COVID-19 Anxiety Research Articles

The Relationship Between Work Engagement, Depression, Anxiety, and COVID-19 Anxiety in Physician Assistant Students.

Introduction: Physician assistants (PAs) are subject to high levels of burnout, depressive symptoms, and anxiety, which can negatively impact quality of care and patient outcomes. Learning how to handle stress in the classroom may increase success and engagement in PA programs. The goal of this study was to characterize burnout, depressive symptoms, and anxiety in current PA students and examine the relationship between these factors and work engagement.Methods: This cross-sectional study surveyed PA students (n = 42) via convenience sampling from eighteen different PA programs across North and South Carolina in October, 2021. Questionnaires included the Utrecht Work Engagement Scale (UWES-17), the Patient Health Questionnaire (PHQ-2), the General Anxiety Disorder scale (GAD-7), and the COVID-19 Anxiety Scale (CIAS). Adjusted linear regression was used to assess associations between the GAD-7, PHQ-2, and CIAS and the three subscales of the UWES-17 (vigor, dedication, and absorption).Results: Students were primarily female (79%), white (79%), second-year students (62%), and had an average body mass index of 21.0 ± 3.9kg/m2. A one-unit increase in the GAD-7 was associated with a decrease in the vigor (β = -0.94, SE = 0.19, p < .01) and dedication (β = -0.42, SE = 0.15, p = .01) subscales. A one-unit increase in the PHQ-2 was associated with a decrease in the vigor subscale (β = -2.94, SE = 0.60, p < .01).Conclusions: Recognizing warning signs of declining mental health early among PA school students may be key to increasing resilience, enthusiasm, and concentration, which may enhance school/work engagement. More work is needed to elucidate potential intervention targets to increase school/work engagement in PA students.

DBT Skills Training Groups for School Personnel Working in High-Need Schools

The COVID-19 pandemic presented unprecedented challenges for school communities with long term impacts still unknown. School personnel working in high need, low wealth schools are uniquely at risk for pandemic-related stress given extensive changes to their work life and concerns regarding student trauma exposure. We delivered DBT skills training to 39 school personnel (89% female, mean years of experience was 18.49 [SD = 7.88]). Close to 20% of the sample reported moderate-to-severe anxiety, depression, and stress and substantial impact of COVID-19 on loved ones. Multilevel regressions indicated significant decreases in stress between the 1st-2nd sessions attended (p = .004), and the 3rd-6th sessions attended (p = .04). Sessions 7-8 were not associated with significant decreases in stress (p = .51). Study limitations, implications, and conclusions are discussed.

The mediating role of COVID-19 anxiety on the relationship between quality of life and spiritual well-being, and hopelessness: A study on cancer patients.

The coronavirus pandemic has caused concern in the community, especially in patients. Spirituality, hopelessness, and quality of life have an impact on the management of the process in cancer patients during these crisis periods. To investigate COVID-19 anxiety's mediating role in hopelessness' relationships with the quality of life and spiritual well-being among cancer patients. This study used a cross-sectional design to collect data from cancer patients using self-administered questionnaires. The study recruited 176 cancer patients receiving treatment at a university hospital. The participants completed measures of spiritual well-being, COVID-19 anxiety, hopelessness, and quality of life. Following preliminary analyses, a mediation model was analyzed using the PROCESS macro for SPSS, with the bootstrap method applied (model 4). The results showed that spiritual well-being was negatively associated with COVID-19 anxiety and hopelessness, and positively associated with the quality of life. COVID-19 anxiety was associated positively with hopelessness, and negatively with the quality of life. Moreover, COVID-19 anxiety mediated the relationship between hopelessness, spiritual well-being, and quality of life. This study provides evidence for COVID-19 anxiety's mediating role in the relationship between spiritual well-being and quality of life and hopelessness among cancer patients. The findings suggest that interventions aimed at reducing COVID-19 anxiety may be effective in reducing hopelessness among cancer patients, by promoting higher levels of spiritual well-being and improving quality of life.

