Query: Epidemic  Mental health

title: Mental Health and Psychosocial Problems of Medical Health Workers during the COVID 19 Epidemic in China
abstract: We explored whether medical health workers had more psychosocial problems than nonmedical health workers during the COVID 19 outbreak.  An online survey was run from February 19 to March 6, 2020; a total of 2,182 Chinese subjects participated. Mental health variables were assessed via the Insomnia Severity Index (ISI) the Symptom Check List revised (SCL 90 R) and the Patient Health Questionnaire 4 (PHQ 4) which included a 2 item anxiety scale and a 2 item depression scale (PHQ 2)  Compared with nonmedical health workers (n 1,255) medical health workers (n 927) had a higher prevalence of insomnia (38.4 vs. 30.5% p 0.01) anxiety (13.0 vs. 8.5% p 0.01) depression (12.2 vs. 9.5% p< 0.04) somatization (1.6 vs. 0.4% p 0.01) and obsessive compulsive symptoms (5.3 vs. 2.2% p 0.01) They also had higher total scores of ISI, GAD 2, PHQ 2, and SCL 90 R obsessive compulsive symptoms (p 0.01) Among medical health workers, having organic disease was an independent factor for insomnia, anxiety, depression, somatization, and obsessive compulsive symptoms (p 0.05 or 0.01) Living in rural areas, being female, and being at risk of contact with COVID 19 patients were the most common risk factors for insomnia, anxiety, obsessive compulsive symptoms, and depression (p 0.01 or 0.05) Among nonmedical health workers, having organic disease was a risk factor for insomnia, depression, and obsessive compulsive symptoms (p 0.01 or 0.05)  During the COVID 19 outbreak, medical health workers had psychosocial problems and risk factors for developing them. They were in need of attention and recovery programs.

title: Mental Health, Risk Factors, and Social Media Use During the COVID 19 Epidemic and Cordon Sanitaire Among the Community and Health Professionals in Wuhan, China: Cross Sectional Survey
abstract: The mental health consequences of the coronavirus disease (COVID 19) pandemic, community wide interventions, and social media use during a pandemic are unclear. The first and most draconian interventions have been implemented in Wuhan, China, and these countermeasures have been increasingly deployed by countries around the world.  The aim of this study was to examine risk factors, including the use of social media, for probable anxiety and depression in the community and among health professionals in the epicenter, Wuhan, China.  We conducted an online survey via WeChat, the most widely used social media platform in China, which was administered to 1577 community based adults and 214 health professionals in Wuhan. Probable anxiety and probable depression were assessed by the validated Generalized Anxiety Disorder 2 (cutoff =3) and Patient Health Questionnaire 2 (cutoff =3) respectively. A multivariable logistic regression analysis was used to examine factors associated with probable anxiety and probable depression.  Of the 1577 community based adults, about one fifth of respondents reported probable anxiety (n=376, 23.84% 95% CI 21.8 26.0) and probable depression (n=303, 19.21% 95% CI 17.3 21.2) Similarly, of the 214 health professionals, about one fifth of surveyed health professionals reported probable anxiety (n=47, 22.0% 95% CI 16.6 28.1) or probable depression (n=41, 19.2% 95% CI 14.1 25.1) Around one third of community based adults and health professionals spent =2 hours daily on COVID 19 news via social media. Close contact with individuals with COVID 19 and spending =2 hours daily on COVID 19 news via social media were associated with probable anxiety and depression in community based adults. Social support was associated with less probable anxiety and depression in both health professionals and community based adults.  The internet could be harnessed for telemedicine and restoring daily routines, yet caution is warranted toward spending excessive time searching for COVID 19 news on social media given the infodemic and emotional contagion through online social networks. Online platforms may be used to monitor the toll of the pandemic on mental health.

