Factors Associated With Highest Symptoms of Anxiety During COVID-19: Cross-Cultural Study of 23 Countries.

The COVID-19 restrictions have impacted people's lifestyles in all spheres (social, psychological, political, economic, and others). This study explored which factors affected the level of anxiety during the time of the first wave of COVID-19 and subsequent quarantine in a substantial proportion of 23 countries, included in this study. The data was collected from May to August 2020 (5 June 2020). The sample included 15,375 participants from 23 countries: (seven from Europe: Belarus, Bulgaria, Croatia, Hungary, Italy, Romania, Russia; 11 from West, South and Southeast Asia: Armenia, India, Indonesia, Iran, Iraq, Jordan, Malaysia, Pakistan, Saudi Arabia, Thailand, Turkey; two African: Nigeria and Tanzania; and three from North, South, and Central America: Brazil, Canada, United States). Level of anxiety was measured by means of the 7-item Generalized Anxiety Disorder Scale (GAD-7) and the 20-item first part of The State-Trait Anxiety Inventory (STAI)-State Anxiety Inventory (SAI). Respondents were also asked about their personal experiences with COVID-19, attitudes toward measures introduced by governments, changes in attitudes toward migrants during a pandemic, family income, isolation conditions, etc. The factor analysis revealed that four factors explained 45.08% of variance in increase of anxiety, and these components were interpreted as follows: (1) personal awareness of the threat of COVID-19, (2) personal reaction toward officially undertaken measures and attitudes to foreigners, (3) personal trust in official sources, (4) personal experience with COVID-19. Three out of four factors demonstrated strong associations with both scales of anxiety: high level of anxiety was significantly correlated with high level of personal awareness of the threat of COVID-19, low level of personal reaction toward officially undertaken measures and attitudes to foreigners, and high level of presence of personal experience with COVID-19. Our study revealed significant main effects of sex, country, and all four factors on the level of anxiety. It was demonstrated that countries with higher levels of anxiety assessed the real danger of a pandemic as higher, and had more personal experience with COVID-19. Respondents who trusted the government demonstrated lower levels of anxiety. Finally, foreigners were perceived as the cause of epidemic spread.

The Road Not Taken: What Developmental Psychology Might Learn From Darwin's Insights Concerning Sexual Selection.

Developmental Psychology is the branch of psychology that studies, not only human behavior, but how and why human behavior changes over time. This essay seeks to review to what extent Developmental Psychology has failed to perceive human behavior through the lens of evolutionary theory in general, and in particular sexual selection as first described by Darwin and later elaborated on by many, including Robert Trivers and Geoffrey Miller; the essay asserts that this failure has resulted in many wrong turns and missed opportunities. In some cases, major developmental theorists (e.g., Freud, Erikson) were bedeviled by sex-based differences which they saw but could not explain and which compromised the parsimony of their stage theories. In the case of stage theories of moral development, some major theorists (e.g., Piaget, Kohlberg) were able to offer simpler explanations of moral development only by limiting their studies to male subjects. And, while Developmental Psychology textbooks thoroughly describe sex differences in the timing of morphological changes in puberty, writers seldom discuss why the timing is different in the two sexes, universally, and functionally. On the other hand, several domains of developmental focus, including play, mate choice, parenting, and spatial cognition, have seen successful research efforts that utilized sexually selected predispositions as foundational assumptions. The essay concludes with a discussion of how a more evolutionary and functional view of human behavior might move the field of Developmental Psychology to an even more robust and accurate understanding of how humans change over the course of a lifetime.

Dealing with Anxious Patients: An Integrative Review of the Literature on Nonpharmaceutical Interventions to Reduce Anxiety in Patients Undergoing Medical or Dental Procedures.

