Shaped by the COVID-19 pandemic: Psychological responses from a subjective perspective-A longitudinal mixed-methods study across five European countries.

BACKGROUND: Contextual factors are essential for understanding long-term adjustment to the COVID-19 pandemic. Therefore, the present study investigated changes in mental health outcomes and subjective pandemic-related experiences over time and across countries. The main objective was to explore how psychological responses vary in relation to individual and environmental factors. METHODS: The sample consisted of N = 1070 participants from the general population of Austria, Croatia, Georgia, Greece, and Portugal. We applied a longitudinal mixed-methods approach, with baseline assessment in summer and autumn 2020 (T1) and follow-up assessment 12 months later (T2). Qualitative content analysis by Mayring was used to analyse open-ended questions about stressful events, positive and negative aspects of the pandemic, and recommendations on how to cope. Mental health outcomes were assessed with the Adjustment Disorder-New Module 8 (ADNM-8), the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5), the Patient Health Questionnaire-2 (PHQ-2), and the 5-item World Health Organization Well-Being Index (WHO-5). The analyses were performed with SPSS Statistics Version 26 and MAXQDA 2022. RESULTS: The mental health outcomes significantly differed over time and across countries, with e.g. Greek participants showing decrease in adjustment disorder symptoms (p = .007) between T1 and T2. Compared with other countries, we found better mental health outcomes in the Austrian and the Croatian sample at both timepoints (p < .05). Regarding qualitative data, some themes were equally represented at both timepoints (e.g. Restrictions and changes in daily life), while others were more prominent at T1 (e.g. Work and finances) or T2 (e.g. Vaccination issues). CONCLUSIONS: Our findings indicate that people's reactions to the pandemic are largely shaped by the shifting context of the pandemic, country-specific factors, and individual characteristics and circumstances. Resource-oriented interventions focusing on psychological flexibility might promote resilience and mental health amidst the COVID-19 pandemic and other global crises.

You can't do anything about it, but you can make the best of it: a qualitative analysis of pandemic-related experiences in six European countries.

Background: The complex system of stressors related to the coronavirus disease 2019 (COVID-19) pandemic has affected the global population, provoking a broad range of psychological reactions. Although numerous studies have investigated the mental health impact of COVID-19, qualitative research and cross-country comparisons are still rare. Objective: This qualitative study aimed to explore self-perceived challenges and opportunities related to COVID-19 across six European countries. The overall objective was to provide a differentiated picture of individual subjective experiences in the early stages of the pandemic. Method: The present study included 7309 participants from Austria, Croatia, Georgia, Greece, Poland, and Portugal. We performed qualitative content analysis according to Mayring analyse open-ended questions regarding stressful events, positive and negative aspects of the pandemic, and recommendations to cope with the pandemic situation. MAXQDA software was used for data management and analysis. Results: Participants' accounts were moderately consistent across the countries. The most prominent themes regarding stressful and negative pandemic aspects included: Restrictions and changes in daily life, Emotional distress, and Work and finances. Answers about positive pandemic consequences were mainly centred around the themes Reflection and growth, Opportunity for meaningful/enjoyable activities, and Benefits on interpersonal level. Key themes identified from participants' recommendations to cope with the pandemic included Beneficial behavioural adjustment, Beneficial cognitive-emotional strategies, and Social support. Conclusions: Participants experienced various challenges, but also shared several positive pandemic consequences and recommendations to cope with the pandemic. These first-hand data could inform mental health practices to promote well-being during COVID-19 and similar global challenges in the participating countries and possibly beyond. HIGHLIGHTS: We examined COVID-19-related experiences in 7309 adults from six European countries.Besides challenges, participants identified many positive pandemic consequences.Participants' recommendations to cope with COVID-19 included behavioural and cognitive-emotional strategies.

Resilience after natural disasters: the process of harnessing resources in communities differentially exposed to a flood.

