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Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science
Abstract
The coronavirus disease 2019 (COVID-19) pandemic is having a profound effect on all aspects of society, including mental health and physical health. We explore the psychological, social, and neuroscientific effects of COVID-19 and set out the immediate priorities and longer-term strategies for mental health science research. These priorities were informed by surveys of the public and an expert panel convened by the UK Academy of Medical Sciences and the mental health research charity, MQ: Transforming Mental Health, in the first weeks of the pandemic in the UK in March, 2020. We urge UK research funding agencies to work with researchers, people with lived experience, and others to establish a high level coordination group to ensure that these research priorities are addressed, and to allow new ones to be identified over time. The need to maintain high-quality research standards is imperative. International collaboration and a global perspective will be beneficial. An immediate priority is collecting high-quality data on the mental health effects of the COVID-19 pandemic across the whole population and vulnerable groups, and on brain function, cognition, and mental health of patients with COVID-19. There is an urgent need for research to address how mental health consequences for vulnerable groups can be mitigated under pandemic conditions, and on the impact of repeated media consumption and health messaging around COVID-19. Discovery, evaluation, and refinement of mechanistically driven interventions to address the psychological, social, and neuroscientific aspects of the pandemic are required. Rising to this challenge will require integration across disciplines and sectors, and should be done together with people with lived experience. New funding will be required to meet these priorities, and it can be efficiently leveraged by the UK's world-leading infrastructure. This Position Paper provides a strategy that may be both adapted for, and integrated with, research efforts in other countries.
... While the age range of "young adults" varies in the literature, partly influenced by increasing longevity, this study defined young adults as individuals aged 20 to 44 years. This classification distinguishes them from middle-aged individuals (aged [45][46][47][48][49][50][51][52][53][54][55][56][57][58][59] [26,27] and adolescents (aged 10-19) [18], aligning with the World Health Organization (WHO) definition [28] and the data structure of the GBD 2021 study. ...
... As indicated by previous studies, the pandemic may have exacerbated the risk of mental disorders, including dysthymia, not only through its direct physical and psychological effects but also through its long-term economic and social consequences [48,49]. Psychological stressors, such as isolation, loneliness, relationship breakdowns, and bereavement, were compounded by the pervasive fear of illness, directly contributing to the observed rise in both the incidence and prevalence of dysthymia [50,51]. Furthermore, economic and social repercussions of the pandemic disproportionately affected young adults, who experienced additional stressors such as job loss, business closures, and financial instability [52]. ...
... These disruptions not only hindered academic progress but also increased social isolation, further escalating the risk of dysthymia within this group. In the post-pandemic context, cultural shifts, including an increased reliance on digital communication and social media, have further influenced mental health [51]. These changes have contributed to a heightened sense of social comparison and exacerbated feelings of isolation, particularly among young adults [53]. ...
Background
Dysthymia, a chronic depressive disorder, poses a significant public health challenge due to its prolonged course and substantial impact on quality of life, particularly among high-risk populations such as young adults. This study aims to investigate trends in dysthymia incidence and prevalence among young adults in China from 1990 to 2021 and to project future patterns through 2026.
Methods
Using data from the Global Burden of Disease (GBD) 2021 Study, we conducted an Age-Period-Cohort (APC) analysis to assess the relative risks (RRs) of dysthymia incidence and prevalence among Chinese young adults aged 20–44 years from 1990 to 2021. Bayesian and Nordpred APC models were applied to forecast age-standardized incidence rates (ASIR) and prevalence rates (ASPR) for the next 25 years (2022–2046).
Results
Between 1990 and 2019, both ASIR and ASPR of dysthymia exhibited a declining trend. Among females, ASIR decreased from 363.099 (95% uncertainty interval [UI]: 339.146, 387.051) per 100,000 population to 318.100 (95% UI: 296.812, 339.388), while among males, it declined from 232.757 (95% UI: 216.022, 249.492) to 208.467 (95% UI: 193.617, 223.317). Similarly, ASPR decreased from 2,072.562 (95% UI: 1,813.254, 2,331.870) to 1,795.234 (95% UI: 1,582.628, 2,007.841) for females and from 1,278.432 (95% UI: 1,116.869, 1,439.994) to 1,131.620 (95% UI: 994.059, 1,269.180) for males. However, a marked increase was observed from 2020, with 2021 rates approaching 1990 levels for both sexes. APC analysis showed that RRs for dysthymia incidence and prevalence increased with age, particularly beyond 35–39 years. More recent cohorts demonstrated lower RRs compared to earlier cohorts, whereas period effects remained relatively stable. Projections indicate a continuous rise in ASIR and ASPR from 2022 to 2046 for both sexes. Throughout the study period, dysthymia prevalence rates consistently exceeded incidence rates, with females exhibiting higher rates than males.
Conclusion
Enhancing early diagnostic capabilities in primary care, advancing standardized treatment strategies, improving mental health literacy through health education and social media, and implementing targeted interventions for high-risk groups—particularly young women and individuals in early adulthood—are essential for alleviating the burden of dysthymia in China and other countries with similar demographic and epidemiological characteristics.
... In summary, both COVID-19 itself, which is highly contagious and infectious, and the challenges of controlling it have become serious global health threats (e. g., Mahamid et al., 2022;Sahu et al., 2021). Among the many challenges faced by the majority of humanity during these years, anxiety and fear were expressed through thoughts, beliefs and behaviours, and were particularly triggered by the novelty and unpredictable possibility of contact with COVID-19, of which at one point no one was sure how dangerous it was (Holmes et al., 2020). This unpredictable nature of COVID-19 and its detrimental effects on an infected individual instills fear in individuals (Holmes et al., 2020). ...
... Among the many challenges faced by the majority of humanity during these years, anxiety and fear were expressed through thoughts, beliefs and behaviours, and were particularly triggered by the novelty and unpredictable possibility of contact with COVID-19, of which at one point no one was sure how dangerous it was (Holmes et al., 2020). This unpredictable nature of COVID-19 and its detrimental effects on an infected individual instills fear in individuals (Holmes et al., 2020). Psychological trauma can result from witnessing or experiencing an event that is perceived as life threatening. ...
The COVID-19 pandemic led to sudden changes in many people's lives, due to the risky and unpredictable nature of the disease and the consequences of public policies aimed at controlling its spread. As the pandemic progressed, people became more aware of what to do, and restrictions were relaxed. Our aim was to investigate the impact of the COVID-19 pandemic on individuals' psychological reactions and to examine differences due to long-term exposure between the start of the pandemic in early 2020 and the lifting of restrictions in mid-2022. We used an anonymous online survey at two different points in the COVID-19 pandemic - early 2020 and mid-2022 - and collected data from two independent samples of Portuguese individuals (194 in 2020 and 220 in 2022). Measures of the psychological impact of trauma, emergency response, anxiety and sensation seeking were collected. Participants reported significantly lower levels of negative effects of COVID-19, anxiety and sensation seeking in 2022 compared to 2020. The negative impact of the COVID-19 pandemic on individuals appears to have gradually decreased between 2020 and 2022.
... 38 Other studies found that the total COV19-QoL score did not differ significantly according to whether the COVID-19 test was previously positive. 39,40 Furthermore, the significant effects noted in individuals with direct or familiar experiences of COVID-19 resonate with the work of Holmes et al., 41 who identified high-risk groups such as those with direct health impacts from the virus and their close contacts as particularly susceptible to longterm psychological distress. Our study suggests that these impacts are nuanced and vary significantly with personal health history and experiences of loss due to the virus, indicating the need for specialized mental health services tailored to these experiences. ...
... Other studies have reported that individuals who are likely to be exposed to more negative consequences during the COVID-19 pandemic include the elderly, young people, women, students, migrant workers, 43,44 and individuals in prison and the homeless population. 41 According to Cao et al., 4 residing in an urban area, as opposed to a rural one, living within a family unit, and having a stable, regular income are protective factors in the process of navigating COVID-19. The study also found that when a family member, relative, or acquaintance contracts the COVID-19 virus, it increases the anxiety levels of individuals. ...
Objective
The purpose of this study was to analyze the impact of COVID-19 on the quality of life of individuals who received psychological treatment compared to those who did not.
Methods
The survey method was used to collect data. The questionnaire consisted of questions that elicit the personal characteristics of the participants and the COVID-19–Impact on Quality of Life Scale (COV19-QoL). A total of 480 individuals aged 18 years or older were administered the questionnaires in Türkiye. The data obtained from the survey was analyzed using the SPSS 26 software package.
Results
The results showed that the effect of COVID-19 on quality of life differed significantly depending on whether the participants received psychological treatment or not.
Conclusions
It was concluded that individuals who received psychological treatment had a higher impact of COVID-19 on their quality of life. The findings are discussed concerning the relevant literature on theoretical and practical implications.
... 2 Whether through pathophysiology or social conditions, describing effects of the COVID-19 pandemic on population mental health was promptly identified as a critical research objective. 3 As a growing body of literature describes the short-and medium-term outcomes of COVID-19and unravels some mechanisms through which these effects are occurring 4work in the near future should also consider longer-term projections of increased mental health problems following COVID-19. 3 Ito et al 5 pursue this aim: their paper models the prevalence of anxiety disorders in the German population from 2019 to 2030. ...
... 3 As a growing body of literature describes the short-and medium-term outcomes of COVID-19and unravels some mechanisms through which these effects are occurring 4work in the near future should also consider longer-term projections of increased mental health problems following COVID-19. 3 Ito et al 5 pursue this aim: their paper models the prevalence of anxiety disorders in the German population from 2019 to 2030. The authors estimate a series of multistate models (illness-death models) of anxiety disorder in which individuals in the population may transition between three states: susceptible, diseased and dead (see Fig. 1). ...
Ito et al present an illness–death model projecting 82 scenarios for the prevalence of anxiety disorders in Germany from 2019 to 2030 following the COVID-19 pandemic. We suggest the modelling framework used by Ito et al has promising applications for mental health epidemiology.
... This spread was exacerbated by the COVID-19 pandemic and by prolonged stringent measures applied by public health institutions to mitigate this highly contagious pandemic 8,9 . Studies have shown the prevalence of psychological distress, specifically anxiety and depression 10,11 , during prolonged COVID-19 lockdowns. These restrictions were associated with social adherence measures such as reduced social interaction, specifically stringent social distancing and systematic quarantine. ...
The unprecedented outbreak of the COVID-19 pandemic has altered the course of many lives, resulting in multiple health and social challenges. Due to the speed at which this pandemic spread, various public health ‘lockdown’ measures were introduced to mitigate its spread. The outcome of adherence to these measures has revealed the possible influence on individuals’ varying cognitive abilities. Accordingly, this study aimed to explore the predictive relationships between lockdown responses and COVID-19 restrictions, memory recall performance, and associated emotional responses while examining the sociodemographic influences of age and sex. Participants were drawn from a secondary dataset of an international online survey study of 1634 individuals aged 18–75 years across 49 countries. Participants’ demographic questionnaires, free memory recall, and hospital anxiety and depression scale scores were used to collect the data for analysis. Four-way MANOVA and hierarchical multiple regression were utilised to explore the mean differences and predict relationships between the study variables. Significant differences were found in memory recall performance and anxiety and depression scores across lockdown groups (the comply, sufferer, and defiant). Regression analysis indicated that age and gender were predictive markers of lockdown responses and anxiety (R² = 0.14, F4,1625 = 66.15, p < .001, f² = 0.17), while age was the only predictor of lockdown responses and depression association ( = -0.78, t(1625) = -4.35, p < .001). Lockdown compliance was associated with better free recall (M = 8.51, SD = 6.38, p < .001; η² = 0.01), lockdown suffering was associated with greater anxiety (M = 9.97, SD = 4.36, p < .001; η² = 0.06), and lockdown deviance was associated with greater depression (M = 7.90, SD = 3.12, p < .001; η² = 0.05). The current study provides valuable information on the mechanisms of cognitive interpretations and emotional arousal in individuals’ social isolation responses to recent life stress and potential severe pandemics. This may support the need for robust interventions aimed at improving people’s psychological appraisals associated with anxiety in preparation for any new potential waves or future pandemics.
... [8] Besides, it is already evidenced that the direct and indirect psychological and social effects of the rapidly spreading diseases including the COVID-19 pandemic are pervasive and could affect an individual's psychological and physical well-being. [9,10] Health professionals on the front line who are directly in contact with the treatment, diagnosis, and care of patients with COVID-19 are at higher risk of experiencing psychological distress and other mental health symptoms. [11] Generally, the worldwide healthcare systems, particularly those in Kurdistan Region, are facing enormous challenges as a result of this pandemic. ...
Background: The last line of defense against risks is frequently regarded as personal protective equipment (PPE). Therefore, there is a shortage of PPE in places with high demand because of COVID-19's widespread nature. Objective: The aim of the study was to address the shortage of personal protective equipment (PPE), as well as to identify factors that increased the risk of mental health problems among healthcare workers during coronavirus disease 19 (COVID-19). Materials and Methods: A cross-sectional study was conducted from June 22nd to August 22nd, 2020, in Iraqi Kurdistan region. A total of 337 healthcare professionals participated in an online survey that included questions about socio-demographic information, personal protective measures, and risk factors for mental health issues. SPSS software version 24.0 was used to analyze data. Results: The majority of healthcare professionals 196 (58.2%) were men. The majority of the population was aged 25-34 years 211 (62.6%), with nursing, representing the highest percentage among all professions 151 (44.8%). At least 46.6% of the participants reported a lack of PPE. The most common shortages reported were hats, boots, N95 masks, goggles, and face shields. A significant positive correlation (r = 0.181, P = 0.001) was observed between direct contact with COVID-19 patients and the spreading of fear and panic among healthcare professionals due to their concerns about transmitting the virus to their relatives. Also, results revealed that healthcare professionals' non-receive training on the ways of facing the COVID-19 crisis was another risk factor affecting healthcare professionals' mental health in all hospitals (r = 0.119, P = 0.001). Conclusion: According to the current study, healthcare professionals lacked the resources needed to treat COVID-19 patients. To avoid healthcare professionals' mental health problems during medical emergencies, the government should take action, especially the Ministry of Health, which should address the challenges in the case of a future health crisis.
... The intervention development phase reported here also took place over a relatively short period-18 months from 2016 to 2018and our analysis of the interviews and focus groups prioritised themes directly relevant to our development aims rather than being more exploratory. The development also predated the COVID-19 pandemic, which has significantly altered the availability and accessibility of mental health and other vital health and social care services [86]. Even still, the DBI in Scotland has successfully adapted to changes in services and service use, including a new pathway via national telehealth services and hybrid support from community services. ...
Background
Mental health problems, self-harm and suicide are major public health concerns. Following national strategic commitments to improve the response and follow-up support for adults in Scotland presenting to frontline services in emotional distress, this study describes the development of the first national Distress Brief Intervention, a multi-agency service to provide connected, compassionate support for people in distress.
Methods
The six step Intervention Mapping protocol was used to account for the complexity of the intervention and to guide development, testing and implementation. Data/information sources comprised: literature and evidence review; delivery partner and stakeholder consultations (n = 19); semi-structured interviews and/or focus-groups with frontline services staff experienced in responding to distress (n = 8); interviews and/or focus groups with adults with experience of distress (n = 9); feedback from test training for staff (n = 16); self-assessed confidence ratings provided by staff immediately before and following training (n = 388).
Results
We developed a time-limited, two-level, complex intervention for adults experiencing emotional distress, provided by ‘frontline’ statutory services (primary and acute healthcare, police, ambulance) and third-sector community organisations in Scotland. Intervention components included competency-based training programmes for staff, information, protocols and guidance for providers, personalised distress management planning and behaviour change tools. During the development phase, 525 intervention providers (n = 472 frontline statutory service staff; n = 53 third-sector community organisation staff) completed training programmes in four pilot areas in Scotland. Training evaluations from 388 providers (74%) indicated significantly greater confidence following training on key competencies.
