Is a Positive COVID-19 Infection Status Associated with Higher Risk of Depression, Insomnia, & Anxiety in Medical Workers?

Research Paper Title

Prevalence of psychological disorders in the COVID-19 epidemic in China: A real world cross-sectional study.

Background

This study aimed to explore the prevalence of psychological disorders and associated factors at different stages of the COVID-19 epidemic in China.

Methods

The mental health status of respondents was assessed via the Patient Health Questionnaire-9 (PHQ-9), Insomnia Severity Index (ISI) and the Generalised Anxiety Disorder 7 (GAD-7) scale.

Results

5,657 individuals participated in this study. History of chronic disease was a common risk factor for severe present depression (OR 2.2, 95% confidence interval [CI], 1.82-2.66, p < 0.001), anxiety (OR 2.41, 95% CI, 1.97-2.95, p < 0.001), and insomnia (OR 2.33, 95% CI, 1.83-2.95, p < 0.001) in the survey population. Female respondents had a higher risk of depression (OR 1.61, 95% CI, 1.39-1.87, p < 0.001) and anxiety (OR 1.35, 95% CI, 1.15-1.57, p < 0.001) than males. Among the medical workers, confirmed or suspected positive COVID-19 infection as associated with higher scores for depression (confirmed, OR 1.87; suspected, OR 4.13), anxiety (confirmed, OR 3.05; suspected, OR 3.07), and insomnia (confirmed, OR 3.46; suspected, OR 4.71).

Limitations

The cross-sectional design of present study presents inference about causality. The present psychological assessment was based on an online survey and on self-report tools, albeit using established instruments. We cannot estimate the participation rate, since we cannot know how many potential subjects received and opened the link for the survey.

Conclusions

Females, non-medical workers and those with a history of chronic diseases have had higher risks for depression, insomnia, and anxiety. Positive COVID-19 infection status was associated with higher risk of depression, insomnia, and anxiety in medical workers.

Reference

Wang, M., Zhao, Q., Hu, C., Wang, Y., Cao, J., Huang, S., Li, J., Huang, Y., Liang, Q., Guo, Z., Wang, L., Ma, L., Zhang, S., Wang, H.,m Zhu, C., Luo, W., Guo, C., Chen, C., Chen, Y., Xu, K., Yang, H., Ye., L., Wang, Q., Zhan, P., Li, G., Yang, M.J., Fang, Y., Zhu, S. & Yang, Y. (2020) Prevalence of psychological disorders in the COVID-19 epidemic in China: A real world cross-sectional study. Journal of Affective Disorders. 281, pp.312-320. doi: 10.1016/j.jad.2020.11.118. Online ahead of print.

Book: Sleep Medicine and Mental Health

Book Title:

Sleep Medicine and Mental Health – A Guide for Psychiatrists and Other Healthcare Professionals.

Author(s): Karim Sedky, Racha Nazir, and David Bennett (Editors).

Year: 2020.

Edition: First (1st).

Publisher: Springer.

Type(s): Hardcover and Kindle.

Synopsis:

Advances in sleep medicine research are improving our clinical work for individuals with sleep problems. The aim of this book is to educate psychiatrists and other mental health professionals about the importance of understanding sleep disorders, including their bidirectional relationship with psychiatric conditions.

This book consists of six major sections with seventeen chapters. It is led off by an introduction on the function of sleep, its neurophysiology, and types of sleep problems. Since insomnia represents a common and significant challenge for patients with psychiatric disorders, its clinical presentation and treatments are reviewed in the second section. Cognitive behavioural therapy for insomnia (CBT-I), mindfulness-based CBT, acceptance and commitment therapy (ACT), and the medication management of insomnia are reviewed.

A third section addresses sleep related breathing disorders. The pathology of sleep apnea, its treatments, and therapeutic modalities to address non-compliance with positive pressure ventilation are reviewed. Other sleep disorders such as hypersomnia, circadian rhythm disorders, movement disorders and parasomnias are discussed in the fourth section.

Since features of sleep disorders can vary by age, gender, and trauma history, a fifth section discusses the unique sleep problems associated with children, women, older adults, and veterans. The book concludes with a final section discussing how sleep disorders and psychiatric conditions overlap.

We hope this book highlights the importance of understanding and addressing comorbid sleep disorders among individuals with psychiatric conditions. We are confident that this book will be valuable in helping clinicians improve the management of sleep disorders in their clinical practice.

Book: Combined Treatments for Mental Disorders

Book Title:

Combined Treatments for Mental Disorders: A Guide to Psychological and Pharmacological Interventions.

Author(s): Morgan T. Sammons and Norman B. Schmidt (editors).

Year: 2001.

Edition: First (1st).

Publisher: American Psychological Association.

