Mental health and clinical psychological science in the time of COVID-19: Challenges, opportunities, and a call to action

Examining the relationship between physical literacy and resilience against COVID-19-induced negative mental states in Chinese adolescents

Research indicates that COVID-19 has had adverse effects on the mental health of adolescents, exacerbating their negative psychological states. The purpose of this study is to investigate the impact of Physical Literacy (PL) on Negative Mental State caused by COVID-19 (NMSC) and identify potential factors related to NMSC and PL in Chinese adolescents. This cross-sectional study involved a total of 729 Chinese high school students with an average age of 16.2 ± 1.1 years. Participants' demographic data, PL data, and NMSC data were collected. PL and NMSC were measured using the self-reported Portuguese Physical Literacy Assessment Questionnaire (PPLA-Q), the Stress and Anxiety to Viral Epidemics-6 (SAVE-6), and the Fear of COVID-19 Scale (FCV-19). Adolescents in the current study demonstrated higher levels of NMSC and lower PL, with average scores of 3.45 and 2.26, respectively (on a scale of 5). Through multiple linear regression analysis, Motivation (MO), Confidence (CO), Emotional Regulation (ER), and Physical Regulation (PR) were identified as factors influencing NMSC in adolescents. The study findings contribute to providing guidance for actions aimed at alleviating NMSC among adolescents.

Brief School-Based Interventions Targeting Student Mental Health or Well-Being: A Systematic Review and Meta-Analysis

Brief, school-based mental health interventions hold promise for reducing barriers to mental health support access, a critical endeavor in light of increasing rates of mental health concerns among youth. However, there is no consensus on whether or not brief school-based interventions are effective at reducing mental health concerns or improving well-being. This systematic review and meta-analysis aims to provide consensus and determine directions for future work. Articles were included if they examined a brief (≤ four sessions or 240 min of intervention time) psychosocial intervention, were conducted within a Pre-K through 12th-grade school setting, included at least one treatment outcome evaluating mental health or well-being, and were published since 2000. A total of 6,702 papers were identified through database searching, of which 81 papers (k studies = 75) were ultimately selected for inclusion. A total of 40,498 students were included across studies and a total of 75 unique interventions were examined. A total of 324 effect sizes were extracted. On average, interventions led to statistically significant improvements in mental health/well-being outcomes versus control conditions up to one-month (g = .18, p = .004), six-month (g = .15, p = .006), and one-year (g = .10, p = .03) post-intervention. There may be benefits to brief school-based interventions from a preventative public health standpoint; future research may focus on how to optimize their real-world utility. Prospero pre-registration: CRD42021255079.

The link between exposure to violence and psychological distress among middle-aged Muslims in Israel: the role of gender

Introduction

To date, it is still unclear if exposure to violence affects psychological distress in middle-aged adults and if the effects are gender specific. This age group is of special interest as it is at the onset of the aging process and is often overlooked or understudied in scholarly research. Specifically, targeted research on middle-aged Muslims living in Israel, a unique population exposed to increasing violence, is lacking.

Methods

We examined the relationship between exposure to violence and psychological distress in a cohort of 363 middle-aged adults (223 women) from three Muslim villages in northern Israel, collecting data on violence exposure (Screen for Adolescent Violence Exposure (SAVE) questionnaire), psychological distress (Kessler 6 Psychological Distress questionnaire), and other demographic characteristics including education level and socioeconomic status. We used this data to answer two questions: (1) is exposure to violence a predictor of psychological distress in middle-aged Muslims, and (2) does the relationship between exposure and distress differ between men and women?

Results

We revealed a positive link between exposure to violence and psychological distress (β = 0.145, p = 0.017) when controlling for gender, age, education level, and socioeconomic level.

Discussion

Despite previous evidence of gender-based differences in this interplay in younger cohorts, we did not find a significant interaction between gender and the violence exposure-psychological distress interplay. Our findings are some of the first to focus on middle-aged individuals and show that both men and women exhibit connections between exposure to violence and psychological distress when considering covariates. This research provides insights that can be used when planning community-wide interventions and treatment schemes to support healthy aging.

Nursing student perspectives on improving mental health support services at university in Saudi Arabia - a qualitative study

BACKGROUND

University students' needs for mental health (MH) services are an important aspect of academic success or failure. Nursing students enrolled at Saudi Arabian universities in need of MH care encounter obstacles in accessing this type of care.

AIMS

The present work explores students' views and suggestions about the existing problems surrounding university students' MH and well-being support services.

METHODS

Twenty students enrolled in a Master of Nursing program were recruited as research participants. Individual interviews of students' perceptions of the needs and availability of MH services during their studies provided inductive data. These data were analysed through a constructivist thematic method.

FINDINGS

Three major themes and sub-themes regarding the issues and possibilities of MH services were distinguished from the research data, namely, social implications, access and opportunity, and ways to improve care. Participants emphasised a need for a university-wide approach to reforming MH services to provide students with the required support and alleviate service demand by qualified professionals.

CONCLUSION

The present work underscores the need for provision of good quality MH care for university students and health promotion which strives to reduce stigma related to MH care.

Changes in emotion regulation strategies during the pandemic: prospective pathways to adolescent depressive symptoms

BACKGROUND

Emotion regulation (ER) is considered central in adolescent psychopathology, and ER strategies may change during challenging times, such as a global pandemic. Despite this, there remains a limited understanding of individual differences in ER mechanisms and their associations with psychopathology. This study examined whether and how cognitive reappraisal, expressive suppression, and self-compassion changed over COVID-19 and how these changes uniquely predicted adolescents' depressive symptoms.

METHODS

A total of 2,411 adolescents (58.6% females; Mage = 18.51, SD = 0.80) completed the Emotional Regulation Questionnaire, the Self-compassion Scale, and the Symptom Checklist-90 before COVID-19 (in 2019) and during COVID-19 (in 2020). The predictive associations between each ER strategy and depressive symptoms were tested with latent change score models.

RESULTS

Adolescents' use of expressive suppression and self-compassion strategies both increased during COVID-19. More increases in expressive suppression predicted more depressive symptoms, whereas more increases in self-compassion predicted fewer depressive symptoms. Although, on average, cognitive reappraisal did not change, it did show significant variations within the sample - increases (vs. decreases) in cognitive appraisal predicted fewer depressive symptoms.

CONCLUSIONS

The study indicates how adolescents' ER strategies changed during the unprecedented global pandemic. It underscores protective roles of increased cognitive reappraisal and self-compassion, as well as the adverse consequence of heightened expressive suppression on adolescents' depressive symptoms. Findings offer insights for targeted interventions aimed at addressing specific ER strategies.

The Role of Anxiety and Prosocial Behaviors on Adherence Behaviors to Prevent COVID-19 in University Students in the United States: Cross-Sectional Study

Background

In situations of acute stress, individuals may engage in prosocial behaviors or risk-taking self-oriented behaviors. The COVID-19 pandemic created large stress-promoting conditions that impacted individuals' decisions to adhere to COVID-19 preventative behaviors.

objectives

The study aimed to examine the relationship between anxiety during the pandemic and adherence behaviors to prevent the spread of COVID-19, and the moderating influence of prosocial behaviors. We hypothesized that individuals with high anxiety during COVID-19 would adhere more to preventive COVID-19 behaviors than ones with low anxiety and that this relationship would be stronger in those individuals with higher prosocial behaviors.

Methods

A web-based survey was administered through the SONA web-based participant tool of the psychology department of a university in the Northeastern United States. A final sample of 54 undergraduate students completed web-based questionnaires during the second wave of the COVID-19 pandemic, from January to May 2021, which included demographic measures and surveys on prosocial behaviors, anxiety, and COVID-19 preventive behaviors. Moderation analyses were conducted using PROCESS in SPSS.

Results

Participants reported high levels of trait and state anxiety symptoms, most of them meeting or exceeding the cutoff criteria to be clinically meaningful (state anxiety: 47/54, 87%; trait anxiety: 38/44, 86%), and over 50% highly adhered to the COVID-19 preventive behaviors of wearing a face mask, using hand sanitizer, handwashing, coughing/sneezing into their elbow or a tissue, self-quarantining, maintaining social distance, avoiding social gatherings, and avoiding nonessential travel. No significant associations were observed between prosocial behavior, anxiety types, and adherence to COVID-19 preventive behaviors. However, when moderation analyses were conducted between anxiety types and adherence to COVID-19 preventive behaviors, results demonstrated a statistically significant interaction of public prosocial behavior with state anxiety (β=-.17, t53=-2.60; P=.01), predicting engagement in COVID-19 preventative behaviors. At high levels of anxiety, low levels of prosocial public behaviors were associated with higher engagement in COVID-19 preventative behaviors. In contrast, high levels of public prosocial behavior were associated with low engagement in COVID-19 preventative behaviors at higher levels of anxiety.

Conclusions

These results provide information that can aid in the creation of interventions that could increase adherence to COVID-19 preventative behaviors (Reviewed by the Plan P #PeerRef Community).

