Digital interventions to promote psychological resilience: a systematic review and meta-analysis.

Societies are exposed to major challenges at an increasing pace. This underscores the need for preventive measures such as resilience promotion that should be available in time and without access barriers. Our systematic review summarizes evidence on digital resilience interventions, which have the potential to meet these demands. We searched five databases for randomized-controlled trials in non-clinical adult populations. Primary outcomes were mental distress, positive mental health, and resilience factors. Multilevel meta-analyses were performed to compare intervention and control groups at post-intervention and follow-up assessments. We identified 101 studies comprising 20,010 participants. Meta-analyses showed small favorable effects on mental distress, SMD = -0.24, 95% CI [-0.31, -0.18], positive mental health, SMD = 0.27, 95% CI [0.13, 0.40], and resilience factors, SMD = 0.31, 95% CI [0.21, 0.41]. Among middle-aged samples, older age was associated with more beneficial effects at follow-up, and effects were smaller for active control groups. Effects were comparable to those of face-to-face interventions and underline the potential of digital resilience interventions to prepare for future challenges.

Cognitive reappraisal in mHealth interventions to foster mental health in adults: a systematic review and meta-analysis.

Background: An increasing number of mHealth interventions aim to contribute to mental healthcare of which interventions that foster cognitive reappraisal may be particularly effective. Objectives: To evaluate the efficacy of mHealth interventions enhancing cognitive reappraisal to improve mental health in adult populations. Methods: The literature search (four databases) yielded 30 eligible randomized controlled trials (comprising 3,904 participants). We performed a multi-level meta-analysis to examine differences between intervention and comparator conditions at post-intervention assessment. Moderator analyses were conducted for potential moderator variables (e.g., type of comparators). Results: Most interventions were CBT-based with other training components in addition to cognitive reappraisal. We found preliminary evidence for a small to medium effect favouring mHealth interventions to enhance cognitive reappraisal over comparators, M(SMD) = 0.34, p = .002. When analysing single symptoms, there was evidence for a small to medium effect of mHealth interventions on anxiety and depressive symptoms, but not for psychological distress and well-being. All analyses showed substantial heterogeneity. Moderator analyses revealed evidence for more favourable effects in studies with passive comparators. There was an overall high risk of bias in most of the studies. Conclusions: We found preliminary evidence for a small to medium effect of mHealth interventions including a cognitive reappraisal component to improve mental health. However, most of the interventions were complex (i.e., reappraisal was provided alongside other components), which prevents us from examining reappraisal-specific effects beyond general mental health promotion in mHealth. Dismantling studies examining the effects of single intervention components are warranted to corroborate these promising results. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=142149, identifier [CRD42019142149].

Interrelations of resilience factors and their incremental impact for mental health: insights from network modeling using a prospective study across seven timepoints.

Resilience can be viewed as trajectory of stable good mental health or the quick recovery of mental health during or after stressor exposure. Resilience factors (RFs) are psychological resources that buffer the potentially negative effects of stress on mental health. A problem of resilience research is the large number of conceptually overlapping RFs complicating their understanding. The current study sheds light on the interrelations of RFs in the face of the COVID-19 pandemic as a use case for major disruptions. The non-preregistered prospective study assessed a sample of 1275 German-speaking people from February 2020 to March 2021 at seven timepoints. We measured coping, hardiness, control beliefs, optimism, self-efficacy, sense of coherence (SOC), sense of mastery, social support and dispositional resilience as RFs in February 2020, and mental health (i.e., psychopathological symptoms, COVID-19-related rumination, stress-related growth) at all timepoints. Analyses used partial correlation network models and latent growth mixture modeling (LGMM). Pre-pandemic RFs were strongly interrelated, with SOC being the most central node. The strongest associations emerged between coping using emotional support and social support, SOC and sense of mastery, and dispositional resilience and self-efficacy. SOC and active coping were negatively linked. When we examined RFs as predictors of mental health trajectories, SOC was the strongest predictor of psychopathological symptoms and rumination, while trajectories of stress-related growth were predicted by optimism. Subsequent network analyses, including individual intercepts and slopes from LGMM, showed that RFs had small to moderate associations with intercepts but were unrelated to slopes. Our findings provide evidence for SOC playing an important role in mental distress and suggest further examining SOC's incremental validity. However, our results also propose that RFs might be more important for stable levels of mental health than for adaptation processes over time. The differential associations for negative and positive outcomes support the use of multidimensional outcomes in resilience research.