Type(s): Hardcover.

Synopsis:

An exploration of the best way to integrate pharmaceuticals and pyschotherapy in the treatment of mental disorders. Combined treatment is relatively common, but because of biases in the fields of medicine and psychology that champion one form over another, many clinicians are not fully informed about use of both modalities. This practical volume seeks to end this situation.

As this text reveals, exclusive reliance on one mode of treatment may result in a practitioner being unable to address many clients’ needs. Each chapter closely examines the combined treatment for a different disorder, such as insomnia, depression, schizophrenia, and obsessive-compulsive disorder. Different disorders are addressed in separate chapters in relation to combined treatments which many clinicians may not be fully informed of. The social and ethical ramifications of prescriptive authority for pyschologists is also addressed in relation to its increasing relevance. A practical guide for clinicians both experienced and non-experienced in the psychological and pharmacological fields.

Coronavirus: Healthcare Workers & their Mental Health

Research Paper Title

Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019.

Background

Health care workers exposed to coronavirus disease 2019 (COVID-19) could be psychologically stressed.

Objective: To assess the magnitude of mental health outcomes and associated factors among health care workers treating patients exposed to COVID-19 in China.

Methods

This cross-sectional, survey-based, region-stratified study collected demographic data and mental health measurements from 1257 health care workers in 34 hospitals from January 29, 2020, to February 3, 2020, in China. Health care workers in hospitals equipped with fever clinics or wards for patients with COVID-19 were eligible.

The degree of symptoms of depression, anxiety, insomnia, and distress was assessed by the Chinese versions of the 9-item Patient Health Questionnaire, the 7-item Generalized Anxiety Disorder scale, the 7-item Insomnia Severity Index, and the 22-item Impact of Event Scale-Revised, respectively. Multivariable logistic regression analysis was performed to identify factors associated with mental health outcomes.

Results

A total of 1,257 of 1,830 contacted individuals completed the survey, with a participation rate of 68.7%. A total of 813 (64.7%) were aged 26 to 40 years, and 964 (76.7%) were women. Of all participants, 764 (60.8%) were nurses, and 493 (39.2%) were physicians; 760 (60.5%) worked in hospitals in Wuhan, and 522 (41.5%) were frontline health care workers.

A considerable proportion of participants reported symptoms of depression (634 [50.4%]), anxiety (560 [44.6%]), insomnia (427 [34.0%]), and distress (899 [71.5%]).

Nurses, women, frontline health care workers, and those working in Wuhan, China, reported more severe degrees of all measurements of mental health symptoms than other health care workers (eg, median [IQR] Patient Health Questionnaire scores among physicians vs nurses: 4.0 [1.0-7.0] vs 5.0 [2.0-8.0]; P = .007; median [interquartile range {IQR}] Generalized Anxiety Disorder scale scores among men vs women: 2.0 [0-6.0] vs 4.0 [1.0-7.0]; P < .001; median [IQR] Insomnia Severity Index scores among frontline vs second-line workers: 6.0 [2.0-11.0] vs 4.0 [1.0-8.0]; P < .001; median [IQR] Impact of Event Scale-Revised scores among those in Wuhan vs those in Hubei outside Wuhan and those outside Hubei: 21.0 [8.5-34.5] vs 18.0 [6.0-28.0] in Hubei outside Wuhan and 15.0 [4.0-26.0] outside Hubei; P < .001).

Multivariable logistic regression analysis showed participants from outside Hubei province were associated with lower risk of experiencing symptoms of distress compared with those in Wuhan (odds ratio [OR], 0.62; 95% CI, 0.43-0.88; P = .008).

Frontline health care workers engaged in direct diagnosis, treatment, and care of patients with COVID-19 were associated with a higher risk of symptoms of depression (OR, 1.52; 95% CI, 1.11-2.09; P = .01), anxiety (OR, 1.57; 95% CI, 1.22-2.02; P < .001), insomnia (OR, 2.97; 95% CI, 1.92-4.60; P < .001), and distress (OR, 1.60; 95% CI, 1.25-2.04; P < .001).

Conclusions

In this survey of heath care workers in hospitals equipped with fever clinics or wards for patients with COVID-19 in Wuhan and other regions in China, participants reported experiencing psychological burden, especially nurses, women, those in Wuhan, and frontline health care workers directly engaged in the diagnosis, treatment, and care for patients with COVID-19.

Reference

Jianbo, Lai., Simeng, Ma., Ying, Wang., Zhongxiang, Cai., Jianbo, Hu., Ning, Wei., Jiang, Wu., Hui, Du., Tingting, Chen., Ruiting, Li., Huawei, Tan., Lijun, Kang., Lihua, Yao., Manli, Huang., Huafen, Wang., Gaohua, Wang., Zhongchun, Liu. & Shaohua, Hu. (2020) Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019. JAMA Network Open. 3(3):e203976. doi: 10.1001/jamanetworkopen.2020.3976.

