The examine examines inequalities in psychological misery attributable to the COVID-19 pandemic

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Researchers in Israel conducted a study examining the behavioral and psychological effects of the coronavirus disease 19 (COVID-19) pandemic to understand the biological and environmental factors that may affect how people deal with the crisis .

The study spanned a six-week period that spanned the end of the first outbreak and the start of the second outbreak in Israel, capturing a window of time during which people may have found ways to adapt to new circumstances.

An online survey of nearly 5,000 adult respondents found inequalities in the psychological distress associated with the pandemic. The researchers say this underscores the importance of understanding the differences in people's ability to deal with the long-term stressful challenges of COVID-19.

Alon Chen of the Weizmann Institute of Science in Rehovot and colleagues say such considerations could help guide future strategies and plans to deal with future waves of the pandemic.

A pre-print version of the paper is available on the medRxiv * server while the article is being peer-reviewed.

COVID-19 presents several psychological stressors

The COVID-19 pandemic presents unprecedented challenges that affect virtually all aspects of life and present several psychological stressors that could increase the risk of mental illness.

"The pandemic has resulted in the largest global recession since the Great Depression and extreme social isolation from changes in educational and work activities, local bans, and international travel restrictions," write Chen and the team.

The researchers say that studies examining the psychological distress caused by this pandemic and possible approaches to mitigating the adverse mental health consequences of vulnerable subgroups are urgently needed.

"To date, most of the work in this area has focused on the acute psychological effects of the COVID-19 pandemic, as measured during the outbreak," it said.

To shed light on the long-term mental health impact of the pandemic, the researchers collected data over the six-week period between the end of the first outbreak and the start of the second outbreak.

The data therefore reflect a period of time when people had the opportunity to adjust to and deal with the new circumstances, rather than people's initial reactions to the outbreak.

What did the study include?

Researchers conducted an online survey in Israel that asked adult participants about COVID-19-related physiological symptoms and behaviors, as well as the impact of the pandemic on their mental and emotional state. Participants also provided demographic and medical background information.

The team used clinically validated tools to assess emotional stress, symptoms, and coping strategies, as well as questions specifically designed to assess COVID-19-related concerns.

Within a period of six weeks between April 28 and June 9, 2020, the researchers received 12,125 responses from a total of 4,933 respondents.

"This six-week data collection gave us a comprehensive and dynamic overview of the period between the first and second outbreak," write Chen and colleagues.

What did the study find out?

Respondents mainly said they were concerned about the situation in their country and their loved ones who have contracted the virus.

"These non-self-centered concerns can reflect an increased sense of belonging to the country and community," suggest Chen and colleagues.

The team observed correlations between the temporal dynamics of five major distress levels and the number of new daily COVID-19 cases.

COVID-19 caused mostly non-self-centered concerns. (a-e) Blue lines represent the distribution of responses to specific reasons of concern among all respondents. Orange circles represent answer means. (f) Enlarged view of the response means shown in panels a-e. Note that all five SE areas are shorter than the circle diameter and have therefore been omitted from the illustration.

COVID-19 caused mostly non-self-centered concerns. (a-e) Blue lines represent the distribution of responses to specific reasons of concern among all respondents. Orange circles represent answer means. (f) Enlarged view of the response means shown in panels a-e. Note that all five SE areas are shorter than the circle diameter and have therefore been omitted from the illustration.

All of these levels gradually declined over the first few weeks of the study as the number of new daily COVID-19 cases decreased as well. Around May 26th, when the number of new daily cases began to rise, so did the values.

However, about a week later, these emergency levels began to decline, although the daily cases continued to rise.

The researchers say this likely reflects an adjustment or habituation to the new situation.

Factors associated with higher emotional stress

Higher emotional stress was associated with living in places of low socio-economic status and unemployment.

The team suggests that the level of community resources can affect an individual's ability to cope with life's challenges. Previous studies have shown that areas of low socioeconomic status characterized by fewer resources are more vulnerable in Israel.

People who had lost their jobs as a result of the pandemic reported similar emotional distress as people who were unemployed before the pandemic.

In addition, people who became unemployed as a result of COVID-19 reported using significantly more stress management strategies than respondents who either worked or were unemployed prior to the pandemic, possibly due to higher levels of stress among the unemployed.

Higher emotional stress was also associated with being female and having physiological symptoms.

Female respondents scored higher than men on the general scale for emotional distress. They also reported more stress-related symptoms and more coping skills.

In particular, women were more likely to report difficulty sleeping, increased heart rate, and increased appetite. They were also more likely to contact someone for assistance, exercise, or meditate.

"This could suggest that more coping methods are needed to alleviate greater feelings of emotional distress," the researchers write.

What does the team advise?

According to Chen and colleagues, the results underscore the importance of understanding the biological and environmental factors that can affect people's ability to meet the challenges of the COVID-19 pandemic.

"Such considerations should influence planning and policy for subsequent waves of the pandemic," they write.

"Given the dramatic increase in COVID-19 cases and the unprecedented socio-economic crisis that Israel and the rest of the world are experiencing, it is of great importance to further study the long-term health impact of the pandemic and mental health and its consequences" closes the team.

* Important NOTE

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be considered conclusive, guide clinical practice / health-related behavior, or treated as established information.