Health behavior adherence and emotional adjustment during the COVID-19 pandemic in a US nationally representative sample: The roles of prosocial motivation and gratitude

Psychological responses to the COVID-19 pandemic and situational impact: A network analysis in Hong Kong residents

BACKGROUND

The COVID-19 pandemic has had situational impacts and induced various psychological responses among residents. The present study aims to analyze the network structure of psychological responses to the pandemic and their relationships with situational impact, resilience, and well-being through a network approach.

METHODS

An online survey recruited 1122 residents (mean age = 32.5 years, 65.4 % female) in Hong Kong from October 2020 to October 2021. The participants completed the Mental Impact and Distress Scale: Psychological Response (MIDc-PR) and other validated measures. Gaussian graphical modeling was conducted in R to identify the central MIDc-PR symptoms and their bridge linkages with situational impact, resilience, and well-being.

RESULTS

In the MIDc-PR network, the central symptoms were 'Routine' and 'Images' for Anticipation and 'Tense' and 'Lonely' for Modulation, with 12 bridge edges between the two clusters. In the combined network, the MIDc-PR nodes showed 12 bridge edges with situational impact, particularly in the health domain. 'Concerned', 'Sleep', and 'Lonely' showed negative linkages with resilience; 'Unmotivated' and 'Trapped' showed negative linkages with well-being. The network models showed good levels of stability and did not differ significantly in network structure and global strength across gender and age groups.

LIMITATIONS

The cross-sectional study design only allowed undirected associations in the network and could not model the within-subject effects.

CONCLUSIONS

The study findings contributed to the literature by elucidating the network structure of psychological responses to the pandemic. The central and bridge symptoms have clinical implications as potential targets for future interventions.

What drives preventative health behaviors one year into a pandemic? A replication and extension

Objective: There is continued interest in understanding what leads people to engage in CDC-recommended COVID-19 prevention behaviors. We tested whether fear and COVID-19 worry would replicate as the primary drivers of six CDC recommended prevention behaviors. Methods and Measures: We recruited 741 adult participants during the second major peak of the COVID-19 pandemic in the United States (early 2021). Using very similar methods to the original study, participants completed a 10-day daily diary. Mixed effects models identified the strongest predictors of each individual prevention behavior as well as approach and avoidance behavior clusters. Results: At the between-person level, COVID-19 worry, COVID-19 perceived susceptibility, fear, and positive emotions all had positive zero-order associations with the prevention behaviors. However, with all predictors in the same model together, primarily COVID-19 worry remained significant for both the individual behaviors and behavior clusters. At the within-person level, only fear related to assessing oneself for COVID-19 and approach behaviors on the same day, but not the next day. Mediational analyses suggested COVID-19 worry, but not COVID-19 susceptibility, mediated the links between fear and approach/avoidance behaviors. Conclusion: Findings replicated worry about yourself or a loved one getting COVID-19 as the strongest predictor of prevention behaviors.

A Longitudinal Study of Adherence among Cystic Fibrosis Patients: Associations with Gratitude Over the Course of One Year

BACKGROUND

Daily airway clearance therapy (ACT) is a critical aspect of treatment in cystic fibrosis (CF), but poor adherence is a prominent concern. Identifying factors that might enhance or diminish adherence is a priority for treatment centers. Gratitude, a generalized tendency to notice and appreciate positive facets of experience, is a psychosocial resource that has commanded growing research interest. This longitudinal study examined whether gratitude at baseline was associated with ongoing or persistent ACT adherence over the course of a year.

METHODS

Trait gratitude was evaluated at baseline using a validated measure, among adults receiving care at a regional CF treatment center. Self-reported adherence to ACT was assessed at baseline, 6 months, and 12 months using the Cystic Fibrosis Treatment Questionnaire. Average age of participants was 27.2 years, 45.5% were women, and 19.7% had severe disease.

RESULTS

In multivariable logistic regression models that accounted for disease severity (Forced Expiratory Volume1% predicted) and other clinical and demographic variables, individuals with higher baseline gratitude were significantly more likely to demonstrate persistent adherence over the course of the year. Gratitude remained predictive after additionally adjusting for other well-known psychosocial resource variables (social support and emotional well-being).

CONCLUSION

This is among the first demonstrations that gratitude is associated with persistent self-reported adherence to treatment over time. Findings suggest that gratitude may be important psychosocial resource for adults with CF, as they contend with complex, highly burdensome treatment regimens. Further research is warranted to examine these relationships and their impact on downstream health outcomes.

Assets and depression in U.S. adults during the COVID-19 pandemic: a systematic review

PURPOSE

Mental health is shaped by social and economic contexts, which were altered during the COVID-19 pandemic. No study has systematically reviewed the literature on the relation between different assets and depression during the COVID-19 pandemic.