Resilience and mental and physical health of higher and lower educated youth during COVID-19

Abstract Background COVID-19 had a considerable impact on the mental and physical health of youth. To limit the impact of this crisis on their health, resilience was required. This study aims to discover how resilient, in terms of mastery, emotional reactivity and social support, groups of youth with different SES were during COVID-19, and what risk and protective factors they experienced. Methods Two qualitative datasets were analyzed. One dataset included 10 interviews of university students during April-May 2020, and the other dataset included 8 interviews with pre-vocational secondary education adolescents during October 2021 to March 2022. Interviews were held in person or online. Data were analyzed with thematic analysis in Atlas.ti. Results In general, university students displayed resilience despite the tumultuous beginning of the pandemic, and their mental and physical health was positive. Protective factors that helped them during COVID-19 were spending time with friends and family, being healthy and having a healthy lifestyle, and being able to avoid stressful situations. Risk factors that impacted their resilience were loneliness, COVID-19 anxiety, and missing stability and routine. Adolescents receiving pre-vocational secondary education showed mixed resilience later in the COVID-19 period, and they made negative observations about their health. Protective factors that helped them were achieving good results in school, hobbies, and avoiding stressful situations. Risk factors they experienced were lack of motivation and having difficulties at school. They experienced worry about school progress during COVID-19. Conclusions University students and lower educated adolescents seemed to have differing resilience during the impactful stages of COVID-19, possibly due to differences in their psychological development. To protect their well-being, it is important that policy makers consider the protective and risk factors that impact the health of youth during crises. Key messages • Resilience differs among the two different age groups and education levels. • Policy makers should consider the protective and risk factors that impact the health of youth during crises.

Exploring the ‘Pet Effect’: Does Playing with Pets Contribute to Owner Wellbeing?

Although many people strongly believe in wellbeing benefits of having pets (the ‘pet effect’), research on the ‘pet effect’ in actuality is highly mixed. Surprisingly, little research has explored the nature of (i.e., specific components of) the human–pet relationship, as a way to explain the contradictory findings. One such component is human–pet play, with play outside of the human–pet relationship being important for wellbeing and social buffering. Thus, the current quantitative study explores whether greater perceived play with pets contributes to greater wellbeing (‘pet effect’) and reduces anxiety during a time of acute stress (social buffering). The study employs a regression design recruiting men and women residing in the UK during the COVID-19 pandemic who own a dog and/or cat, with perceived pet play as the key predictor variable, and outcome variables of wellbeing and COVID-19 anxiety. Data were gathered and analysed cross-sectionally on day one (N = 189), and longitudinally over five days (N = 105), using multiple regressions. Overall, perceived pet play did not predict wellbeing nor COVID-19 anxiety. As such, the current study indicates human–pet play does not contribute to the ‘pet effect’ nor social buffering, thus raising questions for future research regarding the exact purpose of play within the human–pet relationship.

The Serial Mediation Effect of COVID-19 Anxiety and COVID-19 Burnout on the Relationship Between the Fear of COVID-19 and COVID-19 Quality of Life in Nurses

There is growing interest in the association between COVID-19-related stressors and quality of life. This study aimed to extend current knowledge by investigating the potential mediating roles of COVID-19 anxiety and COVID-19 burnout in the association between fear of COVID-19 and COVID-19 quality of life in nurses. A total of 300 nurses were selected by convenience sampling approach from a training and research hospital serving as a pandemic hospital in Turkey. COVID-19 anxiety, COVID-19 burnout, and COVID-19 quality of life data were collected using the self-reported questionnaires using both online and paper-and-pencil versions of the questionnaires. Structural equation modeling was used to conduct serial multiple mediation analysis. We found statistically significant associations among fear of COVID-19, COVID-19 anxiety, COVID-19 burnout, and COVID-19 quality of life. Serial multiple mediation analysis revealed that the association of fear of COVID-19 with COVID-19 quality of life was partially mediated by COVID-19 anxiety and COVID-19 burnout. These results indicate that the association of fear of COVID-19 with COVID-19 quality of life in nurses may be changed through COVID-19 anxiety and COVID-19 burnout, which appear to play serial multiple mediating roles in this association. These findings enrich our understanding of the associations among these psychological factors and suggest that focusing solely on fear of COVID-19 without considering the mediating effects of COVID-19 anxiety and COVID-19 burnout might not be adequate for reducing the COVID-19–impact on the quality of life among nurses.

'I am more stressed if my infection affects others': development of a COVID-19-related stress scale in older people and examination of its validity and associations with mental health risks.

