Understanding the mental health impacts of biological disasters: Lessons from Taiwan's experience with COVID-19.

Biological disasters pose a growing challenge in the 21st century, significantly impacting global society. Taiwan has experienced such disasters, resulting in long-term consequences like loss of life, trauma, economic decline, and societal disruptions. Post-disaster, mental health issues such as fear, anxiety, depression, post-traumatic stress disorder (PTSD), and stress surge, accompanied by increased suicide rates. The Coronavirus disease 2019 (COVID-19) (also called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)) pandemic, recognized as a biological disaster, triggered lockdowns and quarantines in Taiwan, causing lifestyle changes, economic recession, and so on. These shifts may elevate uncertainty about the future, intensifying mental stress and leading to a rise in various mental illnesses. This article reviews mental health studies conducted in Taiwan during the pandemic, emphasizing the need to integrate this research for future preparedness and interventions regarding the mental health impacts of biological disasters, including COVID-19. Further research is essential to explore long-term effects, interventions, and generalizability.

The Impact of Psychological Burdens and Vaccine Worries on Confidence and Adherence to Governmental Policies Against COVID-19 Among Patients with Substance Use Disorder: A Cross-Sectional Study in Taiwan.

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has had an impact on patients with substance use disorder (SUD). We aimed to investigate factors associated with confidence and adherence to governmental policies against COVID-19 (social desirability) among patients with SUD. Methods: This cross-sectional study was conducted during 2020 to 2021. Patients with SUD and healthy controls were recruited. The severity of sleep disturbance, social desirability, drug dependence, vaccine worries, other psychological burdens and demographic variables were collected through self-administrated questionnaires. Differences between the SUD and control groups were estimated. Hierarchical regression analysis was used to identify significant relationships between social desirability and other factors. Results: In total, 58 of patients with SUD and 47 healthy controls were recruited. The patients with SUD had a lower level of social desirability and more severe sleep disturbance than the control group. Older age, more severe sleep disturbance, lower level of drug dependence, and lower level of vaccine worries were significantly associated with a higher level of social desirability among the patients with SUD. Conclusion: Our results show the importance of timely interventions for drug dependence and to address vaccine worries in patients with SUD.

Structural reinvestigation of the photoluminescent complex [NdCl2(H2O)6]Cl.

The structure of the photoluminescent compound hexaaquadichloridoneodymium(III) chloride has been redetermined from single-crystal X-ray diffraction data at 100 K, with the aim of providing an accurate structural model for the bulk crystalline material. The crystal structure may be described as a network of [NdCl2(H2O)6](+) cations with distorted square-antiprism geometry around the Nd(III) centre. The Nd(III) cation and the nonbonded Cl(-) anion are both located on twofold symmetry axes. The crystal packing consists of three different neodymium pairs linked by a three-dimensional network of O-H···Cl intermolecular interactions. The pair distribution function (PDF) calculated from the experimentally determined structure is used for the discussion of the local structure.

Mental Health and Aggression in Indonesian Women.

Aggression is a global problem and complex social behavior. In Indonesia, some common manifestations of aggression are sexual harassment, domestic violence, and the stigmatization of other people. However, unlike men, aggression in women is still rarely studied, whereas facts find that many conditions can make women more vulnerable. There are various aspects related to biological, psychological, social, and cultural issues that can potentially provoke female aggression. Furthermore, mental health and aggression are often viewed as an automatic association and are inseparable in society, reinforcing the stigma against people with mental problems, particularly women, who tend to suffer more stigma of mental health issues than men. However, there has not yet been a study explicitly related to this relationship in the general population of women. The current study aims to examine the overall relationship between mental health and aggression in the extensive general population of Indonesian women with various mental conditions ranging from a normal mental state to severe mental health problems. This was a cross-sectional study conducted using uncontrolled quota sampling via distributing online self-report questionnaires, the modified Indonesian version instruments of the Brief Symptoms Rating Scale-5, and the Buss Aggression Scale with high internal consistency. This study among 203 women aged 19-67 in Indonesia, a multicultural nation and the fourth densest country in the world, proposes that mental health can be a predictor of aggressive behavior, with the influence of mental health on the aggression of women being 21.6% only. The finding indicates that mental health issues are not a macro contributing factor to women's aggressiveness in society and may help reduce stigma against women with mental health problems.

