Post-traumatic stress, growth, and depreciation during the COVID-19 pandemic: evidence from Turkey

Meaning-making while staying connected matters in psychological adaptation during pandemic: a longitudinal moderated mediation study

Adversity may bring about both negative and positive changes in psychological adaptation. Although there is mounting evidence regarding the psychological distress during the pandemic, the other side of posttraumatic change, posttraumatic growth (PTG) and its predictors are relatively underexamined. Moreover, there is a paucity of longitudinal investigations that examined intra- and interpersonal predictors responsible for both sides of psychological adaptation. Therefore, this study comprehensively examined the longitudinal relationship among cognitive processing, social support, and adaptation during the pandemic using a moderated mediation model. Specifically, it was tested whether two types of event-related rumination mediated the link between perceived stress and ambilateral adaptational outcomes, and whether social support moderated the mediating pathways of ruminations on adaptation. After informed consent, a representative sample of adults was followed up for over a year, and answered a package of online questionnaires. The results showed that intrusive rumination prospectively predicted greater psychological distress and less PTG in response to stress, whereas deliberate rumination led to less psychological distress and more PTG over time. As predicted, the indirect protective effect of deliberate rumination was stronger when perceived social support was higher. This longitudinal study highlighted the core factors responsible for continued suffering and personal growth during the pandemic. These results have both practical and clinical implications for mental healthcare in the post-COVID era, when the heterogeneity of psychological adaptation increases and preparation for the next pandemic is warranted.

Prevalence and factors of posttraumatic growth among Hubei residents during the COVID-19 pandemic: A cross-sectional study

The adverse impact of the COVID-19 pandemic on mental health has been widely concerned, but the research on positive psychological factors is insufficient, this study aims to investigate the prevalence and factors of posttraumatic growth (PTG) among residents in the worst-hit areas of China (Hubei Province). We were conducted in three disaster areas with different severity in Hubei Province three months after the outbreak, and the data were from 575 respondents. Instruments included the simplified Chinese version of the Posttraumatic Growth Inventory (C-PTGI) and the public health emergency psychological questionnaire. Nonparametric tests, Spearman correlation analyses, and multiple linear regression equations were used to analyze the data. The results showed that three months after the outbreak of COVID-19, the PTG of Hubei residents was at a low level, and their sense of fear was the most prominent, with a positive detection rate of 82.09%. According to the results of this study, high PTG levels were associated with high levels of fear, married and healthcare providers, while low levels of PTG were associated with serious chronic diseases, males, good economic status, and poor prevention and control measures. Government departments should strengthen social support for residents, carry out necessary stress management training to help them correctly deal with negative emotions and promote their personal growth.

Factors Associated with Post-Traumatic Growth during the COVID-19 Pandemic: A Systematic Review

The COVID-19 pandemic was an unprecedented event that further stimulated the debate on the concept of trauma. To increase knowledge about the traumatic potential of the pandemic, the main objective of this study was to identify, through a systematic literature review, the main factors associated with the adaptive outcome of post-traumatic growth caused by COVID-19. Studies were selected from the PsychInfo, Embase, and PubMed databases, and 29 articles were included at the end of the screening process. The identified factors are of different natures, including personal variables such as personality traits, coping, and cognitive strategies used to face adversity, and interpersonal variables, one of the most important of which is the level of social support. In addition, several results confirmed a relationship between post-traumatic growth and post-traumatic stress symptoms, as well as indices related to psychological well-being. Finally, the results are discussed by comparing them with those already present in the literature, as well as with some of the main explanatory models of post-traumatic growth. In this regard, some of the factors identified, such as maladaptive coping, avoidance symptoms, optimism, and low-stress tolerance, suggest the possibility that the process of post-traumatic growth may also be characterized by an illusory dimension.

Does perceived post-traumatic growth during the COVID-19 pandemic reflect actual positive changes?

BACKGROUND AND OBJECTIVES

People commonly report positive changes following stressful experiences (perceived posttraumatic growth; PPTG), yet whether PPTG validly reflects positive changes remains unestablished.

DESIGN AND METHODS

We tested the extent to which COVID-19 pandemic-related PPTG relates to positive changes in corresponding psychosocial resources in a national US sample participating in a five wave study (T1-T5), focusing here on T2-T5: ns = 712-860. We examined correlations between resource change (both latent and observed difference scores) and PPTG at each occasion and conducted structural equation models to separate occasion-specific and stable (traitlike) PPTG variance. We related changes in resources to occasion-specific and stable PPTG components.

RESULTS

Associations between change scores and occasion-specific PPTG were sparse, providing limited evidence of PPTG validity. Associations between change scores and stable PPTG tended to be positive and stronger than associations for occasion-specific PPTG.

DISCUSSION

Perceptions of growth were largely unrelated to experienced positive changes and thus appear to be largely illusory. However, a personality-like tendency to believe one grows from stressful experiences relates more strongly to actual resource growth. These results suggest that people are not accurate reporters of positive changes they experience and that interventions aimed at promoting post-traumatic growth may be premature.

