4), and Congo Crimean Haemorrhagic Fever (CCHF) in Kosovo (5) and Pakistan in 2001 (6). Large outbreaks have affected populations in endemic areas, living mainly in inaccessible areas or refugee camps where living conditions are very difficult. Poorly resourced medical facilities have played a role in amplifying transmission and infection control measures have been difficult or virtually impossible to establish. These viruses are likely to remain a threat until the reservoir is identified and as long as endemic areas are afflicted with ecological change, poverty and social instability. Recent events since September 11 2001 remind us of their potential to be used as weapons, and that fear can present a risk to public health.
An epidemic of Ebola hemorrhagic fever has sputtered along unabated since October 2001 in the dense jungles that span the northern border between Gabon and Congo raising questions about how health officials respond to outbreaks of the deadly infection. (excerpt)
The outbreak of severe acute respiratory syndrome (SARS) in the first half of 2003 in Canada was unprecedented in several respects. Understanding the psychological impact of the outbreak on healthcare workers, especially those in hospitals, is important in planning for future outbreaks of emerging infectious diseases. This review draws upon qualitative and quantitative studies of the SARS outbreak in Toronto to outline the factors that contributed to healthcare workers' experiencing the outbreak as a psychological trauma. Overall, it is estimated that a high degree of distress was experienced by 29-35% of hospital workers. Three categories of contributory factors were identified. Relevant contextual factors were being a nurse, having contact with SARS patients and having children. Contributing attitudinal factors and processes were experiencing job stress, perceiving stigmatization, coping by avoiding crowds and colleagues, and feeling scrutinized. Pre-existing trait factors also contributed to vulnerability. Lessons learned from the outbreak include: (i) that effort is required to mitigate the psychological impact of infection control procedures, especially the interpersonal isolation that these procedures promote; (ii) that effective risk communication is a priority early in an outbreak; (iii) that healthcare workers may have a role in influencing patterns of media coverage that increase or decrease morale; (iv) that healthcare workers benefit from resources that facilitate reflection on the effects of extraordinary stressors; and (v) that healthcare workers benefit from practical interventions that demonstrate tangible support from institutions.
Severe acute respiratory syndrome (SARS) is a major new infectious disease of this century that is unique in its high morbidity and concentration in health care settings. We aimed to determine the level of psychological impact and coping styles among the medical staff in a primary health care setting.
Using a structured questionnaire, we conducted a cross-sectional survey of the doctors and nurses working within a public, primary health care setting in mid-July 2003. The main outcome measures were rates of psychiatric morbidity, level of posttraumatic stress symptoms, and coping strategies.
The response rate was 92.0%. Of the 277 respondents (91 doctors and 186 nurses), psychiatric morbidity and posttraumatic morbidity were found in 20.6% and 9.4%, respectively. Both psychiatric and posttraumatic morbidities were associated with higher scores on coping efforts including self-distraction, behavioral disengagement, social support, venting, planning, and self-blame (all p <.001), but not with direct exposure factors such as contact with suspected SARS patients or working in fever rooms/tentages. Multivariate analysis showed that psychiatric morbidity was associated with post-traumatic morbidity (p =.02) and denial (p =.03), whereas posttraumatic morbidity was associated with younger age (p =.007), being married (p =.02), psychiatric morbidity (p =.02), self-distraction (p =.02), behavioral disengagement (p =.01), religion (p =.003), less venting (p =.04), less humor (p =.04), and less acceptance (p =.02).
SARS-related psychiatric and posttraumatic morbidities were present in the medical staff within a primary health care setting. Specific coping efforts, age, and marital status, not direct exposure factors, were associated with psychological morbidity. These findings provide possible foci for early identification and psychological support.
The agents causing viral hemorrhagic fever (VHF) are a taxonomically diverse group of viruses that may share commonalities in the process whereby they produce systemic and frequently fatal disease. Significant progress has been made in understanding the biology of the Ebola virus, one of the best known examples. This knowledge has guided our thinking about other VHF agents, including Marburg, Lassa, the South American arenaviruses, yellow fever, Crimean-Congo and Rift Valley fever viruses. Comparisons among VHFs show that a common pathogenic feature is their ability to disable the host immune response by attacking and manipulating the cells that initiate the antiviral response. Of equal importance, these comparisons highlight critical gaps in our knowledge of these pathogens.
The objectives of the present study were to examine the degree and the sources of mental distress and the coping strategies adopted by healthcare workers (HCW) of emergency departments (ED) in Hong Kong during the outbreak of severe acute respiratory syndrome (SARS).
Questionnaires were sent to all doctors, nurses and healthcare assistants (HCA) working in the ED of all public hospitals. The overall degree of mental distress was measured by a single-item 11-point Likert scale. The source of distress was measured by an 18-item questionnaire, which was designed based on the experience of clinical psychologist colleagues providing counselling to staff taking care of SARS patients. The Brief Cope questionnaire was used to study coping strategies adopted by staff.
