Observational study on implications of the COVID-19-pandemic for cardiopulmonary resuscitation in out-of-hospital cardiac arrest: qualitative and quantitative insights from a model region in Germany.

BACKGROUND: The city of Freiburg has been among the most affected regions by the COVID-19 pandemic in Germany. In out of hospital cardiac arrest (OHCA) care, all parts of the rescue system were exposed to profound infrastructural changes. We aimed to provide a comprehensive overview of these changes in the resuscitation landscape in the Freiburg region. METHODS: Utstein-style quantitative data on OHCA with CPR initiated, occurring in the first pandemic wave between February 27th, 2020 and April 30th, 2020 were compared to the same time periods between 2016 and 2019. Additionally, qualitative changes in the entire rescue system were analyzed and described. RESULTS: Incidence of OHCA with attempted CPR did not significantly increase during the pandemic period (11.1/100.000 inhabitants/63 days vs 10.4/100.000 inhabitants/63 days, p = 1.000). In witnessed cases, bystander-CPR decreased significantly from 57.7% (30/52) to 25% (4/16) (p = 0.043). A severe pre-existing condition (PEC) was documented more often, 66.7% (16/24) vs 38.2% (39/102) there were longer emergency medical services (EMS) response times, more resuscitation attempts terminated on scene, 62.5% (15/24) vs. 34.3% (35/102) and less patients transported to hospital (p = 0.019). Public basic life support courses, an app-based first-responder alarm system, Kids Save Lives activities and a prehospital extracorporeal CPR (eCPR) service were paused during the peak of the pandemic. CONCLUSION: In our region, bystander CPR in witnessed OHCA cases as well as the number of patients transported to hospital significantly decreased during the first pandemic wave. Several important parts of the resuscitation landscape were paused. The COVID-19 pandemic impedes OHCA care, which leads to additional casualties. Countermeasures should be taken.

Meaning in Life Moderates Relations between Personality and Temperament and Nonsuicidal Self-Injury in Hospitalized Adolescents.

Previous research indicates that sensation seeking, emotion dysregulation, and impulsivity are predictive of non-suicidal self-injury (NSSI). A body of research supports that meaning in life predicts improved mental health and well-being, including fewer suicidal thoughts and attempts, yet no research has examined the moderating effects of meaning in life on the relations between personality and temperament and NSSI. Given the growing incidence rates of NSSI among adolescents and the potential lifelong consequences of NSSI, it is imperative to better understand the factors that reduce the rates at which adolescents in a clinical sample engage in NSSI. The present study investigates if the protective factors of meaning in life moderate the relation between personality and temperament variables and NSSI among 126 adolescents (71% female, Mage = 16.1, SD = 1.1, range 13-18, 80% White) residing in an inpatient psychiatric hospital who endorsed NSSI in the last 12 months. Results from hurdle modeling indicate that two subtypes of meaning in life, presence of meaning in life and search for meaning of life, may serve as robust protective factors against engagement in NSSI among a clinical sample of adolescents. Additionally, results suggest that search for meaning, but not presence of meaning in life, variables moderate the relations between personality and temperament and NSSI. Results provide evidence that meaning in life is an understudied variable of importance in understanding how to prevent or treat NSSI. It also underscores the need to develop, refine, and test meaning-making interventions.

Assessing meaning & purpose in life: development and validation of an item bank and short forms for the NIH PROMIS®.

