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* Home * Epi * Epidemics * Medicine * Pandemics ArticlePDF Available THE COVID-19 PANDEMIC AND MENTAL HEALTH IN KAZAKHSTAN Cambridge Prisms: Global Mental Health * August 2023 * 10:1-28 DOI:10.1017/gmh.2023.46 * License * CC BY 4.0 Authors: Gauhar Mergenova * Columbia University Susan L. Rosenthal Susan L. Rosenthal * This person is not on ResearchGate, or hasn't claimed this research yet. Akbope Myrkassymova * Kazakh National Medical University Assel Bukharbayeva * Kazakh National Medical University Show all 13 authorsHide Download full-text PDFRead full-text Download full-text PDF Read full-text Download citation Copy link Link copied -------------------------------------------------------------------------------- Read full-text Download citation Copy link Link copied References (94) Figures (3) ABSTRACT AND FIGURES The COVID-19 pandemic had significant impacts on mental health. We examined factors associated with symptoms of depression and anxiety during the COVID-19 pandemic in Kazakhstan. We surveyed 991 adults in Kazakhstan in July 2021 using multistage stratified sampling. Depression and anxiety were measured with the Patient Health Questionnaire-4. We conducted logistic regression to assess associations between depression and anxiety and sociobehavioral factors. Overall, 12.01% reported depressive symptoms and 8.38% anxiety. Higher likelihood of depression was associated with being female (AOR: 1.64; 95% CI [1.05, 2.55]), having experience with COVID-19 in the social environment (AOR: 1.85; 95% CI [1.1–3.14]), experiencing food insecurity (AOR: 1.80; 95% CI [1.11–2.89]), increased family conflict (AOR: 2.43; 95% CI [1.32–4.48]) and impaired healthcare access (AOR: 2.41; 95% CI [1.32–4.41]). Higher likelihood of anxiety was associated with being female (AOR: 3.43; 95% CI [1.91–6.15]), increased family conflict (AOR: 2.22; 95% CI [1.11–4.44]) and impaired healthcare access (AOR: 2.63; 95% CI [1.36–5.12]). Multiple factors were associated with mental health in Kazakhstan during the COVID-19 pandemic. Further research is needed to determine the extent to which these factors and their associated mental health outcomes may persist. Population proportion with PHQ-4, PHQ-2, GAD-2 elevated scores. … Sociodemographic characteristics and mental health of the sample (n = 991) … Bivariate and adjusted logistic regression estimates of odds ratios and 95% confidence intervals for association between depression and anxiety and studied variables … Figures - available from: Cambridge Prisms: Global Mental Health This content is subject to copyright. Discover the world's research * 25+ million members * 160+ million publication pages * 2.3+ billion citations Join for free Publisher Full-text 1 Public Full-text 1 Access to this full-text is provided by Cambridge University Press. Learn more Content available from Cambridge Prisms: Global Mental Health This content is subject to copyright. The COVID-19 pandemic and mental health in Kazakhstan Gaukhar Mergenova 1,2 , Susan L. Rosenthal 3 , Akbope Myrkassymova 2 , Assel Bukharbayeva 2 , Balnur Iskakova 2 , Aigulsum Izekenova 2 , Assel Izekenova 4 , Lyailya Alekesheva 2 , Maral Yerdenova 2 , Kuanysh Karibayev 2 , Baurzhan Zhussupov 2 , Gulzhan Alimbekova 5 and Alissa Davis 6 1 Global Health Research Center of Central Asia, Almaty, Kazakhstan; 2 Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan; 3 Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA; 4 Kenzhegali Sagadiyev University of International Business, Almaty, Kazakhstan; 5 CIOM (Public Opinion Research Centre), Almaty, Kazakhstan and 6 Columbia University School of Social Work, New York, NY, USA Abstract The COVID-19 pandemic had significant impacts on mental health. We examined factors associated with symptoms of depression and anxiety during the COVID-19 pandemic in Kazakhstan. We surveyed 991 adults in Kazakhstan in July 2021 using multistage stratified sampling. Depression and anxiety were measured with the Patient Health Questionnaire-4. We conducted logistic regression to assess associations between depression and anxiety and socio- behavioral factors. Overall, 12.01% reported depressive symptoms and 8.38% anxiety. Higher likelihood of depression was associated with being female (AOR: 1.64; 95% CI [1.05, 2.55]), having experience with COVID-19 in the social environment (AOR: 1.85; 95% CI [1.1–3.14]), experiencing food insecurity (AOR: 1.80; 95% CI [1.11–2.89]), increased family conflict (AOR: 2.43; 95% CI [1.32–4.48]) and impaired healthcare access (AOR: 2.41; 95% CI [1.32–4.41]). Higher likelihood of anxiety was associated with being female (AOR: 3.43; 95% CI [1.91–6.15]), increased family conflict (AOR: 2.22; 95% CI [1.11–4.44]) and impaired healthcare access (AOR: 2.63; 95% CI [1.36–5.12]). Multiple factors were associated with mental health in Kazakhstan during the COVID-19 pandemic. Further research is needed to determine the extent to which these factors and their associated mental health outcomes may persist. Impact statement The COVID-19 pandemic had significant impacts on mental health. Our results suggest that in Kazakhstan, women experienced higher rates of depression and anxiety than men. Rurality, limited access to healthcare services, increased family conflicts, and knowing someone who died of COVID-19 were also associated with an increased likelihood of mental health symptoms. In addition, economic vulnerability, such as food insecurity, was associated with increased depres- sion. By identifying factors associated with greater risk, policies can be developed that either mitigate these factors (e.g., limited access to health care) or their relationship to mental health (e.g., being female or living in a rural area) so as to support the mental health of the general population of Kazakhstan. Introduction The coronavirus disease 2019 (COVID-19) pandemic is a multidimensional global public health problem. Along with its effects on physical health, previous infectious disease epidemics have also had a substantial negative impact on people’s mental health (Lee et al., 2007; Lau et al., 2010). The COVID-19 pandemic resulted in mass disruptions globally that impacted emotional well-being and mental health, not only due to fears around COVID-19 infection and mortality, but also due to social and behavioral factors, including strict lockdown and quarantine measures, disrupted work and school routines, and increased social isolation (Brooks et al., 2020; Campion et al., 2020; Kola et al., 2021). Particularly with regard to the latter, it has been believed that lockdowns made people feel lonely, irritable, restless and anxious (Fullana et al., 2020; Saladino et al., 2020; Gonda and Tarazi, 2022). Difficulties acquiring food and medical services, medical comorbidities and lack of specialized treatment further resulted in a substantial mental burden that in turn caused psychological distress and mental health disorders (De Sousa et al., 2020; Lai et al., 2020; Gillard et al., 2021; Rahman et al., 2021; Han et al., 2022). Cambridge Prisms: Global Mental Health www.cambridge.org/gmh Research Article Cite this article: Mergenova G, Rosenthal SL, Myrkassymova A, Bukharbayeva A, Iskakova B, Izekenova A, Izekenova A, Alekesheva L, Yerdenova M, Karibayev K, Zhussupov B, Alimbekova G and Davis A (2023). The COVID-19 pandemic and mental health in Kazakhstan. Cambridge Prisms: Global Mental Health,10, e52, 1–10 https://doi.org/10.1017/gmh.2023.46 Received: 26 April 2023 Revised: 13 July 2023 Accepted: 10 August 2023 Keywords: anxiety; COVID-19; depression; low and middle- income countries; mental health Corresponding author: Gaukhar Mergenova; Email: gaukhar.mergenova@gmail.com © The Author(s), 2023. Published by Cambridge University Press. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http:// creativecommons.org/licenses/by/4.0), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited. Studies indicate that up to 40% of the general population experi- enced high levels of anxiety or distress associated with the COVID- 19 pandemic and that there may be psychological and emotional trauma that would last a lifetime (Hossain et al., 2020; Jung et al., 2020; Vindegaard and Benros, 2020; Jin et al., 2021; Mauz et al., 2021; Bonati et al., 2022). Depression and anxiety disorders rank among the top debilitating medical conditions and have one of the highest socioeconomic impacts (GBD 2019 Diseases and Injuries Collaborators, 2020; GBD 2019 Mental Disorders Collaborators, 2022). Studies in both high- and low-income countries exhibit heterogeneity in factors most associated with mental health out- comes during the COVID-19 pandemic (COVID-19 Mental Dis- orders Collaborators, 2021; Kola et al., 2021; Shevlin et al., 2021; Bonati et al., 2022). Kazakhstan is considered an upper middle- income country but has high suicide mortality rate. According to the World Health Organization (WHO), the age-standardized suicide rate in Kazakhstan was 6.9 per 100,000) (WHO, 2021) and the UNICEF-2013 report (UNICEF, 2013) indicates that the risk of suicides among adolescents (15–19 years) in Kazakhstan is three times higher than in the Commonwealth of Independent States (CIS). Suicides are usually associated with underlying depres- sive conditions (Isacsson, 2000; Gotlib and Hammen, 2002). Currently, there are limited data on the prevalence of depression and anxiety in Kazakhstan. According to official data posted on the website of the Republican Scientific and Practical Center of Mental Health, the number of registered patients with mental and behav- ioral disorders was 1,020.1 per 100 000 –in 2019 and 1,004.0 per 100 000 –in 2020 with depressive and anxiety disorders included in these numbers (Respublikanskiy Nauchno-Prakticheskiy Tsentr Psikhicheskogo Zdorov’ya, 2021). Furthermore, a WHO mental health report indicated that the COVID-19 pandemic negatively affected mental health globally with an increase of 28% and 26% for major depressive disorders and anxiety disorders, respectively in just one year (WHO, 2022). Important factors for mental health during the COVID-19 pandemic appear to vary based on local context, but little research has been conducted examining the impact of COVID-19 on mental health outcomes among the gen- eral population in Kazakhstan. The first major lockdown in Kazakhstan occurred in March 2020, with severe restrictions on travel between cities, closure of entertainment and other venues, suspension of cultural events and large family and public gatherings, and strict quarantine rules. In the summer of 2021, when new vaccines were available and people were feeling some hope, the more contagious Delta variant became the predominant SARS-CoV-2 variant, leading to a dramatic increase in hospitalizations worldwide (Hart et al., 2022). In Kaz- akhstan, COVID-19 cases started to rise at the end of June 2021 and reached their peak in August 2021. This was also the period with the highest number of recorded daily deaths in Kazakhstan during the entire COVID-19 pandemic. As a result, Kazakhstan implemented a second lockdown in July 2021, which included reducing the operating hours of businesses and entertainment venues, prohibit- ing in-person dining and restricting public gatherings (UNCT, 2020; Haruna et al., 2022). These restrictions likely led to changes in health behaviors, such as physical activity, smoking and alcohol use, interpersonal relationships, such as family dynamics, and structural factors, such as income and employment and health care access, as well as increased depression and anxiety. Although there have been studies targeting specific groups and mental health in relation to or during the COVID-19 pandemic in Kazakhstan (Bolatov et al., 2020; Bazarkulova and Compton, 2021; Crape et al., 2021; Kamkhen et al., 2022; Konstantinov et al., 2022), little is known about which specific COVID-19-related factors were associated with mental health among the general Kazakhstani population. To address this gap, we sought to examine the multi- level COVID-19 related factors associated with mental health in order to inform the country’s future programmatic and policy response to this public health crisis. Methods Study design We conducted a cross-sectional face-to-face survey of 1,021 parti- cipants between June 26 and July 10, 2021. Data collection was performed by the Public Opinion Research Centre. The team of Public Opinion Research Centre is an experienced team of special- ists that have worked in the field for several years. We provided training sessions via Zoom for the research assistants to ensure adherence to data collection protocols, confidentiality rules and ethical principles of the study. Our team provided support and supervision to ensure high quality of the process of data collection. Once data were collected, we checked audio records and survey data, to ensure the quality of data and excluded from the final dataset data that were incomplete of low quality. Participants were recruited using a multi-stage sampling approach. Strata were iden- tified in the first stage, which represented the administrative regions of the country, separated into urban and rural populations. The number of respondents in each stratum corresponded to the popu- lation living there. At the second stage, the settlements where the survey would be conducted were chosen: the region’s largest city and a randomly selected rural settlement. A random route sample was used to determine households in the third stage. Streets were chosen at random from a list of streets to generate random routes throughout the urban and rural settlements. The starting point of the route was chosen randomly by picking a house number on the designated street. Then, in increasing order, every third house was selected. If an apartment complex was picked for the survey, a systematic sample was employed to identify every fifth apartment in the building. In households, interviewers recruited participants applying a gender and age frequency-match approach. General population data were obtained from official 2019 census (Bureau of National Statistics, 2020). Oral informed consent was obtained from all participants of the study before the start of the survey. All databases, folder and personal computers were password- protected. All databases were deidentified prior to the start of data cleaning and analysis. File linking identifiable information and ID numbers of participants were only available for the limited number of research assistants who were involved in data collection and the principal investigator. The average time required to complete the survey was 40–60 minutes. Out of 1,021 respondents, 30 were dropped due to incomplete surveys. The final sample consisted of 991 adults. Measures Dependent variables: Depression and anxiety To measure the presence of depressive and anxiety symptoms, we used the Patient Health Questionnaire-4 (PHQ-4). The PHQ-4 is an ultra-brief tool for detecting both anxiety and depressive dis- orders (Kroenke et al., 2009). It has been used in numerous studies in several countries (Schnell and Krampe, 2020; Zhang et al., 2020a; Daly and Robinson, 2021; Workneh et al., 2021). An elevated PHQ-4 score is not diagnostic, but is an indicator for further 2 Gaukhar Mergenova et al. inquiry to establish the presence or absence of a clinical disorder warranting treatment. The PHQ-4 begins with the stem question: “Over the last 2 weeks, how often have you been bothered by the following problems?”Responses are scored as 0 (“not at all”), 1(“several days”), 2 (“more than half the days”)or3(“nearly every day”). The total composite score of PHQ-4 ranges from 0 to 12, and goes from normal (0–2) to mild (3–5) to moderate (6–8) to severe (9–12) (Cronbach Alpha = 0.76). Positive screening for anxiety was defined as a score of ≥3 