The WHO-5 well-being index – validation based on item response theory and the analysis of measurement invariance across 35 countries

Mapping the well-being of Norwegian mothers during the COVID-19 pandemic

The COVID-19 pandemic had negative effects on many people's well-being and quality of life. In the present work, we focused on Norwegian mothers with elementary school children, and investigated whether their well-being, stress, and worries (and the relationships between them) changed across the early months of the pandemic. We collected data at two time points in 2020. In June 2020, 231 mothers (mean age = 40.09, SD = 6.22) responded to an online questionnaire in which they were asked to indicate their well-being, stress, and worries before the pandemic, during the lockdown (i.e., March 2020), and currently (i.e., June 2020). Of these 231 mothers, 97 (mean age = 40.58, SD = 5.66) answered the same questionnaire again in November 2020. Mothers' well-being was lower in November 2020 than before the pandemic (retrospectively reported). The age of the youngest child showed the strongest and most consistent relationship with mothers' well-being across all time points. In addition, we found that the stress mothers felt during the national lockdown in March 2020 was strongly associated with their well-being both during the lockdown and in June 2020. Finally, in November 2020, mothers' financial pandemic-related worries were negatively related to their well-being. Implications and suggestions for future research and for how societies can cope with future health-related crises are discussed.

A holistic lifestyle mobile health intervention for the prevention of type 2 diabetes and common mental disorders in Asian women with a history of gestational diabetes: a randomised control trial with 3-year follow-up protocol

BACKGROUND

Women with a history of gestational diabetes mellitus (GDM) are 12-fold more likely to develop type 2 diabetes (T2D) 4-6 years after delivery than women without GDM. Similarly, GDM is associated with the development of common mental disorders (CMDs) (e.g. anxiety and depression). Evidence shows that holistic lifestyle interventions focusing on physical activity (PA), dietary intake, sleep, and mental well-being strategies can prevent T2D and CMDs. This study aims to assess the effectiveness of a holistic lifestyle mobile health intervention (mHealth) with post-GDM women in preventing T2D and CMDs in a community setting in Singapore.

METHODS

The study consists of a 1-year randomised controlled trial (RCT) with a 3-year follow-up period. Post-GDM women with no current diabetes diagnosis and not planning to become pregnant will be eligible for the study. In addition, participants will complete mental well-being questionnaires (e.g. depression, anxiety, sleep) and their child's socio-emotional and cognitive development. The participants will be randomised to either Group 1 (Intervention) or Group 2 (comparison). The intervention group will receive the "LVL UP App", a smartphone-based, conversational agent-delivered holistic lifestyle intervention focused on three pillars: Move More (PA), Eat Well (Diet), and Stress Less (mental wellbeing). The intervention consists of health literacy and psychoeducational coaching sessions, daily "Life Hacks" (healthy activity suggestions), slow-paced breathing exercises, a step tracker (including brisk steps), a low-burden food diary, and a journaling tool. Women from both groups will be provided with an Oura ring for tracking physical activity, sleep, and heart rate variability (a proxy for stress), and the "HAPPY App", a mHealth app which provides health promotion information about PA, diet, sleep, and mental wellbeing, as well as display body mass index, blood pressure, and results from the oral glucose tolerance tests. Short-term aggregate effects will be assessed at 26/27 weeks (midpoint) and a 1-year visit, followed by a 2, 3, and 4-year follow-up period.

DISCUSSION

High rates of progression of T2D and CMDs in women with post-GDM suggest an urgent need to promote a healthy lifestyle, including diet, PA, sleep, and mental well-being. Preventive interventions through a holistic, healthy lifestyle may be the solution, considering the inextricable relationship between physical and psychological health. We expect that holistic lifestyle mHealth may effectively support behavioural changes among women with a history of GDM to prevent T2D and CMDs.

TRIAL STATUS

The protocol study was approved by the National Healthcare Group in Singapore, Domain Specific Review Board (DSRB) [2023/00178]; June 2023. Recruitment began on October 18, 2023.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05949957. The first submission date is June 08, 2023.

Spouses of patients treated for colon cancer: identification of key caregiver skills using the Delphi method

PURPOSE

Spouses are often the front-line caregivers for colon cancer patients. Providing this support requires a particular set of coping skills. Our objective was to identify key skills that healthcare and medico-social sector professionals could assess in routine practice that would allow them to propose appropriate support to spouses who are accompanying colon cancer patients in their care pathway.

METHODS

An online two-round Delphi study was conducted among French colon cancer patients, spouses and professionals. The content of the Delphi study was developed from a previously published qualitative study.

RESULTS

In the first round of the study, 63% of the participants were professionals (n = 40), 19% spouses (n = 12) and 17% patients (n = 11). In the second round, they were respectively 55% (n = 22), 22% (n = 9) and 22% (n = 9). Twenty-seven of the 75 proposed skills were consensually identified as key skills. Nine were related to emotional and psychological well-being, six to social relations, four to organisation, five to health and three to domestic domains. The three most consensual skills (≥ 90% agreement) for spouses were (1) helping the tired patient in everyday life, (2) stimulating the patient to prevent him/her from giving up and (3) limiting one's amount of personal time to care for the patient.

CONCLUSION

The study identified the key skills needed by spouses of patients being treated for colon cancer. Better awareness of these skills among professionals would enable them to offer tailored support to help patients and spouses maintain their physical and emotional well-being.

Conditional reciprocal stressor-strain effects in university students: a cross-lagged panel study in Germany

University students worldwide are facing increasing mental health challenges. Traditional stress models, like the Job/Study Demand-Resources Model, link stressors directly to strain. Yet, recent studies suggest the influence of strain on stressors may be even stronger. Our research explored these reciprocal dynamics among university students, considering social support and mindfulness as potential moderators. We conducted a two-wave panel study with 264 university students. We ran separate cross-lagged panel structural equation analyses for three key health outcomes-emotional exhaustion, depression, and well-being-each paired with perceived study stressors, specifically workload and work complexity. Findings revealed significant stressor and strain effects, with social support notably moderating the impact of emotional exhaustion on workload. These insights challenge traditional stress theories and underscore the importance of mental health support and effective stress management strategies for students, emphasizing the need for proactive mental health initiatives in academic environments.

Effect of childbirth experience on the psychological well-being of postpartum women in Accra, Ghana

BACKGROUND

Women's experience of childbirth can affect their mental health outcomes, many years after the delivery. Consequently, the World Health Organisation has provided recommendations to ensure women receive positive birth experiences during intrapartum care. Yet, negative childbirth experience is widespread in Ghana. This study examined the association between women's childbirth experience (i.e. own capacity, professional support, perceived safety, and participation) and their psychological well-being, and whether or not perceived social support and resilience moderate the childbirth experience - psychological well-being relationship.

METHODS

Mothers (N = 117) who had given birth in the past month and were receiving postnatal care at two health facilities in the Greater Accra Region of Ghana provided the data for the current analysis. Data were collected using the Childbirth Experience Questionnaire, WHO-5 Well-Being Index, Multidimensional Scale of Perceived Social Support, and Brief Resilience Scale. Hierarchical Linear Regression was used to analyse the data.

RESULTS

Results showed that childbirth experience domains of own capacity and perceived safety were significantly, and positively associated with psychological well-being. The domains of professional support and participation were not associated with psychological well-being in this sample. Perceived social support and resilience did not moderate the association between childbirth experience and psychological well-being.

CONCLUSION

The results suggest that efforts by birth practitioners (i.e. midwives, obstetricians, and gynaecologists) to give Ghanaian women positive childbirth experiences through the encouragement of personal control over the birthing process as well as ensuring the safety of the birthing procedure and environment would provide women with optimal mental health outcomes.

3 Months without the car in Bielefeld, Germany- a mixed-method study exploring individual motivation to participate in a municipal intervention

BACKGROUND

Climate change is a major public health issue worldwide. To achieve climate targets and reduce morbidity, a paradigm shift in individual behavior e.g., in mobility, is needed. Municipal interventions can motivate individuals to engage in climate-friendly behavior through different psychological mechanisms. In order for successful interventions, it is necessary to gain better insight from study participants and their reasons for participating in mobility projects (e.g., motivational aspects).

MATERIALS AND METHODS

A mixed-methods design was used to evaluate reasons and characteristics of people for participating in an municipal mobility intervention. The quantitative sub-study assesses socioeconomic characteristics, environmental awareness and perceived stress. The qualitative sub-study explores motivation for participation and change, perspectives on car replacement and reasons for car use.