Background: Disasters negatively impact mental health and well-being. Studying how people adapt and recover after adversity is crucial for disaster preparedness and response. Objective: This study examined how differentially affected communities harness their resources to adapt to the aftermath of a flood. We predicted that stronger individual, interpersonal, and community resources protect against psychosocial resource loss and, through that, are related to fewer symptoms of posttraumatic stress and depression and higher life satisfaction. We also predicted that these effects would be stronger in a flooded community, compared to a threatened, but non-flooded community. Method: Participants were randomly sampled community members from two neighbouring municipalities. One municipality was severely flooded during the 2014 floods in South East Europe (affected community, na = 223), the other was threatened but not flooded (comparison community, nc = 224). Interviews were conducted one and a half years after the disaster using the Connor-Davidson Resilience Scale 10-item version, the Multidimensional Scale of Perceived Social Support, the Community Resources Scale, the Psychosocial Resource Loss Scale, the PTSD Checklist for DSM-5, the Center for Epidemiological Studies Depression Scale Revised and the Satisfaction with Life Scale. Results: Stronger individual, interpersonal, and community resources were found to be related to better post-disaster outcomes directly and indirectly through psychosocial resource loss. In the affected community, interpersonal resources and community social capital and engagement were stronger predictors of positive adaptation. In the comparison community, community economic development and trust in community leadership were more important. Conclusion: This study provides evidence that people affected by disasters can harness their individual, interpersonal, and community resources to recover and adapt. Post-disaster interventions should aim to strengthen family and community ties, thus increasing available social support and community connectedness.

Antecedentes: Las catástrofes tienen un impacto negativo en la salud mental y el bienestar. Estudiar cómo se adaptan y se recuperan las personas tras la adversidad es crucial para la preparación y la respuesta ante los desastres.Objetivo: Este estudio examinó cómo las comunidades afectadas de forma diferencial aprovechan sus recursos para adaptarse a las secuelas de una inundación. Predecimos que contar con recursos individuales, interpersonales y comunitarios más fuertes protegen contra la pérdida de recursos psicosociales y, a través de ello, se relacionan con menos síntomas de estrés postraumático y depresión y una mayor satisfacción vital. También predijimos que estos efectos serían más fuertes en una comunidad inundada, en comparación con una comunidad amenazada, pero no inundada.Método: Los participantes fueron miembros de la comunidad seleccionados al azar de dos municipios vecinos. Uno de los municipios sufrió graves inundaciones durante las inundaciones del 2014 en el sureste de Europa (comunidad afectada, na = 223), el otro, estuvo amenazado pero no se inundó (comunidad de comparación, nc = 224). Las entrevistas se realizaron un año y medio después del desastre, utilizando la versión de 10 ítems de la Escala de Resiliencia de Connor-Davidson, la Escala Multidimensional de Apoyo Social Percibido, la Escala de Recursos Comunitarios, la Escala de Pérdida de Recursos Psicosociales, la Lista de Verificación del TEPT para el DSM-5, la Escala de Depresión Revisada del Centro de Estudios Epidemiológicos y la Escala de Satisfacción con la Vida.Resultados: Los recursos individuales, interpersonales y comunitarios más fuertes se relacionaron con mejores resultados después de la catástrofe, directamente e indirectamente a través de la pérdida de recursos psicosociales. En la comunidad afectada, los recursos interpersonales y el capital social y el compromiso de la comunidad fueron los mayores predictores de una adaptación positiva. En la comunidad de comparación, el desarrollo económico de la comunidad y la confianza en el liderazgo comunitario fueron más importantes.Conclusión: Este estudio aporta pruebas de que las personas afectadas por catástrofes pueden aprovechar sus recursos individuales, interpersonales y comunitarios para recuperarse y adaptarse. Las intervenciones posteriores a las catástrofes deberían tener como objetivo reforzar los lazos familiares y comunitarios, aumentando así el apoyo social disponible y la conectividad de la comunidad.

Mental health status and risk factors during Covid-19 pandemic in the Croatia's adult population.