on the General Anxiety Disorder (GAD)-2 (which assesses “feeling nervous, anxious or on edge”and “not being able to stop worrying”) of the PHQ-4 (Cronbach Alpha = 0.67) (Kroenke et al., 2007; Levis et al., 2020), and positive screening for depression was defined as a score of ≥3 on the 2-item Depression subscale (PHQ-2) which assesses “feeling down, depressed and hopeless”and “little interest or pleasure in doing things”)) of the PHQ-4 (Cronbach Alpha = 0.61) (Kroenke et al., 2003; Löwe et al., 2005; Bisby et al., 2022). PHQ-4 is a subset of the Patient Health Questionnaire (PHQ-9), which had been previously validated in Russian. In Kazakhstan, historically, population is fluent in Russian (Pogosova et al., 2014). Independent variables Sociodemographic characteristics included self-reported age, gen- der, education, type of residence, employment status, and if they had adults older than 65 in their households. COVID-19 related experiences and behavior. Participants self- reported if they thought they ever had a COVID-19 infection (yes/no). They were also asked if they knew someone who was infected with COVID-19 or had died of COVID-19 and were classified into three categories (knew someone who had died/knew someone infected, but did not die /did not know anyone who had died or was infected). Likelihood of severe COVID-19 was assessed with 5-point Likert-type questions: “In your opinion, how severe would con- tracting COVID-19 be for you?”(1 –“very mild”to 5 –“very severe”) (Brewer et al., 2007). We also asked about changes in terms of level of conflicts in the home at the time of COVID-19 pandemic using the question “During the COVID-19 pandemic, have the level of conflicts in your home”with dichotomized categories of response options: decreased or stayed the same compared to the period before the COVID-19 pandemic and Increased compared to the period before the COVID-19 pandemic. Participants self-reported changes regarding their health behav- iors, including smoking, alcohol use and physical activity. For example, “How has your physical activity level changed during the pandemic (i.e., from March 2020 to the present) compared to the period before the COVID-19 pandemic?”with response options: “has not changed,”“decreased”and “increased.”We then used dichotomized variables (decreased/has not changed vs. increased). Economic vulnerabilities and healthcare service access. We asked participants questions about their change of financial status (Deteriorated/Has not changed/Improved/Do not know) and working conditions (Deteriorated/Has not changed/Improved) during the pandemic. We also asked participants if they faced food insecurity (yes/no) during the pandemic. To evaluate how changes regarding work might affect mental health, we asked if working conditions worsened (yes/no). We evaluated changes in healthcare access and asked partici- pants if their medical care for other non-COVID-19 illnesses changed during the COVID-19 pandemic compared to the pre- pandemic period. Responses were dichotomized for analysis: did not have problems with healthcare access (No, I have not had to use other healthcare services during the pandemic/No, my healthcare remains the same as before the pandemic/Yes –I have been offered remote appointments via telephone or video call); and had prob- lems with healthcare access (Yes –I have had appointments and procedures postponed or canceled/Yes –I have been unable to make appointments for new health issues). Statistical analysis Participant characteristics were described using means and stand- ard deviations (SDs) for continuous variables and frequencies and percentages for categorical variables. The PHQ-4 score was cat- egorized according to questions measuring depression and anxiety, indicating the presence or absence of depression (PHQ-2 ≥3) or anxiety symptoms (GAD-2 ≥3) (Kroenke et al., 2003,2007). To examine which multi-level factors were associated with mental health symptoms, we conducted logistic regression analyses. First, we conducted bivariate analyses to identify potential associ- ations with all multi-level factors we hypothesized would be asso- ciated with mental health symptoms. Then all variables that were significant for depression symptoms or anxiety symptoms at the p≤0.10 level and were entered simultaneously into a multivariable logistic regression model (Heinze et al., 2018). For the final multi- variable model, we used a significance level of p≤0.05. We checked variables for multicollinearity before including them into the model. We used SAS 9.4 for analysis. Ethical approvals. The study was approved by the ethical committee No. 10 of the Asfendiyarov Kazakh National Medical University on September 30, 2020. Role of the funding source Funded by the Science Committee of the Ministry of Science and Higher Education of the Republic of Kazakhstan №AP09260497 “The Impact of the COVID-19 Pandemic and Restrictive Measures on Lifestyles and Access to Health Care in Kazakhstan.”The funders had no role in study design; data collection, analysis, interpretation; writing; or the decision to submit the article. Results Sample characteristics Table 1 summarizes the sociodemographic characteristics of the study population and the variables we used in our analysis. The mean age of participants was 41.1 (SD = 15.00) years old and about half of the sample were women (n= 524, 52.9%). The majority of participants were married (n= 618, 62.4%), lived in urban areas (n= 591, 59.6%), and were employed full-time (n= 529, 53.4%) or part-time (n= 94 (9.49%)). Over a third of participants had a postgraduate degree (completed a bachelor or higher degree) (n= 412, 41.6%). Less than a fifth (n= 162, 16.4%) lived with a person who was older than 65 years old. Over a third experienced deterioration in their financial status (n= 362, 36.5%) and more than third (n= 410, 41.4%) reported food insecurity during the pandemic. Cambridge Prisms: Global Mental Health 3 Symptoms of anxiety and depression The mean value of the PHQ-4 score was 1.6 (SD: 2.26). Nearly a fifth of respondents n= 190 (19.17%) reported at least mild mental health symptoms, 4.8% (n= 48) had moderate symptoms and 2.1% had severe symptoms (Figure 1). In the total sample, 12.0% of participants had positive screening for depression (≥3 PHQ-2) and 8.4% of participants had positive screening for anxiety (≥3 GAD-2). COVID-19-related experiences and health behavior About one-fifth of our respondents think that they had COVID-19 at least one time in their life (n= 180, 18.2%). Two-thirds of the sample did not know anyone who was infected with COVID-19 (n= 608, 61.4%). In terms of adverse behavioral changes, almost a fifth (19.9%) of the sample reported decreased physical activity (n=197).7.4% reported increased family conflicts level (n=73)and7.9%reported problems accessing healthcare (n= 78). A minority (3.8%) reported increased alcohol consumption (n=38)and1.7%reportedincreased smoking (n= 17). In the multivariable regression analysis, regarding depressions symptoms we found that being female (AOR: 1.64; 95% CI [1.05, 2.55]), living in a rural area (AOR: 1.75; 95% CI [1.14–2.68]), perceiving greater severity of a COVID-19 infection (AOR: 1.28; 95% CI [1.00, 1.63), knowing someone who died from COVID-19 (AOR: 1.85; 95% CI [1.1–3.14]) or someone who was infected with COVID-19 (AOR: 1.90; 95% CI [1.12–3.17]), having increased conflict in the home (AOR: 2.43; 95% CI [1.32–4.48]), having food insecurity (AOR: 1.80; 95% CI [1.11–2.90]) or having problems accessing health care (AOR: 2.41; 95% CI [1.32–4.41]) were asso- ciated with higher odds of having depressive symptoms (Table 2). For anxiety, we found that being female (AOR: 3.43; 95% CI [1.91–6.15]), having decreased physical activity (AOR: 2.11; 95% CI [1.24–3.57]), perceiving greater severity of a COVID-19 infection (AOR: 1.45; 95% CI [1.09–1.92]), having increased conflict in the home (AOR: 2.22; 95% CI [1.11–4.44]), and having problems accessing healthcare (AOR: 2.63; 95% CI [1.36–5.12]) were associ- ated with higher odds of having anxiety symptoms in the multi- variable model (Table 2). Discussion Consistently with other studies, we found that multiple factors associated with depression and anxiety symptoms among the gen- eral population of Kazakhstan during the COVID-19 pandemic, including gender, home, economic, work and healthcare factors. Although numerous studies have shown that the COVID-19 pan- demic had an adverse impact on mental health with increases in depression and anxiety, the results of these studies are highly heterogeneous, suggesting each country has a unique combination of different factors that may be affecting the mental health of their population (Vindegaard and Benros, 2020; Jin et al., 2021). To our knowledge, our study is the first study to assess factors associated with mental health during the COVID-19 pandemic variant Delta wave among the general population in Kazakhstan and fills an important gap in the literature. Our findings are consistent with the literature in regards to women experiencing higher rates of depression and anxiety during the pandemic (Hou et al., 2020; Jung et al., 2020; Xiong et al., 2020). Many research documented that women usually have more anxiety Table 1. Sociodemographic characteristics and mental health of the sample (n= 991) Characteristics Total sample, n(%) Mean (SD) Age 41.1 (15.0) n(%) Gender Male 467 (47.12) Female 524 (52.88) Marital status Married, in relationships 618 (62.36) Single, widowed, divorced 373 (37.64) Education High and postgraduate 412 (41.57) Up to secondary 242 (24.42) Specialized secondary 337 (34.01) Current employment status Full-time 529 (53.38) Part-time 94 (9.49) Unemployed 80 (8.07) Other 288 (29.06) Area of residence Rural 400 (40.36) Urban 591 (59.64) Living with older people (65+) 162 (16.35) Perception of COVID-19 severity (mean, SD) 2.55 (0.87) COVID-19 self-report or diagnose 180 (18.16) Knowing someone with COVID-19 Knows someone who died of COVID-19 192 (19.37) Knows someone who had COVID-19 191 (19.27) Does not know anyone with COVID-19 608 (61.35) Physical activity decreased 197 (19.88) Alcohol consumption increased 38(3.83) Smoking increased 17 (1.72) Conflicts increased 73 (7.37) Financial status deteriorated 362 (36.53) Food insecurity 410 (41.37) Worked remotely from home 76 (7.67) Working conditions worsened 89 (8.98) Had problems with healthcare access 78 (7.87) Mental health symptoms (PHQ-4) Anxiety symptoms (GAD-2 ≥3) 83 (8.38) Depression symptoms (PHQ-2 ≥3) 119 (12.01) Moderate (6 ≤PHQ-4 < 9) 44 (4.84) Severe (PHQ-4 > 9) 19 (2.12) SD, standard deviation. 4 Gaukhar Mergenova et al. mood disorder than men (Pigott, 1999; Kuehner, 2003; Seedat et al., 2009). Some studies suggest that public health measures such as lockdown worsened the pre-existing issues of vulnerable groups, including women (Kola et al., 2021). This could also be explained by a number of different factors that we were unable to assess such as biological and social factors especially in countries with high levels of gender inequality (Urbaeva, 2019; Oginni et al., 2021; Turusbe- kova et al., 2022). A systematic review conducted on 32 studies from across the globe suggested high rates of domestic violence and abuse against women during the pandemic that may have led to psychi- atric distress (Kourti et al., 2023). In less extreme situations, women may experience an increased burden of household chores during lockdown due to traditional roles and imbalanced distribution of household responsibilities between women and men. Consistent with other studies, decreased physical activity was associated with increased depression and anxiety (Stanton et al., 2020;Violant-Holzetal.,2020;Zhangetal.,2020b). However, we cannot conclude the direction of these associations (Rebar et al., 2015; Lesser and Nienhuis, 2020; Meyer et al., 2020). In a cross-sectional study of 3,052 U.S. adults, individuals who decreased physical activity had stronger/higher depressive symptoms and stress compared to those who maintained adherence to physical activity. In another multi-country cross-sectional study of physical activity and mental health among adults during the initial phases of the COVID-19 pandemic, participants who reported decreases in exercise behavior had worse mental health compared to those who had an increase or no change in their exercise behavior (Faulkner et al., 2021). Those respondents who reported increased conflicts in family had higher odds of having symptoms of both depressionand anxiety. The study among young adults aimed to understand the role of family conflict in young adult well-being found that people from families experiencing higher than usual levels of family conflict experienced more anxiety (Wang et al., 2022). In a cross-sectional study con- ducted by Kuśnierz et al. (2022), it was suggested that work–family conflicts and family–work conflicts are related to the worsening of mental health, including high symptoms of stress, anxiety and depression, and decreased physical health and life satisfaction. We found that knowing someone with COVID-19 or who died from COVID-19 was associated with higher odds of reporting depressive symptoms. It is possible that those who have heard someone with severe COVID-19 infection symptoms with lethal outcomes can be more fearful of the infection and its severity. Moreover, the pandemic has changed the regular grieving process for the deceased due to the restrictions on funeral rituals and might have led to an increased anxiety and anger among the loved ones of the deceased. The fact that many deaths from COVID-19 during the pandemic occurred at the medical facilities in isolation may have worsened this situation due to the lost chance of saying farewells (Mortazavi et al., 2021). Both qualitative and quantitative literature on the subject are consistent on the psychological burden of death from COVID-19 on psychological well-being of the rela- tives and friends of the deceased (Das et al., 2021; Mayland et al., 2021; Mohammadi et al., 2021; Mortazavi et al., 2021; Aguiar et al., 2022; Hernández-Fernández and Meneses-Falcón, 2022). Living in a rural area was associated with higher odds of having depressive symptoms, which is in contrast to some other studies in China in which anxiety and depression were higher among urban residents (Zhang et al., 2021). Higher rates of depression and anxiety among rural residents have important implications, as rural areas generally tend to have poorer access to health services, par- ticularly for mental health (Fitzmaurice, 2021; Tulegenova et al., 2022). Moreover, the ancillary effects of efforts to contain the pandemic, including lockdown, closure of schools and reallocation of health resources can be especially long-lasting and devastating to poor and vulnerable people in countries with weak social protection systems and insufficient economic resources (Kola et al., 2021). Factors of economic vulnerability, like food insecurity, were associated with worsening of mental health and reporting symptoms of depression. A bidirectional association between food insecurity and mental health has been well described prior to the pandemic (Maynard et al., 2018). A global analysis of nationally representative surveys conducted in 149 countries found that food insecurity has a dose-response relationship with poor mental health status independ- ent of socioeconomic and demographic characteristics (Jones, 2017). Stress levels, a potential contributor to poor mental health, have been found to increase as food insecurity deteriorates (Rahman et al., 2021). Other studies have found that the number of households experiencing food insecurity has increased during the COVID-19 pandemic (Lim et al., 2022). Moreover, food-insecure subjects were more likely to have an abnormal mental health screen compared to