Generation climate crisis, COVID-19, and Russia-Ukraine-War: global crises and mental health in adolescents.

Climate change, COVID-19, and the Russia-Ukraine War are some of the great challenges of our time. These global crises affect young people in a particularly vulnerable phase of their lives. The current study aimed to assess the impact of these crises on mental health (depression, anxiety, and health-related quality of life) in secondary school students in Germany. Furthermore, we assessed known predictors of mental health, such as socio-economic factors, individual life stressors, and resilience factors (self-efficacy, expressive flexibility) as covariates. In our sample of 3998 pupils, pandemic- and climate-related distress were linked to greater depression and anxiety and reduced health-related quality of life. War-related distress was associated with greater anxiety. Critically, these associations remained significant after controlling for all covariates, supporting the incremental predictive value of the crises measures. The study reveals a significant impact of the crises on the mental health of the current generation of adolescents. As such it suggests that mental health policies should include interventions that help youth to cope with the stress caused by the crises.

The interplay between music engagement and affect: A random-intercept cross-lagged panel analysis.

Engagement with music has the capacity to influence and be influenced by affective experiences. Although cross-sectional and experimental research provides evidence that music engagement is related to higher positive and lower negative affect, few studies have investigated the bidirectional nature of this relationship over time. The present longitudinal study, therefore, examined the interplay between passive and active music engagement and affect using random-intercept cross-lagged panel analysis. Over 8 weeks in 2022, 428 participants regularly engaging with music completed weekly online surveys on quantitative music engagement (i.e., time spent with music listening/music making), qualitative music engagement (i.e., use of music listening/music making for mood regulation) as well as positive and negative affect. Results revealed cross-lagged associations between music engagement and negative affect, but not positive affect: regarding quantitative music engagement, more time spent with music listening (but not music making) was related to less negative affect than usual at the following measurement. Results on qualitative music engagement showed that weeks with more negative affect than usual were followed by an increased use of music listening and music making for mood regulation. Our findings emphasize the bidirectional nature of the relationship between music engagement and affect corroborating the significant role of music engagement in affect regulation. Future research should replicate these findings with a more diverse sample regarding age, sex, ethnicity, education, and socioeconomic status. Additionally, further studies could examine individual and contextual factors and adequate measurement time points for further investigation of bidirectional affective processes involved in music engagement. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

World Health Organization's low-intensity psychosocial interventions: a systematic review and meta-analysis of the effects of Problem Management Plus and Step-by-Step.

Many societies have been recently exposed to humanitarian and health emergencies, which have resulted in a large number of people experiencing significant distress and being at risk to develop mental disorders such as depression, anxiety and post-traumatic stress disorder. The World Health Organization has released a series of scalable psychosocial interventions for people impaired by distress in communities exposed to adversities. Prominent among these is a low-intensity transdiagnostic psychosocial intervention, Problem Management Plus (PM+), and its digital adaptation Step-by-Step (SbS). This systematic review is the first to summarize the available evidence on the effects of PM+ and SbS. Up to March 8, 2023, five databases were searched for randomized controlled trials examining the effects of PM+ or SbS on distress indicators (i.e., general distress; anxiety, depressive or post-traumatic stress disorder symptoms; functional impairment, self-identified problems) and positive mental health outcomes (i.e., well-being, quality of life, social support/relationships). We performed random-effects multilevel meta-analyses on standardized mean differences (SMDs) at post-intervention and short-term follow-up assessments. Our search yielded 23 eligible studies, including 5,298 participants. We found a small to medium favorable effect on distress indicators (SMD=-0.45, 95% CI: -0.56 to -0.34) and a small beneficial effect on positive mental health outcomes (SMD=0.31, 95% CI: 0.14-0.47), which both remained significant at follow-up assessment and were robust in sensitivity analyses. However, our analyses pointed to substantial between-study heterogeneity, which was only partially explained by moderators, and the certainty of evidence was very low across all outcomes. These results provide evidence for the effectiveness of PM+ and SbS in reducing distress indicators and promoting positive mental health in populations exposed to adversities, but a larger high-quality evidence base is needed, as well as research on participant-level moderators of the effects of these interventions, their suitability for stepped-care programs, and their cost-effectiveness.

The mental health impact of the COVID-19 pandemic on older adults: a systematic review and meta-analysis.

