It matters what you see: Graphic media images of war and terror may amplify distress.

Media exposure to graphic images of violence has proliferated in contemporary society, particularly with the advent of social media. Extensive exposure to media coverage immediately after the 9/11 attacks and the Boston Marathon bombings (BMB) was associated with more early traumatic stress symptoms; in fact, several hours of BMB-related daily media exposure was a stronger correlate of distress than being directly exposed to the bombings themselves. Researchers have replicated these findings across different traumatic events, extending this work to document that exposure to graphic images is independently and significantly associated with stress symptoms and poorer functioning. The media exposure-distress association also appears to be cyclical over time, with increased exposure predicting greater distress and greater distress predicting more media exposure following subsequent tragedies. The war in Israel and Gaza, which began on October 7, 2023, provides a current, real-time context to further explore these issues as journalists often share graphic images of death and destruction, making media-based graphic images once again ubiquitous and potentially challenging public well-being. For individuals sharing an identity with the victims or otherwise feeling emotionally connected to the Middle East, it may be difficult to avoid viewing these images. Through a review of research on the association between exposure to graphic images and public health, we discuss differing views on the societal implications of viewing such images and advocate for media literacy campaigns to educate the public to identify mis/disinformation and understand the risks of viewing and sharing graphic images with others.

Contrasting Objective and Perceived Risk: Predicting COVID-19 Health Behaviors in a Nationally Representative U.S. Sample.

BACKGROUND: Individuals confronting health threats may display an optimistic bias such that judgments of their risk for illness or death are unrealistically positive given their objective circumstances. PURPOSE: We explored optimistic bias for health risks using k-means clustering in the context of COVID-19. We identified risk profiles using subjective and objective indicators of severity and susceptibility risk for COVID-19. METHODS: Between 3/18/2020-4/18/2020, a national probability sample of 6,514 U.S. residents reported both their subjective risk perceptions (e.g., perceived likelihood of illness or death) and objective risk indices (e.g., age, weight, pre-existing conditions) of COVID-19-related susceptibility and severity, alongside other pandemic-related experiences. Six months later, a subsample (N = 5,661) completed a follow-up survey with questions about their frequency of engagement in recommended health protective behaviors (social distancing, mask wearing, risk behaviors, vaccination intentions). RESULTS: The k-means clustering procedure identified five risk profiles in the Wave 1 sample; two of these demonstrated aspects of optimistic bias, representing almost 44% of the sample. In OLS regression models predicting health protective behavior adoption at Wave 2, clusters representing individuals with high perceived severity risk were most likely to report engagement in social distancing, but many individuals who were objectively at high risk for illness and death did not report engaging in self-protective behaviors. CONCLUSIONS: Objective risk of disease severity only inconsistently predicted health protective behavior. Risk profiles may help identify groups that need more targeted interventions to increase their support for public health policy and health enhancing recommendations more broadly.

As we move into an endemic stage of the COVID-19 pandemic, understanding engagement in health behaviors to curb the spread of disease remains critically important to manage COVID-19 and other health threats. However, peoples' perceptions about their risk of getting sick and having severe outcomes if they do fall ill are subject to bias. We studied a nationally representative probability sample of over 6,500 U.S. residents who completed surveys immediately after the COVID-19 pandemic began and approximately 6 months later. We used a computer processing (i.e., machine learning) approach to categorize participants based on both their actual risk factors for COVID-19 and their subjective understanding of that risk. Our analysis identified groups of individuals whose subjective perceptions of risk did not align with their actual risk characteristics. Specifically, almost 44% of our sample demonstrated an optimistic bias: they did not report higher risk of death from COVID-19 despite having one or more well-known risk factors for poor disease outcomes (e.g., older age, obesity). Six months later, membership in these risk groups prospectively predicted engagement in health protective and risky behaviors, as well as vaccine intentions, demonstrating how early risk perceptions may influence health behaviors over time.

Earthquake exposure, adverse childhood experiences, and psychosocial functioning in Chilean children: A longitudinal study.

