Exploring heterogeneity in PTSD symptoms and associated predictors and outcomes in Afghanistan veterans: A latent profile analysis.

Research on posttraumatic stress symptoms (PTSS) typically focuses on diagnosis or symptom severity, however, this overlooks the variety of symptom patterns that exist. Latent profile analysis was used to explore PTSS profiles in a sample of Norwegian Afghanistan veterans (n = 4052, 91.7% males). Multinomial logistic regression analyses were conducted to examine predictors and outcomes associated with PTSS profile membership. Three profiles emerged: Low Symptoms profile (85%); High Numbing and Arousal profile (13%); and High Symptoms profile (2%). Being female, lower number of deployments, barriers to disclose war-related experiences, and higher number of potentially morally injurious events (PMIEs) were associated with belonging to the High Symptoms profile compared to the High Numbing and Arousal (Male gender: OR = 0.37, p < .05; Number of deployments: OR = 0.68, p < .05; Barriers to disclose: OR = 1.39, p < .001; PMIEs: OR = 1.15. p < .05), or Low Symptoms profile (Male gender: OR = 0.36, p < .05; Number of deployments: OR = 0.67, p < .01; Barriers to disclose: OR = 1.80, p < .001; PMIEs: OR = 1.32. p < .001). Participants in the High Symptoms profile had the highest probability of mental health service use (0.37) and endorsing suicidal ideation (0.38), compared to the two other profiles (p < .01). Participants in the High Numbing and Arousal profile had a higher probability of seeking professional mental health care (0.17), endorsing suicidal ideation (0.16), and reporting more suicide attempts compared to the Low Symptom profile (0.02 vs. 0.00, p < .001). These findings highlight the importance of considering the heterogeneity of PTSS profiles and understanding the predictors and responses of individuals who exhibit elevated PTSS symptoms.

The Prevalence of Sexual Harassment and Bullying Among Norwegian Afghanistan Veterans: Does Workplace Harassment Disproportionately Impact the Mental Health and Life Satisfaction of Female Soldiers?

Experiencing sexual harassment and bullying during military service can lead to negative consequences for a soldier's mental health and life satisfaction, including increased risk of depression, anxiety, and posttraumatic stress. No studies have to date investigated the prevalence and correlates of sexual harassment and bullying among Norwegian Afghanistan veterans, despite the increased global focus on these topics. In 2020, 6,205 Norwegian Afghanistan veterans (8.3% women) completed an online post-deployment survey, including questions about experiences of sexual harassment, bullying, mental health, and life satisfaction. Compared to their male counterparts, female veterans experienced significantly more sexual harassment and bullying during Afghanistan deployment (3.2% vs. 0.04% for experiencing sexual harassment, and 4.0% vs. 1.0% for bullying) and during other military services (14.3% vs. 0.4% for sexual harassment, and 15.9% vs. 3.7% for bullying). Sexual harassment was associated with younger age and experiencing childhood sexual harassment for both women and men, with men also having longer deployments. Bullying was associated with longer deployments and childhood sexual harassment for women, while men who reported bullying more often had longer deployments, held an officer rank, were less inclined to have a spouse/intimate partner, and reported childhood sexual harassment and bullying. Both sexual harassment and bullying were associated with increased risk of mental health problems and reduced life satisfaction for women, but this was only true for bullying among men. Despite lower reported rates of workplace harassment compared to studies from other cultures, this study demonstrates that sexual harassment and bullying in the military can negatively impact soldiers' mental health and life satisfaction. Notably, female veterans' mental health and life satisfaction appear to be particularly affected by sexual harassment during military service, an association not seen in males. This underscores the need for gender-specific, cultural, and context-sensitive prevention and support for workplace harassment experiences.

Metacognitive strategies mediate the association between metacognitive beliefs and perceived quality of life.