Properties of metastable linkage NO isomers in Na2[Fe(CN)5NO]·2H2O incorporated in mesopores of silica xerogels.

We study the properties of photoinduced metal-nitrosyl linkage isomers in sodium nitroprusside (SNP) as a function of particle size. By embedding the molecular complex at various concentrations into mesopores of silica xerogels the size of the particles can be adjusted. The ground state is characterized by X-ray diffraction, absorption and infrared spectroscopy. The physical properties of the photoswitched molecules were analysed by steady-state low-temperature absorption, infrared spectroscopy and by nanosecond transient absorption spectroscopy. The electronic structure as well as the activation energies of the metastable linkage isomers are independent of the particle size down to single isolated molecules, indicating that the SNP complexes are quasi-free inside the pores of the gel.

The social and mental impact on healthcare workers: A comparative and cross-sectional study during two waves of the COVID-19 pandemic in Taiwan.

The coronavirus disease 2019 (COVID-19) pandemic has caused a heavily burden on healthcare workers (HCWs) worldwide. The aim of this study was to compare differences in psychological and social impact between two waves of the pandemic among first- and second-line HCWs in Taiwan. The current study derived data from two cross-sectional surveys conducted in 2020 and 2021. Levels of depression, sleep disturbance, psychological distress, social impact, and demographic variables were collected through self-reported questionnaires. The independent t test was used to compare differences in scores between the first and second wave of the pandemic. Differences between first- and second-line HCWs were also analyzed. A total of 711 HCWs in the first wave and 560 HCWs in the second wave were recruited. For the first- and second-line HCWs, the social impact during the second wave was higher than during the first wave, and they expressed a higher intention to maintain social distancing and were more aware of the pandemic overseas in the second wave. The first-line HCWs had a trend of worse sleep quality during the second wave. In addition, sleep quality was worse in the first-line HCWs than in the second-line HCWs during both waves. The second-line HCWs expressed a greater desire to seek COVID-19-related information than the first-line HCWs during the first wave, and more intended to maintain social distancing during the second wave. Our results show the importance of evaluating the social and mental health burden of HCWs, and especially first-line workers.

Relationship of Societal Adaptation with Vaccine Worries among Healthcare Workers during the COVID-19 Pandemic: The Mediating Effects of Posttraumatic Stress Disorder.

Vaccine hesitancy has become a major public health problem among healthcare workers (HCWs) in this coronavirus disease 2019 (COVID-19) pandemic. The aim of this study was to examine the relationship between societal adaptation and vaccine worries and the mediating effects of posttraumatic stress disorder (PTSD) indicators in HCWs. A total of 435 HCWs (327 women and 108 men) were recruited. Their levels of societal adaptation were evaluated using the Societal Influences Survey Questionnaire (SISQ). Their severity and frequency of PTSD symptoms were examined using the Disaster-Related Psychological Screening Test (DRPST). The severity of vaccine worries was assessed using the Vaccination Attitudes Examination (VAX) Scale. The relationships among societal adaptation, PTSD, and vaccine worries were examined using structural equation modeling. The severity of societal adaptation was positively associated with both the severity of PTSD and the severity of vaccine worries. In addition, the severity of PTSD indicators was positively associated with the severity of vaccine worries. These results demonstrated that the severity of societal adaptation was related to the severity of vaccine worries, either directly or indirectly. The indirect relationship was mediated by the severity of PTSD. Societal adaptation and PTSD should be taken into consideration by the community of professionals working on vaccine hesitancy. Early detection and intervention of PTSD should be the objectives for programs aiming to lower vaccine hesitancy among HCWs.

Development and validation of the Lo's Healthy and Happy Lifestyle Scale (LHHLS): The resilience in general population facing COVID-19 in Taiwan.

BACKGROUND: This article explores the effectiveness of development of the Lo's Healthy and Happy Lifestyle Scale (LHHLS), which is an evaluative tool that monitors the resilience of the Taiwan population in times of such COVID-19 epidemic. Also, to verify factors of resilience, namely the reliability and validity of self-efficacy and positive thinking, and establishment of a prospective norm analysis. METHOD: The study mainly applied Explorative Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) to develop LHHLS and establish the reliability and validity of the tool's structure, verify norm analysis and the reliability of data from each question using Cronbach's alpha. RESULTS: According to statistics, LHHLS has a good factorial effectiveness and relatively high reliability, with factor reliability analyses where Cronbach's alpha lies between 0.83 to 0.94. The 14 questions in the LHHLS has a total variance of 67.04%. The tool includes two sub-assessments that are theoretically and statistically appropriate: mental health/self-efficacy and positive thinking. CONCLUSION: The tool LHHLS can be applied to populations affected by COVID-19. With participants' self-awareness of mental health state and state of happy living, this tool is valid and reliable in assessing and evaluating the resilience of such participants against times of COVID-19. This study can become future use for epidemic prevention communities in monitoring residents' healthy living and changes in their resilience. Also, can become a reference standard for interventions to reduce the impacts populations' happy and healthy living, in times of biological disasters.

