Towards precision in the diagnostic profiling of patients: leveraging symptom dynamics as a clinical characterisation dimension in the assessment of major depressive disorder

BACKGROUND

International guidelines present overall symptom severity as the key dimension for clinical characterisation of major depressive disorder (MDD). However, differences may reside within severity levels related to how symptoms interact in an individual patient, called symptom dynamics.

AIMS

To investigate these individual differences by estimating the proportion of patients that display differences in their symptom dynamics while sharing the same overall symptom severity.

METHOD

Participants with MDD (n = 73; mean age 34.6 years, s.d. = 13.1; 56.2% female) rated their baseline symptom severity using the Inventory for Depressive Symptomatology Self-Report (IDS-SR). Momentary indicators for depressive symptoms were then collected through ecological momentary assessments five times per day for 28 days; 8395 observations were conducted (average per person: 115; s.d. = 16.8). Each participant's symptom dynamics were estimated using person-specific dynamic network models. Individual differences in these symptom relationship patterns in groups of participants sharing the same symptom severity levels were estimated using individual network invariance tests. Subsequently, the overall proportion of participants that displayed differential symptom dynamics while sharing the same symptom severity was calculated. A supplementary simulation study was conducted to investigate the accuracy of our methodology against false-positive results.

RESULTS

Differential symptom dynamics were identified across 63.0% (95% bootstrapped CI 41.0-82.1) of participants within the same severity group. The average false detection of individual differences was 2.2%.

CONCLUSIONS

The majority of participants within the same depressive symptom severity group displayed differential symptom dynamics. Examining symptom dynamics provides information about person-specific psychopathological expression beyond severity levels by revealing how symptoms aggravate each other over time. These results suggest that symptom dynamics may be a promising new dimension for clinical characterisation, warranting replication in independent samples. To inform personalised treatment planning, a next step concerns linking different symptom relationship patterns to treatment response and clinical course, including patterns related to spontaneous recovery and forms of disorder progression.

Fear of giving birth alone: Experiences of psychological distress, symptoms of anxiety and depression, and coping- strategies of childbearing women during COVID-19

BACKGROUND

Psychological distress during pregnancy is a well-documented risk factor for adverse maternal outcomes. Distress related to the COVID-19 pandemic may further increase the vulnerability of pregnant women to negative mental health outcomes.

AIM

To explore the mental health experiences of pregnant women, focusing on mental health outcomes, challenges related to the pandemic, coping strategies, and factors buffering mental health factors during the restricted COVID-19 lockdown period.

METHODS

A mixed-methods survey study was conducted, examining symptoms of anxiety, depression, and burnout among 21 pregnant women. Qualitative data were gathered through open-ended questions about participants' experiences of challenges, coping strategies and buffering factors amid the pandemic. Symptoms of anxiety, depression and burnout were calculated, and qualitative data was thematically analyzed.

RESULTS

Approximately one-third (24 %) of the respondents reported clinically significant levels of depression, 19 % reported clinically significant levels of anxiety, and 43 % reported experiencing burnout. All participants reported distress and emotional burden, including fear, worry, stress and anxiety related to the pandemic. Specific concerns such as fear of giving birth alone, fear of the consequences due to lockdown restrictions, insufficient information, disruption of prenatal healthcare services, and fear of miscarriage were prevalent among the participants. Social support, financial stability, stable relationships, adherence to daily routines, reduced stress and social demands, a calmer daily life, physical activity, and less work-related stress including working from home, emerges as buffering factors that aided women in coping with pandemic-related distress.

CONCLUSION

Healthcare providers should prioritize stability, predictability, and minimizing disruptions to prenatal care. Broad-based screening is crucial to identify women at risk of depression, anxiety, and burnout. Recommendations for clinical pathways aimed at pregnant women are discussed.

