Group member attachment style interacts with actor and partner helping alliance to predict decreasing binge eating episodes.

OBJECTIVE: An individual's attachment style may impact how they interact with their therapy group. This study examined the moderating role of a group member's attachment on the dynamic relationships between that group member's (actor) and other group members' (partner) therapeutic alliances and symptom outcomes. Method: This is a secondary analysis of data from a trial testing the outcome of emotionally-focused group therapy for binge-eating disorder. The sample consisted of 2,360 sessions nested within 118 group members who attended a 20-session treatment. Patients recorded binge eating episodes (BEE), their body weight and an alliance measure session-by-session. RESULTS: Dynamic structural equation modelling showed decreases in BEE and weight over the therapy. When attachment style was not included in the model, higher-than-average partner's alliance scores in the previous session were related to decreases in BEE in the current session. Attachment style moderated these actor and partner effects. For patients with preoccupied attachments, higher-than-average actor alliance in the previous session was related to subsequent decreases in BEE. For patients with dismissing or disorganized attachments, higher partner alliance in the previous session was related to subsequent decreases in BEE. CONCLUSION: Group members' attachment characteristics can play a role in the development of alliance-outcome patterns in group therapy.

A network analysis in adolescent anorexia nervosa exploring the connection between both patient and carer reactions and outcome.

OBJECTIVE: This paper used network analysis to test the associations between eating disorder-related psychopathology and carers' responses to anorexia nervosa symptoms in adolescents. Additionally, the prognostic value of central and bridge network nodes was explored. METHOD: This is a secondary analysis of a three-armed randomised-controlled-trial of adolescents with anorexia nervosa (n = 149) and their primary carer (n = 149) who were allocated to either treatment as usual (TAU), or one of two versions of a carer skills intervention (ECHO) added to TAU. A network analysis was run in the full sample. The prognostic role of central and bridge nodes was tested through multiple regression analyses. RESULTS: Carers' depression and emotional over-involvement, as well as patients' depression showed the highest strength centrality. Patients' depression and carers' accommodation exhibited the highest bridge expected influence. Across the full sample, and in the ECHO group, carers' accommodation predicted patients' higher body mass index (BMI), while patients' depression predicted worse psychosocial functioning at 1-year follow-up. In the ECHO group, higher carers' depression also predicted lower BMI. CONCLUSIONS: Carers' accommodation and depression in both carers and patients were involved in the maintenance of psychopathology in adolescents with anorexia nervosa. Depression in both patients and carers is a potential treatment target for family interventions.

Patient and mentor language style matching as a predictor of working alliance, engagement with treatment as usual, and eating disorders symptoms over the course of an online guided self-help intervention for anorexia nervosa.

OBJECTIVE: The aim of this study was to examine the processes involved in a guided self-help (GSH) pre-treatment intervention (RecoveryMANTRA) for patients with anorexia nervosa (AN), by measuring the levels of patient/mentor Language Style Matching (LSM). RecoveryMANTRA was supported by student mentors or peer mentors (recovered individuals) over six weekly chat-based sessions. We examined whether LSM during RecoveryMANTRA predicted patients'working alliance with the clinic therapist, motivation, eating disorder (ED) and general psychopathology. A further aim was to examine differences in LSM between student mentors and peer mentors. METHOD: 87 AN adults received RecoveryMANTRA plus treatment as usual. The LSM algorithm was used to calculate verbal attunement between patient and mentor. Participants were assessed at baseline and at the end of the intervention. RESULTS: Both early (1st session) and late (6th session) LSM predicted higher working alliance with the clinic therapist. Moreover, late LSM predicted lower EDs symptoms at the end of the RecoveryMANTRA intervention. Patient/peer mentor dyads showed higher late verbal attunement than patient/student mentor dyads. CONCLUSIONS: These findings suggests that in the early phase of treatment relational aspects can impact on engagement with treatment. Verbal attunement in a GSH for AN is associated with working alliance and better clinical outcome.

The impact of Facebook use on self-reported eating disorders during the COVID-19 lockdown.

