The COVID-19 pandemic and ensuing isolation measures has had negative psychological impact on the general population of China, measured by mean levels of stress, depression and anxiety. Authors conducted a cross-sectional study (Jan. 31 - Feb. 2) (n=1210, from 194 cities) using an online questionnaire disseminated to university students who were encouraged to pass it along. Overall, 75.5% of respondents reported psychological impacts resulting from the pandemic. Women, students, presentation of various symptoms (ex: dizziness, coryza), and low reported health-status are high risk-factors for worsened mental health. Identifying populations vulnerable to psychological distress, and factors favouring psychological health, provide insight for the formulation of psychological interventions.

Psychological response to the first wave of COVID-19 in China (stress, depression and anxiety)

Hoarding disorder is characterized by a persistent difficulty in discarding or parting with possessions, regardless of their actual value. This behavior frequently results in the accumulation of items that clutter and congest the individual's living area.

Hoarding Disorder

Schizophrenia is a severe psychological disorder that leads to a profound breakdown in an individual's ability to function, often necessitating hospitalization. It is characterized by significant disruptions in thought, perception, emotion, and behavior, including symptoms like hallucinations, delusions, incoherent thinking, bizarre actions, flat emotions, and a lack of motivation for basic activities. It is important to distinguish schizophrenia from dissociative identity disorder ('split personality'), as the term 'schizophrenia' refers to a 'splitting of psychic functions,' not a divided personality.

Schizophrenia

- Factors increasing anxiety
- Protective factors against anxiety

Areas impact between COVID and Anxiety/Panic Disorders

Post-traumatic Stress Disorder (PTSD) is a condition where an individual experiences a collection of persistent symptoms following a traumatic or profoundly stressful event, such as combat, sexual assault, or a natural disaster. For a diagnosis, these symptoms must last for at least one month. The traumatic event can be witnessed firsthand or secondhand. Historically, PTSD was referred to by terms like 'shell shock' and 'combat neurosis' due to its frequent association with war, but it is now recognized as affecting a wider population.

Post-traumatic Stress Disorder (PTSD)

Laura J. Dixon, Sara M. Witcraft & Mary J. Schadegg (2023) COVID-19 anxiety and mental health among university students during the early phases of the U.S. pandemic, Journal of American College Health, 71:4, 1152-1160, https://doi.org/10.1080/07448481.2021.1923504 

The Effects of COVID-19 on Anxiety-Related Mental Health Concerns

Obsessive-compulsive disorder (OCD) is characterized by the presence of obsessions and/or compulsions. Obsessions are defined as intrusive and unwanted thoughts, mental images, fears, sensations, or urges. Compulsions are repetitive behaviors or mental acts that an individual feels driven to perform, often in response to an obsession. These cycles of obsessions and compulsions are typically distressing, time-consuming, and can significantly disrupt a person's daily activities.

Obsessive-Compulsive Disorder (OCD)

Body Dysmorphic Disorder (BDD) is a condition where an individual is intensely preoccupied with a perceived flaw in their physical appearance, which is often nonexistent or barely perceptible to others. This preoccupation can cause the person to believe they are unattractive, ugly, or deformed. The intense focus on these imagined defects leads to repetitive, ritualistic behaviors and mental acts. These compulsions can include constantly checking one's appearance in the mirror, attempting to conceal the perceived flaw, making comparisons to others, and in some cases, seeking cosmetic surgery.

Body Dysmorphic Disorder (BDD)

- Depression
- Obsessive-Compulsive Disorder
- Hoarding Disorder
- Post-traumatic Stress Disorder
- Anxiety/ Panic Disorders
- Social Anxiety Disorder
- Body dysmorphic disorder
- Schizophrenia 
- Borderline Personality Disorder

Smith College

Princeton University

Georgetown University

Ohio State University, Columbus

Columbia University

Syracuse University

University of California, Davis

From ages 2-10, children have an active social life at school which helps them develop personality traits and sense of identity, and disruptions of close peer relationships have been associated with depression, guilt, and anger. In quarantine, children have shown an increased risk of developing post-traumatic stress disorder, anxiety, grief, and adjustment disorder. Moreover, by spending long periods of time in households where parents suffer from mental health issues or economic hardship, children may become victims of domestic violence.



Re-opening Schools For Fall 2020 as a Means to Improve Children's Mental Health

- higher risk of SARS-CoV-2 infection for those with pre-existing mental health disorders
- Difficulty in following safety measures due to entenuating circumstances
- increased symptoms, relapse, and poorer access to services and supports

Potential consequences of COVID-19 for mental health for people with pre-existing mental health disorders

- Mental Disorders
- Mental Health and psychological distress
- Mental Health Care
- Mental Health Consequences and physical distancing
- Mental Health Risk Factors
- Students mental health

Mental health focuses (COVID-19)

Generally speaking, anxiety is a reaction by the body that ensues negative internal experiences such as negative thoughts or feelings. Physical changes may also follow, such as an increase in blood pressure, rapid heartbeat, trembling, and so on.

