When one door closes: a qualitative exploration of women's experiences of access to sexual and reproductive health services during the COVID-19 lockdown in Nigeria.

BACKGROUND: COVID-19 pandemic widely disrupted health services provision, especially during the lockdown period, with females disproportionately affected. Very little is known about alternative healthcare sources used by women when access to conventional health services became challenging. This study examined the experiences of women and adolescent girls regarding access to sexual and reproductive health (SRH) services during the COVID-19 lockdown in Nigeria and their choices of alternative healthcare sources. METHODS: The study sites were two northern states, two southern states, and the Federal Capital Territory. Qualitative data were obtained through 10 focus group discussion sessions held with married adolescents, unmarried adolescents, and older women of reproductive age. The data were transcribed verbatim and analysed using a thematic approach and with the aid of Atlas ti software. RESULTS: Women reported that access to family planning services was the most affected SRH services during the COVID-19 lockdown. Several barriers to accessing SRH services during COVID-19 lockdown were reported, including restriction of vehicular movement, harassment by law enforcement officers, fear of contracting COVID-19 from health facilities, and fear of undergoing compulsory COVID-19 tests when seeking care in health facilities. In the face of constrained access to SRH services in public sector facilities during the COVID-19 lockdown, women sought care from several alternative sources, mostly locally available and informal services, including medicine vendors, traditional birth attendants, and neighbours with some health experience. Women also widely engaged in self-medication, using both orthodox drugs and non-orthodox preparations like herbs. The lockdown negatively impacted on women's SRH, with increased incidence of sexual- and gender-based violence, unplanned pregnancy resulting from lack of access to contraceptives, and early marriage involving adolescents with unplanned pregnancies. CONCLUSION: COVID-19 negatively impacted access to SRH services and forced women to utilise mostly informal service outlets and home remedies as alternatives to conventional health services. There is a need to ensure the continuity of essential SRH services during future lockdowns occasioned by disease outbreaks. Also, community systems strengthening that ensures effective community-based health services, empowered community resource persons, and health-literate populations are imperative for overcoming barriers to healthcare access during future lockdowns.

Challenges associated with coronavirus disease (COVID-19)-related self-quarantine in Ghana: lessons for future self-quarantine interventions.

Introduction: self-quarantine was one of the key public health interventions in halting the spread of the coronavirus disease (COVID-19) in Ghana. Despite its success, self-quarantine was bridled with challenges across the country, including in the Eastern Region. Consequently, it was pertinent to ascertain these challenges to inform future self-quarantine interventions in the region and the country. The study aimed to ascertain challenges faced by COVID-19 self-quarantined persons in the Eastern Region of Ghana to inform future policies on self-quarantine in the region and the country in general. Methods: thirty-five (35) participants were interviewed in both Twi and English. Following the thematic content analysis approach, Atlas. ti software was used to analyse the data. Relevant quotes were extracted from the transcripts to back the various sub-themes in presenting the results. Results: three global themes emerged from the analyses: socio-economic challenges of self-quarantine (lack of access to essential goods and services, loss of income, and poor housing conditions), health-related challenges (sedentary lifestyle, non-supply of essential personal protective equipment such as face masks, development of oedema and weight gain), and psychological challenges (loneliness, boredom, and anxiety). Conclusion: COVID-19-related challenges self-quarantined persons faced in the Eastern Region of Ghana were multifaceted, ranging from socio-economic, and health to psychological ones. Consequently, emergency preparedness for future pandemic control using self-quarantine as a tool should bring on board various stakeholders to ensure challenges identified in this study are holistically addressed and do not recur.

Effects of COVID-19 Mental Health Interventions Among Children, Adolescents, and Adults Not Quarantined or Undergoing Treatment Due to COVID-19 Infection: A Systematic Review of Randomised Controlled Trials.

