The association between the sense of control and depression during the COVID-19 pandemic: a systematic review and meta-analysis.

Introduction: High levels of depression and low sense of control have been reported during the COVID-19 pandemic. The removal of typical freedoms through public health restrictions may have played an important role. The aim of this review was to examine data collected during the pandemic and (1) estimate the strength of the association between sense of control and depression, (2) examine whether the different types of control measures affected the strength of the association, and (3) whether this changed as a function of pandemic indicators. Methods: We conducted a systematic review and meta-analysis of studies published in English between December 2019 and November 2022. A total of 993 articles were identified, of which 20 were included in the review and 16 in the meta-analysis after conducting a quality assessment using the standard NIH tool. Results: The control-depression association gave a bias-independent pooled effect size of r = .41, and grew stronger over the 130 weeks covered by this review but did not change as a function of local COVID incidence rates. Subgroup analyses showed that external and overall control were more strongly related to depression than internal control. Discussion: These findings emphasize that external factors are important to the sense of control and the importance of preserving the sense of control in situations where the removal of personal freedoms is necessary, such as public health emergencies.

Experiences of people with multiple sclerosis participating in a social cognitive behavior change physical activity intervention.

BACKGROUND: Understanding the experiences of people with MS taking part in physical activity interventions is critical to inform future interventions. AIM: The aim was to gain insight into the experiences of people with MS taking part in a behavior change group physical activity intervention with a novel social cognitive theory component. METHODS: A qualitative semi-structured interview format was utilized. Questions focussed on expectations, views and beliefs at being involved in the study, beliefs on physical activity, and subjective evaluation of the trial content and delivery. Seventeen people were interviewed and data were analyzed using thematic analysis. RESULTS: Three themes were generated: psychological and social factors, intervention processes, and MS identity. The acceptance of MS as an identity acted as an initial barrier to exercise, with a more positive, exercise-enabling identity post-intervention. Psychological factors such as self-efficacy and anxiety, as well as social factors such as social support, were found to play an important role in how participants experienced the program. Similarly, intervention processes included support for group-based activities and structure of exercise classes, and were also inter-linked to the other themes. CONCLUSION: It appears that group-based exercise interventions are acceptable and feasible for people with MS. The qualitative findings support previously reported quantitative findings that the Step it Up intervention is effective at promoting physical activity and improving psychological outcomes.

Sense of Control and Depression during Public Health Restrictions and the COVID-19 Pandemic.

Depression rates have increased significantly since the onset of the COVID-19 pandemic, with a number of factors implicated in this increase, including stress, fear, social isolation and the psychological impact of public health restrictions. The main purpose of the current cross-sectional survey study was to examine the relationship between the experience of public health restrictions, the sense of control and depression, both during and after restrictions were lifted. A survey methodology was chosen, with data collected in the Republic of Ireland at two time points (January 2022 and May 2022). Time 1 participants (n = 314) were invited to repeat the measures 5 months later, with 172 agreeing to be recontacted, and 47 participants completing all measures at two time points. Findings showed that both the sense of control, in relation to perceived constraints, w = 0.43, and the experience of restrictions, w = 0.14, predicted depression at Time 1. Participants were less likely to be depressed at Time 2 and had a stronger sense of control. The Time 1 sense of control through perceived constraints predicted depression at Time 2, w = 0.45. Overall, these data show that public health restrictions and the sense of control are linked and that the sense of control has a powerful and long-lasting effect on depression status in restricted conditions, even once these have been lifted.

Depression symptoms and the perception of public health restrictions during the COVID-19 pandemic in Saudi Arabia: The protective effect of sense of control.

The psychological impact of public health restrictions may play a role in the increased depression levels reported since the COVID-19 pandemic began. Data further suggest that people's sense of personal control has been reduced during the pandemic also producing psychological distress. This study aimed to test whether perceptions of public health restrictions predict depression under pandemic conditions and if the sense of control can serve as a protective factor. For this cross-sectional study, 641 residents in Saudi Arabia over the age of 17 years were recruited between November and December of 2020 to complete an online survey. The survey assessed depression levels (Beck Depression Inventory, BDI), the sense of control and perceptions of public health restrictions. Demographic information was also collected. Depression levels were higher compared to previous samples (d = 0.12). The number of restrictions perceived as distressing strongly predicted the probability of high BDI scores, ß = 0.92 , with higher sense of control predicting lower levels of depression (constraints, ß = - 0.50 , mastery, ß = - 0.71 ). A strong sense of control significantly reduced the impact of the perception of restrictions on depression. These results suggest that the perception of public health restrictions is part of the reason for increased levels of depression during the pandemic. A strong sense control reduced the impact of restrictions on depression. It is therefore possible that simple interventions enhancing the sense of control, such as the availability of choice, could support mental health in restricted situations.

