Mental Health, Well-Being, and Psychological Flexibility in the Stressful Times of the COVID-19 Pandemic

Effectiveness of a mindfulness and acceptance-based intervention for improving the mental health of adolescents with HIV in Uganda: An open-label trial

Adolescents with HIV (AWH) face the double burden of dealing with challenges presented by their developmental phase while coping with stigma related to HIV, affecting their mental health. Poor mental health complicates adherence to daily treatment regimens, requiring innovative psychosocial support strategies for use with adolescents. We assessed the effectiveness of a mindfulness and acceptance-based intervention on the mental health of AWH in Uganda. One hundred and twenty-two AWH, mean age 17 ±1.59 (range 15 to 19 years), 57% female, receiving care at a public health facility in Kampala were enrolled in an open-label randomized trial (ClinicalTrials.gov: NCT05010317) with assessments at pre-and post-intervention. The mindfulness and acceptance-based intervention involved weekly 90-minute group sessions for four consecutive weeks facilitated by two experienced trainers. Sessions involved clarifying values, skillfully relating to thoughts, allowing and becoming aware of experiences non-judgmentally, and exploring life through trial and error. The control group received the current standard of care. Three mental health domains (depression, anxiety, and internalized stigma) were compared between the intervention and control groups. A linear mixed effects regression was used to analyze the effect of the intervention across the two time points. Results showed that the intervention was associated with a statistically significant reduction in symptoms of depression (β = -10.72, 95%CI: 6.25, -15.20; p < .0001), anxiety (β = -7.55, 95%CI: 2.66, -12.43; p = .0003) and stigma (β = -1.40, 95%CI: 0.66 to -2.15; p = .0004) over time. Results suggest that mindfulness and acceptance-based interventions have the potential to improve the mental health of AWH.

Impact of the COVID-19 Pandemic on the Use of Antidepressants by Young Adults in the ASL TO4 Regione Piemonte (Italy)

The association between younger age and poorer mental health during the COVID-19 pandemic has been documented. Whether these changes were associated with a change in antidepressant (AD) use is not well understood. This study aimed to estimate the impact of the COVID-19 pandemic on AD use by young adults in the ASL TO4 Regione Piemonte (Italy). The impact of the pandemic on the weekly prevalence of AD users was assessed using interrupted time-series analysis with autoregressive integrated moving average models. A total of 1071 subjects (18-22 years with ≥1 AD dispensation) were included in the study. The observed prevalence was lower than the predicted value for several weeks after the introduction of the lockdown. However, it was consistently higher than the predicted values from week 134. The maximum difference between observed and predicted values (25 subjects per 10,000 young adults) was found at week 170. Changes in AD use were observed in both genders and were more pronounced for selective serotonin reuptake inhibitors. In conclusion, the impact of the COVID-19 pandemic on the mental health of young adults is likely to be significant in the coming years, which may place a future burden on pharmaceutical public health and community health.

Just as Essential: The Mental Health of Educators During the COVID-19 Pandemic

OBJECTIVE

The coronavirus disease 2019 (COVID-19) pandemic deleteriously impacted physical and mental health. In the summer of 2020, return-to-learn plans were enacted, including virtual, hybrid, and in-person plans, impacting educators and students. We examined (1) how return-to-learn plan was related to depressive and social anxiety symptoms among educators and (2) how psychological flexibility related to symptoms.

METHODS

Educators (N = 853) completed a survey via Qualtrics that assessed internalizing symptoms, psychological flexibility, and occupational characteristics. Two one-way analyses of variance (ANOVAs) examined between-group differences in return-to-learn plans across depression and social anxiety. Two hierarchical linear regressions examined the relation between psychological flexibility components and depressive and social anxiety symptoms.

RESULTS

Median T-scores were well above the national normative means for General Depression (median T-score: 81) and Social Anxiety (median T-score: 67). There were no significant differences between reopening plans in general depression nor social anxiety T-scores. Psychological flexibility accounted for 33% of the variance in depressive symptoms and 24% of the variance in social anxiety symptoms.

CONCLUSIONS

Results indicated high levels of psychiatric symptoms among educators during COVID-19, and psychological flexibility was associated with lower symptoms. Addressing educator mental health is of utmost importance in future research.