food-secure subjects (Lim et al., 2022). Next, we found a strong association of impaired access to healthcare services with symptoms of depression and anxiety dur- ing the pandemic. Feeling anxious about COVID-19 or depressive feelings may serve as a barrier to reach the medical care needed, while canceled appointments and restricted access to healthcare can Figure 1. Population proportion with PHQ-4, PHQ-2, GAD-2 elevated scores. Cambridge Prisms: Global Mental Health 5 also deteriorate one’s mental well-being. Furthermore, some studies suggest that quarantine measures combined with restrictions in getting physical medical appointments may have exacerbated the existing mental health difficulties during the pandemic (Gillard, et al., 2021; Kola et al., 2021). Countries with fragile healthcare systems and scarce sources struggled the most to provide equal access to adequate medical interventions (De Sousa et al., 2020; Vigo et al., 2020). This can also be relatable to Kazakhstani health- care settings due to extreme shortages in healthcare capacity includ- ing personnel, equipment and medication supply during the pandemic (Haruna et al., 2022). Consequently, failed access to care needed may have added an extra burden and anxiety among the general public on top of the existing concerns over the fear of infection, financial and psychological difficulties. There is a scarcity of scientific literature on the impact of limited access to healthcare on one’s psychological health during the pan- demic in Kazakhstan. Nevertheless, the available sources suggest that Kazakhstan had a number of challenges prior to COVID-19 such as shortage in healthcare funding, high prevalence of chronic diseases, and limited access to medical care (Haruna et al., 2022). The Table 2. Bivariate and adjusted logistic regression estimates of odds ratios and 95% confidence intervals for association between depression and anxiety and studied variables Categorical variables Frequency Depression symptoms (PHQ-2 ≥3) Anxiety symptoms (GAD-2 ≥3) Bivariate unadjusted OR [95% CI] Multivariable adjusted OR [95% CI] Bivariate unadjusted OR [95% CI] Multivariable adjusted OR [95% CI] Age 41.1 (15.0) 1.00 (0.99, 1.01) 1.00 (0.98, 1.01) 1.00 (0.99, 1.02) 1.00 (0.99, 1.02) Gender Male 467 (47.1) ref ref ref ref Female 524 (52.9) 1.82 (1.22, 2.71)*** 1.64 (1.05, 2.55)*3.53 (2.06, 6.05)*** 3.43 (1.91, 6.15)*** Education Completed high or postgraduate degree 412 (41.6) ref ref ref ref Up to secondary 242 (24.4) 1.11 (0.70, 1.76) 1.22 (0.72, 2.07) 1.06 (0.60, 1.87) 1.07 (0.57, 2.03) Specialized secondary 337 (34.0) 0.71 (0.45, 1.13) 0.67 (0.41, 1.12) 1.01 (0.60, 1.70) 0.85 (0.48, 1.51) Current employment status Full-time 529 (53.4) ref ref ref ref Part-time 94 (9.5) 1.51 (0.82, 2.80) 1.32 (0.68, 2.59) 2.47 (1.27, 4.80)** 1.94 (0.93, 4.02) Unemployed 80 (8.1) 1.14 (0.56, 2.33) 1.19 (0.55, 2.58) 0.94 (0.36, 2.48) 0.95 (0.34, 2.66) Other 288 (29.1) 1.10 (0.71,1.72) 0.99 (0.60, 1.63) 1.58 (0.95, 2.64) 1.10 (0.62, 1.96) Area of residence Rural 400 (40.4) 1.42 (0.97, 2.08) 1.75 (1.14, 2.68)*1.27 (0.81, 2.00) 1.42 (0.86, 2.35) Urban 591 (59.6) ref ref ref ref Living with older people (65+) 162 (16.4) 1.51 (0.94, 2.43) 1.32 (0.79, 2.21) 1.71 (1.00, 2.92)*1.34 (0.74, 2.41) COVID-19 self-report or diagnose 180 (18.2) 1.89 (1.22, 2.94)*** 1.30(0.79, 2.15) 1.38 (0.80, 2.36) 1.04 (0.56, 1.94) Perception of COVID-19 severity (mean, SD) 2.55 (0.9) 1.46 (1.17, 1.81)*** 1.28 (1.00, 1.63)*1.61 (1.25, 2.07)*** 1.45 (1.09, 1.92)* Knowing someone with COVID-19 Does not know anyone with COVID-19 608 (61.4) ref ref ref ref Knows someone with COVID-19 191 (19.3) 1.99 (1.24, 3.20)*** 1.89 (1.12, 3.17)*1.26 (0.72, 2.20) 1.23 (0.66, 2.27) Knows someone who died from COVID-19 192 (19.4) 2.21 (1.39, 3.51)*** 1.85 (1.10, 3.14)*0.97 (0.53, 1.77) 0.69 (0.35, 1.37) Physical activity decreased 197 (19.9) 2.01 (1.31, 3.07)*** 1.48 (0.93, 2.36) 2.51 (1.56, 4.05)*** 2.11 (1.24, 3.57)** Alcohol consumption increased 38(3.8) 2.77 (1.31, 5.85)** 1.78 (0.75, 4.20) 2.13 (0.87, 5.26) 1.64 (0.60, 4.47) Smoking increased 17 (1.7) 3.14 (1.09, 9.09)*1.73 (0.50, 6.01) 2.40 (0.67, 8.51) 1.48 (0.32, 6.79) Conflicts increased 73 (7.4) 3.38 (1.95, 5.85)*** 2.43 (1.32, 4.48)*** 3.23 (1.74, 6.00)*** 2.22 (1.11, 4.44)* Financial status deteriorated 362 (36.5) 1.52 (1.03, 2.24)*0.98 (0.61, 1.59) 1.52 (0.97, 2.39) 1.0 (0.56, 1.76) Had food insecurity 410 (41.4) 2.24 (1.51, 3.30)*** 1.80 (1.11, 2.89)*1.96 (1.25, 3.09)*** 1.32 (0.75, 2.32) Healthcare access problems 78 (7.9) 2.84 (1.64, 4.91)*** 2.41 (1.32, 4.41)*** 3.26 (1.78, 5.96)*** 2.63 (1.36, 5.12)*** Working conditions worsened 89 (9.0) 1.42 (0.77, 2.60) 1.01 (0.50, 2.03) 2.03 (1.08, 3.84)*1.74 (0.82, 3.69) *p< 0.05; **p< 0.01; ***p< 0.005. 6 Gaukhar Mergenova et al. emergence of the pandemic compounded the existing issues leading to an acute shortage of essential medicines and lack of hospital beds. For example, data from 2016 indicate an availability of 4.8 beds/1,000 people and a healthcare workforce of about 252,000, among them 74,600 were medical doctors. However, this coverage varied greatly across rural (61 physicians per 10,000 population in urban areas compared to 15 physicians per 10,000 in remote areas) and urban residencies. Considering suchstatistics,many other countries with the similar income levels (e.g., Hungary, Poland, Turkey) outperformed Kazakhstan in terms of access to medical care prior to COVID-19. One source suggests that the depressed salary among the healthcare staff to be one of the driving reasons for having low numbers of medical personnel in the country (Kumenov, 2021). Furthermore, the attempt taken by the local government on paying extra salaries to the medical staff engaged in COVID-19 care had little impact on access to care. These matters should be addressed more in future studies due to their negative impact on health outcomes. Strengths and limitations The current study has several strengths and limitations. This is the first large-scale study that we are aware of that examined the population’s mental health and its association with other charac- teristics in Kazakhstan during the peak of the COVID-19 pan- demic. We used a multi-stage stratification sampling approach to increase the generalizability of findings. However, the likelihood of systematic selection bias influencing the accuracy of the estimations cannot be ruled out. We are unable to determine the effects of COVID-19 or other factors on mental health due to the study’s cross-sectional design, as longitudinal or experimental research is needed to investigate cause-effect relationships. However, our study enabled us to exam- ine how multi-level stressors and socioeconomic factors affected the mental health of a general population sample during the height of the COVID-19 pandemic, when COVID-19 cases were spread- ing rapidly in Kazakhstan and restrictive measures were being imposed in all regions of the country. While many studies sampled general populations during the early stages of the pandemic (March–April 2020), to our knowledge, our study is one of the few studies to investigate factors associated with depression and anxiety symptoms during the second wave of the pandemic caused by Delta variant in Kazakhstan. Conclusions We found a number of individual-, interpersonal- and structural- level factors associated with mental health symptoms among a sample of the general population in Kazakhstan during the second wave of COVID-19 pandemic. Our data suggests that individuals living in rural areas had disproportionately high levels of mental health symptoms. People living in rural areas can be especially vulnerable in times of crisis because of insufficient infrastructure and inadequate access to social services including health care. Strong associations found between economic vulnerability fac- tors and mental health symptoms are concerning, since those factors may persist as a