Examining risk and protective factors for psychological health during the COVID-19 pandemic

Gender differences in the association between body shame and binge eating: Body image flexibility as a moderator in women

BACKGROUND

Body shame is an established antecedent and maintaining factor of binge eating, beyond global negative affect and body weight, and partly through the effects of dietary restriction. These associations have mainly been established in women and are understudied in men. Body image flexibility, a concept from Acceptance and Commitment Therapy, may be a protective psychological process against the effects of negative body image on binge eating.

METHODS

Using structural equation modeling and a non-clinical sample of 244 women and 185 men, this cross-sectional study tested an integrated model of the association between body shame and binge eating, mediated by dietary restriction and moderated by body image flexibility, controlling for depressive symptoms and BMI.

RESULTS

Body shame predicted binge eating in women but not in men, whereas depressive symptoms predicted binge eating in men but not in women. Body image flexibility moderated the association between body shame and binge eating in women.

CONCLUSIONS

These cross-sectional findings highlight the importance of considering gender differences in current negative affect models of binge eating, and further support the role of body image flexibility in attenuating the influence of body shame on binge eating in women. Longitudinal studies are required to examine the temporal dynamics between these variables.

Intolerance of Uncertainty as a Situational Vulnerability Factor in the Context of the Pandemic: A Systematic Review and Meta-Analysis of COVID-19-Related Psychological Impacts

BACKGROUND

Intolerance of uncertainty (IU) is widely accepted as a transdiagnostic vulnerability factor for a range of mental health problems. It is considered a transsituational vulnerability factor associated with a range of responses to different stressful life situations. The aim of this systematic review and meta-analysis is to examine the association between IU and specific psychological responses to the COVID-19 pandemic and the moderators of this relationship drawn from IU research and other studies on COVID-19.

METHOD

The studies included were as follows: (i) English-language articles published in peer-reviewed journals or thesis/dissertations; (ii) reporting specific psychological impacts of COVID-19; (c) reporting IU; (iii) case-control studies, prospective cohort studies, experimental studies and cross-sectional studies of large populations and (iv) reporting correlation coefficients between the variables of interest. Studies on participants with a diagnosis of neurological and/or organic impairment were excluded. The databases searched were Google Scholar, PubMed, ScienceDirect, and ProQuest, up until 31 December 2022. The risk of bias was assessed using the Risk of Bias Utilized for Surveys Tool (ROBUST, Nudelman et al., 2020). Sensitivity analysis was conducted using the one-study remove method, and studentized residuals and Cook's distance were examined. A random effects model was used.

RESULTS

We examined the association between IU and COVID-19-related psychological impacts across 85 studies from 22 countries (N = 69,997; 64.95% female; mean sample age, 32.90 ± 9.70). There was no evidence of publication bias. We found a medium and positive association between IU and COVID-19-related psychological impacts (N = 69,562, r = 0.35, k = 89, 95% CI [0.32, 0.37]), which was independent of the IU measure used or whether the psychological impact was measured in relation to the virus alone or broader aspects of the pandemic. It was also independent of severity, publication year, sample type and size, study quality, age and sample levels of anxiety, depressive symptoms, stress, mental well-being and social support. However, the observed association varied significantly between countries and country income levels (stronger among low-incomes) and across genders (stronger among males) and was stronger for measures with greater reliability and more items, but lower among samples with more people who had been exposed to COVID-19.

CONCLUSIONS

The findings support that IU is a higher order transsituational vulnerability factor related to cognitive, behavioural and distress responses during the pandemic. Limitations include English-language-only sources, reliance on a wide range of measures that were coded using a novel system and variable risk of bias across studies. The implications are considered in relation to the management of psychological consequences of major situational stressors experienced at a global scale, but the variations at a national and socioeconomic level also have implications for different or localized stressors at a regional or community level.

Resilience mediates the effect of the COVID-19 pandemic on mental health in a sample of adults in Panama

Background

The COVID-19 pandemic was characterized by global increases in depression, anxiety, and stress symptoms. Previous studies have shown that resilience mitigates these symptoms, however there is limited research exploring the link between resilience and mental illness during the COVID-19 pandemic in Central America.

