Optimism in dire times: The buffering role of optimism in the relationship between food insecurity and mental health during the COVID-19 pandemic.

Considering the need to gain a deeper understanding of the protective factors associated with coping with food insecurity, specifically in times of severe prolonged stress, the current longitudinal study seeks to examine the role of optimism in the relationship between food insecurity and adverse mental health outcomes during the COVID-19 pandemic. A three-wave longitudinal study involving 1921 Israeli adults was performed during the COVID-19 pandemic. Participants completed questionnaires assessing food insecurity, anxiety, depression, optimism, and socio-demographic characteristics. To explore the relationship between food insecurity and symptoms of anxiety and depression, as well as the moderating role of optimism in this relationship, we employed a set of panel regression models with individual fixed effects. Our results indicate that the degree and change in food insecurity over time were positively associated with both anxiety and depression symptoms, whereas the degree and change in optimism were negatively correlated. Optimism was found to moderate the association between food insecurity and anxiety symptoms over time, but not the association between food insecurity and depression symptoms. A subgroup analysis revealed that optimism moderated the relationship between food insecurity and anxiety and depression for women, but not for men; for married/coupled individuals but not for singles; for non-parents with regard to anxiety, and for parents with regard to depression. Our results highlight the need to practice and enhance optimism in times of great despair, uncertainty, and hardship, especially in situations of food insecurity where tangible change may take time.

Freely Available Training Videos for Suicide Prevention: Scoping Review.

BACKGROUND: Freely available and asynchronous implementation supports can reduce the resource burden of evidence-based practice training to facilitate uptake. Freely available web-based training videos have proliferated, yet there have been no efforts to quantify their breadth, depth, and content for suicide prevention. OBJECTIVE: This study presents results from a scoping review of freely available training videos for suicide prevention and describes a methodological framework for reviewing such videos. METHODS: A scoping review of freely available training videos (≥2 minutes) for suicide prevention practices was conducted using 4 large video-sharing platforms: YouTube, Vimeo, Bing Video, and Google Video. Identified suicide prevention training videos (N=506) were reviewed and coded. RESULTS: Most content was targeted toward gatekeepers or other lay providers (n=370) versus clinical providers (n=136). Videos most commonly provided content related to suicidal thoughts or behaviors (n=420). Many videos (n=274, 54.2%) included content designed for certain communities or organizations. Less than half (n=232, 45.8%) of training videos included formal clinical content pertaining to assessment or intervention for suicide prevention. CONCLUSIONS: Results suggested an abundance of videos providing broad informational content (eg, "signs and symptoms of someone at risk for suicide") and a limited portion of videos with instructional content aimed at clinical providers delivering formal evidence-based assessments or interventions for suicide prevention. Development of resources to address identified gaps may be needed. Future work may leverage machine learning techniques to expedite the review process.

Home quarantines and cumulative risk exposure among young children: Isolation and maladaptation.

Self-isolation and quarantine are common and effective measures to contain the spread of COVID-19. However, it may have detrimental implications on young children's adaptation and mental health. The present study explores the prevalence of home quarantines among young children in Israel and their associations with children's maladaptive behaviors. The analysis is based on self-reported data obtained by 374 parents of young children in November 2021. Participants completed questionnaires, assessing the prevalence of home quarantines among children (aged 3-11 years old), and maladaptive behaviors, including rage outbursts, physical violence against family or friends, and panic attacks. Multivariate regression models were used to determine the relationships between the number of child quarantines and their maladaptive behaviors. Our results suggest that 51% of parents reported having their child quarantined more than once, which did not differ across socioeconomic characteristics. Furthermore, 66% of parents reported that during the pandemic, their child exhibited maladaptive behaviors at least once. Children who were quarantined more than once were more likely to exhibit rage outbursts, physical violence, and/or panic attacks. The associations between children's quarantine and physical violence were slightly stronger among families living in high-density households. Repeated experiences of home quarantine may operate as exposure to accumulative risk and have a lasting effect on young children's development. Practice and policy recommendations for interventions for young children and their families who experience home quarantines are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

How does social support relate to emotional availability for learning during COVID-19? A multi-group structural equation model of university students from the U.S. and Israel.