OBJECTIVES: Our objective was to assess the effects of mental health interventions for children, adolescents, and adults not quarantined or undergoing treatment due to COVID-19 infection. METHODS: We searched 9 databases (2 Chinese-language) from December 31, 2019, to March 22, 2021. We included randomised controlled trials of interventions to address COVID-19 mental health challenges among people not hospitalised or quarantined due to COVID-19 infection. We synthesized results descriptively due to substantial heterogeneity of populations and interventions and risk of bias concerns. RESULTS: We identified 9 eligible trials, including 3 well-conducted, well-reported trials that tested interventions designed specifically for COVID-19 mental health challenges, plus 6 other trials with high risk of bias and reporting concerns, all of which tested standard interventions (e.g., individual or group therapy, expressive writing, mindfulness recordings) minimally adapted or not specifically adapted for COVID-19. Among the 3 well-conducted and reported trials, 1 (N = 670) found that a self-guided, internet-based cognitive-behavioural intervention targeting dysfunctional COVID-19 worry significantly reduced COVID-19 anxiety (standardized mean difference [SMD] 0.74, 95% confidence interval [CI], 0.58 to 0.90) and depression symptoms (SMD 0.38, 95% CI, 0.22 to 0.55) in Swedish general population participants. A lay-delivered telephone intervention for homebound older adults in the United States (N = 240) and a peer-moderated education and support intervention for people with a rare autoimmune condition from 12 countries (N = 172) significantly improved anxiety (SMD 0.35, 95% CI, 0.09 to 0.60; SMD 0.31, 95% CI, 0.03 to 0.58) and depressive symptoms (SMD 0.31, 95% CI, 0.05 to 0.56; SMD 0.31, 95% CI, 0.07 to 0.55) 6-week post-intervention, but these were not significant immediately post-intervention. No trials in children or adolescents were identified. CONCLUSIONS: Interventions that adapt evidence-based strategies for feasible delivery may be effective to address mental health in COVID-19. More well-conducted trials, including for children and adolescents, are needed.

The associations between metacognition problems, mindfulness, and internalizing symptoms in university students quarantined due to Covid-19 in Turkey.

PURPOSE: To investigate the associations between internalizing problems, metacognition problems, and mindfulness levels in university students during the COVID-19 pandemic. DESIGN AND METHODS: Depression, anxiety, and stress levels were compared between university students quarantined in dormitories and their homes under curfew conditions. The direct and indirect associations between internalizing problems, metacognition problems, and mindfulness levels of students under quarantine were evaluated. FINDINGS: Metacognition problems and low mindfulness levels were associated with higher depression, anxiety, and stress symptoms under quarantine conditions. PRACTICE IMPLICATIONS: Therapeutic interventions focusing on metacognition problems and mindfulness levels may reduce the negative psychological effects of quarantine.

Stuck in a lockdown: Dreams, bad dreams, nightmares, and their relationship to stress, depression and anxiety during the COVID-19 pandemic.

BACKGROUND: An upsurge in dream and nightmare frequency has been noted since the beginning of the COVID-19 pandemic and research shows increases in levels of stress, depression and anxiety during this time. Growing evidence suggests that dream content has a bi-directional relationship with psychopathology, and that dreams react to new, personally significant and emotional experiences. The first lockdown experience was an acute event, characterized by a combination of several unprecedent factors (new pandemic, threat of disease, global uncertainty, the experience of social isolation and exposure to stressful information) that resulted in a large-scale disruption of life routines. This study aimed at investigating changes in dream, bad dream and nightmare recall; most prevalent dream themes; and the relationship between dreams, bad dreams, nightmares and symptoms of stress, depression and anxiety during the first COVID-19 lockdown (April-May 2020) through a national online survey. METHODS: 968 participants completed an online survey. Dream themes were measured using the Typical Dreams Questionnaire; stress levels were measured by the Cohen's Perceived Stress Scale; symptoms of anxiety were assessed by Generalized Anxiety Disorder (GAD-7) scale; and symptoms of depression were assessed using the Quick Inventory of Depressive Symptomatology. RESULTS: 34% (328) of participants reported increased dream recall during the lockdown. The most common dream themes were centered around the topics of 1) inefficacy (e.g., trying again and again, arriving late), 2) human threat (e.g., being chased, attacked); 3) death; and 4) pandemic imagery (e.g., being separated from loved ones, being sick). Dream, bad dream and nightmare frequency was highest in individuals with moderate to severe stress levels. Frequency of bad dreams, nightmares, and dreams about the pandemic, inefficacy, and death were associated with higher levels of stress, as well as with greater symptoms of depression and anxiety. CONCLUSIONS: Results support theories of dream formation, environmental susceptibility and stress reactivity. Dream content during the lockdown broadly reflected existential concerns and was associated with increased symptoms of mental health indices.

