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      Häusliche Gewalt und ihre psychischen Folgen während der COVID-19-Pandemie – Zentrale Befunde aus dem deutschsprachigen Raum Translated title: Domestic violence and its psychological consequences during the COVID-19 pandemic—key findings from German-speaking countries

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          Abstract

          Die Auswirkungen traumatischer Erfahrungen auf die psychische Gesundheit während der COVID-19-Pandemie sind im deutschsprachigen Raum bisher unzureichend diskutiert worden. Vor diesem Hintergrund wurde im Auftrag der Deutschsprachigen Gesellschaft für Psychotraumatologie (DeGPT) eine Arbeitsgruppe aus wissenschaftlich und praktisch tätigen Fachkolleginnen und -kollegen gebildet. Ziel der Arbeitsgruppe war es, zentrale Forschungsbefunde zur Prävalenz von häuslicher Gewalt und damit einhergehende psychische Belastungen während der COVID-19-Pandemie im deutschsprachigen Raum zusammenzufassen und deren Implikationen zu diskutieren. Darüber hinaus sollten Zusammenhänge zwischen vorbestehenden Kindheitstraumata und psychischen Belastungen während der Pandemie beleuchtet werden. Hierzu wurde die vorliegende narrative Übersichtsarbeit erstellt.

          Die Ergebnisse der durchgeführten Studien weisen auf hohe Prävalenzen häuslicher Gewalt während der COVID-19-Pandemie hin, die jedoch überwiegend den Prävalenzen vor der Pandemie entsprechen. Erwachsene, die während der Pandemie oder bereits in ihrer Kindheit oder Jugend interpersonaler Gewalt ausgesetzt waren, wiesen während der Pandemie eine erhöhte psychische Belastung im Vergleich zu Erwachsenen ohne Gewalterfahrungen auf. Eine Reihe an Faktoren (z. B. weibliches Geschlecht, geringe Sozialkontakte) erhöhten das Risiko für psychische Belastung und Symptome einer posttraumatischen Belastungsstörung während der Pandemie. Nach diesen Ergebnissen stellen Menschen mit aktuellen, aber auch zurückliegenden Gewalterfahrungen eine vulnerable Gruppe dar, die während einer Pandemie besondere Unterstützungsbedarfe aufweist.

          Translated abstract

          The impact of traumatic experiences on mental health during the COVID-19 pandemic has been insufficiently discussed in the German-speaking countries. Against this background, a working group of scientifically and clinically active colleagues was formed on behalf of the German-Speaking Society for Psychotraumatology (DeGPT). The aim of the working group was to summarize central research findings on the incidence of domestic violence and associated psychological distress during the COVID-19 pandemic in German-speaking countries and to discuss their implications. In addition, associations between pre-existing childhood trauma and psychological distress during the pandemic should be illuminated. The present narrative review was prepared for this purpose.

          The results of the studies conducted indicate high prevalences of domestic violence during the COVID-19 pandemic, which, however, predominantly correspond to pre-pandemic prevalences. Adults with current or pre-existing interpersonal traumatic experiences during childhood or adolescence reported increased psychological distress during the pandemic compared with adults without such experiences. A number of risk factors (e.g., female gender, lower frequency of social contacts) increased the risk of psychological distress and posttraumatic stress disorder symptoms during the pandemic. According to these findings, people with current or past interpersonal trauma exposure represent a vulnerable group with special support needs during pandemic contexts.

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          Most cited references34

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          COVID-19: the gendered impacts of the outbreak

