Sebastian Skalski Selected aspects of mental health during the COVID-19 pandemic in Poland

Artykuł jest dostępny na warunkach międzynarodowej licencji 4.0 (CC BY-NC-ND 4.0).

Introduction

In March 2020, the World Health Organization (WHO) announced an international pandemic, due to the high incidence of SARS-CoV-2 coronavirus (Ghebreyesus, 2020). In addition to the widespread threat to life and health, the pandemic caused significant socio-economic changes.

Increasing numbers of illnesses and deaths necessitated the introduction of a sanitary regime and restrictions in interpersonal contacts. Calls were made to practice social distancing and to minimise meetings with others. The introduction of safety rules has forced many people to change their habits. Recommendations for hand washing and disinfection may have exacerbated anxiety, resulting in excessive attention to cleanliness.

The situation of working people changed. Some service establishments suspended their activities, while other enterprises operated only to a limited extent. Many employers reduced wages to maintain liquidity without resorting to redun-dancies. Regardless, many people lost their jobs. Research shows that a loss of salary continuity or unemployment due to the economy freeze was associated with a greater severity of symptoms in mental disorders. In contrast, there was no deterioration of mental health in people who had a fixed remuneration, worked remotely or had no changes in their professional situation (Gambin et al., 2020; Ueda et al., 2020).

Research conducted during the global economic freeze has confirmed the negative consequences of the COVID-19 pandemic on mental health (Bao et al., 2020; Xiang et al., 2020). An unstable personal, professional and economic situation can cause frustration and emotional exhaustion. Moreover, prolonged psychological distress increases the risk for symptoms of anxiety and depression (Lee, Jobe, Mathis, 2020; Petzold et al., 2020; Solomou, Constantinidou, 2020). Consequently, mental disorders have arisen in healthy people and have increased in psychiatrically treated individuals (Asmundson et al., 2020).

As a result of the COVID-19 pandemic, access to health care services, including psychiatric and psychotherapeutic assistance, was significantly limited. Due to the infection and the related quarantine of healthcare workers, the number of active medical and psychological personnel was reduced. The implemented remote counseling made it difficult to properly diagnose patients. The lack of direct contact made it difficult to establish a bond with the patient and conduct psychotherapy.

The pandemic has affected virtually every person, regardless of their age, gender, place of residence or socioeconomic status. Variable predictions about the development of the pandemic may have caused pessimism and feelings of helplessness.

Healthcare workers, particularly those exposed to coronavirus infection, have risked their health and life by treating COVID-19 patients. The conditions in which healthcare professionals must work have caused symptoms of anxiety and depression (Xiao et al., 2020; Tiete et al., 2021).

The pandemic has caused individuals to be more anxious about people in the immediate vicinity than about their own health (Maaravi, Heller, 2020). Many people have lost their loved ones to the COVID-19 pandemic. The elderly and chronically ill are particularly at risk. Among people aged over 55 years, an intensification of anxiety and depression symptoms is associated with a sense of loneliness, fatigue with the situation and a need for lifestyle changes (Gambin et al., 2020).

Quarantined persons are in a particularly difficult situation. They may experience feelings of loss, lack of support and loneliness. Limiting contact with loved ones may cause strong longing and anxiety about their health. Moreover, quarantine has been shown to adversely affect sleep quality, anxiety and psychological distress (Casagrande et al., 2020).

The pandemic has negatively affected those who have been diagnosed with COVID-19. For a substantial duration, these individuals experience an increased risk to health and life, which may negatively affect their mental health. Studies in this group have revealed a relationship between fear of COVID-19 effects and depression, feelings of lack of social support and suicidal tendencies (Lee, Jobe, Mathis, 2020).

The gradual de-freezing of the economy and the easing of restrictions introduced on 20 April 2020 have positively influenced the situation in Poland. Enterprises started operating in a manner similar to that of the pre-pandemic period. However, the risk of SARS-CoV-2 infection remained, posing a threat to the life and health of many people. A protracted pandemic can adversely affect mental health in a society, fostering a deepening sense of helplessness and increased severity of anxiety and depression.

