Adaptive and maladaptive pathways of COVID-19 worry on well-being: A cross-national study.

OBJECTIVE: In a preregistered study, we examined whether worries about COVID-19 are simultaneously linked with enhanced well-being through social interaction and with reduced well-being through depression symptoms. METHOD: In August 2020, census-matched participants from high- and low-prevalence regions in the United States and Italy (N = 857) completed assessments of COVID-19 worry, social interaction, depression symptoms, and well-being. RESULTS: Worries about COVID-19 predicted both more social interaction and more depression (ps < 0.001). In multiple mediational analyses, an adaptive pathway of COVID-19 worry through social interaction was associated with higher well-being, whereas a maladaptive pathway through depression symptoms was associated with lower well-being. Further, a comparison of high and low COVID-19 prevalence regions replicated the mediational findings for social interaction, providing evidence against reverse causation and common method variance. CONCLUSION: Findings suggest that normative worries about acute stressors may both benefit and undermine well-being, depending on their impact on social behavior or depression symptoms.

The psychological impact of COVID-19 pandemic lockdowns: a review and meta-analysis of longitudinal studies and natural experiments.

Lockdowns to control the spread of the coronavirus disease 2019 (COVID-19) have had profound effects on everyday life worldwide, but their effect on mental health remains unclear because available meta-analyses and reviews rely mostly on cross-sectional studies. We conducted a rapid review and meta-analysis of longitudinal studies and natural experiments investigating the relationship between COVID-19 lockdowns and mental health. A total of 25 studies involving 72 004 participants and 58 effect sizes were analyzed. Using a random effects model, we found that lockdowns had small effects on mental health symptoms, g = 0.17, s.e. = 0.05, 95% CI (0.06-0.24), p = 0.001, but the effects on positive psychological functioning, g = -0.12, s.e. = 0.11, 95% CI (-0.33 to 0.09), p = 0.27, were not significant. Multivariate analysis of effect sizes revealed significant and relatively small effect sizes for anxiety and depression, while those for social support, loneliness, general distress, negative affect, and suicide risk were not significant. The results indicated substantial heterogeneity among studies, but meta-regression analyses found no significant moderation effects for mean age, gender, continent, COVID-19 death rate, days of lockdown, publication status or study design. The psychological impact of COVID-19 lockdowns is small in magnitude and highly heterogeneous, suggesting that lockdowns do not have uniformly detrimental effects on mental health and that most people are psychologically resilient to their effects.

Predictors of Prolonged Grief, Resilience, and Recovery Among Bereaved Spouses.

OBJECTIVE: Most reactions to loss can be characterized by three prototypical trajectories of resilience, gradual recovery, and chronic distress (Bonanno, ). However, research on the factors that uniquely predict these trajectories of response has been limited. We examined theoretically relevant predictors of each of the trajectory patterns. METHOD: We assessed 115 bereaved spouses at 1.5 to 3 years postloss and 74 married controls. To identify grief trajectory, we provided bereaved participants with a graphical depiction of the trajectories and asked them to select the one that best described their experience. RESULTS: Group comparisons revealed substantial differences between resilient and prolonged grievers, and almost no differences between resilient and married controls. Multivariate analyses indicated that prolonged grief, when compared to resilience, was uniquely associated with maladaptive dependency traits, difficulty accessing positive memories of the deceased, and higher recalled marital adjustment. CONCLUSION: The present results extend our understanding of factors associated with distinct trajectories of adjustment after loss.

Are positive appraisals always adaptive?

The authors provide an original and integrative framework for understanding the complex array of factors that contribute to resilience. Their faith in the uniform benefits of positive appraisals neglects the potential costs of overly positive appraisals, however. As a result, their theory may have difficulty capturing the complexity of appraisal's role in determining resilience.

Disruptions in self-regulatory processes predict depression and sleep disturbance in bereaved young adults.

