Oxytocin-Augmented Modular-Based Group Intervention for Loneliness: A Proof-Of-Concept Randomized Controlled Trial.

INTRODUCTION: Loneliness poses a significant health problem and existing psychological interventions have shown only limited positive effects on loneliness. Based on preliminary evidence for impaired oxytocin signaling in trait-like loneliness, the current proof-of-concept study used a randomized, double-blind, placebo-controlled design to probe intranasal oxytocin (OT) as an adjunct to a short-term modular-based group intervention for individuals suffering from high trait-like loneliness (HL, UCLA Loneliness Scale ≥55). METHODS: Seventy-eight healthy HL adults (56 women) received five weekly group psychotherapy sessions. HL participants received OT or placebo before the intervention sessions. Primary outcomes were trait-like loneliness measured at baseline, after the intervention, and again at two follow-up time points (3 weeks and 3 months), and, assessed at each session, state loneliness (visual analog scale), perceived stress (Perceived Stress Scale, PSS-10), quality of life (World Health Organization Five Well-Being Index, WHO-5), and the therapeutic relationship (Group Questionnaire, GQ-D). RESULTS: The psychological intervention was associated with significantly reduced perceived stress and improved trait-like loneliness across treatment groups, which was still evident at the 3-month follow-up. OT had no significant effect on trait-like loneliness, quality of life, or perceived stress. However, compared to placebo, OT significantly facilitated the decrease in state loneliness within sessions and significantly improved positive bonding between the group members. CONCLUSION: Despite significantly improved trait-like loneliness after the intervention, OT did not significantly augment this effect. Further studies are needed to determine optimal intervention designs to translate the observed acute effects of OT into long-term benefits.

Efficacy of an Internet-based self-help intervention with human guidance or automated messages to alleviate loneliness: a three-armed randomized controlled trial.

Loneliness is a prevalent and stigmatized phenomenon associated with adverse (mental) health outcomes. However, evidence-based interventions to alleviate loneliness are scarce. This randomized controlled trial (ClinicalTrials.gov-ID: NCT04655196) evaluated the efficacy of an internet-based cognitive behavioral self-help intervention (ICBT) to reduce loneliness by comparing two intervention groups with guidance or automated messages against a waitlist control group. Adults (N = 243) suffering from loneliness were recruited from the general public and then randomly assigned (2:2:1) to a 10-week ICBT with human guidance (GU) or automated messages (AM) or to a waitlist control group (WL). Loneliness, assessed with the UCLA-9, was the primary outcome. Outcomes were assessed at baseline and 10 weeks (post) and analyzed using mixed-effects models. The pooled intervention conditions resulted in lower loneliness scores at post-assessment than the WL (Cohen's d = 0.57, 95% CI [0.25; 0.89]) and reduced depressive symptoms, social anxiety, social avoidance behavior, and rejection sensitivity (d = 0.32-0.52). The GU group had lower loneliness scores at post-assessment than the AM group (d = 0.42, 95% CI [0.13; 0.70]). ICBT effectively alleviated loneliness, and guidance increased the reduction in loneliness compared to automated messages. Alleviating loneliness with ICBT further seems to reduce the overall burden of psychopathological symptoms.

The relationship between the perception of major life events and depression: A systematic scoping review and meta-analysis.

BACKGROUND: Major life events can lead to depression in adulthood. However, as predicted by several depression theories, not only the mere occurrence of major life events but also the way people perceive them determines the onset of a depression. METHODS: Based on a systematic literature search, we identified 276 studies (Ntotal = 89,600) that examined the relationship between the perception of major life events and depression. We provide an overview of how this relationship has been examined. Furthermore, we meta-analytically integrated 420 effect sizes (172 studies) on the association between the perception of major life events and depression. RESULTS: Most studies relied on college student samples, were cross-sectional, and were conducted in the United States. A more negative perception of events was significantly associated with higher levels of depressive symptoms (r = 0.28). This association was robust across several design and sample characteristics. Furthermore, the perception of major life events and depression were also longitudinally associated with each other (event perception predicting later depressive symptoms: r = 0.26; depressive symptoms predicting later event perception: r = 0.17). LIMITATIONS: Longitudinal research on the relationship between depression and the perception of major life events was relatively rare impairing definite conclusions on whether the perception of life events can predict changes in depressive symptoms over time. CONCLUSION: The perception of major life events is related to depression. However, further longitudinal research considering a range of different perceived event characteristics and using non-Western heterogeneous samples is needed to better understand their relationship.