Predictors for Depression, Sleep Disturbance, and Subjective Pain among Inpatients with Depressive Disorders during the COVID-19 Pandemic: A Cross-Sectional Study.

The coronavirus disease 2019 (COVID-19) pandemic can have a negative impact on patients with mood disorders. The aim of this study is to explore the societal influence of COVID-19 and associated impacts on levels of depression, sleep disturbance, and subjective pain among patients with mood disorders. This cross-sectional study recruited inpatients with depression and bipolar disorder. Levels of depression, sleep disturbance, subjective pain, and related demographic variables were collected through self-reported questionnaires. Potential factors associated with levels of depression, sleep disturbance, and subjective pain were identified using univariate linear regression and further entered into a stepwise multivariate linear regression model to identify the independent predictors. A total of 119 participants were included in the analysis, of whom 50.42% had bipolar disorder and 49.58% had unipolar depression. Multivariate analysis showed that a higher level of depression was associated with female subjects, subjects with partners, present history of psychological trauma, and drinking alcohol. Sleep disturbance was associated with subjects with partners and drinking alcohol. A higher level of subjective pain was associated with a higher level of social anxiety and a history of psychological trauma. The current study identified several predictors of psychological burden and subjective pain among inpatients with depression during the COVID-19 pandemic. Further investigations are warranted to extend the application and generalizability of our results.

The Societal Influences and Quality of Life Among Healthcare Team Members During the COVID-19 Pandemic.

Background: The coronavirus infection disease 2019 (COVID-19) pandemic is likely to put healthcare professionals across the world in an unprecedented situation. Methods: A total of 683 healthcare workers were recruited in this study. Short form-12 items (SF-12), Societal Influences Survey Questionnaire (SISQ), and Disaster-Related Psychological Screening Test (DRPST) were used to survey participants. Multiple linear regression and structural equation model (SEM) were used to explore the possible factors to the societal influences and quality of life. Results: After multiple linear regression analysis, female, older, more education years, married, regular intake, and posttraumatic stress disorder (PTSD) frequency had positive association with SISQ. To physical component summary (PCS) of SF-12, chronic illness, sleep score, PTSD frequency, and social distance had negative association, and exercise habits had positive association. A mental component summary (MCS) value of SF-12, age, participate in social activities, and social information had positive association, and PTSD frequency, sleep score, social anxiety, and depression had negative association. Under SEM analysis, PTSD had positive influence on SISQ. Sleep score and MCS value had negative influences on SISQ. PTSD severity, older age, sleep score, smoking, and nursing staff had negative influences on PCS value. Young age, PTSD frequency, sleep score, and depression had negative influences on MCS value. Conclusion: Healthcare team members with severe PTSD symptoms suffered more societal influences. Relative to PTSD severity, PTSD frequency was more important to the quality of life. Members of older age who frequently participate in clubs, volunteers, or charity activities had better mental life quality.

Mental health in biological disasters: From SARS to COVID-19.

BACKGROUND: The outbreak of coronavirus disease 2019 (COVID-19), like severe acute respiratory syndrome (SARS), provokes fear, anxiety and depression in the public, which further affects mental health issues. Taiwan has used their experience of the SARS epidemic for the management of foreseeable problems in COVID-19 endemic. AIM/OBJECTIVE: This review summarizes issues concerning mental health problems related to infectious diseases from current literatures. RESULTS: In suspected cases under quarantine, confirmed cases in isolation and their families, health care professionals, and the general population and related effective strategies to reduce these mental health issues, such as helping to identify stressors and normalizing their impact at all levels of response as well as public information and communication messages by electronic devices. The importance of community resilience was also addressed. Psychological first aid, psychological debriefing, mental health intervention and psychoeducation were also discussed. Issues concerning cultures and religions are also emphasized in the management plans. CONCLUSION: Biological disaster like SARS and COVID-19 not only has strong impact on mental health in those being infected and their family, friends, and coworkers, but also affect wellbeing in general public. There are evidenced that clear and timely psychoeducation, psychological first aid and psychological debriefing could amileorate negative impact of disaster, thus might also be helpful amid COVID-19 pandemic.