Quality of life may be understood as a multidimensional evaluation of life circumstances in relation to values, expectations, and perceived well-being. Quality of life is thus dependent on the subjective perception of the current life situation, not only objective circumstances. According to metacognitive theory, metacognition guides the appraisal of inner experiences (i.e., thoughts and feelings) and influences how one relates to external stressors. Hence, dysfunctional metacognitive beliefs and the cognitive attentional syndrome (CAS), which includes perseverative thinking, threat monitoring and ineffective coping strategies, may negatively influence subjective quality of life. Therefore, we aimed to investigate if metacognitive beliefs and CAS strategies were associated with quality of life. A sample of 503 participants (77.1% women, mean age 41.0, SD = 11.5) completed the metacognitions questionnaire 30 (MCQ-30), the CAS-1 and the quality of life scale (QOLS). We used structural equation modelling (SEM) to estimate associations between the variables founded in metacognitive theory. The results of the SEM showed a significant direct relationship between metacognitive beliefs and quality of life. CAS strategies mediated the effect of metacognitive beliefs on quality of life. Higher level of metacognitive beliefs was associated with greater use of CAS strategies, which in turn was associated with lower quality of life. Further, more CAS strategies were associated with lower quality of life. The results support the generic metacognitive model and suggest that stronger endorsement of dysfunctional metacognitive beliefs and corresponding CAS strategies are associated with lower quality of life. This observation held even when controlling for relevant covariates and suggests that modifying metacognitive beliefs may impact on subjective quality of life.

Mental health problems, interpersonal trust, and socio-cultural correlates of corruption perception in Ghana.

Introduction: This study examines the overall levels and effects of corruption perception on mental health while controlling for the effect of interpersonal trust as a routine covariate in studies of corruption. Methods: Participants (N = 730; 60.8% Men; Mean age = 22.13, SD = 3.66) were invited to answer a cross-sectional survey. Group mean difference tests and network analysis were performed. Results: Women, urban dwellers, and those who showed moderate religiosity, and lower nationality reported the highest levels of corruption perception, but the effect on mental health problems was stronger for higher religiosity. The perception that politicians and government officials are corrupt emerged as the most influential to link other corruption perceptions (e.g., state institutions are corrupt). Witnessing corruption among state institutions and government officials and the perception that the rich in society can influence any state institutions and actors showed the strongest and broadest links to depression and anxiety symptoms. Discussion: The findings suggest that there may be substantial effect of corruption on mental health problems than trust in interpersonal relationships. The relatively high poverty rate in Ghana may explain why those who do not have the financial means or personal connections to meet the demands of bribery and corruption experience a sense of helplessness associated with mental health problems when they perceive that the rich in society can influence state institutions and actors for personal gains. Furthermore, the tendency to remain silent to protect others from being exposed in corruption in order to maintain relationships, or to expose them to ruin relationships, or conform to a culture of corruption either in solidarity or fear of victimisation, may create a psychological burden that may be associated with mental health problems. The implications for reconceptualising corruption as a key social determinant of public mental health are discussed.

Differences in resilience profiles between military veterans and the general population: An exploratory latent profile analysis using the HUNT-4 survey.

Using latent profile analyses, the current work investigated levels of adverse childhood experiences, symptoms of anxiety and depression and 3 dimensions of relational promotive factors) to identify resilience profiles in a large general population sample (N = 161,622, mean age = 53.02; SD = 17.80; 56.1% females). We then used the same method to identify the resilience profiles of military veterans (N = 386, mean age = 43.47; SD = 10.08; 9.8% females), all of whom had served in Afghanistan. A four-profile-solution was the best fitting for the general population (High resilient 30%, Moderate resilient 13%, Low resilient 53%, Work/social-based resilience 4%), while a three-profile-solution had the best fit in the veteran cohort (Family-based resilience 28%, Work/social-based resilience 62%, Hardy loners 10%). To ground the identified profiles in occupational function, we also checked how they predicted reports of sleep difficulties, job demand and job control. Despite both samples inhabiting a geographic region known for high socioeconomic similarity among residents, we found marked differences in profile-solutions between the military veterans and the general population. Our findings suggests that resilience profiles are highly influenced by cohort characteristics and the specific resources needed to manage a given stressor load. Accordingly, the generalisability of specific protective factors may be low across distinct cohorts, and reliable findings need to be obtained in specific populations as defined by stressor context, sample characteristics, and relevant outcomes.