Fear of COVID-19, Perceived Stress, and PTSD: The Serial Mediating Role of Sense of Coherence

The literature has identified that a sense of coherence plays a protective role in the relationship between adverse events and mental health. The current study examines the role of a sense of coherence (SOC) in the relationship between fear of COVID-19, perceived stress, and dimensions of post-traumatic stress disorder (PTSD). Participants (n = 322) were students at a metropolitan university in South Africa who completed the Fear of COVID-19 Scale, the Perceived Stress Scale, the 13-item Sense of Coherence Scale, and the PTSD Checklist. Path analysis was used to conduct a serial mediation analysis. The results show that SOC mediates the relationship between perceived stress and the dimensions of PTSD but does not mediate the relationship between fear of COVID-19 and PTSD. Furthermore, the relationship between fear of COVID-19 and dimensions of PTSD was mediated by serial perceived stress and sense of coherence, supporting the hypothesis that higher levels of fear of COVID-19 leads to higher levels of perceived stress. However, while high levels of fear of COVID-19 increase perceived stress, SOC significantly mediates the subsequent impact on PTSD symptoms.

COVID-19-associated impact and post-traumatic stress symptoms 39 days after pandemic in a sample of home-quarantined Chinese college students: the mediating effecting of past stressful events, psychological resilience, and social support

BACKGROUND

During the COVID-19 outbreak, most Chinese college students were home-quarantined to prevent the spread of the virus. COVID-19-associated impact has been shown to be a risk factor for the development of post-traumatic symptoms disorder (PTSD). However, little is known about the psychological processes that mediate this association. This study investigated the association between COVID-19-associated impact and PTSD and examined whether past stressful events, psychological resilience, and social support have mediating effects on this association.

METHODS

The 12,397 valid responses from 31cities in China via an online survey assessed PTSD symptoms, past stressful events, psychological resilience, social support and social-demographic variables. AMOS was used to test the hypotheses of mediating effects.

RESULTS

On the 39th day of the declared COVID-19 epidemic in China, 6.75% of the surveyed sample showed PTSD symptoms. A positive mediating effect of past stressful events was found between COVID-19-associated impact and PTSD, whereas psychological resilience and social support had negative mediating effects. The fit indices for the path model were found to be significant (β = 0.28, p < 0.001), COVID-19-associated impact indirectly affects the risk of PTSD through mediating pathways (past stressful events → psychological resilience → social support) on PTSD.

CONCLUSIONS

Attention should be paid to the effects of past stressful events of Chinese college students who were home-quarantined during the COVID-19 epidemic, and strategies should also be implemented to improve social support and develop psychological resilience.

TRIAL REGISTRATION

The study was approved by the ethics committee of the Southwest Minzu University.

The traumatic impact of the COVID-19 pandemic: the possible role of rumination and uncertainty

The COVID-19 pandemic has caused some traumatic injuries to individuals due to the isolation, loneliness, and uncertainty it has created. Ruminative thoughts and uncertain situations are known to affect trauma. It aimed to evaluate the traumatic effect of the pandemic based on the ruminative thoughts and intolerance of uncertainty in the study. The sample for the descriptive and cross-sectional study consisted of 402 participants. Data were collected by using the questionnaire form, the Post Traumatic Stress Disorder Scale (PTSD), the Ruminative Reactions Scale (RRS), and the Intolerance of Uncertainty Scale (IUS). A positive correlation was discovered between the PTSD mean scores of the study participants and their RRS and IUS scores (p < .05). Furthermore, RRS (β = 0.280) was identified as a variable that primarily affected PTSD (p < .05). It was concluded that both ruminative thoughts and intolerance of uncertainty were predictors of post-traumatic stress disorder in the COVID-19 pandemic. Considering the possible effects of the pandemic, it is recommended to reduce the intolerance to uncertainty, to rework the ruminative thought content with appropriate and effective methods, and to create some programs for gaining problem-solving skills.

Associations between Mental Health and COVID-19 Status among 18- and 19-Year-Old Adolescents: A Multi-Country Study

The aim of this study was to describe the mental health status of 18- and 19-year-old adolescents who were infected or affected by COVID-19 during the first wave of the COVID-19 pandemic. This was a secondary analysis of a dataset collected from 152 countries between July and December 2020. Dependent variables were anxiety, depression, and post-traumatic stress symptoms. The independent variable was COVID-19 status (tested positive for COVID-19, had COVID-19 symptoms but did not test, had a close friend who tested positive for COVID-19, knew someone who died from COVID-19). Three multivariable logistic regression analyses were conducted to determine the associations between the dependent and independent variables while adjusting for confounding variables (sex—male, female, and country income level). Data of 547 participants were extracted, and 98 (17.9%) had experienced depression, 130 (23.8%) had experienced anxiety, and 219 (40.0%) had experienced post-traumatic stress symptoms. Knowing someone who died from COVID-19 was associated with significantly lower odds of having post-traumatic stress symptoms (AOR: 0.608). Having COVID-19 symptoms but not getting tested was associated with significantly higher odds of having anxiety symptoms (AOR: 2.473). Results indicate diverse mental health responses among adolescents aged 18–19-years old as a sequela of COVID-19. This needs to be studied further.

The influence of deliberate rumination on the post-traumatic growth of college students during the COVID-19 pandemic and the moderating role of self-efficacy

Objective

To understand the relationship between deliberate rumination and post-traumatic growth and the mechanisms affecting this relationship, we constructed an adjustment model to test the impact of deliberate rumination on the post-traumatic growth of college students and the moderating role of self-efficacy during the 2019 COVID-19 pandemic.

Study design and setting

A total of 881 college students from a university of science and technology in Guangdong Province, China, completed a questionnaire that measured deliberate rumination, post-traumatic growth, and self-efficacy. SPSS (version 26) and the PROCESS plug-in (version 4.0) were used for correlation and moderation analyses.