Conclusions
A multi-agency national Distress Brief Intervention was systematically developed and implemented in a range of non-specialist frontline and community settings in Scotland. Up-take of training and evaluations of training indicate it is highly acceptable to potential providers and improves key competencies. Following independent evaluation, the Distress Brief Intervention has been rolled out nationally across the whole of Scotland, and has significant potential as a model of care and prevention internationally, including countries with low statutory health resources.
... In a study by Holmes et al. [36] (2020), communication-based digital interventions reduced stress levels in COVID-19 patients. In another research by Ahmadian et al. [37] (2013), planned visitation significantly reduced stress in hospitalized patients. ...
BACKGROUND
One of the patients’ support needs during hospitalization is visits, which are usually associated with many restrictions for patients with coronavirus disease 2019 (COVID-19). Implementing as planned online video visits to communicate with the patients and their family may help reduce psychological complications.
MATERIALS AND METHOD
This study was a randomized clinical trial with two groups from April 2022 to August 2022. Sixty patients were randomly divided into intervention and control groups, each with 30 individuals, based on a sequence from SPSS and using sealed envelopes for assignment. Then, in the intervention group, a video call was made in the morning, evening, and night shifts and once in each shift for 10–15 minutes between the patient and the family by the researcher’s tablet in the ward and the patient’s family’s smartphone at home. The demographic information questionnaire and Depression Anxiety Stress Scale (DASS-21) were completed before and 48 hours after the patient’s hospitalization. Statistical analysis was conducted with SPSS version 20 utilizing both descriptive and inferential techniques alongside the paired t -test for within-group comparisons and the Kolmogorov–Smirnov test for normality assessment. All tests were evaluated with a 95% confidence interval and a significance level set at 0.05.
RESULTS
Initially, no significant differences were noted in anxiety and stress scores between the intervention and control groups. Later, post-test results showed significantly lower mean anxiety scores in the intervention group compared to the control both for anxiety and stress.
CONCLUSION
The researchers advocate for the adoption of virtual visitation as an effective measure to facilitate visual communication between patients and their family members, aiming to enhance patient well-being by alleviating anxiety and stress.
... Without this affordance, an individual's wellbeing is affected negatively as their work community and psychological support (Pratt & Ashforth 2003) is withdrawn. The literature suggests that individuals who have problems securing employment experience extreme psychological suffering, (Dooley et al. 1996, Hamilton et al. 1993).There has been a significant decline in the mental health of individuals across the world, in comparison to before the pandemic, (Czeisler et al. 2020, Ettman et al. 2020, McGinty et al. 2020) global responses to the pandemic include suicidal ideation, depressive symptoms, insomnia, stress and anxiety, (Holmes et al. 2020, Killgore et al. 2020, Torales et al. 2020. ...
Purpose: Existing literature suggests there is a relationship between aggression and global crises as well as health pandemics. Despite previous research highlighting this relationship, research in the UK that examines this relationship, and particularly between the pandemic containment measures with aggression, has not been thoroughly examined. This pilot study investigates the aggression levels in the UK before and during the implementation measures for containing the latest global health crisis. Design: For the needs of the pilot study, 149 participants (127 female and 21 males) completed an online questionnaire which measures aggression levels before and during lockdown. Findings: The investigation showed that aggression increased during the lockdown periods, with themes of anger and loneliness also being identified through a content analysis. This project is one of the first to examine aggression during lockdown and isolation restrictions. Further implications and limitations are discussed. Keywords: crises, lockdown, pandemic, conformity, violence, aggression
... "Although there are certainly successful examples of interdisciplinarity, established academic disciplines remain dynamic centres of knowledge production that are open to external developments even while insisting on internal standards" (Jacobs & Frickel, 2009, p. 60). Global crises such as the COVID-19 pandemic and the climate crisis have been publicly negotiated along disciplinary domains-with several observers remarking on a public imbalance between the social and the natural sciences (Holmes et al., 2020;Lohse & Canali, 2021). The infamous incompatibility of a world with problems and a university with departments does not seem to be easily resolved through journalistic and public intermediaries. ...
Public movements such as Scientists4Future, which often rally behind a monolithic and definite idea of scientific knowledge, have been criticised for promoting scientocratic political premises (e.g., Bogner in Die Epistemisierung des Politischen: Wie die Macht des Wissens die Demokratie gefährdet . Reclam, 2021). Appeals to “follow the science” assume both a political necessity to adhere to unambiguous, consistent scientific facts and a general scientific voice speaking a kind of truth merged from every scientific field. This chapter argues that, while at least in Germany a lot of political attention has lately been given to the democratic value of science communication (SPD in Mehr Fortschritt wagen: Bündnis für Freiheit, Gerechtigkeit und Nachhaltigkeit , 2021), and funding has been on the rise for years, the promoted ideal of science communication lacks sensitivity regarding the diverse and multifaceted nature of specialised research cultures and institutions. To provide their discipline with an honest trust base in public, researchers and communicators first need to reflect on their work and the environment they operate in. Drawing from a process of field-specific self-reflection could help to design individual communication strategies that increase scientific trust by targeting the dimensions of “ expertise ”, “ integrity ”, and “ benevolence ” (Hendriks et al. in PLoS ONE 10, 2015) from a discipline-specific starting point. Science studies and the social sciences, in general, are destined to act as an integrative force in this process.
... Research demonstrated that the SARS-CoV-2 infection could lead to the development of mental disorder and suicide behaviors [30,31]. During the pandemic, people may be exposed to a wide sort of stressful or traumatic events, such as social isolation, being quarantined or infected, which can increase perceived anxiety, depression, disturbing sleep, and quality of life [32]. Our study also found that while the DALYs of schizophrenia was high, the ASR of schizophrenia globally had not changed signi cantly, with the ASR even slightly decreasing between 2019 and 2021. ...
Background Mental disorders, one of the leading causes of the global health-related burden, which has been exacerbated by the emergence of the COVID-19 pandemic. In this study, we aim to provide global, regional, and national estimates of the mental disorders burden from 1990 to 2021, including during the COVID-19 pandemic. Methods We collected data on the incidence, DALYs, ASIR, and ASR for 12 mental disorders at the global, regional, and national levels from 204 countries and regions across 21 geographical areas spanning from 1990 to 2021. We utilized joinpoint regression analysis to estimate the Average Annual Percentage Change (AAPC). We also determined the trends in ASIR and ASR of mental disorders during the COVID-19 pandemic (2019-2021). Results Globally, between 1990 and 2021, there was an upward trend in both ASIR [15.23% (12.97% to 17.60%)] and ASR [17.28% (15.06% to 19.44%)]. Regionally, there were increases in both incidences and DALYs in all 21 GBD regions. In 2021, the highest ASIR was observed in Central Sub-Saharan Africa (8706.11), while the lowest was in East Asia (3340.99). Australia (2787.87) had the highest ASR. Nationally, Greenland, Greece, the United States, and Australia had the highest ASRs. During the COVID-19 pandemic, ASIR and ASR showed an upward trend in five SDI and 21 GBD regions, except for East Asia, where they remained stable. In 2021, the ASR for females was higher than that for males. Among the 12 subtypes, major depressive disorder (557.87) and anxiety disorders (524.33) had the highest ASR in 2021. Major depressive disorder ranked first in ASR in 13 of the 21 regions worldwide. Despite the overall upward trend in DALYs for mental disorders [AAPC: 5.96; 95%CI: (4.99, 6.92)], the ASR exhibited varying trends among different subtypes, with anxiety disorders experiencing the most significant increase. Conclusions GBD 2021 showed that the burden of mental disorders was still on the rise gradually worldwide and significantly exacerbated by the emergence of the COVID-19 pandemic. High-middle SDI regions and females should be paid more attention. To reduce the future burden, providing comprehensive mental health support, establishing effective mental health knowledge dissemination and tailored interventions are in great need.
... The COVID-19 pandemic caused unprecedented mental health challenges, including prolonged and elevated global psychological distress [1,2]. Significant pandemic-related increases in depression, anxiety, and posttraumatic stress disorder (PTSD) in diverse populations, e.g., healthcare workers, young adults, and others, have been attributed to pandemic-related stress [3,4]. ...
Background/Objectives: The COVID-19 pandemic increased psychiatric symptoms in patients with pre-pandemic mental health conditions. However, the effects of pandemic on the brain, stress, and mental illness remain largely conjectural. Our objective was to examine how the pandemic affected prefrontal cortical thicknesses (CTs), stress, and PTSD symptoms in people with pre-pandemic trauma histories. Methods: Fifty-one survivors from a pre-pandemic trauma study who had completed a pre-pandemic PTSD Checklist-5 (PCL) to assess PTSD symptoms and a sMRI scan to measure prefrontal CTs were re-recruited after the pandemic. They subsequently completed the COVID Stress Scale (CSS) to assess stress, the Clinician Administered PTSD Scale-5 (CAPS) to diagnose PTSD, and a second sMRI scan. COVID-19 infection was self-reported. Associations between stress and symptom assessments and post-pandemic CTs, differences in CTs in PTSD vs. non-PTSD groups, and changes in pre- to post-pandemic CTs were examined. Results: Pre-pandemic PCL scores were positively associated with CSS scores which, in turn, were higher in the PTSD group. Thicker IFG-opercularis CTs were associated with COVID-19 infection. Post-pandemic rMFG and IFG-orbitalis CTs were positively associated with CAPS scores. rACC CTs were negatively associated with CSS scores. Pre- to post-pandemic rMFG and frontal pole CTs thickened in the PTSD group but thinned in the non-PTSD group, whereas rACC CTs thinned in the PTSD group but thickened in the non-PTSD group. Conclusions: These findings provide novel evidence that the COVID-19 pandemic had diverse effects involving prefrontal cortex structure, stress, and PTSD symptoms in subjects with pre-pandemic trauma history and suggest that treatments are needed to counter these diverse effects.
... Government mandated lockdown measures to curb the spread of Covid-19 in the UK have adversely impacted the population's physical (Robinson et al., 2021) and mental health (Creswell et al., 2021;Holmes et al., 2020;Mansfield et al., 2021) with negative psychological consequences found particularly for children and adolescents (Kauhanen et al., 2023). The unprecedented disruption to schooling during the pandemic (Gouseti, 2021;McDonald et al., 2023) also contributed to significant early childhood learning loss (Dela Cruz et al., 2024;Uğraş et al., 2023), i.e., specific or general loss of knowledge and skills, and/or reversals in academic progress (Huong & Na-Jatturas, 2020). ...
Pupils’ behavioural and emotional difficulties are disruptive to classrooms. These issues have exacerbated post-Covid, but little is known about the specific methods used by teachers to manage such issues in the classroom. An online survey was completed by 133 Key Stage 1 (KS1) educators who use yoga and/or mindfulness activities with their seven- to nine-year-old pupils within 101 mainstream state schools in England’s North East Mayoral Combined Authority. Participants reported using these activities ‘To support the children to calm down and relax’ (88% of participants) and, ‘To support pupils’ self-awareness and self-regulation' (62% of participants), with most participants (65%) rating these activities as extremely or very useful for their KS1 pupils. Early career teachers with 0–2 years’ experience in the profession provided significantly fewer reasons for using classroom-based yoga/mindfulness than those who have been in the profession for three years or more (means = 2.38 and 3.48 respectively). Also, teachers who reported being aware of research into the benefits of yoga or mindfulness for schoolchildren provided significantly more reasons for using such activities in the classroom (mean = 3.79) than those unaware of the research (mean = 2.96). This study is the first of its kind to explore teachers’ use of, and reasons for using, yoga/mindfulness activities in KS1 classrooms in the North East, one of the most deprived areas in England. Results are discussed in the context of current research alongside suggestions for future studies and practice recommendations for KS1 teachers.
... COVID-19 altered students' social and emotional lives worldwide [5]. The prevalence of anxiety and depression increased tremendously during that time [6]. Because of this devastating mental health condition, the number of suicides has also increased in various countries [7]. ...
The teacher-student relationship has far-reaching implications for educational outcomes at the tertiary level. Teachers contribute to students’ success in various ways, including academic support, career counseling, personal mentoring, etc., that help them succeed academically and professionally. COVID-19 disrupted teacher-student interaction and hindered the flow of teacher’s support to students. The damage caused by the pandemic to the higher education sector has mostly recovered. However, the trusting relationship between teacher and student is yet to get back to a pre-pandemic stage. Using stratified sampling technique, we collected nationally representative data from university students in Bangladesh and examined the relationship between COVID-19 and various aspects of the teacher-student relationship. We also explored the association between aspects of the teacher-student relationship and academic outcomes. In our sample, 28% of respondents are from STEM, and 72% are from non-STEM academic disciplines. We employed a subset of Artificial Intelligence (unsupervised machine learning) algorithms K-Modes clustering and Non-negative matrix factorization to cluster the data according to its internal structure. We created a new analysis technique called Absolute Rate of Fluctuation (ARF) to identify the fluctuations between the variables. ARF can track the fluctuations in any relationship induced by undesirable events such as the COVID-19 outbreak. We observed a deterioration in the interaction between teachers and students during COVID-19. However, the class conduction, exam taking, and assessment system were the most affected areas compared to personal interaction, catering support to students, and collaborative research activities.
... This research aligns with contemporary debates in psychology, psychiatry and technology, including the role of interdisciplinary approaches in the design of digital interventions [12]. For example, the integration of user-centred design principles and participatory research methodologies has been highlighted as a key strategy for improving the uptake and effectiveness of mental health technologies [13]. ...
Background/Objectives: Children’s mental health is an issue of growing global concern, with a significant impact on children’s emotional, social and cognitive development. In recent years, digital apps and platforms have emerged as innovative tools to address mental health challenges. This systematic review aims to evaluate the effectiveness of these technologies in supporting children’s and adolescents’ mental health. Methods: A systematic search of PubMed, PsycINFO, Scopus and Web of Science databases was conducted. Results: The results suggest that digital apps and platforms have significant potential to support children’s mental health. However, their effectiveness depends on factors such as app design, parental involvement and cultural adaptation. Conclusions: The inclusion of gamified elements and integration with traditional mental health strategies can enhance outcomes.
... The distress was clinically significant for one out of every five individuals with anxiety symptoms less pronounced than other factors which resulted in vigilance (Cavicchiol et al., 2021). Cavicchiol and colleagues (2021) Some researchers agree on COVID-19 impacts negatively affect coping skills (Yıldırım et al., 2021), which aligns with previous epidemic research findings (Gunnell et al., 2020) in those with no previous mental disorder (Holmes et al., 2020). Most people without pre-existing mental health disorders do not develop psychological pathology after experiencing traumatic events (Breslau et al., 1999;, which may be explained by how they perceive and appraise these stressors although those with pre-existing psychological disorders are prone to heightened issues after traumatic event experiences (Norris et al., 2002). ...
Excellent childcare should be one of our leaders' deepest concerns since children who receive high-quality education and nurturing in their early years should be prepared for elementary school rigor. Unfortunately, the early childhood educator turnover rate has been high over the past decade. The focus of this study investigated childcare educator job satisfaction and the motivation of early childhood educators. The Self-Determination Theory was used as the theoretical framework underlying the investigation. Four major themes were revealed: the motivation for being a childcare teacher, a community of collegiality, a definition of childcare teacher job satisfaction, and the inspiration for becoming a childcare teacher. Evidence also showed that the participants would recommend the early childhood profession to other potential childcare teachers because of their job satisfaction and their love for children despite the low wages and lack of recognition. The study expounded an organic voice of the childcare teacher profession.
