Risk perception as a motivational resource during the COVID-19 pandemic: the role of vaccination status and emerging variants.

BACKGROUND: People's perceived risk of being infected and having severe illness was conceived as a motivational source of adherence to behavioral measures during the COVID-19 crisis. METHODS: We used online self-reported data, spanning 20 months of the COVID-19 crisis in Belgium (n = 221,791; 34.4% vaccinated; July 2020 - March 2022) to study the association between risk perception and motivation. RESULTS: Both perceived infection probability and severity fluctuated across time as a function of the characteristics of emerging variants, with unvaccinated persons perceiving decreasingly less risk compared to vaccinated ones. Perceived severity (and not perceived probability) was the most critical predictor of autonomous motivation for adherence to health-protective measures, a pattern observed at both the between-day and between-person level among both vaccinated and unvaccinated individuals. An integrated process model further indicated that on days with higher hospitalization load, participants reported being more adherent because risk severity and autonomous motivation for adherence were more elevated on these days. CONCLUSIONS: These findings suggest that risk severity served as a critical and dynamic resource for adherence to behavioral measures because it fostered greater autonomous regulation.

Do cancer centres and palliative care wards routinely measure patients' quality of life? An international cross-sectional survey study.

PURPOSE: Routinely assessing quality of life (QoL) of patients with cancer is crucial for improving patient-centred cancer care. However, little is known about whether or how cancer centres assess QoL for clinical practice or for research purposes. Therefore, our study aimed to investigate if QoL data is collected and if so, how and for what purposes. METHOD: We conducted a cross-sectional survey study among 32 cancer centres in Europe and Canada. Centre representatives identified persons who they judged to have sufficient insight into QoL data collections in their wards to complete the survey. Descriptive statistics were used to summarise the information on QoL assessment and documentation. RESULTS: There were 20 (62.5%) responding cancer centres. In total, 30 questionnaires were completed, of which 13 were completed for cancer wards and 17 for palliative care wards. We found that 23.1% and 38.5% of the cancer wards routinely assessed QoL among inpatients and outpatients with cancer, respectively, whereas, in palliative care wards, 52.9% assessed QoL for outpatients with cancer and 70.6% for the inpatients. Wide variabilities were observed between the cancer centres in how, how often, when and which instruments they used to assess QoL. CONCLUSION: A sizable proportion of the cancer wards, especially, and palliative care wards apparently does not routinely assess patients' QoL, and we found wide variabilities between the cancer centres in how they do it. To promote routine assessment of patients' QoL, we proposed several actions, such as addressing barriers to implementing patient-reported outcome measures through innovative e-health platforms.

The Vulnerability of Older Informal Caregivers with Care Needs: Significance of Multidimensional Frailty.

OBJECTIVES: To improve our understanding of older informal caregivers' (ICs) health, this paper aimed to compare multidimensional frailty and sociodemographic and economic characteristics between (subgroups of) older ICs and non-caregivers. METHODS: Using data originating from the Belgian Ageing studies (n = 6054), intergroup differences between older ICs and non-caregivers and between care-dependent and -independent older ICs/non-caregivers were conducted. In addition binary logistic regressions were carried out to determine which variables were related to caregiver status and need of assistance. RESULTS: Among all respondents, 14.3% were ICs reporting care needs themselves. Informal and non-caregivers with care needs, relative to those without, more often only (partially) completed primary education, were significantly older, more likely to be female and widowed, found it more difficult to make ends meet, and reported higher levels of frailty in each domain. Moreover, environmental and psychological frailty were associated with an increase in the likelihood of reporting need of assistance among older non-caregivers and ICs, respectively. CONCLUSIONS: This study revealed a particular vulnerable subpopulation of older ICs with care needs. CLINICAL IMPLICATIONS: It is essential for clinicians to be observant for unrecognized frailty and care needs in older ICs and to develop targeted intervention and prevention strategies.

What too strict a method obscures about the validity of outcome measures.