Objective

To examine the role of resilience as it relates to the perceived effect of the pandemic on mental health symptoms.

Methods

A sample of 480 adults in Panama were recruited from March to May 2021 to complete an online survey. The online survey consisted of sociodemographic questions and scale measures assessing depression, anxiety and stress symptoms, resilience, and social support.

Results

Results indicated that resilience mediated the relationship between the perceived effect of the COVID-19 pandemic and mental health symptoms; participants who felt more personally affected by the pandemic reported more depression, anxiety, and stress symptoms via decreased resilience. Further analyses revealed that resilience was moderated by sex and social support, showing that the indirect effect of resilience was greater for women and individuals who perceived low social support.

Discussion

These findings contribute to a growing body of research documenting the adverse effects of the COVID-19 pandemic on mental health and reveal potential mechanisms through which pandemic-related distress decreases resilience, thereby increasing symptoms of mental illness.

Mediating effect of social interaction anxiety between emotional intelligence and life satisfaction in physical education students: post-COVID-19 study

The aim of this research is to analyze the effect of social interaction anxiety on satisfaction with life mediated by emotional intelligence. The research design was descriptive, cross-sectional, and non-randomized. In total, 1,164 Mexican physical education students participated (Mage = 21.21; SD = 3.26; 30.0% female; 69.6% male; 0.4% other). The scales used were the Social Interaction Anxiety Scale, Trait Meta-Mood Scale and Satisfaction with Life and a structural equation analysis with latent variables was conducted. The results highlight that it can be asserted that emotional clarity and repair had a mediating effect between social interaction anxiety and satisfaction with life, as they did decrease the negative effects of social interaction anxiety on satisfaction with life. In addition, social interaction anxiety had a direct and positive effect on emotional attention and a negative effect on emotional clarity and repair.

Predicting anxiety and depression over 12 months of the COVID-19 pandemic: A machine learning study

OBJECTIVES

The coronavirus disease 2019 (COVID-19) pandemic was associated with substantial increases in anxiety and depressive symptoms. To understand individual risk, we examined a large set of potential risk factors for anxiety and depression in the pandemic context.

METHODS

Adults in the United States (N = 1200) completed eight online self-report assessments over 12 months of the COVID-19 pandemic. Area under the curve scores summarized cumulative experiences of anxiety and depression over the assessment period. A machine learning approach to elastic net regularized regression was used to select predictors of cumulative anxiety and depression severity from a set of 68 sociodemographic, psychological, and pandemic-related baseline variables.

RESULTS

Cumulative anxiety severity was most strongly explained by stress and depression-related variables (such as perceived stress) and select sociodemographic characteristics. Cumulative depression severity was predicted by psychological variables, including generalized anxiety and depressive symptom reactivity. Being immunocompromised or having a medical condition were also important.

CONCLUSIONS

By considering many predictors, findings provide a more complete view than previous studies focused on specific predictors. Important predictors included psychological variables suggested by prior research and variables more specific to the pandemic context. We discuss how such findings can be used in understanding risk and planning interventions.

Reconsidering the role of interpersonal stress in eating pathology: Sensitivity to rejection might be more important than actual experiences of peer stress

Rejection sensitivity (i.e., the tendency to anxiously expect, readily perceive, and overreact to real or perceived rejection) is theorized to play a role in the onset and maintenance of disordered eating. Although rejection sensitivity has repeatedly been associated with eating pathology in clinical and community samples, the pathways through which this psychological trait influences eating pathology have been not fully established. The current study investigated peer-related stress, which can be influenced by rejection sensitivity and is associated with eating pathology, as a mechanism linking these constructs. In two samples of women - 189 first-year undergraduate students and 77 community women with binge eating - we examined whether rejection sensitivity was indirectly associated with binge eating and weight/shape concerns via ostracism and peer victimization, both cross-sectionally and longitudinally. Our hypotheses were not supported: there were no indirect associations between rejection sensitivity and eating pathology via interpersonal stress in either sample. However, we did find that rejection sensitivity was directly associated with weight/shape concerns in both samples and with binge eating in the clinical sample in cross-sectional (but not longitudinal) analyses. Our findings suggest that the association between rejection sensitivity and disordered eating is not dependent on actual experiences of interpersonal stress. That is, simply anticipating or perceiving rejection may be sufficient to play a role in eating pathology. As such, interventions targeting rejection sensitivity may be helpful in the treatment of eating pathology.