The impact of an 8.8 magnitude Chilean earthquake on elementary school students' psychosocial functioning was assessed along with exposure to adverse childhood experiences (ACEs). Skills for Life, a national school-based mental health program in Chile, routinely assesses first- and third-grade students' psychosocial functioning and classroom adaptation. Students (N = 19,627) were screened before (2009) and after (2011) the 2010 earthquake with parent- and teacher-report measures and with a parent-report of four ACEs (family psychopathology, child chronic illness, family social isolation, father absence). Earthquake exposure was categorized as mild, moderate, or severe for Chile's 15 regions. Multilevel models analyzed the unadjusted and adjusted impacts of earthquake exposure and ACEs on functioning while clustering for school- and district-level effects. In covariate-adjusted models, earthquake exposure and three ACEs were significantly associated with worsened psychosocial functioning; earthquake exposure and all four ACEs were significantly associated with worsened classroom adaptation. New family psychopathology, B = 1.90, p < .001; chronic illness, B = 2.25, p < .001; and severe earthquake impact, B = 1.29, p < .001, held the strongest negative effects on psychosocial well-being. Moderate, B = 3.04, p = .011, and severe earthquake exposure, B = 2.53, p = .047, and new family psychopathology, B = 1.99, p < .001, were associated with the worst classroom functioning 1-year postdisaster. Findings suggest that both exogenous and home-based stressors can have significant consequences for children's psychosocial functioning and classroom adaptation, and routine screening helps quantify how individual students are affected by chronic versus acute stressors.

Media exposure, threat processing, and mitigation behaviors in Gulf Coast residents facing the co-occurring threats of COVID-19 and hurricanes.

The 2020 hurricane season threatened millions of Americans concurrently grappling with COVID-19. Processes guiding individual-level mitigation for these conceptually distinct threats, one novel and chronic (COVID-19), the other familiar and episodic (hurricanes), are unknown. Theories of health protective behaviors suggest that inputs from external stimuli (e.g., traditional and social media) lead to threat processing, including perceived efficacy (self- and response) and perceived threat (susceptibility and severity), guiding mitigation behavior. We surveyed a representative sample of Florida and Texas residents (N = 1846) between April 14, 2020 and April 27, 2020; many had previous hurricane exposure; all were previously assessed between September 8, 2017 and September 11, 2017. Using preregistered analyses, two generalized structural equation models tested direct and indirect effects of media exposure (traditional media, social media) on self-reported (1) COVID-19 mitigation (handwashing, mask-wearing, social distancing) and (2) hurricane mitigation (preparation behaviors), as mediated through perceived efficacy (self- and response) and perceived threat (susceptibility and severity). Self-efficacy and response efficacy were associated with social distancing (p = .002), handwashing, mask-wearing, and hurricane preparation (ps < 0.001). Perceived susceptibility was positively associated with social distancing (p = 0.017) and hurricane preparation (p < 0.001). Perceived severity was positively associated with social distancing (p < 0.001). Traditional media exhibited indirect effects on COVID-19 mitigation through increased response efficacy (ps < 0.05), and to a lesser extent self-efficacy (p < 0.05), and on hurricane preparation through increased self-efficacy and response efficacy and perceived susceptibility (ps < 0.05). Social media did not exhibit indirect effects on COVID-19 or hurricane mitigation. Communications targeting efficacy and susceptibility may encourage mitigation behavior; research should explore how social media campaigns can more effectively target threat processing, guiding protective actions.

National Opinions on Death Penalty Punishment for the Boston Marathon Bomber Before vs. After Sentencing.

Humans seek consistency between their internal thoughts and the outside world. Thus, when legal authorities make decisions, people are likely to accept and obey these decisions in order to remain consistent with the societies in which they live. Few studies have explored these biases in an applied context. We examined the relationship between the sentencing of Dzhokhar Tsarnaev (the Boston Marathon bomber) and Americans' opinions about his punishment in a natural quasi-experiment. We expected that Tsarnaev's sentencing would be associated with increased support for his death penalty sentence, in a manner consistent with the legitimization literature. A survey of a representative U.S. national sample (N=3,341; 78.13% total response rate) was conducted between April 29 and June 26, 2015. We assessed views about Tsarnaev's sentencing (i.e., whether he should receive the death penalty), political party, demographics, and psychological indicators; 81.77% of our sample completed the survey prior to Tsarnaev's sentencing and 18.23% completed the survey afterwards. Multiple logistic regression analyses indicated that those who completed the survey after Tsarnaev was sentenced to death were more likely to support a death penalty sentence than were those who took the survey prior to the sentencing (OR=1.48, p=.007; 95% confidence [1.11, 1.96]). These results remained significant after adjusting for significant covariates, including male gender, White race, Protestant-Christian religious affiliation, Boston residency, beliefs in a just world, and Republican political party identification. Results of this quasi-experiment suggest that people adjust their opinions to be consistent with the fait accompli, particularly once the outcome is widely known.

