Wang, C., Pan, R., Wan, X., Tan, Y., Xu, L., McIntyre, R. S., … & Ho, C. (2020). A longitudinal study on the mental health of general population during the COVID-19 epidemic in China. Brain, Behavior, and Immunity.


In addition to being a public physical health emergency, Coronavirus disease 2019 (COVID-19) affected global mental health, as evidenced by panic-buying worldwide as cases soared. Little is known about changes in levels of psychological impact, stress, anxiety and depression during this pandemic. This longitudinal study surveyed the general population twice - during the initial outbreak, and the epidemic's peak four weeks later, surveying demographics, symptoms, knowledge, concerns, and precautionary measures against COVID-19. There were 1738 respondents from 190 Chinese cities (1210 first-survey respondents, 861 s-survey respondents; 333 respondents participated in both). Psychological impact and mental health status were assessed by the Impact of Event Scale-Revised (IES-R) and the Depression, Anxiety and Stress Scale (DASS-21), respectively. IES-R measures PTSD symptoms in survivorship after an event. DASS -21 is based on tripartite model of psychopathology that comprise a general distress construct with distinct characteristics. This study found that there was a statistically significant longitudinal reduction in mean IES-R scores (from 32.98 to 30.76, p < 0.01) after 4 weeks. Nevertheless, the mean IES-R score of the first- and second-survey respondents were above the cut-off scores (> 24) for PTSD symptoms, suggesting that the reduction in scores was not clinically significant. During the initial evaluation, moderate-to-severe stress, anxiety and depression were noted in 8.1%, 28.8% and 16.5%, respectively and there were no significant longitudinal changes in stress, anxiety and depression levels (p > 0.05). Protective factors included high level of confidence in doctors, perceived survival likelihood and low risk of contracting COVID-19, satisfaction with health information, personal precautionary measures. As countries around the world brace for an escalation in cases, Governments should focus on effective methods of disseminating unbiased COVID-19 knowledge, teaching correct containment methods, ensuring availability of essential services/commodities, and providing sufficient financial support.


Higher IES-R scores among the participants of the two surveys reflect the presence PTSD symptoms. During the COVID-19 pandemic, face-to-face psychotherapy is not feasible due to strict quarantine and lockdown measures. Mental health providers need to consider adopting online psychotherapy. Pre-implementation training of mental health professionals with involvement of multiple relevant agencies may help in various psychological interventions targeting PTSD symptoms. One example of evidence-based treatment is trauma-focused -cognitive behavior therapy (TF-CBT) (Cao et al., 2020). TF-CBT can be modified for the COVID-19 pandemic with emphasis on 1) education on the psychological impact of the COVID-19 pandemic; 2) development of psychosocial skills to optimize emotional and behavioral adjustment during quarantine and lockdown; 3) affective expression and problemsolving to handle emotions and common problems (e.g., shortage of necessities) encountered during quarantine and lockdown; 4) cognitive formulation to illustrate the relationships among thoughts, feelings and behaviors; 5) cognitive challenge or modification of unhelpful thoughts about COVID-19 and perceived discrimination; 5) trauma narration, in which public describe their personal traumatic experiences during COVID-19 pandemic; 6) home-based relaxation techniques and stress management skills with online guidance; 7) grief therapy to handle potential loss of family members or friends who died of COVID-19; 8) online peer support group session to talk to one other about their trauma; 9) enhancing safety and precaution to reduce the risk of contracting COVID-19 and 10) exposure to trauma reminders to overcome avoidance of situations that are no longer risky when the COVID pandemic is over. Delivery of TF-CBT during the COVID-19 pandemic requires healthcare organizations to develop online readiness and engagement of other stakeholders including counselors, psychologists, doctors, insurers and the public to accept the new model of mental health service.

Rossi, R., Socci, V., Talevi, D., Mensi, S., Niolu, C., Pacitti, F., … & Di Lorenzo, G. (2020). COVID-19 pandemic and lockdown measures impact on mental health among the general population in Italy. An N= 18147 web-based survey. medRxiv.


In this study, we report for the first time on the mental health outcomes related to COVID-19 206 outbreak and related lockdown measures on the general population in Italy. To the best of our  knowledge, this is the first study to report on mental health outcomes related to the COVID-19  outbreak in Europe on such a large sample size. This study shows relatively high rates of PTSS,  Depression, Anxiety, Insomnia, Perceived stress and ADS, with young women having higher odds  of endorsing a mental health outcome. These outcomes were associated with a number of COVID- 19-related risk factors, including being under quarantine, having a loved one deceased by COVID-19, working activity discontinued due to lockdown measures, or experiencing other stressful  events (i.e. working, financial, relationship or housing problems) due to the pandemic or  lockdown measures. These findings were adjusted for previous psychiatric illness and a history of  childhood trauma, suggesting that the COVID-19 pandemic is exerting an independent effect on 216 the population mental health.


Background:  The psychological impact of the CoronaVirus Disease 2019 (COVID-19) outbreak and lockdown measures on the Italian population are unknown.  The current study assesses rates of mental health outcomes in the Italian general population three to four weeks into lockdown measures and explores the impact of COVID-19 related potential risk factors.