... Tis rapid review conducted by colleagues at the University of Central Lancashire's Social Prescribing Unit will inform future research on MH as a MC and SP in the UK. NASP's [24] response to this MC strategy highlighted the potential and existing benefts to individuals and communities where SP could contribute to prevention, diagnosis, treatment and management with people in the groups of In the UK, strategies to address the population's MH needs are multifaceted, addressing the growing MH crisis which has been exacerbated by the COVID-19 pandemic and other socioeconomic factors [25]. Te COVID-19 pandemic has been described as a catalyst for a 'shadow pandemic' of MH issues [26]. ...
This rapid review explores the use of social prescribing for individuals with mental health needs. Mental health conditions are one of the six areas of focus in the UK government’s major conditions strategy, which aims to increase healthy life expectancy, alleviate pressure on the health system, and recognise the impact of comorbidity. It aims to improve the treatment of patients through the integration of mental health and physical health pathways. Social prescribing shows promise in contributing to positive mental health outcomes and could be a viable option as part of this strategy. Fifty-three articles were included in this rapid review from 4 databases (CINAHL, Cochrane, PubMed and Scopus) which discussed the use of social prescribing in addressing mental health conditions. Social prescribing activities, the roles and responsibilities of practitioners, and the need for further underpinning research are all explored. Overall, this review highlights the potential benefits of social prescribing for individuals with mental health conditions.
... There is recognition among the proponents who see the absence of clinical psychologists as a lost opportunity with increasing crisis in mental healthcare services. The burden of mental health is increasing, recently exacerbated by Coronavirus disease of 2019 COVID-19 [54,55,22]. There is a way in which psychologists can be trained on time to fill the apparent gaps in service delivery and as a cost cutting measure [23]. ...
Prescription privileges for psychologists (RxP) refer to the ability of appropriately trained psychologists to prescribe psychotropic medications to their patients. There are clear arguments that support or dismiss treatment privilege for psychologists. The movement for prescription privileges for psychologists has been a gradual and ongoing process, with significant progress made in recent decades. The field of psychologist prescribing is still relatively new, and more research is needed to fully understand its impact on patient care. However, the available evidence suggests that prescribing psychologists can provide safe and effective mental healthcare. At present, prescribing rights for psychologists are being considered in Canada, the United Kingdom, and Australia. In most Latin American countries, clinical psychologists are not legally authorized to prescribe medication. In the exception of a few countries, such as Mexico and Brazil. In South Africa, the Health Professions Council of South does not authorize clinical psychologists to prescribe psychotropic medication. The American Psychological Association (APA) has indeed played a significant role in the movement to grant prescription privileges to psychologists. In 2011, the APA published a comprehensive set of practice guidelines for psychologists involved in pharmacotherapy. In this paper review of countries that have facilitated or are in the process of doing so are reviewed. The legislation governing the profession of psychologists in relation to prescriptive authority in South Africa is reviewed and recommendations made. The psychologists in South Africa will have to address the misconceptions and legal ramifications in similar ways as the USA in order to get acceptance.
... Therefore, research on this relationship, with a focus on adolescents, is needed to clarify the strength and the direction of these associations and to identify individuals at high-risk or in the early stages who may progress to develop full-blown disorders. Understanding the factors that predict this progression is crucial to develop early and effective interventions (Cuijpers et al., 2021;Holmes et al., 2020). Digital interventions in particular have a great potential to promote wide access and sustained and sustainable care to younger populations (Rodgers et al., 2020). ...
Background: Eating and insomnia disorders (E&IDs) are prevalent and often comorbid among adolescents. A possible explanation for their coexistence is that they share some common maintaining mechanisms, such as increased negative affect, functional impairment, and reactivity to disease-related stimuli. This longitudinal study will identify common and specific risk factors for E&IDs and will employ virtual reality to test whether increased reactivity to disease-related stimuli discriminates between individuals at risk or with clinical symptoms and healthy peers. An additional aim is to test the feasibility of virtual reality exposure to target anxiety towards disease-related stimuli. Methods: At least 850 adolescents (14-17 years) will complete a baseline assessment and two follow-ups (at 3 and 6-9 months), along with a 4-day ecological momentary assessment via a mobile app. Individuals at high-risk or with clinical symptoms of E&IDs and healthy peers will be exposed to a virtual reality (VR) environment including sleep or eating-related stimuli in a laboratory setting. Individuals at risk or with clinical symptoms will also be invited to use a self-directed, automatised exposure intervention for a week through VR. S. Cerolini, D. Meneo, V. Meregalli et al. Contents
... According to a study carried out in the UK, it is important to evaluate the consequences that the pandemic has brought on patients infected with the new virus, vulnerable groups and the general population. Regarding this aspect, media messages about health and COVID-19 can have a great influence (Holmes et al., 2020). ...
This study was performed during the fourth wave of COVID-19 cases in Romania and had three objectives. First, it has assessed the opinions regarding COVID-19 vaccination during a severe wave of the pandemic among Romanian adults. Second, it aimed to get insights into their behavior regarding vaccination and factors influencing it. Last, but not least, intention regarding future vaccination and associated factors were assessed. A cross-sectional study was conducted in 3 general practitioners’ (GP) medical offices, in one city from Cluj county, Romania, from October 2021 to December 2021. The study involved 502 Romanian adults who filled in an anonymous questionnaire. 71.7% of the participants were vaccinated and most of those patients were vaccinated with a vaccine that was given in several doses and received the second dose-45% or even the third one-33.1%. The results of the logistic regression analyses show that there were no age, gender or educational level differences regarding vaccination status. On the other hand, people who got the disease (OR = 0.533, CI = 0.315–0.903) or thought the vaccine provoked sterility for women (OR = 0.635, CI = 0.453–0.888) were less likely to get vaccinated. People who were more convinced about the efficacy and safety of the vaccine (OR = 1.718, CI = 1.338–2.206) as well as its importance for getting back to normality (OR = 2.151, CI = 1.705–2.713) were more likely to get vaccinated. A percentage of 42.3% of those who were not vaccinated said they do not know if they would get vaccinated, 33.1% of them said they would not get vaccinated, while around one quarter declared their intention to get vaccinated in the near future. The results of the logistic regression analyses show that there were no differences regarding the intention to get vaccinated based on age, gender or educational level, but people who had stronger beliefs that the vaccine is not protecting against the disease so is not useful were less convinced that they will get vaccinated (OR = 0.600, CI = 0.402–0.894), while those who believe it will help our return to normality were more likely to declare their intention to get vaccination (OR = 2.355, CI = 1.544–3.592). The study gives insights into attitudes, behavior and intention related to COVID-19 vaccination among Romanian adults during a challenging period of COVID-19 pandemic. The results have implications for public health, organization of health communication campaigns and pandemics management.
The study of online discourse on social networking sites (SNSs) is a relatively recent field of study where most of the methodology to study online conversations has been derived from spoken conversation analysis (CA). This study attempts to contribute to the development of digital conversation analysis by analysing screen-captured data of publicly available online conversations on Instagram on April 2020. 186 screen-captured data are analysed with digital conversation analysis to discuss and compare the turn-taking, repair, action formation, action sequencing and the role of technology on the production of online conversations. Results show tentative proof that the screen-capture method of data collection has a unique strength in that it gives researchers insight onto the moment-by-moment production of the online conversation that is not available from the traditional method of transcribing. The novelty of this digital CA research is the comparison between smartphone- and laptop-version of screen-captured data, specifically how the different medium affects the production of online discourse of the same SNS.
The COVID-19 pandemic is believed to have strongly impacted adolescents' mental health through limiting their day-to-day social lives. However, little is known about the role of (social) risk/protective factors and adolescent mental health. Subclinical psychopathology, and risk and protective factors of n = 173 adolescents (T1 mean age = 16.0; 89% girls) were assessed prepandemic and early-pandemic (T1: 2018/2019; T2: May 2020). Daily-life social interactions were assessed in 6-day experience sampling periods. Correcting for age, multilevel analyses revealed declines in general psychopathology and anxiety symptoms; fewer face-to-face social interactions, more online social interactions; and higher-quality face-to-face interactions during the pandemic than before. Negative associations between psychopathology and the quality of face-to-face peer and family interactions were stronger during the pandemic than prepandemic. The results reflect that, early in the pandemic, the mental health impact on adolescents may have been limited. High-quality face-to-face interactions with family and peers seemed particularly powerful in keeping adolescents resilient.
The impact of the pandemic has diminished, and while it is still present, it no longer causes the same degree of societal disruption as before. The nature of this disruption has also shifted. Considering the psychosocial and economic disruption triggered by COVID-19, this study explores the adverse financial consequences of COVID-19 restrictions and its mental health impact on household heads. The study employed a quantitative cross-sectional survey research design. A questionnaire was distributed to a nationally representative sample of individuals ( N = 1580) through computer-assisted telephone interviewing and self-completion. From this dataset, 550 household heads who were employed before the implementation of COVID-19 regulations were selected for inclusion in this study. Findings reveal that while there were no discernible gender differences in terms of financial distress experienced during COVID-19, females were more prone to psychological distress compared to males during this period. These results offer insights into gender disparities concerning the mental health and economic repercussions of COVID-19. Policy initiatives and interventions should consciously address the specific needs of females, aiming not only to mitigate the current pandemic’s impact but also to fortify resilience against potential future crises.
In the course of the work, the clinical phenomenology was studied and a comprehensive system of therapy for mental disorders in people who have suffered from COVID-19 was developed. It was established that the clinical picture of mental disorders in the examined patients is represented by depressive (29.1 % of patients), anxiety (33.4 %), asthenic-neurotic (24.2 %) and cognitive (13.3 %) syndrome complexes, and their phenomenology was described. Taking into account the data obtained during the comprehensive examination, a personalized system for correcting mental disorders in people who have suffered from COVID-19 was developed, which included the use of pharmacotherapy, psychotherapy and psychoeducation. Psychopharmacotherapy included the differentiated use of SSRI antidepressants and SSRI non-benzodiazepine anxiolytics, a short course of benzodiazepine. The psychotherapeutic program included the differentiated use of: cognitive behavioral therapy, biosuggestive therapy, psychodynamic psychotherapy, art therapy, social skills training, desensitization, mindfulness, relaxation exercises and cognitive training. Analysis of the clinical results of using the developed program of personalized therapy of mental disorders of people who have suffered COVID-19 has proven its effectiveness. Against the background of using the developed program, positive dynamics of the mental state, rapid reduction of anxiety-depressive and asthenic symptoms, improvement of cognitive functions, formation of adaptive types of attitude to the disease and improvement of the quality of life of people who have suffered COVID-19 were noted.
Background
The last line of defense against risks is frequently regarded as personal protective equipment (PPE). Therefore, there is a shortage of PPE in places with high demand because of COVID-19’s widespread nature.
Objective
The aim of the study was to address the shortage of personal protective equipment (PPE), as well as to identify factors that increased the risk of mental health problems among healthcare workers during coronavirus disease 19 (COVID-19).
Materials and Methods
A cross-sectional study was conducted from June 22nd to August 22nd, 2020, in Iraqi Kurdistan region. A total of 337 healthcare professionals participated in an online survey that included questions about socio-demographic information, personal protective measures, and risk factors for mental health issues. SPSS software version 24.0 was used to analyze data.
Results
The majority of healthcare professionals 196 (58.2%) were men. The majority of the population was aged 25–34 years 211 (62.6%), with nursing, representing the highest percentage among all professions 151 (44.8%). At least 46.6% of the participants reported a lack of PPE. The most common shortages reported were hats, boots, N95 masks, goggles, and face shields. A significant positive correlation ( r = 0.181, P = 0.001) was observed between direct contact with COVID-19 patients and the spreading of fear and panic among healthcare professionals due to their concerns about transmitting the virus to their relatives. Also, results revealed that healthcare professionals’ non-receive training on the ways of facing the COVID-19 crisis was another risk factor affecting healthcare professionals’ mental health in all hospitals ( r = 0.119, P = 0.001).
Conclusion
According to the current study, healthcare professionals lacked the resources needed to treat COVID-19 patients. To avoid healthcare professionals’ mental health problems during medical emergencies, the government should take action, especially the Ministry of Health, which should address the challenges in the case of a future health crisis.
Одним із наслідків початку повномасштабної війни в Україні стало переміщення цивільного населення як у межах країни, так і за її кордонами. Адже станом на червень 2023 року біля 5 мільйонів пересічних громадян отримали статус внутрішньо переміщених осіб та більше 8 мільйонів українців перебувало за кордоном, переважно в Польщі (22%), Німеччині (15%) та Сполучених Штатах Америки (11%). Зміна місця проживання мала на меті знайти передусім безпечне місце для дітей та дорослих, проте водночас перетворилось на низку викликів щодо адаптації до нових умов проживання, соціалізації в іншомовному суспільстві та пошуку місць роботи і навчання для дітей. Дослідження, результати якого представлено в статті, було проведено до другої річниці повномасштабного вторгнення, у Сполучених Штатах Америки в лютому – квітні 2024 р. та мало на меті дослідити особливості травматичного досвіду зовнішньо переміщених осіб, які виїхали до США після 24 лютого 2022 року. У досліджуваних визначено помірний рівень тривоги, виражений рівень депресивних проявів та зону ризику виникнення посттравматичного стресового розладу. Емпіричним шляхом підтверджено, що зміна країни та місця життя не виступає стабілізаційним складником для учасників дослідження. Серед низки предикторів, що зумовлюють рівень тривожності, депресивні прояви та схильність до проявів посттравматичних стресових симптомів, визначено втрату житла, об’єм споживання медіаресурсів, досвід проживання в окупації та перебування під бомбардуванням. Станом на лютий 2024 року вибір ресурсів для опанування складних ситуацій і стресоподалання у внутрішньо переміщених осіб, що мешкають у Сполучених Штатах, є подібним за кількісним та якісним складниками до тих, якими користуються українці, що залишилась в Україні. Актуальними до вивчення залишаються питання щодо адаптації в нових умовах проживання, стабілізації психічного стану і пошуку конструктивних ресурсів та стратегій.
The COVID-19 pandemic has adversely influenced the mental health of individuals in developing countries, whereas the impoverished urban population has been affected the most due to unattainable mental healthcare and the societal stigma surrounding mental illness. This research aims to assess the mental health status of slum dwellers in the aftermath of COVID-19. Psychological well-being, post-traumatic stress disorder (PTSD), anxiety and depression symptoms were evaluated through structured face-to-face interviews with 404 individuals from July to September 2023. More than half of the participants experienced poor mental well-being, while women tended to have high symptoms of depression (35%) and PTSD (18%). Slum dwellers who experienced food scarcity and used unimproved or community latrines during the pandemic were more likely to report symptoms of PTSD. Furthermore, those who experienced any crime or domestic violence (OR = 2.19; 95% CI: 1.08–4.45) and lost their jobs (OR = 1.56; 95% CI: 1.04–2.33) during the pandemic were more likely to report poor mental health. Therefore, the vulnerable population urgently needs targeted interventions, such as skill-building opportunities for the unemployed, gender-segregated sanitation facilities and training programs to support their mental health. Prioritizing mental health awareness campaigns and establishing strong social safety nets can help communities become more resilient to future pandemics and crises.