Symptoms and prevalence of common mental disorders in a heterogenous outpatient sample: an investigation of clinical characteristics and latent subgroups.

BACKGROUND: Patient-reported outcome measures (PROM) provide clinicians with information about patients' perceptions of distress. When linked with treatment and diagnostic registers, new information on common mental health disorders (CMHD) and service use, may be obtained, which might be useful clinically and for policy decision-making. This study reports the prevalence of CMHD and their association with PROM severity. Further, subgroups of self-reported symptoms of depression and anxiety were examined, and their association with clinician-assessed mental disorders, functional impairment, and service use. METHODS: In a cohort study of 2473 (63% female) outpatients, CMHD was examined with pre-treatment scores of self-reported depression and anxiety, and the number of assessments and psychotherapy appointments one year after treatment start. Factor mixture modelling (FMM) of anxiety and depression was used to examine latent subgroups. RESULTS: Overall, 22% of patients with a CMHD had an additional comorbid mood/anxiety disorder, making the prevalence lower than expected. This comorbid group reported higher symptoms of anxiety and depression compared to patients with non-comorbid disorders. FMM revealed three classes: "anxiety and somatic depression" (33%), "mixed depression and anxiety" (40%), and "cognitive depression" (27%). The anxiety and somatic depression class was associated with older age, being single and on sick leave, higher probability of depressive-, anxiety-, and comorbid disorders, having more appointments and higher functional impairment. Although the cognitive depression class had less somatic distress than the mixed depression and anxiety class, they reported more functional impairment and had higher service use. CONCLUSION: The results show that higher levels of somatic symptoms of depression could both indicate higher and lower levels of functional impairment and service use. A group of patients with high somatic depression and anxiety was identified, with severe impairment and high service needs. By gaining insights into CMHD factors' relation with clinical covariates, self-reported risk factors of depression and anxiety could be identified for groups with different levels of aggravating life circumstances, with corresponding service needs. These could be important symptom targets in different groups of patients.

Prospective Relations Between Dysfunctional Metacognitive Beliefs, Metacognitive Strategies, and Anxiety: Results From a Four-Wave Longitudinal Mediation Model.

The metacognitive model of psychological disorders suggests that emotional disorders are related to maladaptive metacognitive strategies corresponding to underlying dysfunctional metacognitive beliefs. There is substantial empirical evidence supporting a role of metacognition in psychopathology, but fewer studies have evaluated the metacognitive model using longitudinal data and taken into consideration its differentiation between components and how they are hypothesized to be related to each other. Thus, more specific model evaluation is important as it relates to identifying mechanisms of disorder with a potential to provide clinical advances. In the present study, 868 participants took part in a 4-wave survey and reported on metacognitive beliefs and strategies and anxiety symptoms. Two longitudinal mediation models (forward and reversed causation) were run to test temporal precedence and bidirectional relations. The results indicated that metacognitive beliefs significantly predicted metacognitive strategies, which further predicted anxiety symptoms and mediated the indirect effect in the relationship between metacognitive beliefs and anxiety over time. The relationship between metacognitive beliefs and anxiety symptoms over time were bidirectional, but this relationship was not accounted for by metacognitive strategies. These findings largely support central predictions set forward by the metacognitive model and indicate that metacognitions play a preceding and maintaining role in anxiety.

Measuring Resilience in Long-term Sick-listed Individuals: Validation of the Resilience Scale for Adults.

Return to work from long-term sick leave is influenced by personal and social factors, which can be measured by resilience, a construct that describe healthy adaptation against adversity. This study aimed to validate the validity and psychometric properties of the resilience scale for adults in a sample of long-term sick-listed individuals, and to investigate measurement invariance when compared with a university student sample. Confirmatory factor analysis was used on a sick-listed sample (n = 687) to identify the scale?s factor structure, and comparison with a university student sample (n = 241) was utilized to determine measurement invariance. Results show that a slightly modified factor structure, in accordance with previous research, achieved acceptable fit in the sick-listed sample, while comparisons with the student sample supported measurement invariance. This means that the study to a large degree support the factor structure of the resilience scale for adults in long-term sick-listed. Furthermore, the results indicate that the scale is similarly understood among long-term sick-listed as in a previously validated student sample. Thus, the resilience scale for adults can be a valid and reliable measure of protective factors in the long-term sickness absence and return to work context, and the subscale and total score can be interpreted similarly in long-term sick-listed as in other populations.

