Health Anxiety and Mental Health Outcome During COVID-19 Lockdown in Italy: The Mediating and Moderating Roles of Psychological Flexibility

Psychological Flexibility, Coronavirus Anxiety, Humor and Social Media Addiction During COVID-19 Pandemic in Turkey

Psychological flexibility is associated with psychological health and affected by various factors. The aim of the present study is to examine the role of coronavirus anxiety, humor and social media addiction on psychological flexibility during the COVID-19 pandemic in Turkey. Variables were measured with online self-report surveys and data were gathered from December 2020 to January 2021 in Turkey. The sample consisted of 376 people (295 female, M = 29.88, SD = 11.05). The relationships between the variables were tested with path analysis using structural equation modelling (SEM). According to results, the constructed model showed that COVID-19 anxiety significantly and directly increased social media addiction (β = .17, p < .01), decreased coping humor (β = -.11, p < .05) and decreased psychological flexibility indirectly through social media addictions (β = -.08, p < .01). Humor coping significantly and directly increased psychological flexibility (β = .25, p < .01), and social media addiction significantly and directly decreased psychological flexibility (β = -.31, p < .01). Findings indicated that psychological flexibility is influenced by coronavirus anxiety, social media addiction and humor coping.  Supporting humor coping and reducing anxiety and problematic social media use would be helpful to enhance psychological flexibility of individuals during the pandemic.

Exploring the Longitudinal Relationship Between Lockdown Policy Stringency and Public Negative Emotions Among 120 Countries During the COVID-19 Pandemic: Mediating Role of Population Mobility

BACKGROUND

To limit the spread of COVID-19, governments worldwide have implemented a series of lockdown policies to restrict the social activities of people. Although scholars suggest that such policies may produce negative effects on public emotions, the existing research is limited because it only provides a cross-sectional snapshot of the effect of lockdown policies in small and local samples. Using large-scale longitudinal cross-country data, the current study aims to gain a better understanding of the dynamic effect of lockdown policies on public emotions and their underlying mechanisms.

METHODS

Drawing on a large-scale longitudinal data from multiple sources, the study employs fixed-effects models to analyze the association between lagged lockdown policy stringency and public negative emotions among 120 countries from February to July 2020 (N = 9,141 country-day observations). The bootstrapping mediation test is used to examine the mediation effects of increased population mobility in residential areas.

RESULTS

The results show a statistically significant and positive association between lagged lockdown policy stringency and general public negative emotion (standardized coefficient = 0.32, CI = 0.30-0.35, p < 0.001). This pattern remains similar to other specific negative emotions, such as depression, anxiety, hopelessness, and helplessness. Moreover, the negative health effects of lockdown policy stringency are significantly mediated by increased mobility in residential areas (51-74% points, p < 0.001).

CONCLUSION

The findings confirm that stringent lockdown policies have a negative effect on public emotions via confining population mobility residential areas. To tackle the COVID-19, future public health policies should pay more attention to the unintended negative consequences of lockdown measures on public emotions.

Developing a Brief Tele-Psychotherapy Model for COVID-19 Patients and Their Family Members

Objective: The COVID-19 pandemic is negatively impacting the mental health of COVID-19 patients and family members. Given the restrictions limiting in person contact to reduce the spread of the virus, a digital approach is needed to tackle the psychological aftermath of the pandemic. We present the development of a brief remote psychotherapy program for COVID-19 patients and/or their relatives. Methods: We first reviewed the literature on psychotherapeutic interventions for COVID-19 related symptoms. Based on this evidence, we leveraged ongoing clinical experiences with COVID-19 survivors and family members to design an intervention model that could be disseminated and integrated into the workflow of the mental health system. Results: This 8-session model -inspired by constructivist and hermeneutic-phenomenological therapies- serves COVID-19 patients during hospitalization, remission and recovery. This model can also be delivered to people dealing with the COVID-19 hospitalization/discharge of a family member, or the loss of a family member due to COVID-19. Conclusion: We described a remote psychotherapeutic approach to tackle the COVID-19 pandemic psychological aftermath. To date, the approach seems feasible and highly customizable to patients' needs. Studies are underway to test its preliminary efficacy. Once proven efficacious, this treatment model could provide a blueprint for future tele-psychology wide-scale interventions.