COVID-19 was a collective traumatic event; however, different individuals may have perceived it differently. This study investigated what older people in a collective culture perceived as stressful during COVID-19 and examined how different stressors related to COVID-19 infection and mental health risks. Thirty-six participants from diverse backgrounds engaged in a three-round Delphi study to generate items for a COVID-19-related stress scale for older adults (CSS-OA). Subsequently, 4674 people (aged ≥60 years) participated in a cross-sectional telephone survey; interviewers collected their responses to CSS-OA and information about COVID-19 infection, depressive symptoms, anxiety, loneliness and demographics. Exploratory factor analysis and confirmatory factor analysis were conducted on CSS-OA. A multiple indicator multiple cause (MIMIC) model was used to examine associations between CSS-OA and other measures. The Delphi process generated eight items, all secondary or tertiary stressors related to infection. Exploratory factor analysis revealed a three-factor model, and confirmatory factor analysis confirmed an excellent fit (comparative fit index = 0.99, root mean square error of approximation = 0.06). Pre-existing mental health conditions, having family members/friends infected with COVID-19, loneliness, anxiety and depressive symptoms were associated with higher stress. Conversely, self-infection with COVID-19, older age, being female and living alone were negatively associated with some domains of CSS-OA (all P < 0.05). The Delphi process enhanced our understanding of what older people perceived as stressful, much of which resulted from certain healthcare strategies and reflected cultural influences. These and the MIMIC results highlight the need to balance public health policies with respect to infectious diseases and older people's mental health and quality of life.

The association of micro and macro worries with psychological distress in people living with chronic kidney disease during the COVID-19 pandemic.

Psychological distress can be exacerbated by micro (personal) and macro (societal) worries, especially during challenging times. Exploration of this relationship in people with chronic kidney disease is limited. (1) To identify the types and levels of worries concerning people with chronic kidney disease in the context of the COVID-19 pandemic; (2) to explore the association of worries with psychological distress including depression, stress, anxiety, and health anxiety. A cross-sectional online survey collected data at two time points (Autumn 2020, n = 528; Spring 2021, n = 241). Participants included kidney transplant recipients and people with non-dialysis dependent chronic kidney disease. The survey included questions about worry taken from the World Health Organisation COVID-19 Survey, the Depression, Anxiety and Stress Scale, and the Short Health Anxiety Index. Data were analysed using descriptive statistics and multiple regression. Worries about loved ones' health, the healthcare system becoming overloaded, losing a loved one, economic recession, and physical health were the highest rated concerns. Worrying about mental health was associated with higher depression, stress, anxiety, and health anxiety. Worrying about physical health was associated with anxiety and health anxiety. Worrying about losing a loved one was associated with health anxiety, and worrying about not being able to pay bills was associated with stress. People with kidney disease reported micro and macro worries associated with psychological distress during the COVID-19 pandemic. This study highlights factors that should be considered to improve the mental health and well-being of people with kidney disease.

THE RELATIONSHIP OF COVID-19 FEAR WITH PREOPERATIVE ANXIETY AND POSTOPERATIVE ANALGESIC REQUIREMENT IN TOTAL HIP AND KNEE ARTHROPLASTY PATIENTS

It was conducted to determine the relationship between fear of Covid-19 and preoperative anxiety and postoperative analgesic requirement in total hip and knee arthroplasty patients. This descriptive study was conducted with 331 patients scheduled for arthroplasty who were hospitalized in the orthopedic clinic of a hospital in eastern Turkey between March 2022-2023. Fear of covid-19, state anxiety inventory, and visual analogue pain scale were used. The mean age of the patients was 61.9±14.4 years, 52.0% had undergone total knee arthroplasty, and there was no relationship between Covid-19 fear score and state anxiety score. A positive significant correlation was found between opioid requirement and Covid-19 fear score on the first and second days after surgery. A weak positive correlation was found between non-steroidal anti-inflammatory drug (NSAID) requirement and Covid-19 fear score on the zero, first and second days after surgery. A weak negative correlation was found between paracetamol use and Covid-19 fear score on the first and second days. It was determined that the Covid-19 fear experienced by the patients before surgery was not associated with preoperative anxiety and increased the use of analgesics such as NSAIDs and opioids after surgery.

Impact of visitation restrictions in neonatal intensive care units during the COVID-19 pandemic on parents in northern Hokkaido, Japan.