Change in interpersonal problems and metacognitive beliefs as predictors of improvement in patients with generalized anxiety disorder.

INTRODUCTION: Generalized anxiety disorder (GAD) is characterized by persistent worry and anxiety, often with a chronic course. We tested the role of two suggested underlying factors in GAD, interpersonal problems and negative metacognitive beliefs, as predictors of trait-worry and trait-anxiety. METHODS: The sample consisted of 56 patients with a primary diagnosis of GAD from a randomized controlled trial. We first estimated the proportion of variance lying between the higher level of the data structure to account for potential therapists' effects. Two hierarchical regression analyses were conducted testing change in interpersonal problems and negative metacognitive beliefs as predictors of change in trait-worry and trait-anxiety following treatment. Change in depression and anxiety symptoms was controlled. RESULTS: Change in negative metacognitive beliefs was the strongest predictor of improvement of both trait-worry and trait-anxiety. Change in interpersonal problems was not a unique predictor of change in trait-worry but did make a significant and unique contribution to trait-anxiety. CONCLUSIONS: Negative metacognitive beliefs may be important targets to improve trait-worry and trait-anxiety in GAD. Interpersonal problems may be relevant for trait-anxiety but could also be a surface marker of higher order vulnerability factors. Implications for treatment are discussed.

The network structure of dysfunctional metacognition: Analysis of the MCQ-30.

The Metacognitive Control System (MCS) model gives central importance to maladaptive metacognition in psychological vulnerability and disorder. The metacognitions questionnaire 30 (MCQ-30) is widely used to assess such metacognitions and to establish their effects. Previous studies consistently demonstrate that the MCQ-30 consists of five latent factors, with some factors showing wide-ranging positive associations with symptoms and some demonstrating more specific symptom links. Questions remain concerning relationships between MCQ-items (or domains) and the most central of these outside of the latent-factor model. In the present study we set out to explore the internal structure of the MCQ-30 using network analysis and estimated two graphical Gaussian models, one with items- and one with domains, in an unselected sample (N = 1080). The robustness and stability of the networks, as well as the node predictability were assessed. Among our observations was that the items of the MCQ-30 appeared to cluster in meaningful substructures, corresponding to metacognitive theory. Furthermore, "need for control" was the most centrally placed domain, suggesting it plays an important role in the network and that its activation has a strong influence on other nodes. The theoretical and clinical implications of the current findings are discussed in light of the metacognitive model of psychological disorder.

Resilience profiles across context: A latent profile analysis in a German, Greek, and Swiss sample of adolescents.

The present study investigated resilience profiles (based on levels of symptoms of anxiety and depression and five dimensions of protective factors) of 1,160 students from Germany (n = 346, 46.0% females, Mage = 12.77, SDage = 0.78), Greece (n = 439, 54.5% females, Mage = 12.68, SDage = 0.69), and Switzerland (n = 375, 44.5% females, Mage = 12.29, SDage = 0.88) using latent profile analyses. We also checked for measurement invariance and investigated the influence of gender and migration on class membership. A three-profile-solution was found for Switzerland (nonresilient 22.1%, moderately resilient 42.9%, untroubled 34.9%), and a four-profile-solution was the best fitting model for Germany (nonresilient 15.7%, moderately resilient 44.2%, untroubled 27.3%, resilient 12.7%) and Greece (nonresilient 21.0%, moderately resilient 30.8%, untroubled 24.9%, resilient 23.3%). Measurement invariance did not hold across the three countries. Profile differences regarding class membership predictions were detected for Germany and Greece, but none for Switzerland. Results implicate that resilience profiles are highly contextually sensitive, and resilience research findings should not be generalized considering the particularity of contexts, people, and outcomes.

Relevance of well-being, resilience, and health-related quality of life to mental health profiles of European adolescents: results from a cross-sectional analysis of the school-based multinational UPRIGHT project.