Validation of the Committed Action Questionnaire-8 and Its Mediating Role Between Experiential Avoidance and Life Satisfaction Among Chinese University Students

Background: Committed action is one of the core processes of psychological flexibility derived from acceptance and commitment therapy. It has not been widely investigated in mainland China as appropriate measures are lacking. The current study aimed to validate a Chinese (Mandarin) version of the Committed Action Questionnaire (CAQ-8) in a non-clinical college sample and to explore whether committed action would have a mediating effect in the association between experiential avoidance (EA) and life satisfaction.

Methods: We translated the CAQ-8 into Chinese (Mandarin). A total of 913 Chinese undergraduates completed a set of questionnaires measuring committed action, EA, mindful awareness, anxiety, depression, stress, and life satisfaction. For test–retest reliability, 167 respondents completed the CAQ-8 again 4 weeks later.

Results: The entire scale of CAQ-8 (Mandarin) and two subscales showed adequate internal consistency and acceptable test–retest reliability. Confirmatory factor analyses confirmed the two-factor structure and the convergent and criterion validity were acceptable. Committed action was correlated with less EA, more mindful awareness, less depressive symptoms, less anxiety, less stress, and more life satisfaction. In bootstrap mediation analyses, committed action partially mediated the association between EA and life satisfaction.

Conclusion: The results suggest that the CAQ-8 (Mandarin) is a brief, psychometrically sound instrument to investigate committed action in Chinese populations, and the relationship between EA and life satisfaction was partially explained by committed action. This study provides new information about the usefulness of CAQ-8 and supports the assumption that committed action may be considered a promising factors for improving life satisfaction who have involved in EA among an educated non-clinical population.

Living Alone or Together During Lockdown: Association with Mood, Immune Fitness and Experiencing COVID-19 Symptoms

Purpose

The aim of this study was to evaluate whether or not living alone or together throughout the lockdown had an impact on mood, perceived immune fitness, as well as the presence and severity of COVID-19 symptoms.

Methods

N = 505 participants completed an online survey, which included questions on living situations, as well as mood, perceived immune fitness and COVID-19 symptom presence and severity. These factors were assessed retrospectively for the time periods before and during the COVID-19 pandemic.

Results

An overall decrease in mood was observed for both those living alone and together during the lockdown period. However, significantly larger increases in feelings of loneliness were observed for the group living alone. Furthermore, both groups reported decreases in perceived immune fitness, whereas only the group living alone reported a significant increase in COVID-19 symptom presence and severity. Moreover, significant correlations were found between perceived immune fitness, anxiety, and loneliness. These correlations were strongest in the group living alone. Lastly, positive correlations were found between perceived immune fitness and mood outcomes with being active, optimistic and the ability to cope with stress. Increased optimism, being more active and the adequate ability to cope with stress were associated with a reduced negative impact on perceived immune fitness.

Conclusion

The first COVID-19 lockdown period in the Netherlands was a challenging period for both people who lived alone and those living together, resulting in decreases in mood and poorer perceived immune fitness. Those living alone were, however, more heavily impacted by the lockdown restrictions. This was further reflected by the increased presence and severity of COVID-19 symptoms in people who lived alone during the first COVID-19 lockdown in The Netherlands.

Investigating the Impact of Isolation During COVID-19 on Family Functioning - An Australian Snapshot

This study explored possible changes in family functioning from the perspective of parents during the COVID-19 pandemic. Thirty-four parents/guardians of children under 18 years completed a semi-structured interview, average length 47 min. Interviews focussed on changes in different aspects of family functioning including family roles, routines, and rules; parenting practices; communication and relationships; and strengths, challenges, and tensions. Data were analysed using reflexive thematic analysis applied in an idiographic and inductive manner to reduce the loss of individual experiences and perspectives. Four superordinate themes were identified: shifting family roles and boundaries throughout the pandemic; impacts on routines and relationships; opportunities and resourcing; and, experiences of support and unity. Gender differences were evident across some themes, particularly changing roles, workload and work-home boundaries. Challenges and tensions were frequently highlighted, particularly by "vulnerable" family groups such as those with children with disabilities. Parents also described a renewed sense of family and community that underpinned adaptive coping responses. The results highlight the importance of family connectedness in times of need.

Validation of the Acceptance and Action Questionnaire-II in the general Spanish population

Acceptance and Commitment Therapy states that Experiential Avoidance contributes to the development of psychological issues. The Acceptance and Action Questionnaire-II measures Experiential Avoidance. The objective of the current study is to perform a validation of the Acceptance and Action Questionnaire-II in the general Spanish population. A sample of 964 participants from all over Spain was used (M = 43.43 years; SD = 15.27). The psychometric properties of the questionnaire were examined according to Classical Test Theory. In addition, assessments were made of participants’ personality, Emotional Intelligence, Anxiety, and Depression, and the influence of sex and age on Experiential Avoidance was examined. The Acceptance and Action Questionnaire-II is a unidimensional instrument, with excellent reliability (α = .93) and adequate evidence of validity. Differences were observed based on sex, with women scoring higher, and based on age, with lower scores in the older age groups. The Acceptance and Action Questionnaire-II is a valid, reliable instrument for use in the general Spanish population.