A total of 1260 questionnaires were sent out and the response rate was approximately 37%. The mean overall distress level was 6.19 out of a 10-point scale. The mean overall distress levels for doctors, nurses and HCA were 5.91, 6.52 and 5.44, respectively (F(2,420)=6.47, P<0.005). The overall distress level for nurses was significantly higher than for HCA (P<0.005) but not doctors. The overall distress level was highly and significantly correlated with the six sources of distress: vulnerability/loss of control (r=0.68); health of self (r=0.62); spread of virus (r=0.60); health of family and others (r=0.59); changes in work (r=0.46); being isolated (r=0.45). The scores for nurses were significantly higher than for doctors in terms of the six sources of distress (all P values <0.01). HCA were significantly higher than doctors (but not nurses) in worrying about their family's and others' health (P<0.05). In terms of coping strategies, doctors were significantly more likely than nurses and HCA to use planning (P<0.05 and <0.01 respectively); nurses were significantly more likely than doctors to use behavioural disengagement (P<0.01); whereas HCA were significantly more likely than doctors to use self distractions (P<0.05).
SARS had caused a significant level of distress among ED staff. The distress level was highest for nurses, followed by doctors and HCA. The three most important variables that could account for the distress level were loss of control/vulnerability, fear for self-health and spread of the virus. Overall, the more frequently adopted coping strategies were acceptance, active coping, and positive framing.
The outbreak of severe acute respiratory syndrome (SARS) posed an unprecedented threat and a great challenge to health professionals in Hong Kong. The study reported here aimed at investigating the origin of stress and psychological morbidity among frontline healthcare workers in response to this catastrophe.
Self-administered questionnaires were sent to frontline healthcare workers in three hospitals. The General Health Questionnaire was used to identify psychological distress. Socio-demographic and stress variables were entered into a logistic regression analysis to find out the variables associated with psychological morbidity.
The response rate was 40 %. Sixty-eight per cent of participants reported a high level of stress. About 57 % were found to have experienced psychological distress. The healthcare workers' psychological morbidity was best understood by the perceptions of personal vulnerability, stress and support in the workplace.
These findings shed light on the need for hospital administrators to be aware of the extent and sources of stress and psychological distress among frontline healthcare workers during disease outbreak.
During the 2003 severe acute respiratory syndrome (SARS) outbreak, health care workers (HCWs) experienced unusual stressors. The study hospital introduced psychosocial interventions to help HCWs. This study aimed to examine the coping strategies adopted by the emergency department (ED) HCWs who cared for the SARS patients.
In November 2003, a self-administered questionnaire of physicians and nurses was conducted in the hospital ED that is the national SARS screening center in Singapore. Data collected included demographics and responses to these instruments: 1) the Coping Orientation to Problems Experienced (COPE) to assess coping strategies, 2) the Impact of Event Scale (IES) to measure psychological reactions, and 3) the General Health Questionnaire 28 (GHQ 28) to measure psychiatric morbidity.
Thirty-eight of 41 (92.7%) physicians and 58 of 83 (69.9%) nurses responded. The respondents reported a preference for problem-focused and emotion-focused coping measures. The physicians chose humor as a coping response significantly more frequently (p < 0.001) than nurses, scoring 9.61/16 (95% CI = 8.52 to 10.69), compared with the nurses' score of 7.05/16 (95% CI = 6.28 to 7.83). The Filipino HCWs turned to religion as a coping response significantly more frequently (p < 0.001) than the non-Filipino HCWs, scoring 14.38/16 (95% CI = 13.33 to 15.42), compared with 9.93/16 (95% CI = 9.00 to 10.87) for the non-Filipinos. Psychiatric morbidity was 17.7% on the IES and 18.8% on the GHQ 28, with the trend for physicians to report lower psychiatric morbidity.
With a supportive hospital environment, ED HCWs chose adaptive coping in response to the outbreak and reported low psychiatric morbidity. Physicians chose humor and Filipinos chose turning to religion as their preferred responses. Psychosocial interventions to help HCWs need to take these preferences into account.
Healthcare workers (HCWs) were at the frontline during the battle against Severe Acute Respiratory Syndrome (SARS). Understanding their fears and anxieties may hold lessons for handling future outbreaks, including acts of bioterrorism.
We measured risk perception and impact on personal and work life of 15,025 HCWs from 9 major healthcare institutions during the SARS epidemic in Singapore using a self-administered questionnaire and Impact of Events Scale and analyzed the results with bivariate and multivariate statistics.