BACKGROUND: The social isolation due to the COVID-19-related lockdown has had an impact on social media consumption around the world. This study examines the relationship between fear of COVID-19, Facebook use and disordered eating. METHODS: Structural Equation Modeling was used to analyse two-wave survey data (T0: Italian first lockdown; T1: after two months) during the pandemic. Young adults with self-reported dysfunctional eating behaviors (N = 115; 91.3% females; mean age = 28.60 ± 7.31) were recruited to complete an online survey at T0; 66 participants (92.4% females; mean age = 28.85 ± 7.85) completed the survey at T1. They were assessed on Facebook use, dysfunctional eating cognitions, and fear of COVID-19. RESULTS: Participants' disordered eating cognitions increased during the pandemic. At T0, higher fear of COVID-19 was positively associated to time spent on Facebook, which in turn predicted disordered eating cognitions at T1. Moreover, maladaptive Facebook use mediated the relationship between daily time on Facebook and Shape concerns. CONCLUSIONS: The findings of this study suggest an influence of dysfunctional Facebook use in increasing disordered eating cognitions during the pandemic.

Self-esteem and binge eating: Do patients with binge eating disorder endorse more negatively worded items of the Rosenberg Self-Esteem Scale?

OBJECTIVE: Self-esteem is a core aspect of eating disorder symptomatology. This study aims to examine whether method effects associated with negatively worded items of the Rosenberg Self-Esteem Scale (RSES) may interact the negative self-evaluations experienced by patients with obesity and binge eating disorder (BED). We also examined whether negatively worded items were associated with psychological distress and eating symptoms. METHOD: Five hundred thirty three female outpatients (mean age: 42.59) with BED (n = 160) or obesity without BED (n = 373) completed the RSES and measures of interpersonal problems, psychological distress, and eating symptoms. RESULTS: Patients with BED responded more strongly to the negatively worded items of the RSES than those with obesity. The RSES negatively worded item factor was negatively associated with higher interpersonal problems, psychological distress, and binge eating. CONCLUSIONS: Patients with BED may be more responsive to negatively phrased items on the RSES consistent with their negative self-evaluations and self-perceptions.

From telescope to binoculars. Dyadic outcome resulting from psychological counselling for infertile couples undergoing ART.

OBJECTIVE: This longitudinal study aims to evaluate the effect of psychological counselling on quality of life, marital satisfaction and need for parenthood in couples undergoing fertility treatments (ART). BACKGROUND: Recent guidelines on the ART suggest that psychological counselling should target both members of the infertile couple in order to improve their conjoint management of the infertility-related stress. However, studies on the dyadic outcome of couples are scarce. METHODS: 262 patients were originally considered in the study and completed questionnaires on quality of life, need for parenthood and marital satisfaction, before treatment (T1) and at the day of intrauterine insemination/embryo transfer (T2). For the purposes of this study, 34 counselled couples were then matched to 34 non-counselled couples by propensity scores. The Common Fate Model (CFM) was used to examine dyadic changes. RESULTS: Couples receiving counselling had higher dyadic quality of life and lower dyadic stress due to the need for parenthood at T2 compared to non-counselled couples. No differences were found on marital satisfaction. CONCLUSION: The findings provide support for the effectiveness of counselling on interpersonal outcome. The CFM allows researchers to examine how the dyad as a whole responds to counselling, highlighting the change in the couple's relational dynamics.

Patients with Binge Eating Disorder and Obesity have qualitatively different interpersonal characteristics: Results from an Interpersonal Circumplex study.

BACKGROUND: Patients with Binge Eating Disorder (BED) and obesity experience distressing relationships, which could trigger negative affect and over-eating. To date no studies compared the interpersonal profiles and prototypicality of both groups using the Interpersonal Circumplex. METHOD: A sample of 177 patients with BED (mean age: 41.0 ±â€¯12.5 years; 11.3% males), 321 obese non-BED adults (mean age: 44.5 ±â€¯13.4 years; 28% males), and 108 normal weight adults (mean age: 37.3 ±â€¯9.6 years; 52.77% males) completed the Inventory of Interpersonal Problems (IIP-32), and scales of binge eating and psychological distress at one time-point. RESULTS: Compared to normal weight and obese participants, those with BED reported higher levels of interpersonal problems on all circumplex dimensions, except for Vindictive, with small to medium effects. All groups had highly prototypical profiles. Both obese and normal weight adults had very similar interpersonal profiles characterized by predominant friendly-dominant themes. On the contrary, those with BED had predominant friendly-submissive themes. Patients with BED reported significantly higher levels of psychological distress and binge eating severity, compared to the other two groups. Greater Domineering, Cold, Socially Inhibited and Non-Assertive scale scores, and lower Vindictive scale scores significantly predicted higher binge eating and psychological distress, regardless of group membership. DISCUSSION: Findings lend support to an interpersonal model of binge eating and to the presence of qualitative differences between patients with obesity and BED. Finally, results suggest some strategies for the clinical management of BED focused on non-assertion and problems with experiences and expression of anger.