COVID-19 fear and anxiety as mediators in the relationship between repetitive negative thinking and psychopathology: a community-based study during the 2nd confinement in Portugal

Repetitive negative thinking is a cognitive dimension of the onset and maintenance of psychopathology, and increased levels of psychopathology have been observed during COVID-19 lockdowns. The role of fear of COVID-19 and COVID-19 anxiety has been poorly explored in terms of psychopathology during lockdowns due to the pandemic crisis. This study examines the mediating role of fear of COVID-19 and COVID-19 anxiety in the relationship between repetitive negative thinking and psychopathology during the second lockdown in Portugal. Participants completed a web survey that included a sociodemographic questionnaire, the Fear of COVID-19 Scale, the COVID-19 Anxiety Scale, the Persistent and Intrusive Negative Thoughts Scale, and the Depression, Anxiety, and Stress Scale - 21. The results showed a positive and significant correlation between all variables and identified fear of COVID-19 and COVID-19 anxiety as significant mediators in the relationship between repetitive negative thinking and psychopathology during the second lockdown in Portugal, after controlling for being isolated, being infected, and working in first line response of COVID-19. Overall, the current findings highlight the role of cognitive dimensions such as anxiety and fear in the context of COVID-19, nearly a year after the pandemic outbreak and after the release of a vaccine. Mental health programs should consider improving coping strategies for emotion regulation, particularly fear and anxiety, during major catastrophic health-related events.

The level of health anxiety before and during the COVID-19 pandemic

BACKGROUND

Concerns about disease and an increase in health anxiety levels are expected consequences of the COVID-19 pandemic. However, there have been few longitudinal studies of health anxiety in the general population during this time period. The aim of this study was to examine health anxiety levels before and during the COVID-19 pandemic in an adult, working population in Norway.

MATERIAL AND METHODS

This study included 1012 participants aged 18-70 years with one or more measurements of health anxiety (1402 measurements total) from the pre-pandemic period (2015 to March 11, 2020) and/or during the COVID-19 pandemic (March 12, 2020 to March 31, 2022). Health anxiety was measured with the revised version of the Whiteley Index-6 scale (WI-6-R). We estimated the effect of the COVID-19 pandemic on health anxiety scores with a general estimation equation analysis, and age, gender, education, and friendship were included in subgroup analyses.

RESULTS

We found no significant change in health anxiety scores during the COVID-19 pandemic compared to the pre-pandemic period in our adult, working population. A sensitivity analysis restricted to participants with two or more measurements showed similar results. Moreover, the effect of the COVID-19 pandemic on health anxiety scores was not significant in any subgroup analysis.

CONCLUSION

Health anxiety remained stable, with no significant change observed between the pre-pandemic period and the first 2 years of the COVID-19 pandemic in an adult, working population in Norway.

Relationship between COVID-19 Pandemic-Related Life Behavior, Dispositional Mindfulness, and Psychological Health: Evidence from a Sample of Japanese Working Adults

The present study investigated how altered daily life behavior and its self-evaluation associated with the coronavirus disease 2019 (COVID-19) pandemic relate to psychological health in Japanese working adults, and how such relationships may be moderated by dispositional mindfulness. A total of 1000 participants completed an online survey comprising questions on how they used time and self-evaluated life behavior before and during the pandemic, as well as scales on mindfulness and psychological health. The results revealed that after the pandemic, participants spent significantly more time at home and using a PC/smartphone. They were also more likely to perceive frequent exposure to COVID-19-related media reports and less likely to find their work going well. Many of these variables were significantly correlated with lower psychological health. Moreover, hierarchical multiple regression analyses revealed the moderating effects of mindfulness, such that the perceived frequency of exposure to pandemic-related media reports and poorer views that work was going well were less likely to predict lower psychological health when mindfulness was high. These findings suggest that altered daily life behavior and its self-evaluation after the pandemic are associated with deteriorated psychological health, but that mindfulness can serve as a protective factor against psychological distress among Japanese workers.

