The psychology of ongoing threat: relative risk appraisal, the September 11 attacks, and terrorism-related fears

Authoritarianism, perceptions of security threats, and the COVID-19 pandemic: A new perspective

This article offers a new perspective on when and why individual-level authoritarian perceptions of security threats change. We reexamine claims that authoritarian members of the public responded to the COVID-19 pandemic in a counterintuitive fashion. The response was counterintuitive in that, rather than a desire for a stronger government with the ability to impose measures to address the pandemic and its consequences, authoritarian individuals rejected a stronger government response and embraced individual autonomy. The article draws on perceptions of security threats-issues that directly or indirectly harm personal or collective safety and welfare-from surveys in two different contexts in England: 2012, when perceptions of the threat from infectious disease was low relative to most other security threats, and 2020, when perceptions of the personal and collective threat of COVID-19 superseded all other security threats. We argue that the authoritarian response was not counterintuitive once we account for the type of threat it represented.

Media experiences during the Ukraine war and their relationships with distress, anxiety, and resilience

This study investigates the relationships between perceiving media as a positive or negative influence (both news media and fictional media) during the war in Ukraine in 2022 and anxiety, distress, and resilience. Corroborating existing research, our study (N = 393, 47.3% male) showed that there was a clear relationship between the perceived negative impact of both news and fictional media during the war and increased symptoms of anxiety (b = .09, SE = 0.04, p = .024; b = 0.16, SE = 0.04, p < .001, respectively) and distress (b = 0.08, SE = 0.04, p = .047; b = 0.17, SE = 0.04, p < .001, respectively) as well as lowered psychological resilience (b = -0.10, SE = 0.05, p = .047; b = -0.15, SE = 0.06, p = .009, respectively). The study is the first to demonstrate this association for fictional media. Contrary to expectations, however, the perception of a positive impact of both news and fiction was not associated with decreased symptoms of anxiety and distress or higher resilience.

Daily Effects of COVID-19 News on Personal Protective Behaviors Through COVID-19 Anxiety: The Significance of Direct Wuhan Epidemic Experience

BACKGROUND

Drawing on cognitive appraisal theory, this study investigates the effect of daily COVID-19 news on daily anxiety and protective behaviors (e.g., wearing masks and washing hands). This study proposes that such processes, leading to self-protection, are highly likely when individuals have directly experienced the Wuhan epidemic at the beginning of 2020, which is the most serious COVID-19 outbreak in history.

METHODS

The positive effect of daily COVID-19 news on daily protective behaviors through daily COVID-19 anxiety was examined in this study, which was hypothesized to be accentuated by direct Wuhan epidemic experience. An online survey based on the experience sample method (ESM) was conducted during the COVID-19 epidemic in Hebei Province, China, at the beginning of 2021, in which 82 working adults participated in a daily survey for five consecutive days. Once a day during the five-day period, the participants reported their daily COVID-19 news exposure, daily COVID-19 anxiety, and daily protective behaviors. Wuhan epidemic experience was measured by the place of residence of the participants during the 2020 Wuhan epidemic through a separate general survey conducted before the ESM survey.

RESULTS

Analysis of 392 day-level data confirmed the positive link between daily COVID-19 news and daily protective behaviors, mediated by daily COVID-19 anxiety (b = 0.03, SE = 0.01, p = 0.018). Furthermore, the mediated effect was significant for the participants with direct COVID-19 experience in Wuhan in 2020 (b = 0.05, SE = 0.03, p = 0.041) but not significant for those without direct experience in Wuhan (b = 0.01, SE = 0.01, p = 0.461). Thus, the results confirmed the positive moderating role of Wuhan epidemic experience.

CONCLUSIONS

The analysis reveals the psychological mechanism through which COVID-19 information promotes self-protection measures to control the infectious disease and highlights the importance of direct COVID-19 experience in generating such an effect.

A confirmatory factor analysis of a cognitive model of COVID-19 related anxiety and depression

The mental health impact of the COVID-19 pandemic has been significant, with many regions across the globe reporting significant increases in anxiety, depression, trauma, and insomnia. This study aims to validate a potential cognitive model of maintenance factors of COVID-19 related distress by examining psychological predictors of distress, and their goodness-of-fit as a coherent model. Participants from the general population (n = 555) were recruited using a cross-sectional on-line survey design, assessing Demographic factors, Anxiety, Depression, Loneliness, COVID-19 related distress, Trauma Cognitions related to COVID-19, Rumination, Safety Behaviours, Personality Factors, and Mental Effort related to COVID-19. A series of stepwise linear regressions found that components of the model were significant and accounted for a large percentage of variance when examining Covid-19 related distress (R² = 0.447 Covid Stress Scale), Anxiety (R² = 0.536 DASS-Anxiety Subscale) and Depression (R² = 0.596 Depression DASS-subscale). In a confirmatory factor analysis, Loneliness, Post-Traumatic Cognitions about Self, Post-Traumatic Cognitions about the World, Emotional Stability, and Mental Effort related to COVID-19 loaded onto a single factor. The final model showed adequate fit (CFI = 0.990, TLI = 0.983, RMSEA = 0.053 (0.027-0.080), GFI = 0.986, SRMR = 0.0216, χ2 = 23.087, p = .006). The results highlight the importance of cognitive factors, such as post-traumatic cognitions, rumination, and mental effort in maintaining COVID-19 related distress.

Understanding the Motives for Terrorism-Does it Have an Effect on Psychological Reactions? A Replication and Extension

The collective communication model of terrorism (CCMT) proposes that understanding terrorists' motives influences appraisal (threat perception and emotional well-being) and reaction to terrorism (intention to retaliate). Fischer et al. (2011) presented evidence from two experiments for the assumption that understanding motives of terrorism influences appraisal. The present preregistered experiment aimed to replicate their second experiment, validate the measures they used, and also test the second proposition of the CCMT. Ensuring sufficient power for multiple tests and the given effect size, we collected data from 188 participants. The findings by Fischer et al. (2011) were partly replicated, but the comparison of the original effect sizes and the effect sizes from the replication attempt does not provide convincing evidence for the hypothesis that understanding the motives for terrorism reduces the perceived threat or negative emotional impact of acts of terrorism. Correlations with other risk-perception measures call into question the validity of the items used to assess perceived threat. Results suggest that understanding the motives for terrorism may influence whether the targeted populations want to retaliate.

Household expenditure in the wake of terrorism: Evidence from high frequency in-home-scanner data

This paper adds to the scant literature on the impact of terrorism on consumer behaviour, focusing on household spending on goods that are sensitive to brain-stress neurocircuitry. These include sweet- and fat-rich foods but also home necessities and female-personal-hygiene products, the only female-targeted good in our data. We examine unique continuous in-home-scanner expenditure data for a representative sample of about 15,000 French households, observed in the days before and after the terrorist attack at the Bataclan concert-hall. We find that the attack increased expenditure on sugar-rich food by over 5% but not that on salty food or soda drinks. Spending on home maintenance products went up by almost 9%. We detect an increase of 23.5% in expenditure on women's personal hygiene products. We conclude that these effects are short-lived and driven by the responses of households with children, youths, and those residing within a few-hours ride of the place of the attack.

Mental Health in the Time of Coronavirus Disease 2019

Certain life experiences can have a profound effect on human emotions. During the coronavirus disease 2019 pandemic, patients are reporting mood disturbances at much higher levels. Multiple encounters with real and imagined threat, prolonged isolation, and loss of control have adversely impacted the country’s behavioral health. However, most people will not pursue psychological care when needed, and some who pursue it will be unable to access it. Nurse practitioners and other health care professionals are in an optimal position to help. Psychological research explains some of what is driving this phenomenon and offers suggestions of benefit to patients, families, and colleagues.