RESULTS

Results show that participants (n = 42) are rather high educated and show medium environmental awareness. Participants of the qualitative study part (n = 15) were motiviated to reduce car use already before the intervention and used the intervention as starting point or trial phase.

CONCLUSIONS

Urban intervention projects with fitted recruitment strategies and better insights from study participants with the aim to motivate individuals to engage in climate-friendly behavior can help to strengthen sustainability and public health.

Rasch analysis of a patient-reported outcome measure for self-perceived health among psychiatric patients in Denmark

BACKGROUND

Patient-reported outcome measures (PROMs) are valuable and necessary tools for establishing and maintaining patient-centred healthcare. The PRO-Psychiatry initiative was primarily initiated to support the patient's voice in treatment decision-making and secondarily to monitor patient-perceived quality of care. The result of the initiative is a patient-reported instrument developed in collaboration between patients and clinicians. We aimed to validate the PROM developed for measuring self-perceived health among psychiatric patients in North Denmark Region, in terms of internal consistency, criterion validity and responsiveness.

METHOD

Patients in contact with a psychiatric hospital in the North Denmark Region from September 2018 to March 2021 were included in the study. The PROM constitutes a scale of 17 items covering various aspects of self-perceived health including well-being (7 items), lack of well-being (5 items) and social functioning (5 items), where the former domain entails the WHO-5 Well-Being Index. The potential range of the total scale score is 0-85. We applied McDonald's omega, average inter-item correlation (AIIC) and differential item functioning (DIF). In addition, we used mixed effects analyses to estimate temporal correlations. The instrument was compared with self-rated overall mental and psychiatric health.

RESULTS

The patient population consisted of 1132 unique patients and a total of 2476 responses corresponding to one response per patient pathway. McDonald's omega was found to be 0.92 (95% CI 0.92 to 0.93), while the AIIC was found to be 0.42 (95% CI 0.39 to 0.44). For DIF, the largest systematic variation resulted in a maximum difference of 2.3 points on the total score when adjusting for the latent trait and was found when comparing initial measurements with follow-up measurements. The correlation between the total score and the outcomes regarding overall physical and mental health was 0.52 (95% CI 0.48 to 0.56) and 0.74 (95% CI 0.72 to 0.76). Similar correlations were found for the corresponding changes over time.

CONCLUSION

The scale showed high consistency and little systematic variation between the comparison groups. The concurrent correlations and analyses of responsiveness coincided with the prespecified hypotheses. Overall, we deem the Danish PRO-Psychiatry instrument to possess suitable psychometric properties for measuring self-perceived health among a psychiatric population.

Feasibility of a breath robot intervention to reduce sleep problems in posttraumatic stress disorder: protocol for a randomized controlled study

BACKGROUND

Many patients with posttraumatic stress disorder (PTSD) suffer from sleep problems. Robot-based interventions might be an innovative approach to reduce sleep problems and hyperarousal in PTSD. However, the feasibility and effectiveness of a breath robot in patients with PTSD have never been empirically tested. The aim of this study is to investigate the feasibility of a breath robot to reduce sleep problems and hyperarousal in patients with PTSD.

METHODS

This randomized controlled feasibility study will include N = 30 adult patients with at least subsyndromal PTSD (PTSD Symptom Scale - Interview-5 (PSSI-5)) according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) and impaired sleep quality (Pittsburgh Sleep Quality Index (PSQI) > 5). Patients with organic sleep disorders or currently in psychotherapeutic treatment are excluded. Study participants are randomized to receive either a 4-week Somnox 2 robot intervention including simulation of human breath or a 4-week Somnox 2 robot intervention without human breath simulation. The primary outcome will be the proportion of randomized participants providing outcome data at post-treatment. We consider a proportion of > 50% to indicate feasibility. Additional feasibility outcomes include eligibility rate, recruitment speed, uptake, retention, treatment adherence, and dropout. Potential outcomes of effectiveness (sleep quality, PSQI; severity of PTSD symptoms, PSSI-5) will be assessed at two time points, before (T0) and after (T1) the intervention. Sleep characteristics (Consensus Sleep Diary (CSD)) are measured daily.

DISCUSSION

This study is the first to investigate the feasibility of a novel breath robot intervention for reducing sleep problems and hyperarousal in PTSD patients, with effectiveness considered as a secondary outcome. If feasible and effective, the use of a breath robot could be a nonintrusive and flexible intervention to supplement psychotherapy or to bridge treatment gaps.

TRIAL REGISTRATION

DRKS, DRKS00031063. Registered on 10/012023.

Structural validity of the 5-item World Health Organization Well-being Index (WHO-5) in patients with schizophrenia spectrum disorders

BACKGROUND

When monitoring the severity and impact of schizophrenia spectrum disorders, a measure of subjective well-being should ideally accompany measures of symptom severity and medication side effects. The self-reported 5-item World Health Organization Well-being Index (WHO-5) is a brief, generic, and widely used measure of subjective well-being. However, the structural validity of the WHO-5, namely, whether the individual item scores can be combined to produce a meaningful total score, has not been examined among patients with schizophrenia spectrum disorders.

METHOD

Utilizing data from 399 Danish patients with schizophrenia spectrum disorders attending the Psychiatric Services of the Central Denmark Region, we employed Rasch analysis to examine the structural validity (i.e., unidimensionality, overall fit to the Rasch model, and differential item functioning) of the WHO-5.

RESULTS

The WHO-5 was found to be unidimensional with no differential item functioning for age, sex, or inpatient/outpatient status. However, in the initial analysis, some misfit to the Rasch model, partially caused by the disordering of response categories, was evident. In adjusted analyses in which the item response categories 2 (Less than half of the time) and 3 (More than half of the time) were merged, overall fit to the model was improved.

CONCLUSIONS

When two item response categories were merged, the Danish version of the WHO-5 was found to be structurally valid for patients with schizophrenia spectrum disorders. This suggests that the WHO-5 holds promise as a measure of subjective well-being in this patient population.

Impaired Well-Being and Insomnia as Residuals of Resolved Medical Conditions: Survey in the Italian Population

BACKGROUND

Well-being encompasses physical, mental, social, and cultural aspects. Sleep quality and pathologies are among the objective conditions jeopardising it. Chronic insomnia, inflammatory-based diseases, and mood disorders often occur in a single cluster, and inflammation can negatively impact sleep, potentially harming well-being. Some evidence from specific clinical populations suggests that also some resolved past diseases could still have an impact on present sleep quality and well-being. The aim of the present study is to investigate, in the general population, whether and to what degree well-being and insomnia are associated with resolved pathologies.

METHODS

A cross-sectional survey (IPSAD®) was carried out using anonymous postal questionnaires that investigated past and present general health, well-being, and insomnia. A total of 10,467 subjects answered the questionnaire.

RESULTS

Several classes of both current and resolved pathologies resulted in increased odds ratios for current insomnia (odds ratios = 1.90; 1.43, respectively) and impaired well-being (odds ratios = 1.75; 1.33, respectively), proportional to the number of the displayed pathologies. Notably, both current and resolved past psychiatric disorders were strongly associated with both current impaired well-being (odds ratios = 5.38; 1.70, respectively) and insomnia (odds ratios = 4.99; 2.15, respectively).

CONCLUSIONS

To explain these associations, we suggest that systemic inflammation conveyed by several medical conditions disrupts homeostatic processes, with final effects on sleep quality and behaviour.

Post-migration stressors, mental health and well-being in resettled refugees from Syria: Do individuals' coping strategies matter?

BACKGROUND

The evidence is mixed as to whether individuals' coping strategies may mitigate the adverse mental health effects of post-displacement stressors in refugee populations, with some indications that the buffering effects of coping strategies are context dependent. The present study examined if problem-solving and acceptance coping strategies were effect modifiers between post-migration stressors and mental health in adult refugees from Syria resettled in Sweden.