Predicting PTSS in general population during COVID-19 pandemic: The mediating role of health anxiety

BACKGROUND

Despite health anxiety (HA) is associated with higher incidence of anxiety disorders, no studies have examined the association between this variable and the increased levels of Post-Traumatic Stress Symptoms (PTSS) reported during COVID pandemic.

METHODS

This study was conducted online between April and May 2020. Data were collected from 468 men and women from the Spanish general population. Sociodemographic and COVID-19-related data, health anxiety, PTSS, fear of becoming infected, social support, sleep problems and past/current psychological/psychiatric history were assessed. The mediating effect of HA when predicting PTSS was explored with mediational analyses. Moderated mediational analyses were also performed to test if receiving psychological treatment during pandemic changes the mediating effect of HA.

RESULTS

Prevalence of PTSS was higher in high-scorers in HA (p<.01). High HA was also more likely to be reported by women, individuals with sleep problems, frequently fear of getting infected, and those who have previously received psychological treatment (p<.01). HA mediates the relationship between PTSS and the following predictors of PTSS: sleep problems, psychiatric history and fear of getting infected. Being under psychological treatment did not moderate the mediating effect of health anxiety.

LIMITATIONS

Further longitudinal studies with bigger sample sizes are needed to examine the causal relationship between HA and PTSS after COVID-19 pandemic.

CONCLUSIONS

Our findings suggest that HA could influence the psychological consequences of the pandemic. Screening of HA could be useful to identify people with heightened risk of developing PTSS during pandemic.

Mental Pain, Psychological Distress, and Suicidal Ideation During the COVID-19 Emergency: the Moderating Role of Tolerance for Mental Pain

The psychosocial stressors related to the ongoing COVID-19 pandemic and associated lockdowns have been shown to lead to an exacerbation of suicide risk. The present study aims to examine (a) the contribution of mental pain intensity to psychological distress and suicidal ideation during the COVID-19 pandemic and (b) the protective role of mental pain tolerance in buffering these adverse mental health effects. A total of 652 adults (74.2% female, M = 33.99 years, SD = 13.74) were assessed through an online survey during the first mandatory lockdown in Italy. Participants completed measures of mental pain intensity and tolerance, psychological distress, and suicidal ideation. Results showed that mental pain intensity significantly predicted increases in psychological distress and suicidal ideation while mental pain tolerance significantly buffered the adverse effects of mental pain intensity on psychological distress and suicidal ideation. The findings highlight that tolerance for mental pain may act as a powerful protective factor during the pandemic. Evidence-based public health interventions fostering tolerance for mental pain during a pandemic are needed in order to effectively reduce suicide in potential risk groups.

Key factors affecting people's unwillingness to be confined during the COVID-19 pandemic in Spain: a large-scale population study

Population confinements have been one of the most widely adopted non-pharmaceutical interventions (NPIs) implemented by governments across the globe to help contain the spread of the SARS-CoV-2 virus. While confinement measures have been proven to be effective to reduce the number of infections, they entail significant economic and social costs. Thus, different policy makers and social groups have exhibited varying levels of acceptance of this type of measures. In this context, understanding the factors that determine the willingness of individuals to be confined during a pandemic is of paramount importance, particularly, to policy and decision-makers. In this paper, we study the factors that influence the unwillingness to be confined during the COVID-19 pandemic by the means of a large-scale, online population survey deployed in Spain. We perform two types of analyses (logistic regression and automatic pattern discovery) and consider socio-demographic, economic and psychological factors, together with the 14-day cumulative incidence per 100,000 inhabitants. Our analysis of 109,515 answers to the survey covers data spanning over a 5-month time period to shed light on the impact of the passage of time. We find evidence of pandemic fatigue as the percentage of those who report an unwillingness to be in confinement increases over time; we identify significant gender differences, with women being generally less likely than men to be able to sustain long-term confinement of at least 6 months; we uncover that the psychological impact was the most important factor to determine the willingness to be in confinement at the beginning of the pandemic, to be replaced by the economic impact as the most important variable towards the end of our period of study. Our results highlight the need to design gender and age specific public policies, to implement psychological and economic support programs and to address the evident pandemic fatigue as the success of potential future confinements will depend on the population's willingness to comply with them.