BACKGROUND: Early in the COVID-19 pandemic, many experts pointed to potential adverse mental health effects for older adults. By contrast, many studies in young to middle-aged adults found older age to be associated with reduced mental burden. However, a systematic review on older adults is missing. OBJECTIVES: To comprehensively assess the pandemic's mental health impact on older adults. DATA SOURCES: We searched nine databases from December 2019 to April 2022. STUDY SELECTION: We included longitudinal and repeated cross-sectional studies assessing pre- and/or peri-pandemic mental distress and/or positive mental health indicators (e.g. wellbeing) on at least two occasions. DATA SYNTHESIS: We identified 108 studies comprising 102,136 participants (≥60 years). After removal of outliers, there was a small increase in mental distress from pre-to-peri-pandemic assessments, standardised mean difference (SMD) = 0.10, 95% confidence interval (CI) [0.01, 0.18]. Furthermore, a small peri-pandemic decrease in anxiety symptoms was observed, whereas other symptoms remained unchanged. For positive mental health indicators, wellbeing and quality of life showed an initial decrease, whereas overall positive mental health increased during the pandemic, SMD = 0.08, 95% CI [0.01, 0.15]. Being female was related to larger peri-pandemic increases in mental distress. CONCLUSIONS: Based on many studies, this review demonstrated small decreases in mental health during early stages of the pandemic in older adults, with evidence for later recovery. These findings are similar to those for younger adults and correct earlier claims that older adults are at particular risk for negative mental health consequences. The results ask for further research into resilience and adaptation processes in older adults.

Differential associations of leisure music engagement with resilience: A network analysis

Background/Objective: Several factors associated with resilience as the maintenance of mental health despite stress exposure can be strengthened through participation in leisure time activities. Since many people listen to or make music in their leisure time, the aim of the present study was to provide insights into the architecture of how resilience relates to passive and active music engagement. Method: 511 participants regularly listening to and/or making music completed an online survey on resilient outcomes (i.e., mental health and stressor recovery ability), different resilience factors (e.g., optimism, social support), quantitative music engagement (i.e., time spent with music listening/making) and qualitative music engagement (i.e., use of music listening/making for mood regulation). Results: Bivariate correlations showed that subjects spending more time with music making reported better stressor recovery ability and less mental health problems, while partial correlational network analysis revealed no unique associations for quantitative music engagement. Regarding qualitative music engagement, people using music-based mood regulation reported lower mental health, mindfulness, and optimism, but also higher social support. A more heterogeneous pattern emerged for single music-based mood regulation strategies. Conclusions: Our findings highlight the importance of the individual (mal-)adaptive use of music, painting a more nuanced picture of music engagement and resilience. (AU)

To sleep or not to sleep, that is the question: A systematic review and meta-analysis on the effect of post-trauma sleep on intrusive memories of analog trauma.

Distressing intrusive memories of a traumatic event are one of the hallmark symptoms of posttraumatic stress disorder. Thus, it is crucial to identify early interventions that prevent the occurrence of intrusive memories. Both, sleep and sleep deprivation have been discussed as such interventions, yet previous studies yielded contradicting effects. Our systematic review aims at evaluating existing evidence by means of traditional and individual participant data (IPD) meta-analyses to overcome power issues of sleep research. Until May 16th, 2022, six databases were searched for experimental analog studies examining the effect of post-trauma sleep versus wakefulness on intrusive memories. Nine studies were included in our traditional meta-analysis (8 in the IPD meta-analysis). Our analysis provided evidence for a small effect favoring sleep over wakefulness, log-ROM = 0.25, p < .001, suggesting that sleep is associated with a lower number of intrusions but unrelated to the occurrence of any versus no intrusions. We found no evidence for an effect of sleep on intrusion distress. Heterogeneity was low and certainty of evidence for our primary analysis was moderate. Our findings suggest that post-trauma sleep has the potential to be protective by reducing intrusion frequency. More research is needed to determine the impact following real-world trauma and the potential clinical significance.

The Perceived Stress Scale 2&2: a two-factorial German short version of the Perceived Stress Scale.

