Positive Mental Health, Stressful Life Events, and Suicide Ideation

Positive mental health accounts for the relationship between insomnia symptoms and suicide-related outcomes

Insomnia symptoms have been shown to be associated with suicide ideation/behavior. However, the underlying mechanism is unclear and studies on protective factors that might mitigate the association between sleep-related problems and suicide ideation/behavior are largely missing. On this background the aim of the current study was to investigate, whether positive mental health (PMH) accounts for the association between insomnia symptoms and suicidal ideation/behavior. A total of 913 participants (72.2% women; age: M(SD) = 25.91 (7.08)) completed measures on insomnia symptoms, PMH and suicide ideation/behavior via an online survey. The results reveal a significant association between insomnia symptoms and PMH. Both variables were significantly linked to lifetime suicide ideation/behavior and 12-month suicide ideation. Moreover, the association between insomnia symptoms and suicide-related outcomes was significantly mitigated by PMH. The current findings complement previous studies on the association between insomnia symptoms and suicide ideation/behavior. Furthermore, they demonstrate that PMH can mitigate the risk of suicide-related outcomes. Therapeutic intervention targeting insomnia symptoms and fostering PMH might be useful in the prevention of suicide ideation/behavior.

Resilience to Stress and Adversity: A Narrative Review of the Role of Positive Affect

The modern conception of mental health encompasses not only mental illness but also mental wellbeing, including positive emotional states and other forms of positive experience. Accordingly, research on resilience - that is, recovery or adaptation following adversity - has recently expanded to consider the roles of positive affect in the resilience process. To review this research, we performed a keyword search of all peer-reviewed journals within the American Psychological Association's PsycInfo database, retrieving all studies of positive affect in the context of resilience. These studies measured positive affect either as the outcome of the resilience process or as a resilience resource in its own right. With positive affect as the outcome, the literature suggests that various resilience resources can promote positive affect following a stressor, especially positive personality traits (eg, hope, optimism, self-compassion) and supportive interpersonal connections. With positive affect as a resilience resource, the literature suggests that higher levels of positive affect may protect individuals from the impact of stress on a number of outcomes, such as depression and trauma symptoms. In all, the reviewed research showcases a wide range of stressors, resources, and outcomes, and there are numerous openings for future discoveries in this promising area of inquiry.

A Moderation Model for Bolstering Resilience to Suicidal Psychopathology: Positive Sociopsychological Constructs and Coping Flexibilities Buffering the Impact of Daily Life Stress Among Medical Students

ABSTRACT

Positive sociopsychological constructs and coping flexibility may be helpful for alleviating suicidal psychopathology, although relatively little research has examined this possibility among medical students. This survey aimed to investigate whether positive sociopsychological constructs and coping flexibility could buffer the negative impact of daily life stress and bolster the resilience to suicidal ideations and attempts among medical students. This cross-sectional model was based on a study of 787 Indian medical students (725 women and 62 men; mean age, 21.08 years; SD = 2.78; range, 19-37 years) who were asked to complete a battery of self-administered questionnaires. For the purpose of determining the independent and interaction impacts of potential variables of influence, hierarchical multiple linear regression models were used. The moderation analysis investigated that the association between daily life stress and suicidal ideation was buffered among the students having higher levels of positive mental health and coping flexibility, whereas this association was no longer significant at the highest level of positive mental health. Furthermore, the relationship between daily life stress and suicidal attempts continued to be buffered by above-average levels of coping flexibility, emotional stability (ES), and optimism. These findings represent that promoting positive mental health, coping flexibility, ES, and optimism may be a promising approach to mitigate suicidal thoughts and attempts in interventions for medical students at high risk. These modifiable moderating factors can be enhanced by empirically supported treatment and prevention efforts to bolster suicidal resilience.

Reporting Ethical Procedures in Suicide Prevention Research: Current Status and Recommendations

OBJECTIVE

Ethical concerns frequently arise in suicide prevention research regarding participant safety and confidentiality. Despite a substantial literature on managing and navigating ethical concerns in suicide research, little attention has been paid to the reporting of ethical procedures. Furthermore, standard procedures for reporting ethical risk management procedures have not been developed.

METHOD

A review of the current literature was performed to examine the current state of reporting of ethical procedures within suicide research. Articles published in 2020 (N = 263) from three suicide-focused publications were screened and then coded (n = 131) to identify reporting of procedures for the ethical conduct of research and suicide risk management steps taken by the research teams.

