Genetic Predisposition to Severe COVID-19 Might Increase the Risk of Stroke: A Two-Sample Mendelian Randomization Study.

Aims: The causal relationship between COVID-19 infection and stroke has not yet been fully established. This study aimed to explore this causality using two-sample Mendelian randomization (MR). Materials and Methods: Genetic variants associated with COVID-19 infection and stroke were both obtained from genome-wide association study (GWAS) summary data. The single nucleotide polymorphisms (SNPs) were selected as instrumental variables. The standard inverse variance weighted (IVW) was primarily used to assess this causality. Finally, sensitivity analysis was performed to evaluate the reliability and stability. Results: The results showed that being hospitalized due to COVID-19 had a positive effect on stroke [OR = 1.05; 95% CI= (1.01, 1.10); p = 2.34 × 10-5] and ischemic stroke [OR = 1.06; 95% CI= (1.02, 1.11); p = 2.28 × 10-6] analyzed by inverse variance weighted. Moreover, the results revealed that severe respiratory symptoms due to COVID-19 had a positive effect on stroke [OR = 1.04; 95% CI= (1.00, 1.06); p = 0.04] and that the causal effect of severe respiratory symptoms due to COVID-19 on ischemic stroke estimated by IVW suggested a positive effect [OR = 1.06; 95% CI= (1.02, 1.09); p = 0.0068], too. Conclusion: In summary, this study showed that severe COVID-19 might increase the risk of stroke, thus much more attention should be paid to patients with severe COVID-19.

The associations among the stress symptoms, depressive symptoms, anxiety symptoms and insomnia symptoms in depressed patients after the first COVID-19 outbreak was initially controlled in China: A prospective cohort study.

BACKGROUND: Depressed patients suffered from severe psychological distress even after the first COVID-19 outbreak was initially controlled. The longitudinal changes and associations among stress and other psychological problems during this period remained unknown. In this study we investigated stress symptoms and the longitudinal impact of stress symptoms on other psychological symptoms in depressed patients after the first COVID-19 outbreak was initially controlled. METHODS: A total of 5241 depressed patients at the outpatients of 56 hospitals across mainland China were recruited from May 18 to June 18, 2020. Five months later, 2113 of them responded again. Demographic characteristics were collected and psychological symptoms were evaluated at baseline and the follow-up. The longitudinal associations between stress symptoms at baseline and the changes of other psychological problems were assessed using Poisson regression. RESULTS: The prevalence of stress symptoms, depressive symptoms, anxiety symptoms and insomnia symptoms declined over time. Having stress symptoms at baseline was positively associated with the new occurrences of depressive symptoms, anxiety symptoms and insomnia symptoms (range, adjusted RRs 1.69-1.81). LIMITATIONS: The sampling method and the high dropout rate are the major limitations. Additionally, the mental conditions of the participants were not obtained, which may lead to unavoidable bias. CONCLUSIONS: The prevalence of stress symptoms declined over time after the first COVID-19 outbreak was initially controlled. We found that having stress symptoms at baseline was a predictor for the new occurrences of depressive symptoms, anxiety symptoms and insomnia symptoms.

The platform development, adherence and efficacy to a digital Brief therapy for insomnia (dBTI) during the COVID-19 pandemic.

Brief therapy for insomnia (BTI) is a short-term cognitive behavioral therapy for insomnia. At present, there is no study combining BTI with digital technology. However, in the context of the outbreak of coronavirus disease 2019 (COVID-19), patients with acute insomnia may need an online treatment which can quickly improve insomnia symptoms. Our team built a digital BTI (dBTI) platform based on the WeChat mini program. This research provides a framework design and a course design of dBTI, and evaluates the system via recruiting participants suffering from acute insomnia in pandemic. What's more, it explores patients' adherence, the efficiency of the system and their relationship. As the result demonstrates, 68% of participants have completed more than half of the course with medium to high adherence. Gender, pre-sleep arousal scale (PSAS) somatic score and insomnia severity index (ISI) score have affected participants' adherence, and higher adherence has led to better improvement in the severity of insomnia and somatic pre-sleep arousal. It is proved that the platform we built is effective, which not only offers an entry point for the study of how to set up a dBTI platform, but also provides theoretical basis for its clinical application.

Decreased Transition Rate From Situational Insomnia to Chronic Insomnia by One-Week Internet Cognitive Behavioral Treatments for Insomnia During the COVID-19 Pandemic.