When and How Video Games Can Be Good: A Review of the Positive Effects of Video Games on Well-Being.

Video games are a source of entertainment for a wide population and have varied effects on well-being. The purpose of this article is to comprehensively examine game-play research to identify the factors that contribute to these disparate well-being outcomes and to highlight the potential positive effects. On the basis of existing literature, we argue that the effects of gaming on well-being are moderated by other variables, such as motivations for gaming and video-game characteristics. Specifically, the inclusion of social activity can benefit prosocial behaviors and affect the relationship between violent video games and aggression that some studies have demonstrated. Moreover, the research on the relationship between violent video games and aggression depends greatly on individual and sociocontextual variables outside of game play. The inclusion of physical activity in games can provide an improvement in physical health with high levels of enjoyment, potentially increasing adherence rates. Overall, following our review, we determined that the effects of gaming on well-being are moderated by and depend on the motivation for gaming, outside variables, the presence of violence, social interaction, and physical activity. Thus, we argue that there is potential for an "optimal gaming profile" that can be used in the future for both academic- and industry-related research.

The relationship between perception of control and mood: The intervening effect of cultural values in a Saudi Arabian sample.

The relationship between the constructs of perceived control and symptoms of mood disorders has been demonstrated. The current study evaluates cultural values both as an individual difference moderating variable and as one of the mechanisms through which the association between perceived control and mood disturbances may operate. The hypotheses were examined with a sample of 615 participants recruited in Saudi Arabia. Participants completed measures of perceived control, individualism and collectivism, and symptoms of depression and bipolar disorder. In general, the results supported a model in which higher levels of perceived control promote a less symptomatic mood state. In most cases, cultural values positively mediated the relationship between perceived control and mood disturbance with lower symptom levels predicted. However, when the components of perceived control were examined separately, high perceived mastery together with highly individualistic values predicted higher levels of bipolar symptoms. In this sample, there was less evidence of cultural values moderating the control-mood disturbance relationship. Only one moderator relationship was identified, which showed low control linking to higher symptom levels only in those who disagreed with individualistic values. Overall, our data are in agreement with the notion that pre-existing cultural values have an important effect on mood disorder symptoms.

The impact of community-based mental health service provision on stigma and attitudes towards professional help-seeking.

BACKGROUND: Stigma of mental ill-health and attitudes towards help-seeking are recognized barriers to seeking professional help, and have previously been linked to the type of support services available. AIMS: This study examined if the introduction of community-based mental health services to an area impacts mental health stigma and attitudes towards professional help-seeking amongst local residents. METHOD: A repeated cross-sectional study comprising of community surveys in two localities was carried out before and after community-based mental health services were introduced (N = 1074). Measures including perceived public and self-stigma of mental ill-health, and attitudes towards seeking professional help were compared across the two time points. RESULTS: Both public and self-stigma were significantly lower, and attitudes towards seeking professional help significantly more positive, after community-based mental health services had been introduced in each locality. CONCLUSIONS: The presence of local, accessible mental health services can positively impact help-seeking behaviour by reducing stigma and changing norms and attitudes around professional help-seeking.

Using Mobile Phones to Examine and Enhance Perceptions of Control in Mildly Depressed and Nondepressed Volunteers: Intervention Study.