METHODS

We conducted a systematic review of the literature on financial (e.g. income/savings), physical (e.g., home ownership), and social (e.g., marital status, educational attainment) assets and depression in U.S. adults. For each asset type, we created binary comparisons to report on the direction of the relationship and described if each study reported insignificant, positive, negative, or mixed associations.

RESULTS

Among the 41 articles identified, we found that income was the most studied asset (n=34), followed by education (n=25), marital status (n=18), home ownership (n=5), and savings (n=4). 88%, 100%, and 100% of articles reported a significant association of higher income, home ownership, and higher savings, respectively, with less depression. The association between marital status and education with depression was more nuanced: 72% (13 of 18) studies showed that unmarried persons had greater risk of depression than married or cohabitating persons and 52% (13 of 25) of studies reported no significant difference in depression across educational groups.

CONCLUSION

This work adds to the literature a deeper understanding of how different assets relate to depression. In the context of largescale traumatic events, policies that maintain and protect access to social, physical, and financial assets may help to protect mental health.

Perceived a community with shared future for doctor-patient and benefit finding: a moderated mediation model

BACKGROUND

Under the background that the concept of a community with shared future for mankind has been advocated, the doctor-patient relationship has rapidly sublimated into a community with shared future for doctor-patient. The purpose of this study was to analyze the changes and relationships of anxiety, perceived a community with shared future for doctor-patient (PCSF), health self-consciousness (HSC) and benefit finding (BF) in the outbreak stage of COVID-19 and in the stable stage of COVID-19.

METHODS

The questionnaire consisted of a self-designed health self-consciousness scale, perceived a community with shared future for doctor-patient scale, revised 7-item generalized anxiety disorder scale and benefit finding scale. Questionnaires were administered in the outbreak stage of COVID-19 and in the stable stage of COVID-19 to address public anxiety, BF, and trust between medical staff and patients.

RESULTS

Risk perception will increase anxiety in public, and the public who trust medical staff and the ability of the government to prevent and control the epidemic will have a higher PCSF. Compared with those in the outbreak stage of COVID-19, PCSF, HSC and BF all decreased in the stable stage of COVID-19. HSC partly plays a mediating role in the process of the influence of PCSF and BF (95% CI = [0.3785, 0.5007], [0.2357, 0.3695], P < .001). The R-value of the model in the outbreak stage of COVID-19 and in the stable stage of COVID-19 were 0.555 and 0.429, and the value of R² was 0.308 and 0.184 respectively (P < .001). In the stable stage of COVID-19, the coefficient of anxiety ✕ PCSF is negative. The B values of anxiety and PCSF are positive, and the moderating effect is negative (P = .038). Anxiety has a negative moderating effect between PCSF and HSC, indicating that anxiety will weaken the positive impact of PCSF on HSC. It means that there exists a substitution relationship between anxiety and PCSF.

CONCLUSIONS

The common goal of medical staff and patients is health, and health is the premise of the meaning of life. Vigorously advocating for PCSF can not only promote a harmonious doctor-patient relationship, but also establish a good HSC and improve the understanding of the meaning of life in the public. Furthermore, if the common concept of a community with a shared future for doctor-patient is integrated into the values of life, it may be more stable and long-term to maintain a good doctor-patient relationship. In addition, we should guard against the influence of high-level anxiety on the path of meaning perception.

Predictors of changing patterns of adherence to containment measures during the early stage of COVID-19 pandemic: an international longitudinal study

BACKGROUND

Identifying common factors that affect public adherence to COVID-19 containment measures can directly inform the development of official public health communication strategies. The present international longitudinal study aimed to examine whether prosociality, together with other theoretically derived motivating factors (self-efficacy, perceived susceptibility and severity of COVID-19, perceived social support) predict the change in adherence to COVID-19 containment strategies.

METHOD

In wave 1 of data collection, adults from eight geographical regions completed online surveys beginning in April 2020, and wave 2 began in June and ended in September 2020. Hypothesized predictors included prosociality, self-efficacy in following COVID-19 containment measures, perceived susceptibility to COVID-19, perceived severity of COVID-19 and perceived social support. Baseline covariates included age, sex, history of COVID-19 infection and geographical regions. Participants who reported adhering to specific containment measures, including physical distancing, avoidance of non-essential travel and hand hygiene, were classified as adherence. The dependent variable was the category of adherence, which was constructed based on changes in adherence across the survey period and included four categories: non-adherence, less adherence, greater adherence and sustained adherence (which was designated as the reference category).

