Posttraumatic Stress Symptoms and Predictors Among Spanish Police and Armed Forces During the COVID-19 Pandemic in Spain.

OBJECTIVE: To assess the psychological impact of the COVID-19 crisis on the police and armed forces. METHODS: Participants ( N = 242) completed an online survey that assessed posttraumatic stress symptoms (PTSS), burnout, emotional suppression, and labor and sociodemographic variables. Mean difference, correlation, and stepwise linear regression tests were performed. RESULTS: One-third of participants showed severe PTSS, linked to patrolling duties, very frequent contact with other people, fear of contagion, perceived pandemic severity, living with at-risk people, taking a COVID-19 test, working more than normal, suffering an assault, having little vacation, and having to distance from loved ones. PTSS also correlated with the burnout dimensions and emotional suppression. Three-quarters had not received any support from their workplace. CONCLUSIONS: Effective interventions to optimize these professionals' personal, social, and working conditions are needed.

Predictors of mental health in healthcare workers during the COVID-19 pandemic: The role of experiential avoidance, emotion regulation and resilience.

AIMS: This study explores the mediational role of resilience, experiential avoidance and emotion regulation in the levels of anxiety, depression and posttraumatic stress disorder (PTSD) of healthcare workers during the COVID-19 pandemic. Additionally, we explored the association of such levels with personal and professional variables. DESIGN: Cross-sectional study. METHODS: Healthcare professionals working in Spain (N = 786) were recruited following a snowball approach in November and December 2021. Resilience, emotion regulation, experiential avoidance, depression, anxiety, PTSD and work-related variables were measured. Mean differences and correlations were computed, and a path analysis with latent variables (PALV) model was tested. RESULTS: In total, 18.8% of the sample scored above the cut-off score for depression, 24.6% for anxiety and 36.4% for PTSD. Higher resilience and lower experiential avoidance and expression suppression were correlated with better mental health. The PALV model explained 42%-53% of mental health outcomes. Experiential avoidance showed the greatest explanatory power and mediated the impact that stressors had on mental health. Some work-related variables correlated with greater psychological impact. These factors encompassed being a nurse, feeling that their job remained stressful and had not yet returned to its pre-pandemic state and having interacted with individuals facing economic difficulties due to the pandemic, and those who had lost their lives to COVID-19. CONCLUSION: Healthcare workers showed high levels of psychological impact during the COVID-19 pandemic. Such impact was predicted from some work-stress variables and the reliance on maladaptive strategies such as experiential avoidance and expressive suppression. IMPACT: Training healthcare professionals to use coping strategies incompatible with experiential avoidance may improve their mental health. Additionally, better working conditions are fundamental for reducing the impact of critical situations on healthcare workers' mental health. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

The religious faith item of the Spanish Posttraumatic Growth Inventory (PTGI) and its Short Form (PTGI-SF): challenges and solutions.

Background: The Posttraumatic Growth Inventory (PTGI) and its Short Form (PTGI-SF) are two instruments highly used in research on posttraumatic growth. They include a religious growth item that has been demonstrated to be problematic in cultures that are not very religious. Previous research has addressed this issue in other countries, but no attention has been paid to this critical problem in Spanish samples.Objective: Our aim is to address the psychometric issues presented by the religious growth item in Spain.Method: To do so, we reviewed several studies conducted with various populations in Spain.Results: The scores of the religious growth item in Spain present very low means and standard deviations, as well as high skewness and kurtosis, all of which point to a floor effect. The item scores show low item-test correlations, and it has failed to load on a specific dimension in factor analyses, thus casting doubts about its validity.Conclusions: The inventory does not seem to work properly in its current form in Spain. The inappropriateness of the item measuring religious growth in Spain may be due to cultural reasons. We recommend using the PTGI expanded version (PTGI-X) instead of the PTGI and exploring the possible substitution of the religious growth item in the PTGI-SF for an alternative item. In both cases, ascertaining the psychometric properties of the scores in Spain will be necessary.

The religious growth item in the PTGI and the PTGI-SF show serious psychometric validity issues in Spain. The PTGI Expanded version (PTGI-X) should be used instead of the PTGI in Spain. For the PTGI-SF, the religious item needs to be substituted.

