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      Self-reported changes in anxiety, depression and suicidality during the COVID-19 lockdown in Greece

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          Highlights

          • During the lockdown:

          • Clinical depression was present in 9.31%

          • Severe distress was present in 8.5%

          • Increased anxious and depressive emotions were present in more than 40%.

          • 23.31% experienced a relapse of depression

          • 8.96% of cases without previous history, who manifested their first depressive episode.

          • Beliefs in conspiracy theories were widely prevalent, with, on average, at least half of cases accepting various misconceptions.

          • Beliefs in conspiracy theories probably constitute a maladaptive copying mechanism

          Abstract

          Introduction

          There are only a few published empirical data on COVID‐19’s effects on the mental health.

          Material and Methods

          During lockdown, an online questionnaire registered demographic, health data, previous psychiatric history, current anxiety, depression and suicidality, believing in conspiracy theories and domains. Data from 3399 persons were used (81.08% females; aged 34.02 ±9.72 and 18.27 % males; aged 36.38±10.33). Distress and clinical depression were identified with the use of cut-off and a previously developed algorithm respectively.

          Statistical Analysis

          A post-stratification method was used; descriptive statistics were calculated. Chi-square tests, multiple forward stepwise linear regression analyses and Factorial Analysis of Variance (ANOVA) tested relations among variables.

          Results

          Clinical depression was present in 9.31% of the stratified sample, while 8.5% had severe distress; increased anxiety was present in more than 45%. Suicidal thoughts increased in 10.40% and decreased in 4.42%. Beliefs in conspiracy theories were widely prevalent; at least half of cases were following various misconceptions. A model for the development of depression was created with general health status, previous history of depression, self-harm and suicidal attempts, family responsibility, economic change, and age acting as risk factors, while keeping a daily routine, pursuing religiousness/spirituality, and believing in conspiracy theories acting as protective factors.

          Conclusions

          The model developed here revealed multiple vulnerabilities and an interplay leading from simple anxiety to clinical depression and suicidality through distress. This could be of practical utility since most of these factors are modifiable. Future research, as well as interventions, should focus specifically on them.

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          Most cited references35

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          Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China

          Background: The 2019 coronavirus disease (COVID-19) epidemic is a public health emergency of international concern and poses a challenge to psychological resilience. Research data are needed to develop evidence-driven strategies to reduce adverse psychological impacts and psychiatric symptoms during the epidemic. The aim of this study was to survey the general public in China to better understand their levels of psychological impact, anxiety, depression, and stress during the initial stage of the COVID-19 outbreak. The data will be used for future reference. Methods: From 31 January to 2 February 2020, we conducted an online survey using snowball sampling techniques. The online survey collected information on demographic data, physical symptoms in the past 14 days, contact history with COVID-19, knowledge and concerns about COVID-19, precautionary measures against COVID-19, and additional information required with respect to COVID-19. Psychological impact was assessed by the Impact of Event Scale-Revised (IES-R), and mental health status was assessed by the Depression, Anxiety and Stress Scale (DASS-21). Results: This study included 1210 respondents from 194 cities in China. In total, 53.8% of respondents rated the psychological impact of the outbreak as moderate or severe; 16.5% reported moderate to severe depressive symptoms; 28.8% reported moderate to severe anxiety symptoms; and 8.1% reported moderate to severe stress levels. Most respondents spent 20–24 h per day at home (84.7%); were worried about their family members contracting COVID-19 (75.2%); and were satisfied with the amount of health information available (75.1%). Female gender, student status, specific physical symptoms (e.g., myalgia, dizziness, coryza), and poor self-rated health status were significantly associated with a greater psychological impact of the outbreak and higher levels of stress, anxiety, and depression (p < 0.05). Specific up-to-date and accurate health information (e.g., treatment, local outbreak situation) and particular precautionary measures (e.g., hand hygiene, wearing a mask) were associated with a lower psychological impact of the outbreak and lower levels of stress, anxiety, and depression (p < 0.05). Conclusions: During the initial phase of the COVID-19 outbreak in China, more than half of the respondents rated the psychological impact as moderate-to-severe, and about one-third reported moderate-to-severe anxiety. Our findings identify factors associated with a lower level of psychological impact and better mental health status that can be used to formulate psychological interventions to improve the mental health of vulnerable groups during the COVID-19 epidemic.
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            Prevalence of stress, anxiety, depression among the general population during the COVID-19 pandemic: a systematic review and meta-analysis

