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Mathieu A, Reignier J, Le Gouge A, Plantefeve G, Mira JP, Argaud L, Asfar P, Badie J, Botoc NV, Bui HN, Chatellier D, Chauvelot L, Cracco C, Darmon M, Delbove A, Devaquet J, Dumont LM, Gontier O, Groyer S, Hourmant Y, Jaber S, Lambiotte F, Madeux B, Maizel J, Martinet O, Maxime V, Mercier E, Nay MA, Nseir S, Piton G, Quenot JP, Renault A, Rigaud JP, Schneider F, Sirodot M, Souweine B, Tamion F, Thévenin D, Thieulot-Rolin N, Tinturier F, Tirot P, Vinatier I, Vinsonneau C, Lascarrou JB, Laurent A. Resilience after severe critical illness: a prospective, multicentre, observational study (RESIREA). Crit Care 2024; 28:237. [PMID: 38997759 PMCID: PMC11245798 DOI: 10.1186/s13054-024-04989-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 06/14/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND Critical-illness survivors may experience post-traumatic stress disorder (PTSD) and quality-of-life impairments. Resilience may protect against psychological trauma but has not been adequately studied after critical illness. We assessed resilience and its associations with PTSD and quality of life, and also identified factors associated with greater resilience. METHODS This prospective, multicentre, study in patients recruited at 41 French ICUs was done in parallel with the NUTRIREA-3 trial in patients given mechanical ventilation and vasoactive amines for shock. Three months to one year after intensive-care-unit admission, survivors completed the Connor-Davidson Resilience Scale (CD-RISC-25), Impact of Event-Revised scale for PTSD symptoms (IES-R), SF-36 quality-of-life scale, Multidimensional Scale of Perceived Social Support (MSPSS), and Brief Illness Perception Questionnaire (B-IPQ). RESULTS Of the 382 included patients, 203 (53.1%) had normal or high resilience (CD-RISC-25 ≥ 68). Of these resilient patients, 26 (12.8%) had moderate to severe PTSD symptoms (IES-R ≥ 24) vs. 45 (25.4%) patients with low resilience (p = 0.002). Resilient patients had higher SF-36 scores. Factors independently associated with higher CD-RISC-25 scores were higher MSPSS score indicating stronger social support (OR, 1.027; 95%CI 1.008-1.047; p = 0.005) and lower B-IPQ scores indicating a more threatening perception of the illness (OR, 0.973; 95%CI 0.950-0.996; p = 0.02). CONCLUSIONS Resilient patients had a lower prevalence of PTSD symptoms and higher quality of life scores, compared to patients with low resilience. Higher scores for social support and illness perception were independently associated with greater resilience. Thus, our findings suggest that interventions to strengthen social support and improve illness perception may help to improve resilience. Such interventions should be evaluated in trials with PTSD mitigation and quality-of-life improvement as the target outcomes.
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Affiliation(s)
- Alice Mathieu
- Laboratoire de Psychologie: Dynamiques Relationnelles Et Processus Identitaires (Psy-DREPI), Université de Bourgogne Franche-Comté, EA7458, Dijon, France
| | - Jean Reignier
- CHU Nantes, Movement - Interactions - Performance, MIP, UR 4334, Nantes Université, 44000, Nantes, France.
- Médecine Intensive Réanimation, Nantes Université, CHU Nantes, 44000, Nantes, France.
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Hôtel-Dieu, 30 Bd. Jean Monnet, 44093, Nantes Cedex 1, France.
| | - Amélie Le Gouge
- Inserm CIC 1415, Tours, France
- Centre Hospitalier Universitaire de Tours, Tours, France
| | - Gaetan Plantefeve
- Service de Médecine Intensive Réanimation, Centre Hospitalier d'Argenteuil, Argenteuil, France
| | - Jean-Paul Mira
- Service de Médecine Intensive Réanimation, Hôpital Cochin, Groupe Hospitalier Paris Centre-Université Paris Cité, Assistance Publique -Hôpitaux de Paris, Paris, France
| | - Laurent Argaud
- Service de Médecine Intensive Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Pierre Asfar
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Angers, Angers, France
| | - Julio Badie
- Service de Médecine Intensive Réanimation, Hôpital Nord Franche Comté, Trevenans, France
| | - Nicolae-Vlad Botoc
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Saint Malo, Saint-Malo, France
| | - Hoang-Nam Bui
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Delphine Chatellier
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Louis Chauvelot
- Service de Médecine Intensive Réanimation, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Christophe Cracco
- Service de Médecine Intensive Réanimation, Centre Hospitalier d'Angoulême, Angoulême, France
| | - Michael Darmon
- Université Paris Cité ; Assistance Publique -Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Saint Louis, Paris, France
| | - Agathe Delbove
- Service de Réanimation Polyvalente, Centre Hospitalier Bretagne-Atlantique, Vannes, France
| | - Jérôme Devaquet
- Service de Réanimation Polyvalente, Hôpital Foch, Suresnes, France
| | - Louis-Marie Dumont
- Service de Médecine Intensive Réanimation, Hôpital Louis-Mourier, Assistance Publique -Hôpitaux de Paris, Colombes, France
| | - Olivier Gontier
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Chartres, Chartres, France
| | - Samuel Groyer
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Montauban, Montauban, France
| | - Yannick Hourmant
- CHU Nantes, INSERM, Nantes Université, Anesthesie Reanimation, CIC 1413, Nantes, France
| | - Samir Jaber
- Service de Réanimation Chirurgicale, Hôpital Saint-Eloi, CHU de Montpellier, Montpellier, France
- PhyMedExp, INSERM, CNRS, Montpellier, France
| | - Fabien Lambiotte
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Valenciennes, Valenciennes, France
