{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T04:03:59Z","timestamp":1762056239979,"version":"build-2065373602"},"reference-count":50,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2022,6,22]],"date-time":"2022-06-22T00:00:00Z","timestamp":1655856000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002428","name":"Austrian Science Fund (FWF)","doi-asserted-by":"publisher","award":["KLI 968-B"],"award-info":[{"award-number":["KLI 968-B"]}],"id":[{"id":"10.13039\/501100002428","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Throughout the COVID-19 pandemic, mental health of individuals with bipolar disorders (BD) is potentially more vulnerable, especially regarding COVID-19-related regulations and associated symptomatic changes. A multicentric online study was conducted in Austria, Germany, and Denmark during the COVID-19 pandemic. Overall, data from 494 participants were collected (203 individuals with BD, 291 healthy controls (HC)). Participants filled out questionnaires surveying emotional distress due to social distancing, fear of COVID-19, and the Brief Symptom Inventory-18 to assess symptom severity at four points of measurement between 2020 and 2021. General linear mixed models were calculated to determine the difference between the groups in these pandemic specific factors. Individuals with BD reported higher distress due to social distancing than HC, independently of measurement times. Fear of COVID-19 did not differ between groups; however, it was elevated in times of higher infection and mortality due to COVID-19. Individuals with BD reported higher psychiatric symptom severity than HC; however, symptom severity decreased throughout the measured time in the pandemic. Overall, individuals with BD experienced more distress due to the COVID-19 situation than HC. A supportive mental health system is thus recommended to ensure enhanced care, especially in times of strict COVID-19-related regulations.<\/jats:p>","DOI":"10.3390\/ijerph19137626","type":"journal-article","created":{"date-parts":[[2022,6,22]],"date-time":"2022-06-22T21:31:06Z","timestamp":1655933466000},"page":"7626","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Greater Emotional Distress Due to Social Distancing and Greater Symptom Severity during the COVID-19 Pandemic in Individuals with Bipolar Disorder: A Multicenter Study in Austria, Germany, and Denmark"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9645-4503","authenticated-orcid":false,"given":"Elena M. D.","family":"Sch\u00f6nthaler","sequence":"first","affiliation":[{"name":"Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7716-3674","authenticated-orcid":false,"given":"Nina","family":"Dalkner","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michaela","family":"Ratzenhofer","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0459-6553","authenticated-orcid":false,"given":"Eva","family":"Fleischmann","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7215-3848","authenticated-orcid":false,"given":"Frederike T.","family":"Fellendorf","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susanne A.","family":"Bengesser","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Armin","family":"Birner","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Maget","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melanie","family":"Lenger","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martina","family":"Platzer","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Queissner","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adelina","family":"Tmava-Berisha","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christina","family":"Berndt","sequence":"additional","affiliation":[{"name":"Department of Psychiatry & Psychotherapy, Faculty of Medicine, Carl Gustav Carus University Hospital, Technische Universit\u00e4t Dresden, 01307 Dresden, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julia","family":"Martini","sequence":"additional","affiliation":[{"name":"Department of Psychiatry & Psychotherapy, Faculty of Medicine, Carl Gustav Carus University Hospital, Technische Universit\u00e4t Dresden, 01307 Dresden, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Bauer","sequence":"additional","affiliation":[{"name":"Department of Psychiatry & Psychotherapy, Faculty of Medicine, Carl Gustav Carus University Hospital, Technische Universit\u00e4t Dresden, 01307 Dresden, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jon Dyg","family":"Sperling","sequence":"additional","affiliation":[{"name":"Psychiatric Research Unit, Psychiatric Centre North Zealand, 3400 Hiller\u00f8d, Denmark"},{"name":"Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maj","family":"Vinberg","sequence":"additional","affiliation":[{"name":"Psychiatric Research Unit, Psychiatric Centre North Zealand, 3400 Hiller\u00f8d, Denmark"},{"name":"Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5964-4087","authenticated-orcid":false,"given":"Eva Z.","family":"Reininghaus","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,6,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1111\/tmi.13383","article-title":"The COVID-19 epidemic","volume":"25","author":"Velavan","year":"2020","journal-title":"Trop. Med. Int. Health."