PURPOSE: The existing evidence suggests that a complete evaluation of mental health should incorporate both psychopathology and mental well-being indicators. However, few studies categorize European adolescents into subgroups based on such complete mental health data. This study used the data on mental well-being and symptoms of mental and behavioral disorders to explore the mental health profiles of adolescents in Europe. METHODS: Data collected from adolescents (N = 3767; mean age 12.4 [SD = 0.9]) from five European countries supplied the information on their mental well-being (personal resilience, school resilience, quality of life, and mental well-being) and mental and behavioral disorder symptoms (anxiety, depression, stress, bullying, cyber-bullying, and use of tobacco, alcohol, or cannabis). Multiple correspondence analysis and cluster analysis were combined to classify the youths into mental health profiles. RESULTS: Adolescents were categorized into three mental health profiles. The "poor mental health" profile (6%) was characterized by low levels of well-being and moderate symptoms of mental disorders. The "good mental health" profile group (26%) showed high well-being and few symptoms of mental disorders, and the "intermediate mental health" profile (68%) was characterized by average well-being and mild-to-moderate symptoms of mental disorders. Groups with higher levels of well-being and fewer symptoms of mental disorders showed lower rates of behavioral problems. Mental well-being indicators strongly contributed to this classification. CONCLUSION: Adolescents with the "intermediate" or "poor" mental health profiles may benefit from interventions to improve mental health. Implications for school-based interventions are discussed. TRIAL REGISTRATION NUMBER (TRN) AND DATE OF REGISTRATION: ClinicalTrials.gov Identifier: NCT03951376. Registered 15 May 2019.

Metacognition, cognition and social anxiety: A test of temporal and reciprocal relationships.

Cognitive models of social anxiety give prominence to dysfunctional schemas about the social self as the key underlying factors in maladaptive self-processing strategies and social anxiety symptoms. In contrast, the metacognitive model argues that beliefs about cognition represent a central belief domain underlying psychopathology and cognitive schemas as products of a thinking style regulated by metacognition. The present study therefore evaluated the temporal and reciprocal relations between metacognitive beliefs, social self-beliefs, and social anxiety symptoms to shed light on possible causal relationships among them. Eight hundred and sixty-eight individuals gathered at convenience participated in a four-wave online survey with each measurement wave 6 weeks apart. Using autoregressive cross-lagged panel models, we found significant temporal and reciprocal relations between metacognition, social self-beliefs (schemas), and social anxiety. Whilst social self-beliefs prospectively predicted social anxiety this relationship was reciprocal. Metacognitive beliefs prospectively predicted both social interaction anxiety and social self-beliefs, but this was not reciprocal. The results are consistent with metacognitive beliefs causing social anxiety and social self-beliefs and imply that negative social self-beliefs might be a product of metacognition. The clinical implications are that metacognitive beliefs should be the central target in treatments of social anxiety.

Sick leave and return to work for patients with anxiety and depression: a longitudinal study of trajectories before, during and after work-focused treatment.

OBJECTIVES: Sick leave due to anxiety and depression is a heterogeneous process constituting a pressing public health issue. This longitudinal study aimed to identify sick leave trajectories among patients before, during and after work-focused treatment, in all 29.5 months. We then aimed to determine the background and clinical characteristics of these trajectory groups. METHODS: Background and clinical data were collected by patient self-report (N=619) in an observational study in a specialised mental healthcare clinic. Sick leave was recorded from national registry data. A latent growth mixture model identified trajectories. Multinomial logistic regression determined differences in background characteristics while a one-way analysis of variance (ANOVA) identified clinical differences. RESULTS: We identified three trajectories: The 'Resilient' group (47.7%) had low sick leave throughout the period. The two other groups ('Recovery', 31.8% and 'High risk', 20.5%) had similar pretreatment trajectories: lower sick leave one year prior which increased to high sick leave at the start of treatment. After treatment, the 'Recovery' group made an almost full return to work while the 'High risk' group remained at high sick leave. The two groups with high sick leave had more women and higher age compared with the 'Resilient' group. All groups had similar clinical scores at the start of treatment, but the 'High risk' groups had residual depressive symptoms at the end of treatment. Effect sizes for anxiety and depression were moderate or large for all groups, (Cohen's d=0.74-1.81), and 87.2% of the total sample were fully working one year after treatment. CONCLUSION: We found three subgroups with distinctly different trajectories. Female gender and higher age were associated with high sick leave at the start of treatment, while residual depressive symptoms at the end of treatment predicted continued sick leave. The study points to the possibility of improving patient outcomes in the future by stratifying and tailoring treatment to patient characteristics.