Future Directions for Community-Engaged Research in Clinical Psychological Science with Youth

Despite advances in clinical science, the burden of mental health problems among youth is not improving. To tackle this burden, clinical science with youth needs methods that include youth and family perspectives on context and public health. In this paper, we illustrate how community-engaged research (CEnR) methods center these perspectives. Although CEnR methods are well-established in other disciplines (e.g. social work, community psychology), they are underutilized in clinical science with youth. This is due in part to misperceptions of CEnR as resource-intensive, overly contextualized, incompatible with experimentally controlled modes of inquiry, or irrelevant to understanding youth mental health. By contrast, CEnR methods can provide real-world impact, contextualized clinical solutions, and sustainable outcomes. A key advantage of CEnR strategies is their flexibility-they fall across a continuum that centers community engagement as a core principle, and thus can be infused in a variety of research efforts, even those that center experimental control (e.g. randomized controlled trials). This paper provides a brief overview of this continuum of strategies and its application to youth-focused clinical science. We then discuss future directions of CEnR in clinical science with youth, as well as structural changes needed to advance this work. The goals of this paper are to help demystify CEnR and encourage clinical scientists to consider adopting methods that better consider context and intentionally engage the communities that our work seeks to serve.

Chinese college students' mental health during the first three months of the COVID-19 pandemic: the protective role of family functioning

Background

Various psychological theories suggest that a supportive family environment protects the mental health of young adults during stressful life events. However, evidence is limited regarding the protective role of family support during a major public health crisis.

Objective

To examine the role of family functioning on mental health among Chinese college students during first stage of the COVID-19 pandemic.

Methods

Between January-March 2020, 1,555 college students (44% female, on average 19 years old) from five Chinese universities participated. Participants rated their family functioning on the Family APGAR Index and their mental health on the Psychological Questionnaires for Emergent Events of Public Health, measuring depression, neurasthenia, fear, obsessive-anxiety and hypochondriasis.

Results

Better family functioning was associated with having fewer psychological symptoms. In addition, we identified three mental health profiles related to the severity across the psychological symptoms: Low-level, medium-level and high-level symptom clusters. Latent profile analysis showed that as family function improved, students were, respectively, 16 to 24% more likely to be in the low-level symptom group, compared to being in the medium symptom group or the high-level symptom group.

Conclusion

These results support the notion that family support may act as a psychological buffer for young adults during a large-scale public health crisis like the COVID-19 pandemic.

Exploring the Impact of COVID-19-Related Changes on the Well-Being of Korean Adolescents: An Analysis Using a Serial Mediation Model

PURPOSE

Few studies have investigated both the positive and negative impacts of perceived changes related to the COVID-19 pandemic on adolescents' wellbeing. This study aimed to comprehensively identify the factors associated with the overall wellbeing of the youth population.

METHODS

A cross-sectional study design was employed using data from the 2020 Korean Survey of Children and Youth. Data were collected from N = 7,170 adolescents (aged 9-24 years) during the implementation of social distancing measures in response to the COVID-19 pandemic. Participants provided self-reported data about their COVID-19-induced perceived changes, wellbeing, parental support, and self-esteem between November 2020 and February 2021. The effect of COVID-19-induced perceived changes on adolescents' wellbeing during the pandemic was assessed by evaluating the mediating roles of parental support and self-esteem.

RESULTS

The findings highlighted a serial mediating effect of parental support and self-esteem on the relationship between adolescents' COVID-19-related perceived changes and wellbeing.

DISCUSSION

This study deepens the understanding of the intricate interplay between pandemic-related perceived changes, mediating factors, and wellbeing among adolescents. The findings imply that a comprehensive approach combining interventions aimed at enhancing self-esteem at the individual level with parental support may be most effective in improving adolescents' wellbeing.

Testing a brief, self-guided values affirmation for behavioral activation intervention during COVID-19

This pilot study tested a single-session digital values affirmation for behavioral activation (VABA) intervention. Hypotheses predicted the VABA intervention would be more effective than an active control condition in improving mood, decreasing COVID-19 fear/worry and depressive symptoms, and promoting positively reinforcing behaviors during early weeks of the COVID-19 pandemic. Participants were a diverse sample of undergraduate students (N = 296) under a state-wide lockdown. Students were randomized to either VABA, a 10-min values clarification and affirmation task, or Control, a time- and attention-matched task. Positive and negative affects were assessed pre- and post-intervention. At next-day follow-up, positive and negative affects were reassessed, as well as past 24-h behavioral activation and depressive symptoms. Within-group increases in positive affect were observed in both conditions (VABA d = 0.39; Control d = 0.19). However, VABA produced a significantly larger increase than Control (F[2] = 3.856, p = .022, d = 0.22). At 24-h follow-up, behavioral activation, which was significantly higher in VABA versus Control (t[294] = -5.584, p < .001, d = 0.65), predicted fewer depressive symptoms (R2 change = .019, β = -.134, p = .003). VABA is an ultra-brief intervention that appears to have acute effects on mood-enhancement and behavioral activation.

Initial Effects of a Brief Transdiagnostic Intervention on Parent Emotion Management During COVID-19

Parents are a vulnerable group to increased distress resulting from the COVID-19 pandemic. In this study, 80 parents with at least mildly elevated internalizing symptoms were randomized to receive a four session, transdiagnostic intervention via telehealth during the height of the COVID-19 pandemic based on the Unified Protocols for Transdiagnostic Treatment of Emotional Disorders (UP-Caregiver), immediately or 6-weeks after receipt of psychoeducational materials. Results showed no between-condition differences in slopes of primary outcome measures; however, significant group differences in intercepts indicated that those receiving UP-Caregiver immediately had greater improvements in distress tolerance and intolerance of uncertainty than those in the delayed condition. Analyses also suggested within-condition improvements in emotional functioning and high satisfaction with UP-Caregiver. Results suggest that psychoeducation and symptom monitoring may be helpful to some distressed parents. Future investigations should utilize a larger sample to identify which parents might benefit the most from interventions like UP-Caregiver during crises.

The efficacy of internet-delivered cognitive-behavioral therapy for posttraumatic stress disorder according to the mean age of patients: a systematic review and meta-analysis

Internet-delivered cognitive-behavioral therapy (I-CBT) is effective in treating post-traumatic stress disorder (PTSD) symptoms, offering enhanced accessibility and cost-effectiveness. However, it's important to note that these technologies may not be suitable for all age groups. Therefore, we conducted a systematic review and meta-analysis to determine if the effectiveness of I-CBT in treating PTSD varies based on the patients' mean age. We conducted a systematic review of the literature, focusing on randomized controlled trials (RCTs) in the ISI Web of Science, PubMed/MEDLINE, and PsycINFO databases. Following this, we performed a meta-analysis and evaluated the risk of bias using the Cochrane risk of bias quality assessment tool. In this study, we examined patient-related factors (civil or military status, age, and gender), clinical characteristics (baseline PTSD severity and type of trauma), and treatment characteristics (type of intervention, synchronous or asynchronous delivery, and the number of sessions) as independent variables. The dependent variable was the reduction in mean PTSD symptoms. Five RCTs out of 1,552 screened studies were included in this review, all of which showed some level of concern regarding potential bias. Our meta-analysis indicates that I-CBT is equally effective regardless of patients' mean age. Since all RCTs included only provide the mean age of the patients, further randomized controlled trials should address the effectiveness of I-CBT among different age groups.

College student interest in teletherapy and self-guided mental health supports during the COVID-19 pandemic

Objective The COVID-19 pandemic has worsened college students' mental health while simultaneously creating new barriers to traditional in-person care. Teletherapy and online self-guided mental health supports are two potential avenues for addressing unmet mental health needs when face-to-face services are less accessible, but little is known about factors that shape interest in these supports. Participants: 1,224 U.S. undergraduate students (mean age = 20.7; 73% female; 40% White) participated. Methods: Students completed an online questionnaire assessing interest in teletherapy and self-guided supports. Predictors included age, sex, race/ethnicity, sexual minority status, and anxiety and depression symptomatology. Results: Interest rates were 20% and 25% for at-cost supports (teletherapy and online self-help, respectively) and 70% and 72% for free supports (teletherapy and online self-help, respectively). Patterns emerged by age, anxiety symptom severity, and race/ethnicity. Conclusions: Results may inform universities' efforts to optimize students' engagement with nontraditional, digital mental health supports, including teletherapy and self-guided programs.

The SARS-CoV2 (COVID-19) pandemic has taken a severe toll on public health, with effects reaching far beyond unprecedented illness and mortality. Levels of mental health difficulties appear to be rising broadly as the pandemic has progressed, both in the general U.S. population and among college students specifically.1,2 The COVID-19 pandemic and its repercussions may undermine college student mental health in myriad ways.2 Concurrently, students now face the potential for serious illness, loss of loved ones, financial strain, social isolation, loss of on-campus resources, and sudden disruption of routines-creating a "perfect storm" for the emergence or exacerbation of psychological distress.