BACKGROUND: Perceived control is strongly linked to healthy outcomes, mental healthiness, and psychological well-being. This is particularly important when people have little control over things that are happening to them. Perceived control studies have been performed extensively in laboratory settings and show that perceived control can be increased by experimental manipulations. Although these studies suggest that it may be possible to improve people's mental health by increasing their perceived control, there is very little evidence to date to suggest that perceived control can also be influenced in the real world. OBJECTIVE: The first aim of this study was to test for evidence of a link between noncontrol situations and psychological well-being in the real world using a mobile phone app. The second and arguably more important aim of the study was to test whether a simple instructional intervention on the nature of alternative causes would enhance people's perceptions of their own control in these noncontrol situations. METHODS: We implemented a behavioral action-outcome contingency judgment task using a mobile phone app. An opportunity sample of 106 healthy volunteers scoring low (n=56, no depression) or high (n=50, mild depression) on a depression scale participated. They were given no control over the occurrence of a low- or high-frequency stimulus that was embedded in everyday phone interactions during a typical day lasting 8 hours. The intervention involved instructions that either described a consistent alternative cause against which to assess their own control, or dynamic alternative causes of the outcome. Throughout the day, participants rated their own control over the stimulus using a quantitative judgment scale. RESULTS: Participants with no evidence of depression overestimated their control, whereas those who were most depressed were more accurate in their control ratings. Instructions given to all participants about the nature of alternative causes significantly affected the pattern of perceived control ratings. Instructions describing discrete alternative causes enhanced perceived control for all participants, whereas dynamic alternative causes were linked to less perceived control. CONCLUSIONS: Perceptions of external causes are important to perceived control and can be used to enhance people's perceptions. Theoretically motivated interventions can be used to enhance perceived control using mobile phone apps. This is the first study to do so in a real-world setting.

Identification Reduces Stigma of Mental Ill-Health: A Community-Based Study.

The stigma surrounding mental ill-health is an important issue that affects likelihood of diagnosis and uptake of services, as those affected may work to avoid exposure, judgment, or any perceived loss in status associated with their mental ill-health. In this study, we drew upon social identity theory to examine how social group membership might influence the stigma surrounding mental ill-health. Participants from two urban centers in Ireland (N = 626) completed a survey measuring stigma of mental health, perceived social support as well as identification with two different social groups (community and religion). Mediation analysis showed that subjective identification with religious and community groups led to greater perceived social support and consequently lower perceived stigma of mental ill-health. Furthermore, findings indicated that high identification with more than one social group can lead to enhanced social resources, and that identification with a religious group was associated with greater community identification. This study thus extends the evidence base of group identification by demonstrating its relationship with stigma of mental ill-health, while also reinforcing how multiple identities can interact to enhance social resources crucial for well-being.

Restricted reproductive rights and risky sexual behaviour: How political disenfranchisement relates to women's sense of control, well-being and sexual health.

Few studies have investigated the role of disenfranchisement and denial of agency in women's sexual health. To address this, a cross-sectional study of disenfranchisement, control (general and reproductive control) and health was conducted in Ireland, where abortion is severely restricted. Multiple mediation models ( N = 513 women) indicated that general but not reproductive control mediates the association between disenfranchisement and psychological well-being. Additionally, serial mediation shows disenfranchisement is associated with lower sense of control, which is linked to poorer well-being and risky sexual behaviour. Disenfranchisement arising from socio-political contexts may have important implications for women's sexual health.

ULTEMAT: A mobile framework for smart ecological momentary assessments and interventions.

In this paper we introduce a new Android library, called ULTEMAT, for the delivery of ecological momentary assessments (EMAs) on mobile devices and we present its use in the MoodBuster app developed in the H2020 E-COMPARED project. We discuss context-aware, or event-based, triggers for the presentation of EMAs and discuss the potential they have to improve the effectiveness of mobile provision of mental health interventions as they allow for the delivery of assessments to the patients when and where these are most appropriate. Following this, we present the abilities of ULTEMAT to use such context-aware triggers to schedule EMAs and we discuss how a similar approach can be used for Ecological Momentary Interventions (EMIs).

The effects of cognitive load during intertrial intervals on judgements of control: The role of working memory and contextual learning.

When there is no contingency between actions and outcomes, but outcomes occur frequently, people tend to judge that they have control over those outcomes, a phenomenon known as the outcome density (OD) effect. Recent studies show that the OD effect depends on the duration of the temporal interval between action-outcome conjunctions, with longer intervals inducing stronger effects. However, under some circumstances OD effect is reduced, for example when participants are mildly depressed. We reasoned that working memory (WM) plays an important role in learning of context; with reduced WM capacity to process contextual information during intertrial intervals (ITIs) during contingency learning might lead to reduced OD effects (limited capacity hypothesis). To test this, we used a novel dual-task procedure that increases the WM load during the ITIs of an operant (e.g., action-outcome) contingency learning task to impact contextual learning. We tested our hypotheses in groups of students with zero (Experiments 1, N=34), and positive contingencies (Experiment 2, N=34). The findings indicated that WM load during the ITIs reduced the OD effects compared to no load conditions (Experiment 1 and 2). In Experiment 2, we observed reduced OD effects on action judgements under high load in zero and positive contingencies. However, the participants' judgements were still sensitive to the difference between zero and positive contingencies. We discuss the implications of our findings for the effects of depression and context in contingency learning.