Percepciones y sentimientos de niños argentinos frente a la cuarentena COVID-19 / Perceptions and feelings of Argentine children regarding the COVID-19 quarantine

La Subcomisión de Derechos del Niño y el Comité de Pediatría Social, de la Sociedad Argentina de Pediatría, realizaron un trabajo de campo que permitiera dar voz a nuestros niños, niñas y adolescentes (NNA) durante la cuarentena y el aislamiento social obligatorio impuestos en nuestro país por la pandemia mundial por la enfermedad por el nuevo coronavirus (COVID-19). Los objetivos fueron relevar el impacto sobre sus sentimientos, emociones y deseos; evaluar y comparar las repercusiones personales, familiares y sociales antes, durante y después de la cuarentena; e identificar las necesidades de apoyo y contención.Los resultados de la investigación permiten afirmar que los niños han sido los más afectados y los menos escuchados. La cuarentena ha tenido un enorme impacto individual, social y familiar en los NNA, y reclama un abordaje holístico, comprometido y mancomunado de la sociedad civil, las familias, los profesionales de la salud, los docentes y las autoridades políticas.

The Subcommittee on the Rights of the Child and the Social Pediatrics Committee of the Sociedad Argentina de Pediatría carried out a fieldwork that allowed us to give a voice to our children and adolescents (NNA), during quarantine and social isolation mandatory imposed in our country by the global pandemic COVID-19. The objectives were to analyze the impact on their feelings, emotions and desires; evaluate and compare personal, family and social repercussions pre, intra and post quarantine; and identify support and containment needs.The results of the research allow us to affirm that children have been the most vulnerable and the least listened to. The quarantine has had an enormous individual, social and family impact on children and adolescents and calls for a holistic, committed and joint approach from civil society, families, health professionals, teachers and political authorities

[Perceptions and feelings of Argentine children regarding the COVID-19 quarantine]. / Percepciones y sentimientos de niños argentinos frente a la cuarentena COVID-19.

The Subcommittee on the Rights of the Child and the Social Pediatrics Committee of the Sociedad Argentina de Pediatría carried out a fieldwork that allowed us to give a voice to our children and adolescents (NNA), during quarantine and social isolation mandatory imposed in our country by the global pandemic COVID-19. The objectives were to analyze the impact on their feelings, emotions and desires; evaluate and compare personal, family and social repercussions pre, intra and post quarantine; and identify support and containment needs. The results of the research allow us to affirm that children have been the most vulnerable and the least listened to. The quarantine has had an enormous individual, social and family impact on children and adolescents and calls for a holistic, committed and joint approach from civil society, families, health professionals, teachers and political authorities.

La Subcomisión de Derechos del Niño y el Comité de Pediatría Social, de la Sociedad Argentina de Pediatría, realizaron un trabajo de campo que permitiera dar voz a nuestros niños, niñas y adolescentes (NNA) durante la cuarentena y el aislamiento social obligatorio impuestos en nuestro país por la pandemia mundial por la enfermedad por el nuevo coronavirus (COVID-19). Los objetivos fueron relevar el impacto sobre sus sentimientos, emociones y deseos; evaluar y comparar las repercusiones personales, familiares y sociales antes, durante y después de la cuarentena; e identificar las necesidades de apoyo y contención. Los resultados de la investigación permiten afirmar que los niños han sido los más afectados y los menos escuchados. La cuarentena ha tenido un enorme impacto individual, social y familiar en los NNA, y reclama un abordaje holístico, comprometido y mancomunado de la sociedad civil, las familias, los profesionales de la salud, los docentes y las autoridades políticas.