Anxiety

Lawrence, E., 2020. COVID-19 Worsens Obsessive-Compulsive Disorder - But Therapy Offers Coping Skills. Scientific American. https://www.scientificamerican.com/article/covid-19-worsens-obsessive-compulsive-disorder-but-therapy-offers-coping-skills1/

COVID-19 Worsens Obsessive-Compulsive Disorder—but Therapy Offers Coping Skills

Kluger, J., 2020. How Coronavirus Fear Is Hitting The OCD Community. Time.
https://time.com/5808278/coronavirus-anxiety/ 

The Coronavirus Pandemic May Be Causing an Anxiety Pandemic

Domestic violence refers to a range of violations that happen within a home. For many people, especially women and children, home is often the place they experience physical, mental and sexual violence. The negative effects of the pandemic, such as confinement and loneliness, closure of schools and businesses and economic vulnerability due to loss of jobs have disproportionately increased the occurrences of violence towards women and children. Several different countries, such as the UK, Brazil and Spain, have witnessed an increase in the rates since the announcement of lockdown by their governments. The pandemic therefore creates a paradox around staying safe at home. 

The consequences of COVID-19 on domestic violence

Quarantine and social distancing measures have particularly affected young populations during the COVID-19 pandemic, as they often identify themselves through their social interactions. This cross-sectional study (May 7-May 16, 2020)(n=666) surveyed German individuals, aged between 16 and 25 years of age, online. This study showed that 56% of respondents experienced psychological distress during the COVID-19 pandemic. Social risk indicators for increased psychological distress include unemployment, inability to work, migrant/ethnic minority group position, and single relationship status. This study also shows that individuals who experienced psychological distress are more likely to report having a positive attitude towards mental health apps, possibly suggesting a further need in developing these.

Mental Health Outcomes in Youth (ages 16 to 25) During the COVID-19 Pandemic

Mental Disorders Affected By The Covid-19 Pandemic

The risk of developing a mental health disorder is increased when the environment around is more hostile, such as poverty and homelessness, and other comorbid physical conditions may arise. As such, people with mental disorders are at increased risk of infections in general (and thereby potentially at increased risk of COVID-19), and are more likely to develop severe organ dysfunction and to die in ICUs than people without mental disorders

Higher risk of SARS-CoV-2 infection

Physical distancing can be challenging certain institutions, such as nursing homes, learning disability nursing or prisons. For institutions such as nursing homes and learning disability nursings, the nature of patients' conditions makes it difficult to manage, while prisons may experience difficulty because of overcrowding.

Difficulty in following safety measures 

Particular circumstances that appeared due to the pandemic can have negative impacts on the symptoms of those who had previous mental health problems, such as increased symptoms, relapse, suicidal behavior, lack of access to medical care, and social isolation. Such circumstances include: 
- early discharge from psychiatric units, 
- disruption of face-to-face psychiatric care, 
- lockdown and quarantine, 
- disruption of daily routines,
- Physical distancing: Physical distancing, in particular, can reduce the availability of many families, social, and psychiatric supports. 

Increased symptoms, relapse, and poorer access to services and supports

Due to the large life and routine changes caused by the COVID-19 Pandemic, mental health issues are arising and increasingly relevant public health problems that needs to be addressed.

Mental Health and psychological distress Associated with the COVID-19 Pandemic

As the stress and the isolation of the pandemic begin to produce negative effects on people's mental well-being, there have been many different efforts to adapt the delivery of mental health care to the demands of COVID-19, 

Mental Health Care and Covid-19

- Being at heightened risk of contracting the disease (elderly, people with compromised immune function, people living in congregate settings)
- Burnout and strain against healthcare workers
- Contracting COVID-19
- Having preexisting medical, psychiatric or substance use condition
- High-risk groups (women, students)
- Job loss and income insecurity
- Poor health
- Social isolation

Mental Health Risk Factors

- Domestic violence and child abuse: Individuals at risk for abuse may have limited opportunities to report or seek help when shelter-in-place requirements demand prolonged cohabitation at home and limit travel outside of the home, more time in the home puts certain people at risk of more abuse
- Increase in self-harm and suicidal ideation
- Need to bolster our mental health system in preparation for the inevitable challenges precipitated by the COVID-19 pandemic.  Health systems, both public and private sector, will need to develop mechanisms for refill and delivery of essential medicines, including psychiatric medicines.  
- Online substitutes for daily routines: can be extremely helpful, but not all children have access to technologies that enable remote connectivity.