Human Security Psychology: A Linking Construct for an Eclectic Discipline

Since its inception as a modern and evolving discipline, psychology has been concerned with issues of human security. This think piece offers an initial conceptualisation of human security as a broad security concept that encompasses a range of interrelated dimensions that have been responded to by different sub-disciplinary domains within psychology. We advance an argument for a human security psychology as a connecting focal point for general psychology that enables us to bring knowledge from across our eclectic discipline into further dialogue. This is a necessary step in understanding better the state of current thinking on the psychology of security and as a basis for informing further theory, research and practice efforts to address issues of human (in)security. This initial effort is informed by Assemblage Theory, which offers a dynamic and contextually rich perspective on people as agentive beings entangled within evolving natural and social formations that can foster or undermine their experiences of [in]security. The article is completed with a brief agenda for advancing human security psychology.

A Reinforcement Sensitivity Theory of Violent Extremist Propaganda: The Motivational Pathways Underlying Movement Toward and Away From Violent Extremist Action

Anecdotal evidence supports than engaging with violent extremist content online facilitates the radicalization process. However, there is a consistent lack of empirically grounded research to provide insight into the psychological process through which this influence occurs (if at all). As such, most theories often fail to accommodate both the multifinality (the concept that many people are exposed to violent extremist material, yet never engage in violent extremism), and equifinality (the concept that people can view a range violent extremist content, yet all end up engaging in violent extremism) that naturally is observed in those who engage with violent extremist content online and those who engage in violent extremist behavior. This paper presents Reinforcement Sensitivity Theory (RST) as a theoretical framework to inform understanding of the process that governs the interaction between violent extremist material online and engaging with violent extremism. RST is a motivational theory which has been applied to a range of benevolent and deviant behaviors. Specifically, we argue that RST is suitable to explain the effect of violent extremist content online because (1) it outlines multiple differentiated motivational pathways that can account for multifinality and equifinality observed in those who engage in violent extremist behavior and (2) the extant neurological and psychophysiological research using RST provides a empirically supported framework for developing both research methods and verifiable hypotheses to advance our understanding of how, if at all, violent extremist content online contributes to the process of radicalization.

Psychological responses of medical staff during COVID-19 and the adjustment effect of brief mindfulness meditation

Background

COVID-19 has posed an unprecedented threat to public health and remains a critical challenge for medical staff, especially those who have been fighting against the virus in Wuhan, China. Limited data have been reported regarding the psychological status of these medical staff members. Therefore, we conducted this study to explore the mental health status of medical staff and the efficacy of brief mindfulness meditation (BMM) in improving their mental health.

Methods

A survey was conducted between April 18 and May 3, 2020. Upon completing the pre-test, participants in the treatment group received a 15-min BMM intervention every day at 8 p.m. Post-test questionnaires were completed after 16 days of therapy. The questionnaire comprised demographic data and psychological measurement scales. The levels of pre and post-test depression, anxiety, stress, and insomnia were assessed using the 9-item Patient Health Questionnaire, 7-item Generalized Anxiety Disorder Scale, Perceived Stress Scale, and Athens Insomnia Scale, respectively.

Results

A total of 134 completed questionnaires were received. Of the medical staff, 6.7%, 1.5%, and 26.7% reported symptoms of depression, anxiety, and insomnia, respectively. Public officials from military hospitals reported experiencing greater pressure than private officials (t = 2.39, p = 0.018, d = 0.50). Additionally, BMM treatment appeared to effectively alleviate insomnia (t = 2.27, p = 0.027, d = 0.28).

Conclusions

The medical staff suffered negative psychological effects during the COVID-19 pandemic. BMM interventions are advantageous in supporting the mental health of medical staff.

Association Between Feeling Threatened, Behaviour and Symptoms of Anxiety and Depression: Two and a Half Years After the Terrorist Attacks in Belgium

Feeling threatened by terrorism can be associated with mental health problems and behavioural changes. However, few studies look at the association in the long-term. Using a survey, the population in Brussels, Belgium was studied using a representative database delivered by the national post service. The Patient Health Questionnaire-4 (PHQ-4) assessed mental health, and self-made questions avoidance behaviour. 170 people answered: 60% women and 50% higher educated, 28.2% between 56 and 65 years and 62.4% had a partner. 43.5% felt threatened by the terrorist attacks and 45.9% experienced no mental health problems. Both terrorist threat (p < 0.001) and avoidance behaviour (p < 0.001) significantly predicted PHQ-4 scores, while controlling for gender, age, social support, education level, and traumatic events. There is a relation between terrorist threat and anxiety/depressive symptoms 2.5 years after the last study on terrorist threat in Brussels, but it has weakened. Avoidance behaviour seems to be more present than threat.

The impact of workplace safety and customer misbehavior on supermarket workers' stress and psychological distress during the COVID-19 pandemic

Purpose

Essential frontline workers in the retail sector face increased exposure risks to coronavirus disease 2019 (COVID-19) due to frequent interactions with the general public. Often these interactions are fraught with controversies over public safety protocols. The purpose of this study is to examine the impacts of frontline workers' perceptions of workplace safety and customer misbehaviors on their stress and psychological distress to inform managing workplace health and safety during public health crises.

Design/methodology/approach

The authors conducted an online survey of 3,344 supermarket workers in the state of Arizona (US) during the state's first COVID-19 pandemic wave in July 2020. Measures included mental health distress, and perceptions of workplace safety and customer behaviors. The authors utilized a mixed-methods approach combining multiple regression analyses with qualitative analyses of open-ended comments.

Findings

Workers reported high rates of stress and psychological distress. Increases in mental health morbidity were correlated with perceptions of being unsafe in the workplace and concerns about negative customer encounters. Qualitative analyses reveal frustration with management's efforts to reduce risks intertwined with feelings of being unsafe and vulnerable to threatening customer encounters.

Practical implications

The findings highlight the need to provide and enforce clear safety guidelines, including how to manage potential hostile customer interactions, to promote positive health workplace management during a pandemic.

Originality/value

This study is among the first to assess the COVID-19 pandemic's impact on the mental health of non-health care frontline essential workers and presents novel insights regarding perceived customer misbehavior and need for management support and guidance in a public health crisis.

Hope, fear, and consumer behavioral change amid COVID-19: Application of protection motivation theory

Using protection motivation theory (PMT), this study investigates the influence of cognitive assessment and affective response on customers' behavioral intention amid COVID-19 in the context of restaurants. More specifically, this research draws attention to (1) the influence of protection motivation (i.e., perceived vulnerability, perceived severity, maladaptive reward, response efficacy, self-efficacy, response cost) on hope and fear, (2) hope and fear as mediators between protection motivation and behavioral intention, and (3) diverse customer behavioral intentions that have emerged during the COVID-19 pandemic (i.e., health-focused behavior, conscious consumption, and the supporting of local businesses and products). A total of 473 completed responses were obtained through an online survey. Structural equation modeling (SEM) was employed to test the hypothesized relationships. The research model proposed in the study successfully explained the process in which individuals commit to hygienic behaviors, prioritize local restaurants, and engage in conscious consumption under the threat of COVID-19. The proposed model can be utilized in examining consumer behaviors in the hospitality industry, especially in the COVID-19 era.