Objective: This study aimed to adapt the COVID-19 Pandemic-Related Perceived Stress Scale, which is used to evaluate the prevalence of perceived stress and variables associated with the COVID-19 pandemic, into Turkish and test its validity and reliability on nursing students. Methods: Methodological-descriptive-cross-sectional design. The data were collected using the “Sociodemographic Data Form” bearing the introductory information and the COVID-19 Pandemic-Related Perceived Stress Scale. The sample of this methodological-descriptive-cross-sectional study consisted of 412 students studying at the Nursing Department affiliated to the Faculty of Health Sciences in the spring semester of the 2021-2022 academic year and volunteered to participate in the study. Language, content, face, and construct validity were investigated in the adaptation and testing phases; internal consistency and test-retest methods were used for the reliability of the scale. Results: The fit index of the COVID-19 Pandemic-Related Perceived Stress Scale was found to be above 0.80 in terms of both items and the scale. The results of the content validity analysis revealed that the scale confirmed the language and content validity. The scale measures the subject as adequately as the original construct for the Turkish sample. Conclusions: The scale is confirmed to be a valid and reliable tool that can be used to evaluate the current mental state/problems.
Objective
This study examined the impact of the COVID‐19 pandemic on incidence rates of anorexia nervosa (AN) and bulimia nervosa (BN) in Dutch primary care by comparing pre‐pandemic (2015–2019) and in‐pandemic (2020–2022) periods. We hypothesized that the incidence of AN and BN would increase during the pandemic.
Method
This retrospective cohort study used data from general practitioners' electronic health records from the Nivel Primary Care Database, representing ~0.8% of the Dutch population. Incident AN and BN cases were identified using DSM‐5 criteria. Incidence rates (IR) per 100,000 person‐years were calculated and compared using incidence rate ratios (IRRs).
Results
Overall incidence rates of AN and BN did not increase significantly during the pandemic (AN: IRR = 1.2, 95% CI = 0.8–1.8; BN: IRR = 0.9, 95% CI = 0.5–1.8). Non‐significant increases in AN were observed among females overall (+29%, IRR = 1.3, 95% CI = 0.9–2.0) and among 10‐ to 14‐year‐old females (+28%, IRR = 1.3, 95% CI = 0.4–3.7). The BN incidence decreased significantly among females aged 20–24 years from 53.8 to 10.7 per 100,000 person‐years (IRR = 0.2, 95% CI = 0.0–0.9).
Discussion
Contrary to our hypothesis, we did not find increased incidence rates during the pandemic. The overall incidence of AN among females increased non‐significantly by 29%. The previously observed rising trend in AN among 10‐ to 14‐year‐old females in 1985–2019 did not have a significant sequel into the pandemic era, although it increased by 28%. The BN incidence remained stable overall and decreased significantly among young adult females.
Mentoring and coaching are fundamental strategies in the career development of nurses in tertiary healthcare settings fostering professional growth, clinical competency and job satisfaction. This study explores the effectiveness of mentorship programs identifying key challenges and areas for improvement. The findings indicate that while most nursing mentors express confidence in their ability to guide students, inconsistencies in structured mentorship programs and feedback mechanisms hinder their overall effectiveness. Many mentors demonstrate motivation to engage in student development yet a lack of formal training and standardized mentoring approaches results in varied mentorship quality. The research highlights a significant gap in structured goal-setting with some mentors failing to provide clear learning objectives or engage in progress discussions limiting student competency development. Additionally, while some mentors provide constructive feedback, others struggle with balancing positive reinforcement and critical evaluations which can negatively impact student motivation and learning outcomes. The study also emphasizes the absence of formal mentorship programs in many healthcare institutions leading to missed opportunities for skill transfer, leadership development and professional networking among nurses. To address these challenges, the study suggests implementing structured mentorship programs providing targeted mentor training and incorporating regular feedback and reflection practices into nursing education. By improving mentorship consistency and effectiveness healthcare institutions can enhance job satisfaction, strengthen clinical competency and cultivate a well-prepared nursing workforce capable of meeting the demands of modern healthcare. This research underscores the critical need for institutional support in establishing sustainable mentorship programs that not only benefit nursing professionals but also improve overall patient care and healthcare system efficiency.
Purpose
This study aims to identify the key factors contributing to mental health issues among home-quarantined university students in Bangladesh during the COVID-19 pandemic and analyze how these factors affect their psychological well-being.
Design/methodology/approach
This study adopted a positivist paradigm and used a cross-sectional design. Data were collected from 480 public university students in Bangladesh using a snowball sampling technique. A 22-item standardized questionnaire was administered through Google Form, with responses gathered on a four-point Likert scale. SPSS v. 25 and SmartPLS v. 3.0 were used for data analysis.
Findings
The results indicate that stagnation in the educational system (SES), social interaction and communication changes (SICC), economic crisis (EC) and infrastructural and technological insufficiency (ITI) significantly impact students’ mental health (MDS). All four hypotheses showed p -values below 0.05, with beta values of 0.183, 0.181, 0.242 and 0.262, respectively. The coefficient of determination ( R² ) was 0.420, demonstrating a substantial collective impact on students’ mental health.
Originality/value
This study offers valuable information about how the COVID-19 pandemic affected the mental health of university students in Bangladesh and suggests ways to reduce mental stress in similar situations.
The current SARS-CoV-2 pandemic has placed the entire world in a liminal position whereby our well-rehearsed and predictive practices have been deeply shaken. Within this context of liminality, studies point to potential distress among healthcare workers who are taking care of COVID-19 patients. Most studies focus on emotional distress of frontline healthcare workers as fixed entities. The current approach perceives emotion as a type of connection with social worlds. This article focuses on contextual acts of emoting and is organized around personal, situational, and cultural features of nine frontline medical doctors affiliated with ten hospitals in Metro-Manila who were taking care of COVID-19 patients when they told their stories from March to June 2020. The methodological approach was based on self-reporting narratives that contextualized emotional experiences. Discussions are based on the researcher's subjectivity as an analytical tool since face-to-face fieldwork was not possible. Findings highlight the great variety of emoting events in comparison with the classical focus on six basic universal emotions. Furthermore, words used by the participants only partially expressed what they were going through, pointing to the limitations of our linguistic repertoire to sufficiently represent human experiences. The final insight shows how emotional life appears to be more about contextualized events rather than isolated psychological entities.
Introduction: The COVID-19 pandemic significantly altered the lifestyles of children and adolescents, with school closures and social isolation affecting their mental health. This study aims to evaluate a predictive model incorporating sociodemographic (age and sex), pandemic-related (infection or death of close ones), and psychological variables (rumination, coping strategies) to predict PTSS and PTG in Chilean youth during the pandemic.Methods: The study included 1,466 children and adolescents from Chile, with 48.6% girls and 51.4% boys, aged 10 to 17 years. Bivariate relationships and hierarchical linear regression models were evaluated.Results: Productive and unproductive coping strategies, intrusive and deliberate rumination, gender, age, and pandemic-related variables, such as the death of a loved one, predicted PTSS and PTG.Conclusions: These findings enhance understanding of factors related to PTG and improve the ability to predict PTSS and PTG in children and adolescents after stressful events. They also inform potential strategies for interventions to mitigate the effects of adverse events on mental health.
The aim of this study was to examine the features of psychopathological symptoms (anxiety, depression, insomnia, suicidal risk) in individuals who experienced forced social isolation during the COVID-19 pandemic. The study included 161 respondents: 81 individuals who were in social isolation and 80 individuals in a control group who functioned normally. Data were collected using questionnaires that included the Hamilton Anxiety Rating Scale (HAM-A), the Hamilton Depression Rating Scale (HAM-D), the Insomnia Severity Index (ISI), the Suicide Risk Scale (SRS), and the Perceived Stress Scale (PSS). The study group showed higher levels of anxiety and depression compared to the control group. Severe anxiety was observed in 32.1 % of the study group versus 6.3 % in the control group (p < 0.01), and severe depression in 32.1 % of the study group versus 5 % in the control group (p < 0.01). Severe insomnia was found in 16.1 % of the study group compared to 3.7 % in the control group (p < 0.01). The average level of suicidal risk was significantly higher in the study group (17.3 %) compared to the control group, where it was absent (p < 0.01). The level of perceived stress was also significantly higher in the study group. A high level of stress was found in 25.9 % of the study group, while it was absent in the control group (p < 0.01). Conditions of forced social isolation during the COVID-19 pandemic had a significant negative impact on the psychoemotional state and cognitive functions of individuals. The high levels of anxiety, depression, insomnia, suicidal risk, and increased perceived stress indicate the need to develop and implement effective psychotherapeutic and psychosocial programs to support mental health in quarantine and social isolation conditions.
Background
The cumulative effects of long-term exposure to pandemic-related stressors and the severity of social restrictions may have been important determinants of mental distress in the time of COVID-19.
Aim
This study aimed to investigate mental health among a cohort of Chinese university students over a 28-month period, focusing on the effects of lockdown type.
Methods
Depression, anxiety, stress and fear of COVID-19 infection were measured ten times among 188 Chinese students (females 77.7%, mean age = 19.8, s.d. age = 0.97), every 3 months: from prior to the emergence of COVID-19 in November 2019 (T1) to March 2022 (T10).
Results
Initially depression, anxiety and stress dipped from T1 to T2, followed by a sudden increase at T3 and a slow upward rise over the remainder of the study period (T3 to T10). When locked down at university, participants showed greater mental distress compared with both home lockdown ( d = 0.35–0.48) and a no-lockdown comparison period ( d = 0.28–0.40). Conversely, home lockdown was associated with less anxiety and stress ( d = 0.19 and 0.21, respectively), but not with depression ( d = 0.13) compared with a no-lockdown period.
Conclusions
This study highlights the cumulative effects of exposure to COVID-19 stressors over time. It also suggests that the way in which a lockdown is carried out can impact the well-being of those involved. Some forms of lockdown appear to pose a greater threat to mental health than others.
Suicidal behavior among older military veterans is an important medical and social problem. The goal of this literature review is to discuss this underappreciated issue and identify suicide preventive interventions that can be utilized with the older military veteran population. Older veterans experience psychiatric, medical, and social problems associated with their age and/or military experience that can contribute to suicide risk. These problems include relationship losses through death or estrangement, depression, cognitive decline, loneliness, isolation, frailty, mobility issues, and chronic pain. Therefore, older veterans face a unique set of challenges. Suicide prevention in older veterans should take a multipronged approach which includes screening for suicidality, management of psychiatric and medical disorders, social assistance, safety planning, lethal means restriction, and involving family members in the veteran’s healthcare. Family members should be included in the safety planning process when possible. Gatekeeper training programs can be utilized to train individuals who are working with older veterans to reduce suicides amongst this age group.
Background
Little is known about changes in child well‐being and family quality of life (QoL) among children seeking emergency department care because of mental health concerns over the course of the pandemic.
Methods
Prospective cohort study of children < 18 who visited two paediatric EDs in Alberta, Canada, for an acute mental health concern. Early and late pandemic time periods were defined as 15 March 2020–14 March 2021 and 1 July 2021–30 June 2022, respectively. The Stirling Children's Well‐being and Warwick–Edinburgh Mental Well‐being scales quantified well‐being; the Family Quality of Life Scale assessed family QoL. These scales were completed as soon as possible following the ED visit. Linear regression models assessed the association between pandemic period and the change in well‐being and family QoL.
Results
One thousand four hundred four children were enrolled during the study time periods (50.4% early, 49.6% late). Seventy‐two percent (1009/1404) of participants were White, 53.8% (744/1404) were female, and the median age was 13 (IQR, 11–15) years. Well‐being remained unchanged between time periods, whereas family QoL was lower in the late pandemic time period than in the early period (mean difference: −2.16, 95% CI: −3.79, −0.53; p = 0.01). Among children < 13 years, previous mental health care and requiring inpatient admission were negatively associated with well‐being. Having an autism diagnosis and a comprehensive ED mental health evaluation were negatively associated with well‐being in older children.
Conclusions
Reduced family QoL may signal stressors experienced by caregivers and the lingering consequences of the pandemic. Resources that address well‐being and support the family unit are needed to improve the mental health of children.
Introduction
The COVID-19 pandemic has led to the implementation of social distancing measures on an unprecedented scale, but their impacts on the mental health of the general public, especially in places with strict and prolonged restrictions, are not well understood. This study explored the Hong Kong public’s views on social distancing measures that were implemented approximately two years into the pandemic and examined how these perceptions influence their stay-at-home motivation and mental health based on Protection Motivation Theory (PMT).
Design
A two-phase sequential exploratory mixed-methods study was conducted.
Setting
Data were collected as part of a larger study of a universal online public health campaign in Hong Kong.
Participants
First, qualitative interviews with 26 participants from diverse backgrounds explored their views on COVID-19 and social distancing measures. Subsequently, a quantitative online survey of 1025 participants from the general population examined the relationship between PMT constructs, stay-at-home motivation, and mental health.
Outcome measures
Mental health and PMT constructs, including protective motivation, perceived severity, perceived vulnerability, self-efficacy, response cost, and response efficacy.
Results
The qualitative results identified three themes: ‘the inescapable and unpredictable nature of COVID-19’, ‘stay-at-home impacts all facets of life’, and ‘the realities and challenges of social distancing during a pandemic’. Subsequently, quantitative findings showed that most PMT constructs, such as perceived severity (ß=0.21, 95% CI=0.15–0.27), perceived vulnerability (ß=0.24, 95% CI=0.18–0.30), self-efficacy (ß=0.27, 95% CI=0.20–0.34) and response efficacy (ß=0.09, 95% CI=0.02–0.15), were associated with stay-at-home motivation (all p<0.01), except for response cost. Higher perceived severity (ß=1.42–1.74), perceived vulnerability (ß=0.93–1.36), and response cost (ß=1.29–1.64) were associated with poorer mental health.
Conclusion
This study examined the public perceptions and experiences of strict and prolonged social distancing measures two years into a global pandemic. The findings highlighted the significance of using the PMT model to understand the factors influencing stay-at-home intentions and their mental health during the pandemic. The findings provide valuable insights to guide the development and implementation of future public health interventions.
Wprowadzenie
Potrzeby w zakresie zdrowia psychicznego osób przewlekle chorych stanowią stałe wyzwanie dla zdrowia publicznego, dodatkowo spotęgowane przez pandemię choroby koronawirusowej ( coronavirus disease 2019 – COVID-19). W niniejszym badaniu przeanalizowano zmiany w korzystaniu z usług zdrowia psychicznego przez tę populację w Polsce w trzech okresach: przedpandemicznym (2018–2019), pandemicznym (2020–2021) i popandemicznym (2022–2023). Celem analizy było zidentyfikowanie trendów w korzystaniu z usług z zakresu zdrowia psychicznego przez osoby przewlekle chore, wskazanie różnic regionalnych i diagnostycznych, a także ocena wpływu pandemii na świadczenie usług.
Materiał i metody
W badaniu retrospektywnym o charakterze obserwacyjnym wykorzystano zanonimizowane dane z bazy Narodowego Funduszu Zdrowia (NFZ). Dane obejmowały roczną liczbę pacjentów, rodzaje usług, rozkład regionalny oraz diagnozy. Analizy statystyczne, w tym testy t, testy chi-kwadrat oraz analiza wariancji (ANOVA), oceniały różnice między poszczególnymi okresami i regionami.
Wyniki
Korzystanie z usług zdrowia psychicznego wzrosło podczas pandemii o 40% w porównaniu z okresem przedpandemicznym, z telekonsultacjami stanowiącymi 50% usług. Po pandemii korzystanie z usług zmniejszyło się o 15%, ale pozostało o 20% wyższe niż przed pandemią. Zauważono istotne różnice regionalne, przy czym na obszarach miejskich odnotowano większy wzrost korzystania z usług niż na obszarach wiejskich. Największy wzrost liczby pacjentów dotyczył tych z chorobami nowotworowymi, chorobami układu oddechowego i sercowo-naczyniowego.
