Prevalence of Psychological Distress and Posttraumatic Stress Symptoms and Associated Factors in Hospitalized Iranian COVID-19 Patients.

Objectives: To investigate the prevalence of psychiatric symptoms/distress and posttraumatic stress (PTS) and associated factors among inpatients with COVID-19 before discharge from the hospital. Methods: This cross-sectional study was conducted in two teaching referral hospitals in Babol, Iran from July to November 2020. The subjects were inpatients diagnosed with COVID-19 who were clinically stable. Before their discharge from the hospital, the patients completed three questionnaires: demographic data, Brief Symptom Inventory, and Primary Care Post Traumatic Stress Disorder Screen for Diagnostic and Statistical Manual-5. Results: The subjects were 477 inpatients diagnosed with COVID-19 including 40 (8.4%) admitted to intensive care units. Their average age was 60.5±17.9 years; 53.9% were female. Most had symptoms of significant psychological distress (96.0%) and PTS (8.1%) prior to discharge. A higher level of education (-0.18; standard error (SE) = 0.05; p < 0.001) was a negative predictor of psychiatric distress. The admission to intensive care units (0.86; SE = 0.08; p< 0.001) was a positive predictor of psychiatric distress. Conclusions: Most COVID-19 inpatients suffered significant psychiatric distress and PTS symptoms before discharge. Appropriate mental health crisis interventions are recommended for COVID-19 patients during hospitalization.

The real-world impact of the COVID-19 pandemic on patients with cancer: a multidisciplinary cross-sectional survey.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has caused unprecedented disruptions to cancer care worldwide. We conducted a multidisciplinary survey of the real-world impact of the pandemic, as perceived by patients with cancer. METHODS: A total of 424 patients with cancer were surveyed using a 64-item questionnaire constructed by a multidisciplinary panel. The questionnaire examined patient perspectives regarding COVID-19-related effects (eg, social distancing measures) on cancer care delivery, resources, and healthcare-seeking behaviour, along with the physical and psychosocial aspects of patient well-being and pandemic-related psychological repercussions. RESULTS: Overall, 82.8% of respondents believed that patients with cancer are more susceptible to COVID-19; 65.6% expected that COVID-19 would delay anti-cancer drug development. Although only 30.9% of respondents felt that hospital attendance was safe, 73.1% expressed unaltered willingness to attend scheduled appointments; 70.3% of respondents preferred to receive chemotherapy as planned, and 46.5% were willing to accept changes in efficacy or side-effect profile to allow an outpatient regimen. A survey of oncologists revealed significant underestimation of patient motivation to avoid treatment interruptions. Most surveyed patients felt that there was an insufficient amount of information available concerning the impact of COVID-19 on cancer care, and most patients reported social distancing-related declines in physical, psychological, and dietary wellness. Sex, age, education level, socio-economic status, and psychological risk were significantly associated with patient perceptions and preferences. CONCLUSION: This multidisciplinary survey concerning the effects of the COVID-19 pandemic revealed key patient care priorities and unmet needs. These findings should be considered when delivering cancer care during and after the pandemic.

Cancer nurses have experienced ‘moral injury' due to the pandemic

First, a Happy New Year to you all. I hope you enjoyed the festive break. In this issue, our cover article (evidence and practice, page 21) explains how emotional labour can lead to exhaustion and burnout, which contributes to a high turnover in the nursing workforce. It examines the differences in resilience and coping strategies of less experienced nurses compared with their more experienced counterparts.

THE RESTORATIVE POWER OF CIRCLES

The article discusses how indigenous talking circles can help health and social care professionals recover from moral injury due to the pandemic. Topics include reason for moral injury in the health and social care context, a therapeutic intervention that has been developed for moral injury in the U.S. military, and the evidence-based theory of post-traumatic growth.