Measuring Resilience Across Participating Regions in the UPRIGHT EU Horizon 2020 Project: Factor Structure and Psychometric Properties of the Resilience Scale for Adolescents.

Resilience is the process and outcome of healthy adaptation despite significant adversity. Proliferation of research on the resilience construct has led to scientific concerns about the operationalization and measurement of resilience for assessment science and practice. Various studies that have investigated the psychometric properties and construct validity of the Resilience Scale for Adolescents (READ) have yielded inconsistent findings, which could partly be due to variations in the methodological approaches. This study investigated the factor structure and construct validity of the READ in four European regions participating in the Universal Preventive Resilience Intervention Globally Implemented in Schools to Improve and Promote Mental Health for Teenagers (UPRIGHT) project. Participants included adolescents aged 10-15 years from Spain (n = 391, females = 51%), Iceland (n = 379, females = 55%), Italy (n = 460, females = 55%), and Poland (n = 316, females = 51%). The five-factor model of the READ was similar across gender and participating regions. Construct validity of the READ was supported. After establishing construct separability, incremental validity was supported (except for the social competence subscale). The READ is a valid and reliable measure of protective factors involved in resilience and demonstrates promise for cross-cultural applicability. Recommendations for measuring resilience and validating the READ in future investigations are provided.

Housing first, connection second: the impact of professional helping relationships on the trajectories of housing stability for people facing severe and multiple disadvantage.

BACKGROUND: Despite the accumulating evidence on the role of professional helping relationships for highly disadvantaged populations, methodological shortcomings have made it difficult to establish a robust relationships-outcomes link. This study sought to establish the impact of professional helping relationships on the trajectories over 24 months of housing stability for 2141 people facing severe and multiple disadvantage using data from the Housing First controlled trial in Canada. METHOD: The study used a mixed method design. Latent growth curve and growth mixture models assessed the impact of working alliance across the sample as a whole and within subgroups with different patterns of housing stability. Thematic analysis explored the factors that may affect the quality of working alliances within different subgroups. RESULTS: Three distinct trajectories of housing stability emerged (i.e., Class 1: "sharp rise, sustained, and decline housing"; Class 2: "hardly any time housed"; Class 3: "high rise, sustained, and decline housing") with professional helping relationships having different effects in each. The analysis revealed structural and individual circumstances that may explain differences among the classes. CONCLUSIONS: The findings underscore the role of professional helping relationships, as distinct from services, in major interventions for highly disadvantaged populations, and draws new attention to the temporal patterns of responses to both the quality of relationship and targeted interventions.

Interpersonal stress, anxiety and depressive symptoms: Results from a moderated mediation analysis with resilience / Estrés interpersonal, ansiedad y síntomas depresivos: resultados de una mediación moderada con resiliencia

INTRODUCTION AND OBJECTIVES: Interpersonal stress factors contribute to common mental health problems measured as anxiety and depression. Recently, it is emerging that anxiety precedes depression but not the reverse, and markedly increase in response to stress giving way to depression. As such, anxiety itself could be a predictive risk factor, and mediate the associations between stress and depression. While resilience protects against exposure to stress and common mental health problems, it is unclear to what extent different resilience factors are differentially involved in protection against anxiety and depressive symptoms. This study explored complex theoretical associations between interpersonal stress, anxiety and depressive symptoms and resilience factors. MATERIALS AND METHODS: Participants (N = 210 adults) completed the Resilience Scale for Adults (RSA), Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Questionnaire (GAD-7) and the Stressful Life Events Questionnaire (SLE) in a cross-sectional survey. Hierarchical linear regressions and moderated-mediation analyses were performed using PROCESS macro. RESULTS: Interpersonal stress explained more variance in depressive than anxiety symptoms. Support was found for the mediating effect of anxiety symptoms in the relationship between interpersonal stress and depressive symptoms. Resilience factors are differentially involved in protection against anxiety and depressive symptoms. CONCLUSION: Exposure to interpersonal stress is not only directly associated with depressive symptoms but also indirectly through high scores on anxiety symptoms. Uneven functioning and differential impact of resilience factors can help us understand the mixed successes in implementing resilience-based interventions for positive mental health and judiciously allocate scarce and finite resources for intervention