Given the social and emotional tolls of the COVID-19 pandemic on college and university students, many students have become academically disengaged during the pandemic. Although some colleges and universities have the capacity to promote social support for their students, research has yet to comprehensively demonstrate the relationship between social support and academic engagement. To fill this gap, we leverage survey results from four universities across the United States and Israel. Through multi-group structural equation modelling, we explore (a) how perceived social support relates to being emotionally unavailable for learning, (b) how this relationship is partially explained through coping and COVID-19 concerns, and (c) how these relationships can differ across countries. We find that students who perceived higher levels of social support had lower rates of being emotionally unavailable for learning. Part of this relationship occurred through greater rates of coping and, subsequently, fewer concerns about the pandemic. We also noticed significant differences in these relationships between countries. We conclude with a discussion of study implications for higher education policies and practices.

An Assessment of Faculty Perceptions of Wellness Needs and Strategies to Optimize Engagement With Wellness Resources in Academic Medicine.

OBJECTIVE: Faculty at academic medical institutions are at increased risk for burnout. This study aimed to assess faculty perceptions of wellness needs and identify strategies to optimize engagement with individualized wellness resources. METHODS: Semistructured interviews were conducted with 37 faculty members in one US academic medical center. RESULTS: Participants identified significant barriers to achieving emotional health and wellness goals. Areas where participants identified needing the most support included interpersonal relationships, accountability for wellness goals, career support, financial resources, and mentorship. Most participants were unaware of all wellness resources available at their institution. Participants recommended regular marketing and emphasizing confidentiality of employer-sponsored programs. They also provided feedback on specific dissemination and marketing methods. CONCLUSIONS: This research underscores the need for wellness resources for faculty and the importance of intentional dissemination of these resources to optimize uptake.

Racial and Ethnic Disparities in Housing Instability During the COVID-19 Pandemic: the Role of Assets and Income Shocks.

Stable and adequate housing is critical to sound public health responses in the midst of a pandemic. This study explores the disproportionate impact of the COVID-19 pandemic on housing-related hardships across racial/ethnic groups in the USA as well as the extent to which these disparities are mediated by households' broader economic circumstances, which we operationalized in terms of prepandemic liquid assets and pandemic-related income losses. Using a longitudinal national survey with more than 23,000 responses, we found that Black and Hispanic respondents were more vulnerable to housing-related hardships during the pandemic than white respondents. These impacts were particularly pronounced in low- and moderate-income households. We found that liquid assets acted as a strong mediator of the housing hardship disparities between white and Black/Hispanic households. Our findings imply that housing became less stable for minority groups as a result of the pandemic, particularly those households with limited liquid assets. Such housing-related disparities demonstrate the need for policies and practices that target support to economically marginalized groups and families of color in particular.

Prevalence of Long-COVID Among Low-Income and Marginalized Groups: Evidence From Israel.

Objective: To identify the socioeconomic and demographic factors associated with the prevalence of self-reported long-COVID symptoms. Method: We examined the association between acute-COVID (SARS-CoV-2) and long-COVID symptoms, by a cross-sectional analysis of data obtained on a prospective online-survey, conducted from November to December 2021 on a nationally-representative sample of the Israeli population (N = 2,246). Results: Findings suggest that there is a greater likelihood of experiencing long-COVID symptoms among low-income and among marginalized groups. After controlling for demographic and socioeconomic attributes, those who had moderate/severe acute-COVID were 1.3 (p < 0.05) times more likely to experience a long-term symptom and also reported more long-term symptoms (2.2 symptoms) than those who have not been infected (1.4 symptoms; p < 0.01). Among the low-income group, a larger gap in symptom count was found between those who had moderate/severe acute-COVID (3.3 symptoms) and those who had not been infected (1.8 symptoms, p < 0.05). Conclusion: Our findings highlight the importance of raising awareness of long-COVID among marginalized population groups, and to the therapeutic options available. Such efforts should be tailored and should consider the unique socioeconomic and cultural characteristics, as well as the preexisting low access to healthcare services among these groups.