Canadian Adolescents' Mental Health and Substance Use During the COVID-19 Pandemic: Associations With COVID-19 Stressors

There have been significant concerns regarding the mental health impact of coronavirus disease 2019 (COVID-19) due to isolation, anxiety around the pandemic, and increased conflict in the home. The purpose of this study was to examine the rates of mental health symptoms of clinical concern and substance use, and to assess which COVID-19 related stressors were predictors of these symptoms and substance use in a large Canadian sample of adolescents, with comparisons across genders. Participants (N = 809, Mage = 15.67, SD = 1.37) identified as a girl (56.2%), boy (38.7%), or trans/nonbinary individuals (TNBI;5.1%) and were recruited via social media to complete an online survey. A high proportion of adolescents reported symptoms of clinical concern for depression (51%), anxiety (39%), and posttraumatic stress disorder (45%). Other mental health problems ranged from 9% to 20%. Adolescents were mainly concerned with the health of family members and vulnerable populations, as well as the increased family stress at home during COVID-19. Rates of substance use were higher than expected, with over 50% of youth engaging in some form of substance use in the past 90 days, and almost 20% engaging in substance use at least once a week. TNBI and girls reported higher rates of mental health problems compared to boys. Family stress due to confinement and violence at home predicted higher mental health symptoms, but not substance use problems. Increased rates of mental health problems and substance use necessitate targeted supports that encourage positive coping amidst the additional stresses of COVID-19.

Mental Health Weekly revisits key moments for the mental health field in 2022

As a new year gets underway, Mental Health Weekly looks back at some noteworthy moments in the field. In 2022, one of the most highly anticipated programs for the field was the 988 mental health and suicide prevention crisis hotline, launched July 15, 2022. Congress designated the new 988 dialing code to be operated through the existing National Suicide Prevention Lifeline.

هم هگیری کووید- 19 در شهر رشت در سال 14اختلال استرس پس از آسیب حساسیت اضطرابی و تا بآوری در کارکنان خدمات درمانی طی

Background The coronavirus disease 2019 (COVID-19) pandemic has extensively affected the public physical and mental health, especially the medical staff working in the COVID-19 wards of hospitals. Objective This study aims to evaluate the relationship between post-traumatic stress disorder (PTSD), anxiety sensitivity (AS), and resilience among hospital medical staff in Rasht, during the COVID-19 pandemic. Methods This is an analytical cross-sectional study. The study population consists of all medical staff working in the COVID-19 wards of Poursina and Razi hospitals in Rasht, Iran. Of these, 94 participated who were selected using a convenience sampling method. Weathers et al.'s post-traumatic stress disorder checklist, Reiss et al.'s AS index, and Connor-Davidson resilience scale were used for data collection. The data were analyzed using Pearson correlation test and multiple linear regression analysis. Results There was a significant negative correlation between PTSD and resilience (r = -0.405, P = 0.001). and a significant positive correlation between PTSD and AS (r=0.633, P=0.001). The results of multiple analyses showed that resilience (B=-0.208, P=0.004) and AS (B=0.574, P=0.001) could significantly explain the PTSD in medical staff. Conclusion Resilience can be an important protective factor against PTSD in hospital medical staff during the COVID-19 pandemic. The medial staff with AS may experience the symptoms of PTSD more.

Where'd the Dyads Go? Enrolling Veteran-Centric Dyads into Virtual Complementary and Integrative Health Research Studies...American Congress of Rehabilitation Medicine (ACRM) Annual Conference, November 8-11, 2022, Chicago, Illinois