Essential but Ill-Prepared: How the COVID-19 Pandemic Affects the Mental Health of the Grocery Store Workforce

OBJECTIVES

Frontline essential workers face elevated risks of exposure to COVID-19 because of the interactive nature of their jobs, which require high levels of interaction with the general public and coworkers. The impact of these elevated risks on the mental health of essential workers, especially outside the health care sector, is not well studied. To address this knowledge gap, we examined correlations between perceptions of workplace risks and mental health distress among grocery store workers in Arizona.

METHODS

We collected the first statewide sample of essential workers outside the health care sector focused on mental health and well-being. A total of 3344 grocery store workers in Arizona completed an online survey in July 2020. We used multiple regression models to identify demographic and work-based correlates of mental health distress.

RESULTS

Levels of mental health distress among respondents were high: 557 of 3169 (17.6%) reported severe levels and 482 of 3168 (15.2%) reported moderate levels. Perceptions of workplace safety were strongly correlated with significantly reduced levels of mental health distress (ß = -1.44; SE = 0.20) and reduced perceived stress (ß = -0.97; SE = 0.16). Financially disadvantaged workers and employees aged <55 reported high levels of mental health distress. Perceptions of safety and protection in the workplace were significantly correlated with availability of safety trainings, social distancing, and policies governing customer behaviors.

CONCLUSIONS

Lacking sufficient workplace protections, grocery store employees in Arizona experienced high levels of mental health distress during the COVID-19 pandemic. Providing clear federal and state policies to employers to guide implementation of workplace protections may help reduce sources of mental health distress.

Bull's eye or typhoon eye? Psychological distress and associated factors in Wuhan and surrounding areas during the COVID-19 pandemic

The COVID-19 pandemic caused significant psychological consequences among the public, especially for people in the epicenter. This study examined the 'bull's eye' model by comparing the level of psychological distress and the effect of different stressors in Wuhan (the original epicenter) with that in the surrounding areas in Hubei Province during the pandemic. Data were obtained from a cross-national survey of 10 478 respondents between the ages of 18 and 80 years in Hubei Province during the peak of the pandemic. Results of the ordinary least squares regression models showed that Wuhan residents experienced more psychological distress than those in the surrounding areas. Social and economic problems caused by the pandemic, risk exposure, perceived discrimination, and information-seeking behaviors were positively associated with distress. Social assistance was negatively associated with distress. Findings were consistent with the bull's eye model by revealing both a higher level of psychological distress and a stronger effect of stressors among the Wuhan residents than with those in low-risk areas. Thus, policymakers and psychological workers should provide adequate psychological services in high-risk areas. Lowering risk exposure, reducing discrimination against people in the epicenter, and improving information quality are essential to alleviate their psychological distress.

Psychological impact of the COVID-19 pandemic on Chinese population: An online survey

BACKGROUND

The ongoing coronavirus disease 2019 (COVID-19) pandemic infiltrates every aspect of our life, including the psychological impact. China has experienced the first wave of this epidemic, and it is now affecting the global population.

AIM

This study aimed to investigate the prevalence and associated factors of post-traumatic stress disorder (PTSD) among the general Chinese population.

METHODS

A detailed questionnaire, comprising of 38 questions designed in both English and Chinese, was developed. The survey was conducted via WeChat, a multi-purpose messaging, social media, and mobile payment app, which is widely used by the Chinese population.

RESULTS

In total, 1082 individuals from 31 provinces, autonomous regions, and municipalities participated in the survey by filling the questionnaires through the WeChat app. 97.8% of the participants had an Impact of Event-Scale-Revised (IES-R) total score above 20, which is an indicator of PTSD. The IES-R total and all the three subscales, including intrusion, avoidance, and hyperarousal, are significantly correlated with age. In addition, age, profession, marital status, and level of education are significantly correlated with the degree of PTSD symptoms.

CONCLUSION

The COVID-19 epidemic has widely caused PTSD among the general Chinese population. These results bear important implications for regions struggling with the pandemic to implement effective interventions to cope with these mental health problems.

Factors related to perceived stress during the COVID-19 epidemic context among the general population in China: A cross-sectional nationwide study

BACKGROUND

This study aimed to investigate factors related to high stress levels among the general population in China during the novel coronavirus disease (COVID-19) pandemic when its containment measures were in place and to identify the most stressed populations.

METHODS

A nationwide study was conducted online among 5,039 adults in all 31 provinces in mainland China between March 1 and March 16, 2020. Bivariate analysis and multivariate logistic regressions were performed to explore the related factors of high perceived stress.

RESULTS

Among all respondents, 36.0% reported a high level of stress. Respondents in Hubei province (the epicenter) were more likely to report high stress levels than those in low epidemic areas. Respondents who went outside every day or every other day reported greater odds of experiencing a high level of stress than those who went outside every 8-14 days. People with higher risk perceptions were more prone to report high stress levels. Respondents aged 16-35 were more likely to report high stress than respondents aged 46 or older. Lower household income and lower health literacy were related to increased odds of reporting high stress levels.

LIMITATIONS

We used a convenience sample and self-reported survey data.

CONCLUSIONS

We identified risk factors for high stress levels related to the epidemic (epidemic intensity in residential areas, risk perception, and frequency of going outside) and other vulnerabilities (younger age, low household income, low health literacy). Our findings can directly inform interventions and policies for mitigating stress among the general population for this or future epidemics.

Evaluation of Job Strain of Family Physicians in COVID-19 Pandemic Period- An Example from Turkey

The purpose of this study was to evaluate family physicians' job strain during the Covid-19 pandemic and determine the effective factors. The study was carried out between 01 May 2020 and 01 June 2020 by applying an online questionnaire to family physicians who worked in primary care in Istanbul and could be reached by telephone application. The survey created by us included socio-demographic information and the Job Strain Scale Short Form. P value was accepted as 0.05, and SPSS 20 package program was used in statistical analysis. 448 Family Physicians participated in the study. Anxiety levels of the participants increased after the pandemic (p < 0.001). Job strain score increased significantly during the pandemic process (p < 0.001). The 'Workload' sub-dimension of the job strain score was affected by young age, not having children, thinking that the working hours increased, deterioration of sleep quality and increasing anxiety level. It was determined that there was an increase in the "Control" sub-dimension score of family physicians who thought that they were not provided with adequate protective equipment during the pandemic process and who did not find the use of their own personal protective equipment sufficient. 'Social support' sub-dimension mean score decreased during the pandemic period. It was determined that it significantly increased in married family physicians compared to single ones. In the pandemic process, anxiety, sleep quality deterioration and job strain increased significantly. In family physicians, after the pandemic, workload and control sub-dimension changes increased, while social support sub-dimension decreased.

"Melanincholy": A Qualitative Exploration of Youth Media Use, Vicarious Racism, and Perceptions of Health

PURPOSE

We sought to (1) characterize teens' experiences with news and social media, focusing on news depicting racism, (2) assess youth perceptions of how these experiences may impact their own health, and (3) explore how teens cope with racism encountered in media. We hypothesized that teens access news primarily through social media, and vicarious racism experienced via news increases negative perceptions of health.

METHODS

Eighteen teens (aged 13-19 years) were recruited to participate in focus group interviews (N = 4). These were recorded, transcribed, and coded using qualitative methods.

RESULTS

Youth spend much of each day online and frequently access social media, including news shared on these platforms. Many participants identified concerns surrounding "fake" news on social media. Participants reported encountering racially charged news and described their responses to these stories. Some reported feeling overwhelmed by racism in the news. Most participants perceived negative mood changes after exposure to racism in online news, although few associated this exposure with changes in their own health behaviors. Youth indicated that peer discussion was important for coping with vicarious racism exposure.