Psychometric Properties of the Coronavirus Stress Measure with Malaysian Young Adults: Association with Psychological Inflexibility and Psychological Distress

The COVID-19 pandemic has resulted in multiple physical and psychological stressors, which require quantification and establishment of association with other psychological process variables. The Coronavirus Stress Measure (CSM) is a validated instrument with acceptable validity and reliability. This study aimed to examine the psychometric properties of the CSM in a Malaysian population. University participants were recruited via convenience sampling using snowball methods. The reliability and validity of the Malay CSM (CSM-M) were rigorously evaluated, utilising both confirmatory factor analysis and Rasch analysis, in relation to sociodemographic variables and response to the depression, anxiety, and stress subscales of the Malay validation of the DASS-21, and also perceived stress (measured by the PSS) and psychological flexibility (AAQ-II). The sample comprised of 247 Malaysian participants. The McDonald's omega value for the Malay CSM was 0.935 indicating very good internal reliability. The CSM was significantly correlated with stress, anxiety, depression, perceived stress, and psychological flexibility. The Malay CSM properties were examined also with Rasch analysis, with satisfactory outcomes. There was positive correlated error between items 1 and 3, as well as negative correlated error between items 1 and 4. Hence, item 1 was excluded, leaving with 4 items. Confirmatory factor analysis demonstrated good data-model fit, and model fit statistics confirmed that Malay CSM showed a single-factor model. The Malay CSM hence demonstrates good validity and reliability, with both classical and modern psychometric methods demonstrating robust outcomes. It is therefore crucial in operational and research settings in establishing the true extent of stress levels as a consequence of the COVID-19 pandemic.

Anxiety, anger, and mindfulness as predictors of general health in the general population during COVID-19 outbreak: A survey in southeast Iran

Communities have been exposed to the complications and problems caused by COVID‐19 disease, which has had various and complex effects on general health. The aim of this study was to investigate the relationship between anxiety, anger, mindfulness, and general health in the general population during the COVID‐19 outbreak in Iran. This cross‐sectional study was performed on 456 participants from September 2020 to April 2021. For data collection, Demographic Characteristics Form, General Health Questionnaire, Freiburg Mindfulness Inventory‐Short Form, The trait anxiety section of the State‐Trait Anxiety Inventory, The State‐Trait Anger Expression Inventory‐2 were used. General health was positively correlated with anxiety and anger and negatively correlated with mindfulness. Anxiety was positively correlated with anger and negatively correlated with mindfulness. No significant correlation was found between anger and mindfulness. Based on the multiple regression model, anxiety, anger and a family member infected with COVID‐19 were the predictors of general health (p < 0.001). Given that anxiety, anger, and family members infected with COVID‐19 are all predictors of public health, it is suggested that psychological programs and interventions be designed to reduce anxiety and anger, as well as to support family members infected with COVID‐19, to promote general health.

Face Covered and Six Feet Apart: Behavioral Awareness Predicts Greater Adherence to Public Health Guidelines during the COVID-19 Pandemic

The COVID-19 pandemic has deleteriously impacted physical and mental health. Guidelines to limit the spread of COVID-19 include wearing a face covering in public, limiting close contacts, and physical distancing. In combatting this and future pandemics, it is essential to understand predictors of adherence, such as psychological flexibility. We hypothesized higher psychological flexibility would relate to greater adherence to public health guidelines. Participants (n = 265) were English-reading/speaking adults in the United States and were recruited through Amazon's Mechanical Turk. Included in the present analyses are data from June (n = 360) and July 2020 (n = 265). Measures included the Comprehensive Assessment of ACT Processes (CompACT), which measured psychological flexibility. Outcome measures included mask-wearing and number of close contacts, which were operationalized categorically (100% mask-wearing in public, ≤10 close contacts in past week). Two logistic regression models examined psychological flexibility and distress as predictors of adherence to mask-wearing and limiting close contacts, while controlling for demographic correlates. Results indicated that greater behavioral awareness predicted greater odds of mask-wearing and limiting close contacts. Psychological flexibility, and behavioral awareness specifically, should be investigated in future research as targets for intervention amidst global disasters.