A Comparison of Hugging Frequency and Its Association with Momentary Mood Before and During COVID-19 Using Ecological Momentary Assessment.

The COVID-19 pandemic has necessitated a drastic decrease in human social interactions including social touch. One of the most prevalent forms of touch is hugging. Hugging has been demonstrated to benefit both physical and mental well-being. In the present study, we used an ecological momentary assessment approach to assess the relationship between hugging and momentary mood in two independent cohorts sampled prior or during the pandemic. We found that the frequency of hugging was significantly reduced during the pandemic. Using multilevel modeling, we found a significant positive association between momentary mood and daily hugs. This effect was moderated by the cohort, as individuals during the pandemic showed a stronger positive association compared to the cohort sampled prior to the pandemic. While we have to stress that our results are correlational in nature, they potentially indicate that social touch is more beneficial in times of social distancing.

Subjective experiences of life events match individual differences in personality development.

The last 2 decades have witnessed increased research on the role of life events in personality trait development, but few findings appear to be robust. We propose that a key to resolving this issue is incorporating individuals' subjective experiences into the study of event-related development. To test this, we developed and administered a survey about event-related personality change to a representative Dutch sample (N = 5,513, Ages 16-95) and linked their responses to 12-year trajectories of measured Big Five development. Most participants (63%) believed that a life event impacted their personality in the past 10 years, on average 5 years presurvey. These participants, even those who experienced the same event, had markedly heterogenous perceptions of how their traits changed and why each event affected their personality. In preregistered analyses, we examined participants' individual personality trajectories before and after the event that they identified as most impactful. Across events, retrospective perceptions of event-related personality change were significantly correlated with short-term and long-term postevent personality trajectories across Big Five traits (mean rs = .22, .28) and preevent trajectories in all traits except agreeableness (mean r = .16). We also found correspondence between perceived and measured development in analyses of the two most commonly reported personality-changing events: health problems and death of a loved one/family member. Finally, we explored associations between personality development and perceived change-inducing event characteristics. Using these findings, we argue that future research into event-related personality development should de-emphasize mean-level change to focus on individuals' varied experiences of whether, when, how, and why life events have affected their personality. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Loneliness across time and space.

People feel lonely when their social needs are not met by the quantity and quality of their social relationships. Most research has focused on individual-level predictors of loneliness. However, macro-level factors related to historical time and geographic space might influence loneliness through their effects on individual-level predictors. In this Review, we summarize empirical findings on differences in the prevalence of loneliness across historical time and geographical space and discuss four groups of macro-level factors that might account for these differences: values and norms, family and social lives, technology and digitalization, and living conditions and availability of individual resources. Regarding historical time, media reports convey that loneliness is on the rise, but the empirical evidence is mixed, at least before the COVID-19 pandemic. Regarding geographical space, national differences in loneliness are linked to differences in cultural values (such as individualism) but might also be due to differences in the sociodemographic composition of the population. Research on within-country differences in loneliness is scarce but suggests an influence of neighbourhood characteristics. We conclude that a more nuanced understanding of the effects of macro-level factors on loneliness is necessary because of their relevance for public policy and propose specific directions for future research.

Does intelligence predict development of investment traits from mid to late adolescence? Evidence from a 3-year longitudinal study.

INTRODUCTION: Investment theories have claimed reciprocal relations between intelligence and investment traits (i.e., personality traits related to seeking out, and dealing with, cognitive challenges). However, previous research has primarily addressed the effects of investment traits on intellectual development (environmental enrichment hypothesis) and often focused on either childhood or later adulthood. The present study investigated the effects of intelligence on investment traits (environmental success hypothesis) from mid to late adolescence. METHOD: In a 3-year longitudinal survey (2008-2011) covering four measurement occasions, the predictive effects of both fluid and crystallized intelligence on intraindividual change in both the achievement motive (i.e., hope for success and fear of failure) and need for cognition were examined. Overall, 476 adolescents (t1 : Mage = 16.43, SD = 0.55; 51.3% girls) from Germany participated. RESULTS: Second-order latent growth models indicated that fluid intelligence predicted a steeper growth in hope for success (ß = .40), but was unrelated to change in the other investment traits. Crystallized intelligence had no effects on the investment traits under study. CONCLUSIONS: The results contribute to the research on the bidirectionality of intelligence and investment traits and add to our understanding of personality development from mid to late adolescence. Specifically, they underline the importance of nurturing hope for success especially in individuals with lower intelligence, but also show that support for the environmental success hypothesis seems to be limited to certain investment traits.