Listen to the heart or mind first? Examining sequential coping mechanisms among Indians during the COVID-19 pandemic

The present study examines the mediating role of emotion-focused and problem-focused coping between stress and psychological well-being during the COVID-19 pandemic. The sample comprised 501 (312 women and 184 men aged between 18 and 42) Indians who experienced the first-ever continued lockdown in India during the COVID-19 pandemic. The results of this study confirmed the presence of perceived stress due to the lockdown and pandemic among participants. Furthermore, perceived stress, coping including emotion-focused and problem-focused, and psychological well-being were found to be interrelated. The serial mediation analysis revealed that participants dealt with stress by choosing emotion-focused coping first as an immediate resort. After a reappraisal of stress-inducing situations, they used problem-focused coping, and this sequence of constant coping mechanisms helped maintain their psychological well-being. The findings of this study can be applied to develop strategies for people's mental health by public health organizations and health professionals.

Perceived stress of adolescents during the COVID-19 lockdown: Bayesian multilevel modeling of the Czech HBSC lockdown survey

Objective

Long-term isolation, including lockdowns and quarantines, may have a distressing effect on anyone experiencing it. Adolescent brain architecture is very sensitive to environmental adversities, and the mental health development of adolescents may be particularly vulnerable during the pandemic era. In order to better understand the triggers for perceived adolescent stress (PSS) during the COVID-19 lockdown, the present study aimed to assess the effects of social well-being and changes in time use during the lockdown, as well as the family COVID experience of adolescents.

Methods

The sample for this study comprised n = 3,440 adolescents (54.2% girls; mean age = 13.5 ± 1.6 years). Bayesian correlations between PSS, health and well-being variables were assessed. PSS was then modeled as an outcome variable in a series of nested Bayesian multilevel regression models.

Results

The negative impact of the COVID-19 lockdown was more apparent in girls. PSS was moderately correlated with adolescent health and well-being. The strongest predictor of higher level of PSS was frequent feeling of loneliness. On the contrary, lower level of PSS was most associated with having someone to talk to.

Conclusion

Long-term social isolation of adolescents could be harmful to their mental health. Psychological coping strategies to prevent the consequences of social isolation and development of mental health problems should be promoted on the individual, family, and even community level.

Post-partum Women’s Anxiety and Parenting Stress: Home-Visiting Protective Effect During the COVID-19 Pandemic

Objectives

The COVID-19 pandemic resulted in a particularly adverse and stressful environment for expecting mothers, possibly enhancing feelings of anxiety and parenting stress. The present work assesses mothers' anxiety levels at delivery and parenting stress after 3 months as moderated by home-visiting sessions.

Methods

Women (n = 177) in their second or third trimester of pregnancy during the COVID-19 lockdown were enrolled in northern Italy and split into those who did and did not receive home visits. After 3 months, the association between anxiety at delivery and parenting stress was assessed with bivariate correlations in the whole sample and comparing the two groups.

Results

Higher anxiety at birth correlated with greater perceived stress after 3 months. Mothers who received at least one home-visiting session reported lower parenting stress at 3 months than counterparts who did not receive home visits.

Conclusions for Practice

The perinatal period is a sensitive time window for mother-infant health, especially during a critical time like the COVID-19 pandemic. We suggest that home-visiting programs could be beneficial during global healthcare emergencies to promote maternal well-being after delivery.

Predictors of mental health deterioration from pre- to post-COVID-19 outbreak

BACKGROUND

Mental health was only modestly affected in adults during the early months of the COVID-19 pandemic on the group level, but interpersonal variation was large.

AIMS

We aim to investigate potential predictors of the differences in changes in mental health.