Medical institutions restricted visitation to neonatal intensive care units (NICUs) during the coronavirus disease (COVID-19) pandemic. Therefore, this study aimed to investigate the impact of COVID-19 NICU visitor restrictions on parents. We conducted a questionnaire of 378 parents of infants who were hospitalised for more than 1 week at two NICUs in our area and discharged between 1 April 2020 and 31 March 2022. While the visiting rules for NICUs during this period varied depending on the phase of the COVID-19 epidemic, generally, only parents were allowed to visit the NICUs for a few hours daily. A total of 157 parents (A University Hospital (AMUH), n = 79; AK General Hospital (AKGH), n = 78) responded to the survey (41.3% response rate), with 40% stating that their emotions towards their infants were affected by restrictions due to the COVID-19 pandemic. Parents' feelings towards their infants were influenced by mode of delivery, parity, duration of hospitalisation and opportunities to visit the NICU. More than 70% of respondents felt stressed due to COVID-19 restrictions, and anxiety and emotional stress related to visitor restrictions were significantly affected by the number and duration of visits and allowability of family member visits. Parents felt that the restrictions had a negative impact on breastfeeding, overall infant care and infant-family bonding. As parents felt an impact on the bond with their infant during visitation restrictions, it is essential for facilities to implement measures to protect infant-family bonding during potential future pandemics.

Comparing personality traits of healthcare workers with and without long COVID: Cross-sectional study.

Pathological mechanisms of "long COVID" after recovery from the main symptoms of COVID-19 are unclear. We compared psychological differences between individuals with and without long COVID symptoms after initial COVID-19 infections. This study includes medical workers with and without history of COVID-19. We assessed the degree of depression, health-related quality of life (HRQOL), the degree of anxiety and fear of COVID-19, and we used an original questionnaire. In the COVID-19 group, we also assessed personality traits and anxiety. The COVID-19 group was subclassified into those with and without long COVID to examine differences in circumstantial and psychological examinations. Of 310 participants (141 men, 169 women, median age: 40 years), 167 had history of COVID-19 (83/84, 37 years) and 143 did not (58 men/85 women, 46 years). In the COVID-19 group, 26 had long COVID (12/14, 32 years) and 141 did not (58/85, 46 years). Fewer participants in the COVID-19 group had had COVID-19 vaccinations. The long COVID group had higher number of symptoms at the time of illness and higher NEO Five Factor Inventory Neuroticism scores than the non-long COVID group. They also had poorer mental health according to HRQOL than those without. Risk factors for long COVID may include the number of symptoms at the time of illness and neurotic tendency on NEO Five Factor Inventory. Participants with long COVID had poorer mental health according to HRQOL. People with long COVID might be especially sensitive to and pessimistic about the symptoms that interfere with their daily lives, resulting in certain cognitive and behavioral patterns. They may benefit from early psychiatric intervention.

Sleep disorders among frontline nurses after the COVID-19 outbreak: a large-scale cross-sectional study.

This large-scale cross-sectional multicenter study aims to investigate the prevalence of sleep disorders among frontline nurses in China after the COVID-19 pandemic and to identify potential influencing factors contributing to these sleep disturbances. A total of 2065 frontline nurses from 27 provinces in China participated in an online survey conducted through the Wenjuan Xing platform. Data on demographic characteristics, work-related factors, and mental health assessments, including the Pittsburgh Sleep Quality Index (PSQI), Zung Self-Rating Anxiety Scale (SAS), and Self-Rating Depression Scale (SDS), were collected. Statistical analyses, including chi-square tests, t-tests, binary logistic regression, and ROC analysis, were conducted to explore the relationships between various factors and sleep disorders. Over half (52.7%) of the surveyed nurses exhibited sleep disorders, reflecting a considerable post-pandemic impact on sleep quality. Factors such as nursing titles, personality traits, COVID-19 infection status, and exercise frequency showed statistically significant associations with sleep disorders. Extraverted nurses and those who had recovered from COVID-19 displayed a lower risk of sleep disorders, while anxiety was identified as an independent risk factor. The study also identified a nuanced relationship between exercise frequency and sleep quality. The study highlights a high prevalence of sleep disorders among frontline nurses post-COVID-19, emphasizing the need for targeted interventions. Factors such as nursing titles, personality traits, COVID-19 infection status, exercise habits, and anxiety levels were found to influence sleep quality. Comprehensive support strategies addressing these factors are essential for improving the overall well-being of frontline nurses and, subsequently, sustaining a resilient healthcare workforce. Further research is recommended to explore additional influencing factors and consider diverse nurse populations.