When Happiness is Both Joy and Purpose: The Complexity of the Pursuit of Happiness and Well-Being is Related to Actual Well-Being.

People differ in how they define and pursue happiness and well-being (HWB). Previous studies suggested that the best way to achieve a high level of well-being might be to pursue different facets of HWB simultaneously. We expand on this idea and introduce the concept of complexity of HWB definitions to describe how many HWB definitions people endorse simultaneously, and the complexity of HWB-related intentions to describe how many unique facets of HWB people intend to pursue in everyday life. To operationalize these novel concepts, we developed two parallel measures that integrate psychological and philosophical definitions of HWB. In two independent studies (total N = 542), exploratory and confirmatory factor analyses revealed eight reliable and valid factors for both parallel scales: absence of negativity, positive attitude, tranquility, personal development, luck, joy and desires, purpose, and belonging. Complexity of HWB-related intentions was positively associated with all facets of well-being, whereas complexity of HWB definitions was only positively associated with some facets of well-being. HWB-related intentions and their complexity emerged as more important for the experience of well-being than HWB definitions and their complexity. These studies highlight the importance of a multifaceted conceptualization of HWB when investigating how the pursuit of HWB is related to actual levels of well-being.

The Association of Embracing with Daily Mood and General Life Satisfaction: An Ecological Momentary Assessment Study.

Embracing has several positive health effects, such as lowering blood pressure and decreasing infection risk. However, its association with general life satisfaction and daily mood has not been researched in detail. Here, we used a smartphone-based ecological momentary assessment (EMA) approach to monitor the daily number of embraces and daily mood in a sample of 94 adults over the course of seven days. We found that embracing frequency differed slightly over the week, with embracing occurring more frequently on weekends than on weekdays. We also found that higher daily embracing frequencies were associated with better daily mood using multilevel modeling. Only singles benefitted from increases in average embracing regarding their life satisfaction, whereas individuals in a relationship were unaffected by their embracing tendencies. Although our results are strictly correlational and do not indicate any direction or causality, embraces may be important for daily mood and general life satisfaction, but their efficacy seems to depend on relationship status. Supplementary Information: The online version contains supplementary material available at 10.1007/s10919-022-00411-8.

Evaluating the Efficacy of a Guided and Unguided Internet-Based Self-help Intervention for Chronic Loneliness: Protocol for a 3-Arm Randomized Controlled Trial.

BACKGROUND: Loneliness, or perceived social isolation, is prevalent in both the general population and clinical practice. Although loneliness has repeatedly been associated with mental and physical health, research on interventions that reduce loneliness effectively is still rather scarce. OBJECTIVE: This study aims to evaluate the efficacy of a guided and an unguided version of the same internet-based cognitive behavioral self-help program for loneliness (SOLUS-D) for adults. METHODS: A total of 250 participants will be randomly assigned to 1 of 2 intervention groups (SOLUS-D with guidance or SOLUS-D without guidance) or a wait-list control group (2:2:1 allocation ratio). Adult participants experiencing high levels of loneliness will be recruited from the general population. Individuals currently experiencing at least moderately severe depressive symptoms, an ongoing severe substance use disorder, previous or current bipolar or psychotic disorder, or acute suicidality will be excluded from the trial. Assessments will take place at baseline, 5 weeks (midassessment), and 10 weeks (postassessment). The primary outcome is loneliness assessed using the 9-item University of California, Los Angeles Loneliness Scale at the posttreatment time point. Secondary outcomes include depressive symptoms, symptoms of social anxiety, satisfaction with life, social network size, and variables assessing cognitive bias and social behavior. The maintenance of potentially achieved gains will be assessed and compared at 6 and 12 months after randomization in the 2 active conditions. Potential moderators and mediators will be tested exploratorily. Data will be analyzed on an intention-to-treat basis. RESULTS: Recruitment and data collection started in May 2021 and are expected to be completed by 2022, with the 12-month follow-up to be completed by 2023. As of the time of submission of the manuscript, 134 participants were randomized. CONCLUSIONS: This 3-arm randomized controlled trial will add to the existing research on the efficacy of loneliness interventions. Furthermore, it will shed light on the role of human guidance in internet-based treatments for individuals with increased levels of loneliness and the possible mechanisms of change. If SOLUS-D proves effective, it could provide a low-threshold, cost-efficient method of helping and supporting individuals with increased levels of loneliness. TRIAL REGISTRATION: ClinicalTrials.gov NCT04655196; https://clinicaltrials.gov/ct2/show/NCT04655196. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/36358.