Objectives: A previous systematic literature review (SLR) evaluated 501 experiments on reducing patient anxiety across medical and dental environments. This integrative review examines those interventions and explores possible mechanisms leading to relative success or failure within those environments, in the interest of interprofessional education and communication. Methods: Reviewers evaluated 501 experiments testing interventions for reducing patient anxiety in a variety of medical and dental health care settings. Methodology for the SLR, largely following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, is briefly reviewed. Results: A total of 501 experiments (from 408 articles) met review criteria. One hundred and forty-three Music experiments were included, and Music interventions were largely effective, except in the case of colonoscopy. Education is the only intervention that occasionally (5 times of 130 experiments) raised patient anxiety in the face of a procedure; the discussion focuses on the wisdom of assessing patient need for information. Thirty-seven Cognitive Behavioral Therapy (CBT) experiments of various types are included, with a success rate of 89%, with a particularly high rate of success (12 of 12 experiments) in dentistry. Massage has a success rate that is similar to that of CBT, but Massage has been tested in far fewer specialty areas. Relaxation has been tested in every specialty area, except mechanical ventilation, with promising results. Acupuncture and Acupressure have not been widely tested, but their effectiveness rate is 100% when it comes to reducing patient anxiety in various procedural settings. Similarly, experiments show Hypnosis to be successful in 90% of trials. In contrast, Distraction was successful in only 40% of the experiments summarized, although it was more effective in dentistry. A variety of Nature-based Interventions (Aromatherapy, Nature Sounds, and Visual Stimuli) were highly successful across a variety of settings. Discussion: Possible mechanisms are discussed, along with commentary on feasibility. Limitations include publication bias, small sample sizes, and the lack of placebo controls. Future areas of research are pointed out.

Dealing with Anxious Patients: A Systematic Review of the Literature on Nonpharmaceutical Interventions to Reduce Anxiety in Patients Undergoing Medical or Dental Procedures.

Objectives: State (situational) anxiety can create suboptimal outcomes for patients across a variety of health care specializations. While anxiolytic medications reduce anxiety, problematic side effects can compromise outcomes. These challenges have spurred searches for nonpharmaceutical approaches to alleviate patient anxiety. This systematic literature review, largely following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, aimed to determine patterns and effectiveness of interventions across medical health care specialty areas, including dentistry. Methods: A systematic review was conducted, using PubMed, CINAHL, and PsycINFO databases, with search terms related to anxiety, specific interventions, and medical or dental procedures. Hand searching for additional citations was performed on the bibliographies of dissertations, meta-analyses, and systematic reviews that met article inclusion criteria. The search process yielded 48,324 articles and 257 dissertations published in English between 1974 and 2018. Each abstract was evaluated for inclusion by two reviewers, yielding 718 articles that were read and evaluated for outcomes, risk of bias, pretest and post-test, controls and quality, using a Critical Appraisal Skills Programme instrument. Of these, 408 articles, describing 501 experimental trials, were accepted for inclusion in this analysis. Results: A total of 50,343 patients were included in these experiments, with an overall success rate of 71% for reducing patient anxiety. Results are summarized by health care specialty area: surgery, oncology, cardiology, obstetrics/gynecology, dentistry, and pain/trauma, and the following diagnostic testing and intervention areas: imaging, colonoscopy, mechanical ventilation, and other. The largest number of experiments (114) was in the surgery category. The types of interventions included music, education, relaxation, cognitive behavioral therapy (CBT), massage, distraction, hypnosis, acupuncture/acupressure, social support, aromatherapy, nature sounds, natural visual stimuli, special garment, and other. The largest numbers of experiments were done with music (143) and education (130). Discussion: The following interventions were most successful, reducing anxiety in over 70% of experiments: music, CBT, relaxation, massage, acupuncture/acupressure, hypnosis, and natural sounds. Confidence in results is limited by publication bias, small sample sizes, and the lack of placebo controls. Directions for future research are discussed.

Strategies for Managing Chronic Pain, Chronic PTSD, and Comorbidities: Reflections on a Case Study Documented over Ten Years.