METHODS

Study aims were investigated using cross-sectional survey data from a nationwide, randomly sampled group of adult refugees from Syria granted permanent residency in Sweden between 2011 and 2013 (Nsample = 4000, nrespondents = 1215, response rate 30.4%). Post-migration stressors examined included: financial strain, social strain, host-country competency strain and discrimination. Two mental health outcomes were used: anxiety/depression, measured with the Hopkins Symptom Checklist-25; and well-being, measured with the WHO-5 Well-being Index. Both outcomes were modelled continuously. Coping strategies were measured using the BRIEF Cope scale. Interactions between coping strategies and post-migration stressors were tested in fully adjusted linear regression models using Wald test for interaction, corrected for multiple testing using the Benjamini-Hochberg procedure.

RESULTS

Both problem-solving and acceptance coping strategies buffered the adverse association between financial strain and symptoms of anxiety/depression, and problem-solving coping strategies buffered the adverse association between host-country competency strain and anxiety/depression.

CONCLUSIONS

The study suggests that individuals' coping strategies may to some degree buffer the adverse mental health effects of financial strain and host-country competency strain experienced by refugees in the resettlement phase. Although this pattern was only found in regard to anxiety/depression and not subjective well-being, the findings show that individual-level coping skills among refugees may contribute to adaptation in the face of post-settlement adversities. Notwithstanding the importance of attending to refugees' psychosocial conditions, refugees residing in refugee camps and newly resettled refugees might benefit from interventions aiming at enhancing individual coping resources and skills. The potential effect of increased controllability and decreased conflict-proximity also warrants further exploration in future studies.

Middle school cycling program is associated with improved mental health and wellbeing in adolescents during COVID-19

Introduction

The COVID-19 pandemic has exacerbated mental health issues among adolescents. Exercise is well-regarded for boosting mental health. Riding for Focus (R4F) is a 6-8 week cycling education program designed to equip middle school adolescents with basic cycling skills and introduce students to lifetime physical activity. A secondary goal of the R4F program is to improve adolescent mental health and psychosocial well-being. This study aimed to quantify the change in adolescent psychosocial well-being associated with the R4F program during the COVID-19 pandemic. Program evaluation also examined associations between participating in the R4F and mental health outcomes in the context of established risk factors, including gender, race, socioeconomic status, involvement in IEP programs, participation in after-school clubs, screen time, hours of sleep, and physical activity levels.

Methods

Anonymous surveys were collected before and after the program in 20 schools in North America, with psychosocial well-being quantified using WHO-5 and PSC-17-Y. 1,148 middle school students, aged 11-14, completed pre intervention surveys. 815 students also completed post intervention surveys.

Results

There was a general increase in psychosocial well-being after the R4F program and positive psychosocial well-being changes in students that identified as female, non-white, physically active, part of an IEP program, meeting screentime recommendations, and engaged in school programs, though effect sizes were small. Despite mental health improvements among underrepresented groups, relative risk assessments still indicated that males, white students, those from high socioeconomic status families still had reduced relative risk of developing psychosocial disorders post intervention.

Discussion

These analyses illustrate the feasibility of cycling as a viable PE elective and the need for further, more robust studies to better assess the positive impacts of the R4F scholastic cycling program on the psychological health and well-being of middle school age children.

The longitudinal directional associations of meaningful work with mental well-being - initial findings from an exploratory investigation

BACKGROUND

An increasing number of studies reveal that more meaning in life is positively related to mental well-being. Meaning in life can be derived from different sources, including the workplace. The aim of this study was to explore the longitudinal directional association of meaningful work with mental well-being.

METHODS

Prospective data from 292 persons at two timepoints (two-week interval) were used to estimate the cross-lagged relationship and directionality of meaningful work with mental well-being.

RESULTS

The cross-lagged panel model had a good fit to the data (Chi2 ms(90) = 150.9; p < 0.001; RMSEA = 0.048; p = 0.576; CFI = 0.984; TLI = 0.979; SRMR = 0.040) and showed that levels of meaningful work at t1 had a positive effect on mental well-being at t2 (β = 0.15, p = 0.010). But mental well-being at t1 did not affect meaningful work at t2 (β = 0.02, p = 0.652). Sub-analyses revealed the effects to be mainly driven by women (as opposed to men) and white-collar workers (as opposed to blue-collar workers).

CONCLUSION

This study confirmed a directional association of meaningful work on mental well-being, indicating that more meaningful work has beneficial mental well-being effects.

Tolerance of immersive head-mounted virtual reality among older nursing home residents

Introduction

Virtual Reality (VR) is a tool that is increasingly used in the aging population. Head-Mounted Displays (HMDs) are stereoscopic vision devices used for immersive VR. Cybersickness is sometimes reported after head-mounted display (HMD) VR exposure. Cybersickness severity and anxiety state reflect VR low tolerance. We aimed to evaluate HMD VR tolerance among older nursing home residents through cybersickness and anxiety state.

Methods

A total of 36 participants were included in this preliminary study, 33 of whom (mean age: 89.33 ± 5.48) underwent three individual HMD VR sessions with three different contents. Cybersickness occurrence and severity were scored by the Simulator Sickness Questionnaire (SSQ) after each session. Anxiety state was assessed by the State-Trait Anxiety Inventory form Y-A before and after each session. Anxiety trait (using State-Trait Anxiety Inventory form Y-B) was also evaluated before and after the experiment. In total, 92% (33/36) of patients completed all three sessions, of which 61% (20/33) did not report any cybersickness symptoms (SSQ = 0). Six participants reported significant cybersickness (defined by an SSQ score ⩾10) in at least one session.

Discussion

Only two participants stopped the study after the first exposure because of cybersickness. Age, cognitive function, anxiety trait, and well-being were not associated with cybersickness. The mean anxiety state decreased significantly from pre- to post-session. This immersive HMD VR experience was well tolerated among nursing home dwellers. Further larger studies in this population aiming to identify CS determinants are needed in order to use HMD VR on a standard basis.

Is the meaning of subjective well-being similar in Latin American countries? A cross-cultural measurement invariance study of the WHO-5 well-being index during the COVID-19 pandemic

BACKGROUND

There is an urgent need to assess changes in well-being on a multinational scale during the COVID-19 pandemic, thus culturally valid scales must be available.

METHODS

With this in mind, this study examined the invariance of the WHO well-being index (WHO-5) among a sample of 5183 people from 12 Latin Americans countries (Argentina, Bolivia, Chile, Colombia, Cuba, Ecuador, El Salvador, Guatemala, Mexico, Paraguay, Peru, and Uruguay).

RESULTS

The results of the present study indicate that the WHO-5 is strictly invariant across samples from different Latin American countries. Furthermore, the results of the IRT analysis indicate that all items of the WHO-5 were highly discriminative and that the difficulty required to respond to each of the five items is ascending. Additionally, the results indicated the presence of moderate and small size differences in subjective well-being among most countries.

CONCLUSION

The WHO-5 is useful for assessing subjective well-being in 12 Latin American countries during the COVID-19 pandemic, since the differences between scores can be attributed to differences in well-being and not in other characteristics of the scale.

COVID-19 Pandemic and Lockdown: Associations With Personality and Stress Components

The present study examines the role of personality traits, interpersonal relationships, and sociodemographic factors on perceived stress, related to COVID-19, and compliance with measures to mitigate its spread. Data were collected in the midst of the 'first wave' lockdown, with the survey completed in full by 963 participants. We measured stress, directly related to the pandemic, rather than general stress, and were able to distinguish between symptoms of emotional, behavioural, cognitive, physical stress, and alienation with high concordance. We included personality scoring with standardized T-scores, allowing for cross-study comparison, and a broader questionnaire on the participants' support for COVID-19 mitigation measures. Results of the multiple regression models indicated that low emotional stability and introversion, and high conscientiousness, common conflicts with loved ones, and some demographics (female gender, middle age, chronic health problems) correspond to elevated stress. Conscientiousness was positively associated with total stress and some of its components, whereas opposite results were found for emotional stability. Extraversion was negatively correlated to total stress, its emotional and physical components, and alienation. Surprisingly, increased stress was not related to greater measure adherence. The present results shed light on how personality, interpersonal relationships, and sociodemographic factors influence people's stress response during a pandemic.

A cross-sectional study of university students' pocket money variance and its relationship with digital health literacy and subjective well-being in Ghana

Background

Mental health concerns of university students are gaining more attention since the emergence of the coronavirus disease. Consequently, scholars in education, health and psychology-related fields have attributed the dwindling subjective well-being (SWB) of students to their low levels of digital health literacy (DHL). However, little attention has been paid to an important variable like pocket money (PM) which might serve as a buffer against reduced levels of SWB. In this study, we explored the dynamics of PM and its linkage with DHL and SWB among university students in Ghana.