| | - Benjamin Madeux
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Bigorre, Tarbes, France
| | - Julien Maizel
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France
| | - Olivier Martinet
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de la Réunion, Saint-Denis, La Réunion, France
| | - Virginie Maxime
- Service de Médecine Intensive Réanimation, Hôpital Raymond Poincaré, Assistance Publique Hôpitaux de Paris, Garches, France
- Inserm U 1173, Université de Versailles-Saint Quentin en Yvelines, Versailles, France
| | - Emmanuelle Mercier
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Tours, CRICS-TRIGGERSEP Network Tours, Tours, France
| | - Mai-Anh Nay
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire d'Orléans, Orléans, France
| | - Saad Nseir
- Médecine Intensive-Réanimation, CHU Lille, 59000, Lille, France
- CNRS, Inserm, UMR 8576 - U1285 - UGSF - Unité de Glycobiologie Structurale et Fonctionnelle, Lille University, Lille, France
| | - Gael Piton
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Besançon, Besançon, France
- Université de Franche Comté, EA3920, Besançon, France
| | - Jean-Pierre Quenot
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire François Mitterrand, Dijon, France
- Lipness Team, INSERM, LabExLipSTIC, Université de Bourgogne, Dijon, France
- INSERM Centres d'Investigation Clinique, Département d'épidémiologie Clinique, Université de Bourgogne, Dijon, France
| | - Anne Renault
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire La Cavale Blanche, Brest, France
| | - Jean-Philippe Rigaud
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Dieppe, Dieppe, France
| | - Francis Schneider
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Michel Sirodot
- Service de Médecine Intensive Réanimation, Centre Hospitalier Annecy Genevois, Epagny Metz-Tessy, France
| | - Bertrand Souweine
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Gabriel-Montpied, Clermont-Ferrand, France
| | - Fabienne Tamion
- Service de Médecine Intensive Réanimation, Hôpital Charles Nicolle, Centre Hospitalier Universitaire de Rouen; Normandie Université, UNIROUEN, Inserm U1096, FHU-REMOD-VHF, Rouen, France
| | - Didier Thévenin
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Lens, Lens, France
| | - Nathalie Thieulot-Rolin
- Service de Médecine Intensive Réanimation, Groupe Hospitalier Sud Ile de France, Melun, France
| | - Francois Tinturier
- Service de Réanimation Chirurgicale, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France
| | - Patrice Tirot
- Service de Médecine Intensive Réanimation, Centre Hospitalier du Mans, Le Mans, France
| | - Isabelle Vinatier
- Service de Médecine Intensive Réanimation, Centre Hospitalier Départemental de la Vendée, La Roche sur Yon, France
| | - Christophe Vinsonneau
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Béthune, Béthune, France
| | - Jean-Baptiste Lascarrou
- CHU Nantes, Movement - Interactions - Performance, MIP, UR 4334, Nantes Université, 44000, Nantes, France
- Médecine Intensive Réanimation, Nantes Université, CHU Nantes, 44000, Nantes, France
| | - Alexandra Laurent
- Laboratoire de Psychologie: Dynamiques Relationnelles Et Processus Identitaires (Psy-DREPI), Université de Bourgogne Franche-Comté, EA7458, Dijon, France.
- Department of Anaesthesiology and Critical Care Medicine, Dijon University Medical Centre, Dijon, France.
- Laboratoire Psy-DREPI, Université de Bourgogne Pôle Aafe, Esplanade Erasme, 21078, Dijon, France.
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Grover LE, Williamson C, Burdett H, Palmer L, Fear NT. Level of perceived social support, and associated factors, in combat-exposed (ex-)military personnel: a systematic review and meta-analysis. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02685-3. [PMID: 38771350 DOI: 10.1007/s00127-024-02685-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 05/03/2024] [Indexed: 05/22/2024]
Abstract
PURPOSE Combat deployment increases exposure to potentially traumatic events. Perceived social support (PSS) may promote health and recovery from combat trauma. This systematic review and meta-analysis aimed to synthesize studies investigating the level of PSS and associated factors among (ex-)military personnel who served in the Iraq/Afghanistan conflicts. METHODS Five electronic databases were searched in August 2023 and searches were restricted to the beginning of the Iraq/Afghanistan conflicts in 2001. The search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A quality assessment was carried out, and a meta-analysis and narrative synthesis were performed. RESULTS In total, 35 papers consisting of 19,073 participants were included. Of these, 31 studies were conducted in the United States (US) and 23 were cross-sectional. The pooled mean PSS score was 54.40 (95% CI: 51.78 to 57.01). Samples with probable post-traumatic stress disorder had a lower mean PSS score (44.40, 95% CI: 39.10 to 49.70). Approximately half of the included studies (n = 19) investigated mental health in relation to PSS, whilst only four explored physical health. The most frequently reported risk factors for low PSS included post-traumatic stress disorder, depression and anxiety, whilst post-traumatic growth and unit support were protective factors. CONCLUSION Higher levels of PSS were generally associated with more positive psychosocial and mental health-related outcomes following deployment. PSS should be targeted in psychosocial interventions and education programmes. Future research should investigate PSS in (ex-)military personnel across other countries and cultures, based on the lack of studies that focused on PSS in countries outside of the US.
