IMPACT OF SOCIAL MEDIA DISINFORMATION AND OF FAKE NEWS OVEREXPOSURE ON THE ACTUAL CAPACITIES AND THE PSYCHOLOGICAL WELLBEING DURING THE COVID-19 PANDEMIC: A SYSTEMIC LITERATURE REVIEW

Massive spread of misinformation over social media during the COVID-19 pandemic has negatively impacted the mental health of populations. Social media are among the cheapest and most quickly accessible information sources for a large section of the public, in search of news that is reliable, true, precise and based on conscientious editing. From a Positive Transcultural Psychotherapy (PPT) viewpoint, these secondary capacities – reliability, honesty, precision and conscientiousness – are among other psychosocial norms that sustain psychological well-being, including primary capacities such as time, trust, hope, security and doubt. Also, from a PPT perspective, the energy and time spent by a person in online spaces and activities affects the well-being in the four life dimensions, while those primary capacities (and emotional needs) remain at the basis of emotional well-being. The research employed the systematic review of literature in several open-access scholarly websites from February 2020 to March 2022. The paper reviews the existing research on how disinformation and excess time in fake news spread over social media has the potential to corrode the abovementioned actual capacities, trigger negative emotions, mislead the public in undertaking wrong decisions for their health and well-being


Introduction
Truthfulness or honesty, and trustworthiness or reliability, as synonymous actual secondary capacities, together with trust, hope, doubt and certitude as actual primary capacities, are among key psychosocial norms that are prerequisites of mental health and a balanced well-being (Peseschkian, 1987).Peseschkian continues explaining that the secondary and primary capacities function as both "weapon" and "shield".These functions depend on their improper or proper use in relationship and interaction with the social milieu -the social environment where people interact and deliberate.They may trigger fear, insecurity, sadness, anger, hopelessness, and powerlessness in the short term, and anxiety disorders and depression in the long term, including psychosomatic reactions and disorders (Peseschkian, 2013).Currently, in the internet age, the social milieu also finds significant expression in the social media and on-line networks.
Unfortunately, in addition to being a space for information and connection, social media has served as a terrain for the spreading of both smallscale and large-scale campaigns of fake and deceptive news, including gossip, misinformation, disinformation and even conspiracy theories since the onset of the SARS-COV-2 and the resulting COVID-19 pandemic.According to Pozios, "fake or misleading news is intended to manipulate public opinion; it is formulated to provoke an emotional response from a reader or viewer; is often provocative in nature and can cause feelings of anger, doubt, anxiety and even depression by distorting our thinking" (Erdelyi, 2020).The amount of information and its quality being absorbed during individual online searching, often with insufficient checking of alternative and more reliable, truthful and precise news distributed by conscientious public or private news media, constituted, and still constitutes, a significant portion of the time and energy spent in the lifedimensions of future (fantasy, meaning) and contact (social relations), as people try to make sense of what is happening in the world, what future predicts, and what potential hazards are laying there.
In a study conducted during the 2019 earthquakes that affected western Albania, and related to fake news and disinformation in the country, where online media were monitored between January and November 2019, some 132 fake news were deemed as problematic (IDMC, 2019).Since quarantine measures were adopted by the Albanian Government in mid-March 2020, considerable fake news, pictures and videos circulated in the networks, by being widely spread on the social media.They contained information on how to heal oneself from the virus infection with home ingredients only, such as garlic, schnapps, paracetamol (Hasanaliaj, 2020).This type and other types of disinformation have led to confusion and insecurity, and even distrust in medical expertise and advice.
The paper looks at how navigation over social media has negatively impacted the mental health and psychological well-being of consumers of fake and deceptive news, disinformation and conspiracy theories in many countries.Different studies covering countries and regions were considered for links or correlations between misinformation, emotional and mental states provoked by such news over social media, and the effects on the general psychological well-being.

Methodology
Systematic review of literature was adopted, realized on the open-access databases, including ScienceDirect, PubMed and Google Scholar, from January 2020 through February 2022.To avoid any misunderstandings and prejudices, the study followed the structure based on the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2021).

Research strategy
The study followed several steps by identifying articles with the following search items: "panic and mental health", "social media and fake news", "disinformation and psychological distress", "COVID-19 and stress", "conspiracy theories and depression", and "SARS-CoV-2 and anxiety".