Methods

With a cross-sectional design, a convenient sample of 1160 students was obtained from the University of Education, Winneba, Ghana. The COVID-DHL and WHO-5 Well-being instruments were used for the data collection for a 2 months period (February-March, 2021). Chi-square test, multivariate regression, simple linear regression, and PROCESS mediation analyses were performed with the use of SPSS software version 25.

Results

The study found that while most of the students were financially supported by their parents (n = 715, 61.6%), a larger proportion of them reported that their PM was either less sufficient or not sufficient (n = 550; 76.9%). Findings revealed a positive relationship between PM and SWB (B = -36.419, p < 0.001; B = -13.146, p = 0.012; B = -10.930, p = 0.043), with this relationship mediated by DHL (B = -1.139, confidence interval [CI] [-2.073, -0.263] vs. -2.300, CI [-4.290, -0.532] vs. -8.366, CI [-14.863, -1.908]).

Conclusions

Students with little to insufficient PM were vulnerable to mental health problems, although this could be buffered by the high DHL levels. In practical terms, not only should the PM of university students be increased, but the sources of PM should be complemented since the sufficiency level of PM was associated with the source of finance. More importantly, parents should be empowered through job creation so that sufficient levels of PM can be provided to university students.

Experiences of conflict, non-acceptance and discrimination are associated with poor mental well-being amongst LGBTQ-identified individuals in Singapore

Purpose

Health disparities affecting lesbian, gay, bisexual, transgender and queer (LGBTQ) populations have been reported in many countries. For Singapore, no large quantitative studies on mental health and well-being in the local LGBTQ community have been published. The authors conducted a community-based survey (National LGBT Census Singapore, 2013; NLCS2013) that covered a comprehensive set of demographic, social and health indicators. Here, the authors investigated mental health status and its correlates in 2,350 LGBTQ individuals within the NLCS2013 sample.

Design/methodology/approach

The NLCS2013 was an anonymous online survey conducted amongst self-identified LGBTQ adults (aged ≥ 21 years) residing in Singapore. The survey included the World Health Organisation Well-being Index (WHO-5) as a measure of mental well-being, with low WHO 5 scores (<13/25) indicating poor mental well-being. The authors analysed relationships between low WHO-5 score and a range of respondent characteristics using multivariate logistic regression.

Findings

Strikingly, 40.9% of 2,350 respondents analysed had low WHO-5 scores, indicating poor mental well-being. Parental non-acceptance, experience of conflict at home and bullying/discrimination in the workplace or educational environments were all significantly associated with poor mental well-being. Conversely, community participation appeared protective for mental well-being, as respondents who participated in LGBTQ community organisations or events were less likely to have poor mental well-being than non-participants.

Originality/value

The NLCS2013 represents one of the first broad-based efforts to comprehensively and quantitatively capture the sociodemographic and health profile, including mental health status, within Singapore’s resident LGBTQ population. These findings affirm the need to address the mental health needs of LGBTQ individuals in Singapore and to foster safe spaces and allyship.

Self-care and lifestyle interventions of complementary and integrative medicine during the COVID-19 pandemic-A cross-sectional study

Background

Complementary and Integrative Medicine (CIM), including self-care healthy life-style promotion strategies, is widely used in Germany. Aim of this study was to assess the use of self-care and lifestyle interventions as well as mental/emotional state experienced during the COVID-19 pandemic.

Methods

An exploratory cross-sectional online study was conducted with adults in Germany through an online survey. Custom-developed questions in respiratory disease-status (including COVID-19), CIM-based self-care/lifestyle interventions and dietary patterns, and mental/emotional state as well as parameters for wellbeing (World Health Organization Well-Being Index, WHO-5) and self-efficacy (General Self-Efficacy Short Scale, GSE-3) were assessed. Data was analyzed using frequency and parametric measures.

Results

The online survey was performed from January to March 2021 and included 1,138 participants (81.5% female; mean age: 49.2 ± 13.7 years; 54.9% holding a university degree) living in Germany, of which 62 had had a positive SARS-CoV-2 test, 4 an influenza infection and 375 participants other respiratory infections. The following individual health promotion strategies were reported: spending time in nature (90%; n = 1,024), physical activity (69.3%; n = 789), naturopathic remedies (63.1%; n = 718), plant-based diet (56.3%; n = 640), and Mind-Body interventions (54.7%; n = 623). No differences in strategies between individuals with respiratory diseases or the sample overall were found. Well-being had a mean value of 15.2 ± 5 (WHO-5) and self-efficacy 4.1 ± 0.6 (GSE-3). Nearly 8% reported a low mental/emotional state regarding the COVID-19 pandemic.

Conclusion

Self-care and lifestyle interventions during the COVID-19 pandemic were reported by participants who were predominantly female, middle-aged, and well-educated. Most participants showed an overall balanced mental/emotional state. Further studies should include a representative control group from the general population.

Clinical trial registration

clinicaltrials.gov, identifier NCT04653727.

Money can't buy happiness: A randomized controlled trial of a digital mental health app with versus without financial incentives

Mental health disorders are prevalent among college students and increasing in frequency and severity. However, there is a significant gap between those who need treatment and those who engage in treatment. Given the documented efficacy of financial incentives for promoting health behavior change and engagement in treatment, financial incentives may help, along with nonfinancial behavioral incentives such as motivational messaging, gamification, and loss aversion techniques. We compared brief (28-day) use of two versions of a behavioral economics-inspired digital mental health app, NeuroFlow: (1) the full app including financial incentives and nonfinancial behavioral incentives (treatment group) and (2) a version of the app with nonfinancial behavioral incentives only (control group). In our intent-to-treat analyses, in order to examine the primary outcome of app engagement, a one-way analysis of variance (ANOVA) (treatment vs. control) was conducted, and to examine the secondary outcomes (depression, anxiety, emotion dysregulation, and wellbeing), a two-way repeated measures ANOVAs (treatment vs. control × baseline vs. post-trial) were conducted. We found that there were no differences between treatment groups on app engagement or the change in the mental health/wellness outcome measures. There was a main effect of timepoint on symptoms of anxiety and emotion dysregulation, such that there were significantly lower self-reported symptoms at post-trial relative to baseline. Our results suggest that financial incentives in digital mental health apps over and above nonfinancial behavioral incentives do not have an impact on app engagement or mental health/wellness outcomes.

A workplace mindfulness training program may affect mindfulness, well-being, health literacy and work performance of upper-level ICT-managers: An exploratory study in times of the COVID-19 pandemic

Introduction

Mindfulness-based interventions have gained more importance in workplace health promotion due to increased psychological distress in the digital era. Although managers in the information communication technology sector (ICT)-sector are at risk for lower mental health, few studies have evaluated the effects of workplace mindfulness trainings (WMT) on upper-level ICT-managers.

Methods

By applying a mixed methods approach, the study aimed at exploring differences in upper-level ICT-managers' mindfulness, well-being, health literacy and work performance at the beginning of a WMT (t0), immediately after (t1) and 3  months after (t2) a WMT. Thirteen groups of managers (n = 56) completed the training and three corresponding surveys consecutively from October 2019 to April 2021. Managers rated their mindfulness (MAAS), well-being (WHO-5), health literacy, and work performance (HPQ). During the COVID-19-pandemic the training switched from a live on-site mode to a hybrid mode and finally to a digital mode. Repeated measures ANOVAs and Bonferroni-adjusted post hoc analyses were used for data analysis. Open-ended responses were content analyzed.

Results

We found significant differences in managers' mindfulness [F(2.106) = 3.376, p = 0.038, η_p ² = 0.06, n = 54], well-being [F(2.106) = 73.019, p < 0.001, η_p ² = 0.17, n = 54], health literacy [F(2.108) = 9.067, p < 0.001, η_p ² = 0.15, n = 55], and work performance [F(2.80) = 7.008, p = 0.002, η_p ² = 0.15, n = 41] between t0 and t2. Significant differences between t0 and t1 were also found for well-being, health literacy and work performance, but not for mindfulness. Qualitative findings demonstrated positive training effects, barriers and facilitators to daily application of mindfulness practice.

Discussion

The results suggest that compared to the beginning of the WMT, the post and follow-up measurements showed outcome improvements. The workplace mindfulness training may thus be a promising program to facilitate mental health and working capabilities among upper-level ICT-managers. Contextual workplace factors need to be considered to sustain long-term mindfulness practice of managers.