Background: Stress is among the leading causes for diseases. The assessment of subjectively perceived stress is essential for resilience research. While the Perceived Stress Scale (PSS) is a widely used questionnaire, a German short version of the scale is not yet available. In the current study, we developed such a short version using a machine learning approach for item reduction to facilitate the simultaneous optimization of multiple psychometric criteria. Method: We recruited 1,437 participants from an online panel, who completed the German long version of the PSS along with measures of mental health and resilience. An ant-colony-optimization algorithm was used to select items, taking reliability, and construct validity into account. Findings on validity were visualized by psychological network models. Results: We replicated a bifactor structure for the long version of the PSS and derived a two-factor German short version of the PSS with four items, the PSS-2&2. Its factors helplessness and self-efficacy showed differential associations with mental health indicators and resilience-related factors, with helplessness being mainly linked to mental distress. Conclusion: The valid and economic short version of the PSS lends itself to be used in future resilience research. Our findings highlight the importance of the two-factor structure of the PSS short versions and challenge the validity of commonly used one-factor models. In cases where the general stress factor is of interest, researchers should use the longer versions of the PSS that allow for the interpretation of total scores, while the PSS-2&2 allows of an economic assessment of the PSS factors helplessness and self-efficacy.

Transdiagnostic psychosocial interventions to promote mental health in forcibly displaced persons: a systematic review and meta-analysis.

Background: People forced to leave their homes, such as refugees and internally displaced persons, are exposed to various stressors during their forced displacement, putting them at risk for mental disorders.Objective: To summarize evidence on the efficacy of psychosocial interventions aiming to promote mental health and/or to prevent mental symptoms by fostering transdiagnostic skills in forcibly displaced persons of all ages.Method: Four databases and reference lists were searched for randomized controlled trials on interventions in this population on 11 March 2022. Thirty-six studies were eligible, 32 studies (comprising 5299 participants) were included in random-effects multilevel meta-analyses examining the effects of interventions on mental symptoms and positive mental health (e.g. wellbeing) as well as moderators to account for heterogeneity. OSF Preregistration-ID: 10.17605/OSF.IO/XPMU3Results: Our search resulted in 32 eligible studies, with 10 reporting on children/adolescents and 27 on adult populations. There was no evidence for favourable intervention effects in children/adolescents, with 44.4% of the effect sizes pointing to potentially negative effects yet remaining non-significant. For adult populations, our meta-analyses showed a close-to-significant favourable effect for mental symptoms, M(SMD) = 0.33, 95% CI [-0.03, 0.69], which was significant when analyses were limited to high-quality studies and larger for clinical compared to non-clinical populations. No effects emerged for positive mental health. Heterogeneity was considerable and could not be explained by various moderators (e.g. type of control, duration, setting, theoretical basis). Certainty of evidence was very low across all outcomes limiting the generalizability of our findings.Conclusion: The present review provides at most weak evidence for an effect favouring transdiagnostic psychosocial interventions over control conditions for adult populations but not for children and adolescents. Future research should combine the imperative of humanitarian aid in face of major crises with studying the diverse needs of forcibly displaced persons to improve and tailor future interventions.

This review is the first to examine the efficacy of transdiagnostic interventions for mental health promotion and prevention of mental disorders in forcibly displaced persons of all ages.Overall, we found no favourable effect of transdiagnostic interventions in both children/adolescents and adults. Excluding studies at high risk of bias, there was weak evidence for a small favourable effect in adults, but not in children and adolescents. Thus, so far, there is weak evidence for transdiagnostic interventions in forcibly displaced persons.Research efforts need to match care needs: While most people live and need care in low-income countries, the majority of research has been conducted in high-income countries.

The relationship between pre-surgery self-rated health and changes in functional and mental health in older adults: insights from a prospective observational study.