PURPOSE: A sense of meaning and purpose is important for people living with acute and chronic illness. It can buffer the effects of stress and facilitate adaptive coping. As part of the Patient-Reported Outcomes Measurement Information System (PROMIS), we developed and validated an item response theory (IRT)-based measure of meaning and purpose in life. METHODS: Informed by a literature review and patient and content-expert input, we wrote 52 items to assess meaning and purpose and administered them to a general population sample (n = 1000) along with the Meaning in Life Questionnaire-Presence of Meaning Subscale (MLQ-Presence) and the Life Engagement Test (LET). We split the sample in half for exploratory factor analysis (EFA) followed by confirmatory factor analysis (CFA). IRT analyses included assessments of differential item functioning (DIF). RESULTS: Participants had a mean age of 47.8 years and 50.3% were male. EFA revealed one dominant factor and CFA yielded a good fitting model for a 37-item bank (CFI = 0.962, TLI = 0.960, RMSEA = 0.085). All items were free of sex, age, education, and race DIF. Internal consistency reliability estimates ranged from α = 0.90 (4-item short form) to α = 0.98 (37-item bank). The 8-item Meaning and Purpose short form was correlated with the MLQ-Presence (r = 0.89), the LET (r = 0.79), and the full PROMIS Meaning and Purpose item bank (r = 0.98). CONCLUSIONS: The PROMIS Meaning and Purpose measures demonstrated sufficient unidimensionality and displayed good internal consistency, model fit, and convergent validity. Further psychometric testing of the PROMIS Meaning and Purpose item bank and short forms in people with chronic diseases will help evaluate the generalizability of this new tool.

Meaning making, self-determination theory, and the question of wisdom in personality.

Self-determination theory (SDT) has advanced the most comprehensive model of motives for human flourishing in the field of personality psychology and beyond. In this article, we evaluate SDT relative to the process of meaning making, particularly from a narrative perspective, showing what SDT can and cannot explain about the construction of self-identity and its relation to human flourishing. On the one hand, SDT explains how subjective assessments of need fulfillment drive the process of self-determined living. The internal motives that follow such fulfillment serve as important themes in people's life stories that predict several markers of hedonic and eudaimonic well-being. On the other hand, SDT's focus on subjective fulfillment limits what SDT can explain about how wisdom, which is a canonical good of both eudaimonia and meaning making, helps people make sense of life's more difficult or unfulfilling events. SDT may facilitate a facet of wisdom that is more subjective and experiential but not the critical facet of wisdom defined by objectively more complex structures of interpretation.

Patient-family communication mediates the relation between family hardiness and caregiver positivity: Exploring the moderating role of caregiver depression and anxiety.

Purpose: Despite the theoretical and empirical significance of positive aspects of caregiving in caregiver well-being, relatively little is known regarding family-related predictors of caregiver positivity. This study examines whether patient-family communication (p-f communication) mediates the relation between family hardiness and caregiver positivity and whether the mediating effects of p-f communication are moderated by the levels of caregiver depression and anxiety. Design/Sample: This study used secondary data obtained from a large-scale cross-sectional national survey conducted in South Korea. Participants were 544 spousal cancer patient-caregiver dyads recruited from the National Cancer Center and nine government-designated regional cancer centers in South Korea. Methods: To test the hypotheses, a simple mediation model and two moderated mediation tests were conducted using the PROCESS macro for SPSS. Findings: Higher family hardiness was related to higher p-f positive communication and higher caregiver positivity. The effects of family hardiness were partially mediated by p-f communication, controlling for caregiver sex, education, health status, depression and anxiety, time spent caregiving, and patient depression and anxiety, cancer stage, and time since diagnosis. The mediating effects of p-f communication were not significantly moderated by caregiver depression and anxiety. Conclusions/Implications: Health care professionals could consider p-f communication as a reasonable target of intervention to increase caregiver positivity, even for caregivers with heightened depression and anxiety.

Refining and supplementing candidate measures of psychological well-being for the NIH PROMIS®: qualitative results from a mixed cancer sample.

PURPOSE: The Patient-Reported Outcomes Measurement Information System (PROMIS) is a National Institutes of Health initiative designed to improve patient-reported outcomes using state-of-the-art psychometric methods. The aim of this study is to describe qualitative efforts to identify and refine items from psychological well-being subdomains for future testing, psychometric evaluation, and inclusion within PROMIS. METHOD: Seventy-two items from eight existing measures of positive affect, life satisfaction, meaning & purpose, and general self-efficacy were reviewed, and 48 new items were identified or written where content was lacking. Cognitive interviews were conducted in patients with cancer (n = 20; 5 interviews per item) to evaluate comprehensibility, clarity, and response options of candidate items. RESULTS: A Lexile analysis confirmed that all items were written at the sixth grade reading level or below. A majority of patients demonstrated good understanding and logic for all items; however, nine items were identified as "moderately difficult" or "difficult" to answer. Patients reported a strong preference for confidence versus frequency response options for general self-efficacy items. CONCLUSIONS: Altogether, 108 items were sufficiently comprehensible and clear (34 positive affect, 10 life satisfaction, 44 meaning & purpose, 20 general self-efficacy). Future research will examine the psychometric properties of the proposed item banks for further refinement and validation as PROMIS measures.