Attitudes and intentions of parents towards the COVID-19 vaccine for their children at a special moment of the pandemic.

This research was conducted following the FDA's approval of the COVID-19 vaccine for children aged 5 to 11. Our study aimed to evaluate parents' intentions regarding vaccinating their children in response to the pandemic situation. This period was crucial for understanding parents' initial reactions to health authority recommendations. This descriptive cross-sectional study was conducted with 940 parents. The data were obtained using the Personal Information Form, the COVID-19 Anxiety Scale, and the Scale of Attitudes Towards COVID-19 Vaccine. Descriptive data analysis involved calculating frequency, percentage, mean, and standard deviation values. We employed Student's t-test, one-way ANOVA tests for analysis. Additionally, various characteristics were analyzed using the two-way logistic regression method. In the study, 85.1% of the parents reported having received the COVID-19 vaccine themselves. However, only 20% stated they would accept the COVID-19 vaccine for their children. The intention to vaccinate their children was influenced by factors such as the parent's age, level of COVID-19 anxiety, vaccination status, and knowledge about the COVID-19 vaccine. Despite the FDA's declaration, it was determined that more than two-thirds of parents were hesitant about the COVID-19 vaccine for their children.

Predictive relationship between COVID-19 anxiety and psychological distress in adolescents during the COVID-19 pandemic.

COVID-19 was a novel stressor that gave rise to pandemic related anxiety and increased the risk of mental health issues, particularly in youth. It is important to understand how such events contribute to psychological distress in young people to adequately intervene in the aftermath and to plan for future similar events. Using cross-sectional data from the CoSPACE Ireland study dataset this paper reports on the predictive relationship between COVID-19 anxiety and psychological distress for Irish adolescents (N = 314, M = 14.05, SD = 2.7, 11-18 years), while controlling for other influencing factors across multiple levels of a bioecological systems approach. Covariates were age, gender, ethnicity, social economic status, Peer Support, School Support and Parent-Child Closeness. Findings indicate that COVID-19 anxiety was a significant predictor of adolescents' psychological distress. Specifically, Consequence Anxiety (worries about the indirect consequences of COVID-19) was found to be a predictor of adolescents' psychological distress rather than Disease Anxiety (worries about the COVID-19 virus itself). Individual factors (e.g., age, ethnicity, special educational needs) and microsystem factors (e.g., parent child closeness, peer support) were also found to impact on adolescents' levels of psychological distress. A significant moderation analysis revealed that greater parent-child closeness reduced the strength of the positive association between Consequence Anxiety and psychological distress. These findings suggest that strategies to alleviate adolescents' psychological distress during pandemics should focus on reducing pandemic-related anxiety, specifically Consequence Anxiety. A multisystemic approach is also recommended to reduce the negative mental health impacts of the pandemic on adolescents.

Exploring COVID-19 anxiety across demographics: psychometric validation and application of the COVID-19-Anxiety Questionnaire in Arabic

BackgroundThe emergence of the COVID-19 pandemic in 2019 imposed significant shifts in global health, particularly in understanding and addressing anxiety disorders precipitated by pandemic-related stressors. The current study aimed to adapt and validate the COVID-19 Anxiety Questionnaire (C-19 A) for Arabic-speaking populations (C-19 A-A), assessing its structural integrity, concurrent validity, factorial validity, and reliability.MethodsThe data of 571 individuals, including age range, educational history, gender, and marital status, were collected through online platforms. The translation process of C-19 A-A underwent rigorous verification by linguistic and subject matter experts. Several advanced statistical procedures were used to examine the C-19 A-A’s reliability, validity, and measurement invariances across demographic subsets.ResultsThe results indicated robust internal consistency, with a Cronbach’s alpha coefficient of 0.889, confirming the questionnaire’s reliability. Concurrent validity showed significant and positive correlations between C-19-A and FCV-19S (r = 0.77, p < 0.000). EFA revealed a dominant factor explaining 60.4% of the variance, bolstering the questionnaire’s factorial validity. CFA further validated the model’s adequacy across different demographic groups. Specifically, demographic factors such as age, gender, and educational level showed distinct patterns of COVID-19-related anxiety.ConclusionThe validated Arabic version of the C-19 A-A represents a pivotal tool for assessing pandemic-induced anxiety within Arabic-speaking communities. Its deployment enables targeted identification of vulnerable individuals, facilitating tailored health interventions and informing clinical strategies. This research underscores the pivotal role of culturally attuned assessment instruments in shaping effective public health responses and therapeutic interventions aimed at mitigating the psychological sequelae of global health crises.