This study aimed to identify the most common mental health problems in the Polish population 1.5 months after the WHO declared a SARS-CoV-2 pandemic. Poland was in a difficult situation, due to the economic freeze and the introduction of many restrictions. It is fundamental to the research undertaken here to establish a relationship between mental health problems and the following variables: gender, age, education, employment situation and place of residence.

Most studies on mental health were conducted early in the pandemic. Previous reports provide a preliminary overview of the mental disorders symptoms and determinants related to the coronavirus pandemic. Furthermore, the state of mental health is subjective, and disorders symptoms of surveyed individuals or groups may extend beyond those identified in previous research.

These results will enable adequate action in the event of worrying symptoms of emotional disorders or adaptive problems. Information on the mental health problems experienced for each demographic variable is needed to identify target groups in preparing educational and preventive programmes (Pakpour, Griffiths, 2020).

The research results presented herein relate to the selected area of the research project. Analyses of the remaining areas, i.e. anxiety and interpersonal relationships, will be presented in subsequent reports.

Methods

A survey was conducted in a nationwide sample of 442 people. The survey participants included 332 women (75.1%) and 110 men (24.9%), with 231 people under the age of 30 years (52.3%) and 211 people aged over 30 years (47.7%). Among the respondents, 48.9% had at most a secondary education, with higher education reported for 51.1%. The proportion of participants residing in a village was 54.5%, while 45.5% resided in a town. Among the respondents, 46.2% were working individuals, 45.5% were students, and 8.4% were not workers or students.

The study was conducted between April 14 and 28, 2020. Most people (92%) were examined a week before the introduction of the first stage of defreezing the Polish economy. The remaining 8% were examined up to a week after the lifting of restrictions related to the COVID-19 pandemic in Poland.

Due to the restrictions on social contact introduced in March 2020, it was not possible to randomly select a sample. The survey was conducted, therefore, primarily via social media. Instructions with a link to the survey were sent to all respondents, asking them to send an invitation to people who wished to participate in an anonymous survey. Participants were provided with information about the objectives and procedure of the study.

The survey used in this study was constructed in the Google Forms® application, consisted of five demographic questions relating to gender, age, education, employment situation and place of residence. The survey also contained 21 closed questions covering three key areas: 10 related to mental health, 8 questions related to sources of anxiety experienced, 3 related to interpersonal relationships. The last two areas will be analysed in a separate report.

Results

Percentage distribution of the results

To determine the mental health during the COVID-19 pandemic, I assessed the percentage of respondents that provided certain answers to individual questions. The data analysis presented in Table 1 shows that the respondents felt overwhelmed by negative information about the spread of SARS-CoV-2 virus (55.2%) and experienced a feeling of powerlessness (43.0%). A smaller group of respondents indicated the negative impact of the epidemic situation on mental health (38%), severe stress (35%), mental exhaustion (34%), pessimistic perception of the future (32.1%) and depression (30.3%). The fewest people agreed that as result of the current epidemic, they consume more alcohol and other psychoactive substances (9.0%).

Chi-square test of independence

A chi-square independence test was applied to assess the relationship between mental health and the various variables of sex, age, education, place of residence and employment situation. The findings indicate an association between mental health and gender. Women had more problems with their mental health than men (more frequent answers “Yes”).

Women more often than men agreed with the statement that the current epidemic situation negatively affects their mental health χ² (2, N = 442) = 13.894; p = .001, experienced a feeling of helplessness χ² (2, N = 442) = 13.612; p = .0011, mental ex-haustion χ² (2, N = 442) = 14.916; p = .0006 and felt depressed χ² (2, N = 442) = 12.803; p = .0017. Moreover, they had problems with concentration χ² (2, N = 442) = 6.684; p = .0354, the pandemic situation was stressful for them χ² (2, N = 442) = 29.587; p < .0001, they were pessimistic about the future χ² (2, N = 442) = 13.261; p = .0013 and felt overwhelmed by negative information related to the spread of the coronavirus χ² (2, N = 442) = 25.574; p < .0001 (see Table 2).