Mental health and environmental factors in adults: A population-based network analysis

Few studies have assessed the multifactorial nature of environmental influences on population mental health. In this large-scale, population-based study of adults, we applied network analysis to study the relationship between environmental factors and symptoms of depression, anxiety, and well-being. We estimated networks with overall mental health nodes and individual symptoms to assess both broad and fine-grained associations between environmental factors and mental health. Finally, we conducted an out-of-sample replication in an independent large-scale sample to assess the robustness of our results. Across 31,000 adults randomly sampled from the Norwegian population, we identified associations between numerous environmental characteristics and mental health. Recent discrimination and unsupportive social environments were strongly associated with lower population well-being and higher levels of mental illness symptoms, respectively. The most strongly connected variables in the networks were environmental factors, including perceived problems with crime, violence, or vandalism in the residential area, worrying about violence or threats when outside, and problems with noise or contamination at home. Substantial variation in population mental health was explained by environmental factors included in the networks. Replicability of the results was excellent and suggestive of strong robustness of the results across samples. Our findings are indicative of the importance of environmental factors, such as the social environment, housing satisfaction, and residential area characteristics, for multiple aspects of population mental health. We identify several environmental factors that represent potentially useful targets for future studies and public health efforts seeking to improve mental health in the general population. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Stressful life events exhibit complex patterns of associations with depressive symptoms in two population-based samples using network analysis

BACKGROUND

Stressful life events (SLEs) constitute key risk factors for depression. However, previous studies examining associations between SLEs and depression have been limited by focusing on single events, combining events into broad categories, and/or ignoring interrelationships between events in statistical analyses. Network analysis comprises a set of statistical methods well-suited for assessing relationships between multiple variables and can help surpass several limitations of previous studies.

METHODS

We applied network analysis using mixed graphical models combining two large-scale population-based samples and >34,600 randomly sampled adults to investigate the associations between SLEs and current depressive symptoms in the general population.

RESULTS

Numerous SLEs were uniquely associated with specific symptoms. Strong pairwise links were observed between SLEs during the past year and individual symptoms, e.g., between having experienced illness or injury and sleeping problems, having been degraded or humiliated and feeling blue, and between financial problems and hopelessness and being worried and anxious. Several SLEs, such as financial problems, sexual abuse, and having been degraded or humiliated, were associated with symptoms across more than one timepoint. More recent SLEs were generally more strongly associated with depressive symptoms. Several life events were strongly interrelated, such as multiple forms of abuse, and financial problems, unemployment, divorce, and serious illness or injury.

LIMITATIONS

Limitations include a retrospective SLE measure, cross-sectional data, a brief self-report measure of depressive symptoms, and possible attrition bias in the sample.

CONCLUSIONS

Our findings may have implications for public health efforts seeking to improve population mental health.

Coping style and mental health amid the first wave of the COVID-19 pandemic: a culture-moderated meta-analysis of 44 nations

In the first wave of the COVID-19 pandemic, the rapid transmission of a novel virus and the unprecedented disease-mitigation measures have elicited considerable stress in many countries worldwide. Coping with pandemic stress may be differentially related to psychological symptoms across countries characterised by distinct cultural values. This study aimed to: (a) synthesise the literature by investigating the associations between some major types of coping style and psychological symptoms, and (b) investigate the moderating effects of culture on these associations. We performed a three-level random-effects meta-analysis, which included 151 independent samples from 44 countries across eight world regions (n = 137,088, 66% women, Mage = 36.08). For both problem-focused and avoidant coping styles, their hypothesised associations with psychological symptoms were robust across the countries (anxiety: rs = -.11 and .31; depression: rs = -.19 and .33; ps < .0001). For both emotion-focused and social support seeking styles, their associations with psychological symptoms were moderated by two Hofstede's cultural dimensions: uncertainty avoidance (intolerance of ambiguity) and masculinity (concern for achievement and success). The hypothesised negative coping style-symptom associations were found only in the countries with lower levels of uncertainty avoidance or masculinity, but opposite patterns of findings were found in those with higher levels of either of these two cultural dimensions.