COVID-related psychological distress fully mediates the association from social impact to sleep disturbance among patients with chronic schizophrenia.

The aims of the current study were to identify factors associated with sleep disturbance and Coronavirus disease-19 related psychological distress (CPD), and to develop a conceptual model to verify the mediating effect of CPD on the association between social impact and sleep disturbance. This study recruited patients with schizophrenia. Factors associated with the level of sleep disturbance and CPD were identified using univariate linear regression, and further selected into a stepwise multivariate linear regression model. Using structural equation modeling, a mediation model was developed to test the mediating effect of CPD on the association between social impact and sleep disturbance. After estimating with the stepwise and bootstrap regression, higher levels of CPD were associated with higher levels of social anxiety and subjects without a regular diet. Sleep disturbance was associated with a higher level of social anxiety, a history of psychological trauma, chronic disease, and those who did not smoke. The final model confirmed the mediating effects of CPD; whereas, the direct effect from social impact to sleep disturbance did not reach statistical significance. The current study manifests the crucial role of CPD on the association between social impact and sleep disturbance, and timely intervention for CPD is warranted.

Comparison of Elixhauser and Charlson Methods for Discriminative Performance in Mortality Risk in Patients with Schizophrenic Disorders.

Although Charlson Comorbidity Index scores (CCIS) and Elixhauser comorbidity index scores (ECIS) have been used to assess comorbidity in patients with schizophrenia, only CCIS, not ECIS, have been used to predict mortality in this population. This nationwide retrospective study investigated discriminative performance of mortality of these two scales in patients with schizophrenia. Exploiting Taiwan's National Health Insurance Research Database (NHRID), we identified patients diagnosed with schizophrenia discharged from hospitals between Jan 1, 1996 and Dec 31, 2007. They were followed up for subsequent death. Comorbidities presented one year prior to hospital admissions were identified and adapted to the CCIS and ECIS. Discriminatory ability was evaluated using the adjusted hazard ratio and Akaike information criterion (AIC) and Harrell's C-statistic. We identified 58,771 discharged patients with schizophrenic disorders and followed them for a mean of 10.4 years, 16.6% of whom had died. Both ECIS and CCIS were significantly associated with mortality, but ECIS had superior discriminatory ability by a lower AIC and higher Harrell's C-statistic (201231 vs. 201400; 0.856 vs. 0.854, respectively). ECIS had better discriminative performance in mortality risk than CCIS in patients with schizophrenic disorders. Its use may be encouraged for risk adjustment in this population.

The symptoms of autism including social communication deficits and repetitive and restricted behaviors are associated with different emotional and behavioral problems.

The aim of the study was to investigate the associations between symptoms of autism and emotional and behavioral problems in children with autism spectrum disorder from both caregivers' and clinicians' perspectives. Three main findings were found in our study. First, the association patterns were similar in the preschool and school-aged children. Second, different association patterns were found from caregivers' and professionals' perspectives. From the professionals' perspective, only repetitive behaviors were associated with behavioral problems, while from the caregivers' perspective, all symptoms of autism were associated with emotional and behavioral problems. Third, different types of symptoms of autism were associated with different types of emotional and behavioral problems. For example, from the professionals' perspective, restricted and repetitive behaviors were only associated with hyperactivity and inattention. From the caregivers' perspective, social emotion was associated with emotional symptoms, and other symptoms of autism were associated with hyperactivity and inattention, as well as with peer problems. The results of our study provided deeper understanding of the relationships between symptoms of autism and emotional and behavioral problems, and the findings could serve as a reference for intervention planning when clinicians approach children with autism spectrum disorder.

Challenge and strategies of infection control in psychiatric hospitals during biological disasters-From SARS to COVID-19 in Taiwan.