Table 1. Mental health among respondents – results for individual items

The chi-square test of independence showed a relationship between mental health and age. People under 30, more often than people over 30, experienced mental exhaustion χ² (2, N = 442) = 11.775; p = .0028, they used alcohol / psychoactive substances more often χ² (2, N = 442) = 6.776; p = .0338 and were pessimistic about the future χ² (2, N = 442) = 9.354; p = .0093 (see Table 2).

The chi-square test of independence showed only one relationship between pandemic-related mental health and education level. People with at most secondary education, more often than people with higher education, were pessimistic about the future χ² (2, N = 442) = 6.632; p = .0363 (see Table 3).

Table 3. Mental health versus education and employment situation

There was no relationship between the place of residence of the respondents and their mental health, assessed in individual statements.

It was found that there is a relationship between mental health and the employment situation of the respondents. People not working or of a different employment status felt powerlessness more often than the rest of the respondents because of the coronavirus pandemic χ² (2, N = 442) = 10.799; p = .0289. Students experienced mental exhaustion more often χ² (2, N = 442) = 16.98; p = .0020, they felt depressed by the current situation χ² (2, N = 442) = 12.836; p = .0121, they were more pessimistic about the future χ² (2, N = 442) = 14.661; p = .0055 (see Table 3).

Multinomial logistic regression

In the next step, an attempt was made to standardize the obtained results. For this purpose, a polynomial logistic regression was used. For each of the components of mental health disorders (for each item separately), the values of odds ratios

Table 4. Mental health: a comparison of extreme groups (Yes vs. No) for individual items based on selected independent variables

(ORs) for the occurrence of a given disorder symptom (answer “Yes”) were calculated compared to the lack of such symptom (answer “No”). It was confirmed that the problems related to mental health were mainly related to gender and partially depended on age, education and work situation.

Compared to men, women were three times more likely to believe that the current epidemic situation is very stressful for them (OR = 3.37, 95% CI: 1.96–5.81) and to feel overwhelmed by negative information about the spread of the coronavirus (OR = 3.42, 95% CI: 2.03–5.76). In addition, it was demonstrated that the conviction that the current situation has a negative impact on mental health was more than twice as likely as men (OR = 2.12, 95% CI: 1.26–3.54), of experiencing a feeling of powerlessness (OR = 2.41, 95% CI: 1.44–4.01), mental exhaustion (OR = 2.22, 95% CI: 1.32–3.74) and depression due to the current situation (OR = 2.31, 95% CI: 1.33–3.99). Women were twice as likely to have problems focusing attention on things other than the pandemic (OR = 2.12, 95% CI: 1.01–4.44) and a tendency to pessimistic perception of the future (OR = 2.11, 95% CI: 1.22–3.63).

The chance of developing mental exhaustion was greater among people under 30 (OR = 1.81, 95% CI: 1.02–3.2) compared to the elderly. Subjects with at most secondary education experienced the influence of the current situation on their mental health less frequently (OR = .54, 95% CI: .32–.91) and less often used alcohol or psychoactive substances (OR = .42, 95% CI: .19–.93). The feeling of powerlessness was less common in working people (OR = .25, 95% CI: .1–.62) (see Table 4).

Discussion of the results

This report aimed to establish mental health in the situation of the SARS-CoV-2 coronavirus pandemic, in the final phase of the economic freeze in Poland. The results indicate the most common mental health problems in the study population. A relationship was found between individual mental health problems and the variables studied, i.e. sex, education, age and employment situation. There was no association between the place of residence of the respondents and their mental health.