Prediction of post-traumatic growth in the face of the COVID-19 crisis based on resilience, post-traumatic stress and social participation: A longitudinal study.

The COVID-19 crisis has generated a severe and negative psychological impact worldwide. Despite this, it is also possible to experience post-traumatic growth (PTG). This study aimed to longitudinally explore the prevalence of PTG in the Spanish population and test a predictive model for PTG from resilience, post-traumatic stress symptoms (PTSS), and participation in social activities. Data were collected longitudinally in March, July, and November 2020 via an online survey. About 20% of the sample showed moderate-high levels of PTG, with no significant differences over time. The predictive model explained 19% of the variance in PTG, showing that the inverse relation between resilience and PTG was mediated by PTSS. Additionally, participation in social activities acted as a predictor of PTG. Women, young people, those who had lost their job and people who had experienced COVID-19 symptoms or the loss of a loved one presented higher PTG. Thus, people have experienced positive changes (PTG), but these did not protect them from adverse symptomatology (PTSS).

Evolution of Posttraumatic Symptoms and Related Factors in Healthcare Workers During the COVID-19 Pandemic: A Longitudinal Study.

OBJECTIVE: This study aimed to (1) evaluate the evolution of mental health (posttraumatic stress symptoms [PTSSs], depression, and burnout) of healthcare workers during the second wave of the pandemic (November to December 2020) and compare it with the first wave (March to May 2020), and (2) ascertain the predictors of PTSSs. METHODS: In March to May 2020 (T1), 269 healthcare professionals working in Spain completed PTSSs, sadness, resilience, and coping questionnaires. In November to December 2020 (T2, N = 58), we assessed PTSSs, sadness, burnout, and depression. RESULTS: Among the healthcare professionals, 63.8% displayed severe PTSSs, 51.7% depressive symptoms, and 79.3% emotional exhaustion (T2). Some risk factors were caring for patients who were severely ill or dying and using rumination, thinking avoidance, self-isolation, emotional expression, and self-blaming as coping strategies. CONCLUSIONS: The pandemic has had a deep and long-lasting impact on the healthcare workers' mental health.

The use of online social media for the recruitment of people living with HIV in Spain and Latin America: Lessons from two studies.

Various barriers make recruiting a difficult task for researchers, especially when recruiting people living with HIV (PLWH) or conducting longitudinal studies. Effective recruitment is crucial to the validity of studies, and in this regard, social media can come to aid, although researchers usually rely on paid advertisements. This paper describes the free social media strategies used for participant recruitment in two studies carried out with PLWH in Spain and Latin America. Study 1 was a cross-sectional study on the validation of two stigma scales with a 1-month retest. Study 2 was a longitudinal study exploring the mental health of newly diagnosed PLWH, with a second assessment after 6 months. Facebook posts, Twitter mentions, and discussion forums were used in both studies. Study 2 also recruited participants through a healthcare centre. In Study 1, 5-month recruitment yielded a sample of 458 PLWH, averaging 91.6 surveys/month and a 43% retention rate. In study 2, recruitment took 16 months, yielding a final sample of 145 newly diagnosed PLWH, 92 from the healthcare centre (5.75 surveys/month) and 53 from social media (3.31 surveys/month), with 95% and 60% retention rates, respectively. Participants in Study 2 did not differ in sociodemographic characteristics by recruitment method, except for the region of origin and financial difficulty (more diverse origin and greater difficulty emerged in social media participants). Greater psychological distress and lower personal and social resources were also found in social media participants. These data indicate that free social media recruitment is a feasible and effective tool for the recruitment of Spanish-speaking PLWH, although it is best used in combination with traditional methods for newly diagnosed PLWH and longitudinal studies.

The posttraumatic growth inventory-short form (PTGI-SF): A psychometric study of the spanish population during the COVID-19 pandemic.