result of the prolonged negative impact of the COVID-19 pandemic on the economy of Kazakhstan. Self-reported increased conflict in the home was associated with mental health symptoms, yet it is unclear whether conflict levels in the home have decreased since the height of the pandemic. Many factors that are associated with adverse mental health outcomes have existed before the pandemic, but pandemic may have exacerbated these factors increasing negative impacted mental health of people. Given that many adverse impacts of the COVID- 19 pandemic continue to persist (e.g., economic problems, pro- longed illness, shortages of healthcare workers in rural areas), our study supports the need for policy responses that are focused on mitigating of influence of these factors on mental health of the population of Kazakhstan. Further research is needed to determine the extent to which these factors and their associated mental health outcomes may persist. It is important to continue to monitor the mental health of populations longitudinally in order to prevent long-term unfavorable mental health outcomes. Special attention should be focused on healthcare access in rural areas at the times of crisis in the future. Social care protection, programs to support families disproportionately impacted by COVID-19 should be considered as important part of response policy at the time of crisis to minimize negative consequences on population health and well-being in Kazakhstan. Open peer review. To view the open peer review materials for this article, please visit http://doi.org/10.1017/gmh.2023.46. Data availability statement. According to ethics committee requirements and informed consent, data cannot be shared publicly. Data syntax will be shared upon request to the corresponding author. Acknowledgments. We would like to acknowledge the following persons and institutes who contributed to this study: the study participants for dedicating time to respond to the surveys, the Public Opinion Research Centre for collect- ing data and the Asfendiyarov Kazakh National Medical University and the New York State International Training and Research Program (D43 TW010046) for trainings in epidemiology and biostatistics of our research team members. We also appreciate the efforts of anonymous reviewers for providing constructive feedback to our manuscript in revision rounds enabling us to make the final publication form. Author contribution. G.M., A.M., A.B. and B.I. collaborated on drafting the manuscript. S.L.R., A.D. and G.M. contributed to revisions of manuscript drafts. G.M. contributed to data analysis and outlining the research objectives. B.Z. contributed to sampling design and data analysis. L.A., M.Y., K.K., G.A., Ai.I. and As.I. contributed substantially to the conception and design of the work. All authors had final approval of the version to be published and agreed to be accountable for all aspects of the work. Financial support. This research has been funded by the Science Committee of the Ministry of Science and Higher Education of the Republic of Kazakhstan (Grant Number AP09260497). Competing interest. The authors declare no conflicts of interest. Ethics statement. The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008. 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Despite a large number of studies, evidence on the development of mental health in general populations during the pandemic is inconclusive. One reason may be that representative data spanning the whole pandemic and allowing for comparisons to pre-pandemic data are scarce. Methods We analyzed representative data from telephone surveys of Germany's adults. Three mental health indicators were observed in ~1,000 and later up to 3,000 randomly sampled participants monthly until June 2022: symptoms of depression (observed since April 2019, PHQ-2), symptoms of anxiety (GAD-2), and self-rated mental health (latter two observed since March 2021). We produced time series graphs including estimated three-month moving means and proportions of positive screens (PHQ/GAD-2 score ≥ 3) and reports of very good/excellent mental health, as well as smoothing curves. We also compared time periods between years. Analyses were stratified by sex, age, and level of education. Results While mean depressive symptom scores declined from the first wave of the pandemic to summer 2020, they increased from October 2020 and remained consistently elevated throughout 2021 with another increase between 2021 and 2022. Correspondingly, the proportion of positive screens first decreased from 11.1% in spring/summer 2019 to 9.3% in the same period in 2020 and then rose to 13.1% in 2021 and to 16.9% in 2022. While depressive symptoms increased in all subgroups at different times, developments among women (earlier increase), the youngest (notable increase in 2021) and eldest adults, as well as the high level of education group (both latter groups: early, continuous increases) stand out. However, the social gradient in symptom levels between education groups remained unchanged. Symptoms of anxiety also increased while self-rated mental health decreased between 2021 and 2022. Conclusion Elevated symptom levels and reduced self-rated mental health at the end of our observation period in June 2022 call for further continuous mental health surveillance. Mental healthcare needs of the population should be monitored closely. Findings should serve to inform policymakers and clinicians of ongoing dynamics to guide health promotion, prevention, and care. View Show abstract Gender-related factors associated with delayed diagnosis of tuberculosis in Eastern Europe and Central Asia Article Full-text available * Nov 2022 * BMC PUBLIC HEALTH * Nonna Turusbekova * Cristina Celan * Liliana Caraulan * Nargis Saidova Tuberculosis (TB), a preventable and treatable disease, yearly affects millions of people and takes more than a million lives. Recognizing the symptoms and obtaining the correct diagnosis are vital steps towards treatment and cure. How timely a person with TB gets diagnosed may be influenced by biological differences between the sexes, and factors that are linked to the person’s gender, in the context of the prevailing gender norms. According to our hypothesis, gender-related factors contribute to delays in the diagnosis of TB. We investigated four countries (Georgia, Kazakhstan, Republic of Moldova, and Tajikistan) of Eastern Europe and Central Asia (EECA) - a region with a high burden of drug-resistant TB, scarcity of gender-related TB information, and varying gender equality. Retrospective information was collected directly from the people with a history of TB - through in-depth interviews and focus group discussions. We did not find differences between genders in the way participants recognized TB symptoms. In three countries women de-prioritized seeking diagnosis because of their lack of access to finances, and household-related obligations. In all four countries, men, traditionally carrying the weight of economically supporting the family, tended to postpone TB diagnosis. In two countries women experienced stigma more often than men, and it was a deterrent factor to seeking healthcare. The role of gender in obtaining the correct diagnosis came forth only among the respondents from Georgia and to some extent from Kazakhstan. We conclude that there are barriers to health care seeking and TB diagnosis that affect differently women, men and gender-diverse persons in EECA Region. View Show abstract Specifics of the Mental Component of the Quality of Life of Almaty Doctors in the Context of the COVID-19 Pandemic Article Full-text available * Oct 2022 * Vitaliy Kamkhen * Saltanat Mamyrbekova * Daniyarova Anara * Saule A. Nurmanova Introduction: Today, in the context of COVID-19 pandemic, as a result of their professional activities, Kazakhstani medical workers experience a significant burden, which can lead to a rapid