Antecedents, outcomes and measurement of work related-cognition in non-work time: A multistudy report using the work-related rumination questionnaire in two languages

According to the perseverative cognition hypothesis, prolonged activation for example, via work-related rumination impairs recovery and thereby poses a risk to employee health. The extent to which gender, age, occupation or longitudinal stress exposure may alter work-related rumination is an ongoing debate. Whether group or longitudinal comparisons of work-related rumination are valid, however, has never been tested. In this multistudy report, we therefore investigated measurement invariance of the widely used Work-Related Rumination Questionnaire (WRRQ) across gender, age, occupation, and longitudinal measurements by performing secondary analyses of preexisting data on work-related rumination. We examined the psychometric properties of WRRQ measurements in two languages and expand knowledge about the nomological network of affective rumination, problem-solving pondering and detachment in relation to individual employee characteristics (e.g., personality, work engagement, commitment), job stressors (e.g., work intensity, decision latitude, social relations with colleagues and supervisors) and employee health outcomes (e.g., wellbeing, irritation, somatic symptoms). Multigroup confirmatory factor analyses showed partial scalar invariance of English and German WRRQ measurements and full scalar invariance across gender, age, occupation and over the period of 1 week (Study 1, n = 2,207). Correlation analyses supported criterion, convergent and discriminant validity of WRRQ measurements (Study 2, n = 4,002). These findings represent a prerequisite for comparisons of work-related cognition across groups and further the understanding of the antecedents and outcomes of different types of work-related cognition.

The Role of Sports in the Subjective Psychological Well-Being of Hungarian Adult Population in Three Waves of the COVID-19 Pandemic

(1) Background: In this study, sport and subjective psychological well-being is investigated in three waves of the COVID-19 pandemic. (2) Methods: We have conducted three different representative sample surveys (n = 3600 altogether) on the Hungarian adult population and investigated the sample's subjective psychological well-being with the WHO-5 Well-Being Index, as well as changes in their subjective well-being through the different waves of the pandemic. Sporting habits and socio-economic variables were also surveyed, and OLS regression models were created focused on the WHO-5 measures. (3) Results: The subjective psychological well-being of the Hungarian adult population decreased significantly, but in the second and third wave of pandemic restrictions, an increase in subjective psychological well-being has been measured. The relationships between the time spent on doing sports and subjective psychological well-being were significant in each pandemic waves. The highest subjective psychological well-being and its highest increase were reported by those who could increase their time spent on doing sports as well. (4) Conclusions: The relationships between the sports activities, physical health, size of settlement, changes in income and subjective psychological well-being of the Hungarian adult population were significant in all three waves of the COVID-19 pandemic.

Effects of limiting digital screen use on well-being, mood, and biomarkers of stress in adults

Studies have linked higher digital screen use with poorer mental health. However, there is limited experimental evidence to suggest a causal relationship. In this trial, we aimed to investigate the effects of limiting recreational digital screen use on mental well-being, mood, and biomarkers of stress in healthy young and middle-aged adults. We randomly allocated 89 families (including 164 adults) to participate in an extensive screen media reduction intervention or control. Participants in the intervention group were instructed to decrease their recreational screen use to less than 3 hours/week/person. Intervention compliance was assessed using applications and tv-monitors. Overall subjective mental well-being and mood, and collected daily biomarkers of stress (salivary cortisol and cortisone) was assessed at baseline and 2-week follow-up. Reducing recreational digital screen use resulted in significantly improved self-reported well-being and mood in adults allocated to the intervention compared to control. We observed no intervention effects for biomarkers of stress. (ClinicalTrials.gov: NCT04098913, 23/09/2019).

The significant association between quick return and depressive symptoms and sleep disturbances in paid workers: A nationwide survey

Objectives

Although many studies have examined the association between shift work and depression or insomnia, few studies have examined the relationship between quick return (QR) to work and depressive symptoms, regardless of shift work. Thus, in this study, we aimed to assess the association between depressive symptoms (DS)/sleep disturbances (SDs) and QR.

Methods

Data from the 6^th Korean Working Conditions Survey (2020) were used for this study. Paid workers aged between 20 and 65 years were included. DS were defined using the World Health Organization Well-Being Index (WHO-5) with a cut-off 50, and SD was defined as the occurrence of the following symptoms several times per month: difficulty in falling asleep, waking up in the middle of the night, or feeling tired even after waking up. QR was defined as "at least one case where the working interval between leaving work and the next day's work was < 11 h in the past month." Multivariable logistic regression was performed to estimate the adjusted odd ratios (aORs) and 95% confidence intervals (CIs). Mediation analysis was conducted to examine whether SD was a significant mediator in the association between QR and DS.

Results

Among the 27,554 participants, DS occurred in 8,277 patients, while SD occurred in 6,264 patients. The aORs (95% CIs) of DS and SD by QR were 2.01 (1.78-2.27) and 3.24 (2.87-3.66), respectively, after adjusting for age, gender, income, education, working hours, job status, working duration, region, shift work, and occupation. SD was a significant mediator in the association between QR and DS.

Conclusion

QR is significantly associated with DS or SD regardless of demographic factors and the working environment. The significant relationship between QR and DS may be mediated by SD.

Validating the Five-Item World Health Organization Well-Being Index

Purpose: Research on the psychological well-being of caregivers of children diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD) suggests that the well-being of parents and caregivers has been negatively affected by the COVID-19 pandemic. Although the psychological well-being of caregivers is a major concern, few validated well-being measures exist for caregivers of children diagnosed with ADHD. Therefore, a valid self-report scale is needed to assess well-being during the pandemic. The brief Five-Item World Health Organization Well-Being Index (WHO-5) has previously been used in studies on caregivers. However, its validity in this population remains unknown. This study aimed to evaluate the reliability and construct validity of the WHO-5 with caregivers of children with ADHD. Methods: A cross-sectional anonymous online survey was conducted in Norway. The study recruited caregivers from a community sample during the COVID-19 pandemic. This was carried out to investigate the construct validity by exploring the relationship between well-being, quality of life, social support, self-reported psychological distress, and perceived stress. Results: The findings of unidimensionality and high internal consistency, together with the results from the hypothesis testing, demonstrate the reliability and construct validity of the Norwegian version of the WHO-5 in this population. Conclusions: This study provides the first empirical evidence of the validity and reliability of the WHO-5 from a sample of Norwegian caregivers of children diagnosed with ADHD, with excellent reliability and construct validity. The scale can be used to systematize the measurement of well-being in caregivers because of its brevity and good psychometric properties, making it a valuable resource in research settings and assisting healthcare professionals in their crucial work of caring for caregivers.

Psychometric Properties of the WHO-5 Well-Being Index among Nurses during the COVID-19 Pandemic: A Cross-Sectional Study in Three Countries

Nurses' well-being has been increasingly recognised due to the ongoing pandemic. However, no validation scales measuring nurses' well-being currently exist. Thus, we aimed to validate the WHO-5 Well-Being Index (WHO-5) in a sample of nurses. A cross-sectional multinational study was conducted, and a total of 678 nurses who worked during the COVID-19 pandemic in Spain (36.9%), Chile (40.0%) and Norway (23.1%) participated in this study. The nurses completed the WHO-5, the Patient Health Questionnaire-2 (PHQ-2), the Generalized Anxiety Disorder-2 (GAD-2) and three questions about the quality of life (QoL). The WHO-5 demonstrated good reliability and validity in the three countries. Cronbach's alphas ranged from 0.81 to 0.90. High correlations were found between the WHO-5 and the psychological well-being dimension of QoL, and negative correlations between the WHO-5 and PHQ-2. The unidimensional scale structure was confirmed in all the countries, explaining more than 68% of the variance. The item response theory likelihood ratio model did not show discernible differences in the WHO-5 across the countries. To conclude, the WHO-5 is a psychometrically sound scale for measuring nurses' well-being during a pandemic. The scale showed strong construct validity for cross-cultural comparisons; however, more research is required with larger sample sizes.