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Affiliation(s)
- Laura E Grover
- King's College London, King's Centre for Military Health Research, London, SE5 9RJ, UK.
| | - Charlotte Williamson
- King's College London, King's Centre for Military Health Research, London, SE5 9RJ, UK
| | - Howard Burdett
- King's College London, King's Centre for Military Health Research, London, SE5 9RJ, UK
| | - Laura Palmer
- King's College London, King's Centre for Military Health Research, London, SE5 9RJ, UK
| | - Nicola T Fear
- King's College London, King's Centre for Military Health Research, London, SE5 9RJ, UK
- Academic Department of Military Mental Health, King's College London, London, SE5 9RJ, UK
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Ruotolo F, Ruggiero G, Cattaneo Z, Arioli M, Candini M, Frassinetti F, Pazzaglia F, Fornara F, Bosco A, Iachini T. Psychological Reactions during and after a Lockdown: Self-Efficacy as a Protective Factor of Mental Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6679. [PMID: 37681819 PMCID: PMC10488210 DOI: 10.3390/ijerph20176679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 09/09/2023]
Abstract
The aim of the present study was to investigate the effects of home confinement/social isolation (i.e., lockdown), imposed to reduce large-scale spread of a disease in the population, on the mental health of individuals. Through an online survey during the lockdown (DL) related to COVID-19 (1085 respondents, 627 females, agerange: 18-82) (Italy, 23 April-2 May 2020), we revealed that situational factors, i.e., the presence of children at home and female gender, and psychological factors, i.e., a greater sense of isolation, lower perception of safety outside the home and higher trait anxiety, predicted higher levels of state anxiety (R2 = 0.58). The same factors, but with young age instead of the presence of children, predicted higher levels of perceived stress (R2 = 0.63). Then, these data were compared with those collected after the lockdown (AL) (174 respondents, 128 females, agerange: 19-78) (Italy, 1 July-31 October 2021). The results showed that along with a reduced sense of isolation (DL = 2.90 vs. AL = 2.10) and an increased perception of safety outside the home (DL = 2.63 vs. AL = 3.05), a reduction in state anxiety (DL = 45.76 vs. AL= 40.88) and stress appeared (DL = 18.84 vs. AL = 17.63). However, the situation was better for men than for women. Perceived self-efficacy emerged as a protective factor for mental health (R2range: 0.03-0.27). The results are discussed in light of the evidence on the effects of lockdown on individuals worldwide. These results may be used to make more educated decisions on targeted help for individuals who may be most adversely affected by the adoption of lockdowns in the future.
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Affiliation(s)
- Francesco Ruotolo
- Department of Psychology, Università degli Studi della Campania “L. Vanvitelli”, 81100 Caserta, Italy; (G.R.); (T.I.)
| | - Gennaro Ruggiero
- Department of Psychology, Università degli Studi della Campania “L. Vanvitelli”, 81100 Caserta, Italy; (G.R.); (T.I.)
| | - Zaira Cattaneo
- Department of Social and Human Sciences, University of Bergamo, 24129 Bergamo, Italy; (Z.C.); (M.A.)
| | - Maria Arioli
- Department of Social and Human Sciences, University of Bergamo, 24129 Bergamo, Italy; (Z.C.); (M.A.)
| | - Michela Candini
- Department of Psychology, University of Bologna, 40126 Bologna, Italy; (M.C.)
| | | | | | - Ferdinando Fornara
- Department of Pedagogy, Psychology, Philosophy, University of Cagliari, 09124 Cagliari, Italy;
| | - Andrea Bosco
- Department of Educational Sciences, Psychology, Communication, University of Bari “Aldo Moro”, 70121 Bari, Italy;
| | - Tina Iachini
- Department of Psychology, Università degli Studi della Campania “L. Vanvitelli”, 81100 Caserta, Italy; (G.R.); (T.I.)