The change of psychosocial stress factors in families with infants and toddlers during the COVID-19 pandemic. A longitudinal perspective on the CoronabaBY study from Germany

Background

Over nearly three years, the COVID-19 pandemic has had a lasting impact on people's lives and mental health worldwide with its far-reaching restrictions and concerns about infections and other personal consequences. Families were particularly affected and showed increased stress and psychological problems. Long-term effects cannot be ruled out. So far, data on young families are sparse. The present longitudinal analysis (n = 932) of the CoronabaBY study investigated the development of parenting stress, parental affective symptoms, and child's mental health in young families with children aged 0-3 years in Germany as well as potential influencing factors.

Methods

The observational study includes two measurement points over the course of the pandemic (baseline and follow-up). Data was collected by app using standardized questionnaires.

Results

N = 932 participants, mainly mothers (94.7%) born in Germany (93.1%) with higher education (61.3% with at least high school diploma) and a comfortable financial situation participated in the longitudinal study. Children were on average 14.7 months old at baseline (SD: 12, range: 1-39 months). While the proportion of parents who perceived the pandemic as stressful decreased significantly from baseline (60%) to follow-up (52.3%), the proportion with parenting stress increased significantly (from 40.1% to 45.4%). Both parental and child mental health problems remained constant over time, with infants crying/feeding/sleeping problems ranging above pre-pandemic comparative data. Most predictive for high parenting stress at follow-up was high parenting stress at baseline. This was also true for parental affective symptoms (depression/anxiety) and child mental health problems.

Conclusions

Despite faded pandemic restrictions, parents remained burdened. Support services do not appear to have been sufficient to help families out of their stressful situation. Our results indicate a need for action regarding low-threshold services that effectively reach affected families.

Trial registration

The study was pre-registered in OSF (https://osf.io/search/?q=tksh5&page=1).

'I've never been so stressed in my life': a qualitative analysis of young adults' lived experience amidst pandemic restrictions in Prince Edward Island, Canada

OBJECTIVES

This qualitative study aimed to explore how young adults experienced the COVID-19 pandemic in relation to extensive lockdowns, social isolation and psychosocial distress. Specifically, this research focused on how the pandemic impacted those who did not contract COVID-19 and lived in a low-risk geographical location. The focus was young adults given they have large social circles (high risk for disease transmission) and have an increased propensity to mental health conditions. These insights can inform planning for future pandemics.

DESIGN

This paper draws on 30 in-depth semistructured interviews. Data were analysed inductively following the principles of a constructivist grounded theory approach.

SETTING AND PARTICIPANTS

30 young adults living in Prince Edward Island during the COVID-19 pandemic, a Canadian province with a low number of COVID-19 cases at the time of data collection.

RESULTS

We developed four themes that describe the experience of young adults during the COVID-19 pandemic: (1) life course disruption, (2) fear and anxiety about the COVID-19 virus, (3) isolation and loss of hope and (4) strategies for managing adversity. Our findings highlight the areas of young adults' lives that were affected by extensive social changes related to the COVID-19 pandemic. We demonstrate that even individuals who had not contracted the virus were considerably impacted.

CONCLUSION

We provide a detailed description of the comprehensive impact of COVID-19 on low-risk young adults not previously infected with the COVID-19 virus. By reflecting on the biographical disruption experienced by young adults, we highlight the need and opportunity to direct healthcare resources towards identifying and addressing the secondary impacts of pandemics. Consequently, these findings can guide decisions relating to future pandemic restrictions to better account for the experiences of individuals living through them.

Mental health impact of COVID-19 on healthcare workers versus adults in Africa

BACKGROUND

This review mapped the impact of the coronavirus disease 2019 (COVID-19) pandemic on the mental health of healthcare workers (HCWs) and the adult general population in Africa.

AIM

The study focussed on anxiety, depression, post-traumatic stress disorder and suicide cases to determine the impact of COVID-19 on the mental health of the selected population.

METHOD

A scoping review was conducted on relevant database and search engines. The search resulted in 143 studies. Five studies met the inclusion criteria for synthesis.

RESULTS

Results indicated anxiety was more prevalent among HCWs as opposed to the adult general population, which was in the rise of suicide cases. Among HCWs, mental health was negatively impacted by the loss of their infected patients and concerns over infecting family members. The adult general population was impacted because of isolation and their fear of contracting the virus.

CONCLUSION

The COVID-19 pandemic led to the increase of mental health issues among HCWs as evidenced by a high prevalence of anxiety compared to that of the adult general population. There was, however, a rise in depression and suicide cases among the adult general population.Contribution: This study will assist in adding more knowledge to build a robust and responsive strategy to mental health problems during and post-pandemics like COVID-19. Strategies that have appeared effective in combatting the impact of COVID-19 on mental health include support packages established for frontline HCWs such as social media online chat groups.

A Longitudinal Study of the Influence of the COVID-19 Pandemic on Anxiety and Stress among Medical University Students

(1) Background: The COVID-19 pandemic was declared an international health emergency by the World Health Organization. The dramatic, widespread transmission of the virus, high mortality, and lack of specific drugs caused the development of panic attacks and anxiety. Healthcare professionals, including medical students, were challenged to provide medical care to patients in need, often exposing themselves to the virus. (2) Methods: This study aimed to assess anxiety and stress levels in medical students, both at the beginning and after the end of the COVID-19 pandemic. The STAI and PSS-10 questionnaires were used. (3) Results: This study showed a decrease in anxiety levels among medical students after the end of the COVID-19 pandemic. In both 2020 and 2022, female students were found to experience higher stress levels than male students. Anxiety levels were similar among students of different medical-related faculties. (4) Conclusions: The COVID-19 pandemic caused stress and anxiety among medical students, which decreased throughout the duration of the pandemic.

App-based mindfulness training supported eudaimonic wellbeing during the COVID19 pandemic

A randomized-controlled-trial study (N = 219) tested two pre-registered hypotheses that mobile-phone app-based mindfulness training improves wellbeing and increases self-transcendent emotions: gratitude, self-compassion, and awe. Latent change score modeling with a robust maximum likelihood estimator was used to test how those changes are associated in the training versus the waiting-list group. The training increased wellbeing and all self-transcendent emotions regardless of interindividual variance in the changes across time. Changes in all self-transcendent emotions were positively associated with changes in wellbeing. The strength of those associations was comparable in the waiting-list group and the training group. More studies are needed to test whether the effects of mindfulness practice on wellbeing are driven by increases in self-transcendent emotions. The study was conducted over 6 weeks during the COVID19 pandemic. The results indicate that the mindfulness training can be an easily accessible effective intervention supporting eudaimonic wellbeing in face of adversity.

The crisis is over, long live the crisis: mental health in emerging adulthood during the course of the COVID-19 pandemic

Introduction

As a multidimensional stressor, the COVID-19 pandemic posed a significant threat to mental health, with studies showing younger age groups to be particularly vulnerable. Thus, this study aimed to monitor mental health, potential risk/protective factors, and pandemic-related variables among young university students during the pandemic.

Methods

Students of the University of Greifswald (M age = 23.0 years, 73.9% female) participated in five cross-sectional online surveys in December 2020 (N = 1,127), March 2021 (N = 760), June/July 2021 (N = 531), December 2021 (N = 1,226), and December 2022 (N = 814). Sociodemographic data, depression and anxiety severity, loneliness, quality of life, coping strategies, resilience, self-esteem, and emotion regulation were measured. First, results from December 2020 were compared to pre-pandemic normative data. Second, the time course during the pandemic was analyzed. Third, linear models were calculated to examine the influence of risk and protective factures on depression and anxiety severity.

Results

Higher levels of depression, anxiety, and loneliness, as well as lower levels of self-esteem, physical and mental health, social relationships and well-being were found in December 2020 compared to pre-pandemic. Levels of depression and anxiety severity peaked in December 2022. Female sex, loneliness, and previous mental treatment showed associations with higher depression and anxiety severity, while higher self-esteem, resilience and use of reappraisal strategies appeared to act as protective factors.

Discussion

The study indicates the pandemic's detrimental impact on students' mental health and quality of life. Identified risk and protective factors provide guidance for tailored prevention and treatment, as well as the design of measures for future pandemics and other crisis.

Trends in Mental Wellbeing of US Children, 2019-2022: Erosion of Mental Health Continued in 2022

We provide fresh estimates of a change in the nationwide prevalence of mental health symptoms among US children during the COVID-19 pandemic using National Health Interview Survey data (2019-22) on children aged 2-17 years (n = 27,378; age subgroups 2-5, 6-11, and 12-17) to assess overall mental distress and 19 specific outcomes related to developmental, communicative, cognitive, affective, and behavioral domains. Raw and adjusted (for socio-demographics) linear regressions estimated the change in prevalence for each outcome between 2019 (baseline year) and three succeeding years (2020-2022). Summary scores for mental distress rose between 2019 and 2020 (1.01 to 1.18 points, range of 0-15), declined slightly in 2021 (1.09), and climbed sharply again in 2022 (1.25). The declines primarily affected adolescents (1.11 at baseline, 1.24 in 2020, 1.30 in 2021, and 1.49 in 2022). Specific outcomes belonging to all domains of mental health showed similar increases in prevalence. US children suffered significant erosion of mental health during the COVID-19 pandemic that continued into 2022. Expansion of mental health programs aimed at school-going children will likely be needed to respond effectively to the ongoing crisis.