Covid-19 Anxiety Scale (CAS): A Validity and Reliability Study.

In this study, our aim was to develop a valid and reliable scale to determine the social anxiety level of people regarding COVID-19. A total of 420 people participated in the research. Explanatory and confirmatory factor analyses were used to test the validity and reliability of the scale. As a result of the explanatory factor analysis, it was determined that the scale consisted of 22 items and four sub-dimensions. These sub-dimensions were named "negative thinking", "sociability", "fear" and "vaccination". In examination of the fit indices obtained from the confirmatory factor analysis results, it was seen that the four-factor scale structure was high and acceptable. Based on these results, we concluded that the COVID-19 social anxiety scale (CAS) was valid and reliable for examining the level of social anxiety of people during the pandemic periods.

Depression anxiety stress and fear of COVID-19 among adolescent students and its relationship with possible predictors.

During the COVID-19 pandemic prolonged lockdowns, school closures requiring online education support, and uncertainty about examinations caused stress in students. To estimate the levels of depression, anxiety, stress, and fear of COVID-19 in adolescent students of Jamnagar and its relationship with possible predictors. This is a cross-sectional study using a proportionate probability sampling method during the third wave of COVID-19 of 4423 adolescent students of Jamnagar, Gujarat. The Fear of COVID-19 Scale (FCV-19S) and Depression, Anxiety, and Stress Scale-21 (DASS-21) measured the main construct. T-tests for two independent samples and multiple linear regression analysis were used to assess the relationship. Among the adolescent students, 14.81% had moderate fear, while severe fear was found in 3.37%. Moderate or severe depression was observed in 1.31% and 0.16% of students, respectively; severe and extremely severe anxiety was present in 0.65% and 0.11% of students; and stress was found to be moderate in 0.23%. Depression was associated with education, anxiety with education, gender, and a history of COVID-19 in the family and stress with a history of COVID-19 infection in the family and fear of COVID-19 with gender, standard of class, geographical area, socioeconomic class, and father's education. In our study, the students having a higher fear of COVID-19 were found to have higher depression, anxiety, and stress. The factors associated with a lower level of psychological impact can be used to formulate the interventions needed for the betterment of adolescent mental health.

COVID-19’s Psychological Threats and Future Career Anxiety among University Students

The COVID-19 pandemic brought different intolerable and uncomfortable situations that ruined the students' academic performance, career opportunities, and social lives through depression, anxiety, fear, uncertainty, and mental illness. In this study, we examined the psychological threats of the COVID-19 among Egypt’s public-sector university students. We employed quantitative methods in this study and used a questionnaire to collect cross-sectional data. The Structural Equation Modeling (SEM) results show that Fear of COVID-19 (FoC) has a positive effect of on Depression from COVID-19 (DfC), Future Career Anxiety (FCA) and Uncertainty of COVID-19 (UoC). In addition, DfC and UoC have positive effects on FCA. Finally, DfC and UoC positively mediate the association between FoC and FCA. This study's findings help policymakers and university authorities shape policies to reduce Egypt’s public sector university students ‘psychological problems due to the COVID-19 pandemic. Moreover, this study’s findings assist with the adjustments caused by the complex and rapidly changing pandemic situation.

The impact of social isolation on smartphone addiction among college students: the multiple mediating effects of loneliness and COVID-19 anxiety.