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Kinney AR, Schmid AA, Henry KL, Douglas Coatsworth J, Eakman AM. Combat exposure undermines student veterans' achievement of a meaningful life through its association with health-related symptoms: A longitudinal study. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2021; 69:142-150. [PMID: 31765275 DOI: 10.1080/07448481.2019.1656637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 06/11/2019] [Accepted: 08/11/2019] [Indexed: 06/10/2023]
Abstract
Objective: To understand whether symptoms of health conditions explain the negative association between combat exposure and student Veterans' achievement of a meaningful life. Participants: 153 combat Veterans enrolled in college between November 2013 and April 2018. Methods: Through an online survey, participants reported combat exposure, health status (symptoms of conditions such as depression), and aspects of a meaningful life (belonging, self-understanding, and doing) at two time points. Path analysis was used to explore whether baseline health status mediated the relationship between combat exposure and belonging, self-understanding, and doing at follow-up. Results: Indirect effects indicated that the negative influence of combat on student Veterans' sense of belonging, self-understanding, and doing at follow-up was mediated by poor health at baseline. Conclusions: Combat exposure may contribute to the development of health conditions, which in turn limit student Veterans' experience of three aspects of a meaningful life: a sense of belonging, self-understanding, and doing.
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Affiliation(s)
- Adam R Kinney
- Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, Colorado, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Arlene A Schmid
- Department of Occupational Therapy, Colorado State University, Fort Collins, Colorado, USA
| | - Kimberly L Henry
- Department of Psychology, Colorado State University, Fort Collins, Colorado, USA
| | - J Douglas Coatsworth
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, Colorado, USA
| | - Aaron M Eakman
- Department of Occupational Therapy, Colorado State University, Fort Collins, Colorado, USA
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Kinney AR, Schmid AA, Henry KL, Coatsworth JD, Eakman AM. Protective and Health-Related Factors Contributing to Resilience Among Student Veterans: A Classification Approach. Am J Occup Ther 2020; 74:7404205040p1-7404205040p11. [PMID: 32602443 DOI: 10.5014/ajot.2020.038331] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Occupational therapists can foster student veterans' resilience, but targets for intervention must be developed. OBJECTIVE To explain factors influencing student veterans' successful adaptation to past combat exposure, we hypothesized that participants with high life meaning would have greater levels of protective factors and lower levels of health conditions than those with low life meaning. DESIGN Longitudinal panel study with two measurements. Participants were classified by level of combat exposure (high-low) and life meaning (high-low) at follow-up, yielding four possible classifications (e.g., resilient group: high combat exposure, high life meaning). Linear mixed models were fit to obtain adjusted means of protective factors and health conditions for each classification; independent-samples t tests were used to examine differences between classifications. SETTING Community. PARTICIPANTS Convenience sample of 153 combat-exposed student veterans. OUTCOMES AND MEASURES Psychometrically sound measures of combat exposure, life meaning, protective factors (social and instructor autonomy support, coping ability, academic self-efficacy, social-community participation, and meaningful activity), and health conditions (posttraumatic stress [PTSD], depression, somatic symptoms). RESULTS Groups with high life meaning at follow-up in response to both levels of combat exposure reported greater meaningful activity and coping ability and fewer depressive symptoms. Participants with high life meaning in response to low combat exposure had greater social support and fewer somatic symptoms; participants with high life meaning in response to high combat exposure had lower PTSD. CONCLUSIONS AND RELEVANCE Occupational therapists may foster student veterans' resilience by promoting meaningful activity, social support, and coping ability while managing symptoms of health conditions. WHAT THIS ARTICLE ADDS To the best of our knowledge, this study is the first to offer empirical support for potential targets of occupational therapy intervention that address student veterans' successful adaptation to combat exposure. Findings suggest that researchers should develop and test interventions that facilitate successful engagement in meaningful and shared activities and that occupational therapists should work within multidisciplinary teams to bolster coping ability and manage symptoms of combat-related health conditions.
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Affiliation(s)
- Adam R Kinney
- Adam R. Kinney, PhD, OTR/L, is Polytrauma/TBI Advanced Postdoctoral Fellow, Rocky Mountain Mental Illness Research, Education, and Clinical Center, Department of Veterans Affairs, Aurora, CO, and Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz School of Medicine, Aurora;
| | - Arlene A Schmid
- Arlene A. Schmid, PhD, OTR/L, FAOTA, is Professor, Department of Occupational Therapy, Colorado State University, Fort Collins
| | - Kimberly L Henry
- Kimberly L. Henry, PhD, is Professor, Department of Psychology, Colorado State University, Fort Collins
| | - J Douglas Coatsworth
- J. Douglas Coatsworth, PhD, is Professor, Department of Human Development and Family Studies, Colorado State University, Fort Collins
| | - Aaron M Eakman
- Aaron M. Eakman, PhD, OTR/L, FAOTA, is Associate Professor, Department of Occupational Therapy, Colorado State University, Fort Collins
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Landi G, Pakenham KI, Boccolini G, Grandi S, Tossani E. Health Anxiety and Mental Health Outcome During COVID-19 Lockdown in Italy: The Mediating and Moderating Roles of Psychological Flexibility. Front Psychol 2020; 11:2195. [PMID: 32982888 PMCID: PMC7488226 DOI: 10.3389/fpsyg.2020.02195] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 08/05/2020] [Indexed: 12/22/2022] Open