Depression, social support, and stigma as predictors of quality of life over time: results from an Asha-based HIV/AIDS intervention in India.

Quality of life (QOL) is associated with better outcomes in HIV/AIDS populations. We explored predictors of improved QOL over time in 600 Women Living with HIV/AIDS (WLH/A) in India [mean age = 34.31, SD = 6.97], enrolled in a nurse-led-Asha (Accredited Social Health Activist) intervention. Trained local interviewers ascertained self-report data at baseline and six-month follow-up (post-intervention). Latent Class Analysis (LCA) identified constellations of responses on psychosocial indicators (depression, social support, internalized stigma and stigma fears); their relationship with QOL over time was examined. We identified three classes: Class 1) Highest Social Resources/Lowest Depression; Class 2) Some Social Resources/Highest Depression; and Class 3) Lowest Social Resources/Higher Depression. At baseline, Class 3 reported the lowest QOL (M = 0.25, SD = 0.26); Class 1 reported the highest (M = 0.37, SD = 0.33). Class 2's QOL did not differ from Class 3's QOL, likely due to the potent effects of high depression. At six-month follow-up, all groups reported improved QOL; class membership no longer predicted variability (contrast between Class 2 and 1 = -0.05, 95% CI = -0.14, 0.04; contrast between Class 3 and 1 = 0.01, 95% CI = -0.03, 0.05; contrast between Class 3 and 2 = 0.07, 95% CI = -0.02, 0.16). Psychosocial indicators are important predictors of QOL; an Asha-supported approach may have broad applicability to improve QOL in WLH/A in India.

Aftermath of Terror: A Nationwide Longitudinal Study of Posttraumatic Stress and Worry Across the Decade Following the September 11, 2001 Terrorist Attacks.

Research conducted in the early years after the September 11, 2001 (9/11) terrorist attacks in New York, Pennsylvania, and Washington, DC demonstrated adverse psychological outcomes among residents of the United States who were exposed to the attacks both directly and indirectly via the media. However, less is known about the impact of this collective trauma over time. Beginning at the end of December 2006, a longitudinal study of a nationally representative sample of U.S. residents (Cohort 2, N = 1,613) examined the long-term effects of 9/11, with annual assessments administered every year for 3 years. We assessed rates of 9/11-related posttraumatic stress (PTS) annually during the first 2 years of the study; during the second and third years of the study, we assessed fear and worry regarding future terrorism. Rates of PTS among participants were compared with those assessed annually in a nationally representative sample between 2002 and 2004 (Cohort 1); results indicated a relatively stable pattern of 9/11-related PTS symptoms for 6 years following the attacks. Five to six years after 9/11, we found an association between 9/11-related PTS and both direct, B = 8.45, 95% CI [4.32, 12.59] and media-based (live television), B = 1.78, 95% CI [0.90, 2.65] exposure to the attacks. Six to 7 years post-9/11, fear and worry regarding future terrorism were predicted by 9/11-related PTS symptoms that had been reported approximately 5 years after the attacks, B = 0.04, 95% CI [0.03, 0.05]. The psychological legacy of 9/11 was perceptible among many U.S. residents throughout the decade that followed.

Public Understanding of Ebola Risks: Mastering an Unfamiliar Threat.

Ebola was the most widely followed news story in the United States in October 2014. Here, we ask what members of the U.S. public learned about the disease, given the often chaotic media environment. Early in 2015, we surveyed a representative sample of 3,447 U.S. residents about their Ebola-related beliefs, attitudes, and behaviors. Where possible, we elicited judgments in terms sufficiently precise to allow comparing them to scientific estimates (e.g., the death toll to date and the probability of dying once ill). Respondents' judgments were generally consistent with one another, with scientific knowledge, and with their self-reported behavioral responses and policy preferences. Thus, by the time the threat appeared to have subsided in the United States, members of the public, as a whole, had seemingly mastered its basic contours. Moreover, they could express their beliefs in quantitative terms. Judgments of personal risk were weakly and inconsistently related to reported gender, age, education, income, or political ideology. Better educated and wealthier respondents saw population risks as lower; females saw them as higher. More politically conservative respondents saw Ebola as more transmissible and expressed less support for public health policies. In general, respondents supported providing "honest, accurate information, even if that information worried people." These results suggest the value of proactive communications designed to inform the lay public's decisions, thoughts, and emotions, and informed by concurrent surveys of their responses and needs.