CONCLUSIONS

This study provides insight into the way teens access and share information through social media, including news involving racism, and the effect that this information may have on them. Their vicarious experiences of racism in the news may be associated with feelings of desensitization and mood changes, with potential downstream effects on health. Peer support may help teens cope with vicarious racism. Longitudinal studies examining these exposures' health effects and opportunities for cross-sector intervention are needed.

Sense of Coherence and Mental Health in College Students After Returning to School During COVID-19: The Moderating Role of Media Exposure

The COVID-19 pandemic not only threatens people's physical health, but also affects their mental health in the long term. Although people had returned to work and school, they are closely monitoring the development of the epidemic and taking preventive measures. This study attempted to examine the relationship between media exposure, sense of coherence (SOC) and mental health, and the moderating effect of media exposure in college students after returning to school. In the present study, we conducted a cross sectional survey on 424 college students returning to school around May 2020. Self-report questionnaires were used to assess media exposure scale, SOC, depression, anxiety and stress. Correlation and moderation analysis was conducted. The results showed that (1) negative epidemic information exposure, rather than positive epidemic information exposure, was significantly associated with depression, anxiety, and stress. (2) SOC was also associated with depression, anxiety, and stress. (3) The effect of SOC on depression was modified by negative epidemic information exposure. With the increase of negative epidemic information exposure, the predictive effect of SOC on depression is increasing gradually. These findings demonstrated that negative epidemic information exposure was associated with an increased psychological distress in the sample. A high SOC played a certain protective role in the adaptation of college students in the post-epidemic period. It is important to find more ways to increase the colleges' SOC level and avoid negative information exposure.

Depression level and coping responses toward the movement control order and its impact on quality of life in the Malaysian community during the COVID-19 pandemic: a web-based cross-sectional study

BACKGROUND

Coronavirus 2019 disease (COVID-19) is a highly infectious disease prompting extreme containment measures, including lockdown, travel restrictions, social distancing, and stringent personal hygiene. This study investigates the depression level and coping responses toward the lockdown, referred as the movement control order (MCO) during COVID-19 pandemic in Malaysia and its impact on quality of life.

METHOD

This cross-sectional study was conducted from April to May 2020. The outcomes were assessed using the Depression, Anxiety and Stress Scale-21, Coping Orientation to Problems Experienced Inventory, and World Health Organisation Quality of Life-BREF Scale (WHOQOL-BREF) in both English and validated Malay versions.

RESULTS

Mild-to-severe depression was found in 28.2% (n = 149) of the 528 respondents. Respondents with mild-to-severe depression were significantly younger (33.09 ± 10.08 versus 36.79 ± 12.47 years), without partner (71.8% versus 45.6%), lived in the red zone (85.9% versus 71.0%), and had lower household income as defined in the category of B40 (51.7% versus 39.3%) compared to those without depression (all p < 0.01). The avoidant coping score was significantly higher (25.43 ± 5.69 versus 20.78 ± 5.65), while the religious coping score was significantly lower (5.10 ± 2.07 versus 5.94 ± 2.11) among those with mild-to-severe depression compared to those without depression (both p < 0.001). Respondents with mild-to-severe depression also had significantly lower mean score in each domain of WHOQOL-BREF compare to those without depression [(physical health, 13.63 ± 2.66 versus 16.20 ± 2.11), (psychological, 12.5 ± 2.79 versus 16.10 ± 2.14), (social relationships, 12.17 ± 3.49 versus 15.28 ± 2.93), environment (14.50 ± 2.39 versus 16.21 ± 2.14), all p < 0.001] after controlling for age, marital status, zone, household income, and coping scores.

CONCLUSION

COVID-19 lockdown had adverse mental health effects. Our study highlighted that approximately one in three individual experienced mild-to-severe depression during the nationwide MCO. The varied impact of the pandemic on mental health could be due to different population characteristics and coping strategies used. Identifying those at higher risk to develop depression during MCO for COVID-19 pandemic could help mental healthcare service providers to plan services for those susceptible, thereby mitigating the pandemic's effect on quality of life.

A Perfect Storm? Health Anxiety, Contamination Fears, and COVID-19: Lessons Learned from Past Pandemics and Current Challenges

The novel coronavirus disease 2019 (COVID-19) rapidly spread, becoming a global pandemic with significant health, economic, and social impacts. COVID-19 has caused widespread anxiety, which at healthy levels leads to adaptive, protective behavioral changes. For some individuals, a pandemic outbreak can lead to excessive, maladaptive levels of anxiety, particularly among those with obsessive-compulsive disorder (OCD) and health anxiety. In the present paper, we review past research studies that examined anxiety in response to other disease outbreaks (including Swine Flu, Zika, and Ebola) to serve as a guide for expectable responses to COVID-19. Our review focused on the role of belief-based cognitive variables (obsessive beliefs, contamination cognitions), transdiagnostic processes (disgust sensitivity, anxiety sensitivity, an intolerance of uncertainty), social factors, and environmental/situational variables as contributing factors to excessive concerns about past pandemics. These factors in combination with unique characteristics of the virus (disease, behavioral, social and economic factors) and media consumption might enhance vulnerability to excessive anxiety about COVID-19, in line with a diathesis-stress model. COVID-19 is also unique from past pandemics due to its severity, easy transmissibility, and the nature of prescribed behavioral responses (i.e., hand washing and social distancing). We therefore discuss the ways in which COVID-19 may disproportionately affect individuals with OCD and health anxiety. We conclude with important topics for clinical and research attention to help mental health professionals respond in this time of crisis.

An evaluation of the mental health impact of SARS-CoV-2 on patients, general public and healthcare professionals: A systematic review and meta-analysis

BACKGROUND

The global impact of COVID-19 pandemic continues to affect the lives of billions of people with recurrent waves. Healthcare systems are struggling to manage pre-existing patient care and recurring covid-19 demands. As a result, we evaluated the mental health impact using systematic review and meta-analysis.

METHODS

A comprehensive search was undertaken from April 2020 to 22nd January 2021 using multiple electronic databases. A systematic review protocol was developed and published on PROSPERO registration; CRD42020181481. A random-effects model was used to compute pooled estimates of anxiety, depression, PTSD, insomnia and suicidal thoughts.

FINDINGS

Our search yielded 11,295 studies and of those 287 met the inclusion criteria. The meta-analysis of 206 studies revealed minimal differences in prevalence of anxiety, depression, and PTSD among HCPs compared with the public during the pandemic but higher prevalence of suicidal thoughts/ideation or self-harm (11% vs 5.8%) and lower prevalence of wellbeing (28.2% vs 52.6%) among the public compared to HCPs.

INTERPRETATION

The pandemic has led to a high mental health burden especially amongst HCPs and higher suicidal ideation and lower wellbeing in general public which warrants further investigation and management globally. These findings highlight an emerging critical public health issue that requires urgent solutions.