General mental health

The analysis of the obtained data shows that due to the pandemic, most respondents (55.2%) felt overwhelmed with negative information about the spread of the SARS-CoV-2 coronavirus. The results of other studies (Gao et al., 2020; Sandín et al., 2020; Trnka, Lorencova, 2020) indicate that the excess of information negatively affects mental health, causing an increase in anxiety and depression symptoms. the critical threshold and 2.5 hours of media exposure, seven times a day, differentiating between mild and moderate symptoms of anxiety and depression (Bendau et al., 2020).

There has been a lot of media activity since the beginning of the pandemic. Most of the information on the current epidemic situation was provided in TV news and radio programs, in the press and social media. Over time, the excess of negative information about the spread of coronavus could make many people feel over-whelmed.

The survey results showed that a significant proportion of the respondents experienced deterioration of their mental health (38%). As a result of the pandemic, they experienced powerlessness (43%), mental exhaustion (34%), depression (30.3%) and were pessimistic about the future (32.1%). Research conducted in many countries around the world confirms the increased frequency of mental disorders during the pandemic. Anxiety and depressive disorders were the most commonly reported (Lee, Jobe, Mathis, 2020; Petzol et al., 2020; Sandín et al., 2020; Solomou, Constantinidou, 2020). In addition, there were problems related to insomnia, experiencing intense stress and adjustment disorders. Staying in quarantine was associated with more frequent diagnosis of post-traumatic stress disorder, anxiety and adaptive disorders (Rossi et al., 2020).

In this context, it should be meant that the SARS-CoV-2 coronavirus pandemic was a new and unpredictable phenomenon. The spread of the coronavirus resulted in a loss of hope for a quick stabilization of the situation (Hacimusalar et al., 2020). Previous research results indicate groups that are particularly vulnerable to the psychological effects of the pandemic. For example, they indicate a higher level of powerlessness, strong and fear of coronavirus in people diagnosed with COVID-19 (Lee, 2020). They suggest a significant increase in emotional exhaustion among working women, young people and part-time workers (Hwang, Hur, Shin, 2020).

The obtained data show that the epidemic situation was very stressful for some of the respondents (35.3%). This is confirmed by studies conducted in China (Qiu et al., 2020; Wang et al., 2020). About 25% of the general population have moderate or high levels of stress or anxiety. A detailed analysis of the problem indicates that approximately 16% of the US and Canadian populations surveyed overall showed acute symptoms of COVID Stress Syndrome (Taylor et al., 2020).

The main stressors in the pandemic era could be the fear for one’s own health and the health of loved ones, as well as the fear of the economic consequences of the pandemic. Mental stress can be triggered by media coverage of collective life and health-threatening situations (Holman, Garfin, Silver, 2014). Moreover, different levels of stress were found depending on demographic variables (Qiu et al., 2020). A higher level of psychological distress was most common in women. It has also been shown that people aged 18–30 or over 60 are more susceptible to stress.

Mental health and gender

Data analysis showed that there is a relationship between some mental health problems and gender. Women more often than men indicated that the current situation has a negative impact on their mental health. Due to the pandemic, they experienced feelings of helplessness, mental exhaustion, and felt depressed. In addition, they had difficulty concentrating, experienced severe stress, were pessimistic about the future, and felt overwhelmed by negative news about the spread of the coronavirus.

The above data are consistent with other reports from empirical studies which indicate that women more often experienced negative, psychological consequences of the risk of becoming infected with the SARS-CoV-2 coronavirus. They exhibited higher levels of both stress, anxiety and depression (Wang et al., 2020). They also showed symptoms of adaptive disorders more often than men (Petzold et al., 2020; Rossi et al., 2020; Solomou, Constantinidou, 2020). Research shows that during the outbreak of the pandemic, women more often reported symptoms of post-traumatic stress (Liu et al., 2020a), reliving the traumatic situation, experiencing over-arousal, negative cognitive changes and mood changes. Moreover, they showed a higher fear of COVID-19 (Rossi et al., 2020).