Triggered by worry: A dynamic network analysis of COVID-19 pandemic-related anxiety and parental stress

BACKGROUND

Major disruptions to daily life routines made families and parents particularly vulnerable to psychological distress during the COVID-19 lockdowns. However, the specific psychopathological processes related to within-person variation and maintenance of anxiety symptomatology and parental distress components in the parental population have been largely unexplored in the literature.

METHODS

In this preregistered intensive longitudinal study, a multilevel dynamic network was used to model within-person interactions between anxiety symptomatology, psychopathological processes, parental distress, and protective lifestyle components in a sample of 495 parents-each responding to daily assessments over a 40-day period. A total of 30,195 observations were collected across the subjects.

RESULTS

Extensive worry, threat monitoring, and uncontrollability of worry were identified as overreaching psychopathological processes related to the aggravation of other symptoms of anxiety and parental distress. A strong association was found between parental stress and parental burnout. Anger toward one's child was associated with both parental stress and parental burnout. Protective factors showed the lowest strength centrality, with few and weak connections to other symptoms and processes in the network.

LIMITATIONS

Associations may exist between the study variables on a different time scale; hence, different time lags should be used in future research.

CONCLUSIONS

Accessible, low-cost interventions that address worry, threat monitoring, and the uncontrollability of worry could serve as potential targets for reducing the symptom burden of anxiety and distress in the parental population.

Use of substances to cope predicts posttraumatic stress disorder symptom persistence: Investigating patterns of interactions between symptoms and its maintaining mechanisms

OBJECTIVE

Posttraumatic stress disorder (PTSD) remains a growing public health challenge across the globe and is associated with negative and persistent long-term consequences. The last decades of research have identified different mechanisms associated with the development and persistence of PTSD, including maladaptive coping strategies, cognitive and experiential avoidance, and positive and negative metacognitions. Despite these advances, little is known about how these different processes interact with specific PTSD symptoms, and how they influence each other over time at the within-person level.

METHOD

Leveraging a large (N > 1,800) longitudinal data set representative of the Norwegian population during the COVID-19 pandemic, this preregistered study investigated these symptom-process interactions over four assessment waves spanning an 8-month period.

RESULTS

Our panel graphical vector autoregressive network model revealed the dominating role of substance use to cope in predicting higher levels of PTSD symptoms over time and increases in PTSD symptomatology within more proximal time windows (i.e., within 6 weeks). Threat monitoring was associated with increased suicidal ideation, while threat monitoring itself was increasing upon decreased avoidance behavior, greater presence of negative metacognitions, and higher use of substances to cope.

CONCLUSIONS

Our findings speak to the importance of attending to different coping strategies, particularly the use of substances as a coping behavior in efforts to prevent PTSD chronicity upon symptom onset. We outline future directions for research efforts to better understand the complex interactions and temporal pathways leading up to the development and maintenance of PTSD symptomatology. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

COVID-19 illness severity and 2-year prevalence of physical symptoms: an observational study in Iceland, Sweden, Norway and Denmark

Background

Although the persistence of physical symptoms after SARS-CoV-2 infection is a major public health concern, evidence from large observational studies beyond one year post diagnosis remain scarce. We aimed to assess the prevalence of physical symptoms in relation to acute illness severity up to more than 2-years after diagnosis of COVID-19.

Methods

This multinational study included 64,880 adult participants from Iceland, Sweden, Denmark, and Norway with self-reported data on COVID-19 and physical symptoms from April 2020 to August 2022. We compared the prevalence of 15 physical symptoms, measured by the Patient Health Questionnaire (PHQ-15), among individuals with or without a confirmed COVID-19 diagnosis, by acute illness severity, and by time since diagnosis. We additionally assessed the change in symptoms in a subset of Swedish adults with repeated measures, before and after COVID-19 diagnosis.