          Policies and public health efforts have not addressed the gendered impacts of disease outbreaks. 1 The response to coronavirus disease 2019 (COVID-19) appears no different. We are not aware of any gender analysis of the outbreak by global health institutions or governments in affected countries or in preparedness phases. Recognising the extent to which disease outbreaks affect women and men differently is a fundamental step to understanding the primary and secondary effects of a health emergency on different individuals and communities, and for creating effective, equitable policies and interventions. Although sex-disaggregated data for COVID-19 show equal numbers of cases between men and women so far, there seem to be sex differences in mortality and vulnerability to the disease. 2 Emerging evidence suggests that more men than women are dying, potentially due to sex-based immunological 3 or gendered differences, such as patterns and prevalence of smoking. 4 However, current sex-disaggregated data are incomplete, cautioning against early assumptions. Simultaneously, data from the State Council Information Office in China suggest that more than 90% of health-care workers in Hubei province are women, emphasising the gendered nature of the health workforce and the risk that predominantly female health workers incur. 5 The closure of schools to control COVID-19 transmission in China, Hong Kong, Italy, South Korea, and beyond might have a differential effect on women, who provide most of the informal care within families, with the consequence of limiting their work and economic opportunities. Travel restrictions cause financial challenges and uncertainty for mostly female foreign domestic workers, many of whom travel in southeast Asia between the Philippines, Indonesia, Hong Kong, and Singapore. 6 Consideration is further needed of the gendered implications of quarantine, such as whether women and men's different physical, cultural, security, and sanitary needs are recognised. Experience from past outbreaks shows the importance of incorporating a gender analysis into preparedness and response efforts to improve the effectiveness of health interventions and promote gender and health equity goals. During the 2014–16 west African outbreak of Ebola virus disease, gendered norms meant that women were more likely to be infected by the virus, given their predominant roles as caregivers within families and as front-line health-care workers. 7 Women were less likely than men to have power in decision making around the outbreak, and their needs were largely unmet. 8 For example, resources for reproductive and sexual health were diverted to the emergency response, contributing to a rise in maternal mortality in a region with one of the highest rates in the world. 9 During the Zika virus outbreak, differences in power between men and women meant that women did not have autonomy over their sexual and reproductive lives, 10 which was compounded by their inadequate access to health care and insufficient financial resources to travel to hospitals for check-ups for their children, despite women doing most of the community vector control activities. 11 Given their front-line interaction with communities, it is concerning that women have not been fully incorporated into global health security surveillance, detection, and prevention mechanisms. Women's socially prescribed care roles typically place them in a prime position to identify trends at the local level that might signal the start of an outbreak and thus improve global health security. Although women should not be further burdened, particularly considering much of their labour during health crises goes underpaid or unpaid, incorporating women's voices and knowledge could be empowering and improve outbreak preparedness and response. Despite the WHO Executive Board recognising the need to include women in decision making for outbreak preparedness and response, 12 there is inadequate women's representation in national and global COVID-19 policy spaces, such as in the White House Coronavirus Task Force. 13 © 2020 Miguel Medina/Contributor/Getty Images 2020 Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. If the response to disease outbreaks such as COVID-19 is to be effective and not reproduce or perpetuate gender and health inequities, it is important that gender norms, roles, and relations that influence women's and men's differential vulnerability to infection, exposure to pathogens, and treatment received, as well as how these may differ among different groups of women and men, are considered and addressed. We call on governments and global health institutions to consider the sex and gender effects of the COVID-19 outbreak, both direct and indirect, and conduct an analysis of the gendered impacts of the multiple outbreaks, incorporating the voices of women on the front line of the response to COVID-19 and of those most affected by the disease within preparedness and response policies or practices going forward.
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            COVID-19 Pandemic and Lockdown Measures Impact on Mental Health Among the General Population in Italy

            Background The psychological impact of the COronaVIrus Disease 2019 (COVID-19) outbreak and lockdown measures on the Italian population are unknown. The current study assesses rates of mental health outcomes in the Italian general population three to 4 weeks into lockdown measures and explores the impact of COVID-19 related potential risk factors. Methods A web-based survey spread throughout the internet between March 27th and April 6th 2020. Eighteen thousand one hundred forty-seven individuals completed the questionnaire, 79.6% women. Selected outcomes were post-traumatic stress symptoms (PTSS), depression, anxiety, insomnia, perceived stress, and adjustment disorder symptoms (ADS). Seemingly unrelated logistic regression analysis was performed to identify COVID-19 related risk factors. Results Endorsement rates for PTSS were 6,604 (37%), 3,084 (17.3%) for depression, 3,700 (20.8%) for anxiety, 1,301 (7.3%) for insomnia, 3,895 (21.8%) for high perceived stress and 4,092 (22.9%) for adjustment disorder. Being woman and younger age were associated with all of the selected outcomes. Quarantine was associated with PTSS, anxiety and ADS. Any recent COVID-related stressful life event was associated with all the selected outcomes. Discontinued working activity due to the COVID-19 was associated with all the selected outcomes, except for ADS; working more than usual was associated with PTSS, Perceived stress and ADS. Having a loved one deceased by COVID-19 was associated with PTSS, depression, perceived stress, and insomnia. Conclusion We found high rates of negative mental health outcomes in the Italian general population 3 weeks into the COVID-19 lockdown measures and different COVID-19 related risk factors. These findings warrant further monitoring on the Italian population’s mental health.
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              A systematic review and meta-analysis of longitudinal cohort studies comparing mental health before versus during the COVID-19 pandemic in 2020