INTRODUCCIÓN Y OBJETIVOS: Los factores de estrés interpersonal contribuyen a problemas comunes de salud mental como ansiedad y depresión. Recientemente, se está demostrando que la ansiedad precede a la depresión, pero no al revés, y que aumenta notablemente en respuesta al estrés dando paso a la depresión. Como tal, la ansiedad en sí misma podría ser un factor de riesgo predictivo y mediar las asociaciones entre el estrés y la depresión. Si bien la resiliencia protege contra la exposición al estrés y los problemas comunes de salud mental, no está claro en qué medida los diferentes factores de resiliencia están involucrados de manera específica en la protección contra la ansiedad y los síntomas depresivos. Este estudio exploró asociaciones teóricas complejas entre estrés interpersonal, ansiedad, síntomas depresivos y factores de resiliencia. Instrumentos y MÉTODO: Los participantes (N = 210 adultos) completaron la Escala de Resiliencia para Adultos (RSA), el Cuestionario de Salud del Paciente (PHQ-9), el Cuestionario de Trastorno de Ansiedad Generalizada (GAD-7) y el Cuestionario de Eventos Vitales Estresantes (SLE) en una encuesta transversal. Se realizaron regresiones lineales jerárquicas y análisis de mediación moderada utilizando PROCESS. RESULTADOS: El estrés interpersonal explicó más variaciones en los síntomas depresivos que en los de ansiedad. Se pudo demostrar el efecto mediador de los síntomas de ansiedad en la relación entre el estrés interpersonal y los síntomas depresivos. Los factores de resiliencia intervienen de manera diferencial en la protección contra la ansiedad y los síntomas depresivos. CONCLUSIONES: La exposición al estrés interpersonal no solo se asocia directamente con los síntomas depresivos, sino también indirectamente, a través de puntuaciones altas en los síntomas de ansiedad. El funcionamiento desigual y el impacto diferencial de los factores de resiliencia pueden ayudarnos a comprender los resultados mixtos obtenidos en la implementación de intervenciones basadas en resiliencia para la salud mental positiva, y asignar juiciosamente los recursos escasos y finitos para la intervención

Temporal and Reciprocal Relations Between Worry and Rumination Among Subgroups of Metacognitive Beliefs.

Metacognitive theory provides strong foundation for hypothesizing relations between worry and rumination among subgroups of metacognitive beliefs. However, empirical exploration of prospective and reciprocal relations between worry and rumination are lacking. This study investigated the stability and relations between worry and rumination to better understand how they influence each other over time, and how different levels of metacognitive beliefs affect relations between (i) initial and future worry, and initial and future rumination, and (ii) the cross-lag relations between worry and rumination. Overall, 482 (Females = 63%) participants (Mean age = 26 years) participated in a two-wave data collection and completed the Metacognition Questionnaire (MCQ-30), the Ruminative Response Scale and the Penn State Worry Questionnaire (PSWQ). A multigroup two-wave autoregressive cross-lagged model was estimated. Multigroup autoregression analyses revealed that independent of participants being in the high or low metacognition group, initial levels of worry predicted future levels of worry, as was the case for rumination. Multigroup cross-lagged analyses revealed that initial levels of worry did not predict future levels of rumination in both high and low levels of metacognitions. However, initial rumination predicted future levels of worry in the high metacognitions group, which was not the case for the low metacognitions group. Thus, high levels of metacognitions do not only strengthen the relation between both present and future worry, present and future rumination, but also present rumination with future worry. This finding may imply that those with rumination related conditions at present are more likely in the future to show both rumination and worry related conditions. Conversely, those with worry related conditions show future worry related conditions. These findings may have implications for a clinical sample regarding the high complexity of rumination conditions that may proceed with multifinality causal pathways especially for individuals with high levels of metacognitions. This complexity may be a possible explanation for the limited success in other traditional treatment of rumination related conditions and the relatively high relapse rates for such conditions in clinical samples.