Media's role in broadcasting acute stress following the Boston Marathon bombings.

We compared the impact of media vs. direct exposure on acute stress response to collective trauma. We conducted an Internet-based survey following the Boston Marathon bombings between April 29 and May 13, 2013, with representative samples of residents from Boston (n = 846), New York City (n = 941), and the remainder of the United States (n = 2,888). Acute stress symptom scores were comparable in Boston and New York [regression coefficient (b) = 0.43; SE = 1.42; 95% confidence interval (CI), -2.36, 3.23], but lower nationwide when compared with Boston (b = -2.21; SE = 1.07; 95% CI, -4.31, -0.12). Adjusting for prebombing mental health (collected prospectively), demographics, and prior collective stress exposure, six or more daily hours of bombing-related media exposure in the week after the bombings was associated with higher acute stress than direct exposure to the bombings (continuous acute stress symptom total: media exposure b = 15.61 vs. direct exposure b = 5.69). Controlling for prospectively collected prebombing television-watching habits did not change the findings. In adjusted models, direct exposure to the 9/11 terrorist attacks and the Sandy Hook School shootings were both significantly associated with bombing-related acute stress; Superstorm Sandy exposure wasn't. Prior exposure to similar and/or violent events may render some individuals vulnerable to the negative effects of collective traumas. Repeatedly engaging with trauma-related media content for several hours daily shortly after collective trauma may prolong acute stress experiences and promote substantial stress-related symptomatology. Mass media may become a conduit that spreads negative consequences of community trauma beyond directly affected communities.

Evacuation from Natural Disasters: A Systematic Review of the Literature.

Research on evacuation from natural disasters has been published across the peer-reviewed literature among several disparate disciplinary outlets and has suggested a wide variety of predictors of evacuation behavior. We conducted a systematic review to summarize and evaluate the current literature on demographic, storm-related, and psychosocial correlates of natural disaster evacuation behavior. Eighty-three eligible papers utilizing 83 independent samples were identified. Risk perception was a consistent positive predictor of evacuation, as were several demographic indicators, prior evacuation behavior, and having an evacuation plan. The influence of prior experiences, self-efficacy, personality, and links between expected and actual behavior were examined less frequently. Prospective, longitudinal designs are relatively uncommon. Although difficult to conduct in postdisaster settings, more prospective, methodologically rigorous studies would bolster inferences. Results synthesize the current body of literature on evacuation behavior and can help inform the design of more effective predisaster evacuation warnings and procedures.

Media Use and Exposure to Graphic Content in the Week Following the Boston Marathon Bombings.

Traditional and new media inform and expose the public to potentially distressing graphic content following disasters, but predictors of media use have received limited attention. We examine media-use patterns after the Boston Marathon bombings (BMB) in a representative national U.S. sample (n = 2888), with representative oversamples from metropolitan Boston (n = 845) and New York City (n = 941). Respondents completed an Internet-based survey 2-4 weeks post-BMB. Use of traditional media was correlated with older age, prior indirect media-based exposure to collective traumas, and direct BMB exposure. New media use was correlated with younger age and prior direct exposure to collective traumas. Increased television and online news viewing were associated with exposure to more graphic content. The relationship between traditional and new media was stronger for young adults than all other age groups. We offer insights about the relationship between prior collective trauma exposures and media use following subsequent disasters and identify media sources likely to expose people to graphic content.

Cumulative exposure to prior collective trauma and acute stress responses to the Boston marathon bombings.

The role of repeated exposure to collective trauma in explaining response to subsequent community-wide trauma is poorly understood. We examined the relationship between acute stress response to the 2013 Boston Marathon bombings and prior direct and indirect media-based exposure to three collective traumatic events: the September 11, 2001 (9/11) terrorist attacks, Superstorm Sandy, and the Sandy Hook Elementary School shooting. Representative samples of residents of metropolitan Boston (n = 846) and New York City (n = 941) completed Internet-based surveys shortly after the Boston Marathon bombings. Cumulative direct exposure and indirect exposure to prior community trauma and acute stress symptoms were assessed. Acute stress levels did not differ between Boston and New York metropolitan residents. Cumulative direct and indirect, live-media-based exposure to 9/11, Superstorm Sandy, and the Sandy Hook shooting were positively associated with acute stress responses in the covariate-adjusted model. People who experience multiple community-based traumas may be sensitized to the negative impact of subsequent events, especially in communities previously exposed to similar disasters.