              Background Increases in mental health problems have been observed during the COVID-19 pandemic. The objectives were to examine the extent to which mental health symptoms changed during the pandemic in 2020, whether changes were persistent or short lived, and if changes were symptom specific. Methods Systematic review and meta-analysis of longitudinal cohort studies examining changes in mental health among the same group of participants before vs. during the pandemic in 2020. Results Sixty-five studies were included. Compared to pre-pandemic outbreak, there was an overall increase in mental health symptoms observed during March-April 2020 (SMC = .102 [95% CI: .026 to .192]) that significantly declined over time and became non-significant (May-July SMC = .067 [95% CI: -.022 to .157]. Compared to measures of anxiety (SMC = 0.13, p  = 0.02) and general mental health (SMC = -.03, p  = 0.65), increases in depression and mood disorder symptoms tended to be larger and remained significantly elevated in May-July [0.20, 95% CI: .099 to .302]. In primary analyses increases were most pronounced among samples with physical health conditions and there was no evidence of any change in symptoms among samples with a pre-existing mental health condition. Limitations There was a high degree of unexplained heterogeneity observed (I 2 s > 90%), indicating that change in mental health was highly variable across samples. Conclusions There was a small increase in mental health symptoms soon after the outbreak of the COVID-19 pandemic that decreased and was comparable to pre-pandemic levels by mid-2020 among most population sub-groups and symptom types.
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                Author and article information

                Contributors
                A.Lotzin@uke.de
                Journal
                Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz
                Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz
                Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                1436-9990
                1437-1588
                10 July 2023
                10 July 2023
                2023
                : 66
                : 8
                : 920-929
                Affiliations
                [1 ]GRID grid.13648.38, ISNI 0000 0001 2180 3484, Klinik und Poliklinik für Psychiatrie und Psychotherapie, , Universitätsklinikum Hamburg Eppendorf, ; Martinistr. 52, 20246 Hamburg, Deutschland
                [2 ]GRID grid.461732.5, Institute for Clinical Psychology and Psychotherapy (ICPP), Department Psychologie, , MSH Medical School Hamburg, ; Hamburg, Deutschland
                [3 ]GRID grid.5252.0, ISNI 0000 0004 1936 973X, Lehrstuhl für Klinische Psychologie und Psychotherapie, , Ludwig-Maximilians-Universität München, ; München, Deutschland
                [4 ]GRID grid.4488.0, ISNI 0000 0001 2111 7257, Institut und Poliklinik für Arbeits- und Sozialmedizin, Medizinische Fakultät, , Technische Universität Dresden, ; Dresden, Deutschland
                [5 ]GRID grid.5253.1, ISNI 0000 0001 0328 4908, Institut für Psychosoziale Prävention, Zentrum für Psychosoziale Medizin, , Universitätsklinikum Heidelberg, ; Heidelberg, Deutschland
                [6 ]GRID grid.413047.5, ISNI 0000 0001 0658 7859, Fachbereich Sozialwesen, Ernst-Abbe-Hochschule Jena, , University of Applied Sciences, ; Jena, Deutschland
                [7 ]GRID grid.413047.5, ISNI 0000 0001 0658 7859, Department of Welfare, Ernst-Abbe-Hochschule Jena, , University of Applied Sciences, ; Jena, Deutschland
                [8 ]GRID grid.9463.8, ISNI 0000 0001 0197 8922, Abteilung Klinische Psychologie und Psychotherapie, , Universität Hildesheim, ; Hildesheim, Deutschland
                [9 ]SANU HEALTH, Erlangen, Deutschland
                [10 ]GRID grid.5253.1, ISNI 0000 0001 0328 4908, Klinik für Allgemeine Psychiatrie, Zentrum für Psychosoziale Medizin, , Universitätsklinikum Heidelberg, ; Heidelberg, Deutschland
                [11 ]GRID grid.466457.2, ISNI 0000 0004 1794 7698, Fakultät Naturwissenschaften, , MSB Medical School Hamburg, ; Berlin, Deutschland
                [12 ]GRID grid.10420.37, ISNI 0000 0001 2286 1424, Institut für Klinische und Gesundheitspsychologie, Fakultät für Psychologie, , Universität Wien, ; Wien, Österreich
                Article
                3747
                10.1007/s00103-023-03747-8
                10371903
                37428206
                54ae9d09-8698-4a80-94ff-f72b265a1dce
                © The Author(s) 2023, korrigierte Publikation 2023

                Open Access Dieser Artikel wird unter der Creative Commons Namensnennung 4.0 International Lizenz veröffentlicht, welche die Nutzung, Vervielfältigung, Bearbeitung, Verbreitung und Wiedergabe in jeglichem Medium und Format erlaubt, sofern Sie den/die ursprünglichen Autor(en) und die Quelle ordnungsgemäß nennen, einen Link zur Creative Commons Lizenz beifügen und angeben, ob Änderungen vorgenommen wurden.

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                History
                : 22 March 2023
                : 29 June 2023
                Funding
                Funded by: Universitätsklinikum Hamburg-Eppendorf (UKE) (5411)
                Categories
                Leitthema
                Custom metadata
                © Robert Koch-Institut 2023

                gewalt,trauma,posttraumatische belastungsstörung,covid-19-pandemie,prävalenz,risikofaktoren,violence,post-traumatic stress disorder,covid-19 pandemic,prevalence,risk factors

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