Results

The correlation analysis showed that deliberate rumination was positively correlated with post-traumatic growth (r = 0.353, P < 0.01) and self-efficacy (r = 0.261, P < 0.01). Self-efficacy was also positively correlated with post-traumatic growth (r = 0.466, P < 0.01). In addition, we found that self-efficacy had a regulatory effect on the relationship between deliberate rumination and post-traumatic growth (R ² = 0.287, P < 0.001) and that this effect was significant.

Conclusion

The results show that deliberate rumination can be a positive predictor of post-traumatic growth and can play a certain role in fostering such growth. In addition, self-efficacy is a moderator that plays a buffer role between deliberate rumination and post-traumatic growth. These results contribute to a more comprehensive understanding of the mechanisms that affect post-traumatic growth.

The Relationship among Anxiety, Worry, Perceived Stress, Defense Mechanisms, and High Levels of Post-Traumatic Stress Symptoms: A Discriminant Analytic Approach

Post-traumatic stress disorder (PTSD) is a pathological condition that may lead to a significant deterioration in the quality of life over time. Therefore, the study of the elements that can characterize the disorder could be considered of great clinical interest and relevance. The aim of the present research was to empirically discriminate the influence of perceived stress, state anxiety, worry, and defense mechanisms (mature, neurotic, and immature) at different levels of post-traumatic stress symptoms. A sample of 1250 participants (69.5% women, 30.5% men; M_age = 34.52, SD = 11.857) completed an online survey including the Impact of Event Scale-Revised, Ten-Item Perceived Stress Scale, Penn State Worry Questionnaire, Forty Item Defense Style Questionnaire, and State-Trait Anxiety Inventory-Form X3. Data were analysed by implementing MANOVA and discriminant analysis. Results showed significant differences in the levels of perceived stress, state anxiety, and worry, as well as neurotic and immature defenses based on the levels of post-traumatic stress symptoms: F(12,2484) = 85.682, p < 0.001; Wilk's Λ = 0.430. Furthermore, these variables discriminate significant accuracy between participants who reported a mild psychological impact and those with a probable presence of PTSD, with perceived stress, which was found to be the best predictor. Classification results indicated that the original grouped cases were classified with 86.3% overall accuracy. Such findings may provide useful insight for clinical practice.

Factors associated with posttraumatic growth: gratitude, PTSD and distress; one year into the COVID-19 pandemic in Lebanon

Almost one year since the COVID-19 was declared a global pandemic, mental distress remains elevated with high prevalence of post-traumatic stress disorder (PTSD). Yet studies suggest these challenging circumstances might be conducive of post-traumatic growth (PTG). This study aims to investigate the factors associated with growth after the original trauma. A sample of 252 Lebanese adults filled an online survey to determine levels of PTG, PTSD and gratitude using validated self-rating scales. Participants also subjectively evaluated the sources of their distress such as the COVID-19 pandemic, the Beirut port explosion and/or their deteriorating financials. The PTGi-SF evaluated dimensions of growth while the IES-R_22 measured the degree of distress post-trauma. The GQ-6 was used to measure the proneness to experience gratitude daily. Results indicated 41% of participants scored above the cutoff for PTSD symptomatology. Yet, PTSD was positively correlated, alongside gratitude and accumulated subjective distress, with higher levels of PTG. A forward linear regression taking PTG scores as the dependent variable further showed that more gratitude (Beta = 0.57), a higher impact of events (Beta = 0.16), and knowing anyone who died from COVID-19 (Beta = 3.93) were significantly associated with more growth. The study highlights elevated levels of PTSD symptoms in a context of a global pandemic worsened by financial and socio-political instabilities. It mostly identifies personal factors, including high initial symptomatology post-trauma and gratitude, related to the capacity for growth in spite of these accumulating hardships. As such, it advocates the need to investigate and bolster silver linings amidst unprecedented traumas.

Using knowledge of, attitude toward, and daily preventive practices for COVID-19 to predict the level of post-traumatic stress and vaccine acceptance among adults in Hong Kong

Introduction

COVID-19 has been perceived as an event triggering a new type of post-traumatic stress (PTSD) that can live during and after the pandemic itself. However, it remains unclear whether such PTSD is partly related to people's knowledge of, attitude toward and daily behavioral practices (KAP) for COVID-19.

Methods

Through a telephone survey, we collected responses from 3,011 adult Hong Kong residents. Then using the Catboost machine learning method, we examined whether KAP predicted the participant's PTSD level, vaccine acceptance and participation in voluntary testing.

Results

Results suggested that having good preventative practices for, poor knowledge of, and negative attitude toward COVID-19 were associated with greater susceptibility to PTSD. Having a positive attitude and good compliance with preventative practices significantly predicted willingness to get vaccinated and participate in voluntary testing. Good knowledge of COVID-19 predicted engagement in testing but showed little association with vaccine acceptance.

Discussion

To maintain good mental health and ongoing vaccine acceptance, it is important to foster people's sense of trust and belief in health professionals' and government's ability to control COVID-19, in addition to strengthening people's knowledge of and compliance with preventative measures.