Understanding work enjoyment among older workers: The significance of flexible work options and age discrimination in the workplace.

Although the number of older workers in the U.S. is increasing, there is a gap in knowledge on whether or not they actually enjoy working. This study, based on a conceptual framework focusing on job resources and demands, explored likely workplace determinants of work enjoyment among older workers aged 50 or over. Using the 2012 wave of the Health and Retirement Study, a partial proportional odds model was used to detect determinants of work enjoyment. Results showed that higher levels of work enjoyment were significantly and negatively associated with the level of perceived retirement pressure and promotion preference for younger workers, and positively associated with moving to less demanding positions. Self-employment showed a noticeable enhancement of work enjoyment. This study highlights the significance of flexible work options and age discrimination in the workplace in understanding work enjoyment later in life.

Meaning and Posttraumatic Growth Among Survivors of the September 2013 Colorado Floods.

In the wake of significant adversity, a range of recovery outcomes are possible, from prolonged distress to minimal effects on functioning and even psychological growth. Finding meaning in one's life is thought to facilitate optimal recovery from such adversity. Research on psychological growth and recovery often focuses on the daily hassles or significant traumas of convenience samples or on people's psychological recovery from medical illness. A small body of research is developing to test theories of growth among survivors of natural disasters. The present study of 57 survivors of the 2013 Colorado floods tested the incremental relations between posttraumatic growth (PTG) and dimensions of meaning in life, vitality, and perceived social support. The most consistent relations observed were among the one dimension of meaning-search for meaning-perceived social support, and PTG. Despite the limitations of this study, we conclude that search for meaning in life may be an important part of recovery from natural disasters, floods being one example.

Violations of war: testing the meaning-making model among Vietnam veterans.

OBJECTIVE: Posttrauma adjustment theories postulate that intense stressors violate people's beliefs about the world and perceived ability to achieve valued goals. Failure to make meaning from traumatic events exacerbates negative adjustment (e.g., PTSD), whereas success facilitates positive adjustment (e.g., stress-related growth). The current study aimed to test this model of direct and indirect effects among a sample of veterans. METHOD: Vietnam veterans (N = 130) completed assessment measures in an online survey format. Participants were largely male (91%) and Caucasian (93%) with a mean age of 61 years. RESULTS: Results supported basic model tenets, linking military stress severity to violations of beliefs and goals. In the final model, only goal violations carried indirect effects of severity on PTSD symptoms. Presence of and search for meaning carried a portion of the indirect effects between goal violations and both PTSD and stress-related growth. CONCLUSION: Findings suggest that traumatic stress may disrupt people's goals and meaning-making may center on these disruptions.

The potential role of meaning in life in the relationship between bullying victimization and suicidal ideation.

Adolescent bullying is a common problem in schools across America. The consequences of bullying are significant, and can include severe psychological trauma and suicide. A better understanding of the mechanisms that link bullying and suicidal ideation is needed in order to develop effective prevention and intervention initiatives. Meaning in life is a potential mechanism that has not been studied in this context. It was hypothesized that meaning in life could serve as both a mediator and a moderator of the relationship between bullying victimization and suicidal ideation. As a mediator, meaning in life is considered to explain why bullying victimization leads to suicidal ideation. As a moderator, meaning in life is considered to buffer the ill effect of bullying victimization on suicidal ideation. Data collected from an ethnically diverse sample of 2,936 (50% female), 6th-12th grade students from one urban school district in the Northeastern US were used to examine the hypotheses. The model for girls was consistent with mediation (i.e., meaning in life may explain how victimization leads to suicidal ideation). The model for boys was consistent with moderation (i.e., the ill effect of victimization on suicidal ideation was attenuated as meaning in life increased). Implications for prevention are discussed.