Abstract
The COVID-19 emergency has severely affected the Italian population. During a pandemic, those with high health anxiety are at risk of adverse mental health outcomes, including peritraumatic distress and mood disturbance. No prior research has explored the role of psychological flexibility in protecting people at high risk of poorer mental health impacts due to health anxiety during a pandemic. Psychological flexibility is the cornerstone of psychological health and resiliency. According to acceptance and commitment therapy (ACT), it involves behaving consistently with one's chosen values even in the presence of emotional and mental discomfort. This study examined the mediating and moderating roles of psychological flexibility in the link between trait health anxiety and three mental health outcomes: COVID-19 peritraumatic distress, anxiety, and depression. We hypothesized that higher psychological flexibility would decrease the negative impacts of trait health anxiety on mental health outcomes. During the mandatory national lockdown (M = 35.70 days, SD = 8.41), 944 Italian adults (75.5% female, M = 38.86 years, SD = 13.20) completed an online survey consisting of standardized measures of psychological flexibility, trait health anxiety, COVID-19 distress, anxiety, and depression. Results indicated that psychological flexibility did not moderate the link between trait health anxiety and mental health outcomes. Rather, greater psychological flexibility mediated decreases in the adverse effects of trait health anxiety on COVID-19 distress, anxiety, and depression. In particular, two psychological flexibility processes, observing unhelpful thoughts rather than taking them literally (defusion) and values-based action (committed action), mediated decreases in the negative effects of trait health anxiety on all mental health outcomes. In contrast, the psychological flexibility process acceptance, which involves openness to inner discomfort, mediated increases in negative mental health outcomes. Overall, the combination of these processes mitigated the detrimental impacts of trait health anxiety on mental health during the emergency mandatory COVID-19 nationwide lockdown. Consistent with the ACT conceptualization of psychological flexibility, findings suggest embracing (rather than avoiding) inner discomfort and observing associated unhelpful thoughts, while also engaging in values-based action, increases resilience during adversity. Evidenced-based large-scale online public health interventions that target psychological flexibility in those experiencing health anxiety in the context of a pandemic are urgently needed. Many empirically-based ACT interventions are suited for this purpose.
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Affiliation(s)
- Giulia Landi
- Department of Psychology, University of Bologna, Bologna, Italy
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Cesena, Italy
| | - Kenneth I. Pakenham
- School of Psychology, The University of Queensland, Brisbane, QLD, Australia
| | - Giada Boccolini
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Cesena, Italy
| | - Silvana Grandi
- Department of Psychology, University of Bologna, Bologna, Italy
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Cesena, Italy
| | - Eliana Tossani
- Department of Psychology, University of Bologna, Bologna, Italy
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Cesena, Italy
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Kinney AR, Graham JE, Eakman AM. Participation Is Associated With Well-Being Among Community-Based Veterans: An Investigation of Coping Ability, Meaningful Activity, and Social Support as Mediating Mechanisms. Am J Occup Ther 2020; 74:7405205010p1-7405205010p11. [PMID: 32804619 DOI: 10.5014/ajot.2020.037119] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Occupational therapy practitioners can use therapeutic activity to promote veterans' well-being, but the mechanisms through which participation promotes well-being are poorly understood. OBJECTIVE To examine whether coping ability, meaningful activity, and social support mediate the relationship between participation and two indicators of veterans' overall well-being: life meaning (psychological well-being) and life satisfaction (subjective well-being). DESIGN Explanatory cross-sectional design. We used two multiple mediation models to test whether coping ability, meaningful activity, and social support explained the relationship between participation and both life meaning and life satisfaction. Models were adjusted for demographic characteristics and service-related health conditions (e.g., posttraumatic stress disorder). SETTING Community. PARTICIPANTS Three hundred eighty-nine community-based veterans attending college. INTERVENTION None. OUTCOMES AND MEASURES Measures of participation, coping ability, meaningful activity, social support, life meaning, life satisfaction, and service-related health conditions. RESULTS Meaningfulness of activity partially explained the relationship between participation and both psychological well-being (B = 0.16, standard error [SE] = 0.04, 99% confidence interval [CI] [0.07, 0.27]) and subjective well-being (B = 0.14, SE = 0.03, 99% CI [0.07, 0.24]). Social support partially explained the relationship between participation and subjective well-being (B = 0.05, SE = 0.02, 99% CI [0.01, 0.11]). These findings persisted when symptoms of service-related health conditions were accounted for. CONCLUSIONS AND RELEVANCE Veterans' participation is associated with a greater sense of meaningful activity and social support, which in turn promotes psychological and subjective well-being. Occupational therapy practitioners may promote veterans' well-being by supporting engagement in activities that elicit meaning and enable social interaction, although further study is needed. WHAT THIS ARTICLE ADDS This is among the first studies to test mechanisms underlying the relationship between veterans' engagement in activities and their overall well-being. Results may inform treatment theories for activity-based interventions in the veteran population. For example, results indicate that occupational therapy interventions that facilitate engagement in meaningful and shared activities could be developed to promote veterans' well-being.
