Dynamic patterns of COVID stress syndrome among university students during an outbreak: a time-series network analysis.

OBJECTIVE: Assessing the progression of COVID stress syndrome (CSS) and understanding how cognitive and emotional factors play a role in the dynamic system is critical for prevention and intervention during the COVID-19 pandemic. We investigated the dynamic relationship between self-reported COVID stress syndrome, cognitive factors, and emotional factors through time-series network analysis. METHODS AND MEASURES: Participants were 188 university students involved in an experience sampling method study that lasted 14 days, three times a day, during the COVID-19 pandemic period following a shift in pandemic prevention and control policy. RESULTS: CSS symptoms are usually present simultaneously, and xenophobia is the most central node of the network. There is a complex mutual predictive relationship between CSS symptoms, in which traumatic stress symptoms are crucial in developing and maintaining the CSS symptom network. Negative affect was associated with CSS symptoms at the same time, and subjective health cognition was a significant predictor of CSS symptoms the next time. CONCLUSIONS: Traumatic stress symptoms are essential nodes in the CSS symptom network, and negative emotions and subjective health influence the occurrence and development of CSS symptoms.

Examination of COVID stress syndrome facets and relations to substance misuse using profile analysis via multidimensional scaling (PAMS).

The COVID-19 pandemic has contributed to significant societal challenges, including increased substance misuse. The COVID stress syndrome is a constellation of interrelated processes that occur in response to pandemics, including danger/contamination fears, fears concerning economic consequences, xenophobia, compulsive checking/reassurance-seeking, and pandemic-related traumatic stress symptoms. In the present study, using a sample of 812 adults collected during the early stages of the COVID-19 pandemic in May 2020, we examined the relations between identified profiles of the COVID Stress Scales (CSS) and behavioral and cognitive aspects of substance misuse. Using profile analysis via multidimensional scaling (PAMS), we identified two core profiles of the CSS, which explained 60 % of the variance in participant responding: 1) High compulsive checking & Low xenophobia and 2) High xenophobia & Low danger/contamination. The first profile is consistent with the COVID stress syndrome, while the second profile aligns with the COVID disregard syndrome, which is a constellation of interrelated processes distinguished by a denial or downplaying of the seriousness of the COVID-19 pandemic and lack of perceived vulnerability to disease. Both profiles demonstrated significant positive correlations with drug and alcohol misuse, respectively. However, only the High xenophobia & Low danger/contamination profile demonstrated relations with cognitive aspects of substance misuse via positive and negative correlations with positive and negative expectancies of alcohol use, respectively. These findings provide further support for the relationship between the COVID stress syndrome and substance misuse and offer insight into how unique profiles of this syndrome may impact pandemic-related mental and public health interventions.

The relationship between maladaptive health beliefs, pandemic-related stress, and health anxiety during the COVID-19 pandemic.

BACKGROUND: Research has demonstrated that people experience specific distress and anxiety regarding COVID-19. This distress may consist of interconnected symptom categories corresponding to a COVID stress syndrome. Susceptibility to COVID stress syndrome may be related to one's maladaptive health beliefs; however, no research has investigated the association between maladaptive health beliefs and COVID stress. The present study explored the impact of health beliefs on COVID stress, health anxiety, and associated psychological constructs. PARTICIPANTS AND PROCEDURE: This cross-sectional survey study included 221 adults (M age = 20.59, SD = 2.28). Participants completed an online survey including demographic questionnaires and self-report measures of health beliefs, COVID stress, health anxiety, and related psychological constructs. RESULTS: Health anxiety, anxiety sensitivity, state/trait anxiety, intolerance of uncertainty, and depression accounted for significant variance in COVID stress (F(6, 214) = 11.18, R2 = .24, p < .001). Health beliefs (i.e., perceived likelihood of illness, medical service inadequacy, and difficulty coping) were associated with greater COVID stress, although health beliefs were not found to mediate the relationship between health anxiety and COVID stress. CONCLUSIONS: Health beliefs were associated with greater COVID stress, although health beliefs did not mediate the relationship between health anxiety and COVID stress. The relationship between health anxiety and COVID stress may be better explained by other COVID-related cognitions (e.g., vaccine efficacy, dangerousness of COVID-19). The findings highlight the importance of peoples' health beliefs during the pandemic. Given anxiety's influence on peoples' behavioural responses to the pandemic, further research should identify COVID-specific cognitions for prevention of COVID stress and health anxiety.