Results
13 research articles were included, based on most appropriate selective criteria.The search strategy flowchart is demonstrated in Figure 1:

Study features
In the selected scientific articles, seven of them used inter-sectional methods, three applied quantitative methods, and two employed the systematic literature review.The total number of the champion is around 1,7 million participants, aged ≥10 and spread over 45 countries.Also, three study reports spread over 35 countries with more than 2520 participants over 18 years old and eight media articles were included.The data from the original research articles are summarized in Table 1.

The spread of COVID-19-related disinformation and conspiracy theories over social media
During the COVID-19 pandemic, Albanian government services were transferred to government online portals, and educational institutions began to use digital platforms.According to an Albania study report, about 81% of households reported having a smartphone, and confirmed that 82% of Albanian households had internet access (World Vision Albania, 2020).In Albania, the average monthly consumption per active user of mobile internet services in 2020, increased by 12.4%, compared to the fourth quarter of 2019, and during the first quarter of 2021, the amount of internet traffic increased by 15.5% compared to the fourth quarter of 2020.A study conducted during the earthquake period for fake news and misinformation in Albania by the Institute for Democracy, Media and Culture (2019), where the online media were monitored, in the period from January 2019 to November 2019, have identified 132 fake news items considered problematic.According to data analyzed by BIRN through "Crowdtangle", an application on Facebook, a public activist who opposes vaccination and spreads conspiracy theories has appeared in more than 700 news or videos posted on Facebook by Albanian media on the topic of "COVID-19 vaccines".The videos have generated more than 2.95 million views and the posts more than 85 thousand interactions on the most popular social network in the country (Likmeta, 2021).The Media Literacy Index (2021), which addresses issues of media education, vulnerability to fake news and misinformation, ranks Albania 33rd with 22 points, Bosnia and Herzegovina 34th with 19 points and Northern Macedonia 35th with 15 points.Analysis of a sample of 38 million Englishlanguage media reports, through Cision's Next Generation Communications Cloud (2020) platform, from 1 January to 25 May 2020, shows that over 1.1 million individual articles were disinformation about COVID-19.NewsGuard Technologies (2022), an American company that checks news sites and their authenticity, has focused in particular on information circulating on COVID-19 and vaccination during the pandemic.The network has identified 547 websites that published disinformation about COVID-19 in countries such as the United States of America, United Kingdom, Canada, France, Germany and Italy.A cross-sectional survey conducted with 3621 students in Slovenia (2022) showed that, although the level of digital health education among students is sufficient, assessing the reliability of information remains problematic for half of the study participants.(Vrdelja et al., 2022).In a 2021 survey, about 80% e the Balkan's population believed in conspiracy theories.Nearly 59.4% of Albania's residents and 41.5% of Serbian residents believed in conspiracy theories (Çela, 2021).

Psychological effects of social media during the COVID-19 pandemic
An online survey distributed between June-July 2020 through various social media platforms in the United Arab Emirates and other Arabic-speaking countries, concluded that 49% of the participants reported poor well-being.Low trust in information about COVID-19, long stay on social networks and poor knowledge in general, were associated with deterioration of psychological well-being (Elbarazi, et al., 2022).According to a study conducted at the University of California, people with a previous severe mental and physical condition, after exposure to daily news related to COVID-19, were more likely to exhibit acute stress and depressive symptoms (Holman et al., 2020).Moreover, crosssectional data collected from the University of Illinois, Chicago, found positive correlations between exposure to COVID-19 news and depressive symptoms in 34% of participants (Olagoke et al 2020).Based on a systematic review of the literature which reviewed 14 studies, the results showed that 36% of authors reported that exposure to disinformation on social media generates fear, panic, depression and stress (Rocha, et al., 2021).A study in China, revealed that the prevalence of depression and anxiety increased due to frequent follow-up to social media (Gao et al., 2020).Similar findings were reflected in another Chinese study, which revealed that overexposure to pandemic-related media was a predictor of acute stress (He et al., 2020).TikTok's popularity grew rapidly at the onset of COVID-19 pandemic, rising up to 180% among users aged 15-25 by 2020.During this time period, the Kaiser Foundation reported an increase in mental health concerns: approximately four in 10 adults in the United States reported symptoms of anxiety or depressive disorder (Wood, 2021).In a study reporting on health workers in Egypt and Saudi Arabia, a link was found between exposure to news about COVID-19, for at least two hours a day, and symptoms of depression, anxiety, stress, and sleep disturbances (Arafa et al., 2021).According to an online survey conducted in Iraqi Kurdistan, 75.7% of participants reported that social media has an impact on spreading fear, anxiety and panic during the outbreak of the COVID-19 pandemic.A study conducted with students at the University of Shanghai, concluded that the part that used the most social media during the COVID-19 pandemic, had the highest presence of anxiety symptoms (Jiang, 2021).According to a systematic analysis based on 13 studies, the findings revealed that disinformation and low trust in information about coronavirus published on social media, affects the worsening of mental health (Strasser et al., 2022).An international survey conducted with 10,063 participants over the age of 18 in six Asian jurisdictions, found that perceived information overload on social media tended to increase psychological concerns and people with higher economic status were more vulnerable to problems of mental health (Chen, 2022).A descriptive and cross-sectional study conducted in Paraguay with 1102 participants surveyed aged 18-84, concluded that people who stayed long while navigating around the COVID-19 news were 93.3% more likely to develop depressive symptoms (Torales et al., 2022).