Internally displaced "victims of armed conflict" in Colombia: the trajectory and trauma signature of forced migration.

While conflict-induced forced migration is a global phenomenon, the situation in Colombia, South America, is distinctive. Colombia has ranked either first or second in the number of internally displaced persons for 10 years, a consequence of decades of armed conflict compounded by high prevalence of drug trafficking. The displacement trajectory for displaced persons in Colombia proceeds through a sequence of stages: (1) pre-expulsion threats and vulnerability, (2) expulsion, (3) migration, (4) initial adaptation to relocation, (5) protracted resettlement (the end point for most forced migrants), and, rarely, (6) return to the community of origin. Trauma signature analysis, an evidence-based method that elucidates the physical and psychological consequences associated with exposures to harm and loss during disasters and complex emergencies, was used to identify the psychological risk factors and potentially traumatic events experienced by conflict-displaced persons in Colombia, stratified across the phases of displacement. Trauma and loss are experienced differentially throughout the pathway of displacement.

Can mindfulness-based interventions reduce PTSD symptoms? An umbrella review.

Post-traumatic stress disorder (PTSD) is a debilitating, often chronic condition with substantial cross-national lifetime prevalence. Although mindfulness-based interventions (MBIs) may help reduce PTSD symptoms, efficacy results are inconsistent. Despite many systematic reviews (SRs) examining MBIs for PTSD, SR quality has been neither evaluated nor synthesized. We conducted an umbrella review to summarize and evaluate existing evidence regarding MBIs for PTSD, identifying 69 SRs (27 meta-analyses), consisting of 83 primary studies. Using AMSTAR2 (a valid SR quality assessment tool), we evaluated each SR on key domains relevant to methodological rigor and rated the confidence of inferences. Results found SRs were 65.2% non-rigorous, 27.5% likely rigorous, and 7.2% rigorous; common limitations included inadequate risk of bias assessment, extractions not completed in duplicate, and lack of pre-registration, highlighting the need for higher quality SRs. We then performed a meta-meta-analysis to estimate the efficacy of MBIs to reduce PTSD symptoms, yielding a medium effect size (SMD=0.41, p < .001), derived from 22 meta-analyses (with replicable data) and 35 unique articles. Analyses were consistent across control conditions and MBI type (first-generation/narrow [i.e., MBIs with well-established protocols]) versus broad (i.e., other MBI types), comparable with second-line treatments (e.g., pharmacotherapy). Findings were narratively synthesized; areas for methodological improvements in MBI research were identified.

Climate change anxiety, hurricane exposure, and climate change actions and attitudes: results from a representative, probability-based survey of US Gulf Coast residents.

BACKGROUND: Exposure to climate change-related threats (eg, hurricanes) has been associated with mental health symptoms, including post-traumatic stress symptoms. Yet it is unclear whether climate change anxiety, which is understudied in representative samples, is a specific mental health threat, action motivator, or both, particularly in populations exposed to climate-change related disasters. We sought to examine the associations between exposure to hurricanes, climate change anxiety, and climate change actions and attitudes in a representative sample of US Gulf Coast residents. METHODS: This study used data from a 5-year, representative, prospectively assessed, probability-based, longitudinal cohort sample of residents in Texas and Florida (USA) exposed to exogenous catastrophic hurricanes rated category 3 or greater. Participants were adults aged 18 years and older and were initially recruited from the Ipsos KnowledgePanel in the 60 h before Hurricane Irma (Sept 8-11, 2017). Relationships between climate change anxiety, hurricane exposure, hurricane-related post-traumatic stress symptoms, general functional impairment, and climate change-related individual-level actions (eg, eating a plant-based diet and driving more fuel efficient cars) and collective-level actions (eg, petition signing and donating money) and climate change action attitudes were evaluated using structural equation modelling. FINDINGS: The final survey was completed by 1479 individuals (787 [53·2%] women and 692 [46·8%] men). Two climate change anxiety subscales (cognitive-emotional impairment and perceived experience of climate change) were confirmed using confirmatory factor analysis. Mean values were low for both climate change anxiety subscales: cognitive-emotional impairment (mean 1·31 [SD 0·63], range 1-5) and perceived climate change experience (mean 1·67 [SD 0·89], range 1-5); these subscales differentially predicted outcomes. The cognitive-emotional impairment subscale did not significantly correlate with actions or attitudes; its relationship with general functional impairment was attenuated by co-occurring hurricane-related post-traumatic stress symptoms, which were highly correlated with general functional impairment in all three models (all p<0·0001). The perceived climate change experience subscale correlated with climate change attitudes (b=0·57, 95% CI 0·47-0·66; p<0·0001), individual-level actions (b=0·34, 0·21-0·47; p<0·0001), and collective-level actions (b=0·22, 0·10-0·33; p=0·0002), but was not significantly associated with general functional impairment in any of the final models. Hurricane exposure correlated with climate change-related individual-level (b=0·26, 0·10-0·42; p=0·0011) and collective-level (b=0·41, 0·26-0·56; p<0·0001) actions. INTERPRETATION: Expanded treatment for post-traumatic stress symptoms after disasters could help address climate change-related psychological distress; experiences with climate change and natural hazards could be inflection points to motivate action. FUNDING: National Science Foundation and the National Center for Atmospheric Research.