Objective: To assess the outcome of psychotherapeutic treatments, psychotherapy researchers often compare pre- and post-treatment scores on self-report outcome measures. In this paper, the common assumption is challenged that pre-to-post decreasing and increasing outcome scores are indicative of successful and failed therapies, respectively.Method: The outcome of 29 psychotherapeutic treatments was evaluated by means of quantitative analysis of pre- and post-treatment scores on commonly used outcome measures (such as the Symptom Checklist-90-R, the Inventory of Interpersonal Problems, and the General Health Questionnaire-12), as well as through consensual qualitative research.Results: Overall, a moderate to low convergence between qualitative and quantitative evaluations of outcome was observed. Detailed analyses of six cases are presented in which pre-to-post comparisons of outcome measures proved misleading.Conclusions: It is concluded that psychotherapy outcome research might benefit from assessment strategies that are sensitive to the singularities of individual treatments and to the complexity of the phenomenon of therapeutic outcome. Furthermore, classical psychometric evaluations of the validity of outcome measures might be supplemented with less-systematic evaluations that take any contingent source of information on outcome into account.

Who is motivated to accept a booster and annual dose? A dimensional and person-centered approach.

The transmissibility of new COVID-19 variants and decreasing efficacy of vaccines led authorities to recommend a booster and even an annual dose. However, people's willingness to accept new doses varied considerably. Using two independent longitudinal samples of 4596 (Mean age = 53.6) and 514 (Mean age = 55.9) vaccinated participants, we examined how people's (lack of) vaccination motivation for their first dose was associated with their intention to get a booster (Sample 1) and an annual dose (Sample 2) several months later (Aim 1). We also aimed to capture the impact of the motivational heterogeneity on these intentions by capitalizing on participants' different motivational profiles collected at baseline (Aim 2). Across both samples, autonomous motivation, controlled motivation, and distrust-based amotivation were uniquely related to, respectively, higher, lower, and even lower booster and annual dose intentions. Further, a two-step clustering procedure revealed five profiles, with the profiles characterized by higher autonomous motivation (i.e. Good Quality and High Quantity profiles) reporting the highest vaccination intentions and the profile characterized by the highest number of obstacles (i.e. Global Amotivated profile) yielding the lowest vaccination intentions. These results stress the critical need to support citizens' volitional endorsement of vaccination to harvest long-term benefits with respect to COVID-19.

Psychological need fulfillment as a source of resilience: Its protective role in concerns and symptoms of anxiety and depression during the COVID-19 pandemic.

The essential role of the psychological needs for autonomy, competence, and relatedness in well-being has been demonstrated convincingly. Yet whether their fulfillment also serves as a source of resilience in the face of adversity has received limited attention. A longitudinal sample of Belgian citizens (N = 1869; Mage = 56.23, 68% female) completed an online questionnaire on 13 occasions between April 2020 and April 2022 during the COVID-19 crisis. Multilevel analyses showed that need fulfillment, both at the between- and within-person level, related negatively to concerns, even after controlling for exposure to personal risks. Further, the association between concerns and changes in symptoms of depression and anxiety was dampened when people reported higher need fulfillment compared with others (i.e. between-person level) or when they reported periodically more need fulfillment than usual (i.e. within-person level). This moderation effect occurred on top of the systematic negative main effect of need fulfillment on symptoms of anxiety and depression. Psychological need fulfillment serves as a resilience factor (a) by reducing concerns in the face of adverse events (i.e. an appraisal effect) and (b) by mobilizing resources that help individuals to deal better with concerns (i.e. a coping effect). Theoretical and practical implications of the resilience effect of need fulfillment are discussed.

How the Stringency of the COVID-19 Restrictions Influences Motivation for Adherence and Well-Being: The Critical Role of Proportionality.