A four-level meta-analytic review of the relationship between social media and well-being: a fresh perspective in the context of COVID-19

Social media, one of the most pervasive forms of technology, has been widely studied in relation to the mental health and well-being of individuals. However, the current literature on social media and well-being has provided mixed and inconclusive findings, thus creating a polarizing view of social media. These mixed findings continue to extend into the pandemic, with researchers debating over the effects of social media in the new norms of social isolation. In light of these inconclusive findings, the aim of our meta-analysis was to synthesize previous research data in order to have a holistic understanding of the association between social media and well-being, particularly in the present context of COVID-19. The current meta-analysis systematically investigated 155 effect sizes from 42 samples drawn from 38 studies published during the COVID-19 pandemic (N = 43,387) and examined the potential moderators in the relationship between social media and well-being, such as the different operationalizations of social media usage and demographics. Overall, our study found that the relationship between social media usage and well-being was not significant in the context of COVID-19. Additionally, the impact of various moderators on the relationship between social media and well-being was found to vary. We discuss the various theoretical, methodological and practical implications of these findings and highlight areas where further research is necessary to shed light on the complex and nuanced relationship between social media and well-being.

Posttraumatic growth related to the COVID-19 pandemic among individuals with lived experience of psychiatric disorder

Although the COVID-19 pandemic has been shown to be detrimental to mental health, it may hold a parallel potential for positive change. Little is known about posttraumatic growth (PTG) as a potential outcome for individuals with lived experience of psychiatric disorders following trauma exposure, especially in the context of the COVID-19 pandemic. Participants were 1,424 adults with lived experience of a psychiatric disorder who took part in a longitudinal study of mental health during the COVID-19 pandemic conducted by the National Centre for Mental Health. PTG was measured using the Posttraumatic Growth Inventory-Short Form (PTGI-SF). Factors hypothesized to be associated with PTG were investigated using linear regression. The mean participant PTGI score was 12.64 (SD = 11.01). On average, participants reported the highest scores on items related to appreciation of life and lowest on those related to spiritual change subscale. We found the strongest evidence of associations between higher levels of PTG and higher scores on assessment items related to perceived social support, B = 2.86; perceptions of the pandemic as traumatic, B = 4.89; and higher psychological well-being, B = 0.40. Taken together, we did not observe evidence of widespread PTG related to the COVID-19 pandemic among individuals with lived experiences of psychiatric disorders.

Posttraumatic growth levels of healthcare workers in two periods with different intensities of COVID-19 pandemic

The COVID-19 pandemic threatens health-care workers' (HCW) mental health and well-being. Although traumatic life events may result in psychiatric disorders, occasionally they give rise to positive changes, such as post-traumatic growth. Accordingly, the present study evaluated the traumatic stress, anxiety, and depression levels of HCWs and their post-traumatic growth levels during the pandemic. In addition, the study aimed to assess the changes in psychological outcomes during the pandemic. For this aim, the data were collected in two different periods. The first data-collection period was between May and July 2020, and the second period started in November 2020 and ended in January 2021. The sociodemographic data form, Impact of Events Scale-Revised (IES-R), Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Post-traumatic Growth Inventory (PTGI) were used to collect data. Sixty-six HCWs participated in the study. No significant differences appeared between the baseline scores and 6-month follow-up in the depression, anxiety, and traumatic stress levels of HCWs. Furthermore, the PTGI scores decreased significantly over time. Although the change in the psychological distress scores was not statistically significant, the depression and post-traumatic stress scores increased over time. Previous research specified an inverse-parabolic relationship between traumatic stress and PTGI. Our results support previous research; as the exposure to the stressors continues, individual traumatic stress levels increase, psychiatric disorders become frequent, and affirmative changes (like post-traumatic growth) decline.

The transformative power of pain and posttraumatic growth in nurses with Covid-19 PCR positive

PURPOSE

This study aims to examine the relationship between the transformative power of pain and posttraumatic growth in nurses with positive Covid-19 polymerase chain reaction (PCR) test.

DESIGN AND METHOD

"Sociodemographics Form," "Transformative Power of Pain Scale," and "Post-Traumatic Growth Scale" were used to collect the data of the study.

FINDINGS

In the study, posttraumatic growth increased as the level of the transformative power of pain increased for nurses. Furthermore, some variables were found to have an effect on the transformative power of pain and the posttraumatic growth mean score in nurses who had positive Covid-19 PCR test.

PRACTICE IMPLICATIONS

Nurses should be provided with social and professional psychological support to improve their transformative power of pain and posttraumatic growth levels.

Post-traumatic growth in people experiencing high post-traumatic stress during the COVID-19 pandemic: The protective role of psychological flexibility

The COVID-19 pandemic evokes high levels of post-traumatic stress (PTS) in some people as well as positive personal changes, a phenomenon known as post-traumatic growth (PTG). Experiencing an adverse event as traumatic is crucial for triggering PTG, therefore higher PTS is often associated with higher PTG. This longitudinal study examined the protective role of psychological flexibility in fostering PTG in a group of people reporting high PTS related to COVID-19 as compared to those with low PTS. We hypothesized that higher psychological flexibility will be associated with higher PTG in those with high PTS and that psychological flexibility would be unrelated to PTG in those with low PTS. Secondary data analysis was conducted on data from a larger project investigating the psychological impacts of COVID-19. Adult Italians (N = 382) completed online surveys at Time 1 (three months after the first national lockdown, July 2020) and Time 2 (three months later when the number of COVID-19 cases increased, October 2020). Based on the Impact of Event Scale–Revised cut-off score, two PTS groups were identified at Time 2: low PTS (below cut-off) and high PTS (above cut-off). As predicted, moderation analyses showed that after controlling for Time 1 PTS and PTG and confounding variables, Time 1 psychological flexibility was associated with higher Time 2 PTG in the high PTS group, whereas psychological flexibility was unrelated to PTG in the low PTS group. Four psychological flexibility sub-processes (present moment awareness, defusion, values, committed action) at Time 1 were related to higher Time 2 PTG in only the high PTS group. Findings advance understanding of the role of psychological flexibility in trauma reactions and pandemic mental health adjustment. Evidence-based approaches that target psychological flexibility, like Acceptance and Commitment Therapy, are likely to foster PTG and ultimately adjustment in people with high PTS during and after the pandemic.