Predictors of and barriers to receipt of advance premium tax credits.

OBJECTIVES: The Advance Premium Tax Credit (APTC) is designed to remedy lack of health insurance due to cost; however, approximately 30 million Americans remain without health insurance and millions of households leave billions in tax credits unclaimed each year. A prerequisite of APTC is to file one's taxes; however, few studies have examined tax filing and APTC jointly. This study examined the relationship between tax filing and applying for APTC, as well as perceived barriers to and sociodemographic characteristics associated with applying for the APTC. STUDY DESIGN: Descriptive study. METHODS: Researchers surveyed 372 Marketplace-insured members who were eligible for APTC. RESULTS: Most of the sample filed personal taxes in 2019 and planned to file taxes in 2020, yet only 23% applied for the APTC in 2019, and 26.3% were planning to apply in 2020. Most commonly, respondents were not going to apply because they believed they were not eligible (53.5%), they did not know about the APTC (15.8%), and they did not know whether they were eligible (9.9%). Logistic regression modeling found that employment, income, and race were significantly associated with applying for the APTC. CONCLUSIONS: Barriers to applying for the APTC were unrelated to tax filing and were specific to a lack of knowledge about the APTC and eligibility. These results indicate the need to build knowledge and awareness of the APTC and eligibility and to target groups least likely to apply. Implications and future directions are discussed.

Coping with COVID-19: Differences in hope, resilience, and mental well-being across U.S. racial groups.

OBJECTIVES: To explore if the COVID-19 pandemic revealed differences across racial groups in coping, resilience, and optimism, all of which have implications for health and mental well-being. METHODS: We collect data obtained from four rounds of a national sample of 5,000 US survey respondents in each round from April 2020 to February 2021. Using logistic regression and fixed effects models, we estimate the pandemic impacts on COVID-19 related concerns, social distancing behaviors, and mental health/life satisfaction and optimism for racial/income groups. RESULTS: Despite extreme income and health disparities before and during the COVID-19 outbreak, Blacks and Hispanics remain more resilient and optimistic than their White counterparts. Moreover, the greatest difference in resilience, optimism and better mental health-is found between poor Blacks and poor Whites, a difference that persists through all four rounds. CONCLUSIONS: These deep differences in resilience have implications for the long-term mental health of different population groups in the face of an unprecedented pandemic. Better understanding these dynamics may provide lessons on how to preserve mental health in the face of public health and other large-scale crises.

Household Spending Patterns and Hardships during COVID-19: A Comparative Study of the U.S. and Israel.

The combined supply and demand shocks of the COVID-19 pandemic have created the largest consumer behavior shift in recent history, while exposing millions of households to material hardships like food insecurity and housing instability. In this study, we draw on national surveys conducted early in the pandemic to investigate the pandemic's effects on self-reported consumer spending behaviors and experiences of hardship for households in the US and Israel; two countries that are similar in terms of their development but have had divergent experiences with and responses to the pandemic. We also examine the extent to which racial/ethnic/religious minority status and pre-pandemic employment characteristics predict these outcomes. Using descriptive and logistic regression approaches, we find that housing expenditures were fairly stable in the U.S. and Israel, while food and credit card payment expenditures were relatively volatile. We also find that skipped utility bill payments were much higher in the US than Israel, while rates of skipping housing payments and food insecurity were similar between the two countries. Generally speaking, racial/ethnic/religious minorities in both countries were more likely to experience spending volatility, while Black and Hispanic (in the US) and Arab (in Israel) households were more likely to experience hardships. Employment and financial characteristics also appeared much more predictive of hardship in the US than in Israel. Supplementary Information: The online version contains supplementary material available at 10.1007/s10834-021-09814-z.

Public perceptions and the willingness to get vaccinated against COVID-19: Lessons from Israel.