Measurement Invariance of the WHO-5 Well-Being Index: Evidence from 15 European Countries

(1) Background: The World Health Organization (WHO)-5 Well-Being Index has been used in many epidemiological studies to assess adolescent mental well-being. However, cross-country comparisons of this instrument among adolescents are scarce and, so far, no good-fitting, common invariant measurement model across countries has been reported. The present study aims to evaluate and establish a version of the WHO-5 Well-Being Index that allows for a valid cross-country comparison of adolescent self-reported mental well-being. (2) Methods: Using data from the 2018 Health Behaviour in School-aged Children study, we evaluated the measurement model and measurement invariance of the five items of the WHO-5 Well-Being Index. We used nationally representative samples of 11-, 13-, and 15-year-old adolescents (N = 74,071) from fifteen countries and regions in Europe. Measurement invariance of the WHO-5 was assessed using a series (country, gender, and age) of multi-group confirmatory factor analyses. In addition, we evaluated the convergent validity of the measure by testing its correlations with psychosomatic complaints, life satisfaction, and self-rated health. (3) Results: We found that WHO-5 does not show good psychometric properties or good measurement invariance fit. However, by excluding the first item of the scale ("I have felt cheerful and in good spirits"), the WHO-4, consisting of the other four original items, had good psychometric properties, and demonstrated good suitability for cross-national comparisons (as well as age and gender) in adolescent mental well-being. (4) Conclusions: The present study introduces the WHO-4-a revised version of the WHO-5-, that allows for a valid comparison of mental well-being across fifteen countries and regions in Europe. The WHO-4 proved to be a reliable and valid instrument to assess mental well-being in the adolescent population.

How to Alleviate Hotel Employees’ Job Stress in the Associations between Job Stressors and Its Consequences

This study investigates the relationship between job insecurity, job stress, and the psychological well-being of hotel employees, and the moderating effect of emotional regulation control on the causal relationship between job stress and psychological well-being. A valid sample of 428 employees was used from three five-star hotels and two four-star hotels in Seoul and Busan, South Korea, for hypothesis testing. After confirming the construct validity and reliability of all measurements, a structural equation modeling and multi-group analysis examine the postulated hypotheses. The findings are as follows: (1) the positive effect of job insecurity on job stress is significant; (2) job stress negatively and significantly mediates the linkage between hotel employees’ job insecurity and psychological well-being, while the direct effect of job insecurity on psychological is not significant; (3) the negative relationship between hotel employees’ job stress and psychological well-being is dramatically alleviated by the seeking support strategy; (4) hotel employees’ active coping strategy also has a palliative negative effect of job stress on psychological well-being; (5) however, avoidance is not an effective strategy for stress relief in the context of hotel employees’ job stress and well-being due to the COVID-19 and job insecurity.

COVID-19 countermeasures at the workplace, psychological well-being, and mental health - a nationally representative latent class analysis of Luxembourgish employees

The COVID-19 pandemic has massively changed people's working lives all over the world. While various studies investigated the effects from pandemic-induced unemployment and telecommuting, there is a lack of research regarding the impact of workplace COVID-19 countermeasures on well-being and mental health for employees who are still working on site. Thus, the aim of the present study was to investigate the prevalence of workplace COVID-19 countermeasures in organizations in Luxembourg. A person-centered approach was applied in order to explore how employees' psychological well-being and health (i.e., general psychological well-being, vigor, work satisfaction, work-related burnout, somatic complaints, fear of COVID-19 infection) are impacted by organizational countermeasures and whether there are certain employee groups that are less protected by these. Results of a latent class analysis revealed four different classes (Low level of countermeasures, Medium level of countermeasures, High level of countermeasures, High level of countermeasures low distance). Employees working in a healthcare setting were more likely than employees working in a non-healthcare setting to be members of the High level of countermeasures low distance class. Class membership was meaningfully associated with all well-being outcomes. Members of the High level of countermeasures class showed the highest level of well-being, whereas Members of the Low level of countermeasures class and the High level of countermeasures low distance class showed the lowest level of well-being. Policy makers and organizations are recommended to increase the level of COVID-19 countermeasures as an adjunctive strategy to prevent and mitigate adverse mental health and well-being outcomes during the COVID-19 pandemic.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-022-03377-4.

Symptom severity and well-being of patients with mental illness during the COVID-19 pandemic: a two-wave survey

PURPOSE OF THE ARTICLE

To examine changes in symptom severity and well-being during the coronavirus disease 2019 (COVID-19) pandemic among individuals with pre-existing mental illness.

MATERIALS AND METHODS

In February 2021, we conducted a follow-up questionnaire-based survey among adults with mental illness, who responded to a similar survey on mental health in June 2020. The participants completed the 18-item Brief Symptom Inventory (BSI-18), the five-item World Health Organization Well-Being Index (WHO-5), and 14 questions evaluating worsening or improvement in mental health using the pre-pandemic period as reference. The survey data were merged with sociodemographic and clinical data from the medical records of all invitees to the first survey, enabling analysis of attrition and weighting of the results.

RESULTS

A total of 613 of 992 (62%) invitees participated in the follow-up wave of the survey. The weighted mean WHO-5 and BSI-18 scores were 38 and 27, respectively, and did not differ statistically significantly from the first wave. Multivariate logistic regression showed that having a vocational education (skilled worker/craftsman) was positively associated with reporting deterioration in psychological well-being (OR: 2.95, 95%CI: 1.14-7.81), while being unemployed was negatively associated with reporting deterioration in psychological well-being (OR: 0.20, 95%CI: 0.07-0.56) from the first to the second survey wave. The most common reason for self-reported deterioration in mental health was loneliness (70%).

CONCLUSIONS

Approximately one year into the COVID-19 pandemic, the level of symptoms remained high, whereas the level of psychological well-being remained low among patients with mental illness.

Mothers' Domestic Responsibilities and Well-Being During the COVID-19 Lockdown: The Moderating Role of Gender Essentialist Beliefs About Parenthood

The present work investigates how the increased domestic responsibilities created by the Spring 2020 lockdown of the COVID-19 pandemic in Norway and gender ideologies relate to the well-being of mothers with elementary school children. In June 2020, we conducted a cross-sectional online study including current and retrospective measures with 180 mothers (M age = 39.96 years, SD = 6.11) of elementary school children across Norway. First, in line with earlier research on the strain of the pandemic on parents, and especially mothers, we found that Norwegian mothers' well-being during the lockdown significantly declined compared to before the lockdown (both measured retrospectively). Furthermore, mothers' well-being after the Spring 2020 lockdown did not immediately return to pre-lockdown levels. Finally, we predicted that gender ideologies (i.e., essentialist beliefs about parenthood) would exacerbate the negative impact of increased domestic responsibilities (i.e., childcare and housework) on mothers' well-being (i.e., higher standard-higher stress hypothesis). As predicted, for mothers who more strongly endorsed the belief that mothers are instinctively and innately better caretakers than fathers, perceptions of increased domestic responsibilities were associated with lower well-being post-lockdown. These findings point to the specific challenges mothers face in times of crisis, and the importance of addressing and confronting seemingly benevolent ideologies about motherhood that place additional burdens on women.

Validation of the WHO-5 Well-Being Scale among Adolescents in Ghana: Evidence-Based Assessment of the Internal and External Structure of the Measure

The WHO-5 well-being measure happens to be one of the most renowned measures of subjective well-being across the globe. Although the instrument has been calibrated in different countries, its psychometric properties and applicability in Africa, especially in Ghana, are not known. In this study, the WHO-5 well-being scale was validated among adolescents in Ghana by assessing the validity evidence of the measure based on the internal and external structure. In particular, the study examined the (1) dimensionality of the WHO-5 well-being scale, (2) quality of the items (including the scale functioning) for the measure, and (3) criterion validity of the well-being measure. Using a survey approach, 997 adolescents were recruited in secondary schools across the northern belt of Ghana. The study found a one-factor structure of the scale, which supports the factor solution of the original measure. The items were found to be of high quality, except for one item. The WHO-5 well-being measure was found to have sufficient evidence regarding convergent and divergent validity. The outcome of this validation study provides support for the validity and reliability of the WHO-5 well-being scale’s utility and use among adolescents in Ghana. The study encourages further validation studies to be conducted in Ghana to widen the reproducibility of the WHO-5 well-being measure.