The Role of Couples' Attachment Styles in Patients' Adjustment to Cancer.

OBJECTIVE: This study aimed to understand how psychological variables and attachment styles can contribute to improve effective and functional adjustment to the disease and promote better psychological well-being. METHODS: A total of 176 participants (88 couples) took part in this research. One member of each couple attended surgery centers at the Oncology Department of the University Hospital of Palermo. Each participant had filled in 5 questionnaires assessing the variables couple relationships, quality of life, anxiety, depression, and psychosocial adjustment to illness. RESULTS: Significant correlations were found among the observed variables. Levels of anxiety and the attachment styles of couples influence adjustment to tumor disease and negatively affect the quality of conjugal relationships. Moreover, the results highlighted the correlation between levels of anxiety and depression in patients and in their respective partners. Finally, we found a correlation between the level of psychological distress of the patient and the level of marital satisfaction perceived by the partner: the latter is lower in couples where the oncological patient has high levels of distress. CONCLUSIONS: The results suggest that psychological variables and attachment styles of cancer patients and their partners may be important factors affecting adjustment in multiple domains.

Brain metastases in patients with EOC: Clinico-pathological and prognostic factors. A multicentric retrospective analysis from the MITO group (MITO 19).

BACKGROUND: Brain metastases (BM) from epithelial ovarian cancer (EOC) are considered a rare and unfavourable event. There is no consensus regarding the best management of these patients. METHODS: A multicenter retrospective analysis of patients with BM from EOC treated between 1997 and 2014 in 18 institutions of the MITO (Multicenter Italian Trials in Ovarian cancer) group was conducted. Univariate and multivariate analysis were performed. RESULTS: A total of 174 women were identified as having BM from EOC. The median time interval between primary diagnosis of EOC and occurrence of BM was 26months (range 2-129months). The median overall survival from primary EOC diagnosis was 48months (95% CI 39.5-56.4months) and from diagnosis of BM was 12months (95% CI 9.6-14.3months). The majority of enrolled women (81.7%) were classified as sensitive to platinum-based chemotherapy. Four variables were significantly associated with poor overall survival in multivariate analysis: multiple BM [HR: 1.86 (95% CI: 1.22-2.84)], presence of extracranial disease [HR: 1.77 (95% CI: 1.11-2.83)] age [HR: 1.74 (95% CI: 1.17-2.59)], and monotherapy [HR: 2.57 (95% CI: 1.64-3.86)]. On the contrary, residual tumor at primary surgery, FIGO stage at primary diagnosis and platinum sensitivity were found to have no significant impact on survival from diagnosis of brain lesions. CONCLUSIONS: Our results suggest that BM is a rare and late manifestation of EOC, with a 12-month life-span expectation. Multiple approach is a positive independent prognostic factor and should be proposed to carefully selected patients.

A longitudinal examination of dyadic distress patterns following a skills intervention for carers of adolescents with anorexia nervosa.

Family interventions in anorexia nervosa (AN) have been developed to ameliorate maladaptive patterns of patient-carer interaction that can play a role in illness maintenance. The primary aim of this study is to examine the inter-relationship between baseline and post-treatment distress in dyads of carers and patients with AN to examine the interdependence between carers and patients. The secondary aim is to examine whether a carer skills intervention [Experienced Carer Helping Others (ECHO)] impacts on this inter-relationship. Dyads consisting of treatment-seeking adolescents with AN and their primary carer (n = 149; mostly mothers) were randomised to receive a carer skills intervention (ECHO) in addition to treatment as usual (TAU), or TAU alone, as part of a larger clinical trial. Carers and patients completed a standardised measure of psychological distress (The Depression, Anxiety, and Stress Scale) at baseline and 12 months post-treatment. The Actor Partner Interdependence Model was used to examine longitudinal changes in interdependence by treatment group. As expected, post-treatment levels of distress were related to baseline levels in both groups (actor effects). Moreover, carer distress at 12 months was related to patient distress at baseline for the TAU (partner effects), but not for the ECHO group. Finally, carers' distress change was not a significant predictor of patients' body mass index (BMI) change in the two treatment conditions. These findings are limited to predominantly mother-offspring dyads and may not generalise to other relationships. The ECHO intervention which is designed to teach carers skills in illness management and emotion regulation may be an effective addition to TAU for ameliorating interdependence of distress in patients and their primary carers over time.