Unraveling the complex relationship between work transitions and self-esteem and life satisfaction.

Transitions in and out of work are common experiences with major repercussions for people's lives. The complex link between work transitions and psychological adjustment is not well understood, however. In this preregistered study, we analyzed 11 waves of longitudinal data from a representative sample of 13,671 Dutch participants to examine the transactional effects between repeated work transitions (employment and unemployment) and psychological adjustment (self-esteem and life satisfaction). We investigated change trajectories before and after the transitions and tested whether event-related characteristics moderated transition effects. Participants with higher levels of self-esteem and life satisfaction were less likely to experience unemployment and more likely to experience employment, indicating selection effects. Participants decreased in their self-esteem and life satisfaction before the beginning of unemployment indicating anticipatory effects, with larger decreases in self-esteem for participants who ended up experiencing longer unemployment. We found no effects of employment on changes in life satisfaction or self-esteem (except when accounting for unemployment), but participants entering more satisfying jobs showed larger increases in life satisfaction. Results were mostly robust when accounting for gender, age, socioeconomic status, and the Big Five traits, and when using propensity-score matching. Effects did not differ among multiple experiences of the same transition. Together, these findings point to dynamic transactions between employment/unemployment and self-esteem/life satisfaction. Findings highlight the importance of closely assessing the specific timing of pre- and posttransition changes and the existence of large individual differences in reactions to work transitions that seem to be partly explained by event-related characteristics. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Loneliness from Young Adulthood to Old Age: Explaining Age Differences in Loneliness.

Prior research in non-U.S. samples has found a complex nonlinear relationship between loneliness and age. This research has shown that established predictors of loneliness - poor health, being unmarried, living alone, and having infrequent social interactions - help to explain age differences in loneliness. However, while some variables were found to be universal predictors of loneliness at all ages, others were relevant in specific age groups only. In this study, we describe age differences in frequency of loneliness from age 18 to 89+ years in the U.S., and examine age differences in predictors of loneliness from age-specificity and age-normative perspectives. We used cross-sectional nationally representative data from the General Social Survey (N = 2,477) and found a nonlinear relationship between age and loneliness that closely resembles prior research. However, we found no evidence for age-specific predictors of loneliness. Household income, household size, marital status, health, and frequency of socializing were "universal" predictors of loneliness; their associations with loneliness did not differ in strength with age. Our hypothesis that individuals who deviated from age-specific norms would experience more intense loneliness was not supported. Implications for research and loneliness interventions are discussed.

Stability and change of perceived characteristics of major life events.

The occurrence of major life events is associated with changes in well-being and personality. To better understand these effects, it is important to consider how individuals perceive major life events. Although theories such as appraisal theory and affective adaptation theory suggest that event perceptions change over time and that these changes are relevant for personality and well-being, stability and change of perceived event characteristics have not been systematically examined. This article aims to fill this gap using data from a longitudinal study (N = 619 at T1). In this study, participants rated nine perceived characteristics of the same major life event up to five times within 1 year. We estimated rank-order and mean-level stabilities as well as intraclass correlations of these life event characteristics with continuous time models. Furthermore, we computed continuous time models for the stability of affective well-being and the Big Five personality traits to generate benchmarks for the interpretation of the stability of the life event characteristics. Rank-order stabilities for the life event characteristics were lower than for the Big Five, but higher than for affective well-being. Most of the variance in life event characteristics was explained by between-person differences. Furthermore, we found a significant mean-level increase for the life event characteristic change in world views and a significant decrease for extraordinariness. These mean-level changes are in line with the meaning-making literature and affective adaptation theory, whereas the rather high rank-order stability of the life event characteristics challenges the importance of reappraisal processes of major life events. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Is loneliness in emerging adults increasing over time? A preregistered cross-temporal meta-analysis and systematic review.