The associations of pandemic-related difficulties with depressive symptoms and psychological growth among American older adults: Social support as moderators

The COVID-19 pandemic brought social, health-related, and financial risks to older adults, yet their associations with depressive symptoms and posttraumatic growth (PTG) were not systematically examined. With 3504 respondents aged 60 and over from Health and Retirement Survey, this study found pandemic-related healthcare delay and financial hardship associated with elevated depressive symptoms and decreased PTG, whereas social disruption predicted greater PTG. When confronted with multidimensional difficulties, a higher level of social support buffered depressive symptoms and enhanced PTG following healthcare delay, while those from immediate family members carried the weighing of moderation. Additionally, the moderation effect varied between support types, as exclusive instrumental support engendered more depressive symptoms and squeezed PTG by stimulating a sense of incompetence for older adults. Inversely, receiving both instrumental and emotional support helped individuals of older age against financial-related depressive symptoms. These findings shed light on older adults' mental health promotion in a pandemic context.

Prediction of post-traumatic growth in the face of the COVID-19 crisis based on resilience, post-traumatic stress and social participation: A longitudinal study

The COVID-19 crisis has generated a severe and negative psychological impact worldwide. Despite this, it is also possible to experience post-traumatic growth (PTG). This study aimed to longitudinally explore the prevalence of PTG in the Spanish population and test a predictive model for PTG from resilience, post-traumatic stress symptoms (PTSS), and participation in social activities. Data were collected longitudinally in March, July, and November 2020 via an online survey. About 20% of the sample showed moderate-high levels of PTG, with no significant differences over time. The predictive model explained 19% of the variance in PTG, showing that the inverse relation between resilience and PTG was mediated by PTSS. Additionally, participation in social activities acted as a predictor of PTG. Women, young people, those who had lost their job and people who had experienced COVID-19 symptoms or the loss of a loved one presented higher PTG. Thus, people have experienced positive changes (PTG), but these did not protect them from adverse symptomatology (PTSS).

The impact of non-infection pandemic stress on depression and anxiety severity: Investigating mediation by intrusive and deliberate rumination

BACKGROUND

Social restrictions to curb COVID-19's spread have had adverse effects on population mental health. Rumination is one mechanism through which pandemic stress (PS) might translate into psychopathology. In particular, intrusive rumination (IR) is believed to be problematic. In this study, we investigated whether IR and deliberate rumination (DR) mediated the associations between PS and both depression and anxiety severity.

METHODS

1090 participants recruited online and from an undergraduate psychology participation pool completed an assessment of COVID-19 PS, as well as the Event-Related Rumination Inventory, the Beck Depression Inventory-II, and the Beck Anxiety Inventory. Total scores for PS, IR, DR, depression, and anxiety severity were tested in a parallel mediation model.

RESULTS

PS positively predicted IR, DR, depression, and anxiety severity. IR positively predicted 1depression and anxiety severity, whereas DR did not. Indirect effects of PS on depression and anxiety severity were significant for IR, but not DR. Direct effects of PS on anxiety and depression severity were significant. Taken together, IR partially mediated the association between PS and both measures of psychopathology, and DR did not.

LIMITATIONS

This study was limited by its cross-sectional design and the lack of assessment of when PS exposure occurred.

CONCLUSIONS

Regarding PS that is unrelated to infection by COVID-19, IR is one mechanism through which psychopathology may emerge, whereas DR appears to be benign. Promoting a shift from IR to DR may therefore be one strategy for mitigating the negative effects of PS and other stressors on mental health.

The longitudinal association between Perceived Stress, PTSD Symptoms, and Post-Traumatic Growth during the COVID-19 Pandemic: the role of coping strategies and psychological inflexibility

The present study investigates the mediating roles of psychological inflexibility and differential coping strategies on perceived stress and post-traumatic symptoms and growth in the context of COVID-19. Study one recruited 662 participants (54.8% women; Mage = 40.64 years, SD = 13.04) who completed a cross-sectional questionnaire. It was proposed that orientation to the problem, avoidance strategies, psychological inflexibility, and positive attitude were mediators for the positive association between perceived stress and PTSD symptoms. The fit indices for the path model were excellent: CFI = 0.977, TLI = 0.950, RMSEA = 0.057 [90%CI = 0.043-0.081], and SRMS = 0.042. Gender and stressful events encountered had indirect effects on the endogenous variables. In study two, 128 participants (57.8% women; Mage = 42.30, SD = 12.08) were assessed for post-traumatic growth one year later. Psychological inflexibility and orientation acted as mediators between perceived stress and PTSD symptoms. Furthermore, a novel path model was constructed in which psychological inflexibility and orientation to the problem as mediators for perceived stress and PTSD symptoms. The indices for the path model were excellent: CFI = 0.99, TLI = 0.97, RMSEA = 0.055 [90%CI = 0.001-0.144], and SRMS = 0.49. Furthermore, PTSD symptoms, psychological inflexibility, and orientation to the problem predicted post-traumatic growth. Specifically, both orientation to the problem (β = .06 [90%CI: .01;.13]) and psychological inflexibility (β = .14 [90%CI: .08;.26]) had an indirect effect on post-traumatic growth. Overall, these results significantly contribute to the literature as orientation to the problem positively predicted PTSD symptoms and post-traumatic growth one year later while psychological inflexibility predicted PTSD symptoms and less post-traumatic growth one year later. These results underline the importance of assessing both symptomology and psychological growth to determine adaptive coping strategies in specific contexts.