Resilience Moderates Negative Outcome from Stress during the COVID-19 Pandemic: A Moderated-Mediation Approach.

Resilience refers to an individual's healthy coping abilities when encountering adverse life events. The COVID-19 pandemic represents a situation with a high amount of stress exposure, which in turn may be associated with negative emotional outcome like depressive symptoms. The current study investigated if resilience moderated the effect of stress on symptoms of depression and if anxiety symptoms mediated this association. An adult sample of community controls completed the Perceived stress scale 14 (PSS-14), the Resilience scale for adults (RSA), the Patient health questionnaire 9 (PHQ-9) and the Generalized anxiety disorder 7 (GAD-7). Independent samples t-test, correlation analyses and moderated mediation analyses were conducted. The results showed that resilience moderated the relations between stress and anxiety symptoms (ß = -0.131, p < 0.001) as well as between stress and depressive symptoms (ß = -0.068, p < 0.05). In support of a moderated mediation model, resilience moderated the indirect effect of stress on depressive symptom, as confirmed by the index of moderated mediation (IMM = -0.036, p < 0.001; [95% BCa: -0.055, -0.020]). The high resilience subgroup was less affected than the low resilience subgroup by the effect of stress exposure symptoms of depression, mediated by anxiety. The study shows that stress exposure is associated with symptoms of depression, and anxiety mediates this association. Level of resilience differentiates the direct and indirect effect of stress on depression. Knowledge about the effect of stress in response to a pandemic is important for developing treatment and prevention strategies for stress, depression and health-related anxiety.

Change in Physical Activity During the Coronavirus Disease 2019 Lockdown in Norway: The Buffering Effect of Resilience on Mental Health.

Imposition of lockdown restrictions during the coronavirus disease 2019 (COVID-19) pandemic was sudden and unprecedented and dramatically changed the life of many people, as they were confined to their homes with reduced movement and access to fitness training facilities. Studies have reported significant associations between physical inactivity, sedentary behavior, and common mental health problems. This study investigated relations between participants' reports of change in physical activity (PA; i.e., Reduced PA, Unchanged PA, or Increased PA) and levels of anxiety and depression symptoms during the COVID-19 pandemic lockdown in Norway in the time period from March 12, 2020 to June 15, 2020. The relations between age and gender and levels of anxiety and depression symptoms as well as how different levels of resilience influenced the relation between changes in PA and levels of anxiety and depression symptoms were also investigated. A cross-sectional survey design was used. Participants (N = 1,314; females = 31%) were members of an endurance sports organization aged between 18 and 81 years (M = 49 years; SD = 11.50 years). Participants completed the Resilience Scale for Adults and the Hospital Anxiety and Depression Scale and reported their changes in PA after lockdown restrictions were implemented on March 12, 2020. Regression analysis, independent samples t-test, and two-way multivariate analysis of variance were conducted. Reduced PA was associated with a higher risk of anxiety and depression symptoms. Younger participants in Reduced PA and Unchanged PA subgroups scored significantly higher on levels of anxiety symptoms and significantly higher on depression symptoms in Unchanged PA subgroup. Females in Unchanged PA and Increased PA subgroups scored significantly higher on levels of anxiety symptoms, whereas no gender differences were found for depression symptoms. The main and interaction effects of change in PA and resilience were significantly associated with depression symptoms. For anxiety symptoms, only the main effect of resilience, but not PA, and the interaction effect were significant. Results further showed that resilience was an important factor that influenced the levels of change in PA. High levels of resilience were associated with lower anxiety and depression symptoms in Reduced, Unchanged, and Increased PA subgroups during the COVID-19 lockdown. Promoting PA while boosting resilience factors such as confidence in own ability and drawing on the social support of even reduced social networks or connections while under lockdown can protect against common mental health problems.