            Background The COVID-19 pandemic has had a significant impact on public mental health. Therefore, monitoring and oversight of the population mental health during crises such as a panedmic is an immediate priority. The aim of this study is to analyze the existing research works and findings in relation to the prevalence of stress, anxiety and depression in the general population during the COVID-19 pandemic. Method In this systematic review and meta-analysis, articles that have focused on stress and anxiety prevalence among the general population during the COVID-19 pandemic were searched in the Science Direct, Embase, Scopus, PubMed, Web of Science (ISI) and Google Scholar databases, without a lower time limit and until May 2020. In order to perform a meta-analysis of the collected studies, the random effects model was used, and the heterogeneity of studies was investigated using the I2 index. Moreover. data analysis was conducted using the Comprehensive Meta-Analysis (CMA) software. Results The prevalence of stress in 5 studies with a total sample size of 9074 is obtained as 29.6% (95% confidence limit: 24.3–35.4), the prevalence of anxiety in 17 studies with a sample size of 63,439 as 31.9% (95% confidence interval: 27.5–36.7), and the prevalence of depression in 14 studies with a sample size of 44,531 people as 33.7% (95% confidence interval: 27.5–40.6). Conclusion COVID-19 not only causes physical health concerns but also results in a number of psychological disorders. The spread of the new coronavirus can impact the mental health of people in different communities. Thus, it is essential to preserve the mental health of individuals and to develop psychological interventions that can improve the mental health of vulnerable groups during the COVID-19 pandemic.
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              A Longitudinal Study on the Mental Health of General Population during the COVID-19 Epidemic in China

              Highlights • A significant reduction in psychological impact 4 weeks after COVID outbreak. • The mean scores of respondents in both surveys were above PTSD cut-offs. • Female gender, physical symptoms associated with a higher psychological impact. • Hand hygiene, mask-wearing & confidence in doctors reduced psychological impact. • Online trauma-focused psychotherapy may be helpful to public during COVID-19.
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                Author and article information

                Contributors
                Role: Msc student
                Role: Msc student
                Role: Msc student
                Role: Msc student
                Role: Msc student
                Role: Msc student
                Role: Msc student
                Role: Msc student
                Role: Msc student
                Role: Msc student
                Role: Msc student
                Role: Msc student
                Role: Msc student
                Role: Secretary General for Public Health Professor
                Role: Occupational Doctor
                Role: Student
                Journal
                J Affect Disord
                J Affect Disord
                Journal of Affective Disorders
                Published by Elsevier B.V.
                0165-0327
                1573-2517
                2 November 2020
                2 November 2020
                Affiliations
                [a ]3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki Greece
                [b ]Faculty of Medicine, School of Health sciences, Aristotle University of Thessaloniki. Greece
                [c ]Department of Nursing, University of Peloponnese, Laboratory of Integrated Health Care, Tripoli, Greece
                [d ]Social Cooperative (KoiSPE) “Athina Elpis”, 8th Athens Mental Health Sector, Panhellenic Federation of Social Cooperatives (POKoiSPE), Athens, Greece
                [e ]Faculty of Medicine, Medical University of Sofia, Bulgaria
                [f ]Professor Emeritus of Pediatrics and Endocrinology, National and Kapodistrian University of Athens, Greece
                Author notes
                [* ]Corresponding author: Dr KN Fountoulakis, 6, Odysseos str, 55535 Thessaloniki Greece. Tel 6945776935, fax +30 2310 264756
                Article
                S0165-0327(20)32906-2
                10.1016/j.jad.2020.10.061
                7605790
                33190113
                f0b71337-15df-4fe9-8469-05e1ee159b98
                © 2020 Published by Elsevier B.V.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                : 14 June 2020
                : 30 August 2020
                : 28 October 2020
                Categories
                Research Paper

                Clinical Psychology & Psychiatry
                covid-19,lockdown,depression,suicidality,mental health, conspiracy theories

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