The relationship between tolerance for uncertainty and academic adjustment: the mediating role of students' psychological flexibility during COVID-19

Introduction

University students are among the groups most adversely affected by COVID-19 in terms of their psychological and academic wellbeing, particularly given the pandemic's uncertainty. However, little is known about their psychological flexibility to deal with this uncertain nature of pandemic. This study aimed to examine the mediating role of psychological flexibility (PF) in the relationship between university students' intolerance of uncertainty (IU) and their academic adjustment to the online learning process during COVID-19.

Methods

Data was collected from 388 university students from Türkiye (18-34 (Mage = 21.43, SD = 2.04) who completed five questionnaires - Intolerance of Uncertainty Scale, Acceptance and Action Questionnaire II, Academic Self Efficacy Scale, Educational Stress Scale, and Online Self-Regulatory Learning Scale. Additionally, as indicators of students' academic adjustment, perceived academic performance - ranging 1 to 10, and their last academic grade point average before and during the pandemic were also collected.

Results

The results indicated that PF and IU had a significant effect on the academic adjustment of students during the pandemic. PF had a complete mediating role between the IU and academic adjustment. Results also revealed that online self-regulation, a sub-dimension of academic adjustment, did not show a significant relationship with any other variable in the model.

Discussion

Research findings showed that psychological flexibility is a very important strength for university students to maintain their academic adjustment in stressful times. The results were discussed in light of the relevant research, and recommendations for further research and implications were provided.

Well-being, character strengths, and depression in emerging adults

Introduction

Emerging adulthood is a period of transition between adolescence and adulthood, during which individuals explore different roles and possibilities. This period is often characterized by high levels of stress and uncertainty, which can increase the risk of depression. The aim of this study was to investigate the associations between emerging adulthood dimensions, well-being, character strengths and depression, as well as to verify the differences in the levels of these elements among different groups of depressive symptomatology.

Methods

Participants were 1,060 individuals (741 females, 305 males) between the ages of 18 and 30 years (M = 22.3, SD = 3.72). Spearman's correlation, linear regression, and Kruskal- Wallis with pairwise post-hoc analyses were used to analyze the data.

Results

There were significant positive correlations between emerging adulthood dimensions, well-being, and character strengths, and negative correlations between these variables and depression. There were also significant differences in the means of the evaluated constructs among the symptomm groups.

Discussion

The findings suggest that emerging adulthood dimensions, well-being, and character strengths are all associated with depression in emerging adults and have important implications for the provision of interventions in health and education for emerging adults. The study provides a deeper understanding of the factors influencing depression during emerging adulthood and emphasize the importance of promoting positive psychology elements and developing personalized interventions for emerging adults. This also suggest that public policies related to mental health and education should take into account the unique needs of emerging adults.

Eudaimonic Well-Being of Italian Young Adults during the COVID-19 Pandemic: Predictive and Mediating Roles of Fear of Death and Psychological Inflexibility

The literature has widely acknowledged the impact of the COVID-19 pandemic on the mental health of young adults. Despite extensive research, eudaimonic well-being, which focuses on self-knowledge and self-realization, has been scarcely investigated. This cross-sectional study aimed to add knowledge on the eudaimonic well-being of young adults one year after the outbreak of the COVID-19 pandemic, verifying its potential linkages with fear of death and psychological inflexibility. A total of 317 young Italian adults (18-34 years), recruited through a chain sampling method, completed measures of psychological inflexibility, fear of death, and eudaimonic well-being included in an online survey. The study's hypotheses were tested with multivariate multiple regression and mediational analyses. Results showed that psychological inflexibility was negatively associated with all the dimensions of well-being, while fear of the death of others was associated with autonomy, environmental mastery, and self-acceptance. Furthermore, in the association between fear of death and well-being, the mediation role of psychological inflexibility was verified. These results contribute to the extant literature on the factors associated with eudaimonic well-being, providing clinical insights into the work with young adults within challenging times.

More than one way to say I love you: An Internet-based intervention for training flexible thinking in romantic relationships

OBJECTIVES

This study developed and pilot-tested an adaptation of Cognitive Bias Modification (CBM) to target two aspects of relational flexibility in couples: the ability to generate alternative perspectives, and the ability to respond nondefensively when alternative partner perspectives are raised within challenging relationship situations (referred to as flexibility in partner perspectives).