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/intqhc\/mzaa065","article-title":"COVID-19 pandemic: A time for collaboration and a unified global health front","volume":"33","author":"Vervoort","year":"2021","journal-title":"Int. J. Qual. Health Care."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"285","DOI":"10.5114\/aoms.2020.95955","article-title":"\u201cCelebrating old age\u201d: An obsolete expression during the COVID-19 pandemic? Medical, social, psychological, and religious consequences of home isolation and loneliness among the elderly","volume":"17","author":"Burlacu","year":"2021","journal-title":"Arch. Med. Sci."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1016\/j.spc.2020.10.016","article-title":"Impact of COVID-19 on the social, economic, environmental and energy domains: Lessons learnt from a global pandemic","volume":"26","author":"Mofijur","year":"2021","journal-title":"Sustain. Prod. Consum."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"19926","DOI":"10.1007\/s11356-020-12070-7","article-title":"Socio-economic and environmental impacts of COVID-19 pandemic in Pakistan\u2014an integrated analysis","volume":"28","author":"Rasheed","year":"2021","journal-title":"Environ. Sci. Pollut Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"5005","DOI":"10.1007\/s10668-020-00801-2","article-title":"Global assessment of environment, health and economic impact of the novel coronavirus (COVID-19)","volume":"23","author":"Sarkodie","year":"2021","journal-title":"Environ. Dev. Sustain."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1002\/jclp.23082","article-title":"How the COVID-19 pandemic has changed our lives: A study of psychological correlates across 59 countries","volume":"77","author":"Alzueta","year":"2021","journal-title":"J. Clin. Psychol."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Knolle, F., Ronan, L., and Murray, G.K. (2021). The impact of the COVID-19 pandemic on mental health in the general population: A comparison between Germany and the UK. BMC Psychol., 9.","DOI":"10.1186\/s40359-021-00565-y"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"110236","DOI":"10.1016\/j.pnpbp.2020.110236","article-title":"Younger people are more vulnerable to stress, anxiety and depression during COVID-19 pandemic: A global cross-sectional survey","volume":"109","author":"Varma","year":"2021","journal-title":"Prog. Neuropsychopharmacol. Biol. Psychiatry"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/j.bbi.2020.04.069","article-title":"Do psychiatric patients experience more psychiatric symptoms during COVID-19 pandemic and lockdown? A case-control study with service and research implications for immunopsychiatry","volume":"87","author":"Hao","year":"2020","journal-title":"Brain Behav. Immun."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"581426","DOI":"10.3389\/fpsyt.2020.581426","article-title":"Worsening of Preexisting Psychiatric Conditions During the COVID-19 Pandemic","volume":"11","author":"Gobbi","year":"2020","journal-title":"Front. Psychiatry"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"892","DOI":"10.1002\/gps.5489","article-title":"Psychiatric symptoms during the COVID-19 outbreak in older adults with bipolar disorder","volume":"36","author":"Orhan","year":"2021","journal-title":"Int. J. Geriatr. Psychiatry"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1097\/YCO.0000000000000702","article-title":"Schizophrenia during the COVID-19 pandemic","volume":"34","author":"Barlati","year":"2021","journal-title":"Curr. Opin. Psychiatry"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1016\/j.euroneuro.2021.09.001","article-title":"Outcomes associated with different vaccines in individuals with bipolar disorder and impact on the current COVID-19 pandemic\u2014A systematic review","volume":"54","author":"Reininghaus","year":"2021","journal-title":"Eur. Neuropsychopharmacol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e69","DOI":"10.1016\/S2666-7568(20)30013-1","article-title":"Pre-pandemic psychiatric disorders and risk of COVID-19: A UK Biobank cohort analysis","volume":"1","author":"Yang","year":"2020","journal-title":"Lancet Healthy Longev."