The increase in complementary and integrative health (CIH) treatments and changes to healthcare delivery due to COVID-19 have expanded the need for remotely accessible, non-pharmacological treatments for chronic illnesses. This presentation describes attrition while recruiting dyads of Veterans with chronic pain and PTSD and their partners, to a study of a remotely delivered, CIH program. It also provides baseline characteristics of successfully enrolled participants and offers recommendations for effective enrollment. This RCT randomized 364 dyads to either an intervention or a wait-list control arm. Three Department of Veterans Affairs Medical Centers recruited participants between October 2019 and December 2021. Veterans with chronic pain and PTSD, and their self-elected partners (e.g., spouse). Mission Reconnect is a partnered, self-directed intervention that teaches CIH skills (e.g., meditation, partnered massage) remotely using mobile and web-based platforms. Main Outcome Measure(s): Reported outcomes include: recruitment methods;number of participants screened and onboarded;and participation barriers. Baseline characteristics of successfully enrolled participants will also be presented. Of the 364 recruited dyads, 97 (26.6%) failed to complete onboarding activities, including submission of baseline data. Reported reasons for failure to complete onboarding include loss of self-elected partner buy-in (8.2%), difficulties with using remote data collection methods and interventions (30.9%), and adverse health experiences unrelated to study activities (17.5%). Despite the high attrition rate, Veterans were successfully enrolled from 35 states and 1 US territory with nearly a fifth of successfully enrolled participants drawn from rural zip codes (18.0%). Successful enrollees represent a pool of Veterans with diverse socioeconomic characteristics and moderate-to-severe pain severity. Lessons learned from project challenges relate to recruitment, onboarding, intervention delivery, and data collection processes.Conclusion: Successful enrollment of Veterans with chronic pain and PTSD, and their partners, to studies of remotely delivered CIH treatments requires careful examination of recruitment and onboarding methodologies and simplification of processes. Accommodating the targeted study participants' symptom burden is essential for identifying and addressing possible sources of attrition. None disclosed.

Burnout in nurses: how to cope and when to seek help: An RCN Nurse of the Year describes how work pressures and a traumatic event led her to prioritise her well-being

In April 2022, I was a paediatric NHS nurse and in a bad place emotionally. I was extremely anxious, felt unable to cope and was having nightmares. I was also experiencing what I now know are flashbacks. A series of traumatic events had led me to this point, then an incident with a young patient tipped me over the edge and I realised I needed help.

Factors related to post-traumatic stress in patients with medical discharge due to COVID-19

Introduction: Hospitalization due to COVID-19 can predispose to the appearance of possible long-term psychological sequelae. Objective: To determine the relationship between hospital and non-hospital factors with post-traumatic stress in patients discharged for COVID-19 from a hospital in Peru. Methods: Cross-sectional study and correlational design. The non-probabilistic sample consisted of 126 participants, evaluated through a self-administered questionnaire and the Davidson Trauma Scale. For data processing, the chi-square test and Cramer's V were used as measures of the magnitude of effect. Results: Post-traumatic stress disorder presents moderate associations with hospital factors: hospitalization time (p<0.001) (Cramer's V = 0.33), clinical type of COVID-19 (p<0.001) (Cramer's V = 0 .49) and invasive ventilatory support (p<0.001) (Cramer's V = 0.39);and with non-hospital factors: oxygen therapy in rehabilitation (p<0.001) (Cramer's V = 0.33), neurological sequelae (p<0.001) (Cramer's V = 0.41), respiratory distress (p<0.001) (Cramer's V = 0.53), perception of social discrimination (p<0.05) (Cramer's V = 0.29), difficulty returning to daily activities (p<0.001) (Cramer's V = 0.40) and family members infected with COVID-19 (p<0.001) (Cramer's V = 0.30). Conclusions: There are both in-hospital and out-of-hospital factors associated with post-traumatic stress disorder following discharge from COVID-19. © 2022, Editorial Ciencias Medicas. All rights reserved.

Examining the incidence of acute stress in pediatric trauma patients.