METHODS

CBM-FlexC training materials were developed in Phase 1, and expert users (N = 4) and end-point users (N = 7) provided qualitative feedback. Feasibility and preliminary efficacy of CBM-FlexC were evaluated in Phase 2, using an online sample of distressed couples (N = 18). Using a multiple baseline design, participants completed three baseline assessments, six CBM-FlexC sessions over 2 weeks, and a 1-month follow-up.

RESULTS

CBM-FlexC training resulted in greater flexibility in partner perspectives, relationship satisfaction, and general psychological flexibility compared to baseline, and improvements were maintained 1-month after training when using mixed-effects models. However, analyses of reliable change (based on graphical inspection and the Reliable Change Index) indicated that most participants did not experience reliable improvement in flexibility in partner perspectives, or relationship satisfaction.

CONCLUSION

This pilot study provides some positive signals regarding the potential efficacy of CBM-FlexC, while pointing to the need for further development to strengthen its effects.

Resilience and Wellbeing Strategies for Pandemic Fatigue in Times of Covid-19

The COVID-19 pandemic is truly one of the greatest collective health crises in history which have altered our life and living. For years, people have felt fatigued from following public health directives such as social distancing, wearing masks, washing hands frequently, and working or studying remotely without in-person interactions. In this paper, we explore strategies for resilience and wellbeing which can mitigate pandemic-caused stress and behavioural fatigue. We start with individual level strategies including reworking stress appraisals, the importance of psychological flexibility, reducing loneliness through adaptive online platform use, optimizing familial relationships when living in close quarters for a prolonged period, reducing symptoms of burnout and using adaptive distractions, using specific evidence-based resilience strategies. We discuss specific considerations which tap on our shared identities and shared responsibilities which can enhance a sense of community, especially for individuals from marginalized backgrounds and how suicide risks can be minimized.

Psychological resources and flexibility predict resilient mental health trajectories during the French covid-19 lockdown

The implementation of lockdowns and the Covid-19 pandemic situation have negatively impacted mental health (anxiety, depression). However, little is known about individual differences in the longitudinal reactions to lockdown. We designed a longitudinal study (a) to identify the various trajectories of symptoms of depression and anxiety in the general population during and after lockdown; (b) to determine which positive psychological resources prevent individuals from falling into groups with the most severe trajectories; (c) to test the mediating role of psychological flexibility. We collected and analysed longitudinal data on a sample of French participants (N = 1399, M_age = 43.4; SD_age = 12; 87.8% women) during the end of the first lockdown. Participants were asked to report their psychological resources and (in)flexibility at baseline and symptoms of anxiety and depression at each measurment occasion (five weekly observations from 17 March to 11 May 2020, including baseline). Using growth mixture modelling, seven dynamic profiles of symptoms were identified: four for depression and three for anxiety. Resilience emerged as the most frequent trajectory. Wisdom, optimism, hope, self-efficacy and peaceful disengagement significantly prevented individuals from belonging to the symptomatic groups. Moreover, psychological flexibility emerged as a significant mediator of these effects. This study highlights the importance of cultivating protective factors and psychological flexibility to prevent mental health damage during potentially traumatic events (PTE) and to favour resilience trajectories.

The trajectories of anxiety and depression during the COVID-19 pandemic and the protective role of psychological flexibility: A four-wave longitudinal study

BACKGROUND

Published reports on the adverse mental health impacts of the initial phase of the COVID-19 pandemic suggest an emerging global mental health crisis. However, the trajectories of these mental health impacts over multiple COVID-19 peaks and corresponding lockdowns are unknown. This study explored the trajectories of anxiety and depression over two consecutive lockdowns during the first nine months of the pandemic in Europe (April 2020-January 2021) and examined whether they varied as a function of different psychological flexibility and inflexibility profiles.

METHODS

A total of 569 Italians completed online surveys at four assessment points. Trajectories of anxiety and depression were examined with latent growth modeling and according to different psychological flexibility and inflexibility profiles.