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1093\/qjmed\/hcaa202","article-title":"The impact of the COVID-19 pandemic on suicide rates","volume":"113","author":"Sher","year":"2020","journal-title":"QJM"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"634765","DOI":"10.3389\/fpsyt.2021.634765","article-title":"Living With Bipolar Disorder in the Time of COVID-19: Biorhythms During the Severe Lockdown in Cagliari, Italy, and the Moderate Lockdown in Tunis, Tunisia","volume":"12","author":"Carta","year":"2021","journal-title":"Front. Psychiatry"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3389\/fpsyt.2020.620612","article-title":"Impact of the COVID-19 Pandemic on Patients With Alcohol Use Disorder and Associated Risk Factors for Relapse","volume":"11","author":"Yazdi","year":"2020","journal-title":"Front. Psychiatry"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1561","DOI":"10.1016\/S0140-6736(15)00241-X","article-title":"Bipolar disorder","volume":"387","author":"Grande","year":"2016","journal-title":"Lancet"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/j.ejphar.2015.03.019","article-title":"Investigating the mechanism(s) underlying switching between states in bipolar disorder","volume":"759","author":"Young","year":"2015","journal-title":"Eur. J. Pharmacol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1016\/j.jad.2016.06.029","article-title":"Medically unexplained somatic symptoms and bipolar spectrum disorders: A systematic review and meta-analysis","volume":"204","author":"Edgcomb","year":"2016","journal-title":"J. Affect. Disord."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1161\/CIR.0000000000000229","article-title":"Major Depressive Disorder and Bipolar Disorder Predispose Youth to Accellerated Atherosclerosis and Early Cardiovascular Disease","volume":"132","author":"Goldstein","year":"2015","journal-title":"Circulation"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1016\/j.jpsychores.2015.02.010","article-title":"Metabolic syndrome in patients with bipolar disorder: Comparison with major depressive disorder and non-psychiatric controls","volume":"78","author":"Silarova","year":"2015","journal-title":"J. Psychosom. Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e13480","DOI":"10.1111\/jsr.13480","article-title":"Sleep and circadian rhythm characteristics in individuals from the general population duing the French COVID-19 full lockdown","volume":"31","author":"Bertrand","year":"2021","journal-title":"J. Sleep Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"740","DOI":"10.1016\/j.jad.2021.08.091","article-title":"Implications of the COVID-19 pandemic for people with bipolar disorders: A scoping review","volume":"295","author":"Fornaro","year":"2021","journal-title":"J. Affect. Disord."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1177\/0706743720957825","article-title":"Maintaining Daily Routines to Stabilize Mood: Theory, Data, and Potential Intervention for Circadian Consequences of COVID-19","volume":"66","author":"Murray","year":"2021","journal-title":"Can. J. Psychiatry"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.jad.2020.06.037","article-title":"Mental health status of individuals with a mood-disorder during the COVID-19 pandemic in Australia: Initial results from the COLLATE project","volume":"275","author":"Meyer","year":"2020","journal-title":"J. Affect. Disord."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/s40345-021-00222-8","article-title":"Psychological symptoms during and after Austrian first lockdown in individuals with bipolar disorder? A follow-up control-group investigation","volume":"9","author":"Dalkner","year":"2021","journal-title":"Int. J. Bipolar Disord."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1226","DOI":"10.1016\/j.jad.2021.01.028","article-title":"COVID-19 pandemic and lockdown impacts: A description in a longitudinal study of bipolar disorder","volume":"282","author":"Yocum","year":"2021","journal-title":"J. Affect. Disord."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e02182","DOI":"10.1002\/brb3.2182","article-title":"COVID-19-related fears and information frequency predict sleep behavior in bipolar disorder","volume":"11","author":"Fellendorf","year":"2021","journal-title":"Brain Behav."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e2326","DOI":"10.1002\/brb3.2326","article-title":"Effects of the COVID-19 pandemic in a preexisting longitudinal study of patients with recently diagnosed bipolar disorder: Indications for increases in manic symptoms","volume":"11","author":"Koenders","year":"2021","journal-title":"Brain Behav."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Tundo, A., Betro\u2019, S., and Necci, R. (2021). What Is the Impact of COVID-19 Pandemic on Patients with Pre-Existing Mood or Anxiety Disorder? An Observational Prospective Study. Medicina., 57.","DOI":"10.3390\/medicina57040304"},{"key":"ref_33","unstructured":"Wittchen, H.U., Zaudig, M., and Fydrich, T. (1997). Strukturiertes Klinisches Interview f\u00fcr DSM-IV Achse I und II [Structured Clinical Interview for DSM-IV Axis I and II]. Manual, Hogrefe."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"114451","DOI":"10.1016\/j.psychres.2022.114451","article-title":"Psychological and behavioral response on the COVID-19 pandemic in individuals with bipolar disorder: A multicenter study","volume":"310","author":"Dalkner","year":"2022","journal-title":"Psychiatry Res."