Wnioski
Pandemia znacząco wpłynęła na sposób świadczenia usług w zakresie zdrowia psychicznego dla osób przewlekle chorych. Utrzymanie innowacji, takich jak telemedycyna, oraz zwrócenie uwagi na różnice regionalne są kluczowe dla zapewnienia równego dostępu do opieki i zaspokojenia bieżących potrzeb zdrowia psychicznego tej wrażliwej populacji.
To examine how individuals with anorexia nervosa expressed and navigated their experiences during the COVID-19 pandemic through analysis of social media discourse, with particular attention to the mediation of lived experience through digital platforms. The study analyzed 155 English-language tweets containing keywords related to anorexia nervosa and COVID-19, collected over a 14-month period using systematic data collection protocols. Content underwent rigorous thematic analysis following Braun and Clarke's a (Journal of Qualitative Studies on Health and Well-Being, 9,2014) methodological framework, with two independent coders achieving 84% reliability in identifying semantic themes through iterative analytical refinement. Analysis revealed five interconnected themes characterizing the technological mediation of pandemic experiences: (1) The dialectic between visibility and concealment in digital spaces; (2) Reconfiguration of isolation and social connection through online platforms; (3) Digital expressions of spatial boundaries and safety during restrictions; (4) Virtual articulation of movement and embodiment; and (5) Technological mediation of pandemic-related body perception. These themes illuminate how social media platforms simultaneously enabled expression of distress while shaping manifestations of the “anorexic voice” during unprecedented social disruption. This analysis of naturalistic social media discourse provides crucial insight into how individuals with anorexia nervosa navigated periods of widespread disruption, while revealing the complex role of digital platforms in mediating these experiences. The findings contribute to understanding both immediate clinical implications and broader theoretical frameworks around technological mediation of eating disorder experiences during social restriction periods.
Altered olfactory function is a common symptom of COVID-19, but its etiology is unknown. A key question is whether SARS-CoV-2 (CoV-2) – the causal agent in COVID-19 – affects olfaction directly, by infecting olfactory sensory neurons or their targets in the olfactory bulb, or indirectly, through perturbation of supporting cells. Here we identify cell types in the olfactory epithelium and olfactory bulb that express SARS-CoV-2 cell entry molecules. Bulk sequencing demonstrated that mouse, non-human primate and human olfactory mucosa expresses two key genes involved in CoV-2 entry, ACE2 and TMPRSS2. However, single cell sequencing revealed that ACE2 is expressed in support cells, stem cells, and perivascular cells, rather than in neurons. Immunostaining confirmed these results and revealed pervasive expression of ACE2 protein in dorsally-located olfactory epithelial sustentacular cells and olfactory bulb pericytes in the mouse. These findings suggest that CoV-2 infection of non-neuronal cell types leads to anosmia and related disturbances in odor perception in COVID-19 patients.
Importance
The outbreak of coronavirus disease 2019 (COVID-19) in Wuhan, China, is serious and has the potential to become an epidemic worldwide. Several studies have described typical clinical manifestations including fever, cough, diarrhea, and fatigue. However, to our knowledge, it has not been reported that patients with COVID-19 had any neurologic manifestations.
Objective
To study the neurologic manifestations of patients with COVID-19.
Design, Setting, and Participants
This is a retrospective, observational case series. Data were collected from January 16, 2020, to February 19, 2020, at 3 designated special care centers for COVID-19 (Main District, West Branch, and Tumor Center) of the Union Hospital of Huazhong University of Science and Technology in Wuhan, China. The study included 214 consecutive hospitalized patients with laboratory-confirmed diagnosis of severe acute respiratory syndrome coronavirus 2 infection.
Main Outcomes and Measures
Clinical data were extracted from electronic medical records, and data of all neurologic symptoms were checked by 2 trained neurologists. Neurologic manifestations fell into 3 categories: central nervous system manifestations (dizziness, headache, impaired consciousness, acute cerebrovascular disease, ataxia, and seizure), peripheral nervous system manifestations (taste impairment, smell impairment, vision impairment, and nerve pain), and skeletal muscular injury manifestations.
Results
Of 214 patients (mean [SD] age, 52.7 [15.5] years; 87 men [40.7%]) with COVID-19, 126 patients (58.9%) had nonsevere infection and 88 patients (41.1%) had severe infection according to their respiratory status. Overall, 78 patients (36.4%) had neurologic manifestations. Compared with patients with nonsevere infection, patients with severe infection were older, had more underlying disorders, especially hypertension, and showed fewer typical symptoms of COVID-19, such as fever and cough. Patients with more severe infection had neurologic manifestations, such as acute cerebrovascular diseases (5 [5.7%] vs 1 [0.8%]), impaired consciousness (13 [14.8%] vs 3 [2.4%]), and skeletal muscle injury (17 [19.3%] vs 6 [4.8%]).
Conclusions and Relevance
Patients with COVID-19 commonly have neurologic manifestations. During the epidemic period of COVID-19, when seeing patients with neurologic manifestations, clinicians should suspect severe acute respiratory syndrome coronavirus 2 infection as a differential diagnosis to avoid delayed diagnosis or misdiagnosis and lose the chance to treat and prevent further transmission.
Posttraumatic stress symptoms and attitude toward crisis mental health services among clinically stable patients with COVID-19 in China - Hai-Xin Bo, Wen Li, Yuan Yang, Yu Wang, Qinge Zhang, Teris Cheung, Xinjuan Wu, Yu-Tao Xiang
Importance
Health care workers exposed to coronavirus disease 2019 (COVID-19) could be psychologically stressed.
Objective
To assess the magnitude of mental health outcomes and associated factors among health care workers treating patients exposed to COVID-19 in China.
Design, Settings, and Participants
This cross-sectional, survey-based, region-stratified study collected demographic data and mental health measurements from 1257 health care workers in 34 hospitals from January 29, 2020, to February 3, 2020, in China. Health care workers in hospitals equipped with fever clinics or wards for patients with COVID-19 were eligible.
Main Outcomes and Measures
The degree of symptoms of depression, anxiety, insomnia, and distress was assessed by the Chinese versions of the 9-item Patient Health Questionnaire, the 7-item Generalized Anxiety Disorder scale, the 7-item Insomnia Severity Index, and the 22-item Impact of Event Scale–Revised, respectively. Multivariable logistic regression analysis was performed to identify factors associated with mental health outcomes.
Results
A total of 1257 of 1830 contacted individuals completed the survey, with a participation rate of 68.7%. A total of 813 (64.7%) were aged 26 to 40 years, and 964 (76.7%) were women. Of all participants, 764 (60.8%) were nurses, and 493 (39.2%) were physicians; 760 (60.5%) worked in hospitals in Wuhan, and 522 (41.5%) were frontline health care workers. A considerable proportion of participants reported symptoms of depression (634 [50.4%]), anxiety (560 [44.6%]), insomnia (427 [34.0%]), and distress (899 [71.5%]). Nurses, women, frontline health care workers, and those working in Wuhan, China, reported more severe degrees of all measurements of mental health symptoms than other health care workers (eg, median [IQR] Patient Health Questionnaire scores among physicians vs nurses: 4.0 [1.0-7.0] vs 5.0 [2.0-8.0]; P = .007; median [interquartile range {IQR}] Generalized Anxiety Disorder scale scores among men vs women: 2.0 [0-6.0] vs 4.0 [1.0-7.0]; P < .001; median [IQR] Insomnia Severity Index scores among frontline vs second-line workers: 6.0 [2.0-11.0] vs 4.0 [1.0-8.0]; P < .001; median [IQR] Impact of Event Scale–Revised scores among those in Wuhan vs those in Hubei outside Wuhan and those outside Hubei: 21.0 [8.5-34.5] vs 18.0 [6.0-28.0] in Hubei outside Wuhan and 15.0 [4.0-26.0] outside Hubei; P < .001). Multivariable logistic regression analysis showed participants from outside Hubei province were associated with lower risk of experiencing symptoms of distress compared with those in Wuhan (odds ratio [OR], 0.62; 95% CI, 0.43-0.88; P = .008). Frontline health care workers engaged in direct diagnosis, treatment, and care of patients with COVID-19 were associated with a higher risk of symptoms of depression (OR, 1.52; 95% CI, 1.11-2.09; P = .01), anxiety (OR, 1.57; 95% CI, 1.22-2.02; P < .001), insomnia (OR, 2.97; 95% CI, 1.92-4.60; P < .001), and distress (OR, 1.60; 95% CI, 1.25-2.04; P < .001).
Conclusions and Relevance
In this survey of heath care workers in hospitals equipped with fever clinics or wards for patients with COVID-19 in Wuhan and other regions in China, participants reported experiencing psychological burden, especially nurses, women, those in Wuhan, and frontline health care workers directly engaged in the diagnosis, treatment, and care for patients with COVID-19.
The 2019 novel coronavirus (COVID-2019) has led to a serious outbreak of often severe respiratory disease, which originated in China and has quickly become a global pandemic, with far-reaching consequences that are unprecedented in the modern era. As public health officials seek to contain the virus and mitigate the deleterious effects on worldwide population health, a related threat has emerged: global media exposure to the crisis. We review research suggesting that repeated media exposure to community crisis can lead to increased anxiety, heightened stress responses that can lead to downstream effects on health, and misplaced health-protective and help-seeking behaviors that can overburden health care facilities and tax available resources. We draw from work on previous public health crises (i.e., Ebola and H1N1 outbreaks) and other collective trauma (e.g., terrorist attacks) where media coverage of events had unintended consequences for those at relatively low risk for direct exposure, leading to potentially severe public health repercussions. We conclude with recommendations for individuals, researchers, and public health officials with respect to receiving and providing effective communications during a public health crisis.
COVID-19 (Corona Virus Disease 2019) has significantly resulted in a large number of psychological consequences. The aim of this study is to explore the impacts of COVID-19 on people’s mental health, to assist policy makers to develop actionable policies, and help clinical practitioners (e.g., social workers, psychiatrists, and psychologists) provide timely services to affected populations. We sample and analyze the Weibo posts from 17,865 active Weibo users using the approach of Online Ecological Recognition (OER) based on several machine-learning predictive models. We calculated word frequency, scores of emotional indicators (e.g., anxiety, depression, indignation, and Oxford happiness) and cognitive indicators (e.g., social risk judgment and life satisfaction) from the collected data. The sentiment analysis and the paired sample t-test were performed to examine the differences in the same group before and after the declaration of COVID-19 on 20 January, 2020. The results showed that negative emotions (e.g., anxiety, depression and indignation) and sensitivity to social risks increased, while the scores of positive emotions (e.g., Oxford happiness) and life satisfaction decreased. People were concerned more about their health and family, while less about leisure and friends. The results contribute to the knowledge gaps of short-term individual changes in psychological conditions after the outbreak. It may provide references for policy makers to plan and fight against COVID-19 effectively by improving stability of popular feelings and urgently prepare clinical practitioners to deliver corresponding therapy foundations for the risk groups and affected people.
Background
Coronavirus disease 2019 (COVID-19), formerly known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and 2019 novel coronavirus (2019-nCoV), was first identified in December 2019 in Wuhan City, China. Structural equation modeling (SEM) is a multivariate analysis method to determine the structural relationship between measured variables. This observational study aimed to use SEM to determine the effects of social support on sleep quality and function of medical staff who treated patients with COVID-19 in January and February 2020 in Wuhan, China.
Material/Methods
A one-month cross-sectional observational study included 180 medical staff who treated patients with COVID-19 infection. Levels of anxiety, self-efficacy, stress, sleep quality, and social support were measured using the and the Self-Rating Anxiety Scale (SAS), the General Self-Efficacy Scale (GSES), the Stanford Acute Stress Reaction (SASR) questionnaire, the Pittsburgh Sleep Quality Index (PSQI), and the Social Support Rate Scale (SSRS), respectively. Pearson’s correlation analysis and SEM identified the interactions between these factors.
Results
Levels of social support for medical staff were significantly associated with self-efficacy and sleep quality and negatively associated with the degree of anxiety and stress. Levels of anxiety were significantly associated with the levels of stress, which negatively impacted self-efficacy and sleep quality. Anxiety, stress, and self-efficacy were mediating variables associated with social support and sleep quality.
Conclusions
SEM showed that medical staff in China who were treating patients with COVID-19 infection during January and February 2020 had levels of anxiety, stress, and self-efficacy that were dependent on sleep quality and social support.
Background: The 2019 coronavirus disease (COVID-19) epidemic is a public health emergency of international concern and poses a challenge to psychological resilience. Research data are needed to develop evidence-driven strategies to reduce adverse psychological impacts and psychiatric symptoms during the epidemic. The aim of this study was to survey the general public in China to better understand their levels of psychological impact, anxiety, depression, and stress during the initial stage of the COVID-19 outbreak. The data will be used for future reference. Methods: From 31 January to 2 February 2020, we conducted an online survey using snowball sampling techniques. The online survey collected information on demographic data, physical symptoms in the past 14 days, contact history with COVID-19, knowledge and concerns about COVID-19, precautionary measures against COVID-19, and additional information required with respect to COVID-19. Psychological impact was assessed by the Impact of Event Scale-Revised (IES-R), and mental health status was assessed by the Depression, Anxiety and Stress Scale (DASS-21). Results: This study included 1210 respondents from 194 cities in China. In total, 53.8% of respondents rated the psychological impact of the outbreak as moderate or severe; 16.5% reported moderate to severe depressive symptoms; 28.8% reported moderate to severe anxiety symptoms; and 8.1% reported moderate to severe stress levels. Most respondents spent 20–24 h per day at home (84.7%); were worried about their family members contracting COVID-19 (75.2%); and were satisfied with the amount of health information available (75.1%). Female gender, student status, specific physical symptoms (e.g., myalgia, dizziness, coryza), and poor self-rated health status were significantly associated with a greater psychological impact of the outbreak and higher levels of stress, anxiety, and depression (p < 0.05). Specific up-to-date and accurate health information (e.g., treatment, local outbreak situation) and particular precautionary measures (e.g., hand hygiene, wearing a mask) were associated with a lower psychological impact of the outbreak and lower levels of stress, anxiety, and depression (p < 0.05). Conclusions: During the initial phase of the COVID-19 outbreak in China, more than half of the respondents rated the psychological impact as moderate-to-severe, and about one-third reported moderate-to-severe anxiety. Our findings identify factors associated with a lower level of psychological impact and better mental health status that can be used to formulate psychological interventions to improve the mental health of vulnerable groups during the COVID-19 epidemic.
The Coronavirus Disease 2019 (COVID-19) epidemic emerged in Wuhan, China, spread nationwide and then onto half a dozen other countries between December 2019 and early 2020. The implementation of unprecedented strict quarantine measures in China has kept a large number of people in isolation and affected many aspects of people’s lives. It has also triggered a wide variety of psychological problems, such as panic disorder, anxiety and depression. This study is the first nationwide large-scale survey of psychological distress in the general population of China during the COVID-19 epidemic.