RESULTS

The majority of articles reported ethical review or approval (84.7%) and reported the use of an informed consent process (77.9%). Only 28.2% included risk mitigation procedures. Of those 29.7% of those articles reported conducting risk evaluation, 66.7% reported resource dissemination, and 51.4% reported an intervention.

CONCLUSION

As empirical support for brief interventions accrues, suicide prevention researchers should consider establishing standards for the reporting of procedures to ensure the safety of participants with suicidal risk.HighlightsReporting suicide safety protocols helps ensure high ethical standards in research.Fewer than 1/3 of articles reviewed reported risk mitigation procedures in 2020.Standard procedures for reporting safety protocols in suicide research are needed.

Stressful Life Events and Near-term Suicidal Risk in a Clinical Population

The present study examined 22 specific stressful life events (SLEs) in relation to recent and prospective suicidal thoughts and behaviors (STBs). The effect of assessment method (self-report vs. chart-based ratings) and inpatient/outpatient status was also investigated. Past 3-month STBs and SLEs were assessed for 1,058 psychiatric patients; 696 completed one-month follow-up assessments. SLEs were common, with 684 participants (64.7%) reporting at least one. Total number of SLEs correlated with recent and prospective STB. A higher incidence of SLE's was found with self-report vs. chart-based measures (on 20 SLEs) and inpatients vs. outpatients (on 7 SLEs). SLEs of interpersonal rejection and loss, homelessness and academic failure offered elevated risk. In sum, SLEs are common and associated with STBs in psychiatric patients. SLEs of interpersonal rejection and loss, homelessness and academic failure may merit increased clinical attention.

Depression and Suicide Ideation among Suicide-Loss Survivors: A Six-Year Longitudinal Study

Suicide is not only a tragic end of life but also may be the beginning of a very challenging life for those left behind. Suicide-loss survivors (SLSs) are individuals who were exposed to the suicide of a close family member or a friend and endure highly emotional distress. The psychological stance and reactions of SLS are deeply colored by painful, intense emotions that are expressed through different psychiatric symptoms, including depression and suicide ideation (SI). The present study investigated the long-term effects of interpersonal factors such as social support, self-disclosure, thwarted belongingness, and perceived burdensomeness on depression and suicidal ideation among SLS. One hundred fifty-two Israeli SLS, aged 20-72, participated in this longitudinal study, during which their suicide ideation and depression levels were assessed at four points over six years (T1-baseline, and two (T2), four (T3), and six (T4) years after baseline). At the last time point, interpersonal factors were also assessed. SLSs' interpersonal variables significantly predicted depression and SI levels beyond their usual trajectories over the years. Significant correlations were found between both perceived burdensomeness and thwarted belongingness and depression levels at all measurement points. Moreover, thwarted belongingness was found to be a significant moderator of the relationship between former and current depression levels, as the contribution of depression-T3 to depression-T4 was lower among SLSs with low thwarted belongingness (b = 0.14, CI = 0.05-0.34) compared with SLSs with high thwarted belongingness (b = 0.25, CI = 0.22-0.45). These findings emphasize the vital healing role of interpersonal factors such as belongingness, as they may attenuate depression and SI symptoms over time. Hence, clinicians should focus on therapies that boost interpersonal interactions and belongingness, as they seem to be crucial stepping stones on the way to recovery. Moreover, national programs should be implemented to offer SLSs targeted interventions to reduce distress and depression in the aftermath of suicide loss.

The relationship between abuse and neglect and adolescent suicidality: A moderated mediation model

Abuse and neglect can lead to suicide in adolescents; however, the internal mechanisms between abuse and neglect and suicidality remain unclear. We hypothesized that abuse and neglect could affect adolescent suicidality, and that mediating and moderating mechanisms exist between these two variables. We tested the mediating effects of stressful life events (misunderstanding and discrimination by others, poor academic performance, failed exams, interpersonal problems, and school punishment) on suicidal tendencies and moderating effects of resilience among 5,852 adolescents from 37 middle schools in five provinces of North, south, East, west, and central China. We used a questionnaire to collect data and adopted structural equation modeling to verify the correlation, mediating, and moderating effects among the variables. The results showed that stressful life events mediated the relationship between abuse, neglect, and suicide. Furthermore, resilience moderated the direct effect and second half of the mediating effect.