SSRI enhances sensitivity to background outcomes and modulates response rates: A randomized double blind study of instrumental action and depression.

Serotonin reuptake inhibitors (SSRIs) have immediate effects on synaptic levels of serotonin but their therapeutic effects are often delayed. This delay has been suggested to reflect time required for new learning and therefore that SSRIs might be having effects on the learning process. We examined the effects of elevating serotonin levels, through short-term SSRI administration (escitalopram), on learning about perceptions of instrumental control. A randomised double blind procedure was used to allocate healthy people, categorised as mildly depressed (high BDI⩾10: n=76) or not depressed (low BDI⩽5: n=78) to either a drug (escitalopram, 10mg/7days) or placebo control group. Following treatment, participants were trained with a simple task that involved learning the effectiveness of an instrumental action (key press) and the background context at eliciting an outcome (auditory cue) where there was no programmed contingency. The effects of the drug were (i) to moderate response rates and (ii) to enhance sensitivity to the background or context rate of occurrence of the outcome. These findings suggest that serotonin modulates learning about the long-term rate of outcomes, which supports perception of instrumental control, and that this may provide a clue to the mechanism for supporting the development of the therapeutic effects of the drug.

The relationship between mood state and perceived control in contingency learning: effects of individualist and collectivist values.

Perceived control in contingency learning is linked to psychological wellbeing with low levels of perceived control thought to be a cause or consequence of depression and high levels of control considered to be the hallmark of mental healthiness. However, it is not clear whether this is a universal phenomenon or whether the value that people ascribe to control influences these relationships. Here we hypothesize that values affect learning about control contingencies and influence the relationship between perceived control and symptoms of mood disorders. We tested these hypotheses with European university samples who were categorized as endorsing (or not) values relevant to control-individualist and collectivist values. Three online experimental contingency learning studies (N 1 = 127, N 2 = 324, N 3 = 272) were carried out. Evidence suggested that individualist values influenced basic learning processes via an effect on learning about the context in which events took place. Participants who endorsed individualist values made control judgments that were more in line with an elemental associative learning model, whilst those who were ambivalent about individualist values made judgments that were more consistent with a configural process. High levels of perceived control and individualist values were directly associated with increased euphoric symptoms of bipolar disorder, and such values completely mediated the relation between perceived control and symptoms. The effect of low perceived control on depression was moderated by collectivist values. Anxiety created by dissonance between values and task may be a catalyst for developing mood symptoms. Conclusions are that values play a significant intermediary role in the relation between perceived control and symptoms of mood disturbance.

Understanding help-seeking amongst university students: the role of group identity, stigma, and exposure to suicide and help-seeking.

BACKGROUND: Despite a high prevalence of suicide ideation and mental health issues amongst university students, the stigma of help-seeking remains a barrier to those who are in real need of professional support. Social identity theory states that help received from an ingroup source is more welcome and less threatening to one's identity than that from a source perceived as outgroup. Therefore, we hypothesized that students' stigma toward seeking help from their university mental health service would differ based on the strength of their identification with the university. METHOD: An online survey including measures of stigma of suicide, group identification, experience with help-seeking and exposure to suicide was administered to Irish university students (N = 493). RESULTS: Group identification was a significant predictor of help-seeking attitudes after controlling for already known predictors. Contrary to our expectations, those who identified more strongly with their university demonstrated a higher stigma of seeking help from their university mental health service. CONCLUSIONS: RESULTS are discussed in relation to self-categorization theory and the concept of normative fit. Practical implications for mental health service provision in universities are also addressed, specifically the need for a range of different mental health services both on and off-campus.

A randomised controlled trial of an exercise plus behaviour change intervention in people with multiple sclerosis: the step it up study protocol.