Background: The Covid-19 pandemic is associated with adverse mental health outcomes for people worldwide.Objective: The study aimed to assess mental health during the Covid-19 pandemic and the key risk factors from the human ecology perspective in Croatia's adult population.Method: An online panel survey with 1,201 adult participants (50.1% women) was done with a nationally representative sample in terms of gender, age, and country region four months after the nation lockdown began and two months after most of the restrictions were lifted. Indicators of mental health included symptoms of adjustment disorder (ADNM-8); depression, anxiety, and stress (DASS-21); symptoms of post-traumatic stress disorder (PC-PTSD-5); and well-being (WHO-5).Results: In the entire sample, 9.8% (95% confidence interval [CI]: 7.9%, 14.0%) of the participants were at risk of adjustment disorder, 7.7% (95% CI: 6.7%, 11.9%) were at risk of depression disorder, and 7.8% (95% CI: 5.3%, 10.3%) were at risk of anxiety disorder. In addition, 7.2% (95% CI: 5.3%, 10.2%) were experiencing high levels of stress. The average well-being score was 56.5 (SD = 21.91) on a scale from 0 to 100. Among the participants who have lifetime traumatic experience (n = 429), 14% (95% CI: 10.6%, 17.2%) were at risk for PTSD. Key risk factors for specific mental health outcomes differed, but the common ones included: current health status, previous mental health diagnosis, and psychological resilience. Being younger, having a below-average income, and excessively following news about Covid-19 were predictive for some of the mental health problems.Conclusions: Together, the key risk factors identified in this study indicate the need for public health interventions addressing the general population's mental health, but also for specific risk groups. Lower rates of mental health symptoms assessed soon after lifting quarantine measures that have been found in other studies may indicate human resilience capacity.

Key risk factors for mental health disorders during the Covid-19 pandemic in Croatia were: current health status, previous mental health diagnosis, psychological resilience, younger age, below-average income, and excessively following news about the pandemic.

Stability and change post-disaster: dynamic relations between individual, interpersonal and community resources and psychosocial functioning.

Conservation of Resources (COR) theory defines psychological stress as the result of a threat or actual loss of resources, or lack of resource gain. Given that disasters present a significant risk for resource loss, the aim of this study was to examine the dynamic relationship between the change in different levels of resources and the change in psychosocial functioning. A random sample of N= 224 community members from a municipality affected by the 2014 Southeast Europe floods were interviewed one and a half and two and a half years post-disaster, using the Connor-Davidson Resilience Scale 10-item version, the Multidimensional Scale of Perceived Social Support, the Community Resources Scale - the Social Capital and Community Engagement subscale, the PTSD Checklist for DSM-5, the Center for Epidemiological Studies Depression Scale-Revised and the Satisfaction with Life Scale. The results of the Latent Difference Scores modelling indicate that the increase in resources was related to a decline in post-traumatic stress (PTS) and depression symptoms and increase in life satisfaction, and vice versa. Interpersonal resources were significantly related to all measured psychosocial outcomes, individual resources to PTS and life satisfaction and community resources to life satisfaction only. The mean level of resources remained the same, but a significant inter-individual variability in resource change was found: for some, they have increased, and for some decreased over time. Furthermore, resources changed independently: an increase in one was not related to an increase in another. These findings highlight the importance of resource gain and loss for psychosocial outcomes and call for targeted post-disaster interventions that can, by increasing the levels of resources in affected communities, decrease the levels of symptoms and increase well-being.

La Teoría de Conservación de Recursos (COR) define el estrés psicosocial como el resultado de una amenaza o efectiva pérdida de recursos, o falta de ganancia de éstos. Dado que los desastres presentan un riesgo significativo de pérdida de recursos, el objetivo de este estudio fue examinar la relación dinámica entre el cambio en diferentes niveles de recursos y el cambio en el funcionamiento psicosocial. Una muestra aleatoria de N=224 miembros de la comunidad de un municipio afectado por las inundaciones de 2014 en el Sudeste de Europa fueron entrevistados uno y medio y dos y medio años post-desastre, usando la versión de 10 ítems de la Escala de Resiliencia de Connor-Davidson, La Escala Multidimensional de Apoyo Social Percibido, la Escala de Recursos Comunitarios ­ la subescala de Capital Social y Compromiso Social, la Lista de Chequeo para TEPT del DSM-5, la Escala Revisada de Depresión del Centro de Estudios Epidemiológicos y la Escala de Satisfacción con la Vida. Los resultados del modelo de Puntajes de Diferencia Latente indican que el incremento en recursos se relacionó a una disminución de síntomas de estrés postraumático (EPT) y depresión y a un incremento en la satisfacción vital, y viceversa. Los recursos interpersonales se relacionaron significativamente a todos los resultados psicosociales medidos, los recursos individuales a EPT y satisfacción vital, y los recursos comunitarios sólo a satisfacción vital. El nivel promedio de recursos se mantuvo igual, pero se encontró una significativa variabilidad inter-individual en el cambio de recursos: para algunos aumentó y para otros disminuyó en el tiempo. Más aún, los recursos cambiaron independientemente: un incremento en uno no se relacionó a un incremento en otro. Estos hallazgos destacan la importancia de la ganancia y pérdida de recursos para los resultados psicosociales y llaman a realizar intervenciones post-desastre dirigidas que puedan, a través del incremento de los niveles de recursos en las comunidades afectadas, disminuir el nivel de síntomas e incrementar el bienestar.