Too many lemons to make lemonade? Disentangling mental health during the third wave of COVID-19 infections in Spain

The study aimed to analyze the longitudinal change in mental health during the third wave of COVID-19 infections in Spain. Negative (e.g., emotional distress) and positive (e.g., positive functioning variables) outcomes were analyzed. Protective factors (e.g., resilience) as predictors of psychological adjustment (i.e., positive mental health, openness to the future, and low burden due to COVID-19) after ten months of the pandemic were also examined. The sample consisted of 164 participants, and self-reported questionnaires were administered at the beginning of the lockdown (March 2020), at the end of the lockdown (June 2020), and during the third wave (January 2021). Linear mixed models showed that individuals' emotional distress increased, and positive functioning variables (i.e., meaning in life, gratitude, resilience, and life satisfaction) decreased over time, but an increase was observed in some dimensions of posttraumatic growth. Regression analyses showed that resilience scores at all three data collection time points were significant predictors of positive mental health, openness to the future, and burden during the third wave. Mediation analyses showed that positive mental health and openness to the future were mediators of the effect of resilience on burden. The prolonged situation of the COVID-19 crisis had an important impact on positive and negative mental health. However, resilience may help to build up resources that can act as a buffer against adverse psychological effects.

Psychometric evaluation of the Positive Mental Health (PMH) scale using item response theory

BACKGROUND

The investigation of patient-reported outcomes and psycho-oncological interventions mainly focuses on psychological distress or psychopathology. However, the recognition of the equal importance of positive mental health (PMH) has increased lately. The PMH-scale is a brief questionnaire allowing to assess well-being in individuals in the general population and in patients. Previous studies evaluated the psychometric properties of the PMH-scale using classical test theory (CTT). This study is the first to investigate the PMH-scale in patients with cancer using item analysis according to the Rasch model.

METHODS

In total, N = 357 cancer patients participated in the study. A Rasch analysis of the PMH-scale was conducted including testing of unidimensionality, local independence, homogeneity and differential item functioning (DIF) with regard to age, gender, type of cancer, the presence of metastases, psycho-oncological support, and duration of disease. Additionally, the ordering of the item thresholds as well as the targeting of the scale were investigated.

RESULTS

After excluding one misfitting item and accounting for local dependence by forming superitems, a satisfactory overall fit to the Rasch model was established (χ² = 30.34, p = 0.21). The new PMH-8 scale proved to be unidimensional, and homogeneity of the scale could be inferred. All items showed ordered thresholds, there was no further item misfit. DIF was found for age, but as the impact of DIF was not substantial, no adjustment related to the age-DIF had to be made. The Person Separation Index (PSI = 0.89) was excellent, indicating excellent discriminatory power between different levels of positive mental health. Overall, the targeting of the PMH-8 was good for the majority of the present sample. However, at both ends of the scale item thresholds are missing as indicated by a slight floor effect (1.4%) and a considerable ceiling effect (9.8%).

CONCLUSIONS

Overall, the results of the analysis according to the Rasch model support the use of the revised PMH-scale in a psycho-oncological context.

The Role of Existential Concerns in the Individual's Decisions regarding COVID-19 Vaccine Uptake: A Survey among Non-Vaccinated Italian Adults during the Third Wave of the Pandemic

Recent studies have suggested that health constructs embraced by the Terror Management Theory (TMT) and the Basic Psychological Needs Theory (BPNT) may drive individuals' COVID-19 health-related decisions. This study examines the relationships between existential concerns (ECs; within the TMT), basic psychological needs (BPNs; within the BPNT) and COVID-19 vaccine hesitancy (VH), as well as the mediating role of negative attitudes toward COVID-19 vaccines. A cross-sectional survey was carried out from April to May 2021 on a sample of two hundred and eighty-seven adults (Mage = 36.04 ± 12.07; 59.9% females). Participants provided information regarding existential concerns, basic psychological needs, attitudes toward COVID-19 vaccines and vaccine hesitancy for Pfizer-BioNTech and AstraZeneca vaccines separately. Higher vaccine hesitancy (32.1%) and vaccine resistance (32.8%) rates were found for AstraZeneca than for Pfizer-BioNTech COVID-19 vaccine (22.3% and 10.1%, respectively). Structural equation modeling showed that existential concerns were related to Pfizer-BioNTech and AstraZeneca vaccine hesitancy both directly and indirectly through negative attitudes toward potential side effects of COVID-19 vaccines. The findings of the study confirm that the TMT is efficient in explaining COVID-19 vaccine hesitancy. Targeted efforts are needed to increase the acceptance of COVID-19 vaccines.