RESULTS

In total, 2189 adult participants (82% female, 57.2% aged 31-59 years) from East Asia (217 [9.7%]), West Asia (246 [11.2%]), North and South America (131 [6.0%]), Northern Europe (600 [27.4%]), Western Europe (322 [14.7%]), Southern Europe (433 [19.8%]), Eastern Europe (148 [6.8%]) and other regions (96 [4.4%]) were analyzed. Adjusted multinomial logistic regression analyses showed that prosociality, self-efficacy, perceived susceptibility and severity of COVID-19 were significant factors affecting adherence. Participants with greater self-efficacy at wave 1 were less likely to become non-adherence at wave 2 by 26% (adjusted odds ratio [aOR], 0.74; 95% CI, 0.71 to 0.77; P < .001), while those with greater prosociality at wave 1 were less likely to become less adherence at wave 2 by 23% (aOR, 0.77; 95% CI, 0.75 to 0.79; P = .04).

CONCLUSIONS

This study provides evidence that in addition to emphasizing the potential severity of COVID-19 and the potential susceptibility to contact with the virus, fostering self-efficacy in following containment strategies and prosociality appears to be a viable public health education or communication strategy to combat COVID-19.

Exploring the impact of motivations on individual online and offline preventive actions against COVID-19

Having accurate and sufficient information about the outbreak and actively adopting preventive actions are important to reduce the adverse effects of COVID-19 and control the spread of the epidemic. To this end, grounded in the situational theory of problem solving (STOPS) and self-concern and other-orientation theory, this study aims to examine motivations of individuals to adopt online and offline preventive actions during the COVID-19 pandemic. We explored the effects of three motivations, i.e., situational motivation, concern-for-self and concern-for-others motivation, and their antecedents on individual online and offline preventive actions. We used PLS-SEM to analyze the results of 628 questionnaires and found that: first, individual online preventive actions have a positive predictive effect on offline actions; secondly, individual online preventive actions are positively affected by situational motivation and concern-for-others motivation, and individual offline preventive actions are positively affected by concern-for-self and concern-for-others motivation; finally, three situational perceptual factors including problem, involvement and constraint recognition have significant effects on the three motivations. The findings of this study enriched the research results on individual behaviors in the context of COVID-19, and provided a basis for making decisions on the guidance and management of the individuals' COVID-19 preventive actions.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-023-04283-z.

Self-uniqueness beliefs and adherence to recommended precautions. A 5-wave longitudinal COVID-19 study

RATIONALE

Research on health-related self-uniqueness beliefs suggested that these beliefs might predict adherence to precautions against COVID-19.

OBJECTIVE

We examined if comparative optimism (believing that one is less at less than others), self-superiority (believing that one already adheres better to precautions than others), and egocentric impact perception (believing that adverse events affect oneself more than others) predicted intended adherence to precautions.

METHOD

We measured self-reported intentions, optimism for self and others, perceived past adherence by self and others, and perceived impact of the measures and the disease on self and others in a 5-wave longitudinal study in December 2020-May 2021 (N ≈ 5000/wave). The sample was in key respects representative for the Belgian population. We used joint models to examine the relationship between self-uniqueness beliefs and intended adherence to the precautions.

RESULTS

Believing that COVID-19 would affect one's own life more than average (egocentric impact perception) was associated with higher intentions to adhere to precautions, as was believing that the precautions affected one's life less than average (allocentric impact perception). Self-superiority concerning past adherence to precautions and comparative optimism concerning infection with COVID-19 were associated with higher intended adherence, regardless of whether their non-comparative counterparts (descriptive norm, i.e., perceived adherence to precautions by others, and personal optimism, respectively) were controlled for. Comparative optimism for severe disease and for good outcome were associated with lower intended adherence if personal optimism was not controlled for, but with higher intended adherence if it was controlled for.

CONCLUSION

Self-uniqueness beliefs predict intended adherence to precautions against COVID-19, but do so in different directions.

Influencing Factors and Improvement Path of Academic Engagement among College Students in the Context of Epidemic Prevention and Control

OBJECTIVE

The implementation of online teaching in the context of epidemic prevention and control has had an impact on the learning engagement of college students to some extent. This study aims to investigate the mechanisms that influence perceived social support and health behaviors on learning engagement, so as to make college students more focused on their studies by improving their physical and mental health as well as their ability to perceive social support.

METHODS

A total of 538 college students from Henan Province, China, were studied using the Perceived Social Support Scale, Health Behavior Scale and Learning Engagement Scale, and the data were analyzed by IBM SPSS Amos 26.0 software (IBM SPSS Inc., Chicago, IL, USA).