Increased risk of mental health deterioration in women during a pandemic may result from fulfilled family and professional roles. Women are more likely to bear the burden of caring for children and carry out household chores. Research indicates that the closure of schools and nurseries in the initial period of the pandemic significantly increased the need for childcare. This was a serious problem especially for working mothers (Alon et al., 2020). Moreover, women had a greater risk of losing their jobs than men. This was especially true in the hotel and retail sectors, where mostly women are employed.

Mental health and education level

The mental health among the respondents were analysed in relation to their education level, indicating that people people with at most secondary education looked pessimistic about the future more often than people with higher education.

The above data could result from the rapid spread of the SARS-CoV-2 coronavirus and the unstable economic situation in the country and the world. Being overwhelmed by negative news in the media about the economic and health effects of the SARS-CoV-2 coronavirus could, over time, cause pessimism for many people as to the further development of the situation.

The research results presented herein show that people with at least secondary education experienced the impact of the current situation on their mental health less frequently and used alcohol or other psychoactive substances less often. The obtained data may suggest that the pandemic did not significantly affect the mental condition of this group of respondents.

The studies conducted so far do not clearly define the type of relationship between education and mental health. According to some reports (Paulino et al., 2020; Wang et al., 2020), lower educational attainment is associated with higher depression and anxiety as a result of the pandemic. Other research results suggest the opposite relation (Qiu et al., 2020). People with higher education are more prone to psychological distress compared to people with at most secondary education.

Less frequent alcohol consumption in the group of respondents with primary, vocational and secondary education may be caused by the temporary closure of bars and clubs and the introduced restrictions on the number of people staying in shops while shopping.

Mental health and age

The obtained data show that there is a relationship between some mental health problems and age. People under 30 experienced mental exhaustion more often than the elderly, were pessimistic about the future and used alcohol or psychoactive substances. The presented tendency is confirmed by other previous studies. They indicate a higher severity of symptoms of depression and anxiety Turing a pandemic among people under 35 compared to the elderly (Huang, Zhao, 2020; Liu et al., 2020b; Qiu et al., 2020). Research conducted in Poland (Gambin et al., 2020) shows that in the 18–34 age group, the highest levels of depression and generalized anxiety symptoms appeared, compared to other age groups. In addition, an increased incidence of suicidal or self-harming thoughts has been shown. The above studies show that the severity of anxiety and depression symptoms in a group of young people was not associated with the sense of threat to their own health and life and that of loved ones, but was positively correlated with limitations in freedom, boredom, difficult family relationships, a sense of loneliness, fatigue, and lack of privacy. These factors may have increased the tendency to reach for alcohol and other psychoactive substances.

Mental health and employment situation

The research results show that there is a relationship between some mental health problems and the employment situation. The unemployed felt helplessness more often than employed and students due to the pandemic. The results of previous studies confirm the negative consequences of COVID-19 for the mental health of the unemployed, who, compared to working people, show a high susceptibility to stress and the highest level of depressive symptoms (Montano, Acebes, 2020; Paulino et al., 2020). This is most likely due to greater exposure to the consequences of the economic crisis related to the pandemic. In connection with the constant increase in infections coronavirus SARS-CoV-2, were introduced restrictions on functioning or temporary closure of institutions and workplaces. Many people have lost their jobs. Lack of steady income makes it impossible to plan and achieve long-term goals. Lack of influence on the situation could intensify the feeling of helplessness.

The obtained data show that students experienced psychological exhaustion more often than employed and unemployed people, felt depressed by the current situation and looked more pessimistic about the future. Research carried out in Poland (Debowska et al., 2020) suggests that students in the 18–24 age group have more symptoms of mental health disorders. They show more symptoms of depression, anxiety and suicidal tendency than older students. Other studies (Son et al., 2020) have identified stressors that contributed to increased levels of stress, anxiety and depressive thoughts in this group. The students showed anxiety for their own health and that of their loved ones. They exhibited problems with concentration and sleep disorders. Less frequently maintained social contacts and showed concern about academic performance.