Objective: Pediatric patients can be significantly impacted emotionally by exposure to acute trauma which may negatively impact long-term functioning and lead to an increase in overall distress. This study reports on the incidence of acute stress disorder among pediatric trauma patients in a hospital setting in the southeastern region of the USA. Methods: Pediatric patient mental health assessments were conducted using the Childhood Stress Disorders Checklist- Short Form (CSDC-SF) as part of a new integrated behavioral health standard of care within the Trauma Services Division of a level 1 pediatric hospital. Mental health consultations occurred at bedside on inpatient hospital admission into trauma services, or at the outpatient hospital clinic after discharge for injuries treated in the emergency department. Results: Associations among type of trauma, child age, and sex were explored in a sample of 617 children (58.9% male) aged 2-18 years (M age=10.27). The sample was primarily ethnic minorities (56.1% black/African-American, 5% Hispanic/Latinx). Fifteen per cent or more of trauma reports were for burns (26%), motor vehicle accident (22.7%), and recreational sports or leisure activity-related injury (17.5%). Sixty-four per cent of children scored ≥1 on the CSDC-SF, indicating symptoms consistent with acute stress disorder. Higher scores were associated with female sex, age, and injury type. Level of evidence: Level IV study provides evidence of the link between traumatic injury and mental health symptoms in a pediatric population. Findings highlight the critical need for mental health screening and provision of integrated mental health counseling services at time of acute pediatric trauma.

[Posstraumatic stress disorder in nurses during the COVID-19 pandemic]. / Trastorno de estrés postraumático en enfermeras durante la pandemia de COVID-19.

Aim: To analyse the prevalence of post-traumatic stress disorder (PTSD) in nursing staff and the variables that may contribute to its development. Method: Cross-sectional study using a self-administered questionnaire given to nurses, nursing assistants and nursing supervisors in June 2020. It included sociodemographic, mental health, occupational, COVID-19 related variables, Modified Risk Perception Scale (modified RPS) score, Brief Resilience Scale (BRS) and Davidson Trauma Scale (DTS) score for the assessment of PTSD. Descriptive, bivariate, and multivariate analyses were performed. Results: Of the 344 participants, 88.7% were women and 93.6% cared for infected patients; 45.9% had PTSD (DTS≥40). The variables associated with PTSD were previous PTSD symptoms (OR=6.1, 95% CI [2.68-14.03]), death of a family member or friend due to COVID-19 (OR=2.3, 95% CI [1.22-4.39]), and higher scores on the modified RPS (OR= 1.1, 95% CI [1.07-1.31]). Higher BRS scores were associated with a lower risk of PTSD (OR=0.4, 95% CI [0.31-0.68]). Conclusions: The prevalence of PTSD in nursing staff is high, mainly in professionals with previous PTSD symptoms, family members or friends deceased from COVID-19, high risk perception and/or low resilience.

État des connaissances - Pratiques visant à mesurer ou réduire les symptômes psychologiques des personnes qui présentent une affection post-COVID-19