The widespread use of smartphones has significantly increased smartphone addiction among college students, especially during the COVID-19 pandemic. Since the COVID-19 outbreak, university campuses in mainland China have strictly followed the Chinese government's strict quarantine policy, including closed campus management, prohibitions against gatherings, and social distancing, increasing student loneliness and anxiety and thus increasing the risk of smartphone addiction. Extant Studies have revealed that social isolation is a prominent predictor of smartphone addiction but have failed to systematically explore the complex relationship between social isolation and smartphone addiction in the context of COVID-19; therefore, the underlying mechanisms of these factors in the post-pandemic era are unclear. This study is the first attempt to consider loneliness, COVID-19 anxiety and social isolation as a whole and to clarify the underlying mechanisms of social isolation and smartphone addiction by constructing a multiple mediating model. This study included students enrolled at eight higher education institutions in Conghua District (Guangzhou city). Quota proportional sampling was adopted, 900 self-report questionnaires were distributed through the WeChat groups of these universities from December 10 to December 15, 2022, and 868 valid questionnaires (620 females, 248 males) were ultimately obtained. The direct effect of social isolation on smartphone addiction was significant, and loneliness and COVID-19 anxiety mediated the association between social isolation and smartphone addiction in both parallel and sequential ways. Moreover, a reverse mediation model with COVID-19 anxiety as the first mediator and loneliness as the second mediator was found. College students who experience social isolation are at greater risk for smartphone addiction, and the core factor leading to their smartphone addiction is the subjective psychological state triggered by campus isolation and social distancing, such as loneliness and anxiety. These risky behaviors of people should receive extra attention, and psychological factors such as loneliness and COVID-19 anxiety should be considered in future therapies aimed at reducing addiction.

Psychological and psychosocial determinants of COVID related face covering behaviours: A systematic review.

The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has resulted in illness, deaths and societal disruption on a global scale. Societies have implemented various control measures to reduce transmission of the virus and mitigate its impact. Individual behavioural changes are crucial to the successful implementation of these measures. One commonly recommended measure to limit risk of infection is face covering. It is important to identify those factors that can predict the uptake and maintenance of face covering. We aimed to identify and synthesise the evidence on malleable psychological and psychosocial factors that determine uptake and adherence to face covering aimed at reducing the risk of infection or transmission of COVID-19. We searched various literature sources including electronic databases (Medline ALL, Child Development & Adolescent Studies, ERIC, PsycInfo, CINAHL & Web of Science), web searches, conference proceedings, government reports, other repositories of literature and grey literature. The search strategy was built around three concepts of interest including (1) context (terms relating to COVID19), (2) behaviour of interest and (3) terms related to psychological and psychosocial determinants of COVID Health-Related Behaviours and adherence or compliance with face covering, to capture malleable determines. Searches capture studies up until October 2021. Eligibility criteria included observational studies (both retrospective and prospective) and experimental studies that measure and report malleable psychological and psychosocial determinants and handwashing at an individual level, amongst the general public. Screening was supported by the Cochrane Crowd. Studies titles and abstracts were screened against the eligibility criteria by three independent screeners. Following this, all potentially relevant studies were screened at full-text level by the research team. All conflicts between screeners were resolved by discussion between the core research team. All data extraction was managed in EPPI-Reviewer software. All eligible studies, identified through full-text screening were extracted by one author. We extracted data on study information, population, determinant, behaviour and effects. A second author checked data extraction on 20% of all included papers. All conflicts were discussed by the two authors until consensus was reached. We assessed methodological quality of all included studies using an adapted version of the Joanna Briggs Institute Quality appraisal tool for cross-sectional studies. Our initial searches yielded 23,587 results, of which 23 were included in this review. The included studies were cross-sectional in design, came from nine countries and had a combined sample of 54,401 participants. The vast majority of studies had samples from the general public, with five of the studies focusing on specific samples. All included studies considered people over the age of 18. The quality of 10 of the studies was rated as unclear, 10 were rated as low, and 3 rated high risk of bias, predominately due to lack of reporting of recruitment, sample characteristics and methodology. Ten studies were included in the meta-analysis and 16 in the narrative synthesis. Findings from the meta-analysis indicated that knowledge of COVID-19 (0.341, 95% confidence interval [CI] = 0.06, 0.530, I 2 = 100%) was the malleable determinant most associated with face covering behaviour. Perceived susceptibility of COVID-19 (r = 0.088, 95% CI = -0.004, 0.180, I 2 = 80%) and COVID-related worry and anxiety (r = 0.064, 95% CI = -0.066, 0.191, I 2 = 93% had little to no effect on face covering behaviour. In the narrative synthesis, the strongest association was found between perceived benefits and effectiveness of behaviours and mask wearing behaviour. Understanding the effects of various malleable determinants on COVID-related face covering can aid in the development and implementation of interventions and public health campaigns to promote face covering behaviour in potential new waves of COVID-19 or other respiratory infections. Knowledge of COVID and perceived benefits of face coverings warrant further consideration in future research and policy.