METHOD

Data were aggregated from three Dutch ongoing prospective cohorts with similar methodology for data collection. We included participants with pre-pandemic data gathered during 2006-2016, and who completed online questionnaires at least once during lockdown in The Netherlands between 1 April and 15 May 2020. Sociodemographic, clinical (number of mental health disorders and personality factors) and COVID-19-related variables were analysed as predictors of relative changes in four mental health outcomes (depressive symptoms, anxiety and worry symptoms, and loneliness), using multivariate linear regression analyses.

RESULTS

We included 1517 participants with (n = 1181) and without (n = 336) mental health disorders. Mean age was 56.1 years (s.d. 13.2), and 64.3% were women. Higher neuroticism predicted increases in all four mental health outcomes, especially for worry (β = 0.172, P = 0.003). Living alone and female gender predicted increases in depressive symptoms and loneliness (β = 0.05-0.08), whereas quarantine and strict adherence with COVID-19 restrictions predicted increases in anxiety and worry symptoms (β = 0.07-0.11).Teleworking predicted a decrease in anxiety symptoms (β = -0.07) and higher age predicted a decrease in anxiety (β = -0.08) and worry symptoms (β = -0.10).

CONCLUSIONS

Our study showed neuroticism as a robust predictor of adverse changes in mental health, and identified additional sociodemographic and COVID-19-related predictors that explain longitudinal variability in mental health during the COVID-19 pandemic.

Times Are Harsh, Be Kind to Yourself! Anxiety, Life Satisfaction, and the Mediating Role of Self-Compassion

The present research aimed to explore the indirect effect of self-compassion on the relationship between two dimensions of intolerance of uncertainty (i.e., prospective and inhibitory anxiety) and life satisfaction. One hundred sixty-four Romanian adult participants formed our sample from the country's eastern side. Their ages ranged between 18 and 61 (M = 23.45, SD = 7.70, 72% females). The study was conducted in 2021, when the Delta wave of COVID-19 was at its peak. Our findings suggested significant negative associations between prospective anxiety, self-compassion, and life satisfaction. A similar negative significant association was suggested between inhibitory anxiety and self-compassion. Age did not significantly correlate with any of our primary variables. Mediation analyses indicated a total mediating effect of self-compassion on the relationship between participants' prospective and inhibitory anxiety and their life satisfaction. We discuss the implications of our findings, considering their relevance for therapeutical interventions aimed to promote psychological wellbeing when facing adversity.

Sexual satisfaction and sexual behaviors during the COVID-19 pandemic: results from the International Sexual Health And REproductive (I-SHARE) health survey in Luxembourg

AIM

To identify the impact of COVID-19 measures on sexual behaviors and sexual satisfaction in Luxembourg residents.

METHODS

We conducted a cross-sectional online survey of adults (> 18 years of age) residing in Luxembourg, while COVID-19 restrictions were in place. The survey was available from January 15 to February 12, 2021 in four languages (French, German, English and Portuguese). Survey questions focused on masturbation, cuddling, condom use, sex frequency, sexting, cybersex, watching porn, and sexual satisfaction.

RESULTS

557 volunteers completed the survey (35.5% men, 64.3% women). Sexual satisfaction and sexual problems variables were assessed on 4-point Likert scales (0 = not at all/never to 3 = very/often). Sexual problems increased during the COVID-19 measures while sexual satisfaction decreased compared to before the introduction of COVID-19 restrictions (assessed retrospectively). Factors associated with increased odds of sexual satisfaction included having a steady relationship before COVID-19 restrictions, engaging in sexting, reporting good mental health and not altering alcohol intake.

CONCLUSIONS

The context of the COVID-19 pandemic and the measures implemented in Luxembourg affected sexual behaviors and sexual satisfaction. Sexual and reproductive health care centers and health professionals in general should take these results into consideration when providing care. Recommendations on the importance of sexual health for general wellbeing and behaviors associated with sexual satisfaction should be offered and possibilities to experience sexuality while reducing contamination risks be discussed.