BACKGROUND: Elective surgeries are among the most common health stressors in later life and put a significant risk at functional and mental health, making them an important target of research into healthy aging and physical resilience. Large-scale longitudinal research mostly conducted in non-clinical samples provided support of the predictive value of self-rated health (SRH) for both functional and mental health. Thus, SRH may have the potential to predict favorable adaptation processes after significant health stressors, that is, physical resilience. So far, a study examining the interplay between SRH, functional and mental health and their relative importance for health changes in the context of health stressors was missing. The present study aimed at addressing this gap. METHODS: We used prospective data of 1,580 inpatients (794 complete cases) aged 70 years or older of the PAWEL study, collected between October 2017 and May 2019 in Germany. Our analyses were based on SRH, functional health (Barthel Index) and self-reported mental health problems (PHQ-4) before and 12 months after major elective surgery. To examine changes and interrelationships in these health indicators, bivariate latent change score (BLCS) models were applied. RESULTS: Our analyses provided evidence for improvements of SRH, functional and mental health from pre-to-post surgery. BLCS models based on complete cases and the total sample pointed to a complex interplay of SRH, functional health and mental health with bidirectional coupling effects. Better pre-surgery SRH was associated with improvements in functional and mental health, and better pre-surgery functional health and mental health were associated with improvements in SRH from pre-to-post surgery. Effects of pre-surgery SRH on changes in functional health were smaller than those of functional health on changes in SRH. CONCLUSIONS: Meaningful changes of SRH, functional and mental health and their interplay could be depicted for the first time in a clinical setting. Our findings provide preliminary support for SRH as a physical resilience factor being associated with improvements in other health indicators after health stressors. Longitudinal studies with more timepoints are needed to fully understand the predictive value of SRH for multidimensional health. TRIAL REGISTRATION: PAWEL study, German Clinical Trials Register, number DRKS00013311. Registered 10 November 2017 - Retrospectively registered, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00013311 .

Effects of Upper Body Exercise Training on Aerobic Fitness and Performance in Healthy People: A Systematic Review.

Purpose: This systematic review aimed to evaluate the effects of upper body endurance training (UBET) on oxygen uptake (VO2) in healthy persons and derive evidence-based recommendations to improve upper body fitness and performance. Methods: Databases were systematically searched in accordance with PRISMA guidelines until 1 February 2023. Eligibility criteria included healthy male and female adults and older adults who underwent an UBET intervention. Outcomes of interest included physical fitness (VO2peak and/ or VO2 submax) and transfer effects (i.e., effects from trained (VO2peak ARM) to untrained (VO2peak LEG) musculature). Results: The search identified 8293 records, out of which 27 studies reporting on 29 interventions met our eligibility criteria. The average duration of interventions was 6.8 ± 2.6 weeks with 3.2 ± 0.8 training sessions per week. For 21 of 29 interventions, significant increases in VO2peak ARM were reported following UBET (+16.4% ± 8.3%). Three of the nine studies that analyzed transfer effects of untrained legs after upper body training exhibited significant increases in VO2peak LEG (+9.3% ± 2.6%). Conclusions: This review showed that UBET is a beneficial and useful training modality to increase the oxygen utilization in the upper body. Although UBET is an uncommon form of endurance training in healthy individuals, transfer effects to the untrained muscles can be observed in isolated cases only, rendering transfer effects in UBET inconclusive. Further research should focus on the peripheral changes in muscle morphology of the trained muscles and central changes in cardiovascular function as well as when transfer effects can occur after UBET in healthy people.

Differential associations of leisure music engagement with resilience: A network analysis.

Background/Objective: Several factors associated with resilience as the maintenance of mental health despite stress exposure can be strengthened through participation in leisure time activities. Since many people listen to or make music in their leisure time, the aim of the present study was to provide insights into the architecture of how resilience relates to passive and active music engagement. Method: 511 participants regularly listening to and/or making music completed an online survey on resilient outcomes (i.e., mental health and stressor recovery ability), different resilience factors (e.g., optimism, social support), quantitative music engagement (i.e., time spent with music listening/making) and qualitative music engagement (i.e., use of music listening/making for mood regulation). Results: Bivariate correlations showed that subjects spending more time with music making reported better stressor recovery ability and less mental health problems, while partial correlational network analysis revealed no unique associations for quantitative music engagement. Regarding qualitative music engagement, people using music-based mood regulation reported lower mental health, mindfulness, and optimism, but also higher social support. A more heterogeneous pattern emerged for single music-based mood regulation strategies. Conclusions: Our findings highlight the importance of the individual (mal-)adaptive use of music, painting a more nuanced picture of music engagement and resilience.

The relationship between childhood gender nonconformity, aversive childhood experiences, and mental health in heterosexual and non-heterosexual cisgender men: The buffering effect of sense of coherence.