OBJECTIVES: To explore the associations between vaccine hesitancy and demographic and socio-economic characteristics, as well as perspective towards the COVID-19 and its vaccines. METHODS: Data were collected through four online surveys on Israel's representative sample in March (3/2 to 3/7, n = 1517), August (8/10-8/11, n = 925; 8/18-8/22, n = 1054), and September (9/22-9/24; n=1406), 2021. We employ a set of logistic regression models to explore the association between the vaccination action and intentions and the individual-level attributes. RESULTS: We find that individual characteristics, such as age, ethnicity/religiosity, and income, were associated with the vaccination action and intention during the early stage of vaccine distribution. However, most of the discrepancies across demographic groups have disappeared as time passed, and once we limit to those who had not been infected. Lastly, individuals' perspectives toward COVID-19 and its vaccines have prediction power as high as 39% of the vaccination action and intention, higher than their demographic and socio-economic characteristics. IMPLICATIONS: Our findings have the potential to facilitate efforts to increase vaccine uptake by targeting populations, which are the most likely to express hesitancy, and address reported barriers to receipt.

Financial Shocks and Financial Well-Being: What Builds Resiliency in Lower-Income Households?

Households in the U.S. regularly experience unexpected negative income or expense shocks, and low- and moderate-income households experience these shocks at disproportionately high rates. Relatively little is known about the impact these shocks have on households' subjective sense of financial well-being, and how access to different types of liquidity (e.g., liquid assets, credit cards, social resources, and income flows) can mitigate the impact of these shocks on subjective financial well-being. To address these gaps in the literature, this paper uses data from a two-wave survey administered to 3,911 low- and moderate-income tax filers in 2018. Applying a difference-in-difference analysis, we find that the experience of an income shock between survey waves was associated with a large decline in subjective financial well-being, while the experience of an expense shock was associated with a more modest decline. Relatively liquidity-constrained households tended to be more negatively impacted by shocks than their counterparts, though not all sources of liquidity were equally as effective in buffering households against shocks. The findings of this paper point to the need for policymakers and program administrators to develop tools that can facilitate access to different types of liquidity to offset different financial risks for households.

Patterns of alliance development in cognitive behavioral therapy versus attention bias modification for social anxiety disorder: Sawtooth patterns and sudden gains.

OBJECTIVES: We examined patterns in alliance development in cognitive behavioral therapy (CBT) for social anxiety disorder (SAD) compared to attention bias modification (ABM). We focused on the occurrence of sawtooth patterns (increases within- and decreases between-sessions) and sudden gains and their association with outcome. METHODS: Clients received CBT (n = 33) or ABM (n = 17). Client-rated alliance was measured before and after each session. Self-reported and clinician-rated anxiety were measured weekly and monthly, respectively. RESULTS: The alliance increased in CBT in a sawtooth pattern and did not change in ABM. When examining individual clients, sawtooths were more common in CBT (61% clients) than in ABM (6%) and predicted worse outcome in CBT. Sudden gains were equally frequent (CBT, 18%; ABM, 18%) and did not predict outcome. CONCLUSION: The alliance in CBT is dynamic and important for outcome. Sawtooths are common in CBT and may mark worse outcome.

COVID-19 Among Youth in Israel: Correlates of Decisions to Vaccinate and Reasons for Refusal.

PURPOSE: The primary aim of the present study is to examine the reasons for adolescents' refusal to get vaccinated with the COVID-19 vaccine, and examine correlates of vaccination among adolescents aged 12-18 years in Israel. METHODS: A total of 150 youth aged 12-18 years participated in the study. Following parental consent (30% response rate) from an online internet Israeli participants' pool, 150 youth completed the survey (50.5% response rate). Data were collected from May to June 2021. RESULTS: Over half (64.0%) of youth in this study had received the COVID-19 vaccine (25.5% received one dose and 38.9% two doses). Of the youth who were not vaccinated the most common reasons cited for refusing the vaccine was not knowing enough about the harms that a vaccine has in the long run, not trusting the drug companies that the vaccine will be safe, believing the virus is not dangerous, and doubting the safety of the vaccine in the short term. Bivariate odds ratios indicate that age (older) and having both parents vaccinated was related to increase the odds of the youth getting vaccinated. Higher distress over the effects of the vaccine was significantly related to lower odds of receiving the vaccine. Social media use was also related to a higher likelihood of being vaccinated at the bivariate level. DISCUSSION: Study findings provide specific ways in which peer-designed and peer-led public health programs may encourage youth to receive the COVID-19 vaccine in a manner that recognizes concerns of Israeli youth.