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Affiliation(s)
- Adam R Kinney
- Adam R. Kinney, PhD, OTR/L, is Polytrauma/Traumatic Brain Injury Postdoctoral Fellow, Rocky Mountain Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs, Aurora, CO, and Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO. At the time of the study, he was PhD Candidate, Department of Occupational Therapy, Colorado State University, Fort Collins;
| | - James E Graham
- James E. Graham, PhD, DC, FACRM, is Professor, Department of Occupational Therapy, Colorado State University, Fort Collins
| | - Aaron M Eakman
- Aaron M. Eakman, PhD, OTR/L, FAOTA, is Associate Professor, Department of Occupational Therapy, Colorado State University, Fort Collins
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Resilience and long-term outcomes after trauma: An opportunity for early intervention? J Trauma Acute Care Surg 2020; 87:782-789. [PMID: 31589192 DOI: 10.1097/ta.0000000000002442] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Resilience, or the ability to cope with difficulties, influences an individual's response to life events including unexpected injury. We sought to assess the relationship between patient self-reported resilience traits and functional and psychosocial outcomes 6 months after traumatic injury. METHODS Adult trauma patients 18 years to 64 years of age with moderate to severe injuries (Injury Severity Score, ≥9) admitted to one of three Level I trauma centers between 2015 and 2017 were contacted by phone at 6 months postinjury and asked to complete a validated Trauma Quality of Life (T-QoL) survey and PTSD screen. Patients were classified into "low" and "high" resilience categories. Long-term outcomes were compared between groups. Adjusted logistic regression models were built to determine the association between resilience and each of the long-term outcomes. RESULTS A total of 305 patients completed the 6-month interview. Two hundred four (67%) of the 305 patients were classified as having low resilience. Mean age was 42 ± 14 years, 65% were male, 91% suffering a blunt injury, and average Injury Severity Score was 15.4 ± 7.9. Patients in the low-resilience group had significantly higher odds of functional limitations in activities of daily living (odds ratio [OR], 4.81; 95% confidence interval [CI], 2.48-9.34). In addition, patients in the lower resilience group were less likely to have returned to work/school (OR, 3.25; 95% CI, 1.71-6.19), more likely to report chronic pain (OR, 2.57; 95% CI, 1.54-4.30) and more likely to screen positive for PTSD (OR, 2.96; 95% CI, 1.58-5.54). CONCLUSION Patients with low resilience demonstrated worse functional and psychosocial outcomes 6 months after injury. These data suggest that screening for resilience and developing and deploying early interventions to improve resilience-associated traits as soon as possible after injury may hold promise for improving important long-term functional outcomes. LEVEL OF EVIDENCE Prognostic, level II.
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Polizzi C, Lynn SJ, Perry A. Stress and Coping in the Time of Covid-19: Pathways to Resilience and Recovery. CLINICAL NEUROPSYCHIATRY 2020; 17:59-62. [PMID: 34908968 PMCID: PMC8629051 DOI: 10.36131/cn20200204] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 03/31/2020] [Indexed: 12/15/2022]
Abstract
Coronavirus Disease 2019 (COVID-19) has disrupted virtually every aspect of daily living, engendering forced isolation and social distance, economic hardship, fears of contracting a potentially lethal illness and feelings of helplessness and hopelessness. Unfortunately, there is no formula or operating manual for how to cope with the current global pandemic. Previous research has documented an array of responses to mass crises or disasters, including chronic anxiety and posttraumatic stress as well as resilience and recovery. Much can be learned from this research about how people have coped in the past in order to identify strategies that may be particularly effective in managing distress and cultivating resilience during these perilous times. We delineate multiple coping strategies (e.g., behavioral activation, acceptance-based coping, mindfulness practice, loving-kindness practices) geared to decrease stress and promote resilience and recovery. These strategies may be especially effective because they help individuals make meaning, build distress tolerance, increase social support, foster a view of our deep human interconnectedness, and take goal-directed value-driven actions in midst of the COVID-19 pandemic.
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Affiliation(s)
- Craig Polizzi
- Psychology Department, Binghamton University, Binghamton, NY 13902, United States. Emails: (CP); (SJL)
| | - Steven Jay Lynn
- Psychology Department, Binghamton University, Binghamton, NY 13902, United States. Emails: (CP); (SJL)
| | - Andrew Perry
- Andrew Perry, Binghamton NY, 13905, United States.
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Cogan AM, Haines CE, Devore MD, Lepore KM, Ryan M. Occupational Challenges in Military Service Members With Chronic Mild Traumatic Brain Injury. Am J Occup Ther 2019; 73:7303205040p1-7303205040p9. [PMID: 31120834 PMCID: PMC6533051 DOI: 10.5014/ajot.2019.027599] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The purpose of this study was to identify the needs of military service members with chronic symptoms after mild traumatic brain injury (mTBI) that fall within the scope of occupational therapy practice. METHOD In this qualitative descriptive study, service members with a history of mTBI (N = 12) participated in semistructured interviews about their injury history, symptoms, daily routines, challenges, and plans. RESULTS Two main themes were identified: occupational changes and plans for the future. Occupational changes contains six subthemes: (1) rest and sleep, (2) activities of daily living and instrumental activities of daily living, (3) work, (4) social participation, (5) play and leisure, and (6) education. Plans for the future contains three subthemes: (1) supports, (2) barriers, and (3) fears. CONCLUSION Occupational therapists who work with this population should consider all areas of occupation, especially sleep, during assessment and treatment planning. Some clients may require additional support for preparing for civilian life.