Resilience, Satisfaction with Life and Anxiety in the Israeli Population after Mass Vaccination for COVID-19

OBJECTIVES

The current study aimed to examine the relationships between resilience and personal characteristics such as socio-economic status, employment, satisfaction with life, and anxiety, during the period of returning to routine life after mass vaccination for COVID-19.

METHOD

993 Israeli participants, 52% female and 48% male, with a mean age of 40 years (18 to 89 years old) responded to an online questionnaire during March 2021. We hypothesized that (1) unemployed individuals and those with a low SES would have lower resilience, lower satisfaction with life and higher anxiety, (2) individuals who were ill with COVID-19 would have lower resilience and satisfaction with life and a higher level of anxiety, and (3) a higher resilience would be related to a lower level of anxiety.

RESULTS

The findings showed that unemployed individuals had lower levels of resilience and satisfaction with life and higher levels of anxiety than employed individuals. Specifically, those who experience a large gap between their socio-economic and employment statuses are at a greater risk than others. In addition, differences were found between people who had experienced COVID-19 illness and those who had not, but only with their satisfaction with life. People who had been ill were more satisfied than those who had not been ill. Eventually, as expected, a higher resilience was related to a lower level of anxiety, specifically at the lower levels of resilience.

CONCLUSIONS

The findings of this study can provide additional perspectives on the day after a crisis (COVID-19) and the need for the development of intervention programs to strengthen the resilience of individuals who experience a gap between their SES and employment statuses when returning to their routine life after a crisis. The study also shed light on the unique correlation between anxiety and resilience, implying that following a crisis, high-resilience individuals face their anxiety better than low-resilience individuals.

Learning from Adolescents and Caregivers to Enhance Acceptability and Engagement Within Virtual Dialectical Behavior Therapy for Adolescents Skills Groups: A Qualitative Study

Despite the significant increase in adolescent mental health challenges in recent years, structural barriers continue to limit access to and engagement in mental health services. As such, opportunities to learn directly from adolescents and their families on how to best structure and deliver services are paramount. The current study assumes a multi-informant approach and reports on adolescents' and caregivers' (N = 33) experiences in an adapted telehealth/hybrid Dialectical Behavior Therapy for Adolescents (DBT-A) program. Focus groups were conducted across two cohorts of families who participated in DBT-A skills groups, to collect family-centered data on the acceptability of program modifications, engagement in the adapted telehealth/hybrid DBT-A, and recommendations for improvement. Participants were predominately Latine White and were from a broad range of socioeconomic backgrounds. Additionally, 45.5% of the adolescents identified as LGBTQ + . Focus group findings emphasized how the telehealth platform was both convenient and disengaging, and how in-person sessions offered improved group connection and content engagement. Participants underscored the importance of balancing multi-family group sessions with adolescent- and caregiver-only group sessions in the program, and adolescents emphasized a need for the DBT-A program to better center adolescents' unique experiences and voices throughout sessions. Both adolescents and caregivers suggested modifications to synthesize the content and improve generalizability of the DBT-A skills to their real lives. Overall, these findings add to a new and evolving branch of DBT-A qualitative inquiry, as well as the growing body of work that recommends incorporating the voices of people with lived experiences into the development and modification of psychological services.

A narrative systematic review of changes in mental health symptoms from before to during the COVID-19 pandemic

The onset of the COVID-19 pandemic raised concerns regarding population-wide impacts on mental health. Existing work on the psychological impacts of disaster has identified the potential for multiple response trajectories, with resilience as likely as the development of chronic psychopathology. Early reviews of mental health during the pandemic suggested elevated prevalence rates of multiple forms of psychopathology, but were limited by largely cross-sectional approaches. We conducted a systematic review of studies that prospectively assessed pre- to peri-pandemic changes in symptoms of psychopathology to investigate potential mental health changes associated with the onset of the pandemic (PROSPERO #CRD42021255042). A total of 97 studies were included, covering symptom clusters including obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), fear, anxiety, depression, and general distress. Changes in psychopathology symptoms varied by symptom dimension and sample characteristics. OCD, anxiety, depression, and general distress symptoms tended to increase from pre- to peri-pandemic. An increase in fear was limited to medically vulnerable participants, and findings for PTSD were mixed. Pre-existing mental health diagnoses unexpectedly were not associated with symptom exacerbation, except in the case of OCD. Young people generally showed the most marked symptom increases, although this pattern was reversed in some samples. Women in middle adulthood in particular demonstrated a considerable increase in anxiety and depression. We conclude that mental health responding during the pandemic varied as a function of both symptom cluster and sample characteristics. Variability in responding should therefore be a key consideration guiding future research and intervention.

Predictors of suicidality among Polish university students during COVID-19 pandemic

PURPOSE OF REVIEW

The main purpose of the study was to assess university students' mental health and identify factors associated with the risk of suicidal thoughts, plans, and attempts during coronavirus disease 2019 (COVID-19) pandemic and distance learning.

RECENT FINDINGS

The study was conducted in spring 2021 and comprised 10 760 Polish students. The survey employed modified versions of the C-SSRS, CIDI, WHO-5, GAD-7, the PTSD checklist for DSM-5 and CAGE-AID Questionnaire and included questions about panic attacks, COVID-19-related information and sociodemographic characteristics. The correlates of suicidality were examined using a series of logistic regression analyses. Almost 40% students experienced any suicidal thoughts and/or behaviours in the previous month: passive ideations only (15.8%), active ideations only (7.1%), plans without attempts (15%), and attempts (1.4%). Following variables were related to the increased risk for suicide attempts: severe anxiety [odds ratio (OR) = 11.39; 95% confidence interval (CI): 1.44-90.26], panic attacks (OR = 3.21; 95% CI: 1.75-5.91), and COVID-19 hospitalisation (OR = 11.04; 95% CI: 1.17-104.59). Major depression was associated with passive and active ideations, suicide plans, but not with attempts (OR = 1.37; 95% CI: 0.45-4.13).

SUMMARY

University students present a high level of adverse mental health and increased risk of STBs during COVID-19 pandemic. A suicide prevention program tailored to this population is needed during and after the pandemic.

Gender and Age Influence on Emergency Department Visits for Non-Suicidal Self-Injuries in School Aged Children in Italy: An 11 Years Retrospective Cross-Sectional Study

Objectives: Non-suicidal self-injury (NSSI) poses a threat in developmental ages, yet there is a scarcity of studies on NSSI trends, especially those in emergency departments (ED). Methods: The aim of this cross-sectional study is to describe trends in ED visits for NSSI among young people aged between 5 and 19 years in Italy from 2011 to 2021 in Piedmont. From the ministerial ED discharge information system, all occurring NSSIs were identified by medical report and/or ICD9CM code and reported as a population rate and a visit rate on all ED requests. Results: The general rate of ED visits remained stable, with around 210,000 (55% males) visits each year, along the whole period from 2011 to 2019, then halved during 2020 and 2021. The NSSI population and visits rates increased from 2013, peaking in 2019 at a rate of around 25 and 23 NSSI visits (girls) and 76 and 69 NSSI (boys) per 100,000 ED visits. In 2020 and 2021, the rate of NSSI visits increased, particularly in girls and among older adolescents. Conclusion: The gradual increase of NSSI over the last decade is a rising public health issue, which deserves wider attention to ensure early detection and prevention.

Internet-delivered cognitive behavior therapy versus treatment as usual for anxiety and depression among Latin American university students: A randomized clinical trial

OBJECTIVE

Untreated mental disorders are important among low- and middle-income country (LMIC) university students in Latin America, where barriers to treatment are high. Scalable interventions are needed. This study compared transdiagnostic self-guided and guided internet-delivered cognitive behavioral therapy (i-CBT) with treatment as usual (TAU) for clinically significant anxiety and depression among undergraduates in Colombia and Mexico.

METHOD

1,319 anxious, as determined by the Generalized Anxiety Disorder-7 (GAD-7) = 10+ and/or depressed, as determined by the Patient Health Questionnaire-9 (PHQ-9) = 10+, undergraduates (mean [SD] age = 21.4 [3.2]); 78.7% female; 55.9% first-generation university student) from seven universities in Colombia and Mexico were randomized to culturally adapted versions of self-guided i-CBT (n = 439), guided i-CBT (n = 445), or treatment as usual (TAU; n = 435). All randomized participants were reassessed 3 months after randomization. The primary outcome was remission of both anxiety (GAD-7 = 0-4) and depression (PHQ-9 = 0-4). We hypothesized that remission would be higher with guided i-CBT than with the other interventions.

RESULTS

Intent-to-treat analysis found significantly higher adjusted (for university and loss to follow-up) remission rates (ARD) among participants randomized to guided i-CBT than either self-guided i-CBT (ARD = 13.1%, χ12 = 10.4, p = .001) or TAU (ARD = 11.2%, χ12 = 8.4, p = .004), but no significant difference between self-guided i-CBT and TAU (ARD = -1.9%, χ12 = 0.2, p = .63). Per-protocol sensitivity analyses and analyses of dimensional outcomes yielded similar results.