The relationship between fear of COVID-19 and health anxiety among families with COVID-19 infected: The mediating role of metacognitions, intolerance of uncertainty and emotion regulation

The current study aimed to investigate the mediating role of metacognitions, intolerance of uncertainty and emotion regulation in the relationship between fear of COVID-19 (FC-19) and health anxiety, among families with COVID-19 infected. Participants were 541 individuals from family members of patients with COVID-19 (F = 52.3%, mean age = 41.3 ± 13.2 years). Data were collected with a packet including sociodemographic and risk factors, the Fear of COVID-19 Scale, the Short Health Anxiety Inventory, the Metacognitions Questionnaire 30, the Intolerance of Uncertainty Scale-12 and the Emotion Regulation Questionnaire. Structural equation modelling analyses revealed a full mediation of metacognitions (i.e., positive beliefs about worry, negative beliefs about thoughts concerning uncontrollability and danger, cognitive confidence and beliefs about the need to control thoughts), intolerance of uncertainty and expressive suppression in the relation between FC-19 and health anxiety. Moreover, the strongest indirect links were found between FC-19 and health anxiety through negative beliefs about thoughts concerning uncontrollability and danger and intolerance of uncertainty. These associations were independent of gender and risk status. The final model accounted for 71% of the variance of health anxiety. These findings suggest that particularly metacognitions, intolerance of uncertainty and expressive suppression play a full mediational role in the relation between FC-19 and health anxiety.

COVID-19 Peritraumatic Distress as a Function of Age and Gender in a Spanish Sample

The sudden outbreak of the COVID-19 pandemic has profoundly altered the daily lives of the population with dramatic effects caused not only by the health risks of the coronavirus, but also by its psychological and social impact in large sectors of the worldwide population. The present study adapted the COVID-19 Peritraumatic Distress Index (CPDI) to the Spanish population, and 1094 Spanish adults (mean age 52.55 years, 241 males) completed the Spanish version in a cross-sectional online survey. To analyze the factorial structure and reliability of the CPDI, we performed an exploratory factor analysis (EFA) followed by a confirmatory factor analysis (CFA) on the Spanish sample. The effects of gender and age on the degree of distress were analyzed using the factorial scores of the CPDI as the dependent variables. Results showed that, after rotation, the first factor (Stresssymptoms) accounted for 35% of the total variance and the second factor (COVID-19 information) for 15%. Around 25% (n = 279) of the participants experienced mild to moderate distress symptoms, 16% (n = 179) severe distress, and about 58% (n = 636) showed no distress symptoms. Women experienced more distress than men (p<0.01), and distress decreased with age (p<0.01). We conclude that the CPDI seems a promising screening tool for the rapid detection of potential peritraumatic stress caused by the COVID-19 pandemic.

Harnessing the Neurobiology of Resilience to Protect the Mental Well-Being of Healthcare Workers During the COVID-19 Pandemic

Healthcare workers are at a high risk of psychological morbidity in the face of the COVID-19 pandemic. However, there is significant variability in the impact of this crisis on individual healthcare workers, which can be best explained through an appreciation of the construct of resilience. Broadly speaking, resilience refers to the ability to successfully adapt to stressful or traumatic events, and thus plays a key role in determining mental health outcomes following exposure to such events. A proper understanding of resilience is vital in enabling a shift from a reactive to a proactive approach for protecting and promoting the mental well-being of healthcare workers. Research in the past decade has identified six areas that provide promising leads in understanding the biological basis of individual variations in resilience. These are: (1) the key role played by the monoamines noradrenaline and serotonin, (2) the centrality of the hypothalamic-pituitary-adrenal axis in influencing stress vulnerability and resilience, (3) the intimate links between the immune system and stress sensitivity, (4) the role of epigenetic modulation of gene expression in influencing the stress response, (5) the role played by certain neuropeptides as a natural “brake” mechanism in the face of stress, and (6) the neurobiological mechanisms by which environmental factors, such as exercise, diet, and social support, influence resilience to subsequent life events. Though much of this research is still in its early stages, it has already provided valuable information on which strategies – including dietary changes, lifestyle modification, environmental modification, psychosocial interventions, and even pharmacological treatments – may prove to be useful in fostering resilience in individuals and groups. This paper examines the above evidence more closely, with a specific focus on the challenges faced by healthcare workers during the COVID-19 pandemic, and provides suggestions regarding how it may be translated into real-world interventions, as well as how the more tentative hypotheses advanced in this field may be tested during this critical period.

The impact of COVID-19 on prenatal care in the United States: Qualitative analysis from a survey of 2519 pregnant women

OBJECTIVE

To explore if and how women perceived their prenatal care to have changed as a result of COVID-19 and the impact of those changes on pregnant women.