Time attitudes affecting psychological health during COVID-19 pandemic: a two-wave, six-month prospective study in Taiwan.

The COVID-19 pandemic has induced traumatic and fear responses globally. Time attitudes, which refer to one's feelings toward the past, present and future, may have certain effects on psychological adaptations during this crisis period. This study employed a person-centered approach and a two-wave prospective design to investigate how people with different time attitude profiles change differently in their PTSD symptoms and COVID-19-related fears from a low-risk stage to the first big COVID-19 outbreak in Taiwan. Participants were 354 adults with a mean age of 27.79 years. The result provided support for the theoretical six-factor structure of the traditional Chinese Adolescent and Adult Time Inventory-Time Attitudes Scale (AATI-TA). Four clusters of time attitude profiles were identified (Positives, Negatives, Past Negatives and Pessimists). At both waves, Positives had lower levels of PTSD severity and COVID-19-related fears than most of the other groups, and the reverse was noted for Negatives. As for time effects, people across all profiles were significantly affected during the outbreak, but Negatives showed a greater increase in PTSD severity than other groups. In conclusion, mental health services should put efforts into early identification of those with highly negative time attitudes and implement interventions that nudge people toward a more balanced or positive attitude in each temporal frame, especially during adversity such as the COVID-19 pandemic.

The impact of COVID-related perceived stress and social support on generalized anxiety and major depressive disorders: moderating effects of pre-pandemic mental disorders.

BACKGROUND: We assessed the moderating effect of pre-pandemic mental disorders on the association of COVID-related perceived stress and social support with mental health. METHODS: A nationally representative sample of 3500 Spanish adults was interviewed in June 2020 (mean age 49.25 years, ± 15.64; 51.50% females). Mental health included Generalized Anxiety Disorders (GAD; GAD-7, cut-off point of ≥ 10), Major Depressive Disorders (MDD; PHQ-8, cut-off point of ≥ 10) and the comorbid form (those screening positive for GAD and MDD). COVID-related stress was assessed using an adapted version of the Peri Life Events Scale, and social support using the Oslo Social Support Scale. Logistic regression models were used to assess if COVID-related stress and social support were related to mental health outcomes and interactions were conducted to examine whether these relationships differed according to the presence of pre-pandemic mental disorders. RESULTS: Higher COVID-related stress was associated with a higher risk of lower mental health. The association between COVID-related stress with GAD and MDD was significantly moderated by pre-pandemic mental disorders, except for comorbid GAD + MDD. Higher levels of social support were linked to better mental health. Only the association between social support and GAD was significantly moderated by pre-pandemic mental disorders. That is, for those without pre-pandemic mental disorders, higher levels of social support decreased the odds of GAD, while minor decreases were observed in those with pre-pandemic mental disorders. CONCLUSIONS: The impact of COVID-related stress and social support on specific indicators of mental health may vary depending on the existence of a previous mental disorder.

'Dirty foreigners' are to blame for COVID-19: impacts of COVID stress syndrome on quality of life and gratitude among Singaporean adults.

The outbreak of COVID-19 has caused widespread emotional distress. The current study sought to ascertain the impact of COVID stress syndrome on quality of life and gratitude. The COVID-19 Stress Scale, COVID-19 Quality of Life Scale, and Gratitude Resentment and Appreciation Scale were administered to 199 Singaporeans. Data were collected online using convenience sampling between December 2020 and March 2021. Pearson correlations and hierarchical regression analyses were used to test the research hypotheses. The results showed that fear of spreading SARSCoV2 by foreigners was the most stressful fear among Singaporeans (M = 2.59), while traumatic stress by COVID-19 was the least stressful fear (M = 0.16). COVID stress syndrome was positively correlated with negative quality of life (r ranged from .25 to .66) and negatively correlated with gratitude (r ranged from -.29 to -.14). Xenophobia was also found to be the most influential factor in reducing quality of life (ß = .52) and gratitude (ß = -.37) during the pandemic. Study findings demonstrate how COVID-19 increases Singaporeans' xenophobic attitudes towards foreigners, making them more vulnerable to the pandemic.

Predicting the Severity of Symptoms of the COVID Stress Syndrome From Personality Traits: A Prospective Network Analysis.