Losing a loved one is both common and profoundly stressful for young adults. Little research has examined the longitudinal course of post-loss cognitive processing, depression, and sleep difficulties. Further, little is known about the context of other stressors or the role of individual regulatory resources, such as attentional regulation, that might determine whether loss-related cognitive processing reduces distress. This prospective study examined changes in depression and sleep disturbance over 9 weeks as a function of within- and between-person variation in stress exposure, loss-related cognitive processing, and attention regulation. Participants were 108 recently bereaved college students completing a lab-based assessment of attention regulation and four self-report surveys, spaced three weeks apart. Results revealed that most participants gradually reduced loss-related processing over the study period, with corresponding improvements in depression and sleep. Stress exposure was associated with increased processing, depression, and sleep disturbance. In exploratory analyses, high attentional alertness and slow re-orienting strengthened the association of within-person loss processing with sleep disturbance. Both within- and between-person variation in stress appear to engender risk for a prolonged course of bereavement. Future research should integrate objective attention measures with self-reported adjustment to stress to illuminate reciprocal links between depression, sleep, and loss-related cognitive processing.

Media exposure related to COVID-19 is associated with worse mental health consequences in the United States compared to Italy.

BACKGROUND: Prolonged media exposure after collective crises is widely shown to have adverse effects on people's mental health. Do these effects show variation across different countries? In the present study, we compared the link between media exposure related to COVID-19 and mental health-related outcomes in the United States and Italy, two countries with high levels of early COVID-19 prevalence. METHOD: Participants matched on age and gender in the United States (n = 415) and Italy (n = 442) completed assessments of media exposure, stress, anxiety, COVID-19 worry, and other variables shortly after the first wave of infections in 2020. RESULTS: COVID-19 related media exposure predicted higher levels of stress, anxiety, and COVID-19 worry, net of the effects of neuroticism, political identification, and demographics. Moreover, COVID-19 related media exposure interacted with country to predict more stress and COVID-19 worry in the United States than in Italy. CONCLUSIONS: Findings are among the first to document cross-national differences in the association of media exposure with mental health outcomes.

Social and behavioral consequences of the COVID-19 pandemic: Validation of a Pandemic Disengagement Syndrome Scale (PDSS) in four national contexts.

The aim of the present study was to develop and validate a self-report measure that investigates people's general disengagement after the acute phases of the pandemic. Across three studies, we examined the psychometric features of the Pandemic Disengagement Syndrome Scale (PDSS) in four national contexts. In Study 1, we developed the instrument and investigated the factorial structure, internal consistency, measurement invariance across gender and countries (the United States and Italy), and discriminant validity. A bifactor model with two specific factors (Social Avoidance and Alienation) provided a better fit than the competing models. In Study 2, we tested the stability of the PDSS as well as its predictive validity. In Study 3, we conducted a quasi-experimental comparison between Norway and Sweden, to investigate whether scores on the PDSS are related to a markedly distinct approach to the pandemic in terms of mandatory lockdown. Overall, results from the three studies demonstrated that the PDSS is a valid and reliable measure of a syndrome of disengagement from others following a pandemic. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Happiness before and during the COVID-19 pandemic in Italy: A population-based longitudinal study.

The aims of the present study were to investigate (1) whether the COVID-19 pandemic and the restrictive measures to control its spread were associated with changes in happiness before and after the pandemic and (2) whether household size, living with a partner/spouse, living with at least one son/daughter, financial support, income loss, and job loss following the pandemic were associated with happiness after controlling for previous levels of happiness. We use data from the Italian Survey on Household Income and Wealth (SHIW). Specifically, we used longitudinal data from 2283 respondents who participated in the SHIW 2016 and SHIW 2020. Results revealed a small but significant increase in happiness from 2016 to 2021. In addition, living with a partner/spouse predicted higher happiness with a medium effect size, and total income loss predicted lower happiness with a small to medium effect size. Household size, living with at least one son/daughter, financial support, partial income loss, and job loss following the pandemic were unrelated to happiness.

Contribution of risk and resilience factors to anxiety trajectories during the early stages of the COVID-19 pandemic: A longitudinal study.