Does the Interpersonal Model Generalize to Obesity Without Binge Eating?

The interpersonal model has been validated for binge eating disorder (BED), but it is not yet known if the model applies to individuals who are obese but who do not binge eat. The goal of this study was to compare the validity of the interpersonal model in those with BED versus those with obesity, and normal weight samples. Data from a sample of 93 treatment-seeking women diagnosed with BED, 186 women who were obese without BED, and 100 controls who were normal weight were examined for indirect effects of interpersonal problems on binge eating psychopathology mediated through negative affect. Findings demonstrated the mediating role of negative affect for those with BED and those who were obese without BED. Testing a reverse model suggested that the interpersonal model is specific for BED but that this model may not be specific for those without BED. This is the first study to find support for the interpersonal model in a sample of women with obesity but who do not binge. However, negative affect likely plays a more complex role in determining overeating in those with obesity but who do not binge. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.

The Objective and Subjective Caregiving Burden and Caregiving Behaviours of Parents of Adolescents with Anorexia Nervosa.

OBJECTIVE: The study aimed to examine caregiving burden and levels of distress, accommodating behaviours, expressed emotion (EE) and carers' skills, in parents of adolescents with anorexia nervosa. METHOD: A semi-structured interview assessed the objective burden (time spent across caregiving tasks) in parents (n = 196) of adolescents (n = 144) receiving outpatient treatment for anorexia nervosa. Subjective burden (carers' distress), accommodating behaviours, EE and carers' skills were measured by self-report. RESULTS: Mothers, on average, spent 2.5 h/day of care, mainly providing food and emotional support, compared with 1 h/day by fathers. The level of distress and accommodating behaviour was significantly lower in fathers than in mothers. Accommodating behaviours mediated the relationship between objective burden and subjective burden in mothers, whereas EE and carers' skills did not mediate this relationship for either parent. DISCUSSION: The objective burden for most mothers is high. In order to reduce subjective burden, it may be helpful to target accommodating behaviours. TRIAL REGISTRATION: ISRCTN83003225 - Expert Carers Helping Others (ECHO). Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.

Development and validation of a scale to measure caregiver skills in eating disorders.

OBJECTIVE: The aim of this study was to develop and validate a new questionnaire designed to measure caregiver skills that, in line with the interpersonal component of the cognitive interpersonal maintenance model (Schmidt and Treasure, J Br J Clin Psychol, 45, 343-366, 2006), may be helpful in the support of people with anorexia nervosa (AN). A further aim is to assess whether this scale is sensitive to change following skills-based caregiver interventions. METHOD: The Caregiver Skills (CASK) scale was developed by a group of clinicians and caregivers. Preliminary versions of the scale devised for both caregivers and parents were given at baseline and at follow-up after two studies of caregiver interventions (a clinical trial of the effectiveness of guided self-help and training workshops). Exploratory and confirmatory factor analyses (CFA) were used to test the factorial structure of the CASK scale. Cronbach's alpha was used to measure internal consistency of the CASK scales. RESULTS: Exploratory Factor Analysis suggested a six component solution (Bigger Picture, Self-Care, Biting-Your-Tongue, Insight and Acceptance, Emotional Intelligence and Frustration Tolerance) and this model was confirmed with CFA. Significant clinically relevant correlations were found between the CASK scales and other standardised measures of caregivers' attitudes and behaviours. Furthermore, greater improvements on abilities measured by the CASK scale were found in caregivers who received skills-training than caregivers assigned to a 'treatment as usual' condition. DISCUSSION: The CASK scale is a measure of the fidelity of interventions based on the cognitive interpersonal maintenance model and is sensitive to the intensity of the intervention provided.

Dualistic classification of epithelial ovarian cancer: surgical and survival outcomes in a large retrospective series.