RESULTS

(1) The level of health behavior among college students was positively correlated with perceived social support ability (β = 0.289, p < 0.001); both perceived social support and health behaviors predicted college students' learning engagement significantly (β = 0.200, p < 0.01; β = 0.406, p < 0.001). (2) College students' perceived social support partially mediated the relationship between health behaviors and learning engagement.

CONCLUSION

One of the main ways to improve college students' learning engagement is to improve their health behavior and perceived social support. This study contributes to a better understanding of the relationships between health behaviors and learning engagement, as well as to the development of interventions to improve learning engagement among college students.

Solidarity appraisal, meaning, and markers of welfare in frontline workers in the UK and Ireland during the Covid-19 pandemic

Throughout the Covid-19 pandemic, frontline workers have carried out essential roles to keep society going, while the public have been called to minimise the infection rate to limit the burden on frontline workers. In this sense, navigating Covid-19 has necessitated interdependence between frontline workers and key stakeholder groups (such as their colleagues, organisations, their government, and the public). Reports suggest that frontline workers have perceived varying degrees of solidarity with others throughout the pandemic, yet the influence of perceived solidarity on psychological welfare has received limited empirical or theoretical attention. The aim of the present study was to test the importance of perceived solidarity (or solidarity appraisal) by assessing the relationship between perceptions of solidarity and psychological welfare in frontline workers — across all sectors — during Covid-19, and explore the role of a potential mechanism (i.e., meaning in life) for explaining this relationship. To assess this proposed model, we used cross-sectional and longitudinal data from a project tracking a cohort of frontline workers in the UK and Ireland since March 2020. Participants were surveyed at baseline (T1), at six months (T2), and 12 months (T3). At T3, participants (N ​= ​414) reported their perceived solidarity (with colleagues, organisations, government, and public) along with a range of psychological welfare measures. Overall, frontline workers’ levels of meaning in life dropped significantly over time. Lower levels of perceived solidarity were predictive of poorer wellbeing, and higher anxiety, burnout, post-traumatic stress symptoms, and somatic stress symptoms, and these relationships were mediated by the presence of meaning in life. These findings suggest that perceived solidarity with interdependent social groups may imbue life with meaning, which can in turn have a positive influence on psychological welfare in chronic and cumulatively stressful occupational settings.

Prosocial and Positive Health Behaviors During a Period of Chronic Stress Protect Socioemotional Well-Being

Behavior that helps, supports, or protects others—or prosocial behavior—has emerged as a health-relevant behavior that can promote the giver’s well-being, yet whether prosocial behavior protects against the effects of a major, ongoing chronic stressor warrants further examination. Thus, in the context of the 2020 COVID-19 pandemic, we examined whether two types of behaviors—those enacted to prevent the spread of disease to the self and others (positive health behaviors) and those enacted to promote others’ psychological and financial well-being (prosocial behaviors)—might protect well-being over time. Using a longitudinal survey method, 745 participants (M_age = 62.87 years) reported their engagement in positive health behaviors, prosocial behaviors, and socioemotional well-being (depressive symptoms, anxiety symptoms, loneliness) approximately two months into mandated lockdown orders in the USA. Three months later, participants again reported their well-being. Results showed that greater self-reported positive health behaviors (e.g., wearing a facemask, distancing from others) was related to decreased depressive symptoms over time, whereas greater self-reported prosocial behaviors (e.g., donating time or money, thanking an essential worker) was related to decreased loneliness over time. Neither behavior was related to anxiety symptoms. Together, results suggest that both doing things for the benefit of others and engaging in positive health behaviors protects well-being, even during times of chronic stress. Findings are however limited by the use of self-report measures. Future research should use experimental and behavioral approaches beyond self-report to verify findings.

Does Gratitude Promote Resilience During a Pandemic? An Examination of Mental Health and Positivity at the Onset of COVID-19

Researchers have emphasized the detrimental effects of COVID-19 on mental health, but less attention has been given to personal strengths promoting resilience during the pandemic. One strength might be gratitude, which supports wellbeing amidst adversity. A two-wave examination of 201 college students revealed anxiety symptom severity increased to a lesser extent from pre-COVID (January-March 2020) to onset-COVID (April 2020) among those who reported greater pre-COVID gratitude. A similar trend appeared for depression symptom severity. Gratitude was also correlated with less negative changes in outlook, greater positive changes in outlook, and endorsement of positive experiences resulting from COVID-19. Thematic analysis showed "strengthened interpersonal connections" and "more time" were the most commonly reported positive experiences. Overall findings suggest gratitude lessened mental health difficulties and fostered positivity at the onset of the pandemic, but more research is needed to determine whether gratitude and other strengths promote resilience as COVID-19 continues.