Methods:A web-based survey spread throughout the internet between March 27th and April 6th 2020. 18147 individuals completed the questionnaire, 79.6% women.  Selected outcomes were post-traumatic stress symptoms (PTSS), depression, anxiety, insomnia, 3perceived stress and adjustment disorder symptoms (ADS). Seemingly unrelated logistic regression analysis was performed to identify COVID-19 related risk factors.

Results: Respondents endorsing PTSS, depression, anxiety, insomnia, high perceived stress and adjustment disorder were 6604 (37%), 3084 (17.3%), 3700 (20.8%), 1301 (7.3%), 3895 (21.8%) and 4092  (22.9%), respectively. Being woman and younger age were associated with all of the selected outcomes. Quarantine was associated with PTSS, anxiety and ADS. Any recent COVID-related stressful life event was associated with all the selected outcomes. Discontinued working activity due to the COVID-19 was associated with all the selected outcomes, except for ADS; working more than usual was associated with PTSS, Perceived stress and ADS. Having a loved one deceased by COVID-19 was associated with PTSS, depression, perceived stress and insomnia.

Conclusion: We found high rates of negative mental health outcomes in the Italian general population three weeks into the COVID-19 lockdown measures and different COVID-19 related risk factors. These findings warrant further monitoring on the Italian population’s mental health.

Shiina, A., Niitsu, T., Kobori, O. et al. (2020). Relationship between perception and anxiety about COVID-19 infection and risk behaviors for spreading infection: A national survey in Japan. 6, 100101, Brain, Behavior, & Immunity - Health


Background:The novel corona virus infection (COVID-19) quickly became a pandemic state. Identifying characteristics of“possible super spreaders”, suggested as a dominant cause of rapid spreading transmission, will help us to design proper prevention strategies. Methods:We conducted a nation-wide online survey to investigate the relationship of perception and anxiety levels about COVID-19 to the possible risk behaviors for spread of the virus in Japan. We recruited a total of 4,000 citizens, who responded to the questionnaire including several questions regarding the level of fear and anxiety about COVID-19, infection preventive behaviors and access to media with trust level about the virus as well as some demographic and socioeconomic data during March 27th and 28th, 2020.Findings:Thirteen-point-three percent of the participants rated“1”on a nine-point Likert with respect to the knowledge about COVID-19. Ten-point-one percent and 11.7% presented no anxiety of being infected and transmission to others. Ten-point-eight percent showed no worry about symptomatic aggravation. Eight-point-one percent had no serious concern about expanding infection. The distribution of these items was highly correlated with each other. Participants with the low level of knowledge about COVID-19 were likely to less frequently access any information sources and neither trust them. They were less anxious about their health status, and less likely to put precautionary behaviors such as washing hands and avoiding crowded spaces, suggested by statistical analyses.Interpretation:The present study suggests that it is greatly important to enlighten those have no concerns abou tthis crisis of COVID-19 and modify their risk behavior via various ways, in order to prevent and control this viral pandemic.Funding:This study was funded by the management grand provided to Chiba University Graduate School of Medicine and the Japan Society for the Promotion of Science KAKENHI grants.

This is the first report on the estimation of the potential risk-proportion in the community and the related cognitive and behavioral characteristics. If our hypothesis is correct, enlightening individuals with low understanding properly is important to prevent further expansion ofCOVID-19 infection. Our findings suggest that lack of accurate knowledge regarding the danger of COVID-19 may be responsible for inappropriate behaviors. Education and information are necessary to modify risky behaviors in this context. However, they are less likely to access information sources. Therefore, we have to fill this information gap using any means (official and unofficial) for protection against the pandemic.

Shevlin, M., McBride, O., Murphy, J., Miller, J. G., Hartman, T. K., Levita, L., … & Bennett, K. M. (2020). Anxiety, Depression, Traumatic Stress, and COVID-19 Related Anxiety in the UK General Population During the COVID-19 Pandemic. PsyArXiv.


This study aimed to estimate the association between anxiety associated with COVID-19 and somatic symptoms, using data from a large, representative sample (N=2025) of the UK adult population. Results showed that moderate to high levels of anxiety associated with COVID-19 were significantly associated with general somatic symptoms, and in particular with gastrointestinal and fatigue symptoms. This pattern of associations remained significant after controlling for generalised anxiety disorder, pre-existing health problems, age, gender and income. This is the first evidence that anxiety associated with COVID-19 makes a unique contribution to somatisation, above and beyond the effect of generalised anxiety disorder.

That the effect for COVID-19 anxiety remained even when controlling for screening positive for GAD is an important discovery because it suggests that the anxiety that people are experiencing because of this pandemic is a unique contributor to the somatic problems that they are suffering from. There is, therefore, potential for additional strain on health service providers if individuals seek help for these complaints. A public health message that explains to the public that the stress, worry, and anxiety they are feeling about the current pandemic can manifest in increased levels of physical/somatic problems, particularly fatigue, pain and gastrointestinal discomfort, may be helpful in alleviating unnecessary worry among the public and reducing strain on the health system during this crisis situation. Of course, any such public health message must also stress that individuals with pre-existing health problems, particularly those experiencing cardiopulmonary problems as these symptoms were unrelated to COVID-19 anxiety and may be related to other life-threatening conditions, should seek appropriate medical care if their physiological symptoms change in any way. Furthermore, these findings suggest there may be value in implementing psychological measures of COVID-19 anxiety in primary care facilities for those presenting with non-specific and possibly psychosomatic problems.


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