Mental Health Consequences

Objective: determine if pre-pandemic diurnal cortisol indices can predict the effect of strict social confinement on:
- perceived stress
-  empathy
- attention
- working memory

Differential Susceptibility to the Impact of the COVID-19
Pandemic on Working Memory, Empathy, and Perceived Stress:
The Role of Cortisol and Resilience

The pandemic led to the social isolation and other triggers of many students which may have had effects on their mental health. 

The Effects of COVID-19 Pandemic on Students Mental Health

Gillespie-Smith, K., McConachie, D., Ballantyne, C., Auyeung, B., & Goodall, K. (2023). The Impact of COVID-19 Restrictions on Psychological Distress in Family Caregivers of Children with Neurodevelopmental Disability in the UK. Journal of Autism & Developmental Disorders, 53(4), 1573–1587. https://doi.org/10.1007/s10803-021-05132-3

The Impact of COVID‑19 Restrictions on Psychological Distress
in Family Caregivers of Children with Neurodevelopmental Disability
in the UK

Research studying the impact of COVID on caregivers has shown that caregivers need to spend more time on self-care that focuses on social support and social opportunities rather than traditional areas.

The Impact of COVID-19 on Caregivers of Children with Neurodevelopmental Disabilities

The Covid 19 Pandemic caused distress for children with intellectual and developmental disabilities as well as their families by limiting their access to resources.

How Covid 19 Limited Access to Resources for Individuals and Families with Intellectual and Developmental Disabilities

Cerebral Palsy is known to make the stresses of life more overwhelming. Individuals tend to become shy in social situations out of fear of being bullied or teased by others. They are more prone to depression and anxiety disorders.

Psychological Impacts of Cerebral Palsy

The amygdala is a section of the brain that processes fearful stimuli. Patients with anxiety disorders exhibit stronger amygdala responses than patients without anxiety disorders. Studies suggest that mindfulness interventions can reduce the amygdala response in patients with anxiety disorders.

Mindfulness Effects on the Amygdala and Anxiety


- Persistent worry or feeling overwhelmed by emotions.

- Excessive worry about a number of concerns, such as health problems or finances, and a general sense that something bad is going to happen.

- Restlessness and irritability.

- Difficulty concentrating, sleep problems and generally feeling on edge.

Signs of Anxiety

Some researchers believe that mindfulness is a natural state, so they searched for predictors of mindfulness.  Predictors they looked at included openness to experience and attentional control.  During their study they looked at trait anxiety, attachment anxiety and attentional control. Due to anxiety blocking many of the predictors they tested for, it was concluded that anxiety (both specific and general) is agonistic to mindfulness.  So, because anxiety turns anxious people away from mindfulness, it makes sense to help treat anxiety with mindfulness-based interventions.

Natural Mindfulness and Anxiety

The psychological consequences of distress due to experiencing an environmental disaster.

“Eco-anxiety”

- Generalized anxiety disorder
- Social anxiety disorder
- Specific phobias

Anxiety Disorders Treated by Mindfulness-Based Stress Reduction (MBSR)

- The HADS scale was used to determine levels of anxiety and depression
- It was found that there is a statistically significant relationship between the HADS score and cortisol levels
  - As levels of depression and anxiety increased, cortisol levels also increased
- COVID-19 Patients who had passed away had higher serum cortisol levels compared to the COVID-19 patients that survived
- Stress increases one’s susceptibility to respiratory tract infections, making patients more vulnerable to getting a cold
  - The immune cells become unable to regulate inflammation
- As tissues become less sensitive to cortisol due to high levels of stress, it becomes more difficult to regulate stress levels

Anxiety and Cortisol Levels in COVID-19 Patients

Emotions can play a large factor in the formation of political identity, as well as influence their belief in political misinformation. Anxiety and anger can result in differences in how an individual approaches political misinformation. Having anxiety can influence a person to further seek out political information learning, whereas being angry can influence a person to be more close-minded with the political information they are presented with.

Anxiety and Anger on Partisan Bias in Accepting Misinformation

Anxiety disorders are characterized by features of excessive fear and anxiety, as well as related behavioral disturbances. These symptoms are often not temporary and linger beyond typical expectations. Excessiveness of these symptoms is clinician diagnosed with cultural contexts taken into consideration.

Anxiety Disorders

Exploring how concussion-induced anxiety can be helped by exercise

Concussions, Anxiety, and Exercise

Anxiety may result in or worsen mental/physical conditions.
 

- Depression or other mental disorders
- Substance misuse
- Insomnia
- Bowel issues
- Headaches/ Chronic Pain
- Social Isolation
- Problems with daily functioning, including at school or work
- Poor quality of life 
- Suicidal
- Nausea/Vomitting

Complications of Anxiety

- Oftentimes, anxiety disorders go hand in hand with eating disorders

Comorbidity with Anxiety

The data on measures and therapeutic alliances was not significant. Still, observable trends showed that the combination of CBT and animal-assisted therapy may be beneficial for easing anxiety symptoms in school-aged children.  

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