Translation and Validation of the Malay Version of the WHO-5 Well-Being Index: Reliability and Validity Evidence from a Sample of Type 2 Diabetes Mellitus Patients

The translation and validation process of the WHO-5 Well-Being Index (WHO-5) into Malay is still not yet available. This study is the first psychometric evaluation of the Malay version of the WHO-5 in a sample of 127 primary care patients with type 2 diabetes mellitus. We evaluated the internal consistency and 5-week test–retest reliability of the WHO-5 Malay, and three aspects of its validity—first, the factorial validity in relation to the factor structure of the WHO-5 Malay; second, the concurrent validity in relation to depression and diabetes-related distress; and third, the convergent validity in relation to diabetes management self-efficacy and diabetes self-care behaviors. This study had two phases. Phase 1 involved the translation of the WHO-5 into Malay language following established procedures, whereas Phase 2 involved the validation of the WHO-5 Malay. Excellent internal consistency and 5-week test–retest reliability estimates were obtained. The factorial validity of the WHO-5 was found to be unidimensional. As for concurrent validity, the WHO-5 Malay was found to be negatively correlated with depression and diabetes-related distress. The WHO-5 was found to be correlated with diabetes management self-efficacy and diabetes self-care behaviors, thereby establishing convergent validity. The WHO-5 Malay has reliable and valid psychometric properties and represents a promising tool that informs healthcare providers in making effective and holistic diabetes management.

Spiritual Needs, Religious Coping and Mental Wellbeing: A Cross-Sectional Study among Migrants and Refugees in Germany

It has been widely proven that resettlement is associated with negative psychological effects (e.g., increased depression and symptoms of post-traumatic stress disorder) among refugees. Therefore, there is an urgent need to improve the psychosocial functioning of migrants. This study assessed associations between negative dysfunctional appraisal (perceiving experiences as stressful), spiritual needs, religious coping and wellbeing. Data from paper-and-pencil questionnaires were collected from 744 refugees (69.8% male) aged 18–67 years (M = 27.99) with diverse backgrounds (including from Mashreq countries) who were resettled in Germany. Bootstrapping mediation analysis revealed that the relationship of dysfunctional appraisal and wellbeing among refugees is mediated by spiritual needs (i.e., existential and religious needs). Additionally, negative religious coping mediates the relationship between spiritual needs and wellbeing. The data obtained suggest the need for practitioners to focus on psychological interventions that strengthen spiritual needs in order to improve mental health among refugees.

A Cognitive Behavior Therapy Chatbot (Otis) for Health Anxiety Management: A Mixed-Methods Pilot Study (Preprint)

Background

An increase in health anxiety was observed during the COVID-19 pandemic. However, due to physical distancing restrictions and a strained mental health system, people were unable to access support to manage health anxiety. Chatbots are emerging as an interactive means to deliver psychological interventions in a scalable manner and provide an opportunity for novel therapy delivery to large groups of people including those who might struggle to access traditional therapies.

Objective

The aim of this mixed methods pilot study was to investigate the feasibility, acceptability, engagement, and effectiveness of a cognitive behavioral therapy (CBT)–based chatbot (Otis) as an early health anxiety management intervention for adults in New Zealand during the COVID-19 pandemic.

Methods

Users were asked to complete a 14-day program run by Otis, a primarily decision tree–based chatbot on Facebook Messenger. Health anxiety, general anxiety, intolerance of uncertainty, personal well-being, and quality of life were measured pre-intervention, postintervention, and at a 12-week follow-up. Paired samples t tests and 1-way ANOVAs were conducted to investigate the associated changes in the outcomes over time. Semistructured interviews and written responses in the self-report questionnaires and Facebook Messenger were thematically analyzed.

Results

The trial was completed by 29 participants who provided outcome measures at both postintervention and follow-up. Although an average decrease in health anxiety did not reach significance at postintervention (P=.55) or follow-up (P=.08), qualitative analysis demonstrated that participants perceived benefiting from the intervention. Significant improvement in general anxiety, personal well-being, and quality of life was associated with the use of Otis at postintervention and follow-up. Anthropomorphism, Otis’ appearance, and delivery of content facilitated the use of Otis. Technical difficulties and high performance and effort expectancy were, in contrast, barriers to acceptance and engagement of Otis.

Conclusions

Otis may be a feasible, acceptable, and engaging means of delivering CBT to improve anxiety management, quality of life, and personal well-being but might not significantly reduce health anxiety.

Item Response Theory Analysis of the Fear of COVID-19 Scale (FCV-19S): A Systematic Review

Background

The COVID-19 pandemic is still ongoing and is not yet under control. Evidence regarding the impacts of COVID-19 on psychological distress has been widely reported worldwide, and one of the primary concerns regarding psychological distress is fear (ie, fear of COVID-19). Therefore, having a robust instrument for assessing fear of COVID-19 is important. The present systematic review aimed to synthesize the psychometric evidence evaluated using item response theory (IRT) on the Fear of COVID-19 Scale (FCV-19S).

Methods

Utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, four academic databases (Scopus, PubMed Central, ProQuest, and ISI Web of Knowledge) were used to search target papers. Keywords used for search were “Fear of COVID-19 Scale” and its abbreviation (ie, “FCV-19S”) and IRT-related terms. The COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist was then applied to evaluate the methodological quality of the reviewed papers. Moreover, psychometric properties using IRT methods were synthesized using a qualitative method.

Results

The initial search resulted in 552 papers (73 duplicates) and 479 were screened based on their titles and abstracts. Finally, 16 papers were included for review regarding their methodological quality (via COSMIN) to synthesize the psychometric evidence for FCV-19S. The 16 papers included 21 countries with 16 language versions of FCV-19S.

Conclusion

All the psychometric evidence indicated that the seven items in the FCV-19S fit with the concept of fear. The FCV-19S is a strong and valid instrument for assessing fear across different languages. The seven items in the FCV-19S appear to be unidimensional in assessing fear, which indicates that all items are necessary in the FCV-19S.

Fear of contamination among older adults in the post-COVID-19 era

This study assesses older adults' fear of contamination in the post-coronavirus disease 2019 (COVID-19) era, examining the factors associated with this fear and investigating its effects on their well-being and use of primary healthcare, considering the moderating effects of activities of daily living (ADL) and multimorbidity in these two relationships. A cross-sectional study was conducted in primary healthcare centers in three regions in Saudi Arabia with a convenience sample of 444 older adults diagnosed with chronic diseases. The results indicated that 77.9% of older adults had high contamination fear, predicted by their age, education level, gender, ADL, and previous COVID-19 infection experience. Subjective well-being and the number of primary healthcare visits in the post-COVID-19 era were negatively affected by contamination fear and both ADL and multimorbidity moderated these relationships. In conclusion, the study confirmed the need to focus on older adults' contamination fear to mitigate its negative effects on well-being and critical primary healthcare visits.

Predicting subjective well-being in a high-risk sample of Russian mental health app users

Despite recent achievements in predicting personality traits and some other human psychological features with digital traces, prediction of subjective well-being (SWB) appears to be a relatively new task with few solutions. COVID-19 pandemic has added both a stronger need for rapid SWB screening and new opportunities for it, with online mental health applications gaining popularity and accumulating large and diverse user data. Nevertheless, the few existing works so far have aimed at predicting SWB, and have done so only in terms of Diener's Satisfaction with Life Scale. None of them analyzes the scale developed by the World Health Organization, known as WHO-5 - a widely accepted tool for screening mental well-being and, specifically, for depression risk detection. Moreover, existing research is limited to English-speaking populations, and tend to use text, network and app usage types of data separately. In the current work, we cover these gaps by predicting both mentioned SWB scales on a sample of Russian mental health app users who represent a population with high risk of mental health problems. In doing so, we employ a unique combination of phone application usage data with private messaging and networking digital traces from VKontakte, the most popular social media platform in Russia. As a result, we predict Diener's SWB scale with the state-of-the-art quality, introduce the first predictive models for WHO-5, with similar quality, and reach high accuracy in the prediction of clinically meaningful classes of the latter scale. Moreover, our feature analysis sheds light on the interrelated nature of the two studied scales: they are both characterized by negative sentiment expressed in text messages and by phone application usage in the morning hours, confirming some previous findings on subjective well-being manifestations. At the same time, SWB measured by Diener's scale is reflected mostly in lexical features referring to social and affective interactions, while mental well-being is characterized by objective features that reflect physiological functioning, circadian rhythms and somatic conditions, thus saliently demonstrating the underlying theoretical differences between the two scales.