Childhood gender nonconformity (CGNC) seems to be associated with more mental health problems in adulthood. Previous research has suggested that this link might be mediated via the increased risk for aversive childhood experiences (ACEs) as a negative social reaction to CGNC. However, no study yet examined the role of resilience factors in this relationship. The present study aims to address this gap by examining the potential buffering effect of sense of coherence (SOC). In a German sample of 371 cisgender men, we used mediation models to investigate the relationship between CGNC, ACEs, and mental health problems in adulthood, that is, depressive symptoms, loneliness, and suicidal behavior. We then employed moderated mediation models to examine the buffering effect of SOC on the association ACEs and mental health problems. The results showed that higher levels of CGNC were associated with more severe adult mental health problems, with this link being partially mediated by higher levels of ACEs. For depressive symptoms and suicidal behavior in the last 12 months, we found evidence of a buffering effect of SOC. Higher levels of SOC were associated with a weaker association between ACEs and mental health problems. In contrast, this effect was absent for loneliness and lifetime suicidal behavior. Our study provides evidence that ACEs partly account for the relationship between CGNC and mental health in adulthood. Moreover, we found support for SOC having a buffering effect on this link. Future studies need to examine whether SOC might be an important target for resilience training in those experiencing CGNC. However, sustainable interventions may rather address the negative social reactions to CGNC.

The relationship between sense of coherence and mental health problems from childhood to young adulthood: A meta-analysis.

BACKGROUND: Sense of coherence (SOC) as the key component of the salutogenesis framework is negatively correlated with mental health problems in adults but also in children and adolescents. Since SOC is conceptualized to develop and stabilize from childhood to young adulthood, these life phases are of critical importance for the salutogenesis concept. Individual studies examining SOC's link with mental health at younger ages yielded heterogeneous effect size estimates. Thus, the present meta-analysis is the first to quantify the current state of evidence on the association between SOC and mental health problems. METHODS: The random-effects multi-level meta-analysis followed PRISMA guidelines and was based on 57 studies (70 samples) comprising 41,013 participants. Weighted mean age of participants was 15.46 years and 50.4 % were female. RESULTS: The mean correlation (r) between SOC and overall mental health problems was M(r) = -0.46, 95 % CI [-0.53, -0.39]. However, there was substantial heterogeneity between studies, while differences between symptom types were smaller. Subsequent moderator analyses showed that higher sample age was associated with more negative relationships and higher internal consistencies of SOC measures. Moreover, internalizing symptoms, depressive symptoms, and feelings of loneliness showed a stronger negative association with SOC than psychosomatic symptoms. LIMITATIONS: Our findings on age-related differences were based on (repeated) cross-sectional data and require replication in longitudinal studies. CONCLUSIONS: Results yielded a negative association between SOC and mental health problems with increasing magnitude from childhood to young adulthood. Thus, SOC-fostering interventions may help to buffer negative effects of stress and improve resilience starting from early ages.

Mental Health Impact of Early Stages of the COVID-19 Pandemic on Individuals with Pre-Existing Mental Disorders: A Systematic Review of Longitudinal Research.

In view of disease-related threats, containment measures, and disrupted healthcare, individuals with pre-existing mental illness might be vulnerable to adverse effects of the COVID-19 pandemic. Previous reviews indicated increased mental distress, with limited information on peri-pandemic changes. In this systematic review, we aimed to identify longitudinal research investigating pre- to peri-pandemic and/or peri-pandemic changes of mental health in patients, focusing on the early phase and considering specific diagnoses. PsycINFO, Web of Science, the WHO Global literature on coronavirus disease database, and the Cochrane COVID-19 Study Register weresearched through 31 May 2021. Studies were synthesized using vote counting based on effect direction. We included 40 studies mostly from Western, high-income countries. Findings were heterogeneous, with improving and deteriorating mental health observed compared to pre-pandemic data, partly depending on underlying diagnoses. For peri-pandemic changes, evidence was limited, with some suggestion of recovery of mental distress. Study quality was heterogeneous; only few studies investigated potential moderators (e.g., chronicity of mental illness). Mental health effects on people with pre-existing conditions are heterogeneous within and across diagnoses for pre- to peri-pandemic and peri-pandemic comparisons. To improve mental health services amid future global crises, forthcoming research should understand medium- and long-term effects, controlling for containment measures.

COVID-19-related distress is associated with analogue PTSD symptoms after exposure to an analogue stressor.