BACKGROUND: Exercise has consistently yielded short-term, positive effects on health outcomes in people with multiple sclerosis (MS). However, these effects have not been maintained in the long-term. Behaviour change interventions aim to promote long-term positive lifestyle change. This study, namely, "Step it Up" will compare the effect of an exercise plus Social Cognitive Theory (SCT)-based behaviour change intervention with an exercise plus control education intervention on walking mobility among people with MS. METHODS/DESIGN: People with a diagnosis of MS who walk independently, score of 0-3 on the Patient Determined Disease Steps, who have not experienced an MS relapse or change in their MS medication in the last 12 weeks and who are physically inactive will be randomised to one of two study conditions. The experimental group will undergo a 10-week exercise plus SCT-based behavioural change intervention. The control group will undergo a 10-week exercise plus education intervention to control for contact. Participants will be assessed at weeks 1, 12, 24 and 36. The primary outcome will be walking mobility. Secondary outcomes will include: aerobic capacity, lower extremity muscle strength, participant adherence to the exercise programme, self-report exercise intensity, self-report enjoyment of exercise, exercise self-efficacy, outcome expectations for exercise, goal-setting for exercise, perceived benefits and barriers to exercise, perceptions of social support, physical and psychological impact of MS and fatigue. A qualitative evaluation of Step it Up will be completed among participants post-intervention. DISCUSSION: This randomised controlled trial will examine the effectiveness of an exercise plus SCT-based behaviour change intervention on walking mobility among people with MS. To this end, Step it Up will serve to inform future directions of research and clinical practice with regard to sustainable exercise interventions for people with MS. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02301442.

Time perception and depressive realism: judgment type, psychophysical functions and bias.

The effect of mild depression on time estimation and production was investigated. Participants made both magnitude estimation and magnitude production judgments for five time intervals (specified in seconds) from 3 sec to 65 sec. The parameters of the best fitting psychophysical function (power law exponent, intercept, and threshold) were determined individually for each participant in every condition. There were no significant effects of mood (high BDI, low BDI) or judgment (estimation, production) on the mean exponent, n = .98, 95% confidence interval (.96-1.04) or on the threshold. However, the intercept showed a 'depressive realism' effect, where high BDI participants had a smaller deviation from accuracy and a smaller difference between estimation and judgment than low BDI participants. Accuracy bias was assessed using three measures of accuracy: difference, defined as psychological time minus physical time, ratio, defined as psychological time divided by physical time, and a new logarithmic accuracy measure defined as ln (ratio). The ln (ratio) measure was shown to have approximately normal residuals when subjected to a mixed ANOVA with mood as a between groups explanatory factor and judgment and time category as repeated measures explanatory factors. The residuals of the other two accuracy measures flagrantly violated normality. The mixed ANOVAs of accuracy also showed a strong depressive realism effect, just like the intercepts of the psychophysical functions. There was also a strong negative correlation between estimation and production judgments. Taken together these findings support a clock model of time estimation, combined with additional cognitive mechanisms to account for the depressive realism effect. The findings also suggest strong methodological recommendations.

Context and time in causal learning: contingency and mood dependent effects.

Defining cues for instrumental causality are the temporal, spatial and contingency relationships between actions and their effects. In this study, we carried out a series of causal learning experiments that systematically manipulated time and context in positive and negative contingency conditions. In addition, we tested participants categorized as non-dysphoric and mildly dysphoric because depressed mood has been shown to affect the processing of all these causal cues. Findings showed that causal judgements made by non-dysphoric participants were contextualized at baseline and were affected by the temporal spacing of actions and effects only with generative, but not preventative, contingency relationships. Participants categorized as dysphoric made less contextualized causal ratings at baseline but were more sensitive than others to temporal manipulations across the contingencies. These effects were consistent with depression affecting causal learning through the effects of slowed time experience on accrued exposure to the context in which causal events took place. Taken together, these findings are consistent with associative approaches to causal judgement.

Dysphoric Mood States are Related to Sensitivity to Temporal Changes in Contingency.

A controversial finding in the field of causal learning is that mood contributes to the accuracy of perceptions of uncorrelated relationships. When asked to report the degree of control between an action and its outcome, people with dysphoria or depression are claimed to be more realistic in reporting non-contingency (e.g., Alloy and Abramson, 1979). The strongest evidence for this depressive realism (DR) effect is derived from data collected with experimental procedures in which the dependent variables are verbal or written ratings of contingency or cause, and, perhaps more importantly, the independent variable in these procedures may be ambiguous and difficult to define. In order to address these possible confounds, we used a two-response free-operant causal learning task in which the dependent measures were performance based. Participants were required to respond to maximize the occurrence of a temporally contiguous outcome that was programmed with different probabilities, which also varied temporally across two responses. Dysphoric participants were more sensitive to the changing outcome contingencies than controls even though they responded at a similar rate. During probe trials, in which the outcome was masked, their performance recovered more quickly than that of the control group. These data provide unexpected support for the DR hypothesis suggesting that dysphoria is associated with heightened sensitivity to temporal shifts in contingency.