CONCLUSIONS

Significant reductions in anxiety and depression among LMIC university students could be achieved with guided i-CBT, although further research is needed to determine which students would most likely benefit from this intervention. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Power analysis for idiographic (within-subject) clinical trials: Implications for treatments of rare conditions and precision medicine

Power analysis informs a priori planning of behavioral and medical research, including for randomized clinical trials that are nomothetic (i.e., studies designed to infer results to the general population based on interindividual variabilities). Far fewer investigations and resources are available for power analysis of clinical trials that follow an idiographic approach, which emphasizes intraindividual variabilities between baseline (control) phase versus one or more treatment phases. We tested the impact on statistical power to detect treatment outcomes of four idiographic trial design factors that are under researchers' control, assuming a multiple baseline design: sample size, number of observations per participant, proportion of observations in the baseline phase, and competing statistical models (i.e., hierarchical modeling versus piecewise regression). We also tested the impact of four factors that are largely outside of researchers' control: population size, proportion of intraindividual variability due to residual error, treatment effect size, and form of outcomes during the treatment phase (phase jump versus gradual change). Monte Carlo simulations using all combinations of the factors were sampled with replacement from finite populations of 200, 1750, and 3500 participants. Analyses characterized the unique relative impact of each factor individually and all two-factor combinations, holding all others constant. Each factor impacted power, with the greatest impact being from larger treatment effect sizes, followed respectively by more observations per participant, larger samples, less residual variance, and the unexpected improvement in power associated with assigning closer to 50% of observations to the baseline phase. This study's techniques and R package better enable a priori rigorous design of idiographic clinical trials for rare diseases, precision medicine, and other small-sample studies.

Coping mechanisms during the COVID-19 pandemic and lockdown in metropolitan Johannesburg, South Africa: A qualitative study

BACKGROUND

The COVID-19 pandemic has caused prolonged stress on numerous fronts. While the acute health impacts of psychosocial stress due to the pandemic are well-documented, less is known about the resources and mechanisms utilized to cope in response to stresses during the pandemic and lockdown.

OBJECTIVE

The aim of this study was to identify and describe the coping mechanisms adults utilized in response to the stressors of the COVID-19 pandemic during the 2020 South African lockdown.

METHODS

This study included adults (n = 47: 32 female; 14 male; 1 non-binary) from the greater Johannesburg region in South Africa. Interviews with both closed and open-ended questions were administered to query topics regarding the COVID-19 pandemic. Data were coded and thematically analyzed to identify coping mechanisms and experiences.

RESULTS

Adults engaged in a variety of strategies to cope with the pandemic and the ensued lockdown. The ability to access or engage in multiple coping mechanisms were either enhanced or constrained by financial and familial situations. Participants engaged in seven major coping mechanisms: interactions with family and friends, prayer and religion, staying active, financial resources, mindset reframing, natural remedies, and following COVID-19 prevention protocols.

CONCLUSIONS

Despite the multiple stressors faced during the pandemic and lockdown, participants relied on multiple coping strategies which helped preserve their well-being and overcome pandemic-related adversity. The strategies participants engaged in were impacted by access to financial resources and family support. Further research is needed to examine the potential impacts these strategies may have on people's health.

An ACT self-help intervention for adults with a visible difference in appearance: A pilot feasibility and acceptability randomized controlled study

Individuals living with a visible difference in appearance experience high levels of social anxiety, yet self-help interventions for this heterogeneous population are not available. We conducted a pilot trial of a novel Acceptance and Commitment Therapy (ACT) based self-help intervention.Individuals with anxiety about having a visible difference in appearance (n = 284) were randomized to an ACT-based four-week intervention (n = 145) or a waitlist control condition (n = 139). We collected pre and follow-up (four-weeks after the completion of the intervention) data. Primary outcomes included social anxiety and impairments in functioning. Psychological flexibility (PF) was also examined. ANCOVAs, controlling for pre scores, indicated significant improvements in functioning by the intervention group. No significant differences were observed for anxiety and PF between conditions at follow-up. Drop out was 68% for the intervention and 41% for the control group, with no differences in the groups in age, origin, gender, or type of visible difference. Participants in the intervention group found the intervention almost equally, useful (77%) and helpful (73%). An ACT-based self-help intervention can alleviate distress related to visible difference in appearance. More sophisticated designs are needed now, to collect idiographic and longitudinal data and examine personalized changes across time in this population.

Research Review: The internalizing paradox - youth anxiety and depression symptoms, psychotherapy outcomes, and implications for research and practice

BACKGROUND

Youth anxiety and depression have long been combined within the empirically derived internalizing syndrome. The two conditions show substantial comorbidity, symptom co-occurrence, and overlap in treatment procedures, but paradoxically diverge in psychotherapy outcomes: strong, positive effects for anxiety and weak effects for depression.

METHODS

Drawing on recent research, we examine candidate explanations for this paradox to help identify strategies for addressing it by improving outcomes for youth depression.

RESULTS

Candidate explanations include that youth depression, compared with youth anxiety, has more varied comorbidities and more heterogeneous symptom combinations, has greater uncertainty regarding mediators and mechanisms of change, is treated with more complex and potentially confusing protocols, and has characteristics that may impede client engagement. Candidate strategies for shrinking the psychotherapy effectiveness gap include personalizing through transdiagnostic modular treatment, simplifying therapy by focusing on empirically supported principles of change, developing effective strategies for engaging family members as intervention allies, using shared decision-making to inform clinical decisions and boost client engagement, capitalizing on youth-friendly technological advances, and shortening and digitizing treatments to enhance their accessibility and appeal.

CONCLUSIONS

Recent advances suggest explanations for the internalizing paradox, which in turn suggest strategies for shrinking the youth anxiety-depression psychotherapy outcome gap; these form an agenda for a promising new era of research.

Learning from adversity: What the COVID-19 pandemic can teach us about family resiliency

The present study aimed to characterize the immediate impacts of the COVID-19 pandemic on families with preschool age children and to identify pre-pandemic factors that explained unique family experiences. We leveraged an ongoing longitudinal study of relatively well-resourced community families who had reported on family functioning prior to the pandemic and completed surveys 6 months after pandemic onset. Both parents of dual parenting households endorsed significant hardships as a direct result of the pandemic (e.g., disrupted family routines, challenges at work); however, families also reported aspects of flourishing (i.e., experiencing positive outcomes in response to adversity) such as spending more time together as a family. Families were prone to greater hardships and fewer opportunities for growth to the extent that parents were lower in psychological resources (i.e., greater stress and internalizing symptoms, poor well-being) and were not on the same page as a couple (i.e., interparental discord, low quality coparenting) prior to pandemic onset. Finally, greater pandemic hardships predicted poorer parental mental health, greater family dysfunction, and elevated child psychopathology, controlling for pre-pandemic levels. Parents who reported more family flourishing from the pandemic had a stronger interparental relationship. Results are intended to inform theories of family stress and family interventions that can be tailored to promote resiliency (i.e., adaptation to challenging life events) and prevent dysfunction when families face rapid change and adjustment and high degrees of uncertainty and stress.

Predictors of Dropout Among Psychosomatic Rehabilitation Patients During the COVID-19 Pandemic: Secondary Analysis of a Longitudinal Study of Digital Training

BACKGROUND

High dropout rates are a common problem reported in web-based studies. Understanding which risk factors interrelate with dropping out from the studies provides the option to prevent dropout by tailoring effective strategies.

OBJECTIVE

This study aims to contribute an understanding of the predictors of web-based study dropout among psychosomatic rehabilitation patients. We investigated whether sociodemographics, voluntary interventions, physical and mental health, digital use for health and rehabilitation, and COVID-19 pandemic-related variables determine study dropout.

METHODS

Patients (N=2155) recruited from 4 psychosomatic rehabilitation clinics in Germany filled in a web-based questionnaire at T1, which was before their rehabilitation stay. Approximately half of the patients (1082/2155, 50.21%) dropped out at T2, which was after the rehabilitation stay, before and during which 3 voluntary digital trainings were provided to them. According to the number of trainings that the patients participated in, they were categorized into a comparison group or 1 of 3 intervention groups. Chi-square tests were performed to examine the differences between dropout patients and retained patients in terms of sociodemographic variables and to compare the dropout rate differences between the comparison and intervention groups. Logistic regression analyses were used to assess what factors were related to study dropout.

RESULTS

The comparison group had the highest dropout rate of 68.4% (173/253) compared with the intervention groups' dropout rates of 47.98% (749/1561), 50% (96/192), and 42.9% (64/149). Patients with a diagnosis of combined anxiety and depressive disorder had the highest dropout rate of 64% (47/74). Younger patients (those aged <50 y) and patients who were less educated were more likely to drop out of the study. Patients who used health-related apps and the internet less were more likely to drop out of the study. Patients who remained in their jobs and patients who were infected by COVID-19 were more likely to drop out of the study.