Relationship between COVID-19 anxiety and fear of death: the mediating role of intolerance of uncertainty among a Turkish sample

The Coronavirus Disease 2019 (COVID-19) pandemic has increased the salience of death in our lives. The aim of this study is to uncover potential mechanisms underlying fear of death during the pandemic. A sample of 478 volunteers (312 females and 166 males) aged 18 years and older participated voluntarily in this study. Coronavirus Anxiety Scale, Multidimensional Mortality Awareness Measure, Intolerance of Uncertainty Scale, and Personal Information Form were used for data collection. The mediating role of intolerance of uncertainty in the relationship between COVID-19 anxiety and fear of death was determined using the bootstrapping method. COVID-19 anxiety was associated with increased intolerance of uncertainty, and fear of death. Intolerance of uncertainty was associated with increased fear of death. Furthermore, intolerance of uncertainty partially mediated the relationship between COVID-19 anxiety and fear of death. Results suggest that intolerance of uncertainty is a critical variable in the relationship between COVID-19 anxiety and fear of death. The current research adds to our knowledge of fear of death by investigating COVID-19 anxiety and intolerance of uncertainty. Additionally, this study underlies and contributes to the consideration of psychological health of individuals during the pandemic process. The results are discussed within the context of the COVID-19 pandemic.

Psychological Well-Being During the Second Wave of COVID-19 Pandemic: The Mediation Role of Generalized Anxiety

Introduction

The outbreak of the COVID-19 has largely impacted individuals’ health and lifestyles. This study aimed to investigate people’s psychological well-being during the second phase of the COVID-19 pandemic.

Methods

We selected six indicators of psychological well-being: fear of COVID-19, loneliness, social interaction anxiety, generalized anxiety, PTSD, and depression. A sample of 231 Italian participants (56.3% women), with a mean age of 32.7 (SD=12.61), completed an online survey from February to March 2021, during the so called “second wave”. It included the Fear of COVID-19 Scale (FCV-19S), the UCLA Loneliness Scale- Version 3, the Generalized Anxiety Disorder 7-item Scale (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), the Impact of Event Scale–Revised (IES-R), and the Social Interaction Anxiety Scale (SIAS).

Results

Apart from loneliness, women reported lower levels of psychological well-being than men. Fairly good associations between all the detected variables were found. Based on a mediation model evaluation (in which generalized anxiety was introduced as a mediator in the relationship between fear of COVID-19, PTSD, loneliness, social interaction anxiety, and depression), except for social interaction anxiety, total and partial mediation effects suggested that generalized anxiety played a crucial role in exacerbating depressive symptoms during the pandemic.

Conclusion

Our outcomes may expand the knowledge about the psychological well-being during the pandemic experience, with a focus on the mediating role of generalized anxiety.

A systematic scoping review of research on COVID-19 impacts on eating disorders: A critical appraisal of the evidence and recommendations for the field

OBJECTIVE

Research investigating the effects of COVID-19 on eating disorders is growing rapidly. A comprehensive evaluation of this literature is needed to identify key findings and evidence gaps to better inform policy decisions related to the management of eating disorders during and after this crisis. We conducted a systematic scoping review synthesizing and appraising this literature.

METHOD

Empirical research on COVID-19 impacts on eating disorder severity, prevalence, and demand for treatment was searched. No sample restrictions were applied. Findings (n = 70 studies) were synthesized across six themes: (a) suspected eating disorder cases during COVID-19; (b) perceived pandemic impacts on symptoms; (c) symptom severity pre versus during the pandemic; (d) pandemic-related correlates of symptom severity; (e) impacts on carers/parents; and (f) treatment experiences during COVID-19.

RESULTS

Pandemic impacts on rates of probable eating disorders, symptom deterioration, and general mental health varied substantially. Symptom escalation and mental health worsening during-and due to-the pandemic were commonly reported, and those most susceptible included confirmed eating disorder cases, at-risk populations (young women, athletes, parent/carers), and individuals highly anxious or fearful of COVID-19. Evidence emerged for increased demand for specialist eating disorder services during the pandemic. The forced transition to online treatment was challenging for many, yet telehealth alternatives seemed feasible and effective.

DISCUSSION

Evidence for COVID-19 effects is mostly limited to participant self-report or retrospective recall, cross-sectional and descriptive studies, and samples of convenience. Several novel pathways for future research that aim to better understand, monitor, and support those negatively affected by the pandemic are formulated.