Physical activity, mental and physical health during the Covid-19 outbreak: longitudinal predictors of suicide ideation in Germany

Aim

Suicide ideation has increased since the outbreak of Covid-19 in many countries. The present longitudinal study investigated potential predictors of suicide ideation.

Subject and methods

Data of 406 participants from Germany (age M = 27.69, SD = 6.88) were assessed via online surveys in spring 2020 (baseline, BL) and in spring 2021 (follow-up, FU).

Results

The current results reveal a significant increase in symptoms of depression, anxiety, and stress between 2020 and 2021. Positive mental health (PMH), sense of control, and physical health significantly decreased. Depression symptoms (BL), PMH (BL), and consciously enhanced physical activity since the pandemic outbreak (FU) significantly predicted 12-month suicide ideation (FU). In a moderated mediation analysis, the positive relationship between depression and suicide ideation was significantly mediated by PMH. Consciously enhanced physical activity significantly moderated the negative association between PMH and suicide ideation.

Conclusion

The context of Covid-19 could negatively impact mental health and physical health. This might increase the risk for suicide ideation. However, PMH and physical activity might serve as protective factors. The protective effect of physical activity could be especially important in people with high depression symptoms and low PMH, such as clinical patients. Potential ways of how PMH and physical activity could be enhanced in the Covid-19 context to prevent suicide ideation are discussed.

Perceived Social Support and Stress: a Study of 1st Year Students in Ireland

Social support is consistently associated with positive outcomes for students, in terms of wellbeing and academic achievement. For first year students, social support offers a way to deal with stressors associated with the challenge of transitioning to university. The current research was conducted with a range of first year students (n = 315) early in their first semester in university. Both male and female students reported moderate levels of social support and perceived stress, while those with higher levels of social support reported lower levels of stress. Gender differences were apparent in both the levels and sources of social support that students perceived as available to them. Female students reported higher levels of social support and stress than males, suggesting that university initiatives for enhancing social support and dealing with stress may require a gender-specific focus. The results are discussed in terms of recommendations for developing students' social supports during first year, in order to mitigate for the experience of stress and to enhance student experience of their educational journey.

Validation of the Persian version of the Positive Mental Health Scale

BACKGROUND

Positive mental health (PMH) is a factor of far-reaching salutogenetic importance. The present study aimed at validating the Persian version of the Positive Mental Health Scale (PMH-Scale).

METHODS

Reliability and validity of the Persian version of the PMH-Scale were established in an Iranian student sample (N = 573). Internal consistency, convergent and discriminant validity were investigated, and exploratory factor analysis was conducted. Furthermore, it was assessed how PMH scores moderate the association between depressive symptoms and suicide ideation/behavior.

RESULTS

The Persian version of the PMH-Scale  was shown to have a unidimensional structure with excellent internal consistency, as well as good convergent and divergent validity. PMH differentiated between participants with higher vs. lower suicide risk. Furthermore, PMH proved to moderate the association between depressive symptoms and suicide ideation/behavior.

CONCLUSIONS

The results suggest that the PMH-Scale is a brief, reliable, and valid measure of subjective and psychological well-being that can be used in Iranian student samples and research settings.

Aggression and Non-Suicidal Self-Injury among Depressed Youths: The Mediating Effect of Resilience

Background

The global spread of COVID-19 not only exerted an enormous impact on the public in different countries but also aggravated depression among youths. The aggressive tendencies of depressed individuals can harm their body and life and threaten those of others. The aggressive and non-suicidal self-injurious behaviors of depressed youths may seriously affect their physical and psychological health if not identified and mediated promptly.

Method

A total of 875 young respondents (including college students, community youths, migrant workers, and so on) from three provinces in China were surveyed in 2020 using a depression scale, non-suicidal self-injury scale, aggression scale, and resilience scale.

Results

Depression, non-suicidal self-injury, and aggression are significantly higher among the members of the depression group compared with the members of the healthy control group (P<0.001), and the resilience of the members of the former group is remarkably lower than that of the members of the latter group (P<0.001). Aggression among the depressed youths exhibits a significant positive correlation with non-suicidal self-injury (r= 0.43, P<0.01), whereas aggression (r= -0.18, P<0.05) and non-suicidal self-injury (r= -0.20, P<0.05) demonstrates significant negative correlations with resilience. The resilience of the youths in the depression group plays a partial mediating role in the relationship between aggression and non-suicidal self-injury.