Objectives:The SARS-CoV-2 pandemic, where the infection can be asymptomatic or result in coronavirus 2 disease (COVID-19), was declared an international public health emergency by the World Health Organization (WHO) in March 2020. The prolonged pandemic and health measures aimed at reducing its spread are having different economic, social, health and psychological consequences for the entire population. Beyond the general population, those infected with the virus are more likely to experience a range of effects on their physical and psychological health. The Ministère de la Santé et des Services sociaux (MSSS) therefore asked the Institut national d'excellence en santé et en services sociaux (INESSS) to produce a state-of knowledge report on screening tools for psychological symptoms, the best nonpharmacological practices for reducing such symptoms, and the practices to be avoided in individuals with a post-COVID-19 condition. Conclusions:RESULTS: With regards to tools for screening and monitoring psychological symptoms, no scientific studies were found that present validated tools for individuals with a post-COVID-19 condition or, more broadly, for individuals in the acute phase of COVID-19. However, five clinical practice guidelines on post-COVID-19 conditions present various tools which could be relevant with such clientele, including tools commonly used to screen for anxiety, depression and posttraumatic stress. There is also a consensus among the experts consulted to the effect that psychological symptoms should be screened and monitored in individuals with a post-COVID-19 condition, the same way as physical and cognitive symptoms. However, these experts are faced with the absence of specific screening and monitoring tools for psychological symptoms in this particular patient population and the lack of psychosocial professionals with the necessary skills to manage them. No scientific studies on nonpharmacological practices for reducing psychological symptoms in individuals with a post-COVID-19 condition were found. However, six scientific studies on the effectiveness of practices to reduce psychological symptoms of individuals in the acute phase of COVID-19 were considered. Among these studies, eleven nonpharmacological practices aiming to reduce psychological symptoms of individuals in the acute phase of COVID-19 were evaluated. When described, these practices are based mainly on 1) the cognitive-behavioural approach, 2) relaxation/meditation activities, and 3) individual psychological care. These practices can be self-administered or carried out by different professionals (a physician, nurse or psychologist). They are generally provided over a brief period of time, and the sessions are short. In general, the use of practices aimed at reducing anxiety symptoms or depressive symptoms seems to be effective for individuals in the acute phase of the infection. However, with the current state of scientific knowledge, we are unable to rule on the effectiveness of practices for reducing posttraumatic stress symptoms in individuals in the acute phase of infection. Moreover, three clinical practice guidelines recommend providing psychological support, as needed, at all stages of the follow-up for post-COVID-19 conditions. The clinical practice guidelines also recommend that psychological services for symptoms of anxiety, depression and posttraumatic stress be provided to individuals with a post-COVID-19 condition and moderate to severe psychological symptoms. No publication has reported practices to avoid in the management of psychological symptoms in persons with a postCOVID-19 condition. CONCLUSION: With the current absence of scientific studies specific to individuals with a post-COVID-19 condition, the findings of this report are based on the literature more broadly concerning people infected with COVID-19 to identify screening and monitoring tools for psychological symptoms and nonpharmacological practices for reducing them. Therefore, the work done in this state-of-knowledge report does not allow to rule on the generalizability of the findings to individuals with a post-COVID-19 condition. It should also be noted that little information on the management of psychological symptoms is currently presented in the clinical practice guidelines on post-COVID-19 conditions. As well, the analysis of the perspectives shared by psychosocial and medical experts during consultations makes it possible to document issues relating to the management of psychological symptoms in individuals with a post-COVID-19 condition. However, these consultations do not allow to claim the saturation of the perspectives. Despite certain limitations, this state-of-knowledge reports is a source of information for health and social services network personnel about the screening and monitoring tools and nonpharmacological practices currently in use, and about the issues encountered by stakeholders. Unfortunately, the knowledge from the literature and the consultations is limited, which makes it difficult to recommend tools and practices for managing psychological symptoms associated with post-COVID-19 conditions. Beyond the scientific monitoring for new publications on the subject, further work is needed to determine whether certain tools and practices for individuals with common mental disorders or chronic illnesses could be adapted and used to meet the needs of those with a post-COVID-19 condition. Methods:A synthesis of the available scientific and experiential knowledge was conducted through 1) a literature review (scientific articles and clinical practice guidelines) and 2) consultations with nine medical and psychosocial experts involved with individuals with a post-COVID-19 condition.

Living Your Values in Challenging Times

The pandemic has created serious emotional distress for health care workers. Staffing shortages and a fraught political landscape have made it more challenging for health care organizations to honor their core values, whereas burnout, PTSD, and moral injury have made it more difficult, if not impossible, for caregivers to live up to their personal values. This article describes the problem and presents 7 recommendations for health care leaders.

Monitor mental health: healthcare frontline workers are at risk of post-traumatic stress disorder

The article presents the discussion on monitoring mental health for healthcare frontline workers having risk of post-traumatic stress disorder. Topics include debilitating cost to sufferers, changing the ability for managing the emotions, increasing suicidal thoughts, or harmful behaviours;and PTSD being a stress-related disorder commonly occurring after the sufferer experiences or witnessing a lifethreatening traumatic event.