Judged by the sheer amount of global media coverage, loneliness rates seem to be an increasingly urgent societal concern. From the late 1970s onward, the life experiences of emerging adults have been changing massively due to societal developments such as increased fragmentation of social relationships, greater mobility opportunities, and changes in communication due to technological innovations. These societal developments might have coincided with an increase in loneliness in emerging adults. In the present preregistered cross-temporal meta-analysis, we examined whether loneliness levels in emerging adults have changed over the last 43 years. Our analysis is based on 449 means from 345 studies with 437 independent samples and a total of 124,855 emerging adults who completed the University of California Los Angeles (UCLA) Loneliness Scale between 1976 and 2019. Averaged across all studies, loneliness levels linearly increased with increasing calendar years (ß = .224, 95% CI [.138, .309]). This increase corresponds to 0.56 standard deviations on the UCLA Loneliness Scale over the 43-year studied period. Overall, the results imply that loneliness can be a rising concern in emerging adulthood. Although the frequently used term "loneliness epidemic" seems exaggerated, emerging adults should therefore not be overlooked when designing interventions against loneliness. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Analyzing Stability and Change in Dyadic Attachment: The Multi-Rater Latent State-Trait Model With Autoregressive Effects.

Previous research suggests that parental attachment is stable throughout emerging adulthood. However, the relationships between the mutual attachments in the dyads of emerging adults and their parents are still unclear. Our study examines the stability and change in dyadic attachment. We asked 574 emerging adults and 463 parents at four occasions over 1 year about their mutual attachments. We used a latent state-trait model with autoregressive effects to estimate the time consistency of the attachments. Attachment was very stable, and earlier measurement occasions could explain more than 60% of the reliable variance. Changes of attachment over time showed an accumulation of situational effects for emerging adults but not for their parents. We estimated the correlations of the mutual attachments over time using a novel multi-rater latent state-trait model with autoregressive effects. This model showed that the mutual attachments of parents and emerging adults were moderately to highly correlated. Our model allows to separate the stable attachment from the changing attachment. The correlations between the mutual attachments were higher for the stable elements of attachment than for the changing elements of attachment. Emerging adults and their parents share a stable mutual attachment, but they do not share the changes in their respective attachments.

Self-esteem and satisfaction with social relationships across time.

Research on the longitudinal association between self-esteem and satisfaction with social relationships has led to ambiguous conclusions regarding the temporal order and strength of this relation. Existing studies have examined this association across intervals ranging from days to years, leaving it unclear as to what extent differences in timing may explain differences across studies. In the present study, we used continuous time structural equation models (i.e., CT-SEM) to examine cross-lagged relations between the constructs, and also distinguished between-person differences from within-person processes (i.e., RI-CT-SEM). We analyzed 10 years of annual data from the Longitudinal Internet Studies of the Social Sciences (N = 14,741). When using CT-SEM, we found a bidirectional positive relation between self-esteem and satisfaction with social relationships, with larger effects over longer intervals. When using RI-CT-SEM, we found the largest effects of self-esteem and satisfaction with social relationships across intervals of 1 year, with smaller effect sizes at both shorter and longer intervals. In addition, the effect of fluctuations in people's satisfaction with social relationships on fluctuations in their self-esteem was greater than the reverse effect. Our results highlight the importance of considering time when examining the relation between self-esteem and interpersonal outcomes and likely psychological constructs in general. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A dimensional taxonomy of perceived characteristics of major life events.