Icing on the Cake: "Amplification Effect" of Innovative Information Form in News Reports About COVID-19

In the information era, the instant and diversified broadcasting of the COVID-19 pandemic has played an important role in stabilizing the societal mental state and avoiding inter-group conflicts. The presentation of visual graphics was considered as an innovative information form and broadly utilized in news reports. However, its effects on the audiences' cognition and behaviors have received little empirical attention. The current study applied real-time and retrospective priming paradigms to examine the impacts of information framing (positive vs. negative) and form (plain text vs. pie chart) on individuals' risk perception (cognition), positive emotion (emotion), and willingness to help others (behavioral intention) during the outbreak and post-pandemic period in China. The results indicated the "amplification effect" of the innovative form of information in the real-time priming condition, which increased the effect of the information framing on cognition, emotion, and behavioral intention. However, in the retrospective priming condition, the amplification effect on cognition and emotion were weakened, while its effect on behavioral intention disappeared. In conclusion, the study found the "amplification effect" of innovative information forms. Further, the difference in the results in the real-time and retrospective priming paradigms suggested the constraint of the context of the "amplification effect," and indicated the possible deviation of the retrospective paradigm in studies about disaster-related news. This study provides empirical support for how subtle changes in information presentation influence public mental and behavioral responses during a pandemic and has important implications for media psychology and social governance.

‘Freedom From Fear and Want’ and Our Psychological Response to Environmental Changes

Freedom from fear and freedom from want are two of the fundamental freedoms and likely related to changes in the environment. It has usually been assumed that our subjective feelings should change accordingly with changes in the objective environment. However, two counterintuitive effects reviewed in this article imply a rather complex psychological mechanism behind how people respond to environmental changes and strive for the freedom from fear and want. The first is the ‘psychological typhoon eye’ effect, in which the closer people are to hazards, the calmer they feel. Several possible explanations have been proposed, but the mechanism behind this effect remains unclear. The findings are important for future post-disaster interventions and helpful for policy makers in risk management and researchers in risk studies. The second effect is the ‘town dislocation’ effect, wherein although inhabitants’ objective quality of life is improved during the urbanisation process, the projected endorsement and rated social ambience of town residents is lower than that of residents in the country and in the city; this effect is mediated by social support. The findings have implications for how to better assess the urbanisation process and how to improve people's affective appraisals of their living environment.

Risk Perception and PTSD Symptoms of Medical Staff Combating Against COVID-19: A PLS Structural Equation Model

Medical staff were battling against coronavirus disease 2019 (COVID-19) at the expense of their physical and mental health, particularly at risk for posttraumatic stress disorder (PTSD). In this case, intervening PTSD of medical staff and preparing them for future outbreaks are important. Previous studies showed that perceived stress was related to the development of PTSD. Hence, in this study, the association between risk perception of medical staff and PTSD symptoms in COVID-19 and the potential links were explored. Three hundred four medical staff's exposure to COVID-19 patients, risk perception for working during COVID-19, PTSD symptoms, anxiety, and sleep quality were measured. Mediation analysis tested the indirect effects of anxiety and sleep quality on the relationship between risk perceptions and PTSD symptoms; 27.6% of participants were deemed as having probable PTSD diagnosis. Mediation analysis showed a significant chain-mediating effect of anxiety and sleep quality on the relationships between risk perceptions and PTSD symptoms; higher risk perceptions were related to increased anxiety, worsened sleep quality, and severe PTSD symptoms. Conclusively, medical staff have a high prevalence of PTSD symptoms after 3 months of COVID-19. Their PTSD symptoms were associated with the perceived risk level through the potential links with anxiety and sleep quality. Therefore, risk perception could be critical for our medical staff's responses to public health emergencies. It could be plausible to intervene in the perceived stress to alleviate aroused anxiety and improve sleep quality and thereby deter the development of PTSD.

Preliminary evidence for a relationship between prospective memory and PTSD symptoms in the general population

INTRODUCTION

PTSD sufferers often have problems with remembering the past, but do they also have trouble remembering tasks to be completed in the future? We argue characteristics of PTSD-such as negative appraisals and maladaptive strategies-might contribute to biased reporting of prospective memory failures among PTSD sufferers-or people with severe PTSD symptoms-within a general population.

METHODS

Mechanical Turk participants completed a questionnaire battery measuring self-report prospective memory, PTSD symptoms, negative appraisals and maladaptive strategies (e.g., suppression), and depression, anxiety and stress symptoms.

RESULTS

PTSD symptom severity positively correlated with self-report prospective memory failures (rs = .42-49). PTSD symptoms affected self-report prospective memory via their influence on negative appraisals and maladaptive strategies.

LIMITATIONS

Our findings rely on self-report, therefore we do not know if this relationship generalizes to objective prospective memory tasks.

CONCLUSIONS

Our data provide preliminary evidence for a relationship between PTSD symptomatology and subjective prospective memory in the general population and suggest that the negative appraisals and maladaptive strategies that commonly accompany PTSD might underpin this relationship.

Anxiety and resilience in the face of natural disasters associated with climate change: A review and methodological critique

In the past two decades, climate change-related natural disasters, such as hurricanes, floods, and droughts have become increasingly frequent and severe, impacting the emotional and psychological well-being of those who are directly or indirectly exposed to them. Despite great interest in understanding differences in anxiety and resilience in response to natural disasters, enthusiasm appears to outstrip empirical clarity, as there remains considerable ambiguity as to determinants of resilient or pathological outcomes following exposure to natural disasters. In addition, there are several major methodological limitations in climate change and related natural disaster research, including the use of univariate analyses, cross-sectional design, and retrospective measures. Keeping these limitations in mind, we first review literature examining the mental health outcomes of natural disasters. Findings suggest that, overall, resilience is more common than pathological outcomes. Second, we use a multi-dimensional framework of resilience to selectively review factors at the event, individual, as well as family and community levels that could help inform resilient or pathological outcomes. Finally, we consider key limitations and future directions for research and practice in the field of anxiety and resilience in response to climate disasters.

Safety and Confidence in Local Law Enforcement and Government During Serial Shooting Events: Association With Daily Life Activities

OBJECTIVE

This study examined the relationship of perceived safety and confidence in local law enforcement and government to changes in daily life activities during the Washington, DC, sniper attacks.

METHODS

Participants were 1238 residents from the Washington, DC metropolitan area who were assessed using an Internet survey that included items related to safety at work, at home, and in general, confidence in law enforcement/government, and changes in routine daily life activities.

RESULTS

A majority of participants (52%, n = 640) reported changing their daily life activities, with approximately one-third identifying changes related to being in large places and getting gas. Perceived safety was associated with confidence in local law enforcement/government. After adjusting for demographics, lower feelings of safety and less confidence in law enforcement/government were related to a higher likelihood of altered daily activities. Confidence in local law enforcement/government modified the association of safety with changes in daily activities. Among participants with high safety, less confidence in local law enforcement/government was associated with greater changes in daily life activities.

CONCLUSIONS

Serial shooting events affect feelings of safety and disrupt routine life activities. Focus on enhancing experiences of safety and confidence in local law enforcement and government may decrease the life disruption associated with terrorist shootings.

The psychological states of people after Wuhan eased the lockdown

It has been two months since Wuhan eased the lockdown and the people of Wuhan have been under great pressure during COVID-19. The psychological status among healthcare workers and residents were barely know due to the lack of research after Wuhan eased of the lockdown. The purpose of this study was to assess people's mental health and the changes after Wuhan eased the lockdown. A cross-sectional online study among citizens in Wuhan was conducted. Among 1417 participants, 387(27.0%) were frontline healthcare workers and 1035(73.0%) were residents from the general public. Their COVID-19 psychological status was evaluated using Patient Health Questionnaire-9(PHQ-9), Generalized Anxiety Disorder 7-item (GAD-7), and the PTSD Checklist-Civilian Version (PCL-C). Results show that 16.1%,22.3% and 17.2% healthcare workers and 21.2%, 16.7% and 17.2% general public had symptoms of depression, anxiety and PTSD ranging from moderate to severe. Anxiety levels were not significantly different between healthcare workers and the general public. The decreased income and the frequent social media exposure are the risk factors for general public. Compared to the early COVID-19 epidemic period, the proportion of anxiety and depression among both the general public and health workers decreased after Wuhan eased the lockdown. Our finding can be used to help the government of Wuhan to develop psychological interventions to improve the mental health of the population and work as a reference of public health guidelines for other cities with severe COVID-19 outbreak.