DESIGN

Qualitative analysis of open-ended prompts included as part of an anonymous, online, cross-sectional survey of pregnant women in the United States.

SETTING

Online survey with participants from 47 states within the U.S.

PARTICIPANTS

Self-identified pregnant women recruited through Facebook, Twitter, and other online sources.

MEASUREMENTS AND FINDINGS

An anonymous, online survey of pregnant women (distributed April 3 - 24, 2020) included an open-ended prompt asking women to tell us how COVID-19 had affected their prenatal care. Open-ended narrative responses were downloaded into Excel and coded using the Attride-Sterling Framework. 2519 pregnant women from 47 states responded to the survey, 88.4% of whom had at least one previous birth. Mean age was 32.7 years, mean weeks pregnant was 24.3 weeks, and mean number of prenatal visits at the point of the survey was 6.5. Predominant themes of the open narratives included COVID-19's role in creating structural changes within the healthcare system (reported spontaneously by 2075 respondents), behavioral changes among both pregnant women and their providers (reported by 429 respondents), and emotional consequences for women who were pregnant (reported by 503 respondents) during the pandemic. Changes resulting from COVID-19 varied widely by provider, and women's perceptions of the impact on quality of care ranged from perceiving care as extremely compromised to perceiving it to be improved as a result of the pandemic.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Women who are pregnant during the COVID-19 pandemic have faced enormous upheaval as hospitals and healthcare providers have struggled to meet the simultaneous and often competing demands of infection prevention, pandemic preparedness, high patient volumes of extremely sick patients, and the needs of 'non-urgent' pregnant patients. In some settings, women described very few changes, whereas others reported radical changes implemented seemingly overnight. While infection rates may drive variable responses, these inconsistencies raise important questions regarding the need for local, state, national, or even global recommendations for the care of pregnant women during a global pandemic such as COVID-19.

Sport Cyberpsychology in Action During the COVID-19 Pandemic (Opportunities, Challenges, and Future Possibilities): A Narrative Review

Interest in sport cyberpsychology has become more popular over the last decade, primarily due to the increased use of technology and the online world, including social media, within sport settings (Hurley, 2018). In 2020, this became even more apparent for many athletes, their support teams and their sport organisations, when their professional and social worlds became cyber-dominated due to the COVID-19 pandemic. Many challenges were encountered by: (i) the athletes, in their efforts to remain active and well during this time when all competitions were cancelled and (ii) the healthcare professionals, working with these athletes, in their efforts to continue to support the athletes, when severe travel restrictions and social distancing were in place for considerable periods of time. The purpose of this paper, using a narrative review process, is to present and scrutinise an array of Internet interventions, remote psychological supports and applications (apps) that the athletes and their support personnel used to help them meet their physical, social, and emotional needs during the pandemic. The beneficial and restrictive features of these online options will be presented. Two main themes will be considered in order to focus this discussion, namely, (i) the potential physical and mental opportunities and challenges using the online world extensively during this time presented for the individuals working in sport and (ii) suggestions for how such online interventions used by the athletes, their coaches and sport science personnel during the pandemic may be maintained in some positive ways into the future, to help the athletes prepare for their upcoming competitions, their training and their future careers when they retire from elite sport.

The Influence of Personality, Resilience, and Alexithymia on Mental Health During COVID-19 Pandemic

Following the COVID-19 pandemic, many countries worldwide have put lockdowns in place to prevent the virus from spreading. Evidence shows that lockdown measures can affect mental health; it is, therefore, important to identify the psychological characteristics making individuals more vulnerable. The present study aimed, first, to identify, through a cluster analysis, the psychological attributes that characterize individuals with similar psychological responses to the COVID-19 home confinement; second, to investigate whether different psychological characteristics, such as personality traits, alexithymia, and resilience, specifically influence anxiety, stress, and depression, depending on the scope of the confinement. We analyzed data from 393 participants who completed an online survey on their experiences during two different phases of the Italian lockdown, characterized by more or less strict measures of confinement. Two clusters were identified which included participants reporting a better (+ER) and worse (−ER) emotional response to the lockdown, respectively. Individuals in the −ER group showed lower emotional stability, resilience, and higher alexithymia. Moreover, even if lifting part of the restrictions decreased psychological distress among all participants, a reduction in perceived stress was observed only among individuals with high resilience. Finally, personality traits, alexithymia, and resilience differently affected depression, anxiety, and stress. Our results suggest that different psychological interventions should be planned depending on the context: mental health professionals should focus on enhancing the individuals’ coping strategies to alleviate stress in emergencies, while long-term intervention aiming at alleviating anxiety and depressive symptoms should focus on alexithymic tendencies and personality constructs.