Chronic pain and chronic PTSD are often comorbid sequelae in patients who have experienced life-threatening experiences such as combat, assaults, or motor vehicle accidents, presenting lifelong challenges for patients and for medical management in all settings. This article briefly reviews four models for exploring the interrelationships of chronic pain and chronic PTSD. The article presents a longitudinal case study, documented over 10 years, of a patient with chronic back pain, and delayed-onset chronic PTSD related to sexual trauma experienced as a young adult. Data from the case study are examined for evidence in support of the chronic pain/chronic PTSD models. There is evidence to support all four models, with considerable evidence supporting the Mutual Maintenance Model (Sharp & Harvey, in Clinical Psychology Review 21(6): 857-77, 2001). Data show significant recovery over time from both conditions with improvements in function, work, and relationships, in response to Psychodynamic Therapy (PDT), Cognitive Behavioral Therapy (CBT), and hypnotic interventions, physical therapy, and pilates-based exercise. Notably, both chronic conditions were addressed simultaneously, with providers working collaboratively and sharing information through the patient. Emphasis is on non-pharmaceutical rehabilitative trauma-informed and patient-centered approaches to care.

Sources of marital conflict in five cultures.

This analysis of previously collected data examined four fitness-relevant issues for their possible role in marital conflict. These were sex, finances, division of labor, and raising children, selected in light of their pertinence to sex differences in reproductive strategies. Over 2,000 couples in five diverse cultures were studied. Marital conflict was assessed by the Problems with Partner scale, which was previously shown to demonstrate measurement invariance across cultures and genders. All four issues were significantly related to perceived marital problems in almost all cases. Thus, conflict tended to arise around issues relevant to reproductive strategies. A few cultural idiosyncrasies emerged and are discussed. In all cultures, wives reported more problems than husbands. Another important issue was kindness. The results suggest that a key factor in marital success or failure may be kindness necessary to sustain this prolonged and intimate relationship of cooperation for raising one's offspring.

Sex differences and similarities in married couples: patterns across and within cultures.

In this study, we examined the patterns of sex differences in men and women married to each other in five cultures (China, Russia, Turkey, UK, and the U.S.) to look for universal patterns in behavioral dimorphisms and for cultural variability in those patterns. Over 400 couples in each cultural group completed the 235-item Marriage and Relationship Questionnaire on various aspects of marriage, appropriately translated for each culture. Sex differences were anticipated in responses related to female choosiness, labor performed, emotional expressiveness, interest in sex, physical attractiveness, and jealousy. To measure male-female differences in each culture, t-tests were utilized, and effect sizes were calculated. Significant sex differences (p < .05, two-tailed) emerged in all six areas examined, although cultural differences were also seen in the patterns. For example, on items relevant to female choosiness, women in most, but not all, cultures were more likely than their husbands to endorse these statements: "I have thought of divorcing my spouse" and "My parents played a role in choosing my spouse." In China, where scores on emotional expressiveness were low, sex differences disappeared in the category related to emotions. Results suggest that long-term marriage exhibits a balance between homogamy and dimorphism serving reproductive interests. Moreover, culture may moderate this balance for particular sex differences.

Marriage: an evolutionary perspective.

Marriage is universal, and pair bonding is found in other species too with highly dependent young. So marriage functions as a reproductive social arrangement that traditionally involved the extended family. The sexes are not identical in their biological contributions to children's survival, so they seek somewhat different attributes in a mate. Men seek a young, attractive, sexually faithful bride. Women seek a man who is older, taller, and (as in many other species) socially dominant. Both sexes prefer a kind, healthy, attractive, similar mate who is emotionally attached to them. A spouse who fails to maintain sufficiently high mate value is vulnerable to divorce. Infertility and sexual dissatisfaction predict divorce, as does death of a child, but the more children, the stabler the marriage. Cross-cultural data suggest that cruel or subdominant men (e.g., poor providers) and unfaithful women are prone to divorce. Marriages in which the wife dominates the husband in economic contributions, nonverbal behavior, and decision making tend to be less satisfying. In societies in which wives are economically independent of husbands, divorce rates are high. As women's economic power has risen with industrialization, divorce rates have climbed. Economic and fitness considerations also help explain cultural differences in polygyny, age at marriage, arranged marriage, concern with the bride's sexual chastity, and marriage ceremonies. Other factors also affect marital dynamics, such as state subsidies to families, the sex ratio, and influence of the couple's parents.