Background: The COVID-19 outbreak in early 2020 was associated with an immediate increase in mental health problems in a significant percentage of the general population. Therefore, it is crucial to investigate how the COVID-19 pandemic - as a psychosocial stressor - affected the aetiological processes of mental disorders. Previous research has shown that stress potentiates associative (fear) learning and analogue symptoms of posttraumatic stress disorder (PTSD) and that analogue PTSD symptoms can emerge in response to associative learning. Objective: We investigated whether distress in response to the COVID-19 outbreak support the development of intrusions and rumination after exposure to a non-COVID-19-related analogue trauma. Moreover, we examined if these effects are mediated by the strength of associative learning during analogue trauma. Method: 122 undergraduate university students participated in an online experiment between March and July 2020. They completed questionnaires measuring distress and rumination related to the COVID-19 outbreak. On a subsequent day, they went through an associative learning task, in which neutral stimuli were paired with the appearance of a highly aversive film clip. Subjective ratings were assessed as indicators of associative learning. On the next day, participants documented film-related intrusions and rumination. Results: COVID-19-related distress but not rumination was associated with post-film intrusion and rumination load. These effects were mediated by associative learning. Conclusions: The current findings are in line with the assumptions that stress enhanced both associative learning and PTSD symptoms. Specifically, they indicate that prolonged psychosocial stress - like during the COVID-19 outbreak - is linked to individual differences in memory processing of aversive events. Further confirmatory research is needed to replicate these results.

Antecedentes: El brote de COVID-19 a principios de 2020 se asoció con un aumento inmediato de problemas de salud mental en un porcentaje significativo de la población general. Por lo tanto, es crucial investigar cómo la pandemia de COVID-19, como estresor psicosocial, afectó los procesos etiológicos de los trastornos mentales. Investigaciones anteriores han demostrado que el estrés potencia el aprendizaje asociativo (miedo) y los síntomas análogos del trastorno de estrés postraumático (TEPT) y que los síntomas análogos del TEPT pueden surgir en respuesta al aprendizaje asociativo.Objetivo: Investigamos si el malestar psicológico en respuesta al brote de COVID-19 contribuye al desarrollo de intrusiones y rumiación después de la exposición a un trauma análogo no relacionado con COVID-19. Además, examinamos si estos efectos están mediados por la fuerza del aprendizaje asociativo durante el trauma analógico.Método: 122 estudiantes universitarios de pregrado participaron en un experimento en línea entre marzo y julio de 2020. Completaron cuestionarios que midieron el malestar psicológico y la rumiación relacionados con el brote de COVID-19. Al día siguiente, realizaron una tarea de aprendizaje asociativo, en la que se emparejaron estímulos neutrales con la exposición a un clip de película altamente aversivo. Las calificaciones subjetivas se evaluaron como indicadores de aprendizaje asociativo. Al día siguiente, los participantes documentaron intrusiones y rumiaciones relacionadas con la película.Resultados: El malestar psicológico relacionado con COVID-19, pero no la rumiación, se asoció con la intrusión posterior a la película y la carga de rumiación. Estos efectos fueron mediados por el aprendizaje asociativo.Conclusiones: Los hallazgos actuales están en línea con las suposiciones de que el estrés potenció tanto el aprendizaje asociativo como los síntomas del TEPT. Específicamente, indican que el estrés psicosocial prolongado, como el ocurrido durante el brote de COVID-19, está relacionado con diferencias individuales en el procesamiento de la memoria de eventos aversivos. Se necesita más investigación confirmatoria para replicar estos resultados.

Adaptive responding to prolonged stress exposure: A binational study on the impact of flexibility on latent profiles of cognitive, emotional and behavioural responses to the COVID-19 pandemic.

The high level of uncertainty brought about by the COVID-19 pandemic has affected the general population's well-being and capacity for adaptive responding. Studies indicate that flexibility, defined as the ability to choose and employ a variety of emotional, cognitive and behavioural strategies in accordance with changing contextual demands, may significantly contribute to adaptive responding to long-term stressors such as COVID-19. In the current study, we aimed to investigate which facets of flexibility predict different latent profiles of adaptive responding to the COVID-19 pandemic in Israel and Germany. A total of 2330 Israelis and 743 Germans completed online questionnaires measuring cognitive and coping regulatory flexibility and cognitive, emotional and behavioural responding to the COVID-19 pandemic. Analyses revealed three distinct response profiles in each country (high, medium and low). These profiles differed in both anxiety and depression symptoms with the non-adaptive response group experiencing clinically relevant symptoms both in Israel and Germany. Additionally, cognitive flexibility and coping flexibility emerged as significant predictors of response profiles in both countries. Training cognitive and coping flexibility may thus help individuals respond more adaptively to psychosocial stressors such as COVID-19. Such training could be selectively administered to less flexible subpopulations as well as adapted to the specific population characteristics.