Increasing access to mental health supports for healthcare workers during the COVID-19 pandemic and beyond through a novel coaching program.

The COVID-19 pandemic led to heightened anxiety, distress, and burnout among healthcare workers and faculty in academic medicine. Penn Medicine launched Coping First Aid (CFA) in March 2020 in response to the pandemic. Informed by Psychological First Aid principles and therapeutic micro skills, CFA was designed as a tele-mental healthcare service for health system employees and their families delivered by trained lay volunteer coaches under the supervision of licensed mental health clinicians. We present an overview of the model, feasibility and utilization data, and preliminary implementation and effectiveness outcomes based on cross sectional coach (n = 22) and client (n = 57) self-report surveys with a subset of program users in the first year. A total of 44 individuals completed training and were certified to coach. Over the first 24 months of the program, 513 sessions occurred with 273 clients (119 sessions were no-shows or canceled). Follow-up appointments were recommended in 52.6% (n = 270) of sessions and 21.2% (n = 109) of clients were referred for professional mental health care. Client survey respondents reported CFA was helpful; 60% were very or extremely satisfied, and 74% indicated they would recommend the program. Our preliminary findings suggest that CFA was feasible to implement and most clients found the service beneficial. CFA provides a model for rapidly developing and scaling mental health supports during and beyond the pandemic.

Modelling Pathological Narcissism Using the Brief PNI in Terms of Structure and Convergent and Divergent Validity: A New Perspective.

The Pathological Narcissism Inventory (PNI) is a popular measure and the first to attempt to tap into both grandiose and vulnerable narcissism (GN/VN). However, data have raised questions as to whether it appropriately formulates GN and differentiates it from VN. In this study, we examined the Brief-PNI's structure and construct validity, by using a novel model based on the theoretical notion of GN and VN sharing core features. Participants (N = 1,061) completed the Brief-PNI, and psychological distress and social avoidance questionnaires. Results showed a better fit and differentiation of GN and VN for a model with cross-loading of shared first-order factors on GN and VN, compared with the traditional PNI structure. We concluded that the Brief-PNI can offer an appropriate formulation and differentiation of VN and GN, provided that their shared variance is considered.

The alliance mediates outcome in cognitive-behavioral therapy for social anxiety disorder, but not in attention bias modification.

Objective: The aim of the current study was to examine changes in the therapeutic alliance and its role as a mediator of treatment outcome in cognitive behavioral therapy (CBT) for social anxiety disorder (SAD) compared to attention bias modification (ABM). Method: Patients were randomized to 16-20 sessions of CBT (n = 33) or 8 sessions of ABM (n = 17). Patient-rated alliance and self-reported social anxiety were measured weekly and evaluator-rated social anxiety was measured monthly. Results: Early alliance predicted greater subsequent anxiety reduction in CBT but not in ABM. The alliance increased and weekly improvements in alliance predicted weekly contemporaneous and subsequent decreases in anxiety only in CBT. Decreases in anxiety did not predict subsequent improvements in alliance. Both treatments were effective in reducing anxiety, but treatment effects were mediated by stronger early alliance and stronger cross-lagged effects of alliance on outcome in CBT compared to ABM. Conclusions: The results highlight the importance of the alliance in CBT for SAD. Further studies should examine the role of alliance alongside additional mediators to better understand differential mechanisms in CBT and ABM.

The role of expressive suppression and cognitive reappraisal in cognitive behavioral therapy for social anxiety disorder: A study of self-report, subjective, and electrocortical measures.