Psychological stress reactions to the COVID-19 pandemic are complex and multifaceted. Research provides evidence of a COVID Stress Syndrome (CSS), consisting of (1) worry about the dangerousness of getting infected with SARSCoV2 and coming into contact with infected surfaces, (2) worry concerning the personal socioeconomic consequences of COVID-19, (3) xenophobic fears that SARSCOV2 is being spread by foreigners, (4) COVID-19-related traumatic stress symptoms (e.g., nightmares), and (5) compulsive checking and reassurance-seeking about COVID-19. Little is known about how these symptoms are related to vulnerability and protective personality factors. Based on data from 1,976 US and Canadian adults, we conducted a prospective network analysis in which personality factors were initially assessed at Time 1 and then symptoms of the CSS were assessed at Time 2, 2.5 months later. Results indicated that trait optimism and trait resilience were negatively associated with negative emotionality, suggesting a modulatory (inhibitory) influence. Negative emotionality was positively linked to the narrower traits of intolerance of uncertainty and health anxiety proneness. These narrower traits, in turn, were prospectively linked to symptoms of the CSS. Results suggest that the effects of broad personality traits (e.g., negative emotionality, trait resilience) on symptoms of the CSS were mediated by narrower traits such as the intolerance of uncertainty. Treatment implications are discussed.

COVID Stress Syndrome: Clinical and Nosological Considerations.

PURPOSE OF REVIEW: To review the current state of knowledge on the newly proposed COVID Stress Syndrome. RECENT FINDINGS: The syndrome consists of five inter-correlated elements: (a) fear of SARSCoV2 infection and fear of coming into contact with objects or surfaces contaminated with the coronavirus; (b) fear of socio-economic impacts of the pandemic; (c) fear of foreigners for fear that they are infected; (d) pandemic-related compulsive checking and reassurance-seeking; and (e) pandemic-related traumatic stress symptoms. A severe form of the syndrome, characterized by clinically significant distress and impairment in functioning, is the COVID Stress Disorder, which is regarded as a pandemic-related adjustment disorder. Several treatment options exist but further research is needed. Research during the COVID-19 pandemic has identified a pandemic-related adjustment disorder. The diagnosis of COVID Stress Syndrome should be made only after ruling out other disorders that could potentially account for the pattern of symptoms, such as obsessive-compulsive disorder and posttraumatic stress disorder. Further studies are needed to investigate the long-term course of the syndrome. Similar adjustment disorders may arise in future pandemics. Accordingly, understanding the COVID Stress Syndrome may facilitate efforts to understand and treat psychopathology in future pandemics.

Effects of anxiety sensitivity, disgust, and intolerance of uncertainty on the COVID stress syndrome: a longitudinal assessment of transdiagnostic constructs and the behavioural immune system.

Excessive fear and worry in response to the COVID-19 pandemic (e.g., COVID stress syndrome) is prevalent and associated with various adverse outcomes. Research from the current and past pandemics supports the association between transdiagnostic constructs-anxiety sensitivity (AS), disgust, and intolerance of uncertainty (IU)-and pandemic-related distress. Recent research suggests a moderating effect of disgust on the relationship of AS-physical concerns and COVID-19-related distress, suggesting that transdiagnostic constructs underlie individual differences in activation of the behavioral immune system (BIS). No previous study has examined the independent and conjoint effects of pre-COVID-19 AS-physical concerns, disgust propensity (DP), disgust sensitivity (DS), and IU in this context; thus, we did so using longitudinal survey data (N = 3,062 Canadian and American adults) with simple and moderated moderations controlling for gender, mental health diagnosis, and COVID-19 diagnosis. Greater AS-physical concerns, DP, and DS predicted more severe COVID stress syndrome assessed one month later. Either DP or DS further amplified the effect of AS-physical concerns on COVID stress syndrome, except danger and contamination fears. IU did not interact with AS-physical concerns and DS or DP. Theoretical and clinical implications pertaining to delivery of cognitive behavioural therapy for pandemic-related distress are discussed.

Understanding and managing pandemic-related panic buying.

Pandemics are associated with panic buying (PB) of groceries and other supplies. During the COVID-19 pandemic, community leaders expressed frustration and bewilderment about PB. Psychological explanatory concepts, including those from social learning theory and the concept of the behavioral immune system, along with recent research, suggests the following account of pandemic-related PB. PB arises when people are told to go into self-isolation as part of pandemic containment interventions. Empirically, episodes of PB typically last 7-10 days and are likely initiated by highly fearful people. PB by an anxious minority of shoppers leads to fear contagion among other shoppers, amplified by widespread dissemination, via social media, of images and videos of PB and empty shelves in stores. Thus, a snow-balling effect arises where fear of scarcity creates real but short-term scarcity. People who are highly frightened of infection tend to have heightened disgust proneness. Toilet paper is a means of escaping disgust stimuli, and for this and other reasons, toilet paper became a target of PB for people frightened of contracting COVID-19. Exploitative or selfish over-purchasing also occurred, motivated by "dark" (e.g., psychopathic) personality traits. "Don't panic!" messages from community leaders were ineffective or counter-productive. Alternative forms of messaging are discussed.