Holistic approach supporting mental wellbeing of people in enforced quarantine in South Australia during the COVID-19 pandemic.

OBJECTIVES: To report the experience of quarantine for international arrivals to South Australia requiring quarantine in a medi-hotel setting during the COVID-19 pandemic and to describe the range of evidence-based support services to mitigate the mental health impacts of quarantine. METHODS: A range of services targeted at physical and mental wellbeing were provided. Data from 533 adult respondents out of 721 passengers were included. The Kessler 10 was used to measure psychological distress at two time points. RESULTS: About 7.1% of respondents reported psychological distress at time one, reduced to 2.4% at time two. There was no significant difference in psychological distress by gender at either time point. The mean K10 score at time one was 13.6 (standard deviation=5.2) and the mean score at time two was 11.5 (standard deviation=3.1), with a significant reduction in mean scores (p<0.001) between the two time points. CONCLUSIONS: The level of psychological stress in repatriated Australians was low at arrival and improved further at the time of release from quarantine. Implications for public health: A collaborative multi-sector approach to provide support services for individuals in quarantine can mitigate risks to mental wellbeing.

Suicide epidemic in Malawi: what can we do?

Suicide continues to be a global health concern, affecting all continents. Although some studies have associated it with mental disorders such as severe depression, research also shows that a significant number of cases occur due to emerging life stresses. It is one of the leading causes of death among young people and is steady on the rise in Malawi. Malawi's suicide cases disproportionately affect young males from rural areas. These cases are also higher than those of neighbouring countries. During the lockdown period to mitigate the impact of the COVID-19 pandemic between April and September 2020, Malawi saw a rise in suicide cases, most of which were due to the resulting financial hardship. There is need to tackle the suicide epidemic holistically, on all tiers of intervention. People need to be equipped with socially acceptable coping mechanisms which are easily adaptable to a low resource setting. There is a need for initiative to be taken in training individuals who can manage mental ill health without overwhelming the health system. The entire health system and health policies should acknowledge the importance of mental ill-health and its consequences. Malawi needs to prioritise mental health issues, realising that indeed, there is no health, without mental health.

The Association of COVID-19 Pandemic Stress With Health-Related Quality of Life in the Kingdom of Saudi Arabia: A Cross-Sectional Analytical Study.

Background: There is a global disaster since WHO declared Covid-19 as a pandemic. With the increase in cases & mortality rate, various health issues viz., stress, mental disorders and altered health-related quality of life have been noted as a result of pandemic and lockdowns. This study aimed to assess the association of COVID-19 pandemic stress with health-related quality of life in the Kingdom of Saudi Arabia. Methodology: It was a cross-sectional analytical study. Subjects included 878 citizens and residents of Saudi Arabia aged 18 years and above. Convenience, non-probability sampling technique was used. A web-based, self-administered, electronic questionnaire in Arabic language having three sections; Sociodemographic & clinical profile, Standard PSS-10, and Standard SF-12 was used as the study tool and distributed through various social media means. The study period was of 2 months. Data were analyzed using SPS version 25. Descriptive statistics, Pearson's correlation coefficient, independent sample t-test and the one-way analysis of variance (ANOVA) were employed for suitable statistical analysis. Results: Almost two-thirds of the subjects were between the age of 18 to < 40 and majority (74.1%) being females. Majority (83.0%) reported as having no chronic diseases, and 69.5% had no contact history with COVID-19 cases. The mean of MCS & PCS was (32.34 ± 25.30) & (41.65 ± 11.82), respectively. Majority (67.6%) had a moderate level of COVID-19 stress. A significant negative relationship between total stress scores and HRQOL domains was observed. Conclusion: Majority subjects had a moderate level of stress related to COVID-19 lockdown. Stress during COVID-19 has a significant negative association with both physical and mental HRQOL in which MCS was significantly lower than PCS. It is recommended to evaluate the effectiveness of stress management program and follow a holistic approach.

Is the mental health of young students and their family members affected during the quarantine period? Evidence from the COVID-19 pandemic in Albania.