RESULTS

Anxiety increased linearly throughout the study period, whereas depression displayed a quadratic trajectory evidencing a decrease with the easing of the first lockdown followed by an increase during the second lockdown. Furthermore, two profiles were identified that displayed different anxiety and depression trajectories. Compared to the psychologically flexible profile, the psychologically inflexible profile reported significantly higher anxiety and depression which remained higher across the study period.

LIMITATIONS

A reliance on self-report measures and convenience sampling constitute key study limitations.

CONCLUSIONS

Results suggest that high psychological inflexibility is a risk factor for prolonged elevated anxiety and depression during the COVID-19 pandemic, whereas high psychological flexibility is a protective factor. Psychological flexibility and inflexibility should be targeted by preventive public health interventions that harness evidence-based strategies shown to effectively target these factors.

Psychological Capital, Well-being, and Distress of International Students

International students continue to experience myriad of challenges, some of which further transpired disproportionately during the COVID-19 pandemic era. To this effect, this study investigated psychological capital (PsyCap), psychological distress, and well-being among 188 international students attending U.S universities. Results using Hayes PROCESS indicated that well-being mediated the relationship between PsyCap and psychological distress and in particular moderated the relationship between PsyCap and depression. When higher education institutions are considering steps to mitigate psychological distress experienced by international students during the COVID-19 pandemic and beyond, based on the findings of our study, we suggest investing efforts and resources into two aspects: (a) promotion of positive mental health and well-being and (b) identification and development of positive psychological capital. We further discuss these results and implications for mental health promotion of international students in light of its limitations and recommendations for future research.

Coping profiles and their association with psychological functioning: A latent profile analysis of coping strategies during the COVID-19 pandemic

While many adversities affect limited groups of people, the COVID-19 pandemic brought a range of stressors to entire populations. Using a person-centered approach, this study analyzed the most frequent combinations of coping strategies used by general population during the first wave of the pandemic in a sample of 1347 Slovenian adults. Latent profile analysis identified three coping profiles similar to those found in previous studies in specific samples and stressful circumstances: the engaged profile (active coping, planning, acceptance, positive reframing), the disengaged profile (low problem-focused coping, social support, acceptance, positive reframing), and the avoidant profile (substance use, self-blame, humor). Individuals with the engaged profile reported the highest levels of well-being and the lowest levels of ill-being. While individuals with the avoidant profile had the highest levels of anxiety and stress, those with the disengaged profile had the lowest levels of well-being, especially engagement and positive relationships. The results imply the need to distinguish between the two less adaptive coping profiles, as one is characterized by the active use of dysfunctional strategies, and the other by the low use of all strategies, suggesting that psychological interventions should be tailored to these specificities.

Public Psychosocial and Behavioral Responses in the First Wave of COVID-19 Pandemic: A Large Survey in China

Background: The COVID-19 has grown into a global pandemic. This study investigated the public psychosocial and behavioral responses through different time periods of the pandemic, and assessed whether these changes are different in age, gender, and region. Methods: A three-phase survey was conducted through the DaDui Social Q&A Software for COVID-19. A total of 13,214 effective responses of COVID-19 were collected. Statistical analysis was performed based on their basic information and psychosocial responses. Results: The degree of attention, understanding, and cooperation with preventive and control measures of the disease increased and then decreased. The panic level gradually increased with the epidemic process. The degree of satisfaction with management measures and of confidence in defeating COVID-19 increased throughout the survey. Compared with residents in other areas, respondents from the COVID-19 epicenter (Wuhan) reported a higher degree of self-protection during the outbreak and a significantly lower degree of satisfaction with respect to government prevention and control measures during all phases. Shortages of medical supplies and low testing capacity were reported as the biggest shortcoming in the prevention and control strategies during COVID-19, and an abundance of disorderly and inaccurate information from different sources was the primary cause of panic. Conclusions and Relevance: Major public health events elicit psychosocial and behavioral changes that reflect the different phases of the biologic curve. Sufficient medical supplies and improved organization and accurate information during epidemics may reduce panic and improve compliance with requested changes in behavior. We need to recognize this natural phenomenon and our public policy preparedness should attempt to move the social/psychological curve to the left in order to minimize and flatten the biologic curve.