Post-migration Stressors and Subjective Well-Being in Adult Syrian Refugees Resettled in Sweden: A Gender Perspective

A number of post-migration stressors have been shown to adversely affect mental health in refugees resettled in high-income countries, including poor social integration, financial difficulties and discrimination, and recent evidence suggests that these effects are gender specific. Social support has been found to buffer against post-migration stress in some studies on refugee populations, though the evidence on this is mixed. The present study used cross-sectional survey data from a nationwide, randomly sampled group of adult refugees from Syria resettled in Sweden between 2008 and 2013 (N _sample = 4,000, n _respondents = 1,215, response rate 30.4%) to investigate gender-specific associations between post-migration stressors and subjective well-being (SWB) and whether these associations were modified by social support. SWB was measured with the WHO-5 Well-being Index (scaled 0-100), dichotomized into high (≥50) and low (<50) SWB. Main analyses were stratified by gender, and regressed SWB on four domains of post-migration stress (financial strain, social strain, competency strain and discrimination) using logistic regression, adjusting for sociodemographic variables and traumatic experiences. Social support was tested as an effect modifier. In fully adjusted models, main risk factors for low SWB were high financial strain, especially in males (OR_{high vs. low strain, males} = 10.30 [4.91-21.6], p < 0.001 vs. OR_{high vs. low strain, females}= 3.84 [1.68-8.79], p = 0.002), and high social strain, only in males (OR_{high vs. low strain, males} = 9.21 [3.96-21.4], p < 0.001 vs. OR_{high vs. low strain, females} = 1.03 [0.40-2.64], p = ns). There was some evidence that social support buffered the adverse association of financial strain with SWB. In conclusion, the present study found clear support of gender-specific effects of post-migration stressors on SWB. Mitigation strategies and interventions should be aware of and sensitive to these potential gendered effects, and future research exploring mental health in the context of resettlement stress should have a heightened focus on the important role of gender.

How Managers Perceive and (Do Not) Participate in Health Promotion Measures-Results from a Cross-Sectional Mixed-Methods Survey in a Large ICT Company

Managers often face stress and high work demands. Yet they have received limited attention as targets of workplace health promotion measures (HPMs). This study’s primary objective (1) is to examine managers’ self-reported participation in HPMs and factors associated with HPM participation. The secondary objective (2) is to examine managers’ perceptions of their working conditions. A cross-sectional mixed-methods online survey was conducted with a nonrandom sample of 179 managers in a large German ICT company. Stepwise logistic regression and qualitative content analysis were used for data analysis. Quantitative findings revealed that 57.9% of managers had not participated in HPMs yet. “Workload relief through digital tools” resulted as a significant predictor of managers’ previous HPM participation (OR: 2.84, 95% CI: 1.42–5.66). In qualitative findings, workload, time, lack of knowledge, and lack of demand were reported as participation barriers (1). Managers reported that work facility traits, workload, social support, and corporate culture should be improved to make their working conditions more health-promoting (2). These findings suggest that providing adequate organizational working conditions may help improve managers’ HPM participation rates and their perception of health-promoting work.

Oxford COVID-19 Vaccine Hesitancy in School Principals: Impacts of Gender, Well-Being, and Coronavirus-Related Health Literacy

Purposes: To explore the associated factors of COVID-19 vaccine hesitancy and examine psychometric properties of the coronavirus-related health literacy questionnaire (HLS-COVID-Q22) and Oxford COVID-19 Vaccine Hesitancy questionnaire. Methods: An online survey was conducted from 23 June to 16 July 2021 on 387 school principals across Taiwan. Data collection included socio-demographic characteristics, information related to work, physical and mental health, COVID-19 related perceptions, sense of coherence, coronavirus-related health literacy, and vaccine hesitancy. Principal component analysis, correlation analysis, linear regression models were used for validating HLS-COVID-Q22, Oxford COVID-19 Vaccine Hesitancy, and examining the associations. Results: HLS-COVID-Q22 and Oxford COVID-19 Vaccine Hesitancy were found with satisfactory construct validity (items loaded on one component with factor loading values range 0.57 to 0.81, and 0.51 to 0.78), satisfactory convergent validity (item-scale correlations range 0.60 to 0.79, and 0.65 to 0.74), high internal consistency (Cronbach’s alpha = 0.96 and 0.90), and without floor or ceiling effects (percentages of possibly lowest score and highest score <15%), respectively. Low scores of vaccine hesitancy were found in male principals (regression coefficient, B, −0.69; 95% confidence interval, 95%CI, −1.29, −0.10; p = 0.023), principals with better well-being (B, −0.25; 95%CI, −0.47, −0.03; p = 0.029), and higher HLS-COVID-Q22 (B, −1.22; 95%CI, −1.89, −0.54; p < 0.001). Conclusions: HLS-COVID-Q22 and Oxford COVID-19 Vaccine Hesitancy were valid and reliable tools. Male principals and those with better well-being, and higher health literacy had a lower level of vaccine hesitancy. Improving principals’ health literacy and well-being is suggested to be a strategic approach to increase vaccine acceptance for themselves, their staff, and students.

Psychological Contract Violation or Basic Need Frustration? Psychological Mechanisms Behind the Effects of Workplace Bullying

Workplace bullying is a phenomenon that can have serious detrimental effects on health, work-related attitudes, and the behavior of the target. Particularly, workplace bullying exposure has been linked to lower level of general well-being, job satisfaction, vigor, and performance and higher level of burnout, workplace deviance, and turnover intentions. However, the psychological mechanisms behind these relations are still not well-understood. Drawing on psychological contract and self-determination theory (SDT), we hypothesized that perceptions of contract violation and the frustration of basic needs mediate the relationship between workplace bullying exposure and well-being, attitudinal, and behavioral outcomes. Self-reported data were collected among employees with different working backgrounds (N = 1,257) via Amazon's Mechanical Turk in an online survey. Results showed that feelings of contract violation and frustration of basic needs accounted for unique variation in well-being, work satisfaction, burnout, vigor, and turnover intentions, pointing to individual contributions of both psychological mechanisms. However, when controlled for frustration of basic needs, feelings of psychological contract violation were no longer a mediator between workplace bullying exposure and work performance. Helping employees to deal effectively with workplace bullying exposure might buffer its negative effects and reduce their experienced frustration of basic needs, preserving their well-being, vigor, and work performance and, eventually, prevent burnout. The present study is the first to concurrently elucidate the proposed psychological mechanisms and unique contributions of psychological contract violation and frustration of basic needs in the context of workplace bullying.

Effectiveness and cost effectiveness of a stress management training for leaders of small and medium sized enterprises - study protocol for a randomized controlled-trial

BACKGROUND

Leaders in small and medium-sized enterprises (SMEs) are exposed to increased stress as a result of a range of challenges. Moreover, they rarely have the opportunity to participate in stress management trainings. Therefore, KMU-GO (ger: Kleine und mittlere Unternehmen - Gesundheitsoffensive; en: small and medium-sized enterprises - health campaign) aims at conducting and evaluating such a stress management training. The focus of evaluation does not only lie on the effects on leaders participating but also on their employees.

METHODS

The study is planned as a 2 × 3 mixed design with two groups (intervention and waiting control group) as a between factor and point in time (at baseline, 6 and 12 months later) as a within factor. We aim at collecting data from N = 200 leaders. Based on the results of a preceding assessment, an already successfully implemented stress management training was adapted to SME needs and now serves as the framework of this intervention. The stress management training comprises one and a half days and is followed by two booster sessions (each 180 min) about 3 and 6 months after the training. The main focus of this intervention lies on specifying leaders stress reactivity while at the same time investigating its effects on employees' mental health. Further dependent variables are leaders´ depression and anxiety scores, effort-reward imbalance, sick days and psychophysiological measures of heart rate variability, hair cortisol, and salivary alpha-amylase. Cost-effectiveness analyses will be conducted from a societal and employers' point of view.

DISCUSSION

Stress management is a highly relevant issue for leaders in SMEs. By providing an adequate occupational stress management training, we expect to improve leaders´ and also employees` mental health, thereby preventing economic losses for SMEs and the national economy. However, collecting data from employees about the success of a stress management training of their leader is a highly sensitive topic. It requires a carefully planned proceeding ensuring for example a high degree of transparency, anonymity, and providing team incentives.

TRIAL REGISTRATION

The KMU-GO trial is registered at the German Clinical Trial Register (DRKS): DRKS00023457 (05.11.2020).