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Affiliation(s)
- Alison M Cogan
- Alison M. Cogan, PhD, OTR/L, is Polytrauma/TBI Advanced Postdoctoral Fellow, VA Medical Center, Washington, DC; . She was Doctoral Student, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, when this work was done
| | - Christine E Haines
- Alison M. Cogan, PhD, OTR/L, is Polytrauma/TBI Advanced Postdoctoral Fellow, VA Medical Center, Washington, DC; . She was Doctoral Student, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, when this work was done
| | - Maria D Devore
- Alison M. Cogan, PhD, OTR/L, is Polytrauma/TBI Advanced Postdoctoral Fellow, VA Medical Center, Washington, DC; . She was Doctoral Student, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, when this work was done
| | - Karla M Lepore
- Alison M. Cogan, PhD, OTR/L, is Polytrauma/TBI Advanced Postdoctoral Fellow, VA Medical Center, Washington, DC; . She was Doctoral Student, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, when this work was done
| | - Margaret Ryan
- Alison M. Cogan, PhD, OTR/L, is Polytrauma/TBI Advanced Postdoctoral Fellow, VA Medical Center, Washington, DC; . She was Doctoral Student, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, when this work was done
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Eakman AM, Kinney AR, Reinhardt R. Participation, Meaningful Activity, and Social Support Among U.S. Student Service Members/Veterans. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2019; 39:222-231. [PMID: 30852944 DOI: 10.1177/1539449219833351] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Student service members/veterans (SSM/Vs) may experience diminished social support and meaningful activity due to health-related sequelae, in turn threatening their community reintegration. Social and community participation may foster both social support and meaningful activity. This study assessed whether social and community participation explained social support and meaningful activity and evaluated the psychometric properties of the Veterans' Social and Community Participation Assessment (VSCPA). Online surveys generated responses to the VSCPA, indicators of social support, meaningful activity, health-related challenges, and demographic characteristics. Multiple regression models explored predictors of social support and meaningful activity. The VSCPA comprised three components: active community participation, familial and household participation, and social participation. These components exhibited positive associations with social support and meaningful activity and negative relationships with health-related sequelae. Targeting social and community participation among SSM/Vs may be a fruitful means by which occupational therapists bolster social support and meaningful activity.
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Silva MA, Dillahunt-Aspillaga C, Patel N, Garofano JS, Martinez KM, Lynn CA, Rechkemmer MB, Nakase-Richardson R. Functional Outcome and Mental Health Symptoms in Military Personnel and Veterans Pursuing Postsecondary Education After Traumatic Brain Injury: A VA TBI Model Systems Study. REHABILITATION RESEARCH, POLICY, AND EDUCATION 2019. [DOI: 10.1891/2168-6653.33.1.41] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BackgroundTBI is a leading cause of disability among veterans and active duty military personnel, and presents an obstacle to community reintegration. Prior studies examining adult survivors of TBI pursuing postsecondary education have methodological flaws that limit the understanding the scope and severity of sequelae experienced by persons with TBI who attend college.ObjectiveTo describe (a) physical and cognitive functioning, and (b) postconcussion and mental health symptoms in veterans and military personnel (V/M) with traumatic brain injury (TBI) enrolled in postsecondary education programs after discharge from rehabilitation.MethodCross-sectional study. Participants were recruited from five Veterans Affairs (VA) Polytrauma Rehabilitation Centers, enrolled in the VA TBI Model Systems parent study, and attending school during follow-up (N= 155). Outcome measures included the Functional Independence Measure (FIM), Neurobehavioral Symptom Inventory (NSI), Post-traumatic Stress Disorder (PTSD) Checklist-Civilian version (PCL-C), Patient Health Questionnaire-Depression (PHQ-9), and Generalized Anxiety Disorder Questionnaire (GAD-7).FindingsParticipants were mostly male (92.9%) and White (81.4%), with mild (40.0%), moderate (11.5%), severe (34.5%), or very severe TBI (23.0%). Depression, anxiety, PTSD, and postconcussion symptoms were lowest in participants with very severe TBI and highest in those with mild TBI. There were no significant differences in FIM across TBI severity levels.ConclusionThis study supports the need for rehabilitation counselors, educators, and administrators to prepare future practitioners to deliver tailored services to student V/M with TBI. These services can facilitate successful community reintegration and transition into civilian school settings. Symptom profiling may inform personalized cognitive interventions to enhance these students’ academic success.