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2139","DOI":"10.3389\/fpsyt.2021.759694","article-title":"Physical Health Profile and Associated Behavior During the COVID-19 Pandemic in Patients With Bipolar Disorder","volume":"12","author":"Sperling","year":"2021","journal-title":"Front Psychiatry"},{"key":"ref_36","unstructured":"Maruish, M.E. (2004). The SCL-90-R, the Brief Symptom Inventory (BSI), and the BSI-18. The Use of Psychological Testing for Treatment Planning and Outcomes Assessment: Instruments for Adults, Lawrence Erlbaum Associates Publishers. [3rd ed.]."},{"key":"ref_37","unstructured":"Maruish, M.E. (1999). The SCL-90-R, Brief Symptom Inventory, and Matching Clinical Rating Scales. The Use of Psychological Testing for Treatment Planning and Outcomes Assessment, Lawrence Erlbaum Associates Publishers. [2nd ed.]."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.1080\/10543400903242761","article-title":"Handling Missing Responses in Generalized Linear Mixed Model Without Specifying Missing Mechanism","volume":"19","author":"Zhang","year":"2009","journal-title":"J. Biopharm. Stat."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"110048","DOI":"10.1016\/j.pnpbp.2020.110048","article-title":"Volume of hippocampal subregions and clinical improvement following electroconvulsive therapy in patients with depression","volume":"104","author":"Gbyl","year":"2021","journal-title":"Prog. Neuropsychopharmacol. Biol. Psychiatry"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1007\/s00184-005-0001-3","article-title":"Strong consistency of the maximum likelihood estimator in generalized linear and nonlinear mixed-effects models","volume":"63","author":"Nie","year":"2006","journal-title":"Metrika"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1016\/j.jad.2016.08.057","article-title":"Does stress play a significant role in bipolar disorder? A meta-analysis","volume":"208","author":"Lex","year":"2017","journal-title":"J. Affect. Disord."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1016\/j.jad.2013.12.022","article-title":"Cognitive emotion regulation in euthymic bipolar disorder","volume":"160","author":"Wolkenstein","year":"2017","journal-title":"J. Affect. Disord."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1111\/j.1600-0447.2011.01718.x","article-title":"Cognitive regulation of emotion in bipolar I disorder and unaffected biological relatives","volume":"124","author":"Green","year":"2011","journal-title":"Acta Psychiatr Scand."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.psychres.2014.03.047","article-title":"Characteristics of stress-coping behaviors in patients with bipolar disorders","volume":"218","author":"Moon","year":"2014","journal-title":"Psychiatry Res."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1080\/09638237.2021.1875413","article-title":"Mental health, quality of life, wellbeing, loneliness and use of social media in a time of social distancing during the COVID-19 outbreatk. A cross-country comparative study","volume":"30","author":"Geirdal","year":"2021","journal-title":"J. Ment. Health"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1186\/s12992-021-00680-w","article-title":"Impact of the COVID-19 pandemic on psychological well-being of students in an Italian university: A web-based cross-sectional survey","volume":"17","author":"Villani","year":"2021","journal-title":"Glob. Health"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/j.jad.2003.10.008","article-title":"Effects of stress and social support on recurrence in bipolar disorder","volume":"82","author":"Cohen","year":"2004","journal-title":"J. Affect. Disord."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1034\/j.1399-5618.2003.00021.x","article-title":"Social support in bipolar disorder: Its relevance to remission and relapse","volume":"5","author":"Johnson","year":"2003","journal-title":"Bipolar Disord."},{"key":"ref_49","first-page":"20","article-title":"Managing Bipolar Disorder in Time of COVID-19 Pandemic","volume":"1","author":"Karrouri","year":"2020","journal-title":"J. Clin. Med."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1016\/j.jad.2020.12.186","article-title":"The mental health and lifestyle impacts of COVID-19 on bipolar disorder","volume":"282","author":"Karantonis","year":"2021","journal-title":"J. Affect. Disord."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/13\/7626\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:37:31Z","timestamp":1760139451000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/13\/7626"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,22]]},"references-count":50,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2022,7]]}},"alternative-id":["ijerph19137626"],"URL":"https:\/\/doi.org\/10.3390\/ijerph19137626","relation":{},"ISSN":["1660-4601"],"issn-type":[{"type":"electronic","value":"1660-4601"}],"subject":[],"published":{"date-parts":[[2022,6,22]]}}}