Predictors of distress and coping during pandemic-related self isolation: The relative importance of personality traits and beliefs about personal threat.

During pandemics such as COVID-19, voluntary self-isolation is important for limiting the spread of infection. Little is known about the traits that predict distress or coping with pandemic-related self-isolation. Some studies suggest that personality variables (e.g., introversion, conscientiousness, resilience, optimism) are important in predicting distress and coping during self-isolation, but such studies have not controlled for important variables such as stressors associated with self-isolation, demographic variables, and individual differences in beliefs (worries) about the dangerousness of COVID-19. The present study is, to our knowledge, the first to investigate the role of personality traits, demographic characteristics, and COVID-related beliefs about contracting the coronavirus. Data from a population representative sample of 938 adults from the United States and Canada, in voluntary self-isolation, revealed that COVID-related threat beliefs were more important than various personality variables in predicting (a) self-isolation distress, (b) general distress, (c) stockpiling behaviors, and (c) use of personal protective equipment such as masks, gloves, and visors. There was little evidence that personality traits influenced threat beliefs. The findings are relevant for understanding distress and protective behaviors during the current pandemic, in subsequent waves of this pandemic, and in later pandemics, and for informing the development of targeted mental health interventions.

Substance use and abuse, COVID-19-related distress, and disregard for social distancing: A network analysis.

Research shows that there has been a substantial increase in substance use and abuse during the COVID-19 pandemic, and that substance use/abuse is a commonly reported way of coping with anxiety concerning COVID-19. Anxiety about COVID-19 is more than simply worry about infection. Research provides evidence of a COVID Stress Syndrome characterized by (1) worry about the dangers of COVID-19 and worry about coming into contact with coronavirus contaminated objects or surfaces, (2) worry about the personal socioeconomic impact of COVID-19, (3) xenophobic worries that foreigners are spreading COVID-19, (4) COVID-19-related traumatic stress symptoms (e.g., nightmares), and (5) COVID-19-related compulsive checking and reassurance-seeking. These form a network of interrelated nodes. Research also provides evidence of another constellation or "syndrome", characterized by (1) belief that one has robust physical health against COVID-19, (2) belief that the threat of COVID-19 has been exaggerated, and (3) disregard for social distancing. These also form a network of nodes known as a COVID-19 Disregard Syndrome. The present study, based on a population-representative sample of 3075 American and Canadian adults, sought to investigate how these syndromes are related to substance use and abuse. We found substantial COVID-19-related increases in alcohol and drug use. Network analyses indicated that although the two syndromes are negatively correlated with one another, they both have positive links to alcohol and drug abuse. More specifically, COVID-19-related traumatic stress symptoms and the tendency to disregard social distancing were both linked to substance abuse. Clinical and public health implications are discussed.

Worry, avoidance, and coping during the COVID-19 pandemic: A comprehensive network analysis.

BACKGROUND: Many psychological factors play a role in the COVID-19 pandemic, including various forms of worry, avoidance, and coping. Adding to the complexity, some people believe the threat of COVID-19 is exaggerated. We used network analysis to investigate how these diverse elements are interrelated. METHODS: A population-representative sample of 3075 American and Canadian adults completed an online survey, including measures of COVID-19-related worry, avoidance, self-protective behaviors, and other variables. RESULTS: The network contained three major hubs, replicated across gender and age groups. The most important hub centered around worries about the dangerousness of COVID-19, and formed the core of the previously identified COVID Stress Syndrome. The second most important hub, which was negatively correlated with the first hub, centered around the belief that the COVID-19 threat is exaggerated, and was associated with disregard for social distancing, poor hand hygiene, and anti-vaccination attitudes. The third most important hub, which was linked to the first hub, centered around COVID-19-related compulsive checking and reassurance-seeking, including self-protective behaviors such as panic buying and use of personal protective equipment. CONCLUSION: Network analysis showed how various forms of worry, avoidance, coping, and other variables are interrelated. Implications for managing disease and distress are discussed.