People can experience posttraumatic growth (PTG) when faced with potentially traumatic events. One of the most widely-used instruments to measure PTG is the Posttraumatic Growth Inventory-Short Form (PTGI-SF). However, it has not been validated for the Spanish population. This study explored the psychometric properties of the PTGI-SF in adults living in Spain during the COVID-19 pandemic. Since it is a global disaster, two items were added to assess communal PTG. The participants were adult inhabitants of Spain during the COVID-19 pandemic (N = 855). They completed the PTGI-SF in July 2020, along with the Impact of Event Scale - Revised to measure symptoms of posttraumatic stress disorder (PTSD). They also rated the degree to which they perceived the COVID-19 crisis as being severe. In November 2020, 592 participants once again completed the PTGI-SF. The factorial validity o was tested by Structural Equations Modeling (SEM). McDonald's ω coefficients were calculated to test internal consistency. The Intra-class Correlation Coefficient (ICC) was obtained to assess test-retest reliability. Sensitivity and criterion-related validity were assessed by exploring the association of the PTGI-SF scores with gender, age, PTSD symptoms, and perceived severity. Results indicated good psychometric properties for an eight-item, four-factor structure of the inventory in terms of structural validity, reliability, sensitivity and criterion-related validity. These factors were: Relating to Others, Personal Strength, Spiritual Change, and Life Value and Opportunities. Communal PTG overlapped with social PTG, and therefore it was not included. Cultural differences need to be addressed when measuring PTG, especially in terms of spiritual growth.

Working in the Times of COVID-19. Psychological Impact of the Pandemic in Frontline Workers in Spain.

This study evaluates the psychological impact (PI) of the COVID-19 pandemic in frontline workers in Spain. Participants were 546 workers (296 healthcare workers, 105 media professionals, 89 grocery workers, and 83 protective service workers). They all completed online questionnaires assessing PI, sadness, concerns related to the COVID-19 pandemic, and demographic and work-related variables. All groups but protective services workers showed higher PI levels than the general population. Healthcare and grocery workers were the most affected, with 73.6% and 65.2% of the participants, respectively, showing a severe PI. Women showed a higher PI level. Healthcare workers in the regions with higher COVID-19 incidences reported greater PI levels. The main concerns were being infected by COVID-19 or infecting others. Levels of concern correlated with higher PI levels. The protection equipment was generally reported as insufficient, which correlated with higher PI levels. Professionals reporting to overwork during the crisis (60% mass-media, 38% of healthcare and grocery and 21.7% of protective service) showed higher PI levels. In the healthcare group, taking care of patients with COVID-19 (77%) or of dying patients with COVID-19 (43.9%) was associated with higher PI levels. The perceived social recognition of their work was inversely related to PI. Most of the sample had not received psychological support. We suggest some organizational measures for frontline institutions, such as the periodical monitoring or inclusion of psychologists specialized in crisis-management to prevent negative symptoms and provide timely support.

Psychological Impact and Associated Factors During the Initial Stage of the Coronavirus (COVID-19) Pandemic Among the General Population in Spain.

The outbreak of COVID-19 in Spain started at the end of February. By 9th April 2020 Spain was the second country in confirmed cases and in deaths. On March 14, 2020, the Spanish Government declared the state of alarm to limit viral transmission. During such state, citizens must stay confined at home with few justified exceptions. This whole situation drastically changed the life of the population, which can cause a wide range of psychosocial impacts. This study explored the psychological impact of the COVID-19 pandemic in the general adult population (N = 3055) during the first stages of the outbreak in Spain, as well as their anxiety, stress and depression levels. We also examined the extent to which the following variables were associated to participants' mental health: (1) demographics; (2) degree of concern about the pandemic; (3) environmental conditions during the home confinement, (4) changes in daily life as a consequence of the pandemic; (5) contact with the COVID-19 disease; (6) actual and perceived severity of the crisis; (7) information about the COVID-19, (8) perceived health status and (9) leisure activities conducted within the last 24 h. Our results show that Spanish consider the current COVID-19 health crisis as fairly severe, and the majority felt that the COVID-19 crisis had greatly impacted on their daily life, including changes in their daily routines and cancelation of important activities. About 36% of the participants reported moderate to severe psychological impact, 25% showed mild to severe levels of anxiety, 41% reported depressive symptoms, and 41% felt stressed. Women, young, and those who that lost their job during the health crisis showed the strongest negative psychological symptoms. What worried Spaniards the most was the likelihood of suffering an economic crisis derived from the pandemic. We found factors associated with better mental health, such as being satisfied with the information received about the health crisis, conducting leisure activities, and the perception of being in good health. These findings can be used to design psychological interventions to help coping with COVID-19 pandemic, both in Spain and other countries.