depletion of their psychoemotional resources. The purpose of this paper was to study the characteristics of the psychological component of the quality of life of Almaty doctors of practical healthcare. Methods: The assessment of the psychological component of the quality of life was carried out using the standardised questionnaire SF-36 (Mental Component Summary). Data collection was carried out in September 2020 in Almaty, Republic of Kazakhstan, using the Google-Forms. The study involved 108 medical workers (65 women and 43 men) providing inpatient and outpatient care. To measure the reliability of factors that determine psychological health, the authors used the Spearman rank correlation analysis. Results: The Role-Emotional indicator correlates with the nationality of doctors (p = 0.005), and the presence of children in the family (p = 0.044). A statistically significant relationship between the Mental Health indicator and the living conditions of doctors was determined (p = 0.014). The relationship between Social Functioning and the nationality factor was revealed (p = 0.027). Vitality has a statistically significant relationship with the age of doctors (p = 0.043). Conclusion: The indicators of the psychological component of the quality of life of Almaty doctors depend (statistically) on such personal factors as: age, nationality, the presence of children in the family, and housing conditions. In the future, it is planned to conduct further assessment of the dynamics of the level of psychological health of medical workers and the factors determining it. View Show abstract Towards a post‐COVID world: Challenges and progress of recovery in Kazakhstan Article Full-text available * Sep 2022 * Usman Abubakar Haruna * Amos Abimbola * Dawa Gyeltshen * Antonio Sarría-Santamera Kazakhstan announced the first cases of COVID‐19 in March 2020. Within a span of a few months, the pandemic ravaged all regions affecting vulnerable populations due to limited access to healthcare services and co‐morbidities. To minimize the spread of the pandemic, the government announced the implementation of containment measures such as quarantine, movement restrictions, and lockdowns among others. The collateral effect of the pandemic has disrupted economic and learning activities pushing several people below the poverty line. The pandemic revealed the weakness of healthcare including the acute shortage of essential medicines and lack of hospital beds. This calls for stringent measures to revive the economy and mitigate the reeling effect of the pandemic. As a result, Kazakhstan commenced COVID‐19 vaccination efforts in February 2021. To date, about 47.8% are fully vaccinated pushing Kazakhstan closer to achieving herd immunity at the 60% threshold. However, the country faces challenges such as vaccine hesitancy and uncertainty surrounding vaccine effectiveness against new variants of SARS‐CoV2, among others. This paper aims to explore the health and socioeconomic challenges caused by COVID‐19 in Kazakhstan, control strategies, vaccination campaigns and progress towards herd immunity. This paper describes the COVID‐19 situation in Kazakhstan with special focus on the country's vaccination efforts against COVID‐19. It also explores the challenges and progress the country has made thus far in regard to COVID‐19 vaccination. View Show abstract Associations of Work-Family Conflict with Family-Specific, Work-Specific, and Well-Being-Related Variables in a Sample of Polish and Ukrainian Adults during the Second Wave of the COVID-19 Pandemic: A Cross-Sectional Study Article Full-text available * Sep 2022 * Int J Environ Res Publ Health * Cezary Kuśnierz * Aleksandra Rogowska * Karolina Chilicka-Hebel * Dominika Ochnik The conflict between work and family demands increased during the COVID-19 pandemic due to changes in lifestyle related to the lockdown. This study examines the associations between work-family conflict (WFC) and family-work conflict (FWC) with work-specific, family-specific, and well-being-related variables during the second wave of the COVID-19 pandemic. The results may be used in practice to improve the well-being of employees by adjusting home-based work and family areas of life to dynamic changes during the pandemic. The sample of 736 adults from Poland (53.26%) and Ukraine (46.74%), aged between 19 and 72 (M = 39.40; SD = 10.80), participated in the study. The cross-sectional study was performed using an online survey, including sociodemographic variables, measures of WFC, time pressure, remote work assessment (RWAS), physical health (GSRH), life satisfaction (SWLS), perceived stress (PSS-10), anxiety (GAD-7), and depression (PHQ-9). This study showed numerous inter-group differences in all variables across the country, gender, relationship status, parenthood, caring for children under 12, and remote working status. A high WFC is more likely among Polish workers (than Ukrainian workers), people with a low level of self-perceived time pressure, and high symptoms of stress. Caring for children under 12, low self-perceived time pressure, and high stress can predict FWC. Various paths lead from perceived stress via WFC and FWC, physical health, anxiety, and depression to life satisfaction, as suggested by the structural equation modeling analysis. Parents of children under 12 and women are the most vulnerable groups for increased WFC, FWC, and worse mental health and well-being. Prevention programs should focus on reducing stress, anxiety, and work demands in these adult populations. A unique contribution to the existing knowledge revealed patterns of associations between WFC and FWC in relation to well-being dimensions in a cross-cultural context during the pandemic. View Show abstract Food worry and mental health outcomes during the COVID-19 pandemic Article Full-text available * May 2022 * BMC PUBLIC HEALTH * Brenna B. Han * Eva Purkey * Colleen M Davison * Imaan Bayoumi Background There is limited and inconsistent literature examining the relationship between food worry and mental health in the context of the COVID-19 pandemic. This study examined the association between food worry and mental health among community dwelling Canadian adults during the COVID-19 pandemic. Methods Adults age 16 years and older completed an anonymous online questionnaire between April 1, 2020 and November 30 2020. Measures of pre-pandemic and current food worry, depression (PHQ-2), anxiety (GAD-2), and sociodemographic variables were included. Multivariable logistic regression models were used to determine the association between food worry and symptoms of depression and anxiety. Results In total, 1605 participants were included in analyses. Worry about affording food was reported by 320 (14.78%) participants. In models adjusting for sociodemographic covariates, compared with people without food worry, participants who had food worry were 2.07 times more likely to report anxiety symptoms (aOR 2.07, 95% CI: 1.43 – 2.98, p < .001) and were 1.9 times more likely to report depressive symptoms (aOR 1.89, 95% CI: 1.39–2.57, p < .0001). Lower income, lower education, and pre-existing mental health conditions were significant predictors of symptoms of depression. Female gender, younger age, lower education, lower income, and pre-existing mental health condition were significant predictors of anxiety symptoms. Conclusion Our study highlights the relationship between food worry and poor mental health. Policy supports such as improved income supports, clinical implications such as screening for food worry in primary care, referral to emergency food programs and support with meal planning may help mitigate mental health symptoms during the current pandemic, during future societal recovery from this pandemic and during future pandemics. View Show abstract Food Insecurity and Mental Health During the COVID-19 Pandemic in Cystic Fibrosis Households Conference Paper Full-text