Conclusions
The use of social media during the COVID-19 pandemic increased significantly, especially in the adult age group.The Balkan region, including Albania, ranks among the lowest levels of media education and is vulnerable to false news and misinformation.Research findings indicated that prolonged exposure to fake news over social media has effects on the onset of psychological symptoms and disorders, such as depression, anxiety, stress, fear and insomnia.The data adopted in this paper indicate that the large amount of unchecked and unprofessional information in the form of disinformation, fake news and conspiracy theories has created panic and negatively affected the psychological well-being, especially of vulnerable groups among the populations.In Albania there are no genuine studies on the impact of social media and especially misinformation on mental health, but according to statements and media reports, the large amount of information with false news, misinformation and misunderstandings has affected the psychological well-being of the population.Although several studies have been conducted on the effects of disinformation on mental health, the number of researches is still limited both in time and geography.Globally, the cited studies mainly focus on the age group over 18 years and the two-year time segment.The findings of the cited research indicate that fake news, disinformation and conspiracy theories, being spread over the social media and networks, during the COVID-19 pandemic, have negatively impacted the psychological well-being of populations, by directly affecting in a harmful way the lifedimension of future, fantasy and meaning, as more fear of the present and future, resulting in anxiety and panic, as well as more psychological distress and depression.From a Positive Transcultural Psychotherapy perspective, the effects were harmful because the expectations of the public that the social media display the secondary capacitiessocial norms -of truthfulness, honesty, reliability, precision and conscientiousness, were not generally met.If they had been met, they would have strengthened the individual emotional domain, by "shielding" the primary capacities of security, safety, trust and hope.The latter are prerequisites to good mental health and a balanced well-being.Instead, misinformation over social media has led to their inadequate differentiation, and thus, caused them to become conflict potentials.Furthermore, based on the research cited, there is still no conclusive and longitudinal explanation for the long-term negative effects of social media during epidemics and pandemics.Finally, it is suggested that individuals take a more balanced approach when navigating social media, by consulting with multiple sources of information, diverse media platforms, and enlarging their contact in the life-dimension of relationships, as activities and areas of expanded and reliable information, in order to promote better mental health.It is necessary for the competent bodies to develop strategies on how information related to health should be reliable, available, understandable and accessible especially for vulnerable social groups.Governments and social media management should exercise more conscientiousness, as well as greater oversight and a moderating role in social media content, in order to ensure that true, reliable, and precise information is accessible both on-line and off-line.

Figure 1 .
Figure 1.Search strategy flowchart for eligibility (n= 361) Original articles excluded: Do not meet the scientific criteria (n = 1051) Incomplete text (n = 560) There is no analysis between infodemia and negative effects on mental health (n = 5633) Out of context the term "Infodemic" is simply quoted (n = 220) Records identified from: PubMed (n=37) PsycINFO n= (6) Google Scholar (n=8310) Records after duplicates removed (n =8221) Records screened Records excluded (n= 7850)