Associations Between Media Exposure and Mental Distress Among U.S. Adults at the Beginning of the COVID-19 Pandemic

INTRODUCTION

Exposure to disaster-related media may be a risk factor for mental distress, but this has not been examined in the context of the COVID-19 pandemic. This study assesses whether exposure to social and traditional media during the rise of the COVID-19 pandemic was associated with mental distress among U.S. adults.

METHODS

Data came from the Understanding America Study, conducted with a cross-sectional, nationally representative sample of adults who completed surveys online. Participants included 6,329 adults surveyed between March 10 and March 31, 2020. Regression analyses examined the associations of (1) self-reported average time spent on social media in a day (hours) and (2) number of traditional media sources (radio, TV, and newspaper) consulted to learn about COVID-19 with self-reported mental distress (4-item Patient Health Questionnaire). Data were analyzed in April 2020.

RESULTS

Participants responding at later survey dates reported more time spent on social media (β=0.02, 95% CI=0.01, 0.03), a greater number of traditional media sources consulted to learn about COVID-19 (β=0.01, 95% CI=0.01, 0.02), and greater mental distress (β=0.07, 95% CI=0.04, 0.09). Increased time spent on social media and consulting a greater number of traditional media sources to learn about COVID-19 were independently associated with increased mental distress, even after adjusting for potential confounders (social media: β=0.14, 95% CI=0.05, 0.23; traditional media: β=0.14, 95% CI=0.08, 0.20).

CONCLUSIONS

Exposure to a greater number of traditional media sources and more hours on social media was modestly associated with mental distress during the rise of the COVID-19 pandemic in the U.S.

Is perceived safety and threat after workplace terrorism linked to employee sick-leave? A registry-based longitudinal study of governmental employees in Norway

BACKGROUND

A large body of research has shown that terrorism enhances fears and undermines perceived safety in a high proportion of both directly exposed individuals and individuals without any form of direct exposure (i.e. no geographical proximity to an attack). Some studies have further suggested that fear of terrorism may adversely affect health in those without direct exposure and that this may constitute an important public health burden because of the number who are indirectly exposed. Limited studies have investigated threat and safety perception after workplace terrorism and the possible consequences for employee health.

OBJECTIVE

To explore whether perceived safety and threat in employees whose workplace was subjected to a terrorist attack are associated with subsequent sick-leave.

METHOD

A longitudinal questionnaire survey on governmental employees' perceived safety and threat at work one (T1) and two (T2) years after the 2011 terrorist attack on the Norwegian ministries was linked to registry data on doctor-certified sick-leave for two 9-month periods following T1 and T2 (N = 1703).

RESULTS

There was fairly strong evidence (0.004 < p < 0.034) that higher perceived safety was associated with a close to 30% reduction in sick-leave in fully adjusted models which included terror exposure and symptom-based PTSD. There was inconclusive evidence that lower perceived threat was associated with reduced sick-leave in the full models.

CONCLUSIONS

Reduced perceived safety in employees following workplace terrorism may have adverse health consequences of public health significance given how prevalent this perception seems to be. The study supports that post-terrorism response plans should include strategies on how to address the potentially large number of individuals suffering ill health after terror even if they were not directly exposed and do not meet criteria for PTSD.

Media use and acute psychological outcomes during COVID-19 outbreak in China

The COVID-19 outbreak in China led to an extraordinary threat to public health and wellbeing. This study examined the psychological impact of media use among people indirectly exposed to the disease during the initial phase of the outbreak. We conducted an internet-based survey on January 28, 2020 (one week after the official declaration of person-to-person transmission of the coronavirus). Media use (media forms, content of media exposure, and media engagement) related to the outbreak and psychological outcomes (positive and negative affect, anxiety, depression, and stress) of 917 Chinese adults was assessed. A series of multivariable regressions were conducted. The results showed that use of new media, rather than traditional media, was significantly associated with more negative affect, depression, anxiety, and stress. Viewing stressful content (i.e., severity of the outbreak, reports from hospital) was associated with more negative affect and depression. Media engagement was also associated with more negative affect, anxiety, and stress. However, viewing heroic acts, speeches from experts, and knowledge of the disease and prevention were associated with more positive affect and less depression. The study suggested new media use and more media engagement was associated with negative psychological outcomes, while certain media content was associated with positive psychological impact. The present study highlights the need for timely public health communication from official sources and suggests that reduced exposure to new media may be beneficial.

Immediate psychological impact on nurses working at 42 government-designated hospitals during COVID-19 outbreak in China: A cross-sectional study

BACKGROUND

During an epidemic of a novel infectious disease, frontline nurses suffer from unprecedented psychological stress. This study aimed to assess the immediate psychological impact on frontline nurses in China.

METHODS

A multicenter, cross-sectional survey of frontline nurses was conducted via online questionnaires. Symptoms of depression, anxiety, somatic disorders, and suicidal ideation were evaluated. Demographic, stress, and support variables were entered into logistic regression analysis to identify the impact factors.

FINDINGS

Of the 4,692 nurses who completed the survey, 9.4% (n = 442) were considered to have depressive symptoms, 8.1% (n = 379) represented anxiety, and 42.7% (n = 2,005) had somatic symptom. About 6.5% (n = 306) respondents had suicidal ideation.

DISCUSSION

The study showed that the overall mental health of frontline nurses was generally poor during COVID-19 outbreak, and several impact factors associated with nurses' psychological health were identified. Further research is needed to ascertain whether training and support strategies are indeed able to mitigate psychological morbidities.

Healthcare Providers on the Frontline: A Quantitative Investigation of the Stress and Recent Onset Psychological Impact of Delivering Health Care Services During COVID-19 in Kashmir

BACKGROUND

Frontline healthcare workers (FHCWs) are at an increased risk of contracting COVID-19. We aimed to assess the stress and psychological impact of the COVID-19 pandemic among FHCWs.

METHODS

This was an exploratory hospital-based study. A semistructured e-questionnaire was developed and shared through emails, WhatsApp groups, Facebook, and Twitter. The study instruments used were stress questionnaire and the impact of event scale-revised.

RESULTS

We received 133 valid responses. A total of 81 (61.4%) of the respondents were single, 74 (55.6) were male, 70 (52.6%) were between 20 and 29 years of age, and 91 (68.4%) were from urban background. A total of 83 (62.4%) of respondents were doctors and 28 (21.1%) were registered nurses. A total of 36 (27.1%) were posted in emergency and 34 (25.6%) were in the in-patient department. Feeling sad and pessimistic, feeling of being avoided by others, the burden of change in the quality of work, and worrying whether the family will be cared for in their absence were significantly more in nurses as compared to the doctors. Stress due to burden in an increase in the quantity of work was seen more in FHCWs working in the swab collection center as compared to those working in the in-patient department, emergency, or theaters. Severe psychological impact was seen in 81 (60.9%) of FHCWs. The psychological impact was significantly more in males and in those who were married. It was also significantly related to the place of posting.