Psychiatric hospitals play an important role in supporting patients with mental illness to relieve symptoms and improve functioning in a physically and psychologically safe environment. However, these hospitals are also vulnerable to emerging infectious diseases. In early 2020, a psychiatric hospital and a psychiatric unit were reported to have nosocomial coronavirus disease 2019 (COVID-19) infection. A large number of patients and staff were severely impacted. This type of nosocomial infection threatens patient safety and quality of care. By learning from previous experiences of severe acute respiratory syndrome (SARS) and previous studies, psychiatric hospitals can provide safeguards to prevent nosocomial infection among patients and staff during an epidemic or biological disaster. These strategies include a series of actions such as following national guidelines for infection control, reserving adequate support for disinfection equipment, providing relevant and sufficient pro-service and in-service education and training, establishing regular surveillance of hand hygiene habits, proper communication and health education, and providing opportunities for vaccination if possible. Based on the harm reduction concept, staff division of office breaks and ward classification and shunting are recommended and should be further implemented.

Reduced risk of stroke among psychiatric patients receiving ECT: A population-based cohort study in Taiwan.

Electroconvulsive therapy (ECT) as well as the diseases it treats have been associated with stroke and cognitive impairment. We investigate the relationship between ECT and the subsequent development of stroke in patients with different severe mental illnesses. Tapping Taiwan's National Health Insurance Research Database, we identified patients diagnosed with severe mental illnesses who had received ECT between Jan 1, 2002 and Dec 31, 2007. A comparison cohort was constructed of patients who were matched by age, gender, and diagnosis but did not receive ECT. The patients were then followed up for occurrence of subsequent new-onset stroke. We identified 6264 patients had been diagnosed with mental illness and had received ECT. They were matched with 18,664 mentally ill patients who had not. The study cohort had a lower incidence of subsequent stroke than the matched controls, after controlling for age, diabetes, hypertension, coronary heart disease and enrollee sociodemographic category, risk factors for stroke in both study and control cohorts. ECT is associated with reduced risk of subsequent stroke in patients with severe mental illnesses in Taiwan. Therefore, clinicians should not let risk of stroke stop them from suggesting ECT to physically healthy patients who might benefit from this therapy.

Relationship between Self-Identity Confusion and Internet Addiction among College Students: The Mediating Effects of Psychological Inflexibility and Experiential Avoidance.

Internet addiction (IA) has become a major public health problem among college students. The aim of this study was to examine the relationship between self-identity confusion and IA and the mediating effects of psychological inflexibility and experiential avoidance (PI/EA) indicators in college students. A total of 500 college students (262 women and 238 men) were recruited. Their levels of self-identity were evaluated using the Self-Concept and Identity Measure. Their levels of PI/EA were examined using the Acceptance and Action Questionnaire-II. The severity of IA was assessed using the Chen Internet Addiction Scale. The relationships among self- identity, PI/EA, and IA were examined using structural equation modeling. The severity of self-identity confusion was positively associated with both the severity of PI/EA and the severity of IA. In addition, the severity of PI/EA indicators was positively associated with the severity of IA. These results demonstrated that the severity of self-identity confusion was related to the severity of IA, either directly or indirectly. The indirect relationship was mediated by the severity of PI/EA. Self-identity confusion and PI/EA should be taken into consideration by the community of professionals working on IA. Early detection and intervention of self-identity confusion and PI/EA should be the objectives for programs aiming to lower the risk of IA.

Predictive Effects of Sex, Age, Depression, and Problematic Behaviors on the Incidence and Remission of Internet Addiction in College Students: A Prospective Study.

The aim of the study was to determine the predictive effects of sex, age, depression, and problematic behaviors on the incidence and remission of internet addiction (IA) in college students over a one-year follow-up. A total of 500 college students (262 women and 238 men) were recruited. The predictive effects of sex, age, severity of depression, self-harm/suicidal behaviors, eating problems, risk-taking behaviors, substance use, aggression, and uncontrollable sexual encounters on the incidence and remission of IA over a one-year follow-up were examined. The one-year incidence and remission rates for IA were 7.5% and 46.4%, respectively. Severity of depression, self-harm and suicidal behaviors, and uncontrollable sexual encounters at the initial investigation predicted the incidence of IA in a univariate analysis, whereas only severity of depression predicted the incidence of IA in a multivariable logistic regression (p = 0.015, odds ratio = 1.105, 95% confidence intervals: 1.021⁻1.196). A relatively young age predicted the remission of IA. Depression and young age predicted the incidence and remission, respectively, of IA in college students in the one-year follow-up.