The COVID-19 pandemic, and the response of governments to mitigate the pandemic's spread, resulted in exceptional circumstances that comprised a major global stressor, with broad implications for mental health. We aimed to delineate anxiety trajectories over three time-points in the first 6 months of the pandemic and identify baseline risk and resilience factors that predicted anxiety trajectories. Within weeks of the pandemic onset, we established a website (covid19resilience.org), and enrolled 1362 participants (n = 1064 from US; n = 222 from Israel) who provided longitudinal data between April-September 2020. We used latent growth mixture modelling to identify anxiety trajectories and ran multivariate regression models to compare characteristics between trajectory classes. A four-class model best fit the data, including a resilient trajectory (stable low anxiety) the most common (n = 961, 75.08%), and chronic anxiety (n = 149, 11.64%), recovery (n = 96, 7.50%) and delayed anxiety (n = 74, 5.78%) trajectories. Resilient participants were older, not living alone, with higher income, more education, and reported fewer COVID-19 worries and better sleep quality. Higher resilience factors' scores, specifically greater emotion regulation and lower conflict relationships, also uniquely distinguished the resilient trajectory. Results are consistent with the pre-pandemic resilience literature suggesting that most individuals show stable mental health in the face of stressful events. Findings can inform preventative interventions for improved mental health.

Trajectories of body image and sexuality during the first year following diagnosis of breast cancer and their relationship to 6 years psychosocial outcomes.

We examined degree and determinants of change in body image and sexuality over the first year following breast cancer diagnosis to differentiate body image and sexuality trajectories, and then explored if differences in trajectories predicted 6 years' psychosocial outcomes. 363/405 (90%) Chinese women receiving surgery for BC were assessed at 5-days (Baseline), 1-month, 4-months, and 8-months post-surgery. Psychological distress, treatment decision making (TDM) difficulties, satisfaction with treatment outcome, optimism, and self-efficacy were assessed at Baseline. Self-image and sexuality were recorded at each follow-up assessment. Latent growth mixture modeling identified trajectories of self-image and sexuality. Multinominal logistic regression identified factors predicting trajectory patterns. Six years later 211/363 (58%) of the original patients were successfully traced and their psychosocial status assessed. Three distinct trajectories of self-image and sexuality were identified: high-stable, recovery, and high-deteriorating. Most women (64% self-image; 58% sexuality) showed stable levels of self-image and sexuality scores. TDM difficulties, satisfaction with treatment outcomes, physical symptom and psychological distress predicted trajectory patterns. Self-image trajectories over the first year diagnosis predicted 6-years psychosocial outcomes. Women with high-stable level of self-image had the best 6-year self-image and sexuality; women with initial low level of self-image had significantly greater long-term psychological distress. Low TDM difficulties and high treatment outcome satisfaction predicted high and stable self-image and sexuality. Type of surgery showed little impacts on self-image and sexuality. Self-image during acute illness phase predicted long-term outcomes. Interventions should focus on minimizing self-image decrement.

Trajectories of trauma symptoms and resilience in deployed U.S. military service members: prospective cohort study.

BACKGROUND: Most previous attempts to determine the psychological cost of military deployment have been limited by reliance on convenience samples, lack of pre-deployment data or confidentiality and cross-sectional designs. AIMS: This study addressed these limitations using a population-based, prospective cohort of U.S. military personnel deployed in support of the operations in Iraq and Afghanistan. METHOD: The sample consisted of U.S. military service members in all branches including active duty, reserve and national guard who deployed once (n = 3393) or multiple times (n = 4394). Self-reported symptoms of post-traumatic stress were obtained prior to deployment and at two follow-ups spaced 3 years apart. Data were examined for longitudinal trajectories using latent growth mixture modelling. RESULTS: Each analysis revealed remarkably similar post-traumatic stress trajectories across time. The most common pattern was low-stable post-traumatic stress or resilience (83.1% single deployers, 84.9% multiple deployers), moderate-improving (8.0%, 8.5%), then worsening-chronic post-traumatic stress (6.7%, 4.5%), high-stable (2.2% single deployers only) and high-improving (2.2% multiple deployers only). Covariates associated with each trajectory were identified. CONCLUSIONS: The final models exhibited similar types of trajectories for single and multiple deployers; most notably, the stable trajectory of low post-traumatic stress preto post-deployment, or resilience, was exceptionally high. Several factors predicting trajectories were identified, which we hope will assist in future research aimed at decreasing the risk of post-traumatic stress disorder among deployers.

Distress trajectories at the first year diagnosis of breast cancer in relation to 6 years survivorship.