Experiences of Kyrgyzstani Frontline Healthcare Workers during the "Black July" of 2020: a Qualitative Study

BACKGROUND

The peak of the pandemic in Kyrgyzstan occurred in July 2020 with highest infection rates, almost 1000 cases daily, compared to 100 cases prior to this date. The state health system was fatally unprepared to accommodate patients, mobilize medical staff, or provide clear instructions to the population. This study explores personal narratives of healthcare practitioners who were affected by and survived COVID-19 during the "Black July" of 2020 in Bishkek, Kyrgyzstan.

METHOD

Healthcare workers (n=10) were interviewed using a semi-structured interview protocol. Interviews were transcribed then analyzed in accordance with interpretative phenomenological study guidelines.

RESULTS

The narratives demonstrated both post-traumatic depreciation and post-traumatic growth, resulting in changes of attitudes, lifestyle, and identity. An important aspect of identity shift included an emerging desire for increased self-care, which was characterized by resistance against a heroic Hippocratic ideal to "to save everybody".

CONCLUSION

COVID-19 is perceived as a psycho-socio-cultural phenomenon, which has transformed the identities of healthcare workers in the Kyrgyz Republic. Further research is recommended into developing rehabilitation programs for healthcare workers.

The Contributions of Pandemic Severity, Government Stringency, Cultural Values and Internet Usage to Post-traumatic Stress Disorder During the COVID-19 Pandemic: An Analysis of Data From 35 Countries

Emergent symptoms of post-traumatic stress disorder (PTSD) have been frequently reported in the context of the COVID-19 pandemic, and may affect up to 17-18% of individuals. There is preliminary evidence that pandemic severity, cultural values, restrictions imposed by governments, and Internet usage may all influence the emergence of PTSD symptomatology. In this study, possible linear- and non-linear associations between these factors and the prevalence of PTSD symptoms across 35 countries were examined based on data from existing research. Evidence was found for a positive logarithmic relationship between the COVID-19 case-fatality ratio and PTSD (p = 0.046), a positive logarithmic relationship between power distance and PTSD (p = 0.047), and a trend toward a negative quadratic association with Internet usage (p = 0.051). No significant cross-national effect was observed for government restrictiveness. These findings suggest that strategies aimed at minimizing COVID-19 deaths, and at ensuring equitable access to essential resources, may be of use in reducing the emergence of PTSD symptoms at a population level during this pandemic.

Does perceived post-traumatic growth predict better psychological adjustment during the COVID-19 pandemic? Results from a national longitudinal survey in the USA

Perceiving that one has grown in positive ways following highly stressful experiences (perceived posttraumatic growth; PPTG) is common and sometimes--but not always--related to psychological wellbeing. However, PPTG is typically studied cross-sectionally and well after the stressful experience has passed; how PPTG might relate to wellbeing over time in an unprecedented, ongoing worldwide disaster such as the COVID-19 pandemic remains unknown. Thus, the current study sought to answer whether, in the midst of the pandemic, PPTG relates to subsequent wellbeing, broadly defined. Participants were N = 1544 MTurk workers who completed a five-wave (T1-T5) six-month longitudinal study. Current analyses focused on T2-T5 (ns = 860-712). At each time point, participants completed self-report measures of PPTG and wellbeing (depression, anxiety, stress, positive states of mind, alcohol use, posttraumatic stress). In cross-lagged panel models, PPTG was largely unrelated to subsequent wellbeing. Somewhat more evidence was found that increasing distress led to increases in PPTG, suggesting perceptions of growth may serve as a coping mechanism. PPTG does not appear to benefit adjustment to the COVID-19 pandemic and may simply reflect efforts to manage distress.

The posttraumatic growth inventory-short form (PTGI-SF): A psychometric study of the spanish population during the COVID-19 pandemic

People can experience posttraumatic growth (PTG) when faced with potentially traumatic events. One of the most widely-used instruments to measure PTG is the Posttraumatic Growth Inventory-Short Form (PTGI-SF). However, it has not been validated for the Spanish population. This study explored the psychometric properties of the PTGI-SF in adults living in Spain during the COVID-19 pandemic. Since it is a global disaster, two items were added to assess communal PTG. The participants were adult inhabitants of Spain during the COVID-19 pandemic (N = 855). They completed the PTGI-SF in July 2020, along with the Impact of Event Scale - Revised to measure symptoms of posttraumatic stress disorder (PTSD). They also rated the degree to which they perceived the COVID-19 crisis as being severe. In November 2020, 592 participants once again completed the PTGI-SF. The factorial validity o was tested by Structural Equations Modeling (SEM). McDonald's ω coefficients were calculated to test internal consistency. The Intra-class Correlation Coefficient (ICC) was obtained to assess test-retest reliability. Sensitivity and criterion-related validity were assessed by exploring the association of the PTGI-SF scores with gender, age, PTSD symptoms, and perceived severity. Results indicated good psychometric properties for an eight-item, four-factor structure of the inventory in terms of structural validity, reliability, sensitivity and criterion-related validity. These factors were: Relating to Others, Personal Strength, Spiritual Change, and Life Value and Opportunities. Communal PTG overlapped with social PTG, and therefore it was not included. Cultural differences need to be addressed when measuring PTG, especially in terms of spiritual growth.

