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Numerous studies have been conducted on the psychological effects of the COVID-19 pandemic. However, how the mental health of health workers will be affected among the number of peaks during the pandemic has not been evaluated yet. The study aims to investigate the effects of the first, second, and third peaks of COVID-19 on anxiety, depression, and stress symptoms in healthcare workers.The current study included 4031 healthcare workers, 1051 during the first peak period, 1409 during the second peak period, and 1571 during the third peak period. The Depression-anxiety-stress scale-21(DASS-21) was used to assess the participants' levels of anxiety, depression, and stress symptoms.The mean age of the participants was 33.74 ± 7.95, and 2634 (66.3 %) were female. 36.9 %(n = 1486) of the participants were physicians, 41.1 % (n = 1655) were nurses and 22.1 % (n = 890) were other healthcare workers. A statistically significant difference was documented in the DASS-21 anxiety (F(2:4028) = 502.893, p 2. Peak1. Peak), DASS-21 depression (F(2:4028) = 46.034, p 2. Peak1. Peak), DASS-21 stress (F(2:4028) = 65.548, p 1. Peak), and DASS-21 total scores (F(2:4028) = 156.860, p 2. Peak1. Peak) of healthcare workers during all three peak periods.Our findings show that as the peak number rises, so do the levels of anxiety and depression among healthcare workers. As a result, it is possible to assert that prolongation of the COVID-19 pandemic worsens mental problems (Tab. 2, Fig. 3, Ref. 35).

Metacognitions about the positive and negative effects of smoking have been associated with cigarette use and nicotine dependence. The aim of the present study was to validate the Turkish version of the Metacognitions about Smoking Questionnaire (MSQ; Nikcevic et al., 2015). The sample consisted of 859 self-declared smokers (452 female) aged between 18 and 68 years (mean = 28.3; SD = 7.9). Once the English to Turkish translation of the MDQ was completed, confirmatory factor analyses were conducted based on the four-factor structure of the original measure. Initially results suggested that this model was an inadequate fit of the data obtained. However, by allowing three pairs of items (within factor) to co-vary, a re-specified model was tested that was found to be a satisfactory fit of the data. Internal reliability and predictive validity of the translated scale were observed to be good. The Turkish version of the MSQ exhibited suitable psychometric properties. This study also showed that metacognitions about smoking predict nicotine dependence independently of demographic variables, length of cigarette use, negative affect, and smoking outcome expectancies.

BACKGROUND: Both positive smoking outcome expectancies and metacognitions about smoking have been found to be positively associated with cigarette use and nicotine dependence. The goal of this study was to test a model including nicotine dependence and number of daily cigarettes as dependent variables, anxiety and depression as independent variables, and smoking outcome expectancies and metacognitions about smoking as mediators between the independents and dependents. METHODS: The sample consisted of 524 self-declared smokers who scored 3 or above on the Fagerstrom Test for Nicotine Dependence (FTND: Uysal et al., 2004). RESULTS: Anxiety was not associated with either cigarette use or nicotine dependence but was positively associated with all mediators with the exception of stimulation state enhancement and social facilitation. Depression, on the other hand, was found to be positively associated with nicotine dependence (and very weakly to cigarette use) but was not associated with either smoking outcome expectancies or metacognitions about smoking. Only one smoking outcome expectancy (negative affect reduction) was found to be positively associated with nicotine dependence but not cigarette use. Furthermore one smoking outcome expectancy (negative social impression) was found to be positively associated with cigarette use (but not to nicotine dependence). All metacognitions about smoking were found to be positively associated with nicotine dependence. Moreover, negative metacognitions about uncontrollability were found to be positively associated with cigarette use. CONCLUSIONS: Metacognitions about smoking appear to be a stronger mediator than smoking outcome expectancies in the relationship between negative affect and cigarette use/nicotine dependence. The implications of these findings are discussed.