Following the severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV), another highly pathogenic coronavirus named SARS-CoV-2 (previously known as 2019-nCoV) emerged in December 2019 in Wuhan, China, and rapidly spreads around the world. This virus shares highly homological sequence with SARS-CoV, and causes acute, highly lethal pneumonia (COVID-19) with clinical symptoms similar to those reported for SARS-CoV and MERS-CoV. The most characteristic symptom of COVID-19 patients is respiratory distress, and most of the patients admitted to the intensive care could not breathe spontaneously. Additionally, some COVID-19 patients also showed neurologic signs such as headache, nausea and vomiting. Increasing evidence shows that coronavriruses are not always confined to the respiratory tract and that they may also invade the central nervous system inducing neurological diseases. The infection of SARS-CoV has been reported in the brains from both patients and experimental animals, where the brainstem was heavily infected. Furthermore, some coronaviruses have been demonstrated able to spread via a synapse-connected route to the medullary cardiorespiratory center from the mechano- and chemoreceptors in the lung and lower respiratory airways. In light of the high similarity between SARS-CoV and SARS-CoV2, it is quite likely that the potential invasion of SARS-CoV2 is partially responsible for the acute respiratory failure of COVID-19 patients. Awareness of this will have important guiding significance for the prevention and treatment of the SARS-CoV-2-induced respiratory failure. (229 words) This article is protected by copyright. All rights reserved.
Structure of the nCoV trimeric spike
The World Health Organization has declared the outbreak of a novel coronavirus (2019-nCoV) to be a public health emergency of international concern. The virus binds to host cells through its trimeric spike glycoprotein, making this protein a key target for potential therapies and diagnostics. Wrapp et al. determined a 3.5-angstrom-resolution structure of the 2019-nCoV trimeric spike protein by cryo–electron microscopy. Using biophysical assays, the authors show that this protein binds at least 10 times more tightly than the corresponding spike protein of severe acute respiratory syndrome (SARS)–CoV to their common host cell receptor. They also tested three antibodies known to bind to the SARS-CoV spike protein but did not detect binding to the 2019-nCoV spike protein. These studies provide valuable information to guide the development of medical counter-measures for 2019-nCoV.
Science , this issue p. 1260
Respiratory viruses infect the human upper respiratory tract, mostly causing mild diseases. However, in vulnerable populations, such as newborns, infants, the elderly and immune-compromised individuals, these opportunistic pathogens can also affect the lower respiratory tract, causing a more severe disease (e.g., pneumonia). Respiratory viruses can also exacerbate asthma and lead to various types of respiratory distress syndromes. Furthermore, as they can adapt fast and cross the species barrier, some of these pathogens, like influenza A and SARS-CoV, have occasionally caused epidemics or pandemics, and were associated with more serious clinical diseases and even mortality. For a few decades now, data reported in the scientific literature has also demonstrated that several respiratory viruses have neuroinvasive capacities, since they can spread from the respiratory tract to the central nervous system (CNS). Viruses infecting human CNS cells could then cause different types of encephalopathy, including encephalitis, and long-term neurological diseases. Like other well-recognized neuroinvasive human viruses, respiratory viruses may damage the CNS as a result of misdirected host immune responses that could be associated with autoimmunity in susceptible individuals (virus-induced neuro-immunopathology) and/or viral replication, which directly causes damage to CNS cells (virus-induced neuropathology). The etiological agent of several neurological disorders remains unidentified. Opportunistic human respiratory pathogens could be associated with the triggering or the exacerbation of these disorders whose etiology remains poorly understood. Herein, we present a global portrait of some of the most prevalent or emerging human respiratory viruses that have been associated with possible pathogenic processes in CNS infection, with a special emphasis on human coronaviruses.
Background: A major challenge in providing mental health interventions for young people is making such interventions accessible and appealing to those most in need. Online and app-based forms of therapy for mental health are burgeoning. It is therefore crucial to identify features that are most effective and engaging for young users.
Objectives: This study reports a systematic review and meta-analysis of digital mental health interventions and their effectiveness in addressing anxiety and depression in young people to determine factors that relate to outcomes, adherence, and engagement with such interventions.
Methods: A mixed methods approach was taken, including a meta-analysis of 9 randomized controlled trials that compared use of a digital intervention for depression in young people to a no-intervention control group, and 6 comparing the intervention to an active control condition. A thematic analysis and narrative synthesis of 41 studies was also performed.
Results: The pooled effect size of digital mental health interventions on depression in comparison to a no-intervention control was small (Cohen’s d = 0.33, 95% CI 0.11 to 0.55), while the pooled effect size of studies comparing an intervention group to an active control showed no significant differences (Cohen’s d = 0.14, 95% CI -.04 to 0.31). Pooled effect sizes were higher when supervision was involved (studies with no-intervention controls: Cohen’s d = 0.52, 95% CI 0.23 to 0.80; studies with active control: Cohen’s d = 0.49, 95% CI -0.11, 1.01). Engagement and adherence rates were low. Qualitative analysis revealed that users liked interventions with a game-like feel and relatable, interactive content. Educational materials were perceived as boring, and users were put off by non-appealing interfaces and technical glitches.
Conclusions: Digital interventions work better than no intervention to improve depression in young people when results of different studies are pooled together. However, these interventions may only be of clinical significance when use is highly supervised. Digital interventions do not work better than active alternatives regardless of the level of support. Future interventions need to move beyond the use of digital educational materials, considering other ways to attract and engage young people and to ensure relevance and appeal.
Background
Exercise may improve neuropsychiatric and cognitive symptoms in people with mental disorders, but the totality of the evidence is unclear. We conducted a meta-review of exercise in (1) serious mental illness (schizophrenia spectrum, bipolar disorder and major depression (MDD)); (2) anxiety and stress disorders; (3) alcohol and substance use disorders; (4) eating disorders (anorexia nervosa bulimia nervosa, binge eating disorders, and (5) other mental disorders (including ADHD, pre/post-natal depression).
Methods
Systematic searches of major databases from inception until 1/10/2018 were undertaken to identify meta-analyses of randomised controlled trials (RCTs) of exercise in people with clinically diagnosed mental disorders. In the absence of available meta-analyses for a mental disorder, we identified systematic reviews of exercise interventions in people with elevated mental health symptoms that included non-RCTs. Meta-analysis quality was assessed with the AMSTAR/+.
Results
Overall, we identified 27 systematic reviews (including 16 meta-analyses representing 152 RCTs). Among those with MDD, we found consistent evidence (meta-analyses = 8) that exercise reduced depression in children, adults and older adults. Evidence also indicates that exercise was more effective than control conditions in reducing anxiety symptoms (meta-analyses = 3), and as an adjunctive treatment for reducing positive and negative symptoms of schizophrenia (meta-analyses = 2). Regarding neurocognitive effects, exercise improved global cognition in schizophrenia (meta-analyses = 1), children with ADHD (meta-analyses = 1), but not in MDD (meta-analyses = 1). Among those with elevated symptoms, positive mental health benefits were observed for exercise in people with pre/post-natal depression, anorexia nervosa/bulimia nervosa, binge eating disorder, post-traumatic stress disorder and alcohol use disorders/substance use disorders. Adverse events were sparsely reported.
Conclusion
Our panoramic meta-overview suggests that exercise can be an effective adjunctive treatment for improving symptoms across a broad range of mental disorders.
Contemporary commentators describe the current period as "an era of fake news" in which misinformation, generated intentionally or unintentionally, spreads rapidly. Although affecting all areas of life, it poses particular problems in the health arena, where it can delay or prevent effective care, in some cases threatening the lives of individuals. While examples of the rapid spread of misinformation date back to the earliest days of scientific medicine, the internet, by allowing instantaneous communication and powerful amplification has brought about a quantum change. In democracies where ideas compete in the marketplace for attention, accurate scientific information, which may be difficult to comprehend and even dull, is easily crowded out by sensationalized news. In order to uncover the current evidence and better understand the mechanism of misinformation spread, we report a systematic review of the nature and potential drivers of health-related misinformation. We searched PubMed, Cochrane, Web of Science, Scopus and Google databases to identify relevant methodological and empirical articles published between 2012 and 2018. A total of 57 articles were included for full-text analysis. Overall, we observe an increasing trend in published articles on health-related misinformation and the role of social media in its propagation. The most extensively studied topics involving misinformation relate to vaccination, Ebola and Zika Virus, although others, such as nutrition, cancer, fluoridation of water and smoking also featured. Studies adopted theoretical frameworks from psychology and network science, while co-citation analysis revealed potential for greater collaboration across fields. Most studies employed content analysis, social network analysis or experiments, drawing on disparate disciplinary paradigms. Future research should examine susceptibility of different sociodemographic groups to misinformation and understand the role of belief systems on the intention to spread misinformation. Further interdisciplinary research is also warranted to identify effective and tailored interventions to counter the spread of health-related misinformation online.
The use of data generated passively by personal electronic devices, such as smartphones, to measure human function in health and disease has generated significant research interest. Particularly in psychiatry, objective, continuous quantitation using patients’ own devices may result in clinically useful markers that can be used to refine diagnostic processes, tailor treatment choices, improve condition monitoring for actionable outcomes, such as early signs of relapse, and develop new intervention models. If a principal goal for digital phenotyping is clinical improvement, research needs to attend now to factors that will help or hinder future clinical adoption. We identify four opportunities for research directed toward this goal: exploring intermediate outcomes and underlying disease mechanisms; focusing on purposes that are likely to be used in clinical practice; anticipating quality and safety barriers to adoption; and exploring the potential for digital personalized medicine arising from the integration of digital phenotyping and digital interventions. Clinical relevance also means explicitly addressing consumer needs, preferences, and acceptability as the ultimate users of digital phenotyping interventions. There is a risk that, without such considerations, the potential benefits of digital phenotyping are delayed or not realized because approaches that are feasible for application in healthcare, and the evidence required to support clinical commissioning, are not developed. Practical steps to accelerate this research agenda include the further development of digital phenotyping technology platforms focusing on scalability and equity, establishing shared data repositories and common data standards, and fostering multidisciplinary collaborations between clinical stakeholders (including patients), computer scientists, and researchers.
Background:
College students are increasingly reporting common mental health problems, such as depression and anxiety, and they frequently encounter barriers to seeking traditional mental health treatments. Digital mental health interventions, such as those delivered via the Web and apps, offer the potential to improve access to mental health treatment.
Objective:
This study aimed to review the literature on digital mental health interventions focused on depression, anxiety, and enhancement of psychological well-being among samples of college students to identify the effectiveness, usability, acceptability, uptake, and adoption of such programs.
Methods:
We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (registration number CRD42018092800), and the search strategy was conducted by a medical research librarian in the following databases: MEDLINE (Ovid), EMBASE (Elsevier), PsycINFO (EbscoHost), the Cochrane Library (Wiley), and Web of Science (Thomson Reuters) from the date of inception to April 2019. Data were synthesized using a systematic narrative synthesis framework, and formal quality assessments were conducted to address the risk of bias.
Results:
A total of 89 studies met the inclusion criteria. The majority of interventions (71/89, 80%) were delivered via a website, and the most common intervention was internet-based cognitive behavioral therapy (28, 31%). Many programs (33, 37%) featured human support in the form of coaching. The majority of programs were either effective (42, 47%) or partially effective (30, 34%) in producing beneficial changes in the main psychological outcome variables. Approximately half of the studies (45, 51%) did not present any usability or acceptability outcomes, and few studies (4, 4%) examined a broad implementation of digital mental health interventions on college campuses. Quality assessments revealed a moderate-to-severe risk of bias in many of the studies.
Conclusions:
Results suggest that digital mental health interventions can be effective for improving depression, anxiety, and psychological well-being among college students, but more rigorous studies are needed to ascertain the effective elements of these interventions. Continued research on improving the user experience of, and thus user engagement with, these programs appears vital for the sustainable implementation of digital mental health interventions on college campuses.
The established link between trauma-related media exposure and distress may be cyclical: Distress can increase subsequent trauma-related media consumption that promotes increased distress to later events. We tested this hypothesis in a 3-year longitudinal study following the 2013 Boston Marathon bombings and the 2016 Orlando Pulse nightclub massacre using a national U.S. sample ( N = 4165). Data were collected shortly after the bombings, 6 and 24 months post-bombings, and beginning 5 days after the Pulse nightclub massacre (approximately 1 year later; 36 months post-bombings). Bombing-related media exposure predicted posttraumatic stress symptoms (PTS) 6 months later; PTS predicted worry about future negative events 2 years after the bombings, which predicted increased media consumption and acute stress following the Pulse nightclub massacre 1 year later. Trauma-related media exposure perpetuates a cycle of high distress and media use.
Background
Child mental health problems are common. Previous studies have examined secular changes in their prevalence but have not assessed whether later outcomes have changed. We therefore aimed to test whether outcomes of child mental health problems have changed over a 40‐year period.
Methods
Three cohorts were utilized: The National Child Development Study (NCDS: N = 14,544, aged 7 in 1965), the Avon Longitudinal Study of Parents and Children (ALSPAC: N = 8,188, aged 7 in 1998), and the Millennium Cohort Study (MCS: N = 13,192, aged 7 in 2008). Mental health problems at age 7 were identified using the parent‐reported Rutter‐A scale (NCDS) and Strengths and Difficulties Questionnaire (ALSPAC and MCS). Associated outcomes were compared across cohorts: age 11 social functioning, age 16 exam attainment and age 16 mental health.
Results
Child mental health problems were common in each cohort (boys: 7.0%–9.7%; girls: 5.4%–8.4%). Child mental health problems became more strongly associated with social functioning problems (boys: NCDS OR = 1.95 (1.50, 2.53), MCS OR = 3.77 (2.89, 4.92); interaction p < .001; girls: NCDS OR = 1.69 (1.22, 2.33), MCS OR = 3.99 (3.04, 5.25), interaction p < .001), lower academic attainment for boys (NCDS OR = 0.49 (0.31, 0.78), ALSPAC OR = 0.30 (0.22, 0.41), interaction p = .009), and age 16 mental health problems (boys: NCDS d′ = 0.55 (0.38, 0.72), ALSPAC d′ = 0.95 (0.73, 1.16); interaction p = .004; girls: NCDS d′ = 0.50 (0.34, 0.65), ALSPAC d′ = 0.99 (0.78, 1.20); interaction p < .001).
Conclusions
Child mental health problems have become more strongly associated with negative social, educational and mental health outcomes in recent generations.
The purpose of this meta-analysis was to provide updated pooled effect sizes of evidence-based psychotherapies and medications for generalized anxiety disorder (GAD) and to investigate potential moderators of outcomes. Seventy-nine randomized controlled trials (RCT) including 11,002 participants with a diagnosis of GAD were included in a meta-analysis that tested the efficacy of psychotherapies or medications for GAD. Psychotherapy showed a medium to large effect size (g = 0.76) and medication showed a small effect size (g = 0.38) on GAD outcomes. Psychotherapy also showed a medium effect on depression outcomes (g = 0.64) as did medications (g = 0.59). Younger age was associated with a larger effect size for psychotherapy (p < 0.05). There was evidence of publication bias in psychotherapy studies. This analysis found a medium to large effect for empirically supported psychotherapy interventions on GAD outcomes and a small effect for medications on GAD outcomes. Both groups showed a medium effect on depression outcomes. Because medication studies had more placebo control conditions than inactive conditions compared to psychotherapy studies, effect sizes between the domains should not be compared directly. Patient age should be further investigated as a potential moderator in psychotherapy outcomes in GAD.
Objective:
Loneliness and social isolation are associated with depressive symptoms, cognitive and physical disabilities, and increased risk of mortality among older adults. Socially rewarding activities reduce loneliness, and neurobiological evidence suggests that these activities may activate neural reward systems in older adults to a greater extent than other rewarding experiences. The current study was designed to investigate whether engagement in social and interpersonal activities (i.e., exposure to social rewards) predicts subsequent increase in behavioral activation and reduction in depressive symptoms in reward exposure treatment for late-life depression.
Methods:
Forty-eight older adults without cognitive impairment and with major depression received nine sessions of "Engage" psychotherapy. Behavioral activation and depression severity were assessed by trained raters at baseline and weeks 6 and 9. Patients' weekly behavioral plans were categorized into three groups: 1) solitary activities; 2) social-group activities (attending a social gathering or a social setting such as church or a senior center); and 3) interpersonal-individual activities (engaging in an interpersonal interaction with a specific friend or family member).