Conclusion

The more aggressive the behaviors of the depressed youths, the more serious their non-suicidal self-injurious symptoms. Furthermore, resilience plays a partial mediating role in the relationship between aggression and non-suicidal self-injury.

Be a Mom, a Web-Based Intervention to Promote Positive Mental Health Among Postpartum Women With Low Risk for Postpartum Depression: Exploring Psychological Mechanisms of Change

Background: This study explored whether Be a Mom, a brief and unguided cognitive behavioral web-based intervention, was effective in promoting psychological processes (self-compassion, psychological flexibility, emotion regulation) among low-risk postpartum women. Effects of Be a Mom in psychological processes compared with a control group were examined at post-intervention and at 4-months follow-up. Additionally, this work explored whether changes in psychological processes mediated improvements in positive mental health at postintervention. Methods: In total, 367 postpartum women presenting low risk for postpartum depression were randomly assigned to the intervention group (n = 191) or to a waiting-list control group (n = 176). Results: Compared with the control group, the intervention group reported significantly greater baseline to postintervention increases in self-compassion. No significant effects were found at the 4-month follow-up. Multilevel mediation showed that self-compassion improvements significantly mediated improvements in positive mental health among the intervention group. No significant results were found for psychological flexibility or emotion regulation. Conclusions: This study suggests that Be a Mom has the potential to cultivate self-compassion among low-risk postpartum women and that this may be a key mechanism for promoting positive mental health in this context. Clinical Trial Registration: www.clinicaltrials.gov, identifier: NCT04055974.

The Role of Perceived Social Support in the Association Between Stressful Life Events and Suicidal Behavior

Background: Suicide is a serious public health concern for which there have been well-established protective and risk factors reported in literature. There is a lack of evidence on the indirect effects of other variables on these factors. Specifically, the association between stressful life events and suicidal behavior may be affected by perceived social support, but its role in this association is largely uninvestigated. Objectives: Thus, this paper aims to explore the role of perceived social support in the association between stressful life events and suicidal behavior. Perceived social support will be explored as a mediator and as a moderator in this association. Methods: Data were obtained from the Determinants of Suicidal Behavior Conventional and Emergent Risk (DISCOVER), a study conducted to identify risk factors of suicidal behavior. The study participants are individuals with suicide attempts admitted to hospital. Participants (n = 343) were recruited from hospital setting. Suicidal behavior was measured using two outcomes (1) the occurrence of a suicide attempt (2) level of suicide intent as measured by the Pierce Suicide Intent Scale. Perceived social support was measured using the Sarason Social Support Questionnaire. Results: Stressful life events were significantly associated with suicide attempts (OR 1.440, 95% CI 1.440, 1.682, p < 0.001) and perceived social support (B -0.785, 95% CI -1.501, -0.068, p = 0.032). There was no significant mediation effect by perceived social support in the association between stressful life events and suicide attempts (Sobel's test statistic 1.64, p = 0.100). Perceived social support did not moderate the relationship between stressful life events and suicide attempts [(OR 1.007, 95% CI 0.987, 1.027, p = 0.514] or the relationship between stressful life events and level of suicidal intent (B -0.043, 95% CI -0.132, 0.046, p = 0.343). Conclusion: Stressful life events are associated with increased risk of suicide attempts. The study also identified an inverse relationship between stressful life events and perceived social support. These associations were independent of perceived social support. This study highlights the effects of stressful life events on suicide risk is not affected by perceived social support, requiring further investigation into measures to reduce the impact of social stressors on people with risk of suicide.

Behavioral measures to fight COVID-19: An 8-country study of perceived usefulness, adherence and their predictors

Behavioral measures, such as the wearing of facemasks and maintaining of distance to other people, have been central in fighting the COVID-19 pandemic and will continue to be important in curbing its spread. We therefore investigated their perceived usefulness, adherence and their predictors in representative online samples in eight countries (France, Germany, Poland, Russia, Spain, Sweden, U.K., U.S.). Of the 7,658 participants, 77.4% rated governmental measures (highest: Germany, lowest: France) as useful and 91.7% reported adherence to them. Adherence was lowest in Russia and Poland, where people felt particularly left alone and not well supported, and in the U.S. and Sweden, where governments showed ambivalent attitudes towards the measures. The highest adherence was reported in countries with very high mortality (U.K., Spain, France) or very positively perceived government communication (Germany). Female gender, higher age, belonging to a risk group, being affected physically and mentally, perception of governmental communication as guided by the interests of people, feeling of being well informed and the level of positive mental health positively predicted both outcomes, while being affected economically negatively predicted both outcomes. Country-specific results are considered in the light of the protection motivation theory and the theory of planned behavior together with potential ways to improve active participation of the population. Overall, we recommend the governments and authorities to stress that each individual can contribute to the control of the COVID-19 situation by adherence to the measures in the public communication. Moreover, they should emphasize the risk of unconscious infection of older individuals by younger people, as well as the importance of physical activity for the protection of mental and physical health especially during the pandemic.

