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      Assessment of depression, anxiety and stress levels in the Ecuadorian general population during social isolation due to the COVID-19 outbreak: a cross-sectional study

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          Abstract

          Background

          Coronavirus disease 2019 (COVID-19) has become a global pandemic with serious consequences that have led to the implementation of unprecedented social isolation measures. At the early stages of the pandemic, Ecuador was one of the most affected countries in Latin America. The objective of this study was to assess the levels of depression, anxiety and stress in the Ecuadorian general population during the social isolation period due to COVID-19.

          Methods

          A web-based survey consisting of 31 short-answer and multiple-choice questions was administered to the general population from April 22–May 3, 2020. Mental health status was assessed through the Depression, Anxiety and Stress Scale-21 Items (DASS-21) questionnaire. Ordinal logistic analyses were used to identify potential risk factors associated with the severity of mental health issues.

          Results

          A total of 626 individuals were included. Most of them were females (60.5%), and their mean age was 29.6 ± 11.7 years. Approximately 17.7% of the respondents had moderate to very severe levels of depression, 30.7% had similar levels of anxiety, and 14.2% experienced stress. Female sex, younger age, student status, and having a relative diagnosed with COVID-19 were associated with significantly higher levels of depression, anxiety and stress. Ordinal regression models showed that being a student was a risk factor for having more severe levels of depression (OR = 3.67; 95% CI = 2.56–5.26, p: 0.0001), anxiety (OR= 1.86; 95% CI= 1.35–2.55, p: 0.0001), and stress (OR = 2.17; 95% CI= 1.47–3.19, p: 0.0001). Having a relative with COVID-19 was also found to be a risk factor only for depression (OR= 1.70; 95% CI= 1.03–2.80, p: 0.036) and anxiety (OR = 2.17; 95% CI= 1.35–3.47, p: 0.001). Additionally, male sex,  older age, and having more children were found to be protective factors for the three conditions.

          Conclusions

          Our findings suggest that social isolation due to the COVID-19 outbreak has impacted the mental health of the general population in Ecuador. We identified potential risk and protective factors that could serve as a foundation from which to develop psychological strategies to safeguard the mental health of our population during the current pandemic.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12888-021-03214-1.

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          Most cited references21

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          Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

          Summary Background A recent cluster of pneumonia cases in Wuhan, China, was caused by a novel betacoronavirus, the 2019 novel coronavirus (2019-nCoV). We report the epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of these patients. Methods All patients with suspected 2019-nCoV were admitted to a designated hospital in Wuhan. We prospectively collected and analysed data on patients with laboratory-confirmed 2019-nCoV infection by real-time RT-PCR and next-generation sequencing. Data were obtained with standardised data collection forms shared by WHO and the International Severe Acute Respiratory and Emerging Infection Consortium from electronic medical records. Researchers also directly communicated with patients or their families to ascertain epidemiological and symptom data. Outcomes were also compared between patients who had been admitted to the intensive care unit (ICU) and those who had not. Findings By Jan 2, 2020, 41 admitted hospital patients had been identified as having laboratory-confirmed 2019-nCoV infection. Most of the infected patients were men (30 [73%] of 41); less than half had underlying diseases (13 [32%]), including diabetes (eight [20%]), hypertension (six [15%]), and cardiovascular disease (six [15%]). Median age was 49·0 years (IQR 41·0–58·0). 27 (66%) of 41 patients had been exposed to Huanan seafood market. One family cluster was found. Common symptoms at onset of illness were fever (40 [98%] of 41 patients), cough (31 [76%]), and myalgia or fatigue (18 [44%]); less common symptoms were sputum production (11 [28%] of 39), headache (three [8%] of 38), haemoptysis (two [5%] of 39), and diarrhoea (one [3%] of 38). Dyspnoea developed in 22 (55%) of 40 patients (median time from illness onset to dyspnoea 8·0 days [IQR 5·0–13·0]). 26 (63%) of 41 patients had lymphopenia. All 41 patients had pneumonia with abnormal findings on chest CT. Complications included acute respiratory distress syndrome (12 [29%]), RNAaemia (six [15%]), acute cardiac injury (five [12%]) and secondary infection (four [10%]). 13 (32%) patients were admitted to an ICU and six (15%) died. Compared with non-ICU patients, ICU patients had higher plasma levels of IL2, IL7, IL10, GSCF, IP10, MCP1, MIP1A, and TNFα. Interpretation The 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality. Major gaps in our knowledge of the origin, epidemiology, duration of human transmission, and clinical spectrum of disease need fulfilment by future studies. Funding Ministry of Science and Technology, Chinese Academy of Medical Sciences, National Natural Science Foundation of China, and Beijing Municipal Science and Technology Commission.
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            Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China

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

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

                Contributors
                hmautong@gmail.com
                galvarado@uees.edu.ec
                coroman@uees.edu.ec
                ivancherrez@gmail.com
                Journal
                BMC Psychiatry
                BMC Psychiatry
                BMC Psychiatry
                BioMed Central (London )
                1471-244X
                28 April 2021
                28 April 2021
                2021
                : 21
                : 212
                Affiliations
                [1 ]GRID grid.442156.0, ISNI 0000 0000 9557 7590, School of Medicine, , Universidad de Especialidades Espíritu Santo, ; Samborondon, Ecuador
                [2 ]GRID grid.442156.0, ISNI 0000 0000 9557 7590, Laboratory of Omic Sciences, School of Medicine, , Universidad de Especialidades Espíritu Santo, ; Samborondón, Ecuador
                [3 ]Neurosciences Institute, Guayaquil, Ecuador
                [4 ]Respiralab, Respiralab Research Group, Guayaquil, Ecuador
                Article
                3214
                10.1186/s12888-021-03214-1
                8080088
                33910550
                9527de73-7865-4a46-b1c2-16868a30349f
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 8 January 2021
                : 13 April 2021
                Categories
                Research
                Custom metadata
                © The Author(s) 2021

                Clinical Psychology & Psychiatry
                coronavirus,covid-19,social isolation,depression,anxiety,stress,mental health

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