Psychological impact of COVID-19 in Spain: Early data report.

By the end of March 2020, Spain was one of the countries most affected by the COVID-19 pandemic. This commentary provides an initial picture of the psychological impact of the COVID-19 outbreak during its initial stage in Spain. Data of 3055 participants aged 18-88 years old were collected over a week (March 17th-24th 2020) using an online forms platform. Participants provided information regarding sociodemographic data and completed the Spanish version of the Impact of Event Scale-Revised, which assesses psychological distress caused by a traumatic life event in terms of three symptomatic responses (avoidance, intrusion, and hyperarousal). Results revealed that 36.6% of participants showed psychological distress due to the COVID-19 pandemic. Avoidance was the most prevalent symptom in the total sample and for all genders studied. The psychological impact was consistently higher for young people, and for women compared to men. Our data confirm the great psychological toll that the COVID-19 crisis took on the Spanish general population during the first week of confinement. Women and young people seem particularly vulnerable to the negative psychological impact of the pandemic. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Predictors of anxiety and depression among newly diagnosed people living with HIV: A longitudinal study.

This longitudinal study examined whether past resilience and internalized stigma predicted anxiety and depression among newly diagnosed Spanish-speaking people living with HIV (PLWH). We also analyzed whether coping strategies mediated this relationship. Data were collected at two time points from 119 PLWH. Approximately a third of participants had scores indicative of anxiety symptoms, the same result was found for depressive symptoms. Structural equations modeling revealed that 61% of the variance of anxiety and 48% of the variance of depression 8 months after diagnosis was explained by the proposed model, which yielded a good fit to data. Anxiety and depressive symptoms were significantly and negatively predicted by positive thinking, thinking avoidance, and past resilience, and positively predicted by self-blame. Additionally, anxiety was positively predicted by internalized stigma. Past resilience negatively predicted internalized stigma, self-blame, and thinking avoidance and it positively predicted positive thinking. Internalized stigma positively predicted self-blame. Moreover, internalized stigma had a significant indirect effect on anxiety symptoms through self-blame, and past resilience had significant indirect effects on anxiety symptoms and depressive symptoms through internalized stigma and coping. The results point to the need for clinicians and policy makers to conduct systematic assessments and implement interventions to reduce internalized stigma and train people living with HIV to identify and use certain coping behaviors.

Coping, personality and resilience: prediction of subjective resilience from coping strategies and protective personality factors / Afrontamiento, personalidad y resiliencia: predicción de la resiliencia subjetiva a partir de estrategias de afrontamiento y factores protectores de la personalidad

This study explored how resilience can be predicted from coping styles (problem-focused, emotion-focused, and socially-focused) and personality characteristics (sense of mastery, sense of relatedness, and emotional reactivity). The sample consisted of 430 adults (256 general population, 77 VIH/cancer patients, and 97 parents of children with cancer or developmental problems). Several analyses were carried out: correlations to test discriminant validity; regression analyses to see whether resilience in different adverse situations is predicted by different coping and resiliency variables, and structural equations models and cross-validation analyses to compare two different predictive models (M1: from coping to resiliency, and from resiliency to resilience; M2: from resiliency to coping, and from coping to resilience). Results showed that coping factors as initial predictors and resilience factors as mediators (that is, M1), explained the greater variance in resilience scores. Besides, coping and personality factors predicted resilience differently depending on the type of adversity. Psychological interventions to boost resilience should focus on modifying the use of coping strategies, avoiding the utilization of the emotion-focused coping and social-focused coping, and promoting problem-focused coping