title: Ensuring mental health care during the SARS CoV 2 epidemic in France: A narrative review
abstract: The lack of resources and coordination to face the coronavirus epidemic raises concerns for the health of patients with mental disorders in a country where we still have memories of the dramatic experience of famine in psychiatric hospitals during the Second World War. This article aims to propose guidance to ensure mental health care during the SARS CoV epidemic in France.  The authors performed a narrative review identifying relevant results in the scientific and medical literature and in local initiatives in France.  We identified four types of major vulnerabilities among patients with mental disorders during this pandemic: 1) medical comorbidities that are more frequently found among patients with mental disorders (cardiovascular and pulmonary pathologies, diabetes, obesity, etc. which are risk factors for severe covid 19 infection; 2) age (the elderly form the population most vulnerable to the coronavirus) 3) cognitive and behavioural disorders, which can hamper compliance with confinement and hygiene measures and finally and 4) psychosocial vulnerability as a result of stigmatization and/or socio economic difficulties. Furthermore, the mental health healthcare system is more vulnerable than other healthcare systems. Current government plans are poorly suited to psychiatric establishments in a context of major shortages of organizational, material and human resources. In addition, a certain number of structural aspects make the psychiatric institution particularly vulnerable: many beds have been closed, wards have high densities of patients, mental health community facilities are closed, and medical teams are understaffed and poorly trained to face infectious diseases. There are also major issues when referring patients with acute mental disorders to intensive care units. To maintain the continuity of psychiatric care in this pandemic situation, several directions can be considered, in particular with the creation of "COVID+ units" These units are under the dual supervision of a psychiatrist and an internist infectious disease specialist; all new entrants are placed in quarantine for 14 days; the nursing staff receives specific training, daily medical check ups and close psychological support. Family visits are prohibited and replaced by videoconference. At the end of hospitalization, in particular for the population of patients in compulsory ambulatory care situations, specific case management are organized with the possibility of home visits, in order to support patients when they get back home and to help them cope with the experience of confinement, which is liable to induce recurrences of mental disorders. The total or partial closure of community mental health facilities is particularly disturbing for patients, but a regular follow up is possible with telemedicine and should include the monitoring of suicide risk and psycho education strategies; developing support platforms could also be very helpful in this context. Private practice psychiatrists also have a crucial role of information towards their patients on confinement and barrier measures, and also on measures to prevent the psychological risks inherent in confinement: maintenance of regular sleep r, physical exercise, social interactions, stress management and coping strategies, prevention of addictions, etc. They should also be trained to prevent, detect and treat early warning symptoms of post traumatic stress disorder, because their prevalence was high in the regions of China most affected by the pandemic.  French mental healthcare is now facing a great and urgent need for reorganization and must also prepare in the coming days and weeks to face an epidemic of emotional disorders due to the confinement of the general population.

title: 2019 nCoV epidemic: address mental health care to empower society

title: Patients with mental health disorders in the COVID 19 epidemic

title: Iranian mental health during the COVID 19 epidemic
abstract: To investigate the expression and clin significance of lymphocyte subsets in peripheral blood of patients with novel coronavirus pneumonia (COVID 19) Methods Twenty five patients who were pos for the nucleic acid of new coronavirus (SARS CoV 2) treated at the Changshou District People's Hospital of Chongqing from Jan 18 to Feb 25, 2020 were selected as the research subjects Among them, 21 patients had clin symptoms, and the COVID 19 patient was diagnosed as the COVID 19 group;4 patients had no clin symptoms, but the SARS CoV 2 nucleic acid test was pos as the asymptomatic group;select 20 healthy people in the same period as the control group The lymphocyte subsets of each group were detected, and the differences in the levels of lymphocyte subsets were analyzed Results In 21 patients with COVID 19, the total lymphocyte counts (Lym#)of 18 patients were lower than the normal reference range, and 3 patients were within the normal reference range;the natural killer cell counts (NK# of 20 patients were lower than the normal reference range, and that of 1 patient was within the normal reference range The percentage of T lymphocyte and B lymphocyte in COVID 19 group was higher than that in control group (P &lt;0 05),the percentage of NK cells (NK% Lym# T lymphocyte count, CD4 T lymphocyte count, CD8 T lymphocyte count, NK# were lower than those in the control group (P &lt;0 05) NK and NK% in COVID 19 group were lower than those in asymptomatic group (P &lt;0 05)  The level of lymphocyte subsets is abnormal in patients with COVID 19, and NK cells decrease significantly There are differences in lymphocyte subsets among patients with COVID 19, asymptomatic infection and healthy people, suggesting that lymphocyte subsets may have certain clin value in the diagnosis and disease assessment of COVID 19

title: Rethinking online mental health services in China during the COVID 19 epidemic

title: Mental health status of medical staff in emergency departments during the Coronavirus disease 2019 epidemic in China
abstract: The emergency department is considered to be a high risk area, as it is often the first stop for febrile patients who are subsequently diagnosed with coronavirus disease 2019. This study, which employed a cross sectional design, aimed to assess the mental health of emergency department medical staff during the epidemic in China.  Demographic data and mental health measurements were collected by electronic questionnaires from February 28, 2020 to March 18, 2020.  A total of 14,825 doctors and nurses in 31 provinces of mainland China completed the survey. The prevalence rates of depressive symptoms and post traumatic stress disorder (PTSD) were 25.2% and 9.1% respectively. Men were more likely to have depressive symptoms and PTSD than women. Those who were middle aged, worked for fewer years, had longer daily work time, and had lower levels of social support were at a higher risk of developing depressive symptoms and PTSD. Working in the Hubei province was associated with a higher risk of depressive symptoms, while those working in the Hubei province but residing in another province had a lower risk of depressive symptoms and PTSD. Being a nurse was associated with a higher risk of PTSD.  The findings suggest that targeted psychological interventions to promote the mental health of medical staff with psychological problems need to be immediately implemented. Special attention should be paid to local medical staff in Hubei.