CONCLUSIONS

This study investigated the predictors of dropout in web-based studies. Different factors such as patient sociodemographics, physical and mental health, digital use, COVID-19 pandemic correlates, and study design can correlate with the dropout rate. For web-based studies with a focus on mental health, it is suggested to consider these possible dropout predictors and take appropriate steps to help patients with a high risk of dropping out overcome difficulties in completing the study.

A systematic review on the efficacy of virtual reality and gamification interventions for managing anxiety and depression

This systematic review aims to assess the effectiveness of virtual reality (VR) and gamification interventions in addressing anxiety and depression. The review also seeks to identify gaps in the current VR treatment landscape and provide guidelines for future research and development. A systematic literature search was conducted using Scopus, Web of Science, and PubMed databases, focusing on studies that utilized VR and gamification technology to address anxiety and depression disorders. A total of 2,664 studies were initially identified, 15 of those studies fulfilled the inclusion criteria for this systematic review. The efficacy of VR in addressing anxiety and depression was evident across all included studies. However, the diversity among VR interventions highlights the need for further investigation. It is advised to incorporate more diverse participant samples and larger cohorts and explore a broader spectrum of therapeutic approaches within VR interventions for addressing anxiety and depression to enhance the credibility of future research. Additionally, conducting studies in varying socioeconomic contexts would contribute to a more comprehensive understanding of their real-world applicability.

Pediatric Mental Health Emergencies During 5 COVID-19 Waves in New York City

OBJECTIVES

To describe the proportion of pediatric mental health emergency department (MH-ED) visits across 5 COVID-19 waves in New York City (NYC) and to examine the relationship between MH-ED visits, COVID-19 prevalence, and societal restrictions.

METHODS

We conducted a time-series analysis of MH-ED visits among patients ages 5 to 17 years using the INSIGHT Clinical Research Network, a database from 5 medical centers in NYC from January 1, 2016, to June 12, 2022. We estimated seasonally adjusted changes in MH-ED visit rates during the COVID-19 pandemic, compared with predicted prepandemic levels, specific to each COVID-19 wave and stratified by mental health diagnoses and sociodemographic characteristics. We estimated associations between MH-ED visit rates, COVID-19 prevalence, and societal restrictions measured by the Stringency Index.

RESULTS

Of 686 500 ED visits in the cohort, 27 168 (4.0%) were MH-ED visits. The proportion of MH-ED visits was higher during each COVID-19 wave compared with predicted prepandemic trends. Increased MH-ED visits were seen for eating disorders across all waves; anxiety disorders in all except wave 3; depressive disorders and suicidality/self-harm in wave 2; and substance use disorders in waves 2, 4, and 5. MH-ED visits were increased from expected among female, adolescent, Asian race, high Child Opportunity Index patients. There was no association between MH-ED visits and NYC COVID-19 prevalence or NY State Stringency Index.

CONCLUSIONS

The proportion of pediatric MH-ED visits during the COVID-19 pandemic was higher during each wave compared with the predicted prepandemic period, with varied increases among diagnostic and sociodemographic subgroups. Enhanced pediatric mental health resources are essential to address these findings.

Impact of the COVID-19 pandemic on the mental health of children and adolescents: A systematic review and meta-analysis of longitudinal studies

BACKGROUND

Children's and adolescents' mental health has been affected since the onset of the coronavirus disease (COVID-19) pandemic, receiving global attention. We conducted a systematic review and meta-analysis of longitudinal studies to assess the extent of the mental health changes of children and adolescents in the aftermath of the pandemic.

METHODS

We searched PubMed, Embase, Web of Science, and PsycINFO to explore the pandemic's impact on children and adolescents' mental health; longitudinal studies were included. We used the random effects model to estimate the standardized mean differences (SMD) with 95 % confidence intervals (CI).

RESULTS

Twenty articles were included. Results showed that there was an increase in anxiety (SMD = 0.18, 95 % CI 0.05-0.32) and depressive symptoms (SMD = 0.22, 95 % CI 0.13-0.32) in children and adolescents after the pandemic. Anxiety and depressive symptoms noticeably increased from April to May 2020, subsequently decreased, but saw a small resurgence during the second wave of the pandemic. Anxiety change varied by region; highest in Asia (SMD = 0.38, 95 % CI 0.25-0.51).

LIMITATIONS

Heterogeneity was high in this study, with high variability in psychiatric symptoms among individuals.

CONCLUSIONS

This study on changes in children's and adolescents' mental health, anxiety and depression symptoms showed varying degrees of deterioration. Changes in symptoms were influenced by time and region and showed fluctuations.

Lessons learned from behaviors of the employees in Iranian banks during the Covid-19 pandemic crisis: A phenomenological study

The aim of this research is to analyze the experiences of employees during the Covid-19 pandemic cri-sis and conceptualize the lessons learned to deal with similar crises in the future. To achieve this, a qualitative approach with a phenomenological strategy was conducted through semi-structured, in-depth interviews with 16 front-line employees of Bank Melli, the largest state bank in Iran. The study found that employee behavior plays a critical role in crisis management, with functional behaviors such as preventive measures, stress management, and sharing valid information being essential. Dysfunctional behaviors such as resistance to change and inconsistent behaviors were also identified. The prevention of infection and stress management were identified as key behaviors to cope with the crisis, while media literacy and acceptance of change were crucial for correct information analysis and crisis management. Overall, the study highlights the challenges faced by employees during the Covid-19 crisis and provides valuable lessons from a behavioral perspective for managers in the banking industry to manage disruptions caused by current and future pandemics. The study emphasizes the importance of learning from the lessons of the Covid-19 crisis to reduce negative effects on physical and mental health.

Cognitive and Emotional Well-Being of Preschool Children Before and During the COVID-19 Pandemic

Importance

The association between COVID-19 social disruption and young children's development is largely unknown.

Objective

To examine associations of pandemic exposure with neurocognitive and socioemotional development at 24 and 54 months of age.

Design, Setting, and Participants

This cross-sectional study evaluated associations between pandemic exposure vs nonexposure and developmental outcomes with covariate adjustment using data from the Ontario Birth Study collected between February 2018 and June 2022. Eligible participants were children aged 24 and 54 months. Data were analyzed from June to November 2022.

Exposure

COVID-19 pandemic exposure defined as assessment after March 11, 2020.

Main Outcome and Measures

Neurodevelopmental assessment using the ASQ-3 (Ages and Stages Questionnaire, Third Edition) and MCHAT-R (Modified Checklist for Autism in Toddlers, Revised) at 24 months of age, and neurocognitive and socioemotional assessment using the National Institutes of Health Toolbox at 54 months of age.

Results

A total of 718 children at age 24 months (mean [SD] age, 25.6 [1.7] months; 342 female [47.6%]; 461 White [64.2%]) and 703 at age 54 months (mean [SD] age, 55.4 [2.6] months; 331 female [47.1%]; 487 White [69.3%]) were included. At 24 months of age, 460 participants (232 female [50.4%]) were assessed during the pandemic (March 17, 2020, to May 17, 2022) and 258 (110 female [42.6%]) were assessed prepandemic (April 17, 2018, to March 10, 2020). At 54 months of age, 286 participants (129 female [45.1%]) were assessed from March 14, 2020, to June 6, 2022, and 417 (202 female [48.4%]) were assessed from February 8, 2018, to March 10, 2020. At 24 months of age, pandemic-exposed children had reduced risk of problem-solving difficulties using cutoff scores (odds ratio [OR], 0.33; 95% CI, 0.18-0.62; P = .005) and higher problem-solving (B, 3.93; 95% CI, 2.48 to 5.38; P < .001) compared with nonexposed children. In contrast, pandemic-exposed children had greater risk for personal-social difficulties using cutoff scores (OR, 1.67; 95% CI, 1.09-2.56; P = .02) and continuous scores (B, -1.70; 95% CI, -3.21 to -0.20; P = .02) compared with nonexposed children. At 54 months of age, pandemic-exposed children had higher receptive vocabulary (B, 3.16; 95% CI, 0.13 to 6.19; P = .04), visual memory (B, 5.95; 95% CI, 1.11 to 10.79; P = .02), and overall cognitive performance (B, 3.89; 95% CI, 0.73 to 7.04; P = .02) compared with nonexposed children, with no differences in socioemotional development.

Conclusions and Relevance

This cross-sectional study found both positive and negative associations between pandemic exposure and preschool children's cognitive and emotional well-being within a relatively socioeconomically advantaged sample.

Longitudinal Impact of the COVID-19 Pandemic on Stress and Occupational Well-Being of Mental Health Professionals: An International Study

BACKGROUND

Increased levels of occupational stress among health professionals during the COVID-19 pandemic have been documented. Few studies have examined the effects of the pandemic on mental health professionals despite the heightened demand for their services.

METHOD

A multilingual, longitudinal, global survey was conducted at 3 time points during the pandemic among members of the World Health Organization's Global Clinical Practice Network. A total of 786 Global Clinical Practice Network members from 86 countries responded to surveys assessing occupational distress, well-being, and posttraumatic stress symptoms.