Este estudio explora cómo la resiliencia se predice a partir del afrontamiento (centrado en el problema, en la emoción y en lo social) y las características protectoras de personalidad (sentido del dominio, sentido de relación y reactividad emocional). Participaron 430 adultos (256 población general, 77 pacientes con VIH/cáncer y 97 padres de niños con cáncer/problemas del desarrollo). Se llevaron a cabo correlaciones para estudiar la validez discriminante análisis de regresión para estudiar si la resiliencia en diferentes situaciones puede predecirse por distintas variables, y ecuaciones estructurales y análisis de validación cruzada para comparar dos modelos predictivos (M1: de afrontamiento a factores protectores, y de estos a resiliencia; M2: de factores protectores a afrontamiento y de estos a resiliencia). El M1 mostró un mejor ajuste y el afrontamiento resultó ser el principal predictor de la resiliencia. El afrontamiento y la personalidad predicen la resiliencia de forma diferente en distintas situaciones. Las intervenciones para promover la resiliencia deberían centrarse en evitar la utilización de las estrategias de afrontamiento centradas en la emoción y sociales y promover las centradas en el problema

Evaluating Resilience: Development and Validation of the Situated Subjective Resilience Questionnaire for Adults (SSRQA).

Although resilience varies depending on the specific type of adverse situation faced by the individual, to date resilience questionnaires do not consider its situational character. This study aims to develop and validate the Situated Subjective Resilience Questionnaire for Adults (SSRQA), which assesses resilience in five different adverse contexts. A total of 584 Spanish adults (including general population and clinical samples individuals) completed the SSRQA and other measures of resilience, optimism, and self-efficacy. Confirmatory factor analysis showed that the SSRQA structure fitted the situational model better (χ2/df = 1.90; CFI = .96; TLI = .95; RMSEA = .07) than the non-situational version (χ2/df = 4.99; CFI = .79; TLI = .76; RMSEA = .15). The SSRQA was shown to be reliable (α = .90) and to be significantly and positively correlated with other resilience measures (p < .001) and, to a lower degree, with optimism and self-efficacy (p < .001). Degree of exposure to each adverse situation was negatively correlated with resilience in the face of that situation (p < .05), supporting a vulnerability to stress model. The SSRQA has been demonstrated to be a reliable and valid situated measure for resilience towards different adverse contexts.

HIV-related stigma and optimism as predictors of anxiety and depression among HIV-positive men who have sex with men in the United Kingdom and Ireland.

This study investigated the associations between forms of HIV-related optimism, HIV-related stigma, and anxiety and depression among HIV-positive men who have sex with men (MSM) in the United Kingdom and Ireland. HIV health optimism (HHO) and HIV transmission optimism (HTO) were hypothesised to be protective factors for anxiety and depression, while the components of HIV-related stigma (enacted stigma, disclosure concerns, concern with public attitudes, and internalised stigma) were hypothesised to be risk factors. Data were collected from 278 HIV-positive MSM using an online questionnaire. The prevalence of psychological distress was high, with close to half (48.9%) of all participants reporting symptoms of anxiety, and more than half (57.9%) reporting symptoms of depression. Multiple linear regressions revealed that both anxiety and depression were positively predicted by internalised stigma and enacted stigma, and negatively predicted by HHO. For both anxiety and depression, internalised stigma was the strongest and most significant predictor. The results highlight the continued psychological burden associated with HIV infection among MSM, even as community support services are being defunded across the United Kingdom and Ireland. The results point to the need for clinicians and policy makers to implement stigma reduction interventions among this population.

Development and Validation of the ADAS Scale and Prediction of Attitudes Toward Affective-Sexual Diversity Among Spanish Secondary Students.

Violence against non-heterosexual adolescents in educational contexts remains a worrying reality, but no adequate attitudes toward affective-sexual diversity (AtASD) measure exists for Spanish adolescent students. We developed a 27-item scale including cognitive, affective, and behavioral aspects, which was completed by 696 secondary school students from the Madrid area. Factor analyses suggested a unidimensional model, Cronbach's alpha indicated excellent scale scores reliability, and item calibration under the item response theory framework showed that the scale is especially informative for homophobic attitudes. A hierarchical multiple regression analysis showed that variables traditionally related to AtASD (gender, age, religion, nationality, perceived parental/peer attitudes, direct contact with LGB people) also were so in our sample. Moreover, interest in sexuality topics and perceived center's efforts to provide AtASD education were related to better AtASD. Our scale was reliable and valid, and it may also prove useful in efforts to detect those students with homophobic attitudes and to guide interventions.