WHAT IS KNOWN ON THE SUBJECT?: Mental health is deteriorated during the quarantine period. Mental health status is affected by the quarantine even after the end of it and for an extended period. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Depression levels among nursing/midwifery students during the quarantine period are high. Depression levels among students' family members during the quarantine period are high. Those who are not satisfied with COVID-19 prevention measures and those who believe that COVID-19 and quarantine can cause problems on health, have elevated levels of depression. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Provision of mental health services during the quarantine period should be a priority for the healthcare system. Offering mental health first aid training and support can improve the mental health status of students and their family members. ABSTRACT: Introduction The use of quarantine method has a significant impact on mental health status. Aim This study aimed to assess the levels of depression among bachelor and master university students (nurses/midwives) and their family members' during the quarantine period of COVID-19 pandemic. Method A cross-sectional study was conducted in Vlora University, Albania. Patient Health Questionnaire (PHQ-9) was used. Institutional e-mails of all active students were used for their recruitment. Results In total, 863 students and 249 family members participated in the study. The mean PHQ-9 score was 6.220 (SD = 5.803) and 6.280 (SD = 5.857) for students and family members, respectively. Being unsatisfied with COVID-19 prevention measures, beliefs that COVID-19 infection and quarantine process can cause problems on their health status were the key factors for students to be screened positive for mental problems in multiple regression analysis. For parents, the last two factors were found to contribute significantly. Discussion Our findings indicate that quarantine measures have a significant impact on the levels of depression among both university students and their family members. Broader population studies are necessary to safeguard these results. Implications for Practice Provision of mental health services during the quarantine period is of paramount significance. Mental health first aid training and support could benefit both students and their parents significantly. Additionally, follow-up services after the end of quarantine are recommended.

A rapid review of home-based activities that can promote mental wellness during the COVID-19 pandemic.

BACKGROUND: During the COVID-19 pandemic, public health measures such as isolation, quarantine, and social distancing are needed. Some of these measures can adversely affect mental health. Activities that can be performed at home may mitigate these consequences and improve overall mental well-being. In this study, home-based activities that have potential beneficial effects on mental health were examined. METHODS: A rapid review was conducted based on a search of the following databases: MEDLINE, EMBASE, CINAHL, PyscINFO, Global Health, epistemonikos.org, covid19reviews.org, and eppi.ioe.ac.uk/covid19_map_v13.html. Eligible studies include randomized controlled trials and non-randomized studies published between 1/1/2000 and 28/05/2020 and that examined the impact of various activities on mental health outcomes in low-resource settings and contexts that lead to social isolation. Studies of activities that require mental health professionals or that could not be done at home were excluded. Two review authors performed title/abstract screening. At the full-text review stage, 25% of the potentially eligible studies were reviewed in full by two review authors; the rest were reviewed by one review author. Risk of bias assessment and data extraction were performed by one review author and checked by a second review author. The main outcome assessed was change or differences in mental health as expressed in Cohen's d; analysis was conducted following the synthesis without meta-analysis guidelines (SWiM). PROSPERO registration: CRD42020186082. RESULTS: Of 1,236 unique records identified, 160 were reviewed in full, resulting in 16 included studies. The included studies reported on the beneficial effects of exercise, yoga, progressive muscle relaxation, and listening to relaxing music. One study reported on the association between solitary religious activities and post traumatic stress disorder symptoms. While most of the included studies examined activities in group settings, particularly among individuals in prisons, the activities were described as something that can be performed at home and alone. All included studies were assessed to be at risk of bias in one or more of the bias domains examined. CONCLUSIONS: There is some evidence that certain home-based activities can promote mental wellness during the COVID-19 pandemic. Guidelines are needed to help optimize benefits while minimizing potential risks when performing these activities.

A quantitative and qualitative study on the neuropsychiatric sequelae of acutely ill COVID-19 inpatients in isolation facilities.