Accurate Diagnosis of Suicide Ideation/Behavior Using Robust Ensemble Machine Learning: A University Student Population in the Middle East and North Africa (MENA) Region

Suicide is one of the most critical public health concerns in the world and the second cause of death among young people in many countries. However, to date, no study can diagnose suicide ideation/behavior among university students in the Middle East and North Africa (MENA) region using a machine learning approach. Therefore, stability feature selection and stacked ensembled decision trees were employed in this classification problem. A total of 573 university students responded to a battery of questionnaires. Three-fold cross-validation with a variety of performance indices was sued. The proposed diagnostic system had excellent balanced diagnosis accuracy (AUC = 0.90 [CI 95%: 0.86-0.93]) with a high correlation between predicted and observed class labels, fair discriminant power, and excellent class labeling agreement rate. Results showed that 23 items out of all items could accurately diagnose suicide ideation/behavior. These items were psychological problems and how to experience trauma, from the demographic variables, nine items from Post-Traumatic Stress Disorder Checklist (PCL-5), two items from Post Traumatic Growth (PTG), two items from the Patient Health Questionnaire (PHQ), six items from the Positive Mental Health (PMH) questionnaire, and one item related to social support. Such features could be used as a screening tool to identify young adults who are at risk of suicide ideation/behavior.

Does Mental Well-Being Protect against Self-Harm Thoughts and Behaviors during Adolescence? A Six-Month Prospective Investigation

Mental well-being protects against the emergence of suicidal thoughts. However, it is not clear whether these findings extend to self-harm thoughts and behaviors irrespective of intent during adolescence-or why this relationship exists. The current study aimed to test predictions-informed by the integrated motivational-volitional (IMV) model of suicide-concerning the role of perceived defeat and entrapment within the link between mental well-being and self-harm risk. Young people (n = 573) from secondary schools across Scotland completed an anonymous self-report survey at two time points, six months apart, that assessed mental well-being, self-harm thoughts and behaviors, depressive symptomology and feelings of defeat and entrapment. Mental well-being was associated with reduced defeat and entrapment (internal and external) and a decrease in the likelihood that a young person would engage in self-harm thoughts and behaviors. The relationship between mental well-being and thoughts of self-harm was mediated by perceptions of defeat and entrapment (internal and external). Mental well-being was indirectly related to self-harm behaviors via decreased feelings of defeat and internal (but not external) entrapment. Taken together, these findings provide novel insights into the psychological processes linking mental well-being and self-harm risk and highlight the importance of incorporating the promotion of mental well-being within future prevention and early intervention efforts.

Predicting adaptive and maladaptive responses to the Coronavirus (COVID-19) outbreak: A prospective longitudinal study

Background/Objective

The outbreak of COVID-19 and the lack of vaccine made extraordinary actions such as social distancing necessary. While some individuals experience the restrictions on daily life as a heavy burden, others adapt to the situation and try to make the best of it. The present longitudinal study investigated the extent and predictors of the burden induced by the outbreak of COVID-19 in Germany.

Method

Data were assessed in October 2019 using the DASS-21 and the PMH-Scale, and in March 2020 adding a six-item measure of burden and a 2-item rating of sense of control.

Results

In a sample of 436 participants, about 28% stayed in self-quarantine, 22 persons had relevant symptoms and one person was positively tested for COVID-19. Most participants experienced medium to high levels of burden but tried to make the best of it. Stress symptoms in 2019 predicted a higher level of burden and PMH predicted a lower level of burden in March 2020. Remarkably, depression and anxiety symptoms did not significantly predict burden. The protective effect of PMH and the negative impact of stress symptoms were mediated by perceived sense of control.

Conclusions

The results emphasize the protective effect of PMH in extraordinary situations such as the current outbreak of COVID-19.