title: Impact of viral epidemic outbreaks on mental health of healthcare workers: a rapid systematic review
abstract: To examine the impact of providing healthcare during or after health emergencies caused by viral epidemic outbreaks on healthcare workers (HCWs) mental health, and to assess the available evidence base regarding interventions to reduce such impact.  Systematic rapid review and meta analysis.  MEDLINE, Embase, and PsycINFO, searched up to 23 March 2020.  We selected observational and experimental studies examining the impact on mental health of epidemic outbreaks on HCWs. Titles and abstracts were screened by one reviewer, and full texts were evaluated by two reviewers independently. We extracted study characteristics, symptoms, prevalence of mental health problems, risk factors, mental health interventions, and its impact. We assessed risk of bias for each individual study. We conducted a narrative and tabulated synthesis of the results. We pooled data using random effects meta analyses to estimate the prevalence of specific mental health problems. We followed the GRADE approach to assess the certainty in the evidence.  We included 61 studies (56 examining impact on mental health and five about interventions to reduce such impact) Most were conducted in Asia (59% examined the impact of the SARS epidemic (69% and took place in the hospital setting (79% The pooled prevalence was higher for anxiety (45% 95% CI 21 to 69% 6 studies, 3,373 participants) followed by depression (38% 95% CI 15 to 60% 7 studies, 3,636 participants) acute stress disorder (31% 95% CI 0 to 82% 3 studies 2,587 participants) burnout (29% 95% CI 25 to 32% 3 studies; 1,168 participants) and post traumatic stress disorder (19% 95% CI 11 to 26% 10 studies, 3,121 participants) Based on 37 studies, we identified a broad number of risk factors for these conditions, including sociodemographic: younger age and female gender; social factors: lack of social support, social rejection or isolation, stigmatization; and occupational: working in a high risk environment (frontline staff) specific occupational roles (e.g. nurse) and lower levels of specialized training, preparedness and job experience. Two out of five interventions identified were educational aimed to prevent mental health problems by increasing HCWs resilience. These interventions showed positive effects in confidence in support and training, pandemic self efficacy and interpersonal problems solving (very low certainty) One multifaceted intervention (based on training and organisational changes) targeted at hospital nurses during the SARS epidemic produced statistically significant improvements in anxiety, depression, and sleep quality (very low certainty) The impact of the two remaining interventions (multifaceted and based on psychotherapy provision) was unreported.  The prevalence of anxiety, depression, acute and post traumatic stress disorder, and burnout, was high both during and after the outbreaks. These problems not only have a long lasting effect on the mental health of HCWs, but also hinder the urgent response to the current COVID 19 pandemic, by jeopardising attention and decision making. Governments and healthcare authorities should take urgent actions to protect the mental health of HCWs. In light of the limited evidence regarding the impact of interventions to tackle mental health problems in HCWs, the risk factors identified in this study represent important targets for future interventions.

title: The impact of the COVID 19 epidemic on mental health of undergraduate students in New Jersey, cross sectional study
abstract: The COVID 19 pandemic has been a period of upheaval for college students. The objective of this study was to assess the factors associated with the increased levels of mental health burden among a sample of undergraduate college students in Northern New Jersey, the region of the U.S. severely impacted by the outbreak of COVID 19.  College students (N 162) enrolled in an introductory core curriculum course completed a cross sectional survey. The survey collected information on demographics, knowledge levels and sources of COVID 19 information, behavior changes, academic and everyday difficulties, and mental health measurements (depression, anxiety, somatization, and stress) Multivariable regression analysis was performed to identify factors associated with mental health outcomes.  Descriptive findings indicate that students have a fundamental knowledge of COVID 19 transmission and common symptoms. Students tend to use and trust the official sources and have changed their behaviors in accordance with public health recommendations (i.e. increased hand washing, wearing mask) However, students reported a number of academic and everyday difficulties and high levels of mental health distress. High levels of depression were associated with difficulties in focusing on academic work and with employment losses, while higher levels of anxiety were more likely to be reported by students other than freshmen and those who spend more than one hour per day looking for information on COVID 19. Inability to focus on academic work and an elevated concern with COVID 19 were more likely to be associated with higher levels of somatization, while trusting news sources was associated with lower levels of somatization. Those with higher levels of perceived stress were more likely to be females, unable to focus on academic work, and report difficulties in obtaining medications and cleaning supplies.  The COVID 19 pandemic is making a significant negative impact on mental health of college students. Proactive efforts to support the mental health and well being of students are needed.