available * May 2022 * Meghan Elizabeth Mcgarry * J.T. Lim * Ngoc P. Ly * F. Neemuchwala View Psychological impact of the quarantine during the COVID-19 pandemic on the general European adult population: A systematic review of the evidence Article Full-text available * Apr 2022 * Maurizio Bonati * Rita Campi * Giulia Segre Aims: Due to the coronavirus disease 2019 (COVID-19) different countries implemented quarantine measures to limit the spread of the virus. Many studies analysed the mental health consequences of restrictive confinement, some of which focused their attention on specific populations. The general public's mental health also requires significant attention, however. This study aimed to evaluate the effects of the COVID-19 quarantine on the general population's mental health in different European countries. Risk and protective factors associated with the psychological symptoms were analysed. Methods: A systematic search was conducted on four electronic databases (PubMed, PsycINFO, Scopus and Google Scholar). Studies published up until 20th April 2021, and following eligibility criteria were selected for this review. One thousand three hundred thirty-five (1335) studies were screened, 105 of which were included. Via network analysis, the current study investigated the pathways that underlie possible risk factors for mental health outcomes. Results: Anxiety, depression, distress and post-traumatic symptoms are frequently experienced during the COVID-19 quarantine and are often associated with changes in sleeping and eating habits. Some socio-demographic and COVID-19-related variables were found to be risk factors for an individual's wellbeing. In particular, being female, young, having a low income, being unemployed and having COVID-19-like symptoms or chronic disorders, were found to be the most common risk factors for mental health symptoms. Conclusions: The COVID-19 pandemic represented an unprecedented threat to mental health globally. In order to prevent psychological morbidity and offer support tailored to short-, medium- and long-term negative outcomes, it is essential to identify the direct and indirect psychosocial effects of the lockdown and quarantine measures, especially in certain vulnerable groups. In addition to measures to reduce the curve of viral transmission, policy makers should urgently take into consideration provisions to alleviate hazards to mental health. View Show abstract A qualitative study on the impact of death during COVID-19: Thoughts and feelings of Portuguese bereaved adults Article Full-text available * Apr 2022 * PLOS ONE * Ana Aguiar * Marta Pinto * Raquel Duarte As a global threat, the COVID-19 pandemic has been an important factor in increasing death rate worldwide. As the virus spreads across international borders, it causes severe illness, death, and disruptions in our daily lives. Death and dying rituals and customs aid bereaved people in overcoming their grief. In this sense, the purpose of this study was to access thoughts and feelings of Portuguese adults and the impact of the loss in daily life during COVID-19. A structured online questionnaire was applied (snowball sampling) and qualitative data on death and mourning namely the impact of the loss in daily life, was collected. One hundred and sixty-six individuals have lost someone since the beginning of the pandemic and were included. Analysis was inspired by Braun and Clark’s content analysis. Most participants were female (66.9%), the median age was of 37.3 years, and 70.5% had a high education degree. Moreover, 30.7% of the participants present anxiety symptoms and 10.2% depression symptoms. The answers of studied participants gave insights on the extent of the loss in day-to-day life and four thematic themes were found: (1) The perceived inadequacy of the funeral rituality, (2) Sadness, fear and loneliness, (3) Changes in sleeping and concentration and increased levels of anxiety and (4) Concerns regarding the pandemic situation. We found a high prevalence of anxiety and depression symptoms in the study sample. Also, the changes in post mortem procedures, have shown to be of great importance in the mourning procedure of the participants. View Show abstract A socioemotional network perspective on momentary experiences of family conflict in young adults Preprint * May 2022 * Xinyi Wang * Amanda L. McGowan * Gregory Fosco * David M. Lydon-Staley Family conflict is a well-established predictor of well-being in youth. Traditional approaches focus on between-family differences in conflict. Daily fluctuations in conflict within families might also impact wellbeing, but more research is needed to understand how and why. Using 21 days of daily diary data and 6-times a day experience-sampling data (n=77 participants; mean age=21.18, SD=1.75; 63 women, 14 men), we captured day-to-day and within-day fluctuations in family conflict, anger, anxiety, and sadness. Using multilevel models, we find that days of higher than usual anger are also days of higher than usual family conflict. Examining associations between family conflict and emotions within days, we find that moments of higher than usual anger predict higher than usual family conflict later in the day. We observe substantial between-family heterogeneity in these patterns with implications for well-being; youth showing substantial interplay between family conflict and emotions across time had more perseverative family conflict and greater trait anxiety. Overall, findings indicate the importance of increases in youth anger for experiences of family conflict during young adulthood and demonstrate how intensive repeated measures coupled with network analytic approaches can capture long-theorized notions of circularly causal processes in daily family life. View Show abstract Show more RECOMMENDED PUBLICATIONS Discover more about: Pandemics Article Full-text available MACHINE LEARNING APPROACH TO CLASSIFY STUDENTS' MENTAL HEALTH DURING THE COVID-19 PANDEMIC: A WEB-BA... June 2023 · International Journal of Academic Research in Business and Social Sciences * Suraya Masrom * Nur Fatihah Jamaludin * Fadzilah Abdol Razak * Nor Rashidah Paujah Ismail View full-text Article INFLUENCE OF COVID-19 PANDEMIC ON MENTAL HEALTH OF UROLOGIC PATIENTS June 2021 · European Urology * Giovanni Cochetti * Michele Del Zingaro * Giuseppe Maiolino * [...] * Ettore Mearini Read more Article CORR INSIGHTS®: DID THE PHYSICAL AND MENTAL HEALTH OF ORTHOPAEDIC PATIENTS CHANGE AFTER THE ONSET OF... March 2023 · Clinical Orthopaedics and Related Research * Troy Amen Read more Article Full-text available IMPACT OF COVID-19 ON MENTAL HEALTH December 2022 · International Healthcare Research Journal * Manjinder Kaur * Navdeep Kaur Grewal A pandemic affects people and society and creates disruption, anxiety, tension, embarrassment, and xenophobia. Provincial lockdowns were necessary due to the SARS CoV2's rapid human-to-human transmission to stop the disease's further spread. However, it is undeniable that the restrictive restrictions have had an impact on people's social and emotional wellness in all circumstances. Children may ... [Show full abstract] experience stress, difficulty, social disengagement, and an unfavourable environment that may have short- or long-term effects on their mental health. Specialists, medical professionals, and paramedics working as a front-line force to combat the COVID-19 incident may be more susceptible to nurture psychological health indications. Knowing how the COVID-19 episode affected various populations' emotional health is almost as important as knowing its clinical highlights, transmission scenarios, and executives. Public awareness campaigns that concentrate on the maintenance of psychological wellbeing in the larger context are urgently needed. View full-text Last Updated: 01 Nov 2024 Interested in research on Pandemics? 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