Associations between mindfulness and mental health after collective trauma: results from a longitudinal, representative, probability-based survey.

BACKGROUND/OBJECTIVES: Trait mindfulness (TM) may protect against post-trauma mental health ailments and related impairment. Few studies have evaluated this association in the context of collective traumas using representative samples or longitudinal designs. DESIGN/METHOD: We explored relationships between TM and collective trauma-related outcomes in a prospective, representative, probability-based sample of 1846 U.S. Gulf Coast residents repeatedly exposed to catastrophic hurricanes, assessed twice during the COVID-19 outbreak (Wave 1: 5/14/20-5/27/20; Wave 2: 12/21/21-1/11/22). Generalized estimating equations examined longitudinal relationships between TM, COVID-19-related fear/worry, hurricane-related fear/worry, global distress, and functional impairment; ordinary least squares regression analyses examined the cross-sectional association between TM and COVID-19-related posttraumatic stress symptoms (PTSS) at Wave 1. Event-related stressor exposure was explored as a moderator. RESULTS: In covariate-adjusted models including pre-event mental health ailments and demographics, TM was negatively associated with COVID-19-related fear/worry, hurricane-related fear/worry, global distress, and functional impairment over time; in cross-sectional analyses, TM was negatively associated with COVID-19-related PTSS. TM moderated the relationship between COVID-19 secondary stressor exposure (e.g., lost job/wages) and both global distress and functional impairment over time. CONCLUSIONS: Results suggest TM may buffer adverse psychosocial outcomes following collective trauma, with some evidence TM may protect against negative effects of secondary stressor exposure.

A longitudinal investigation of risk perceptions and adaptation behavior in the US Gulf Coast.

Climate change is occurring more rapidly than expected, requiring that people quickly and continually adapt to reduce human suffering. The reality is that climate change-related threats are unpredictable; thus, adaptive behavior must be continually performed even when threat saliency decreases (e.g. time has passed since climate-hazard exposure). Climate change-related threats are also intensifying; thus, new or more adaptive behaviors must be performed over time. Given the need to sustain climate change-related adaptation even when threat saliency decreases, it becomes essential to better understand how the relationship between risk perceptions and adaptation co-evolve over time. In this study, we present results from a probability-based representative sample of 2,774 Texas and Florida residents prospectively surveyed 5 times (2017-2022) in the presence and absence of exposure to tropical cyclones, a climate change-related threat. Distinct trajectories of personal risk perceptions emerged, with higher and more variable risk perceptions among the less educated and those living in Florida. Importantly, as tropical cyclone adaptation behaviors increased, personal risk perceptions decreased over time, particularly in the absence of storms, while future tropical cyclone risk perceptions remained constant. In sum, adapting occurs in response to current risk but may inhibit future action despite increasing future tropical cyclone risks. Our results suggest that programs and policies encouraging proactive adaptation investment may be warranted.

Finding benefits during collective stress: A study of health behaviors in a longitudinal representative U.S. sample during the COVID-19 era.