Disentangling trait and daily experiences of uncertainty and meaning in life: implications for daily anxiety, negative affect, and somatic symptoms.

BACKGROUND: Although there is growing evidence supporting the association between intolerance of uncertainty (IU) and psychopathology, little is known about the covariation of IU and psychological distress day-to-day. The purpose of this ecological momentary assessment (EMA) study was to examine negative emotional and somatic correlates of trait IU and daily uncertainty, while investigating how a source of stability, meaning in life (MIL), might buffer against deleterious effects of IU and uncertainty. DESIGN AND METHODS: Adult community members (n = 62) from a mid-size town in the Rocky Mountain region completed baseline measures of IU and MIL and ecological momentary assessments (EMA) of meaning, uncertainty, affect, and somatic symptoms over the course of one week. RESULTS: Results indicate individuals high in trait IU experience more uncertainty day-to-day and greater distress when they feel uncertain compared to individuals lower in trait IU; however, MIL plays a stronger protective role for high IU compared to low IU individuals. CONCLUSIONS: These findings support and extend previous research showing IU is associated with psychological distress and that MIL may be a critical resource to cultivate. Interventions promoting meaning day-to-day may reduce the effects of uncertainty on the well-being of those highly intolerant of uncertainty.

Individual and parental factors related to meaning in life among Hungarian minority adolescents from Romania.

Understanding how adolescents achieve meaning in life has important implications for their psychological development. A social cognitive model of meaning development was tested by assessing psychological (self-efficacy, self-regulation and social comparison) and parental (parental responsiveness, demandingness, and social support) variables in a sample of 1944 adolescents (aged 15-19 years; 47.8% males) from secondary schools of the Middle Transylvanian Region, Romania. Both psychological and parental factors were significantly related to meaning in life. For both boys and girls, self-efficacy, self-regulation, and maternal responsiveness related positively with meaning in life, and paternal demandingness related inversely to meaning in life. However, social comparison related positively to meaning only among boys, and paternal responsiveness related positively to meaning only among girls. Results point to a possible meaning-supporting role played by social cognitive variables, as well as parental autonomy support. The gender differences observed here suggest that existing theories of meaning development may need to be elaborated to include family of origin and gender.

Meaning in life: is it a protective factor for adolescents' psychological health?

BACKGROUND: Searching for a coherent meaning in life has long been proposed to be a protective factor in adolescent development. PURPOSE: The present study aimed to examine meaning in life as a protective factor in a largely unstudied population: Romanian adolescents. Additionally, we sought to provide a novel, multidimensional assessment of several health-related variables (substance abuse, health risk behaviors, psychological health). Potential gender differences were explored regarding the role of life meaning in adolescent health. METHOD: Data were collected in 2006 from students enrolled in the secondary schools of the Middle Transylvanian Region, Romania (n = 1,977). Self-administered questionnaires were used as a method of data collection including items of life meaning and psychological health. RESULTS: Meaning in life played a protective role with regard to health risk behaviors except smoking and binge drinking. Among males, meaning in life was found to be correlated only to illicit drug and sedative use, whereas among females, meaning in life was associated with binge drinking, unsafe sex, and lack of exercise and diet control. Psychological health was strongly related to meaning in life. CONCLUSION: In Romanian adolescents, meaning in life is a protective factor against health risk behaviors and poor psychological health.

Make Your Work Matter: development and pilot evaluation of a purpose-centered career education intervention.

Developing a sense of purpose is both salient and desirable for adolescents, and purpose in people's lives and careers is associated with both general and work-related well-being. However, little is known about whether purpose can be encouraged through school-based interventions. This article reports the results of a quasi-experimental pilot study and follow-up focus group that evaluated Make Your Work Matter, a three-module, school-based intervention designed to help adolescent youth explore, discover, and enact a sense of purpose in their early career development. Participants were eighth-grade students. Compared to the control group, the intervention group reported increases in several outcomes related to purpose-centered career development, such as a clearer sense of career direction; a greater understanding of their interests, strengths, and weaknesses; and a greater sense of preparedness for the future. However, no significant differences were found on items directly related to purpose, calling, and prosocial attitudes. These results inform the ongoing development of Make Your Work Matter and other school-based career interventions and pave the way for larger-scale trials of such purpose-promoting intervention strategies.