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Reyes AT, Kearney CA, Isla K, Bryant R. Student veterans' construction and enactment of resilience: A constructivist grounded theory study. J Psychiatr Ment Health Nurs 2018; 25:37-48. [PMID: 29047199 DOI: 10.1111/jpm.12437] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/13/2017] [Indexed: 11/29/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Resilience is an ability and a process that allows an individual to develop positive adaptation despite challenges and adversities. Many military veterans returning to college after their military service have difficulty transitioning to civilian life. Although some research exists that explores factors related to the resilience of college student veterans, limited theoretical descriptions exist that explain how student veterans construct resilience, and how resilience is enacted and enhanced in their academic and personal (non-academic) lives. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: The resilience of student veterans involves a complex process of transitioning from military to civilian life and an iterative journey between positive adaptation and transient perturbations. Student veterans' resilience is a result of integrating and resolving various aspects of their academic and personal challenges. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses can apply this grounded theory as a practical framework for equipping student veterans with effective strategies to develop and enhance resilience. Nurses can employ a holistic approach of care in their interactions with military veterans and student veterans that includes fostering psychological resilience, helping to manage their multiple non-academic responsibilities and supporting their academic success. ABSTRACT Introduction Adjusting to college life is one of the most difficult experiences in a military veteran's transition to civilian life. Many military veterans returning to college not only encounter academic challenges, but also deal with physical and psychiatric disabilities, loss of military camaraderie and social disconnect. These often negatively affect their personal and academic lives. Hence, it is important to explore resilience to best support student veterans as they transition from military to civilian life. Aim The aim of this study was to explore how student veterans construct and enact resilience within their personal and academic lives. Method Using constructivist grounded theory methodology, in-depth individual interviews were conducted with 20 military veterans enrolled as undergraduate students at a U.S. university. Results The process of "integrating," which represents student veterans' construction and enactment of resilience, was the core category. This category has three subcategories: (1) the aspects; (2) the expressions; and (3) the enactments of resilience. Implications for practice Nurses can use this grounded theory as the practical framework for their interactions with military veterans, and more particularly with supporting student veterans in their academic lives, in their personal lives and in the transition from military to civilian life.
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Affiliation(s)
- A T Reyes
- School of Nursing, University of Nevada, Las Vegas, NV, USA
| | - C A Kearney
- Department of Psychology, University of Nevada, Las Vegas, NV, USA
| | - K Isla
- School of Nursing, University of Nevada, Las Vegas, NV, USA
| | - R Bryant
- Military and Veteran Services Center, University of Nevada, Las Vegas, NV, USA
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Eakman AM, Schmid AA, Henry KL, Rolle NR, Schelly C, Pott CE, Burns JE. Restoring effective sleep tranquility (REST): A feasibility and pilot study. Br J Occup Ther 2017. [PMID: 28626295 PMCID: PMC5458872 DOI: 10.1177/0308022617691538] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Introduction The purpose of this pilot study was to establish the feasibility of completing a future controlled trial of a multi-component cognitive behavioral therapy for insomnia program for military veterans with sleep disturbance. Method This was a single-arm feasibility and pilot study. Participants were United States post-9/11 veterans with service-connected injuries, university students, and had self-reported sleep disturbances. Restoring Effective Sleep Tranquility was a multi-component cognitive behavioral therapy for insomnia intervention consisting of seven sessions of group therapy and eight 1:1 sessions delivered by occupational therapists. Feasibility and pilot indicators were process, resources, management, and scientific, including pre–post-assessments of sleep difficulties, dysfunctional sleep beliefs, participation, and pain interference. Findings Indicators were supportive of feasibility, including reduced sleep difficulties (for example Medical Outcomes Study Sleep Measure [t = 3.29, p = .02]), reduced nightmares: t = 2.79, p = .03; fewer dysfunctional sleep beliefs: t = 3.63, p = .01, and greater ability to participate in social roles: t = –2.86, p = .03, along with trends towards improved satisfaction with participation and reduced pain interference. Conclusion The Restoring Effective Sleep Tranquility program may reduce sleep difficulties and improve participation in US veterans with service-connected injuries, and evidence indicates a controlled trial would be feasible to deliver.
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Affiliation(s)
- Aaron M Eakman
- Assistant Professor, Department of Occupational Therapy, College of Health and Human Sciences, Colorado State University, Fort Collins, CO, USA
| | - Arlene A Schmid
- Associate Professor, Department of Occupational Therapy, College of Health and Human Sciences, Colorado State University, Fort Collins, CO, USA
| | - Kimberly L Henry
- Associate Professor, Department of Psychology, College of Natural Sciences, Colorado State University & The Colorado School of Public Health, Fort Collins, CO, USA
| | - Natalie R Rolle
- Occupational Therapist and Student Veteran Coordinator, Center for Community Partnerships, Department of Occupational Therapy, College of Health and Human Sciences, Colorado State University, Fort Collins, CO, USA
| | - Catherine Schelly
- Assistant Professor and Director, Center for Community Partnerships, Department of Occupational Therapy, College of Health and Human Sciences, Colorado State University, Fort Collins, CO
| | - Christine E Pott
- Graduate Student, Department of Occupational Therapy, College of Health and Human Sciences, Colorado State University, Fort Collins, CO, USA
| | - Joshua E Burns
- Student Veteran Coordinator, Center for Community Partnerships, Department of Occupational Therapy, College of Health and Human Sciences, Colorado State University, Fort Collins, CO, USA
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