Cognitive and mental health changes and their vulnerability factors related to COVID-19 lockdown in Italy

The COVID-19 pandemic and government imposed social restrictions like lockdown exposed most individuals to an unprecedented stress, increasing mental health disorders worldwide.

We explored subjective cognitive functioning and mental health changes and their possible interplay related to COVID-19-lockdown. We also investigated potential risk factors to identify more vulnerable groups. Across Italy, 1215 respondents completed our Qualtrics-based online-survey during the end of a seven to 10-week imposed lockdown and home confinement (from April 29 to May 17, 2020). We found subjective cognitive functioning and mental health severely changed in association with the lockdown. Under government regulations, cognitive complaints were mostly perceived in routine tasks involving attention, temporal orientation and executive functions—with no changes in language abilities. A paradoxical effect was observed for memory, with reduced forgetfulness compared to pre-lockdown. We found higher severity and prevalence of depression, anxiety disorders, abnormal sleep, appetite changes, reduced libido and health anxiety: with mild-to-severe depression and anxiety prevalence climbing to 32 and 36 percent, respectively, under restrictions. Being female, under 45 years, working from home or being underemployed were all identified as relevant risk factors for worsening cognition and mental health. Frequent consumers of COVID-19 mass media information or residents in highly infected communities reported higher depression and anxiety symptoms, particularly hypochondria in the latter. If similar restrictions are reimposed, governments must carefully consider these more vulnerable groups in their decisions, whilst developing effective global and long-term responses to the cognitive and mental health challenges of this type of pandemic; as well as implementing appropriate psychological interventions with specific guidelines: particularly regarding exposure to COVID-19 mass-media reports.

A Cross-Cultural Exploratory Study of Health Behaviors and Wellbeing During COVID-19

This study explored the influence of the COVID-19 pandemic on perceived health behaviors; physical activity, sleep, and diet behaviors, alongside associations with wellbeing. Participants were 1,140 individuals residing in the United Kingdom (n = 230), South Korea (n = 204), Finland (n = 171), Philippines (n = 132), Latin America (n = 124), Spain (n = 112), North America (n = 87), and Italy (n = 80). They completed an online survey reporting possible changes in the targeted behaviors as well as perceived changes in their physical and mental health. Multivariate analyses of covariance (MANCOVA) on the final sample (n = 1,131) revealed significant mean differences regarding perceived physical and mental health "over the last week," as well as changes in health behaviors during the pandemic by levels of physical activity and country of residence. Follow up analyses indicated that individuals with highest decrease in physical activity reported significantly lower physical and mental health, while those with highest increase in physical activity reported significantly higher increase in sleep and lower weight gain. United Kingdom participants reported lowest levels of physical health and highest increase in weight while Latin American participants reported being most affected by emotional problems. Finnish participants reported significantly higher ratings for physical health. The physical activity by country interaction was significant for wellbeing. MANCOVA also revealed significant differences across physical activity levels and four established age categories. Participants in the oldest category reported being significantly least affected by personal and emotional problems; youngest participants reported significantly more sleep. The age by physical activity interaction was significant for eating. Discussed in light of Hobfoll (1998) conservation of resources theory, findings endorse the policy of advocating physical activity as a means of generating and maintaining resources combative of stress and protective of health.

The Impact of the SARS-CoV-2 Outbreak on the Psychological Flexibility and Behaviour of Cancelling Medical Appointments of Italian Patients with Pre-Existing Medical Condition: The "ImpACT-COVID-19 for Patients" Multi-Centre Observational Study

Psychological distress imposed by the SARS-CoV-2 outbreak particularly affects patients with pre-existing medical conditions, and the progression of their diseases. Patients who fail to keep scheduled medical appointments experience a negative impact on care. The aim of this study is to investigate the psychosocial factors contributing to the cancellation of medical appointments during the pandemic by patients with pre-existing health conditions. Data were collected in eleven Italian hospitals during the last week of lockdown, and one month later. In order to assess the emotional impact of the SARS-CoV-2 outbreak and the subject's degree of psychological flexibility, we developed an ad hoc questionnaire (ImpACT), referring to the Acceptance and Commitment Therapy (ACT) model. The Impact of Event Scale-Revised (IES-R), the Depression, Anxiety and Stress Scale (DASS) and the Cognitive Fusion Questionnaire (CFQ) were also used. Pervasive dysfunctional use of experiential avoidance behaviours (used with the function to avoid thought, emotions, sensations), feelings of loneliness and high post-traumatic stress scores were found to correlate with the fear of COVID-19, increasing the likelihood of cancelling medical appointments. Responding promptly to the information and psychological needs of patients who cancel medical appointments can have positive effects in terms of psychological and physical health.