BACKGROUND: The stringency of the measures taken by governments to combat the COVID-19 pandemic varied considerably across countries and time. In the present study, we examined how the proportionality to the epidemiological situation is related to citizens'behavior, motivation and mental health. METHODS: Across 421 days between March 2020 and March 2022, 273,722 Belgian participants (Mage = 49.47; 63.9% female; 33% single) completed an online questionnaire. Multiple linear mixed regression modeling was used to examine the interaction between the epidemiological situation, as indicated by the actual hospitalization numbers, and the stringency index to predict day-to-day variation in the variables of interest. RESULTS: Systematic evidence emerged showing that disproportional situations, as opposed to proportional situations, were associated with a clear pattern of maladaptive outcomes. Specifically, when either strict or lenient measures were disproportional in relation to the epidemiological situation, people reported lower autonomous motivation, more controlled motivation and amotivation, less adherence to sanitary rules, higher perceived risk of infection, lower need satisfaction, and higher anxiety and depressive symptoms. Perceived risk severity especially covaried with the stringency of the measures. At the absolute level, citizens reported the highest need satisfaction and mental health during days with proportional lenient measures. CONCLUSION: Stringent measures are not per se demotivating or compromising of people's well-being, nor are lenient measures as such motivating or enhancing well-being. Only proportional measures, that is, measures with a level of stringency that is aligned with the actual epidemiological situation, are associated with the greatest motivational, behavioral, and mental health benefits.

Giving voice to informal caregivers of community-dwelling older adults: A systematic review of empowerment interventions.

Taking care for older adults can place informal caregivers at risk for developing health problems. Therefore, interventions aiming to empower informal caregivers have been developed. Empowerment refers to a health promotion process including strategies to improve informal caregivers' self-care behaviours, stress-management and caregiving skills. In literature, empowerment-oriented interventions often target subsamples of informal caregivers defined through the care receiver's condition. These interventions, however, do not adequately capture the complexity of care needs and might even exclude informal caregivers taking care for older people without a specific diagnosis or with a subthreshold condition. Therefore, the aim of this systematic review is to provide an overview of the content and effectiveness of empowerment-oriented interventions directed at informal caregivers of community-dwelling older adults. Following the PRISMA guidelines, a systematic review was performed by searching the following databases: PubMed, PsycINFO, EMBASE and Web of Science. From a total of 6798 unique publications, 13 intervention studies, of which seven randomised controlled trials, were eligible for inclusion. According to the Mixed Methods Appraisal Tool, eight studies scored poor. The intervention studies under review represented different domains of empowerment, with cultivation of positive feelings being the most prevalent one. Social participation and physical health received little attention in interventions. Although no adverse intervention effects were observed, the studies reported mixed results with 57 positive and 47 neutral effects. The limited number and poor quality of studies emphasise the need for future research investigating the effectiveness of empowerment-oriented interventions targeting informal caregivers of older adults.

Live well and die with inner peace: The importance of retrospective need-based experiences, ego integrity and despair for late adults' death attitudes.

Given that prior research has provided evidence for the role of late adults' attitudes towards death in their mental health, we sought to understand its underlying sources. Guided by Self-Determination Theory and Erikson's theory of psychosocial development, two cross-sectional studies examined whether older individuals' psychological need-based experiences, as accumulated during life, relate to their death attitudes and whether their experienced ego integrity and despair play an intervening role in these associations. Whereas Study 1 (N = 394 late adults; Mage = 75.14; SD = 6.52; 62.9 % female) involved an assessment of need satisfaction only, in Study 2 (N = 126 late adults; Mage = 78.09; SD = 7.17; 61.9 % female) both need satisfaction and need frustration were assessed. Structural equation modeling showed that, across studies, experienced need satisfaction related positively to ego integrity and negatively to despair. Need frustration was related to despair only. In turn, ego integrity related positively to death acceptance and negatively to death anxiety, while despair related positively to death anxiety. Finally, the contribution of need satisfaction to death attitudes was mostly mediated by individuals' ego integrity. Theoretical and practical implications of these results are discussed.