OBJECTIVE: Cognitive strategies like finding benefits during adversity may facilitate coping during collective stressors (like COVID-19) by reducing distress or motivating health protective behaviors. METHOD: We explored relationships between benefit finding, collective- and individual-level adversity exposure, psychological distress, and health protective behaviors using longitudinal data collected during the COVID-19 era from a representative, probability-based sample of U.S. residents: Wave 1 (N = 6,514, March 18, 2020-April 18, 2020, 58.5% completion rate); Wave 2 (N = 5,661, September 26, 2020-October 16, 2020, 87.1% completion rate); Wave 3 (N = 4,881, November 8, 2021-November 24, 2021, 75.3% completion rate); and Wave 4 (N = 4,859, May 19, 2022-June 16, 2022, 75.1% completion rate). RESULTS: Benefit finding was common; k-means clustering (an exploratory, data-driven approach) yielded five trajectories: always high (15.85%), always low (18.52%), always middle (28.47%), increasing (17.79%), and decreasing (19.37%). Benefit-finding trajectories were generally not strong correlates of psychological distress and functional impairment over time. Rather, benefit finding robustly correlated with health protective behaviors relevant to COVID-19 and the seasonal flu. In covariate-adjusted models, benefit finding positively correlated with more social distancing (ß = .24, p < .001) and mask wearing (ß = .18, p < .001) at Wave 2 and greater COVID-19 (odds ratio, OR = 1.23, p = .001) and flu (OR = 1.29, p < .001) vaccination at Wave 3. CONCLUSIONS: Although benefit finding was not generally associated with lower psychological distress during a collective stressor, it correlated with engagement in stressor-related health protective behaviors. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Efficacy of yoga for posttraumatic stress disorder: A systematic review and meta-analysis of randomized controlled trials.

Yoga is an increasingly popular complementary intervention to reduce posttraumatic stress disorder (PTSD) symptoms and related comorbidities, but its safety and treatment efficacy are not firmly established. We conducted a systematic review and meta-analysis of existing randomized control trials (RCTs) of yoga interventions for PTSD and related secondary outcomes (e.g., depression). Initial search results found over 668 potential papers. Twenty met inclusion criteria (e.g., RCTs on adult participants with PTSD that evaluated safety or efficacy outcomes). Meta-analysis indicated that, compared to control interventions, participation in yoga interventions significantly improved self-report PTSD (standardized mean difference [SMD]: -0.51; 95 % confidence interval [CI]: -0.68, -0.35) and immediate (SMD: -0.39; 95 % CI: -0.56, -0.22) and long-term (SMD: -0.44; 95 % CI: -0.74, -0.13) depression symptoms. However, using clinician-reported assessments, yoga interventions were not associated with improved PTSD symptoms. Type of yoga differentially predicted outcomes. Sensitivity analysis showed consistent effect sizes when omitting each study from main analyses. Six studies reported whether any serious adverse events occurred. None were indicated. No publication bias was found, although individual intervention studies tended to be high in bias. Results suggest yoga is likely a safe and effective complementary intervention for reducing PTSD and depressive symptoms in individuals with PTSD. More rigorous RCTs are warranted.

Pilot randomized controlled trial of biofeedback on reducing psychological and physiological stress among persons experiencing homelessness.

People experiencing homelessness report increased exposure to traumatic life events and higher rates of depression, anxiety, and post-traumatic stress disorder as compared with the general population. Heart rate variability-biofeedback (HRV-BF) has been shown to decrease symptoms of stress, anxiety, depression, and PTSD. However, HRV-BF has not been tested with the most vulnerable of populations, homeless adults. The purpose of this randomized controlled trial was to compare the effectiveness of an HRV-BF intervention versus a Health Promotion (HP) active control intervention focused on improving mental health symptoms among homeless adults. Guided by a community advisory board, homeless adults residing in Skid Row, Los Angeles (n = 40) were randomized to either the HRV-BF or an active HP control group and received eight weekly, 30-min sessions over two months, delivered by a nurse-led community health worker team. Dependent variables of HRV, mental health, anxiety, depression, and PTSD were measured at baseline, the 8-week session, and/or 2-month follow-up. All intervention sessions were completed by 90% (36/40) of participants. Both the HRV-BF and HP interventions showed significant increases in HRV from baseline to 2-month follow-up, with no significant difference between the intervention groups. The HRV-BF programme revealed a somewhat greater, although non-significant, improvement in anxiety, depression, and PTSD symptoms than the HP programme. The usefulness of both interventions, focused on emotional and physical health, warrants future studies to examine the value of a combined HRV-BF and HP intervention.