Limitations and implications

The study presented herein has some limitations. Due to the epidemic, the surveys were conducted among others, via social media. Notably, this kind of research does not cover all of society. Some people, especially the elderly, rarely use the internet or do not have social media accounts. Non-computer users probably did not participate in the study. All of these factors limit the possibility of generalising these results to the entire population.

Subsequent studies should be performed using a larger, more representative sample, considering age, gender, education level, employment situation and place of residence.

This study did not collect information regarding whether participants or their family members were infected with the coronavirus, were in quarantine or were in isolation. The level of anxiety in such individuals may differ from that of the general population.

Conclusions

The material collected throughout this research and the subsequent analyses show in the final phase of the economic freeze, the main mental health problems. The persistence of a pandemic over an extended period of time can have a negative impact on many spheres of human life, including mental health.

Due to the dynamic and unpredictable development of the epidemic situation, further studies are recommended. Such data may clarify the psychosocial effects of the COVID-19 pandemic. On this basis, it will be possible to take adequate measures to support specific risk groups, particularly women, students and persons under 30. Action strategies should be tailored to their needs to mitigate the negative effects of the pandemic. Such strategies should focus on preventing mental health issues and minimising anxiety and depression symptoms. It is important to promote pro-health behaviours that enable adaptation to changes caused by the pandemic. It is also advisable to educate people to manage stress effectively, limit reading or viewing news about a pandemic, maintain a daily schedule of the day including routine and regular physical activity, and promote safe means of communication. Social media can be used to maintain contact with loved ones and to reduce lone-liness and mental isolation, as these tools allow one to communicate with others via social networks, blogs and message boards. It is essential to improve access to professional psychological and psychiatric care. Appropriate organization of therapeutic and medical support in mental health clinics is needed. People with mental health disorders should be able to benefit from consultations conducted both in a clinic and remotely, and, if necessary, from inpatient psychiatric care.

References

Alon, T.M., Doepke, M., Olmstead-Rumsey, J., & Tertilt, M. (2020). The impact of COVID-19 on gender equality. National Bureau of Economic Research, doi: 10.3386/ w26947

Asmundson, J., Paluszek, M., Landry, C., Rachor, G., McKay, D., & Taylor S. (2020, August). Do pre-existing anxiety-related and mood disorders differentially impact COVID-19 stress responses and coping? Journal of Anxiety Disorders, 74, doi: 10.1016/j.janxdis.2020.102271

Bao, Y., Sun, Y., Meng, S., Shi, J., & Lu, L. (2020). 2019-nCoV epidemic: Address mental health care to empower society. The Lancet, 395(10224), e37–e38, doi: 10.1016/ S0140-6736(20)30309-3

Bendau, A., Petzold, M.B., Pyrkosch, L., Mascarell Maricic, L., Betzler, F., Rogoll, J., …, Plag, J. (2020). Associations between COVID-19 related media consumption and symptoms of anxiety, depression and COVID-19 related fear in the general population in Germany. European Archives of Psychiatry and Clinical Neuroscience, doi: 10.1007/s00406-020-01171-6

Casagrande, M., Favieri, F., Tambelli, R., & Forte, G. (2020). The enemy who sealed the world: effects quarantine due to the COVID-19 on sleep quality, anxiety, and psychological distress in the Italian population. Sleep Medicine, 75, 12–20, doi: 10.1016/j.sleep.2020.05.011

Debowska, A., Horeczy, B., Boduszek, D., & Dolinski, D. (2020). A repeated cross-sectional survey assessing university students’ stress, depression, anxiety, and suicidality in the early stages of the COVID-19 pandemic in Poland. Psychological Medicine, 1–4, doi: 10.1017/s003329172000392x