Coping with COVID-19 Prolonged and Cumulative Stressors: the Case Example of Egypt

The current study aimed to explore how COVID-19-traumatized populations cope using a coping model based on wills to exist, live, and survive (WTELS) that leads to positive coping and posttraumatic growth (PTG). We used data from 11 Arab countries (N = 2732), including Egypt (N = 831), and included measures for COVID-19 stressors (COVID-fear, economic, lockdown, and grief stressors), WTELS, resilience, religiosity, spirituality, social support, and PTG. We conducted ANOVA on the main sample to explore the differences between Arab countries, hierarchical regressions, and path analysis on the Egyptian subsample to test a model of the effects on WTELS. In the path model, WTELS was the independent variable. Other coping strategies were mediating variables, and COVID-19 stressor types were outcome variables. ANOVA on the main sample indicated that Egypt was the highest on COVID-19 stressors (infection fears, economic, lockdown, and grief stressors), actual infection, and WTELS. Hierarchical regression indicated that social support, resilience, and WTELS were positive predictors of PTG, with WTELS had the highest effect size (β = .41) and WTELS being a negative predictor of COVID-19 stressors, while resilience and social support were not. Path analysis indicated that WTELS predicted higher religiosity, spirituality, social support, resilience, and lower COVID-19 stressors. Religiosity predicted higher spirituality, social support, and resilience and lower COVID-19 stressors. Interfaith spirituality predicted higher resilience and lower COVID-19 grief stressors. The results validated the central role of WTELS. Results helped to identify potentially effective interventions with COVID-19 victims that focus on WTELS, spirituality, and religiosity.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s11469-021-00712-x.

Recovering from COVID-19: psychological sequelae and post-traumatic growth six months after discharge

Background: Clinical and scientific evidence has shown that a range of long-lasting symptoms can persist in the post-virological period. However, little is known about the psychological sequelae of patients hospitalized for coronavirus disease 2019 (COVID-19). Objective: This study aims to assess the prevalence of anxiety-depressive symptoms, post-traumatic stress disorder (PTSD), and post-traumatic growth among patients hospitalized for COVID-19 during the first wave of the pandemic 6 months after discharge, and to identify sociodemographic and clinical factors associated with psychological outcomes. Method: This cross-sectional cohort study enrolled recovered COVID-19 patients during a multidisciplinary follow-up screening. At 6 months post-discharge, participants underwent a remote assessment with the Mini-International Neuropsychiatric Interview Plus and completed the Hospital Anxiety and Depression Scale, PTSD Checklist for DSM-5, and Post-Traumatic Growth Inventory. Descriptive and regression analyses were conducted. Results: The sample was composed of 100 patients, mainly males (72%), with a mean ± SD age of 58.7 ± 11.8 years. Regarding psychological symptoms, 34% and 24% of patients, respectively, reported anxiety and depression over the clinical threshold, and 20% met the criteria for a possible PTSD diagnosis. Psychological symptoms were associated with the presence of a mood disorder in the patient's clinical history and having received a psychological consultation after discharge. Post-traumatic growth was associated with younger age and having received a psychological consultation after discharge. Conclusions: A high prevalence of anxiety and depressive symptoms, potentially indicative for a mood or anxiety disorder, and PTSD was confirmed among COVID-19 survivors after 6 months. Anxiety and depressive symptoms and PTSD were associated with a previous diagnosis of a mood disorder and having received psychological consultation. Post-traumatic growth was associated with younger age and having received psychological consultation. Tailored psychological interventions could help to elaborate the psychological suffering and foster post-traumatic growth after a traumatic experience such as COVID-19 hospitalization.

HIGHLIGHTS

A high prevalence of psychological symptoms has been observed among COVID-19 survivors 6 months after hospitalization.Tailored psychological interventions could help to contain the psychological sequelae and facilitate post-traumatic growth.

Understanding the mental health impacts of COVID-19 through a trauma lens

This special issue of the European Journal of Psychotraumatology (EJPT) presents the first studies published by EJPT on COVID-19. We present 26 qualitative and quantitative studies assessing the prevalence of trauma-related symptoms and psychopathology within specific vulnerable populations such as health-care workers, students, children, and managers, or more broadly at a country level with a diverse set of outcomes including post-traumatic stress, moral injury, grief and post-traumatic growth. Intervention studies focus on whether telehealth delivery of mental health therapy in the pandemic environment was useful and effective. It is clear that the pandemic has brought with it a rise in trauma exposure and consequently impacted on trauma-related mental health. While for many individuals, COVID-19-related events met criteria for a DSM-5 Criterion A event, challenges remain in disentangling trauma exposure from stress, anxiety, and other phenomena. It is important to determine the contexts in which a trauma lens makes a useful contribution to understanding the mental health impacts of COVID-19 and the ways in which this may facilitate recovery. The papers included in this Special Issue provide an important and much-needed evidence-based foundation for developing trauma-informed understanding and responses to the pandemic.