From 10,511 valid questionnaires (70% response), we found that although the majority (76%) perceived a great personal risk of falling ill with SARS, they (69.5%) also accepted the risk as part of their job. Clinical staff (doctors and nurses), staff in daily contact with SARS patients, and staff from SARS-affected institutions expressed significantly higher levels of anxiety. More than half reported increased work stress (56%) and work load (53%). Many experienced social stigmatization (49%) and ostracism by family members (31%), but most (77%) felt appreciated by society. Most felt that the personal protective measures implemented were effective (96%) and that the institutional policies and protocols were clear (93%) and timely (90%).
During epidemics, healthcare institutions have a duty to protect HCWs and help them cope with their personal fears and the very stressful work situation. Singapore's experience shows that simple protective measures based on sound epidemiological principles, when implemented in a timely manner, go a long way to reassure HCWs.
Few studies have focused on describing the experiences of health care workers during rapid killing epidemics. In this article, the views and experiences of nurses during three outbreaks of Ebola hemorrhagic fever (EHF) in Central Africa are examined. These three outbreaks occurred in Kikwit, Democratic Republic of Congo (DRC, 1995); Gulu, Uganda (2000-2001); and Republic of Congo (ROC, 2003). Open-ended and semistructured interviews with individuals and small groups were conducted during the outbreaks in Uganda and ROC; data from DRC are extracted from published sources. Three key themes emerged from the interviews: (a) lack of protective gear, basic equipment, and other resources necessary to provide care, especially during the early phases of the outbreaks; (b) stigmatization by family, coworkers, and community; and (c) exceptional commitment to the nursing profession in a context where the lives of the health care workers were in jeopardy.
The outbreak of severe acute respiratory syndrome (SARS) in 2003 resulted in 346 probable SARS cases and 37 deaths in Taiwan. This descriptive study, which was conducted from May to June 2003, intended to identify staff stress and coping strategies among a SARS team of nursing staff during the outbreak.
Twenty-six female nurses of the SARS team completed a questionnaire about their experiences serving in the SARS team.
SARS had both positive and negative psychological impacts on the nurses. While worrying about infecting their families and colleagues, nurses were able to cope with the situation through various means. Additional findings include the need for more psychiatric staff to provide flexible and continuous service, the importance of meetings to improve teamwork and reduce conflict between doctors and nurses and the useful discovery that video cell phones provided needed reassurance from afar to the worried families of the nurses.
This study reinforces the importance and benefits of psychiatric services for SARS team members in reducing their secondary traumatization. It is hoped that the results will enhance our knowledge on the needs of frontline health care workers and support the planning of better psychiatric services in future epidemics.
Preparation, teamwork, and spirit at a New Orleans hospital helped the staff, patients, families, and even pets weather the storm.
The purpose of this study was to enhance our understanding of the influence of the SARS crisis on the work and personal lives of community nurses.A total of 941 community nurses employed in a range of health-care settings in the province of Ontario, Canada, provided qualitative information about their perceptions of the impact of SARS in their workplace and in their personal lives. Themes and subthemes from the data were organized into 2 categories: The Experience (operational, organizational, and personal narratives), and Learning from the Experience (opportunities for personal learning, professional and policy development, and insight into policy and administrative implications). The findings are discussed within a framework of the learning opportunity presented by the crisis at the local, national, and international levels. The roles of effective communication, emergency response coordination, and education are considered with respect to policy development and administrative responses to infectious disease protocol. The findings are particularly relevant at this time of heightened fear of global epidemics.
Vaccines that could protect humans against the highly lethal Marburg and Ebola viruses have eluded scientists for decades. Classical approaches have been generally unsuccessful for Marburg and Ebola viruses and pose enormous safety concerns as well. Modern approaches, in particular those using vector-based approaches have met with success in nonhuman primate models although success against Ebola has been more difficult to achieve than Marburg. Despite these successes, more work remains to be done. For the vector-based vaccines, safety in humans and potency in the face of pre-existing anti-vector immunity may be critical thresholds for licensure. The immunological mechanism(s) by which these vaccines protect has not yet been convincingly determined. Licensure of these vaccines for natural outbreaks may be possible through clinical trials although this will be very difficult; licensure may also be possible by pivotal efficacy studies in animal models with an appropriate challenge. Nevertheless, nonhuman primate studies have shown that protection against Marburg and Ebola is possible and there is hope that one day a vaccine will be licensed for human use.
The 1995 Kikwit Ebola outbreak in the Democratic Republic of the Congo is one of the first Ebola outbreaks to be treated in a hospital setting and is one of the most well-studied Ebola epidemics to have occurred to date. Many of the lessons learned from identifying, containing, and treating the epidemic are applicable to future viral outbreaks. This article looks at the characteristics of the Ebola virus and health system issues, which affected the healthcare providers' ability to contain and treat the virus. It specifically examines factors such as the disease characteristics, surge capacity, supply issues, press involvement, and the involvement of voluntary organizations.
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