Gambin, M., Sękowski, M., Woźniak-Prus, M., Cudo, A., Hansen, K., Gorgol, J., …, Wnuk, A. (2020). Uwarunkowania objawów depresji i lęku uogólnionego u dorosłych Polaków w trakcie epidemii Covid-19 – raport z pierwszej fali badania podłużnego [Determinants of depression and generalized anxiety symptoms in adult Poles during the Covid-19 epidemic – report from the first wave of longitudinal study]. Retrieved from: http://psych.uw.edu.pl/wp-content/uploads/ sites/98/2020/05/Uwarunkowania_objawow_depresji_leku_w_trakcie_pandemii_raport.pdf

Gao, J., Zheng, P., Jia, Y., Chen, H., Mao, Y., Chen, S., …, Dai, J. (2020). Mental health problems and social media exposure during COVID-19 outbreak. PLoS ONE, 15(4), doi: 10.1371/journal.pone.0231924

Ghebreyesus, T.D. (2020). WHO Director-General’s opening remarks at the media briefing on COVID-19 – 11 March 2020. Retrieved from: https://www.who.int/ dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19-11-march-2020

Hacimusalar, Y., Kahveb, A., Yasarc, A., & Aydind, M. (2020, October). Anxiety and hopelessness levels in COVID-19 pandemic: A comparative study of healthcare professionals and other community sample in Turkey. Journal of Psychiatric Re-search, 129, 181–188, doi: 10.1016/j.jpsychires.2020.07.024

Holman, E.A., Garfin, D.R., & Silver, R.C. (2014). Media’s role in broadcasting acute stress following the Boston Marathon bombings. Proceedings of the National Academy of Sciences of the United States of America, 111(1), 93–98, doi: 10.1073/ pnas.1316265110

Huang, Y., & Zhao, N. (2020). Generalized anxiety disorder, depressive symptoms and sleep quality during COVID-19 outbreak in China: A web-based cross-sectional survey. Psychiatry Research, 288, doi: 10.1016/j.psychres.2020.112954

Hwang, H., Hur, W.M., & Shin, Y. (2020). Emotional exhaustion among the South Korean workforce before and after COVID-19. Psychology and Psychotherapy: Theory, Research and Practice, doi: 10.1111/papt.12309

Lee, S.A. (2020) Coronavirus Anxiety Scale: A brief mental health screener for COVID-19 related anxiety. Death Studies, 44(7), 393–401, doi: 10.1080/07481187. 2020.1748481

Lee, S., Jobe, M., & Mathis, A. (2020). Mental health characteristics associated with dysfunctional coronavirus anxiety. Psychological Medicine, 1–2, doi: 10.1017/ S003329172000121X

Liu, N., Zhang, F., Wei, C., Jia, Y., Shang, Z., Sun, L., …, Liu, W. (2020a). Prevalence and predictors of PTSS during COVID-19 outbreak in China hardest-hit are-as: Gender differences matter. Psychiatry Research, 287, doi: 10.1016/j.psychres. 2020.112921

Liu, C.H., Zhang, E., Wong, G.T.F., Hyun, S., & Hahm, H. “Chris.” (2020b). Factors associated with depression, anxiety, and PTSD symptomatology during the COVID-19 pandemic: Clinical implications for U.S. young adult mental health. Psychiatry Research, 290, doi: 10.1016/j.psychres.2020.113172

Maaravi, Y., & Heller, B. (2020). Not all worries were created equal: The case of COVID-19 anxiety. Public Health, 185, 243–245, doi: 10.1016/j.puhe.2020.06.032

Montano, R.L.T., & Acebes, K.M.L. (2020). Covid stress predicts depression, anxiety and stress symptoms of Filipino respondents. International Journal of Research in

Business and Social Science, 9(4), 78–103, doi: 10.20525/ijrbs.v9i4.773

Pakpour, A.H., & Griffiths, M.D. (2020). The fear of COVID-19 and its role in preventive behaviors. Journal of Concurrent Disorders, 2(1), 58–63. Retrieved from: https://concurrentdisorders.ca/2020/04/03/the-fear-of-covid-19-and-its-role-in-preventive-behaviors/