Connection between the COVID-19 pandemic, war trauma reminders, perceived stress, loneliness, and PTSD in Bosnia and Herzegovina

In order to gain a better understanding of what happens during the COVID-19 pandemic to those who were previously traumatized, this study investigated perceived stress and severity of PTSD symptoms during the COVID-19 pandemic in people who experienced the 1992-1995 war in Bosnia and Herzegovina. It was also examined how reminders of past trauma and loneliness instigated by the COVID-19 crisis relate to current stress and PTSD symptoms. The sample consisted of 123 participants (74.8% women). Participants responded to assessments of sociodemographic characteristics, exposure to COVID-related information, concerns over disease, severity of exposure to war, frequency and intensity of war trauma reminders, loneliness, stress, and severity of PTSD symptoms. Data was collected as part of the COVIDiSTRESS Global Survey. Results showed that in a population previously exposed to the effects of war, severity of PTSD symptoms was positively related to perceived stress, and loneliness during the pandemic significantly mediated this relationship. Intensity of exposure to war trauma reminders was associated with higher levels of PTSD symptom severity. Higher severity of PTSD symptoms was related to forced displacement during the war. Moreover, higher stress was related to increased concerns over disease. To conclude, those exposed to war may be more affected by the global COVID-19 pandemic and preventive measures that accompany it, while loneliness mediates the effects of PTSD and perceived stress in this population.

A Relational Sociological Analysis on the Impact of COVID-19 Pandemic Lockdown on Syrian Migrants' Lives in Turkey: The Case of Mersin Province

The COVID-19 pandemic which expeditiously turned into a global health crisis also triggered many risks and uncertainties especially for vulnerable groups such as migrants and refugees as a result of the measures restricting social, economic, and educational life as well as mobility. According to the relational sociological perspective, each uncertainty process creates various changes on social networks and relationships, and these relational changes also affect identities, roles, and relational strategies. With this study, it is aimed to explore the economic, social, and familial impacts of the COVID-19 lockdown on Syrian migrants’ lives in Turkey from a relational sociological perspective. The data in the study is obtained by semi-structured qualitative interviews with 13 Syrian citizens living in Mersin province of Turkey. According to the findings of the study, the suspension or slowdown of economic activities due to the pandemic has caused not only an uncertainty about the future, but also a change in familial positions and roles. Also the accepted norms of social relations have been inevitably suspended resulting in increased ambiguity. Strengthening the network of solidarity within relatives and building stronger relationships within the family are common relational strategies of the participants to mitigate the social and economic impacts of the COVID-19 outbreak, but these strategies will not be adequate if the lockdown process is prolonged. Considering the fact that the lockdown measures can be tightened again at any time, social and economic policies should be expanded to include the Syrian migrants in Turkey.

Impact of COVID-19 on psychological wellbeing

This cross-sectional study aims to record post-traumatic stress (PTS) and post-traumatic growth (PTG) of the general population of China during the first wave of COVID-19 spread. Method: An online survey was distributed in China during February and March 2020 to record the general population's PTS (using the Post-traumatic Stress Disorder Checklist-Civilian Version, PCL-C) and PTG (using the Post-traumatic Growth Inventory, PTGI) due to COVID-19. Confirmatory Factor Analyses (CFAs) and a Two-Part Model (TPM) of regression analysis were conducted. Results: In total, 29,118 Chinese participants completed the survey (54.20% were in their 20s, 68% were males, and 60.30% had a university education). CFA results illustrated that bifactor models described the Chinese psychometric traits of PTS and PTG over the default models. Results of TPM suggested that female, low-educated, and middle-aged individuals were more vulnerable to PTS. Remarkably, mutual and positive correlations between the PTS and the PTG, though small in statistics, were observed through regression analyses. Conclusions: The current results presented new best-fit structural models, potential predictors, and valuable baseline information on the PTS and the PTG of the Chinese population in the context of COVID-19.

Intolerance of uncertainty, rumination, post-traumatic stress symptoms and aggression during COVID-19: a serial mediation model

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic can be identified as a source of traumatic stress. Previous studies have shown that post-traumatic stress and intolerance of uncertainty are associated with aggressive behaviour.

OBJECTIVE

In the present study, we aimed to test a serial mediation model, considering rumination and post-traumatic stress symptoms (PTSS) as mediators that link intolerance of uncertainty and aggression, while controlling the confounding effect of crisis-induced health and socioeconomic stressors during the COVID-19 pandemic.

METHOD

A total of 714 participants [533 (74.6%) females, 176 (24.7%) males, aged 18-64 years (M _age = 25.16, SD _age = 9.34)] completed the following self-reported scales: Aggression Scale, COVID-19 stressors checklist, Short Version of the Intolerance of Uncertainty Scale, Impact of Event Scale with Modifications for COVID-19, and Ruminative Thought Style Questionnaire.

RESULTS

The results revealed that there was an association between intolerance of uncertainty and aggressive behaviours. Moreover, the results of serial mediation analysis showed that intolerance of uncertainty predicts aggressive behaviours via rumination and PTSS. Besides, socioeconomic stressors are significantly associated with the level of PTSS and aggression, while health stressors are not significantly association with the level of PTSS and aggression.

CONCLUSIONS

The findings provide several contributions to understand the link between intolerance of uncertainty and aggressive behaviours during the COVID-19 pandemic, and confirm the importance of early psychological intervention, especially for those who are more likely to ruminate and suffer from PTSS, to prevent aggression and violence in the long run. In addition to health-related regulations, it is important to take the social and economic aspects of the crisis into account and develop intervention strategies accordingly. Nevertheless, the limitations of cross-sectional mediation analysis in explaining causal relationships should be kept in mind, and future studies should extend these findings using longitudinal data.