RESULTS

On average, respondents' well-being deteriorated across time while their posttraumatic stress symptoms showed a modest improvement. Linear growth models indicated that being female, being younger, providing face-to-face health services to patients with COVID-19, having been a target of COVID-related violence, and living in a low- or middle-income country or a country with a higher COVID-19 death rate conveyed greater risk for poor well-being and higher level of stress symptoms over time. Growth mixed modeling identified trajectories of occupational well-being and stress symptoms. Most mental health professions demonstrated no impact to well-being; maintained moderate, nonclinical levels of stress symptoms; or showed improvements after an initial period of difficulty. However, some participant groups exhibited deteriorating well-being approaching the clinical threshold (25.8%) and persistently high and clinically significant levels of posttraumatic stress symptoms (19.6%) over time.

CONCLUSIONS

This study indicates that although most mental health professionals exhibited stable, positive well-being and low stress symptoms during the pandemic, a substantial minority of an already burdened global mental health workforce experienced persistently poor or deteriorating psychological status over the course of the pandemic.

Mental health concerns precede quits: shifts in the work discourse during the Covid-19 pandemic and great resignation

To study the causes of the 2021 Great Resignation, we use text analysis and investigate the changes in work- and quit-related posts between 2018 and 2021 on Reddit. We find that the Reddit discourse evolution resembles the dynamics of the U.S. quit and layoff rates. Furthermore, when the COVID-19 pandemic started, conversations related to working from home, switching jobs, work-related distress, and mental health increased, while discussions on commuting or moving for a job decreased. We distinguish between general work-related and specific quit-related discourse changes using a difference-in-differences method. Our main finding is that mental health and work-related distress topics disproportionally increased among quit-related posts since the onset of the pandemic, likely contributing to the quits of the Great Resignation. Along with better labor market conditions, some relief came beginning-to-mid-2021 when these concerns decreased. Our study underscores the importance of having access to data from online forums, such as Reddit, to study emerging economic phenomena in real time, providing a valuable supplement to traditional labor market surveys and administrative data.

Supplementary Information

The online version contains supplementary material available at 10.1140/epjds/s13688-023-00417-2.

Aftermath of the COVID-19 Pandemic: Resilience and Mental Health of Emerging Adult University Students

This study explored the relationship between COVID-19 impacts and resilience in emerging adulthood during the final two months of the pandemic. It aimed to examine whether mental health symptoms moderated this relationship. In total, 205 university students completed an online questionnaire survey. Regression analysis was used to examine the prediction of resilience by pandemic-related impacts, and moderation analysis was used to explore the potential moderating effect of mental health on the relationship between impacts and resilience. The findings failed to confirm the hypothesis that total COVID-19 impacts would predict resilience. Rather, resource-type impacts predicted resilience [B = 0.17, p < 0.5]. Significant partial correlations found among resource, financial, and psychological impacts may go some way toward clarifying connections between impacts and resilience [for resource-type impact with financial-type impact, r = 0.48, p < 0.01; for resource-type impact with psychological impact, r = 0.22, p < 0.01]. The results confirmed the hypothesis that mental health symptoms would moderate the relationship between pandemic impacts and resilience [for the overall model, R = 0.41, ΔR2 = 0.16, MSE = 0.76, F (4, 200) = 10.19, p < 0.001; for the interaction between total COVID impacts and resilience, ΔR2 = 0.017, F (1, 200) = 3.98, p < 0.05]. Thus, emerging adult students with low or moderate levels of symptomatology were more resilient, independently of the level of pandemic-related stressors they faced. Those experiencing higher levels of mental health symptoms, in tandem with high levels of pandemic-related impacts, exhibited increasingly higher resilience levels [b = 0.17, 95% CI [0.02, 0.32], t = 2.26, p = 0.025]. These youths may be better equipped to handle severe stress and adversity thanks to skills and resources they possess and are experienced in using. The implications of these findings for each group of young people are discussed for their usefulness in directing future research and interventions to foster resilience during current and future crises and health pandemics.

Generation climate crisis, COVID-19, and Russia-Ukraine-War: global crises and mental health in adolescents

Climate change, COVID-19, and the Russia-Ukraine War are some of the great challenges of our time. These global crises affect young people in a particularly vulnerable phase of their lives. The current study aimed to assess the impact of these crises on mental health (depression, anxiety, and health-related quality of life) in secondary school students in Germany. Furthermore, we assessed known predictors of mental health, such as socio-economic factors, individual life stressors, and resilience factors (self-efficacy, expressive flexibility) as covariates. In our sample of 3998 pupils, pandemic- and climate-related distress were linked to greater depression and anxiety and reduced health-related quality of life. War-related distress was associated with greater anxiety. Critically, these associations remained significant after controlling for all covariates, supporting the incremental predictive value of the crises measures. The study reveals a significant impact of the crises on the mental health of the current generation of adolescents. As such it suggests that mental health policies should include interventions that help youth to cope with the stress caused by the crises.

Parents' and children's intolerance of uncertainty and their reactions to COVID-19: A story of remarkable similarity

The COVID-19 viral outbreak is a one in 100 year public health crisis. In addition to the stunning morbidity and mortality rates related to infection, multiple psychiatric sequelae erupted. Unfortunately, children and adolescents are neither immune to infection nor to the emotional consequences associated with the pandemic. Not surprisingly, the field's understanding of the psychological consequences of the viral outbreak are nascent. Consequently, this study examines the relationship between parents' and children's intolerance of uncertainty (IU) and their reactions to COVID-19. Seventy-three parents and 62 children participated in the on-line survey utilizing innovative measures of IU and COVID-19- related thoughts/behaviors. The results revealed remarkable similarities in parents' and children's responses. Parents' and children's reports of the impact of COVID on their lives were highly correlated (r = .53, df = 60, p < .001). Parents' perceptions of children's COVID-19 thoughts and behaviors were strongly aligned with the youths' self-report of their COVID reactions (r = .69, df = 60, p < .001) as well as the appraisal of the virus' impact on their lives (r = .-.42, df = 60, p < .001). Finally, children's reports of their COVID-19 related thoughts and behaviors were significantly linked to their IU (r = .60, df = 60, p < .001). Methodological limitations notwithstanding, the study's findings provide compelling implications for the conceptualization, assessment, and treatment of emotional distress in the peri- and post-pandemic periods.

Internalizing problems before and during the COVID-19 pandemic in independent samples of Dutch children and adolescents with and without pre-existing mental health problems

The aim of the study was to assess internalizing problems before and during the pandemic with data from Dutch consortium Child and adolescent mental health and wellbeing in times of the COVID-19 pandemic, consisting of two Dutch general population samples (GS) and two clinical samples (CS) referred to youth/psychiatric care. Measures of internalizing problems were obtained from ongoing data collections pre-pandemic (NGS = 35,357; NCS = 4487) and twice during the pandemic, in Apr-May 2020 (NGS = 3938; clinical: NCS = 1008) and in Nov-Dec 2020 (NGS = 1489; NCS = 1536), in children and adolescents (8-18 years) with parent (Brief Problem Monitor) and/or child reports (Patient-Reported Outcomes Measurement Information System®). Results show that, in the general population, internalizing problems were higher during the first peak of the pandemic compared to pre-pandemic based on both child and parent reports. Yet, over the course of the pandemic, on both child and parent reports, similar or lower levels of internalizing problems were observed. Children in the clinical population reported more internalizing symptoms over the course of the pandemic while parents did not report differences in internalizing symptoms from pre-pandemic to the first peak of the pandemic nor over the course of the pandemic. Overall, the findings indicate that children and adolescents of both the general and clinical population were affected negatively by the pandemic in terms of their internalizing problems. Attention is therefore warranted to investigate long-term effects and to monitor if internalizing problems return to pre-pandemic levels or if they remain elevated post-pandemic.

Psychological Health and Risk Factors of College Students within the Context of the COVID-19 Pandemic: A Cross-Sectional Study

BACKGROUND

Students are a priority population in mental health research. This study aimed to explore the risk factors of anxiety and depression symptoms among college students in Chongqing, a megacity under the impact of COVID-19, and to provide a basis for determining the priorities of public health policies and implementing effective educational health care interventions.

METHODS

In this cross-sectional study conducted in Chongqing, China, the data came from web-based stratified random sampling. Anxiety and depression symptoms were measured by the Self-Rating Anxiety Scale (SAS) and the Center for Epidemiological Studies Depression Scale (CES-D), respectively, and risk factors were analyzed by logistic regression.

RESULTS

Data were obtained from 915 college students (34.75% were male, and 65.25% were female) with age (20.29 ± 1.51) in Chongqing, China. The prevalence rates of anxiety and depression were 19.78% and 22.62%, respectively. Logistic regression analysis revealed that the risk factors of anxiety symptoms were associated with junior years, sleep time of less than 6 h a day, influence on career planning, and depression symptoms. Comprehensive, science and engineering, and medicine disciplines, having siblings, poorer mastery of study, and anxiety symptoms were risk factors for developing depression symptoms.

CONCLUSIONS

During the pandemic, college students experienced varying degrees of anxiety and depression. Our research findings highlight the necessity of universities and relevant departments providing precise mental health education for college students under major public health emergencies.