Race and religion: differential prediction of anxiety symptoms by religious coping in African American and European American young adults.

BACKGROUND: Psychosocial factors, including religious coping, consistently have been implicated in the expression of anxiety disorders. This study sought to investigate the relationship between religious coping on anxiety symptoms among a nonclinical sample of African American and European American young adults. METHODS: One hundred twenty-one European American and 100 African American young adults completed measures of anxiety and religious coping. RESULTS: As predicted, results differed according to race. African Americans reported significantly more positive religious coping, less negative religious coping, and experienced fewer anxiety symptoms than European Americans. European Americans demonstrated a significant, positive relationship between negative religious coping and anxiety symptoms, and an opposite trend related to anxiety and positive religious coping. However, no such relationships emerged among the African American sample. CONCLUSIONS: Implications and suggestions for future research are discussed.

A preliminary report on a new measure: Internalization of the Model Minority Myth Measure (IM-4) and its psychological correlates among Asian American college students.

This investigation is a preliminary report on a new measure of internalization of the model minority myth. In 3 studies, there was evidence for the validation of the 15-item Internalization of the Model Minority Myth Measure (IM-4), with 2 subscales. The Model Minority Myth of Achievement Orientation referred to the myth of Asian Americans' greater success than other racial minority groups associated with their stronger work ethics, perseverance, and drives to succeed. The Model Minority Myth of Unrestricted Mobility referred to the myth of Asian Americans' greater success than other racial minority groups associated with their stronger belief in fairness of treatment and lack of perceived racism or barriers at school or work. The 2-subscale structure of the IM-4 was supported by a combination of exploratory and confirmatory factor analyses, with support of discriminant, convergent, and incremental validity, as well as internal reliability and stability over 2 weeks. The IM-4 is a new measure that taps into a uniquely racialized experience of Asian Americans with research and clinical implications.

Validation of the subtle and blatant racism scale for Asian American college students (SABR-A(2)).

This investigation describes the validation of a measure of perceived racism developed to assess racial experiences of Asian American college students. In three studies across two different regions of the United States, there was strong evidence for the validation of the 8-item Subtle and Blatant Racism Scale for Asian American College Students (SABR-A2). The subtle racism subscale refers to instances of discrimination attributable implicitly to racial bias or stereotype, whereas the blatant racism subscale refers to instances of discrimination attributable explicitly to racial bias or stereotype. The two-subscale structure of the SABR-A2 was supported by exploratory and confirmatory factor analyses and demonstrated discriminant, convergent, and incremental validity, as well as internal reliability and stability over 2 weeks.

Meaning, social support, and resilience as predictors of posttraumatic growth: A study of the Louisiana flooding of August 2016.

Individuals who survive natural hazards often develop posttraumatic stress symptoms or other forms of psychological distress. However, some experience psychological growth. Given that natural hazards will increase in the near future due to global warming, it would be helpful to examine predictors of growth across different kinds of natural hazards. The present study examined positive psychological factors that may serve as buffers against the negative effects of exposure to a natural hazard, specifically following the Louisiana flooding of August 2016. Volunteer participants (N = 120) self-reported perceived presence and search for meaning in life, social support, resilience, and posttraumatic growth (PTG). After controlling for amount of property damaged, posttraumatic stress symptoms, gender, religion, and ethnicity or race, presence and search for meaning, social support, and resilience explained significant additional variance in PTG scores. This research adds to the growing understanding of how individuals respond to natural hazards. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Posttraumatic stress disorder, guilt, depression, and meaning in life among military veterans.

Veterans of various service eras (N = 174) completed an Internet survey about combat exposure, posttraumatic stress disorder (PTSD) symptoms, depression, guilt, and meaning in life. Results of a hierarchical regression indicated that younger age; higher levels of combat exposure, depression, and guilt; and lower meaning in life predicted greater PTSD severity. The interaction between meaning in life and depression also was significant, with a stronger inverse relation between meaning and PTSD at lower levels of depression. Meaning in life may be an important treatment concern for veterans with PTSD symptoms, particularly at higher levels of functioning.