CONCLUSION

More than half of the FHCWs had a severe psychological impact owing to COVID-19. The psychological impact was more in males and those who were married, and it was related to the place of posting of the FHCWs. Nurses had significantly higher stress as compared to doctors.

Posttraumatic stress symptoms of health care workers during the corona virus disease 2019

Corona virus disease 2019 (COVID‐19) outbreak has attracted worldwide attention. The COVID‐19 outbreak is unique in its rapid transmission and results in heavy stress for the front‐line health care workers (HCWs). The current study aimed to exam posttraumatic stress symptoms (PTSSs) of HCWs fighting for the COVID‐19 and to evaluate their sleep quality after 1‐month stressful suffering. Three hundred seventy‐seven HCWs working in different provinces of China participated in the survey between February 1 and 5. The demographic information was collected first. Posttraumatic Stress Disorder Checklist for DSM‐5 (PCL‐5) and the Pittsburgh Sleep Quality Index (PSQI) were selected to measure PTSSs and sleep quality. Results showed that 1 month after the outbreak, the prevalence of PTSSs was 3.8% in HCWs. Female HCWs were more vulnerable to PTSSs with hazard ratio of 2.136 (95% CI = 1.388–3.286). HCWs with higher exposure level also significantly rated more hyperarousal symptoms (hazard ratio = 4.026, 95% CI = 1.233–13.140). There was a significant difference of sleep quality between participants with and without PTSSs (z value = 6.014, p < .001) and among different groups with various contact frequencies (chi‐square = 7.307, p = .026). Path analysis showed that there was a significant indirect effect from exposure level to PTSSs through sleep quality (coefficient = 1.750, 95% CI of Boostroop test = 0.543–2.998). In summary, targeted interventions on sleep contribute to the mental recovery during the outbreak of COVID‐19. Understanding the mental health response after a public health emergency might help HCWs and communities prepare for a population's response to disaster.

Active Shooter and Terrorist Event-Related Posttraumatic Stress and Depression: Television Viewing and Perceived Safety

OBJECTIVE

This study examined the relationship of sniper-related television viewing (TV) and perceived safety to posttraumatic stress (PTS) and depressive symptoms during the Washington, DC sniper attacks.

METHODS

Participants were 1238 Washington, DC area residents assessed using an internet survey including the Impact of Event Scale-Revised, Patient Health Questionnaire-9, hours of TV, and perceived safety.

RESULTS

Almost 40% (n = 459) of participants watched at least 2 hours of sniper-related TV daily. TV viewing was associated with lower total perceived safety. After adjusting for demographics, more TV viewing and decreased perceived safety were related to increased PTS and depressive symptoms. TV viewing modified the effect of safety on PTS and depressive symptoms. Among participants with low and high perceived safety, hours of TV were positively associated with PTS; however, the effect was stronger among those with low perceived safety. The relationship of TV to increased depressive symptoms was identified only in participants who reported low perceived safety.

CONCLUSIONS

The influence of media exposure and perceived safety have implications for intervention by community leaders and mental health care providers. Recommendations include limiting media exposure during a terrorist event, particularly among those who perceive that their safety is at risk, and targeting safety in communication strategies. (Disaster Med Public Health Preparedness. 2019;13:570-576).

The Psychophysics of Terror Attack Casualty Counts

In communicating the risk that terror attacks pose to the public, government agencies and other organizations must understand which characteristics of an attack contribute to the public's perception of its severity. An attack's casualty count is one of the most commonly used metrics of a terror attack's severity, yet it is unclear whether the public responds to information about casualty count when forming affective and cognitive reactions to terror attacks. This study sought to characterize the "psychophysical function" relating terror attack casualty counts to the severity of the affective and cognitive reactions they elicit. We recruited n = 684 Mechanical Turk participants to read a realistic vignette depicting either a biological or radiological terror attack, whose death toll ranged from 20 to 50,000, and rated their levels of fear and anger along with the attack's severity. Even when controlling for the perceived plausibility of the scenarios, participants' severity ratings of each attack were logarithmic with respect to casualty count, while ratings of fear and anger did not significantly depend on casualty count. These results were consistent across attack weapon (biological vs. radiological) and time horizon of the casualties (same-day or anticipated to occur over several years). These results complement past work on life loss valuation and highlight a potential bifurcation between the public's affective and cognitive evaluations of terror attacks.

Living Well in Times of Threat: The Importance of Adjustment Processes to Explain Functional Adaptation to Uncertain Security in Expatriates Deployed in the Sudan

The present study investigated expatriate humanitarian aid workers' perceptions and responses to uncertain security while deployed in the Sudan. Interviews conducted in Khartoum (n = 7) and Darfur (n = 17) focused on risk perception, concern for personal security, and strategies used to function well in an insecure environment. Despite a high perceived general risk, as well as broad knowledge and experience with security incidents, participants often expressed low concern. General adjustment processes were drawn on to explain this finding, while different constellations of processes resulted in different patterns of adjustment. Functional adjustment, resulting in adequate risk perception, protective behavior, protection, and low concern, was characterized by a constellation of complementary activation of accommodation and assimilation processes.

Cardiovascular Events after the Sewol Ferry Disaster, South Korea

BACKGROUND

Major incidents affecting large numbers of people may increase the rate of acute cardiovascular events, even among those who are not directly involved in the incident. It is hypothesized that the MV Sewol ferry disaster (South Korea) would increase the incidence of cardiovascular events nation-wide.

METHODS

Data on all adult patients (&gt;18 years) who were diagnosed with acute cardiovascular events, including acute myocardial infarction (MI), angina, and cardiac arrhythmias, were extracted from the National Emergency Department Information System (NEDIS) from March 15 through June 17, during the years 2011-2014 (four weeks before to eight weeks after the event date). Poisson regression models were used to calculate the incidence rate ratios (IRRs) comparing the weekly changes in the occurrences of cardiovascular events from the week of the Sewol event (April 16-22, 2014) to eight weeks after the disaster (June 11-17, 2014), using the one-month period before Sewol as a reference period (March 15-April 15), adjusting for calendar years (years 2011-2014) and environmental factors.

RESULTS

During the study periods, cardiovascular events were identified in 73,823 patients. Compared to the reference period, the week of the Sewol disaster and the three weeks after the disaster showed a significant increase in the number of acute cardiovascular events, IRRs of 1.09 (95% CI, 1.03-1.15) and 1.08 (95% CI, 1.02-1.15), respectively (P &lt;.01 for both). In particular, there was 21% increase in incidence of arrhythmia (IRR = 1.21; 95% CI, 1.02-1.44; P = .03) during the week of the Sewol disaster compared with the reference period.

CONCLUSION

This study showed a significant increase in the incidence of acute cardiovascular events during the week of, and the three weeks after, the Sewol ferry disaster in 2014. These additional cardiac emergencies may be triggered by emotional stressors related to the event, highlighting the public health importance of indirect exposure to a tragic catastrophe.Kong SY, Song KJ, Shin SD, Ro YS. Cardiovascular events after the Sewol ferry disaster, South Korea. Prehosp Disaster Med. 2019;34(2):142-148.