BACKGROUND: Ovarian cancers have been recently categorized into types I and II according to a dualistic model of tumorigenesis. Data on the correlation between this classification and clinical outcome are still scarce and controversial. METHODS: A retrospective analysis of patients with ovarian cancer treated from 1998 to 2013 and operated by the same surgeon was conducted. Patients were classified into two groups: type I (125 patients), including low-grade serous, mucinous, endometrioid, and clear cell tumors; and type II (286 patients), including high-grade serous tumors, unspecified adenocarcinomas, and undifferentiated carcinomas. RESULTS: Type II patients had a significantly higher incidence of advanced disease than type I (88.4 vs. 65.6 %, P = 0.0001) and required more aggressive surgical procedures. Rates of optimal tumor debulking were almost similar between groups (92.6 vs. 91.7 %, type I vs. II, P = NS). After a median follow-up of 41 months, 207 patients (50.4 %) were alive and 204 (49.6 %) were dead; 79 type I patients (63.8 %) and 237 type II patients (82.7 %) experienced relapse (P = 0.02). Progression-free survival was significantly different between groups: 25 months for type I vs. 17 months for type II (P = 0.023). Overall survival was not significantly different between groups, with a median overall survival of 75 months for type I vs. 62 months for type II (P = 0.116). CONCLUSIONS: The dualistic histotype-based classification into types I and II of ovarian cancer does not seem to correlate with prognosis. Different molecular characteristics of type I and II tumors may have therapeutic implications and should be deeply investigated.

A multi-centre cohort study of short term outcomes of hospital treatment for anorexia nervosa in the UK.

BACKGROUND: Individual, family and service level characteristics and outcomes are described for adult and adolescent patients receiving specialist inpatient or day patient treatment for anorexia nervosa (AN). Potential predictors of treatment outcome are explored. METHOD: Admission and discharge data were collected from patients admitted at 14 UK hospital treatment units for AN over a period of three years (adult units N = 12; adolescent N = 2) (patients N = 177). RESULTS: One hundred and seventy-seven patients with a severe and enduring illness with wide functional impairment took part in the study. Following inpatient care, physical improvement was moderate/good with a large increase in BMI, although most patients continued to have a clinical level of eating disorder symptoms at discharge. The potentially modifiable predictors of outcome included confidence to change, social functioning and carer expressed emotion and control. CONCLUSIONS: Overall, the response to inpatient treatment was modest particularly in the group with a severe enduring form of illness. Adolescents had a better response. Although inpatient treatment produces an improvement in physical health there was less improvement in other eating disorder and mood symptoms. As predicted by the carer interpersonal maintenance model, carer behaviour may influence the response to inpatient care, as may improved social functioning and confidence to change.

Time Spent on Mobile Apps Matters: A Latent Class Analysis of Patterns of Smartphone Use among Adolescents.

The aims of the present study are: (1) to determine classes of adolescents with homogeneous patterns of smartphone or social media use; and (2) to examine the level of distress across the empirically derived profiles. Three hundred and forty adolescents (Mage = 15.61, SD = 1.19; 38.2% females) participated in a cross-sectional survey. Participants provided objective trace data on time spent on smartphones and applications, as well as self-reported social media addiction, social media use intensity, online social comparison, emotion dysregulation, and psychological distress. Latent class analysis (LCA) with total smartphone use categorized participants into three classes. Participants in Class 3 (19%) showed a more impaired functioning profile, with a tendency towards social media addiction and greater levels of distress. LCAs with the amount of time devoted to specific applications are more heterogeneous, and results showed that heavy use of social media apps was not consistently connected to the most impaired psychosocial profiles. Although the amount of mobile screen time can be a characteristic of problematic users, the link between social media usage and an adolescent's psychological characteristics is mixed. More research is needed to explore the interplay between mobile screen time and social media usage among adolescents.

Interplay Between Fear of Missing Out and Loneliness: A Three-Wave Panel Study During the COVID-19 Pandemic.

Although the concept of Fear of Missing Out (FoMO) is permeated with individual fears about the lack of social connection, the relationship between FoMO and feelings of loneliness has been the subject of limited research. The aim of this study was to examine bidirectional associations between FoMO and loneliness via a three-wave, random intercept, cross-lagged panel model. Drawing on a survey with 494 adult participants across three waves (45.3 percent participated in Time 2 and 38.7 percent participated at Time 3) during the COVID-19 pandemic, we found that participants with higher FoMO also reported heightened levels of loneliness across the three waves, at a between-person level. Furthermore, loneliness had significant negative cross-lagged associations with subsequent FoMO, at within-person level. The cross-lagged paths between FoMO and subsequent loneliness were not significant. Participants who usually spend more daily time using social media reported higher levels of FoMO. The findings of the study contribute to clarifying the temporal relationship between FoMO and loneliness, by suggesting that FoMO may not represent a risk factor for heightened feelings of loneliness, but it can be triggered by feelings of social isolation and lack of relationships.