Evaluating resilience: development and validation of the Situated Subjective Resilience Questionnaire for Adults (SSRQA)

Although resilience varies depending on the specific type of adverse situation faced by the individual, to date resilience questionnaires do not consider its situational character. This study aims to develop and validate the Situated Subjective Resilience Questionnaire for Adults (SSRQA), which assesses resilience in five different adverse contexts. A total of 584 Spanish adults (including general population and clinical samples individuals) completed the SSRQA and other measures of resilience, optimism, and self-efficacy. Confirmatory factor analysis showed that the SSRQA structure fitted the situational model better (χ2/df = 1.90; CFI = .96; TLI = .95; RMSEA = .07) than the non-situational version (χ2/df = 4.99; CFI = .79; TLI = .76; RMSEA = .15). The SSRQA was shown to be reliable (α = .90) and to be significantly and positively correlated with other resilience measures (p < .001) and, to a lower degree, with optimism and self-efficacy (p < .001). Degree of exposure to each adverse situation was negatively correlated with resilience in the face of that situation (p < .05), supporting a vulnerability to stress model. The SSRQA has been demonstrated to be a reliable and valid situated measure for resilience towards different adverse contexts

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Predictors of Resilience and Posttraumatic Growth Among People Living with HIV: A Longitudinal Study.

This longitudinal study investigated the predictors of HIV-related resilience (HR) and posttraumatic growth (PTG) among Spanish-speaking HIV-positive people. Perceived past resilience, internalised stigma, and coping strategies were hypothesised as possible predictors. Data were collected at two time points from 119 HIV-positive people. Path analyses with latent variables revealed that half of HR 8 months after diagnosis was predicted by rumination, emotional expression, positive thinking, internalised stigma, and perceived past resilience. The latter three, along with isolation, self-blame, thinking avoidance, and help seeking predicted some PTG dimensions 8 months after diagnosis. The results highlight the importance of internalised stigma associated with HIV infection and of the differential use of coping strategies, and point to the need for clinicians and policy makers to implement stigma reduction and appropriate coping strategies interventions.

Social Support in Newly Diagnosed People living With HIV: Expectations and Satisfaction Along Time, Predictors, and Mental Health Correlates.

Social support usually decreases following HIV diagnosis, and decreased support is related to worsening mental health. We investigated the evolution of social support after HIV diagnosis and its relationship to anxiety, depression, and resilience, and sought to develop a social support prediction model. There were 119 newly diagnosed Spanish speakers who participated in this longitudinal study, completing measures of social support, internalized stigma, disclosure concerns, degree of disclosure, coping, anxiety, depression, and resilience. Bivariate associations and multiple regression analyses were performed. Results showed that the highest levels of support arose from friends, health care providers, and partners, and that social support decreased following diagnosis. Subsequent social support was negatively predicted by avoidance coping and positively by approach coping, steady partnership, and disclosure. It was significantly associated with decreased anxiety and depression and higher resilience. Interventions should seek to promote mental health in people living with HIV by increasing social support.

Posttraumatic growth inventory: factor structure in Spanish-speaking people living with HIV.

This cross-sectional study analyzed the factorial structure of the Posttraumatic Growth Inventory (PTGI) in a sample of 304 Spanish-speaking HIV-positive adults. Participants completed the PTGI and a socio-demographic questionnaire. Exploratory factor analysis (EFA) was carried out through structural equations modeling, with a Varimax rotation. Factors with eigenvalues greater than 1 were extracted, and items with loadings higher than .5 on a factor and lower than .4 on the rest were retained. Two confirmatory factor analyses (CFA) were performed to test a hierarchical model and a bifactor model. Reliability analyses were conducted. EFA suggested a three-factor model keeping 11 of the original 21 items. The three factors that emerged were changes in philosophy of life, in the self and in interpersonal relationships. CFAs suggested that only the bifactor model fitted the data. The three factors as well as the global scale showed good reliability. The factor structure of PTGI's scores in our data is consistent with the three dimensions theorized by Tedeschi and Calhoun, which speaks in favor of the construct validity of this measure.