"Violence is Everywhere": Childhood Polyvictimization, Perceptions of the Prevalence of Victimization, and Posttraumatic Stress Symptoms

Childhood polyvictimization is related to a heightened risk for mental health and functional problems in young adulthood, including posttraumatic stress symptoms, but little research has examined how perceptions of the prevalence of victimization may contribute to specific symptoms of posttraumatic stress. The primary aims of the current study were to (a) evaluate the accuracy of young adults' beliefs about the prevalence of multiple types of childhood victimization and (b) determine how inaccurate appraisals of victimization prevalence are associated with posttraumatic stress symptoms. College students (n = 369) drawn from two geographic regions of the United States responded to an online survey assessing their experiences of childhood victimization, perceptions about the prevalence of victimization, emotion regulation skills, and mental health. Childhood polyvictimization was significantly and positively related to distorted appraisals of the prevalence of victimization overall (r = .26, p < .001), and emotion regulation was associated with symptoms of posttraumatic stress in all domains. Distorted perceptions of the prevalence of victimization were linked to higher symptoms of hyperarousal, but not to higher symptoms of reexperiencing, avoidance, or negative mood/cognition. Results suggest that emotion regulation skills training is likely to be beneficial for many individuals experiencing posttraumatic stress, and intervention around perceptions of the prevalence of victimization may be useful for addressing symptoms of hyperarousal.

Is the news making us unhappy? The influence of daily news exposure on emotional states

There is evidence that exposure to negative news is making people feel bad, but not much is known about why this only affects some people or whether this also applies to everyday news exposure. This study examined the direct and indirect effects of daily news exposure on people's affective states. Using ecological momentary assessment (EMA), 63 respondents (24 men and 39 women) reported their news exposure and affective states five times a day for 10 days. In addition, personal relevance of the news and personality characteristics, neuroticism and extraversion, were assessed. Results showed that negative news perceptions were related to more negative affect and less positive affect, and these effects were moderated by personal relevance, but not personality characteristics. The implications of these outcomes are discussed.

The association between disaster exposure and media use on post-traumatic stress disorder following Typhoon Hato in Macao, China

Background: Direct exposure to natural disasters and related losses are associated with post-traumatic stress disorder (PTSD). It is less clear whether indirect media exposure is associated with PTSD. Objective: This study investigated key exposure-related risk factors for PTSD and examined the effect of media exposure on the prevalence of disaster-related PTSD. Method: Typhoon Hato directly hit Macao on 23 August 2017. It was one of the most serious natural disasters ever to strike southern China. One month after the event, 1876 Chinese university students in Macao were recruited into a cross-sectional study (mean age 20.01 years, SD = 2.63; 66.2% female). Self-reported typhoon exposure, media use and exposure to disaster-related content, and PTSD symptoms were collected using an electronic survey. Univariable analyses assessed associations between risk factors and PTSD, which were then included in a series of multivariable logistic regressions. Results: The prevalence of PTSD was 5.1%. Adjusted models demonstrated that being male (vs female) [adjusted odds ratio (aOR) = 1.68, 95% confidence interval (CI) 1.07-2.63], home damage (aOR = 2.86, 95% CI 1.71-4.78), witnessing people injured (aOR = 2.33, 95% CI 1.36-4.00), and almost drowning during the storm (aOR = 8.99, 95% CI 1.92-41.99) were associated with PTSD. After adjusting for direct exposure, indirect exposure to disaster-related social media content, including information related to drowning victims (aOR = 1.29, 95% CI 1.00-1.67) and residents' emotional reactions (aOR = 1.98, 95% CI 1.44-2.72), was associated with PTSD. Viewing more information about the storm itself (aOR = 0.37, 95% CI 0.28-0.49) and images of heroic acts (aOR = 0.72, 95% CI 0.55-0.94) were significantly associated with lower odds of PTSD. Conclusion: These findings add to the literature demonstrating that some types of media use and certain media content following a natural disaster are associated with PTSD.

Distance to threat and risk of acute and posttraumatic stress disorder following bank robbery: A longitudinal study

Identifying pathways through which environmental risk factors influence PTSD is important for understanding PTSD etiology. Here, we hypothesized that the physical proximity to threat influences PTSD risk by increasing ASD following trauma. One hundred six bank employees who had experienced a bank robbery participated in the study. A longitudinal design assessing ASD at day 2 and PTSD at day 30 was used to test the hypothesis. Participants also indicated their location in the bank at the time of the robbery. ASD was identified in 40 (38%) and PTSD in 16 (15%) of the robbery victims. Distance to the robber had a strong effect on ASD (OR 3.51, 95% CI 1.94-6.34) and a somewhat lesser effect on PTSD (OR 2.15, 95% CI 1.04-4.46), indicating that the effect of proximity to threat on PTSD 1 month following trauma could be mediated by its effect on ASD 2 days following trauma. Using structural equation modeling, we confirmed that the effect of distance on PTSD was fully mediated by ASD. These findings suggest that proximity to threat may increase PTSD risk by enhancing the acute stress response following trauma.

Frequency of Improvised Explosive Devices and Suicide Attempts in the U.S. Army

BACKGROUND

Improvised explosive devices (IEDs) were a prominent and initially new threat in the Iraq and Afghanistan war which raised concerns and anticipatory fear in and out of theater. This study examined the association of monthly IED rates with risk of soldier suicide attempt among those deployed and nondeployed.

METHODS

Person-month records for all active duty Regular Army suicide attempters from 2004 through 2009 (n = 9,791) and an equal-probability sample of control person-months (n = 183,826) were identified. Logistic regression analyses examined soldiers' risk of attempting suicide as a function of monthly IED frequency, controlling for sociodemographics, service-related characteristics, rate of deployment/redeployment, and combat deaths and injuries. The association of IED frequency with suicide attempt was examined overall and by time in service and deployment status.

FINDINGS

Soldiers' risk of suicide attempt increased with increasing numbers of IEDs. Suicide attempt was 26% more likely for each 1,000 IED increase in monthly frequency (odds ratio [OR] = 1.26, 95% confidence interval [CI] = 1.22-1.30). The association of IED frequency with suicide attempt was greater for soldiers in their first 2 years of service (OR = 1.30, 95% CI = 1.25-1.36) than for those with 3 or more years of service (OR = 1.18, 95% CI = 1.12-1.24). Among soldiers in their first 2 years of service, the association was constant, regardless of deployment status (χ₂² = 3.89, p = 0.14). Among soldiers with 3 or more years of service, the association was higher for those never deployed (OR = 1.12, 95% CI = 1.01-1.24) and currently deployed (OR = 1.14, 95% CI = 1.05-1.23) than for those previously deployed.

DISCUSSION

To our knowledge, this is the first study to examine and demonstrate an association between the aggregate frequency of IEDs and risk of suicide attempts among U.S. Army soldiers. This association was observed across deployment status and time in service, and for early-career soldiers in particular. The findings suggest that the threat of new weapons may increase stress burden among soldiers. Targeting risk perception and perceived preparedness, particularly early in a soldier's career, may improve psychological resilience and reduce suicide risk.

Changes in Affect, Cognition, and Perceived Behavioral Changes Among Vicarious Victims of the Paris Terrorist Attacks of November 13, 2015

Terrorist attacks are supposed to hit not only the direct victims but the entire society. In this prospective longitudinal study, we examined changes in mood, life satisfaction, and terror-related cognitions and perceived behavioral changes 2, 4, and 8 weeks after the terrorist attacks of November 13, 2015, in Paris in a sample of the so-called vicarious victims ( N = 201). Average mood levels dropped significantly after the attacks compared to preattack levels but recovered within 8 weeks. Average levels of life satisfaction did not change significantly across this time period. Level of preoccupation with the attacks, perceptions of the likelihood of future terrorist attacks, and perceived changes in terror-related cognitions and behaviors declined over the 8 weeks after the attacks. Together, these findings indicate that terrorist attacks may impact changes in affect, cognition, and behavior even among vicarious victims; however, these changes are only temporary.