Anxiety Regarding COVID-19 Is Related to Attentional Control: The Mediating Role of Anxiety Sensitivity

Background: As an emergent public health event, COVID-19 has had a significant impact on mental health, particularly causing anxiety. Some cognitive-affective related studies have demonstrated that attentional control is related to levels of anxiety. More specifically, recent research has shown that anxiety sensitivity is uniquely associated with mental health responses to COVID-19. The aim of the current study was to investigate the role of anxiety sensitivity during COVID-19 outbreak period, especially physical and cognitive concerns, in relation to attentional control and anxiety. Methods: It is a questionnaire study. A total of 464 participants were recruited through online sampling between February and March, 2020. They were surveyed by the Attentional Control Scale (ATTC), Anxiety Sensitivity Index-3 (ASI-3) and Depression Anxiety Stress Scale-21 (DASS-21). Data were analyzed using descriptive statistics and correlation analysis. We also tested the mediating effect. Results: The results showed that attentional control is negatively correlated with physical concern, cognitive concern and anxiety. And results support that physical and cognitive concerns play a mediating role between attentional control and anxiety. Conclusions: Anxiety sensitivity plays a mediating role between attentional control and anxiety. These findings can help effective prevention and intervention of anxiety.

Health Anxiety and Its Correlates in the General Chinese Population During the COVID-19 Epidemic

Background: The novel coronavirus disease 2019 (COVID-19) pandemic has had an adverse impact on the mental health of the general population. This study aimed to investigate the prevalence and correlates of health anxiety (HA) in the general Chinese population to inform psychological interventions in COVID-19-affected areas. Methods: We conducted an online survey of the general population in mainland China between 6 and 17 February 2020 (N = 1,450, 69.79% female; mean age = 37.5 ± 9.1 years). The Whiteley Index-7 (WI-7), COVID-19 knowledge quiz (CKQ), Generalised Anxiety Disorder scale (GAD-7), Patient Health Questionnaire Depression Scale (PHQ-9), and socio-demographic information were surveyed using the Questionnaire-Star program. Results: The prevalence of HA, depression and anxiety were 47.3, 31.3, and 35.7%, respectively. The WI-7 score showed a significant association with age, education level, income, occupation, chronic disease and daily time focused on COVID-19. On binary logistic regression analysis, individuals with masters or higher qualification degree [odds ratio (OR) = 0.632)], older age (OR = 0.981), 2-4 h daily time focused on COVID-19 (OR = 0.684), healthcare workers (OR = 0.749, p = 0.046) and those with more COVID-19 related knowledge (OR = 0.785) showed a significantly negative association with HA. Chronic disease (OR = 1.962), depression (OR = 1.05) and anxiety (OR = 1.228) were significant risk factors for HA. Conclusions: HA was highly prevalent among the general population during the early stages of the COVID-19 outbreak. More than two-fifths of the respondents had obvious HA. Chronic disease, depression and anxiety were risk factors for HA; psychological interventions offered during the pandemic should pay particular attention to these individuals.

A Postcard From Italy: Challenges and Psychosocial Resources of Partners Living With and Without a Chronic Disease During COVID-19 Epidemic

The new Coronavirus (COVID-19) has been declared a global pandemic by the World Health Organization (WHO). The sudden outbreak of this new virus and the measure of lockdown adopted to contain the epidemic have profoundly changed the lifestyles of the Italian population, with an impact on people's quality of life and on their social relationships. In particular, due to forced and prolonged cohabitation, couples may be subject to specific stressors during the epidemic. In addition, living with a chronic health condition may add specific challenges to the ones posed by the epidemic itself. The present cross-sectional study aimed to provide a picture of the challenges as well as the resources for both individual and relational well-being of Italian individuals in a couple relationship (N = 1921), with a specific attention to the comparison between individuals living with and without a chronic disease. Results showed that people with a chronic disease had lower psychological well-being and more fears and worries about the COVID-19. People with a chronic disease perceived fewer resources than healthy people. Moreover, the challenges are shown to be associated with less psychological well-being and high pessimism about the future. Instead individual, relational, and social resources play a protective role during the pandemic for both healthy and chronically ill people.