The interplay between emotion regulation, interpersonal problems and eating symptoms in individuals with obesity: A network analysis study.

INTRODUCTION: A complex and bidirectional relationship between eating and psychological symptoms in individuals with obesity has been proposed. This study aims to identify the specific processes playing a role in this association, using a data-driven approach. METHODS: Two hundred ninety-four adults with obesity, including 106 (36 %) with binge-eating disorder, were consecutively admitted to a specialized public center. They completed self-report questionnaires to assess emotion regulation, interpersonal problems, self-esteem, binge-eating symptoms, and expectancies regarding eating behaviors. To assess the interplay among eating and psychological variables, a network analysis was used. The bridge function analysis was also performed to identify the bridge nodes among three communities (eating symptoms, interpersonal and emotional problems). RESULTS: The network was stable. Limited access to emotion regulation strategies, eating helps manage negative affect, and non-assertiveness were the nodes with the highest strength centrality. Lack of emotional clarity, non-assertiveness, socially inhibition, and binge-eating were the nodes with the highest bridge strength. LIMITATIONS: The main limitation of the study is the cross-sectional nature of the findings which prevents to infer causality regarding the association between symptoms in the network. DISCUSSION: An interplay between eating symptoms and affective and interpersonal factors characterizes individuals with obesity. Across the variety of psychological problems associated with obesity, the present study suggests specific psychological variables and their connections that could be addressed to improve treatment outcome.

Understanding Problematic Gaming During the Covid-19 Pandemic in Adolescents and Adults: A Systematic Review of the Literature.

Objective: A growing body of evidence suggests that online gaming increased during the COVID-19 outbreak. This systematic review aims to summarize extant literature that reported on problematic gaming among both adolescents and adults during the pandemic and to identify available research on the bidirectional association between problematic gaming and mental health outcomes. Method: A systematic search was carried out through PubMed, Web of Knowledge and AGRIS, Embase, Medline, PsychINFO (from January 2020 to January 2023), using keywords related to problematic gaming and mental health outcomes. Both cross-sectional and longitudinal empirical studies which used validated measures of problematic gaming and mental health outcomes during the COVID-19 pandemic were included. Results: Twenty-five empirical articles were eligible for the current review, comprising 28,978 participants. The majority of the selected studies had cross-sectional designs. Overall, most eligible studies showed significant association between problematic gaming and negative mental health outcomes during the pandemic. Correlations were mostly found between problematic gaming, depression and anxiety. Conclusions: Future research focusing on the relationship between problematic gaming and mental health outcomes should go beyond the considerable weaknesses due to methodological limitations of cross-sectional design, sampling and measures.

Psychosocial predictors of trajectories of mental health distress during the COVID-19 pandemic: A four-wave panel study.

Previous research suggested that during the COVID-19 pandemic, mental distress did not affect all people equally. This longitudinal study aims to examine joint trajectories of depressive, anxiety, and stress symptoms in a sample of Italian adults during the pandemic, and to identify psychosocial predictors of distress states. We analyzed four-wave panel data from 3,931 adults who had received assessments of depressive, anxiety and stress symptoms between April 2020 and May 2021. Trajectories of individual psychological distress were identified by Latent Class Growth Analysis (LCGA) with parallel processes, and multinomial regression models were conducted to identify baseline predictors. Parallel process LCGA identified three joint trajectory classes for depression, anxiety and stress symptoms. Most individuals (54%) showed a resilient trajectory. However, two subgroups showed vulnerable joint trajectories for depression, anxiety and stress. Expressive suppression, intolerance to uncertainty, and fear of COVID-19 were risk characteristics associated with vulnerable trajectories for mental health distress. Moreover, vulnerability to mental health distress was higher in females, younger age groups and those unemployed during the first lockdown. Findings support the fact that group heterogeneity could be detected in the trajectories of mental health distress during the pandemic and it may help to identify subgroups at risk of worsening states.