Exploring Sociodemographic Characteristics, Adverse Childhood Experience, and Mental Health History as Predictors of Anxiety and Depression among Adolescents and Young Adults: Findings from the MoreGoodDays Support Program in Alberta, Canada

BACKGROUND

The COVID-19 pandemic has increased psychological disorders among adolescents and young adults.

METHODS

This study used a cross-sectional design. An online survey questionnaire was used to collect sociodemographic and clinical information from subscribers of MoreGoodDays program, a daily supportive text message program co-designed with adolescents and young adults for their peers in Alberta. Validated instruments, the Generalized Anxiety Disorder GAD-7 scale and Patient Health Questionnaire-9 PHQ-9 were used to collect information on likely GAD and likely major depressive disorder (MDD). Data was analyzed with SPSS version 25 using chi-squared tests and binary logistic regression analysis.

RESULTS

343 subscribers of MoreGoodDays participated in the survey. Overall, 117 (56.0%) respondents had a likely MDD and 97 (46.6%) had a likely GAD. Participants who would like to receive mental health counselling were 27 times more likely to experience GAD (OR = 27; 95% CI: 3.09-250.00) and 40 times more likely to experience MDD (OR = 40.03; 95% CI: 4.43-361.51) than those who did not. Respondents who had received mental health counselling in the past were 18.5 times more likely to experience MDD compared with those who had not (OR = 18.52; 95% CI: 1.55-200.00). Demographic variables, including age, education, employment, and relationship status, and clinical variables, such as history of anxiety, depression, obsessive-compulsive disorder, ADHD, and adverse childhood experience, did not independently the predict presence of likely GAD or MDD in subscribers of MoreGoodDays.

CONCLUSION

The prevalence of anxiety and depression was relatively high among subscribers of MoreGoodDays, indicating the long-term effect of the COVID-19 pandemic. This finding has significant implications in the broader contextof mental health research and emphasizes the need for more research into innovative mental health support for this cohort. The desire to receive counselling was predictive of both anxiety and depression and is a positive sign of the openness of this cohort to receive psychological intervention. Since this group is mostly adapted to mobile text technology, government agencies and policymakers should prioritize and implement readily accessible interventions such as supportive text messages to support their psychological well-being.

Structural Correlates of Mental Health Support Access among Sexual Minority Youth of Color during COVID-19

Many youth with mental health needs cannot access treatment, with multiply-marginalized youth, such as sexual minority youth of Color (SMYoC), experiencing both structural and identity-related barriers to care. The COVID-19 pandemic threatens to exacerbate multi-level treatment access barriers facing SMYoC youth nationwide. However, little large-scale research has examined access to mental health care among SMYoC across the United States, either during or prior to the pandemic. Such work is critical to understanding and ameliorating barriers in this domain. Using data from adolescents who self-identified as SMYoC and who endorsed a desire for mental health support during the COVID-19 pandemic (N = 470, ages 13-16, from 43 U.S. states), we examined associations between state-level, structural factors (income inequality; mental health-care provider shortage; anti-Black racism; homophobia; and the interaction between anti-Black racism and homophobia) and SMYoC mental health treatment access. Multinomial logistic regressions revealed state-level mental health-care provider shortage as the only significant predictor of SMYoC reporting they never (versus always) accessed mental health support during the COVID-19 pandemic. SMYoC living in areas with both lower homophobia and lower anti-Black racism were more likely to report always (versus sometimes) accessing mental health treatment. Results highlight the critical importance of considering diverse structural factors and applying an intersectional lens when exploring barriers to mental health treatment among multiply-marginalized youth. In locations where provider shortages are less severe, cultural stigma - including anti-Black racism and homophobia - may still pose challenges for SMYoC in need of mental health care.

The mental health impact of the COVID-19 pandemic on older adults: a systematic review and meta-analysis

BACKGROUND

Early in the COVID-19 pandemic, many experts pointed to potential adverse mental health effects for older adults. By contrast, many studies in young to middle-aged adults found older age to be associated with reduced mental burden. However, a systematic review on older adults is missing.

OBJECTIVES

To comprehensively assess the pandemic's mental health impact on older adults.

DATA SOURCES

We searched nine databases from December 2019 to April 2022.

STUDY SELECTION

We included longitudinal and repeated cross-sectional studies assessing pre- and/or peri-pandemic mental distress and/or positive mental health indicators (e.g. wellbeing) on at least two occasions.

DATA SYNTHESIS

We identified 108 studies comprising 102,136 participants (≥60 years). After removal of outliers, there was a small increase in mental distress from pre-to-peri-pandemic assessments, standardised mean difference (SMD) = 0.10, 95% confidence interval (CI) [0.01, 0.18]. Furthermore, a small peri-pandemic decrease in anxiety symptoms was observed, whereas other symptoms remained unchanged. For positive mental health indicators, wellbeing and quality of life showed an initial decrease, whereas overall positive mental health increased during the pandemic, SMD = 0.08, 95% CI [0.01, 0.15]. Being female was related to larger peri-pandemic increases in mental distress.

CONCLUSIONS

Based on many studies, this review demonstrated small decreases in mental health during early stages of the pandemic in older adults, with evidence for later recovery. These findings are similar to those for younger adults and correct earlier claims that older adults are at particular risk for negative mental health consequences. The results ask for further research into resilience and adaptation processes in older adults.

Effects of eHealth interventions on stress reduction and mental health promotion in healthcare professionals: A systematic review

AIMS

To evaluate the effectiveness of eHealth interventions to reduce stress and promote mental health in healthcare professionals, and to compare the efficacy of different types of programs (guided vs. self-guided; 'third-wave' psychotherapies vs. other types).

BACKGROUND

Healthcare workers present high levels of stress, which constitutes a risk factor for developing mental health problems such as depression and anxiety. eHealth interventions have been designed to reduce these professional's stress considering that the characteristics of this delivery method make it a cost-effective and very appealing alternative because of its fast and easy access.

DESIGN

A systematic review of quantitative studies.

METHODS

A comprehensive database search for quantitative studies was conducted in PubMed, EMBASE and Cochrane (until 1 April 2022). The systematic review was conducted in accordance with the PRISMA and SWiM reporting guidelines. The quality of the studies was assessed using the National Heart, Lung and Blood Institute tools.

RESULTS

The abstracts of 6349 articles were assessed and 60 underwent in-depth review, with 27 fulfilling the inclusion criteria. The interventions were classified according to their format (self-guided vs. guided) and contents ('third-wave' psychotherapies vs. others). Twenty-two interventions emerged, 13 of which produced significant posttreatment reductions in stress levels of health professionals (9 self-guided, 8 'third wave' psychotherapies). Significant effects in improving depressive symptomatology, anxiety, burnout, resilience and mindfulness, amongst others, were also found.

CONCLUSION

The evidence gathered in this review highlights the heterogeneity of the eHealth interventions that have been studied; self-guided and 'third-wave' psychotherapy programs are the most common, often with promising results, although the methodological shortcomings of most studies hinder the extraction of sound conclusions.

PROTOCOL REGISTRATION

PROSPERO CRD42022310199. No Patient or Public Contribution.

A Call to Action on Assessing and Mitigating Bias in Artificial Intelligence Applications for Mental Health

Advances in computer science and data-analytic methods are driving a new era in mental health research and application. Artificial intelligence (AI) technologies hold the potential to enhance the assessment, diagnosis, and treatment of people experiencing mental health problems and to increase the reach and impact of mental health care. However, AI applications will not mitigate mental health disparities if they are built from historical data that reflect underlying social biases and inequities. AI models biased against sensitive classes could reinforce and even perpetuate existing inequities if these models create legacies that differentially impact who is diagnosed and treated, and how effectively. The current article reviews the health-equity implications of applying AI to mental health problems, outlines state-of-the-art methods for assessing and mitigating algorithmic bias, and presents a call to action to guide the development of fair-aware AI in psychological science.

The effects of the COVID-19 pandemic on hallucinations and delusions in youth at clinical high-risk for psychosis and outpatients with schizophrenia

Although the COVID-19 pandemic has had detrimental effects on mental health in the general population, the impact on those with schizophrenia-spectrum disorders has received relatively little attention. Assessing pandemic-related changes in positive symptoms is particularly critical to inform treatment protocols and determine whether fluctuations in hallucinations and delusions are related to telehealth utilization and treatment adherence. In the current longitudinal study, we evaluated changes in the frequency of hallucinations and delusions and distress resulting from them across three-time points. Participants included: (1) outpatients with chronic schizophrenia (SZ: n = 32) and healthy controls (CN: n = 31); (2) individuals at clinically high risk for psychosis (CHR: n = 25) and CN (n = 30). A series of questionnaires were administered to assess hallucination and delusion severity, medication adherence, telehealth utilization, and protective factors during the pandemic. While there were no significant increases in the frequency of hallucinations and delusions in SZ and CHR, distress increased from pre-pandemic to early pandemic in both groups and then decreased at the third time point. Additionally, changes in positive symptom severity in SZ were related to psychiatric medication adherence. Findings suggest that positive symptoms are a critical treatment target during the pandemic and that ongoing medication services will be beneficial.