Purpose: The purpose of the study was to determine the long-term effects of one-week self-guided internet cognitive behavioral treatments for insomnia (CBTI) on situational insomnia during the COVID-19 pandemic. Patients and Methods: The participants with situational insomnia (n = 194) were recruited from March 2020 to April 2020 in Guangzhou, China. The insomnia severity index (ISI), pre-sleep arousal scale (PSAS), and hospital anxiety and depression scale (HADS) were evaluated at baseline and a one-week internet CBTI program was delivered to all individuals. The participants were divided into the complete treatment group (the participants completed all seven modules of the CBTI course, n = 75), and the incomplete treatment group (the participants completed 0-6 modules of the CBTI course, n = 119). A total of 135 participants completed the post-intervention assessments. At 3 months follow-up, a total of 117 participants (complete treatment group: n = 51; incomplete treatment group: n = 66) completed the assessments of the ISI, PSAS and HADS. The transition rate from situational insomnia to chronic insomnia (duration of insomnia ≥ 3 months and ISI ≥ 8) was calculated in the two groups. Linear mixed effect model was used to investigate the effect of group (between the two groups), time (baseline vs. follow-up), and interaction (group x time) on various questionnaire score. Results: The transition rate from situational insomnia to chronic insomnia was significantly lower in the complete treatment group compared to the incomplete treatment group (27.5%, 14/51 vs. 48.5%, 32/66, p = 0.023). There were significant differences in group effect (p = 0.032), time effect (p = 0.000) and group × time effect (p = 0.048) between the two groups in the ISI total score. The ISI total scores decreased in both groups during follow-up compared to their baseline values, with a greater magnitude of decrease in the complete treatment group. There were no significant group x time effects between the two groups in the PSAS-total score, PSAS-somatic, PSAS-cognitive score, HADS total score, HADS anxiety score or HADS depression score. Conclusion: Our results suggested that one-week self-guided internet CBTI prevented the development of chronic insomnia from situational insomnia during the COVID-19 pandemic.

Prevalence and Risk Factors Associated with Insomnia Symptoms Among the Chinese General Public After the Coronavirus Disease 2019 Epidemic Was Initially Controlled.

INTRODUCTION: The prevalence rate and related factors of insomnia remained unknown after the COVID-19 epidemic had been under control. Therefore, we conducted this survey to investigate the prevalence rate and related factors of insomnia symptoms in the Chinese general public after the COVID-19 had been initially control. METHODS: An online survey was conducted among Chinese citizens through the JD Health APP. The questionnaire was used for collecting demographic data and self-designed questions related to the COVID-19 outbreak. Insomnia Severity Index, Patient Health Questionnaire-9, Somatic Symptom Scale-8 and Impact of Events Scale-Revised were used for measuring psychological symptoms. To examine the associations of sociodemographic and psychological factors with insomnia symptoms, a binary logistic regression was used. RESULTS: In total, there were 14,894 eligible participants, and 4601 (30.9%) participants were found to have insomnia symptoms. The regression model revealed that a higher risk of insomnia symptoms was associated with being over the age of 40 years, having history of psychiatric disorders, smoking, having infected friends or colleagues, having depressive or somatic symptoms, experiencing psychological distress and feeling estranged from family members. Meanwhile a lower risk of insomnia symptoms was associated with being female, having closer family relationships, not feeling alienated from others and being satisfied with the available information. CONCLUSION: In our study, 30.9% of the participants in the general public reported insomnia symptoms after the COVID-19 epidemic had been initially controlled. When providing precise interventions for insomnia, extra attention should be paid to the individuals who are male, elderly and smokers, and those with psychiatric disorder history, with infected friends or colleagues, with psychological symptoms and with poor social support.

Mental Health Outcomes in Perinatal Women During the Remission Phase of COVID-19 in China.

BACKGROUND: Since the middle of March, the COVID-19 outbreak has been well contained in China. The prevention and control measures for the outbreak have been downgraded to a normalized level. However, until now, the change in level of psychological health amongst perinatal women during the remission phase of the COVID-19 outbreak has not been investigated in China. The aim of this current study was to assess the symptoms of anxiety, depression, insomnia and quality of life (QOL) in perinatal women and to identify potential risk factors associated with these symptoms. METHODS: This was a cross-sectional, hospital-based survey conducted between March 25th till June 5th, 2020 in southern China. Convenient sampling method was adopted. Women's anxiety, depression, insomnia symptoms and QOL was examined through standardized measurements. Multivariate logistic regression and Analysis of Covariance (ANCOVA) was conducted for the same. RESULTS: A total of 625 perinatal women completed the study; of them, 195 women (31.2%, 95%CI=27.56%-34.84%) reported anxiety, 120 (19.2%, 95%CI=16.10%-22.30%) reported depression, and 87 (13.9%, 95%CI=11.20%-16.64%) experienced symptoms of insomnia. Previous adverse experiences during pregnancy was a significant risk factor for anxiety (OR=1.628, 95%CI=1.069-2.480, P=0.023), depression (OR=1.853, 95%CI=1.153-2.977, P=0.011), and insomnia (OR=2.160, 95%CI=1.290-3.616, P=0.003). Participants having infected friends/families/colleagues were more likely to report anxiety (OR=2.195, 95%CI=1.245-3.871, P=0.007) and depression (OR=2.666, 95%CI=1.482-4.794, P=0.001). Those women whose regular check-ups were severely interrupted by the COVID-19 were also more likely to experience symptoms of anxiety (OR=2.935, 95%CI=1.701-5.062, P<0.001) and insomnia (OR=2.195, 95%CI=1.098-4.390, P=0.026). CONCLUSION: The COVID-19 pandemic does affect the mental health and well being of perinatal women. Increased attention should be paid to women who have infected friends/families/colleagues and those with previous adverse experiences during pregnancy. Coping strategies that relieve psychological stress during the COVID-19 outbreak should be provided to prevent adverse outcomes for women and their infants.