Results:
Mixed-effects models showed reduction in depression severity and increase in behavioral activation over time. In linear regression models, a higher percentage of interpersonal-individual activities (but not solitary or social-group activities) predicted subsequent increase in behavioral activation and improvement of depression.
Conclusion:
These findings highlight the importance of understanding the effects of engagement in specific types of rewarding activities in behavioral activation treatments for late-life depression. Exposure to socially rewarding interpersonal interactions could contribute to the efficacy of psychotherapy for late-life depression.
Background: Access to internet-enabled technology and Web-based services has grown exponentially in recent decades. This growth potentially excludes some communities and individuals with mental health difficulties, who face a heightened risk of digital exclusion. However, it is unclear what factors may contribute to digital exclusion in this population.
Objective: To explore in detail the problems of digital exclusion in mental health service users and potential facilitators to overcome them.
Methods: We conducted semi-structured interviews with 20 mental health service users who were deemed digitally excluded. We recruited the participants from a large secondary mental health provider in South London, United Kingdom. We employed thematic analysis to identify themes and sub-themes relating to historical and extant reasons for digital exclusion and methods of overcoming it.
Results: There were three major themes that appeared to maintain digital exclusion: a perceived lack of knowledge, being unable to access the necessary technology and services owing to personal circumstances, and the barriers presented by mental health difficulties. Specific facilitators for overcoming digital exclusion included intrinsic motivation and a personalized learning format that reflects the individual’s unique needs and preferences.
Conclusions: Multiple factors contribute to digital exclusion among mental health service users, including material deprivation and mental health difficulties. This means that efforts to overcome digital exclusion must address the multiple deprivations individuals may face in the offline world in addition to their individual mental health needs. Additional facilitators include fostering an intrinsic motivation to overcome digital exclusion and providing a personalized learning format tailored to the individual’s knowledge gaps and preferred learning style.
In these times of rapid change, high levels of uncertainty, anxiety, social isolation and financial pressure, our mental health is likely at risk. Researchers are rightly ensuring that mental health research is included in the response to the COVID-19 pandemic. Here we reflect on ethical issues to consider when conducting research on self-harm, suicide, and broader impacts of COVID-19, in the midst of a global pandemic and provide some recommendations to consider when researching these topics.
In a recent review, we have suggested a neuroinvasive potential of SARS‐CoV‐2 and its possible role in the causation of acute respiratory failure of COVID‐19 patients (J Med Viol doi: 10.1002/jmv.25728), based upon the clinical and experimental data available on the past SARS‐CoV‐1 and the recent SARS‐CoV‐2 pandemic. In this article, we provide new evidences recently reported regarding the neurotropic potential of SARS‐CoV‐2 and respond to several comments on our previously published article. In addition, we also discuss the peculiar manifestations of respiratory failure in COVID‐19 patients and the possible involvement of nervous system.
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Recent reports suggest an association between COVID-19 and altered olfactory function. Here we analyze bulk and single cell RNA-Seq datasets to identify cell types in the olfactory epithelium that express molecules that mediate infection by SARS-CoV-2 (CoV-2), the causal agent in COVID-19. We find in both mouse and human datasets that olfactory sensory neurons do not express two key genes required for CoV-2 entry, ACE2 and TMPRSS2. In contrast, olfactory epithelial support cells and stem cells express both of these genes, as do cells in the nasal respiratory epithelium. Taken together, these findings suggest possible mechanisms through which CoV-2 infection could lead to anosmia or other forms of olfactory dysfunction.
Background:
Since December 2019, an outbreak of Coronavirus Disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, and is now becoming a global threat. We aimed to delineate and compare the immunologic features of severe and moderate COVID-19.
Methods:
In this retrospective study, the clinical and immunologic characteristics of 21 patients (17 male and 4 female) with COVID-19 were analyzed. These patients were classified as severe (11 cases) and moderate (10 cases) according to the Guidelines released by the National Health Commission of China.
Results:
The median age of severe and moderate cases was 61.0 and 52.0 years, respectively. Common clinical manifestations included fever, cough and fatigue. Compared to moderate cases, severe cases more frequently had dyspnea, lymphopenia, and hypoalbuminemia, with higher levels of alanine aminotransferase, lactate dehydrogenase, C-reactive protein, ferritin and D-dimer as well as markedly higher levels of IL-2R, IL-6, IL-10, and TNF-α. Absolute number of T lymphocytes, CD4+T and CD8+T cells decreased in nearly all the patients, and were markedly lower in severe cases (294.0, 177.5 and 89.0 × 106/L) than moderate cases (640.5, 381.5 and 254.0 × 106/L). The expressions of IFN-γ by CD4+T cells tended to be lower in severe cases (14.1%) than moderate cases (22.8%).
Conclusion:
The SARS-CoV-2 infection may affect primarily T lymphocytes particularly CD4+T and CD8+ T cells, resulting in decrease in numbers as well as IFN-γ production. These potential immunological markers may be of importance due to their correlation with disease severity in COVID-19.
The recent outbreak of coronavirus infectious disease 2019 (COVID-19) has gripped the world with apprehension and has evoked a scare of epic proportion regarding its potential to spread and infect humans worldwide. As we are in the midst of an ongoing pandemic of COVID-19, scientists are struggling to understand how it resembles and differs from the severe acute respiratory syndrome coronavirus (SARS-CoV) at the genomic and transcriptomic level. In a short time following the outbreak, it has been shown that, similar to SARS-CoV, COVID-19 virus exploits the angiotensin-converting enzyme 2 (ACE2) receptor to gain entry inside the cells. This finding raises the curiosity of investigating the expression of ACE2 in neurological tissue and determining the possible contribution of neurological tissue damage to the morbidity and mortality caused by COIVD-19. Here, we investigate the density of the expression levels of ACE2 in the CNS, the host–virus interaction and relate it to the pathogenesis and complications seen in the recent cases resulting from the COVID-19 outbreak. Also, we debate the need for a model for staging COVID-19 based on neurological tissue involvement.
Since December 2019, more than 79,000 people have been diagnosed with infection of the Corona Virus Disease 2019 (COVID-19). A large number of medical staff was sent to Wuhan city and Hubei province to aid COVID-19 control. Psychological stress, especially vicarious traumatization caused by the COVID-19 pandemic, should not be ignored. To address this concern, the study employed a total of 214 general public and 526 nurses (i.e., 234 front-line nurses and 292 non-front-line nurses) to evaluate vicarious traumatization scores via a mobile app-based questionnaire. Front-line nurses are engaged in the process of providing care for patients with COVID-19. The results showed that the vicarious traumatization scores for front-line nurses including scores for physiological and psychological responses, were significantly lower than those of non-front-line nurses (P < 0.001). Interestingly, the vicarious traumatization scores of the general public were significantly higher than those of the front-line nurses (P < 0.001); however, no statistical difference was observed compared to the scores of non-front-line nurses (P > 0.05). Therefore, increased attention should be paid to the psychological problems of the medical staff, especially non-front-line nurses, and general public under the situation of the spread and control of COVID-19. Early strategies that aim to prevent and treat vicarious traumatization in medical staff and general public are extremely necessary.
The recent emergence of the novel, pathogenic SARS-coronavirus 2 (SARS-CoV-2) in China and its rapid national and international spread pose a global health emergency. Cell entry of coronaviruses depends on binding of the viral spike (S) proteins to cellular receptors and on S protein priming by host cell proteases. Unravelling which cellular factors are used by SARS-CoV-2 for entry might provide insights into viral transmission and reveal therapeutic targets. Here, we demonstrate that SARS-CoV-2 uses the SARS-CoV receptor ACE2 for entry and the serine protease TMPRSS2 for S protein priming. A TMPRSS2 inhibitor approved for clinical use blocked entry and might constitute a treatment option. Finally, we show that the sera from convalescent SARS patients cross-neutralized SARS-2-S-driven entry. Our results reveal important commonalities between SARS-CoV-2 and SARS-CoV infection and identify a potential target for antiviral intervention.
Objective: To investigate the mental health of clinical first-line medical staff in COVID-19 epidemic and provide theoretical basis for psychological intervention. Method: The mental health status of the first-line medical staff was investigated by Self-rating Anxiety Acale (SAS) and Post-Traumatic Stress Disorder Self-rating Scale(PTSD-SS). From February 7 to 14, 2020, 246 medical staff were investigated who participated in the treatment of COVID-19 using cluster sampling , and received 230 responses, with a recovery rate of 93.5%. Results: The incidence of anxiety in medical staff was 23.04% (53/230), and the score of SAS was (42.91 ± 10.89). Among them, the incidence of severe anxiety, moderate anxiety and mild anxiety were 2.17% (5/230), 4.78% (11/230) and 16.09% (37/230), respectively. The incidence of anxiety in female medical staff was higher than that in male [25.67% (48/187) vs 11.63% (5/43), Z=-2.008, P=0.045], the score of SAS in female medical staff was higher than that in male [(43.78±11.12) vs (39.14 ± 9.01), t =-2.548, P=0.012]. The incidence of anxiety in nurses was higher than that in doctors [26.88% (43/160) vs 14.29% (10/70), Z=-2.066, P=0.039], and the score of SAS in nurses was higher than that in doctors [(44.84±10.42) vs (38.50±10.72), t =-4.207, P<0.001]. The incidence of stress disorder in medical staff was 27.39% (63/230), and the score of PTSD-SS was (42.92 ± 17.88). The score of PTSD-SS in female medical staff was higher than that of male [(44.30±18.42) vs(36.91 ± 13.95), t=-2.472, P=0.014]. Conclusions: In COVID-19 epidemic, the incidence of anxiety and stress disorder is high among medical staff. Medical institutions should strengthen the training of psychological skills of medical staff. Special attention should be paid to the mental health of female nurses.
The December, 2019 coronavirus disease outbreak has seen many countries ask people who have potentially come into contact with the infection to isolate themselves at home or in a dedicated quarantine facility. Decisions on how to apply quarantine should be based on the best available evidence. We did a Review of the psychological impact of quarantine using three electronic databases. Of 3166 papers found, 24 are included in this Review. Most reviewed studies reported negative psychological effects including post-traumatic stress symptoms, confusion, and anger. Stressors included longer quarantine duration, infection fears, frustration, boredom, inadequate supplies, inadequate information, financial loss, and stigma. Some researchers have suggested long-lasting effects. In situations where quarantine is deemed necessary, officials should quarantine individuals for no longer than required, provide clear rationale for quarantine and information about protocols, and ensure sufficient supplies are provided. Appeals to altruism by reminding the public about the benefits of quarantine to wider society can be favourable.
Background:
In late December, 2019, patients presenting with viral pneumonia due to an unidentified microbial agent were reported in Wuhan, China. A novel coronavirus was subsequently identified as the causative pathogen, provisionally named 2019 novel coronavirus (2019-nCoV). As of Jan 26, 2020, more than 2000 cases of 2019-nCoV infection have been confirmed, most of which involved people living in or visiting Wuhan, and human-to-human transmission has been confirmed.
Methods:
We did next-generation sequencing of samples from bronchoalveolar lavage fluid and cultured isolates from nine inpatients, eight of whom had visited the Huanan seafood market in Wuhan. Complete and partial 2019-nCoV genome sequences were obtained from these individuals. Viral contigs were connected using Sanger sequencing to obtain the full-length genomes, with the terminal regions determined by rapid amplification of cDNA ends. Phylogenetic analysis of these 2019-nCoV genomes and those of other coronaviruses was used to determine the evolutionary history of the virus and help infer its likely origin. Homology modelling was done to explore the likely receptor-binding properties of the virus.
Findings:
The ten genome sequences of 2019-nCoV obtained from the nine patients were extremely similar, exhibiting more than 99·98% sequence identity. Notably, 2019-nCoV was closely related (with 88% identity) to two bat-derived severe acute respiratory syndrome (SARS)-like coronaviruses, bat-SL-CoVZC45 and bat-SL-CoVZXC21, collected in 2018 in Zhoushan, eastern China, but were more distant from SARS-CoV (about 79%) and MERS-CoV (about 50%). Phylogenetic analysis revealed that 2019-nCoV fell within the subgenus Sarbecovirus of the genus Betacoronavirus, with a relatively long branch length to its closest relatives bat-SL-CoVZC45 and bat-SL-CoVZXC21, and was genetically distinct from SARS-CoV. Notably, homology modelling revealed that 2019-nCoV had a similar receptor-binding domain structure to that of SARS-CoV, despite amino acid variation at some key residues.
Interpretation:
2019-nCoV is sufficiently divergent from SARS-CoV to be considered a new human-infecting betacoronavirus. Although our phylogenetic analysis suggests that bats might be the original host of this virus, an animal sold at the seafood market in Wuhan might represent an intermediate host facilitating the emergence of the virus in humans. Importantly, structural analysis suggests that 2019-nCoV might be able to bind to the angiotensin-converting enzyme 2 receptor in humans. The future evolution, adaptation, and spread of this virus warrant urgent investigation.
Funding:
National Key Research and Development Program of China, National Major Project for Control and Prevention of Infectious Disease in China, Chinese Academy of Sciences, Shandong First Medical University.
Suicide is a global health issue accounting for at least 800,000 deaths per annum. Numerous models have been proposed that differ in their emphasis on the role of psychological, social, psychiatric and neurobiological factors in explaining suicide risk. Central to many models is a stress-diathesis component which states that suicidal behavior is the result of an interaction between acutely stressful events and a susceptibility to suicidal behavior (a diathesis). This article presents an overview of studies that demonstrate that stress and dysregulated hypothalamic-pituitary-adrenal (HPA) axis activity, as measured by cortisol levels, are important additional risk factors for suicide. Evidence for other putative stress-related suicide risk factors including childhood trauma, impaired executive function, impulsivity and disrupted sleep are considered together with the impact of family history of suicide, perinatal and epigenetic influences on suicide risk.
Background:
Digital interventions that deliver psychological self-help provide the opportunity to reach individuals at risk of suicide who do not access traditional health services. Our primary objective was to test whether direct (targeting suicidality) and indirect (targeting depression) digital interventions are effective in reducing suicidal ideation and behaviours, and our secondary analyses assessed whether direct interventions were more effective than indirect interventions.
Methods:
In this systematic review and meta-analysis, we searched online databases MEDLINE, PubMed, PsycINFO, and Cochrane CENTRAL for randomised controlled trials published between database inception to May 21, 2019. Superiority randomised controlled trials of self-guided digital interventions (app or web based, which delivered theory-based therapeutic content) were included if they reported suicidal ideation, suicidal plans, or suicide attempts as an outcome. Non-inferiority randomised controlled trials were excluded to ensure comparability of the effect. Data were extracted from published reports, and intention-to-treat data were used if available. The primary outcome was the difference in mean scores of validated suicidal ideation measures (Hedges'g) with the associated 95% CI for the analysis of digital intervention effectiveness on suicidal ideation. We also present funnel plots of the primary outcome measure (suicidal ideation) for direct and indirect interventions to assess for publication bias. We calculated I2 (with I2 CI) values to test heterogeneity. We used random-effects modelling for the meta-analyses to assess the primary and secondary outcomes. This study is registered with PROSPERO, CRD42018102084.