PURPOSE: To explore how initial trajectories of distress experienced during the first year following diagnosis with early-stage breast cancer (ESBC) relate to subsequent long-term(6 years) psychosocial outcomes. METHODS: 285/303 Chinese women recruited 1-week post-surgery for predominantly ESBC were assessed for distress with the Chinese Health Questionnaire at 1, 4, and 8 months later.Latent growth mixture modeling revealed four distinct distress trajectories during the first 8 months following surgery (Lam et al., 2010). Six years later we reassessed 186 of these 285 women, comparing scores on the Hospital Anxiety and Depression Scale, Impact of Events Scale, and Chinese Social Adjustment Scale by first 8 months' distress trajectory. RESULTS: Distress trajectories over the first 8 months post-operatively predicted psychosocial outcomes 6 years later. Women with stable low levels of distress over the first 8 months postoperatively(resilient group) had the best 6-year psychosocial outcomes. Women who experienced chronic distress had significantly greater longer-term psychological distress, cancer-related distress, and poorer social adjustment in comparison to women in the resilient group. Women in the recovered or delayed-recovery groups were comparable to those in the resilient group, except for concerns about appearance and sexuality, and self-image. CONCLUSION: Women with an illness trajectory characterized by chronic distress over the first 8 months post-operatively had poorest longer-term psychosocial outcomes. Clarification of determinants of chronic distress and means for early identification of at-risk women are needed.This will enable targeted optimization of interventions to prevent and manage chronic distress,improving ESBC rehabilitation efficiency.

Complicated grief and related bereavement issues for DSM-5.

Bereavement is a severe stressor that typically incites painful and debilitating symptoms of acute grief that commonly progresses to restoration of a satisfactory, if changed, life. Normally, grief does not need clinical intervention. However, sometimes acute grief can gain a foothold and become a chronic debilitating condition called complicated grief. Moreover, the stress caused by bereavement, like other stressors, can increase the likelihood of onset or worsening of other physical or mental disorders. Hence, some bereaved people need to be diagnosed and treated. A clinician evaluating a bereaved person is at risk for both over-and under-diagnosis, either pathologizing a normal condition or neglecting to treat an impairing disorder. The authors of DSM IV focused primarily on the problem of over-diagnosis, and omitted complicated grief because of insufficient evidence. We revisit bereavement considerations in light of new research findings. This article focuses primarily on a discussion of possible inclusion of a new diagnosis and dimensional assessment of complicated grief. We also discuss modifications in the bereavement V code and refinement of bereavement exclusions in major depression and other disorders.

Resilience to loss and potential trauma.

Initial research on loss and potentially traumatic events (PTEs) has been dominated by either a psychopathological approach emphasizing individual dysfunction or an event approach emphasizing average differences between exposed and nonexposed groups. We consider the limitations of these approaches and review more recent research that has focused on the heterogeneity of outcomes following aversive events. Using both traditional analytic tools and sophisticated latent trajectory modeling, this research has identified a set of prototypical outcome patterns. Typically, the most common outcome following PTEs is a stable trajectory of healthy functioning or resilience. We review research showing that resilience is not the result of a few dominant factors, but rather that there are multiple independent predictors of resilient outcomes. Finally, we critically evaluate the question of whether resilience-building interventions can actually make people more resilient, and we close with suggestions for future research on resilience.

Self-worth mediates the effects of violent loss on PTSD symptoms.

Although research has confirmed that violent losses can exacerbate grief reactions, few investigations have explored underlying mechanisms. In this study, the authors used a dataset on bereaved spouses and bereaved parents at 4- and 18-months postloss to examine the mediating effects of self-worth and worldviews (benevolence and meaningfulness beliefs). Persons bereaved by violent causes had significantly more posttraumatic stress disorder (PTSD), grief, and depression symptoms at 4- and 18-months postloss than persons bereaved by natural causes. Moreover, self-worth but not worldviews mediated the effects of violent loss on PTSD and depression symptoms cross sectionally and PTSD symptoms longitudinally. Findings underscore that self-views are a critical component of problematic reactions to violent loss, but fail to support the role of "shattered" worldviews.

Adaptive and Maladaptive Dependency in Bereavement: Distinguishing Prolonged and Resolved Grief Trajectories.

Interpersonal dependency is typically viewed as a risk factor for prolonged grief among conjugally bereaved adults. However, emerging empirical evidence and theoretical advances suggest that one manifestation of interpersonal dependency--adaptive dependency--may serve as a protective factor in coping with loss. This study compared adaptive and maladaptive dependency across three matched groups: prolonged grievers, asymptomatically bereaved adults, and a married comparison group. Results suggest a link between adaptive dependency and asymptomatic bereavement, and between maladaptive dependency and prolonged grief.