Assessing refugee healthcare needs in Europe and implementing educational interventions in primary care: a focus on methods.

The current political crisis, conflicts and riots in many Middle Eastern and African countries have led to massive migration waves towards Europe. European countries, receiving these migratory waves as first port of entry (POE) over the past few years, were confronted with several challenges as a result of the sheer volume of newly arriving refugees. This humanitarian refugee crisis represents the biggest displacement crisis of a generation. Although the refugee crisis created significant challenges for all national healthcare systems across Europe, limited attention has been given to the role of primary health care (PHC) to facilitate an integrated delivery of care by enhancing care provision to refugees upon arrival, on transit or even for longer periods. Evidence-based interventions, encompassing elements of patient-centredness, shared decision-making and compassionate care, could contribute to the assessment of refugee healthcare needs and to the development and the implementation of training programmes for rapid capacity-building for the needs of these vulnerable groups and in the context of integrated PHC care. This article reports on methods used for enhancing PHC for refugees through rapid capacity-building actions in the context of a structured European project under the auspices of the European Commission and funded under the 3rd Health Programme by the Consumers, Health, Agriculture and Food Executive Agency (CHAFEA). The methods include the assessment of the health needs of all the people reaching Europe during the study period, and the identification, development, and testing of educational tools. The developed tools were evaluated following implementation in selected European primary care settings.

Primary care for refugees and newly arrived migrants in Europe: a qualitative study on health needs, barriers and wishes.

Background: In order to provide effective primary care for refugees and to develop interventions tailored to them, we must know their needs. Little is known of the health needs and experiences of recently arrived refugees and other migrants throughout their journey through Europe. We aimed to gain insight into their health needs, barriers in access and wishes regarding primary health care. Methods: In the spring of 2016, we conducted a qualitative, comparative case study in seven EU countries in a centre of first arrival, two transit centres, two intermediate-stay centres and two longer-stay centres using a Participatory Learning and Action research methodology. A total of 98 refugees and 25 healthcare workers participated in 43 sessions. Transcripts and sessions reports were coded and thematically analyzed by local researchers using the same format at all sites; data were synthesized and further analyzed by two other researchers independently. Results: The main health problems of the participants related to war and to their harsh journey like common infections and psychological distress. They encountered important barriers in accessing healthcare: time pressure, linguistic and cultural differences and lack of continuity of care. They wish for compassionate, culturally sensitive healthcare workers and for more information on procedures and health promotion. Conclusion: Health of refugees on the move in Europe is jeopardized by their bad living circumstances and barriers in access to healthcare. To address their needs, healthcare workers have to be trained in providing integrated, compassionate and cultural competent healthcare.

Application of empirical model to predict background metal concentration in mixed carbonate-alumosilicate sediment (Adriatic Sea, Croatia).

A 96m long sediment core (S10-33) from the Mali Ston Channel (Adriatic Sea) showed large natural variation in carbonate share (between 1% and 95%) and concentration of elements. These variations indicate rather significant changes in fine-grained sediment that was deposited in this area during Younger Pleistocene and Holocene. Unaffected by anthropogenic influence, sediment in the core was used to determine background concentration of trace elements in sediment with various carbonate content. Here we propose a method of the normalization of trace elements to carbonate share, in order to assess natural/background concentration of metals in sediments consisting of carbonates and alumosilicates in various proportions. Six characteristic metals (Co, Cr, Cu, Ni, Pb, and Zn) that were normalized to carbonate share showed very good correlation, with much higher background concentrations in alumosilicate than in carbonate end member. Simple formulas were proposed to easily determine background concentration of these elements, in coastal and shelf depositional environments with mixed carbonate-alumosilicate sediments.