Gaming Disorders & their Association with Mental Disorders for African Countries

Research Paper Title

Insomnia, Sleepiness, Anxiety and Depression Among Different Types of Gamers in African Countries.

Background

Gaming has increasingly become a part of life in Africa. Currently, no data on gaming disorders or their association with mental disorders exist for African countries.

This study for the first time investigated:

  1. The prevalence of insomnia, excessive daytime sleepiness, anxiety and depression among African gamers;
  2. The association between these conditions and gamer types (i.e. non-problematic, engaged, problematic and addicted); and
  3. The predictive power of socioeconomic markers (education, age, income, marital status, employment status) on these conditions.

Methods

10,566 people from 2 low- (Rwanda, Gabon), 6 lower-middle (Cameroon, Nigeria, Morocco, Tunisia, Senegal, Ivory Coast) and 1 upper-middle income countries (South Africa) completed online questionnaires containing validated measures on insomnia, sleepiness, anxiety, depression and gaming addiction.

Results

Results showed the sample of gamers (24 ± 2.8 yrs; 88.64% Male), 30% were addicted, 30% were problematic, 8% were engaged and 32% were non-problematic.

Gaming significantly contributed to 86.9% of the variance in insomnia, 82.7% of the variance in daytime sleepiness and 82.3% of the variance in anxiety [p < 0.001].

Conclusions

This study establishes the prevalence of gaming, mood and sleep disorders, in a large African sample.

The results corroborate previous studies, reporting problematic and addicted gamers show poorer health outcomes compared with non-problematic gamers.

Reference

Sosso, F.A.E, Kuss, D.J., Vandelanotte, C., Jasso-Medrano, J.L., Husain, M.E., Curcio, G., Papadopoulos, D., Aseem, A., Bhati, P., Lopez-Rosales, F., Becerra, J.R., D’Aurizio, G., Mansouri, H., Khoury, T., Campbell, M. & Toth, A.J. (2020) Insomnia, Sleepiness, Anxiety and Depression Among Different Types of Gamers in African Countries. Scientific Reports. 10(1):1937. doi: 10.1038/s41598-020-58462-0.

Could Light Therapy Help Relieve the Symptoms of Perinatal Depression?

Research suggests that women with perinatal depression appear to have altered circadian rhythms, and using light to reset the body clock seems to improve their symptoms.

Our bodies run on internal clocks that are regulated by a suite of genes. In concert with light, they wake us up in the morning and leave us sleepy by night-time.

People with severe depression tend to have disrupted circadian rhythms, experiencing daytime sleepiness and night-time insomnia.

Research has found higher activity in some circadian genes in people with the condition.

Perinatal depression – which occurs during and after pregnancy – seems to be similar.

Women tend to get less sleep when they are pregnant, particularly if they have perinatal depression.

To find out if circadian genes might play a role, Massimiliano and colleagues (2019) analysed seven genes in 44 women in the third trimester of pregnancy. Thirty of the women were diagnosed with perinatal depression.

By looking at whether epigenetic tags, called methyl groups, were attached to the genes, the researchers could tell how active these genes were.

They found that three circadian genes were more active and one was less active in the women who had been diagnosed with depression. They also found that the more methyl groups there were, the more severe a woman’s symptoms were likely to be.

This suggests that the greater the difference in circadian gene activity, the more likely a woman is to experience symptoms of depression, say the researchers.

Other (unpublished) research by Katherine Sharkey, Brown University in Rhode Island, has found that using a light box to mimic natural daylight improves the symptoms of perinatal depression. In this small trial of 44 women with the condition, sharkey found that those given a light box and sleep routine alongside routine treatment saw their symptoms improve. Although all the women got better, the women given a circadian intervention did better than those without.

The evidence is not yet strong enough to recommend the treatment more widely, but there is evidence that a good sleep routine and outdoor exposure to sunlight is beneficial for mental health. For example, in a typical office space, the light level is 300 to 400 lux, but on a bright, sunny day, outside can be 50,000 lux.

References

Buoli, M., Grassi, S., Iodice, S., Carnevali, G.S., Esposito, C.M., Tarantini, L., Barkin, J.L. & Bollati, V. (2019) The Role of Clock Genes in Perinatal Depression: THe Light in the Darkness. Acta Psychiatrica Scandinavica. 140(4), pp.382-384. https://doi.org/10.1111/acps.13084.

Hamezlou, J. (2019) Light Therapy May Help Relieve Symptoms of Perinatal Depression. New Scientist. 21 September 2019, pp.15.