Outside the Eye of the Storm: Can Moderate Hurricane Exposure Improve Social, Psychological, and Attachment Functioning?

High-intensity disaster can harm psychological functioning. Could moderate-intensity disaster improve psychological and attachment functioning through its effects on social functioning? We used a prospective quasi-experimental cohort design to investigate this possibility among college students. Hurricane cohort participants (N = 209) completed assessments before, 2 weeks, and 6 weeks after Hurricane Sandy. Two matched comparison cohorts (Ns > 140) were assessed 4 months and 1 year later. The hurricane cohort, in contrast to matched comparison cohorts, reported increased social support, reduced global distress, reduced negative emotion, and reduced attachment avoidance at the end of the semester. Increased social support mediated the relationship between hurricane cohort and reduced global distress, negative emotion, attachment avoidance, and attachment anxiety, and increased positive emotion and self-esteem at 6 weeks poststorm. The results suggest moderate disaster exposure can benefit short-term social, psychological, and attachment functioning, underscoring the critical role of the social context in stress adaptation.

Threat appraisals, neuroticism, and intrusive memories: a robust mediational approach with replication.

Background: The appraisal of a stressor substantially influences how we adapt to it. We used an experimental paradigm to test and replicate the effects of threat appraisals on subsequent intrusive memories, as well as their moderation by neuroticism. Method: In three studies (total N = 562), participants were randomly assigned to an aversive or control video and then asked to report their threat appraisals of the video. Intrusive memories were assessed at one, three, five, and seven days. We used a robust framework for testing causal mediational effects and their magnitude, including sensitivity analyses and new effect size metrics. Results: We found that threat appraisals mediated the effect of the video on intrusive memories (studies 1-3), and for people higher in neuroticism, the causal mediational pathway was stronger (study 1 and 2). Conclusions: These findings provide methodologically strong evidence that threat appraisals have causal effects on subsequent intrusive memories and that neuroticism enhances this effect, lending empirical support to appraisal theories of posttraumatic stress disorder.

Trajectories of psychological distress among Chinese women diagnosed with breast cancer.

BACKGROUND: The distinct trajectories of psychological distress over the first year of the diagnosis with breast cancer (BC) and its determinants have not been explored. METHODS: 285 of 405 Chinese women receiving surgery for BC were assessed at 5-day, 1-month, 4-month, and 8-month post-surgery on measures of psychological distress, optimism, treatment decision-making (TDM) difficulties, satisfaction with treatment outcome, satisfaction with medical consultation, and physical symptom distress. Latent growth mixture modelling identified trajectories of psychological response to BC. Multinominal logistic regression compared TDM difficulties, satisfaction with treatment outcome, satisfaction with medical consultation, optimism, and physical symptom distress, by distress pattern adjusted for age, education, employment status, and stage of disease. RESULTS: Four distinct trajectories of distress were identified, namely, resilience (66%), chronic distress (15%), recovered (12%), and delayed-recovery (7%). TDM difficulties, optimism, satisfaction with consultation, and physical symptom distress predicted distress trajectories. Psychologically resilient women had less physical symptom distress at early post-surgery compared with women with other distress patterns. Compared with the resilient group, women in the recovered or chronic distress groups experienced greater TDM difficulties, whereas women in the delayed-recovery group reported greater dissatisfaction with the initial medical consultation. Women in the chronic distress group reported greater pessimistic outlook. CONCLUSION: Optimism and better early post-operative treatment outcomes predicted resilience to distress. Pre-operative interventions helping women to establish a realistic expectation of treatment outcome may minimize disappointment with treatment outcome and resultant distress, whereas post-operative rehabilitation should focus on symptom management.

Heterogeneous mental health consequences of COVID-19: Costs and benefits.

In this commentary, I argue that the mental health impact of COVID-19 will show substantial variation across individuals, contexts, and time. Further, one key contributor to this variation will be the proximal and long-term impact of COVID-19 on the social environment. In addition to the mental health costs of the pandemic, it is likely that a subset of people will experience improved social and mental health functioning. (PsycInfo Database Record (c) 2020 APA, all rights reserved).