This study examined the neuropsychiatric sequelae of acutely ill patients with coronavirus disease 2019 (COVID-19) infection who received treatment in hospital isolation wards during the COVID-19 pandemic. Ten COVID-19 patients who received treatment in various hospitals in Chongqing, China; 10 age- and gender-matched psychiatric patients; and 10 healthy control participants residing in the same city were recruited. All participants completed a survey that collected information on demographic data, physical symptoms in the past 14 days and psychological parameters. Face-to-face interviews with COVID-19 patients were also performed using semi-structured questions. Among the COVID-19 patients, 40% had abnormal findings on the chest computed topography scan, 20% had dysosmia, 10% had dysgeusia, and 80% had repeated positivity on COVID-19 reverse-transcription polymerase chain reaction testing. COVID-19 and psychiatric patients were significantly more worried about their health than healthy controls (p = 0.019). A greater proportion of COVID-19 patients experienced impulsivity (p = 0.016) and insomnia (p = 0.039) than psychiatric patients and healthy controls. COVID-19 patients reported a higher psychological impact of the outbreak than psychiatric patients and healthy controls, with half of them having clinically significant symptoms of posttraumatic stress disorder. COVID-19 and psychiatric patients had higher levels of depression, anxiety and stress than healthy controls. Three themes emerged from the interviews with COVID-19 patients: (i) The emotions experienced by patients after COVID-19 infection (i.e., shock, fear, despair, hope, and boredom); (ii) the external factors that affected patients' mood (i.e., discrimination, medical expenses, care by healthcare workers); and (iii) coping and self-help behavior (i.e., distraction, problem-solving and online support). The future direction in COVID-19 management involves the development of a holistic inpatient service to promote immune and psychological resilience.

Tendency to Worry and Fear of Mental Health during Italy's COVID-19 Lockdown.

BACKGROUND: We tested whether the tendency to worry could affect psychological responses to quarantine by capitalizing on the opportunity of having collected data before the COVID-19 outbreak on measures of worry, anxiety, and trait mindfulness in a group of university students. METHODS: Twenty-five participants completed self-report measures assessing worry (Penn State Worry Questionnaire, PSWQ), anxiety (Anxiety Sensitivity Index, ASI-3), and trait mindfulness (Mindful Attention Awareness Scale, MAAS) at T0 (pre-lockdown, 4 November 2019-17 February 2020) and T1 (at the end of lockdown, 26 April-30 April 2020). We compared assessments at the two time points in the whole sample and in high and low worriers (defined at T0 by scores on PSWQ respectively above and below 1.5 SD from mean of the Italian normative sample). OUTCOMES: High worriers showed at T1 a significant increase of anxiety sensitivity and fear of mental health in comparison to low worriers. Moreover, in the whole sample, at T1 trait mindfulness was inversely related to worry and fear of mental health. INTERPRETATION: A valuable approach to support individuals experiencing anxiety related to the COVID-19 outbreak could be represented by mindfulness-based interventions improving the ability to focus attention and awareness on the present moment.

Quarantine: A Period of Self-discovery and Motivation as Medical Student.

The ongoing nationwide lockdown due to the global pandemic COVID-19 started from March 24, 2020, in Nepal. Lots of medical students are in dilemma about how to utilize this time to make it more productive. To live a good life, we must be able to balance our life in general so, we can use this time to discover ourselves. It is equally important to adjust to the global pandemic and help locally to combat the current situation. This difficult time demands resilience. This article focuses on some ideas to discover ourselves and develop resilience within us.

Rituals in the Time of COVID-19: Imagination, Responsiveness, and the Human Spirit.

Following the format put forth by Imber-Black and Roberts, I examine daily rituals, family traditions, holidays, and life cycle rituals during the pandemic of COVID-19. Marked by symbols capable of carrying multiple meanings, symbolic actions, special time and special place, and newly invented and adapted rituals are illustrated through stories of couples, families, and communities.

Siguiendo el formato presentado por Imber-Black, Roberts y Whiting (1988), analizo los rituales diarios, las tradiciones familiares, las festividades y los rituales del ciclo de vida durante la pandemia de la COVID-19. Los rituales recientemente inventados y adaptados -marcados por símbolos capaces de cargar varios significados, acciones simbólicas, un tiempo especial y un lugar especial- se ejemplifican mediante historias de parejas, familias y comunidades.