Findings:
The literature search yielded 739 articles (including manual searching) for suicidality and 8842 articles for depression. After screening, 14 papers reporting on 16 studies were included in the narrative review and meta-analysis. The 16 studies (ten on direct interventions and six on indirect interventions) provided baseline data for 4398 participants. The primary outcome of overall post-intervention effect for suicidal ideation was small but significant immediately following the active intervention phase (Hedges'g -0·18, 95% CI -0·27 to -0·10, p<0·0001; I2=0%, I2 CI 0·0-47·9). The secondary objective, comparing direct and indirect interventions, showed that direct interventions (targeting suicidality) significantly reduced suicidal ideation at post-intervention (g -0·23, 95% CI -0·35 to -0·11, p<0·0001; I2=17·6%, I2 CI 0·0-58·6), but indirect interventions (targeting depression) failed to reach significance (g -0·12, 95% CI -0·25 to 0·01, p=0·071; I2=0%, I2 CI 0·0-30·7).
Interpretation:
Self-guided digital interventions directly targeting suicidal ideation are effective immediately post-intervention. Indirect interventions were not significant for reducing suicidal ideation. Our findings suggest that digital interventions should be promoted and disseminated widely, especially where there is a lack of, or minimal access to, health services.
Funding:
Australian National Health and Medical Research Council.
Although recent years have seen large decreases in the overall global rate of suicide fatalities, this trend is not reflected everywhere. Suicide and suicidal behaviour continue to present key challenges for public policy and health services, with increasing suicide deaths in some countries such as the USA. The development of suicide risk is complex, involving contributions from biological (including genetics), psychological (such as certain personality traits), clinical (such as comorbid psychiatric illness), social and environmental factors. The involvement of multiple risk factors in conveying risk of suicide means that determining an individual’s risk of suicide is challenging. Improving risk assessment, for example, by using computer testing and genetic screening, is an area of ongoing research. Prevention is key to reduce the number of suicide deaths and prevention efforts include universal, selective and indicated interventions, although these interventions are often delivered in combination. These interventions, combined with psychological (such as cognitive behavioural therapy, caring contacts and safety planning) and pharmacological treatments (for example, clozapine and ketamine) along with coordinated social and public health initiatives, should continue to improve the management of individuals who are suicidal and decrease suicide-associated morbidity. Suicide and suicidal behaviour continue to present key challenges for public policy and health services. This Primer discusses the global burden of suicide and suicidal behaviours, and provides an overview of our current understanding of the mechanisms of suicide, including risk factors for suicidal ideation and the transition from ideation to suicide attempt.
Reviewing and accepting study plans before results are known can counter perverse incentives. Chris Chambers sets out three ways to improve the approach. Reviewing and accepting study plans before results are known can counter perverse incentives. Chris Chambers sets out three ways to improve the approach.
Background:
The aim of this study was to identify self-management strategies that can be used in a workplace setting by workers living with depression and anxiety.
Methods:
A two-round Delphi study was conducted among three panels of experts: (1) employees living with anxiety or depression (n = 31); (2) managers of employees living with anxiety or depression (n = 12); and (3) researchers with expertise in workplace mental health (n = 15). Participants had to indicate whether each of 60 self-management strategies was applicable at work, and how useful each was for managing their symptoms while working. They could also reformulate or add strategies that were then evaluated in the second round.
Results:
A total of 60 existing and new self-management strategies were retained following the two rounds. Most useful strategies refer to the ability to set boundaries, maintain work-life balance, identify sources of stress and create positive relationships with supervisor and colleagues. Panels differed in their assessment of the usefulness of strategies focusing on employees' empowerment.
Limitations:
Most participants were from Canada, limiting the generalizability of the results.
Conclusion:
The self-management strategies identified in this study should be included in programs focusing on mental health at work and disseminated to employees living with depression and anxiety. Managers should take employee's perspective into account when searching for solutions to help them. Future research should use an inductive approach to identify strategies that are specifically related to the workplace setting. Quantitative studies are also needed to evaluate the effect of such strategies on work functioning.
Background
Positive social relationships are known to mitigate the negative effects of stress on mental health. However, the direction of association between social resources and mental health remains unclear, and it is not known whether higher than average levels of social resources confer additional benefits, in the short and longer term.
Aims
To investigate the concurrent and longitudinal contribution of higher levels of social resources in reducing the risk of mental health symptoms after exposure to stress at age 45, and to identify life-course precursors of mid-life social resources.
Method
The National Child Development Study (NCDS) is a prospective birth cohort of over 17 000 births in 1958. We tested concurrent and longitudinal associations between different levels of social resources at age 45 and mental health symptoms among individuals exposed to stress and verified whether prior mental health symptoms (age 42) explained these associations. We also tested a range of child, family and adult precursors of mid-life social resources.
Results
Higher than average levels of social resources were required to confer benefits to mental health among individuals exposed to high stress levels, both concurrently at age 45 and in the longer term at age 50. In general, these associations were not attributable to prior mental health symptoms. Key predictors of mid-life social resources included evidence of early sociability.
Conclusions
Having a broad network of social ties and better personal support helps individuals withstand exposure to higher levels of stress. Given that sociable children had better mid-life social resources, early intervention may benefit individuals' social resources later in life.
Declaration of interest
None.
Executive summary
Malnutrition in all its forms, including obesity, undernutrition, and other dietary risks, is the leading cause of poor health globally. In the near future, the health effects of climate change will considerably compound these health challenges. Climate change can be considered a pandemic because of its sweeping effects on the health of humans and the natural systems we depend on (ie, planetary health). These three pandemics—obesity, undernutrition, and climate change—represent The Global Syndemic that affects most people in every country and region worldwide. They constitute a syndemic, or synergy of epidemics, because they co-occur in time and place, interact with each other to produce complex sequelae, and share common underlying societal drivers. This Commission recommends comprehensive actions to address obesity within the context of The Global Syndemic, which represents the paramount health challenge for humans, the environment, and our planet in the 21st century.
The Global Syndemic
Although the Commission's mandate was to address obesity, a deliberative process led to reframing of the problem and expansion of the mandate to offer recommendations to collectively address the triple-burden challenges of The Global Syndemic. We reframed the problem of obesity as having four parts. First, the prevalence of obesity is increasing in every region of the world. No country has successfully reversed its epidemic because the systemic and institutional drivers of obesity remain largely unabated. Second, many evidence-based policy recommendations to halt and reverse obesity rates have been endorsed by Member States at successive World Health Assembly meetings over nearly three decades, but have not yet been translated into meaningful and measurable change. Such patchy progress is due to what the Commission calls policy inertia, a collective term for the combined effects of inadequate political leadership and governance to enact policies to respond to The Global Syndemic, strong opposition to those policies by powerful commercial interests, and a lack of demand for policy action by the public. Third, similar to the 2015 Paris Agreement on Climate Change, the enormous health and economic burdens caused by obesity are not seen as urgent enough to generate the public demand or political will to implement the recommendations of expert bodies for effective action. Finally, obesity has historically been considered in isolation from other major global challenges. Linking obesity with undernutrition and climate change into a single Global Syndemic framework focuses attention on the scale and urgency of addressing these combined challenges and emphasises the need for common solutions.
Syndemic drivers
The Commission applied a systems perspective to understand and address the underlying drivers of The Global Syndemic within the context of achieving the broad global outcomes of human health and wellbeing, ecological health and wellbeing, social equity, and economic prosperity. The major systems driving The Global Syndemic are food and agriculture, transportation, urban design, and land use. An analysis of the dynamics of these systems sheds light on the answers to some fundamental questions. Why do these systems operate the way they do? Why do they need to change? Why are they so hard to change? What leverage points (or levers) are required to overcome policy inertia and address The Global Syndemic? The Commission identified five sets of feedback loops as the dominant dynamics underlying the answers to these questions. They include: (1) governance feedback loops that determine how political power translates into the policies and economic incentives and disincentives for companies to operate within; (2) business feedback loops that determine the dynamics for creating profitable goods and services, including the externalities associated with damage to human health, the environment, and the planet; (3) supply and demand feedback loops showing the relationships that determine current consumption practices; (4) ecological feedback loops that show the unsustainable environmental damage that the food and transportation systems impose on natural ecosystems; and (5) human health feedback loops that show the positive and negative effects that these systems have on human health. These interactions need to be elucidated and methods for reorienting these feedback systems prioritised to mitigate The Global Syndemic.
Double-duty or triple-duty actions
The common drivers of obesity, undernutrition, and climate change indicate that many systems-level interventions could serve as double-duty or triple-duty actions to change the trajectory of all three pandemics simultaneously. Although these actions could produce win-win, or even win-win-win, results, they are difficult to achieve. A seemingly simple example shows how challenging these actions can be. National dietary guidelines serve as a basis for the development of food and nutrition policies and public education to reduce obesity and undernutrition and could be extended to include sustainability by moving populations towards consuming largely plant-based diets. However, many countries' efforts to include environmental sustainability principles within their dietary guidelines failed due to pressure from strong food industry lobbies, especially the beef, dairy, sugar, and ultra-processed food and beverage industry sectors. Only a few countries (ie, Sweden, Germany, Qatar, and Brazil) have developed dietary guidelines that promote environmentally sustainable diets and eating patterns that ensure food security, improve diet quality, human health and wellbeing, social equity, and respond to climate change challenges.
The engagement of people, communities, and diverse groups is crucial for achieving these changes. Personal behaviours are heavily influenced by environments that are obesogenic, food insecure, and promote greenhouse-gas emissions. However, people can act as agents of change in their roles as elected officials, employers, parents, customers, and citizens and influence the societal norms and institutional policies of worksites, schools, food retailers, and communities to address The Global Syndemic. Across systems and institutions, people are decision makers who can vote for, advocate for, and communicate their preferences with other decision-makers about the policies and actions needed to address The Global Syndemic. Within the natural ecosystems, people travel, recreate, build, and work in ways that can preserve or restore the environment. Collective actions can generate the momentum for change. The Commission believes that the collective influence of individuals, civil society organisations, and the public can stimulate the reorientation of human systems to promote health, equity, economic prosperity, and sustainability.
Changing trends in obesity, undernutrition, and climate change
Historically, the most widespread form of malnutrition has been undernutrition, including wasting, stunting, and micronutrient deficiencies. The Global Hunger Index (1992–2017) showed substantial declines in under-5 child mortality in all regions of the world but less substantial declines in the prevalence of wasting and stunting among children. However, the rates of decline in undernutrition for children and adults are still too slow to meet the Sustainable Development Goal (SDG) targets by 2030.
In the past 40 years, the obesity pandemic has shifted the patterns of malnutrition. Starting in the early 1980s, rapid increases in the prevalence of overweight and obesity began in high-income countries. In 2015, obesity was estimated to affect 2 billion people worldwide. Obesity and its determinants are risk factors for three of the four leading causes of non-communicable diseases (NCDs) worldwide, including cardiovascular diseases, type 2 diabetes, and certain cancers.
Extensive research on the developmental origins of health and disease has shown that fetal and infant undernutrition are risk factors for obesity and its adverse consequences throughout the life course. Low-income and middle-income countries (LMICs) carry the greatest burdens of malnutrition. In LMICs, the prevalence of overweight in children less than 5 years of age is rising on the background of an already high prevalence of stunting (28%), wasting (8·8%), and underweight (17·4%). The prevalence of obesity among stunted children is 3% and is higher among children in middle-income countries than in lower-income countries.
The work of the Intergovernmental Panel on Climate Change (IPCC), three previous Lancet Commissions related to climate change and planetary health (2009–15), and the current Lancet Countdown, which is tracking progress on health and climate change from 2017 to 2030, have provided extensive and compelling projections on the major human health effects related to climate change. Chief among them are increasing food insecurity and undernutrition among vulnerable populations in many LMICs due to crop failures, reduced food production, extreme weather events that produce droughts and flooding, increased food-borne and other infectious diseases, and civil unrest. Severe food insecurity and hunger are associated with lower obesity prevalence, but mild to moderate food insecurity is paradoxically associated with higher obesity prevalence among vulnerable populations.
Wealthy countries already have higher burdens of obesity and larger carbon footprints compared with LMICs. Countries transitioning from lower to higher incomes experience rapid urbanisation and shifts towards motorised transportation with consequent lower physical activity, higher prevalence of obesity, and higher greenhouse-gas emissions. Changes in the dietary patterns of populations include increasing consumption of ultra-processed food and beverage products and beef and dairy products, whose production is associated with high greenhouse-gas emissions. Agricultural production is a leading source of greenhouse-gas emissions.
The economic burden of The Global Syndemic
The economic burden of The Global Syndemic is substantial and will have the greatest effect on the poorest of the 8·5 billion people who will inhabit the earth by 2030. The current costs of obesity are estimated at about 3·5 trillion annually. The World Bank estimates that an investment of 850 billion in economic return. The economic effects of climate change include, among others, the costs of environmental disasters (eg, drought and wildfires), changes in habitat (eg, biosecurity and sea-level rises), health effects (eg, hunger and diarrhoeal infections), industry stress in sectors such as agriculture and fisheries, and the costs of reducing greenhouse-gas emissions. Continued inaction towards the global mitigation of climate change is predicted to cost 5–10% of global GDP, whereas just 1% of the world's GDP could arrest the increase in climate change.
Actions to address The Global Syndemic
Many authoritative policy documents have proposed specific, evidence-informed policies to address each of the components of The Global Syndemic. Therefore, the Commission decided to focus on the common, enabling actions that would support the implementation of these policies across The Global Syndemic. A set of principles guided the Commission's recommendations to enable the implementation of existing recommended policies: be systemic in nature, address the underlying causes of The Global Syndemic and its policy inertia, forge synergies to promote health and equity, and create benefits through double-duty or triple-duty actions.
The Commission identified multiple levers to strengthen governance at the global, regional, national, and local levels. The Commission proposed the use of international human rights law and to apply the concept of a right to wellbeing, which encompasses the rights of children and the rights of all people to health, adequate food, culture, and healthy environments. Global intergovernmental organisations, such as the World Trade Organization, the World Economic Forum, the World Bank, and large philanthropic foundations and regional platforms, such as the European Union, Association of Southeastern Nations, and the Pacific Forum, should play much stronger roles to support national policies that address The Global Syndemic. Many states and municipalities are leading efforts to reduce greenhouse-gas emissions by incentivising less motorised travel and improving urban food systems. Civil society organisations can create a greater demand for national policy actions with increases in capacity and funding. Therefore, in addition to the World Bank's call for 100 billion for LMICs to address climate change, the Commission calls for 5 trillion in annual subsidies from governments. The Commission recommends that governments redirect these subsidies into more sustainable energy, agricultural, and food system practices. A Framework Convention on Food Systems would provide the global legal structure and direction for countries to act on improving their food systems so that they become engines for better health, environmental sustainability, greater equity, and ongoing prosperity.
Stronger accountability systems are needed to ensure that governments and private-sector actors respond adequately to The Global Syndemic. Upstream monitoring is needed to measure implementation of policies, examine the commercial, political, economic and sociocultural determinants of obesity, evaluate the impact of policies and actions, and establish mechanisms to hold governments and powerful private-sector actors to account for their actions.
Similarly, platforms for stakeholders to interact and secure funding, such as that provided by the EAT Forum for global food system transformation, are needed to allow collaborations of scientists, policy makers, and practitioners to co-create policy-relevant empirical, and modelling studies of The Global Syndemic and the effects of double-duty and triple-duty actions. Bringing indigenous and traditional knowledge to this effort will also be important because this knowledge is often based on principles of environmental stewardship, collective responsibilities, and the interconnectedness of people with their environments.
The challenges facing action on obesity, undernutrition, and climate change are closely aligned with each other. Bringing them together under the umbrella concept of The Global Syndemic creates the potential to strengthen the action and accountabilities for all three challenges. Our health, the health of our children and future generations, and the health of the planet will depend on the implementation of comprehensive and systems-oriented responses to The Global Syndemic.