BACKGROUND: Contemporary models of cognitive behavioral therapy (CBT) for social anxiety disorder (SAD) emphasize emotion dysregulation as a core impairment whose reduction may play a causal role in psychotherapy. The current study examined changes in use of emotion regulation strategies as possible mechanisms of change in CBT for SAD. Specifically, we examined changes in expressive suppression and cognitive reappraisal during CBT and whether these changes predict treatment outcome. METHODS: Patients (n = 34; 13 females; Mean age = 28.36 (6.97)) were allocated to 16-20 sessions of CBT. An electrocortical measure of emotion regulation and a clinician-rated measure of SAD were administered monthly. Self-report measures of emotion regulation and social anxiety were administered weekly. Multilevel models were used to examine changes in emotion regulation during treatment and cross-lagged associations between emotion regulation and anxiety. RESULTS: CBT led to decreased suppression frequency, increased reappraisal self-efficacy, and decreased unpleasantness for SAD-related pictures (ps < .05). At post-treatment, patients were equivalent to healthy controls in terms of suppression frequency and subjective reactivity to SAD-related stimuli. Gains were maintained at 3-months follow-up. Decreases in suppression frequency and electrocortical reactivity to SAD-related pictures predicted lower subsequent anxiety but not the other way around (ps < .05). Lower anxiety predicted greater subsequent increases in reappraisal self-efficacy. LIMITATIONS: The lack of a control group precludes conclusions regarding mechanisms specificity. CONCLUSIONS: Decreased frequency of suppression is a potential mechanism of change in CBT for SAD.

Improvement in adult anxious and avoidant attachment during cognitive behavioral therapy for panic disorder.

OBJECTIVE: This study examined attachment within the framework of cognitive behavioral therapy (CBT) for panic disorder with agoraphobia (PDA) by measuring the changes in avoidant and anxious attachment in a session-by-session analysis. METHOD: Thirty-one patients with PDA were treated using CBT. Pre-session data on attachment style (ECR), avoidance behaviors (MI-alone: MI-al; MI-accompanied: MI-ac), anxiety sensitivity (ASI), emotion regulation (ERQ), and working alliance (WAI) were collected. Mixed model analyses were conducted to estimate relationship between changes in attachment, PDA symptoms, and related measures. RESULTS: Variables improved during therapy. Changes in ASI were positively related to changes in avoidant and anxious attachment. Changes in MI-al, but not MI-ac, were related to changes in ECR. Changes in ASI and MI-al predicted changes in ECR-anxiety in the following session, but not vice versa. Similarly, changes in avoidance behaviors and ERQ-suppression, preceded changes in ECR-avoidance unidirectionally. Whereas WAI significantly improved, its variability was related only to simultaneous changes in ECR-anxiety. CONCLUSIONS: Overall, avoidant and anxious attachment improved during CBT for PDA. This change was related to and preceded by improved anxiety sensitivity, avoidance behaviors, and emotion regulation. These findings suggest that CBT for panic probably has downstream effects on attachment representations. Clinical or methodological significance of this article: This is the first report of changes in attachment via cognitive behavioral therapy for panic disorder. Data were examined using repeated measures session by session, allowing for examination of temporal precedence of changes. Results revealed that anxiety sensitivity, avoidance, and suppression preceded changes in attachment. Results are discussed in the framework of modern attachment theory models.

A pilot randomized clinical trial of cognitive behavioral therapy versus attentional bias modification for social anxiety disorder: An examination of outcomes and theory-based mechanisms.

No studies have compared face-to-face cognitive-behavioral therapy (CBT) and attention bias modification (ABM) for social anxiety disorder (SAD) and their purported mechanisms. We asked: 1) Is CBT more effective than ABM? and 2) Are changes in attentional biases and cognitions temporally related to symptom change? Forty-three patients were randomly assigned to 8 sessions of ABM or up to 20 sessions of individual CBT. Intent-to-treat results revealed that CBT was superior to ABM in response rates and on symptom measures at endpoint, but not on other measures. No differences were found on measures in rates of change between CBT and ABM. Frequency of negative cognitions changed in both groups and negative beliefs changed only in CBT. Attentional bias did not change in either group. Cognitive changes bidirectionally correlated with symptom change in cross-lagged analyses in CBT, but not in ABM, suggesting a reciprocal relationship. Trial-level bias away from negative faces was simultaneously related to symptom change in ABM only. Results suggest that CBT is superior to ABM when administered at their typical doses, but raise questions given the similar rates of change. In addition, results support theories of cognitive change and raise questions about changes in attentional biases in CBT.