Paulino, M., Dumas-Diniz, R., Brissos, S., Brites, R., Alho, L., Simões, M.R., & Silva, C.F. (2020). COVID-19 in Portugal: Exploring the immediate psychological impact on the general population. Psychology, Health and Medicine, doi: 10.1080/ 13548506.2020.1808236

Petzold, M.B., Bendau, A., Plag, J., Pyrkosch, L., Mascarell Maricic, L., Betzler, F., …, Ströhle, A. (2020). Risk, resilience, psychological distress, and anxiety at the beginning of the COVID-19 pandemic in Germany. Brain and Behavior, e01745, doi: 10.1002/brb3.1745

Qiu, J., Shen, B., Zhao, M., Wang, Z., Xie, B., & Xu, Y. (2020). A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: Implications and policy recommendations. General Psychiatry. BMJ Publishing Group, doi: 10.1136/gpsych-2020-100213

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 2 survey. medRxiv, doi: 10.1101/2020.04.09.20057802

Sandín, B., Valiente, R.M., García-Escalera, J., & Chorot, P. (2020). Psychological impact of the COVID-19 pandemic: Negative and positive effects in Spanish people during the mandatory national quarantine. Revista de Psicopatologia y Psicologia Clinica, 25(1), 1–22, doi: 10.5944/RPPC.27569

Solomou, I., & Constantinidou, F. (2020, July). Prevalence and Predictors of Anxiety and Depression Symptoms during the COVID-19 Pandemic and Compliance with Precautionary Measures: Age and Sex Matter. International Journal of Environmental Research and Public Health, doi: 10.3390/ijerph17144924

Son, C., Hegde, S., Smith, A., Wang, X., & Sasangohar, F. (2020). Effects of COVID-19 on College Students’ Mental Health in the United States: Interview Survey Study. Journal of Medical Internet Research, 22(9), e21279, doi: 10.2196/21279

Taylor, S., Landry, C.A., Paluszek, M.M., Fergus, T.A., McKay, D., & Asmundson, G.J.G. (2020). COVID stress syndrome: Concept, structure, and correlates. Depression and Anxiety, 37(8), 706–714, doi: 10.1002/da.23071

Tiete, J., Guatteri, M., Lachaux, A., Matossian, A., Hougardy, J.M., Loas, G., & Rotsaert, M. (2021). Mental Health Outcomes in Healthcare Workers in COVID-19 and Non-COVID-19 Care Units: A Cross-Sectional Survey in Belgium. Frontiers in Psychology, 11, doi: 10.3389/fpsyg.2020.612241

Trnka, R., & Lorencova, R. (2020). Fear, Anger, and Media-Induced Trauma During the Outbreak of COVID-19 in the Czech Republic. Psychological Trauma: Theory, Research, Practice, and Policy, doi: 10.1037/tra0000675

Ueda, M., Stickley, A., Sueki, H., & Matsubayashi, T. (2020, September). Mental health status of the general population in Japan during the COVID-19 pandemic. Psychiatry and Clinical Neurosciences. Blackwell Publishing, doi: 10.1111/ pcn.13105

Wang, C., Pan, R., Wan, X., Tan, Y., Xu, L., & Ho, C.S. (2020). Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the 348 general population in China. International Journal of Environmental Research and Public Health, 17, doi: 10.3390/ijerph17051729

Xiang, Y.T., Yang, Y., Li, W., Zhang, L., Zhang, Q., Cheung, T., & Ng, C.H. (2020, March). Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed. The Lancet Psychiatry. Elsevier Ltd, doi: 10.1016/S2215-0366(20)30046-8

Xiao, X., Zhu, X., Fu, S., Hu, Y., Li, X., & Xiao, J. (2020). Psychological impact of healthcare workers in China during COVID-19 pneumonia epidemic: A multi-center cross-sectional survey investigation. Journal of Affective Disorders, 274, 405–410, doi: 10.1016/j.jad.2020.05.081