Major life events (MLEs) are studied in many different areas in psychology such as personality development, clinical psychology, or posttraumatic growth. In all of these areas, a common finding is that MLEs differ in their effects on psychological outcomes. However, a framework that allows a systematic examination of these differences is still absent. This article presents a systematic literature review and 4 empirical studies (Ns between 226 and 449, total N = 1,477) in which we developed and evaluated a dimensional taxonomy of 9 perceived characteristics of MLEs: valence, impact, predictability, challenge, emotional significance, change in worldviews, social status changes, external control, and extraordinariness. These event characteristics can be measured reliably with the Event Characteristics Questionnaire (ECQ). Perceived event characteristics predicted individual differences in changes in subjective well-being in both retrospective and longitudinal data after MLEs over and above established predictors of subjective well-being such as personality and demographic characteristics. A comparison between the ECQ and established taxonomies of situation characteristics such as the DIAMONDS (Rauthmann et al., 2014) showed high conceptual and empirical convergence between some ECQ subscales (e.g., valence, challenge) with characteristics of situations, whereas other ECQ subscales (e.g., social status changes, external control) were conceptually and empirically distinct from situation characteristics. In sum, including measures of perceived event characteristics in studies on MLEs may enhance our understanding of why MLEs differ in the direction, strength, and duration of their effects on psychological outcomes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Nothing going on? Exploring the role of missed events in changes in subjective well-being and the Big Five personality traits.

OBJECTIVE: Missed events are defined as the nonoccurrence of expected major life events within a specified time frame. We examined whether missed events should be studied in research on growth by exploring the role of missed events for changes in subjective well-being (SWB) and the Big Five personality traits. METHOD: The samples were selected from two nationally representative panel studies, the German Socioeconomic Panel Innovation Sample (SOEP-IS, total N = 6,638) and the Dutch Longitudinal Internet Studies for the Social Sciences panel (LISS, Ns between 4,262 and 5,749). Rank-order stability and mean-level change were analyzed using regression and mixed models. Type I error probability was reduced by using conservative thresholds for level of significance and minimal effect size. RESULTS: Expected but missed events were more frequent than actually experienced events. For SWB, rank-order stability tended to be lower among those who experienced a missed event than among those who did not. For the Big Five personality traits, significant differences between those who did and those who did not experience a missed event were rare and unsystematic. CONCLUSION: Missed events merit more attention in future research on growth and personality change, but the effects are probably weak.

Post-traumatic growth as positive personality change: Challenges, opportunities, and recommendations.

OBJECTIVE: Post-traumatic growth typically refers to enduring positive psychological change experienced as a result of adversity, trauma, or highly challenging life circumstances. Critics have challenged insights from much of the prior research on this topic, pinpointing its significant methodological limitations. In response to these critiques, we propose that post-traumatic growth can be more accurately captured in terms of personality change-an approach that affords a more rigorous examination of the phenomenon. METHOD: We outline a set of conceptual and methodological questions and considerations for future work on the topic of post-traumatic growth. RESULTS: We provide a series of recommendations for researchers from across the disciplines of clinical/counseling, developmental, health, personality, and social psychology and beyond, who are interested in improving the quality of research examining resilience and growth in the context of adversity. CONCLUSION: We are hopeful that these recommendations will pave the way for a more accurate understanding of the ubiquity, durability, and causal processes underlying post-traumatic growth.

A propensity-score matched study of changes in loneliness surrounding major life events.

Major life events are often discussed as triggers of loneliness. However, longitudinal studies with frequent assessments investigating changes in loneliness surrounding major life events are lacking. This preregistered study investigated the associations between various family- and work-related major life events and changes in loneliness, using propensity-score matched data from a Dutch nationally representative prospective longitudinal study. We applied mixed-effects models to describe average loneliness trajectories before, during, and after 10 major life events. Event-related loneliness trajectories differed between events and individuals. Most changes in loneliness were found in reaction to family-related major life events. We found immediate and long-lasting increases in loneliness after the transition into parenthood, marital separation, widowhood, but also after a job loss. Further gradual changes in loneliness were found after marriage, marital separation, and job loss. On average, transition into paid employment, reemployment after unemployment, retirement, and cohabitation did not trigger changes in loneliness. For some major life events, we found that event-related loneliness trajectories differed between individuals who experienced an event at an average age and individuals who experienced an event younger or older than average. Overall, our results highlight the importance of considering major life events as possible triggers of loneliness but also point to some general methodological challenges when studying the effects of major life events. (PsycInfo Database Record (c) 2021 APA, all rights reserved).