Findings

During up to 27 months of follow-up, 34.5% participants (22,382/64,880) were diagnosed with COVID-19. Individuals who were diagnosed with COVID-19, compared to those not diagnosed, had an overall 37% higher prevalence of severe physical symptom burden (PHQ-15 score ≥15, adjusted prevalence ratio [PR] 1.37 [95% confidence interval [CI] 1.23-1.52]). The prevalence was associated with acute COVID-19 severity: individuals bedridden for seven days or longer presented with the highest prevalence (PR 2.25 [1.85-2.74]), while individuals never bedridden presented with similar prevalence as individuals not diagnosed with COVID-19 (PR 0.92 [0.68-1.24]). The prevalence was statistically significantly elevated among individuals diagnosed with COVID-19 for eight of the fifteen measured symptoms: shortness of breath, chest pain, dizziness, heart racing, headaches, low energy/fatigue, trouble sleeping, and back pain. The analysis of repeated measurements rendered similar results as the main analysis.

Interpretation

These data suggest an elevated prevalence of some, but not all, physical symptoms during up to more than 2 years after diagnosis of COVID-19, particularly among individuals suffering a severe acute illness, highlighting the importance of continued monitoring and alleviation of these targeted core symptoms.

Funding

This work was mainly supported by grants from NordForsk (COVIDMENT, grant number 105668 and 138929) and Horizon 2020 (CoMorMent, 847776). See Acknowledgements for further details on funding.

Gamification: a Novel Approach to Mental Health Promotion

PURPOSE OF REVIEW

Gamification has emerged as a novel technique for improving mental health and enhancing treatment effectiveness. This paper provides an overview of gamification approaches to mental health intervention, identifies factors that may be related to variations in treatment effectiveness, and discusses possible strategies for tailoring gamified interventions to clients' needs.

RECENT FINDINGS

Recent research has documented the potential of gamified mental health interventions for bolstering mental wellness and mitigating psychological symptoms. However, their effectiveness may vary depending on study design-related factors and gender-specific considerations. Literature reviews have also identified yet-to-be resolved issues surrounding the possible strengths and weaknesses of the personalization versus standardization of gamification, as well as the potential benefits of gamification for increasing engagement versus the potential risks of over-engagement and behavioral addiction to gamified components. This review highlights the need for careful planning and execution of gamified mental health interventions to optimize their effectiveness and suitability for meeting clients' individual needs and preferences.

Elevated symptoms of depression and anxiety among family members and friends of critically ill COVID-19 patients - an observational study of five cohorts across four countries

Background

Little is known regarding the mental health impact of having a significant person (family member and/or close friend) with COVID-19 of different severity.

Methods

The study included five prospective cohorts from four countries (Iceland, Norway, Sweden, and the UK) with self-reported data on COVID-19 and symptoms of depression and anxiety during March 2020-March 2022. We calculated prevalence ratios (PR) of depression and anxiety in relation to having a significant person with COVID-19 and performed a longitudinal analysis in the Swedish cohort to describe temporal patterns.

Findings

162,237 and 168,783 individuals were included in the analysis of depression and anxiety, respectively, of whom 24,718 and 27,003 reported a significant person with COVID-19. Overall, the PR was 1.07 (95% CI: 1.05-1.10) for depression and 1.08 (95% CI: 1.03-1.13) for anxiety in relation to having a significant person with COVID-19. The respective PRs for depression and anxiety were 1.15 (95% CI: 1.08-1.23) and 1.24 (95% CI: 1.14-1.34) if the patient was hospitalized, 1.42 (95% CI: 1.27-1.57) and 1.45 (95% CI: 1.31-1.60) if the patient was ICU-admitted, and 1.34 (95% CI: 1.22-1.46) and 1.36 (95% CI: 1.22-1.51) if the patient died. Individuals with a significant person with hospitalized, ICU-admitted, or fatal COVID-19 showed elevated prevalence of depression and anxiety during the entire year after the COVID-19 diagnosis.

Interpretation

Family members and close friends of critically ill COVID-19 patients show persistently elevated prevalence of depressive and anxiety symptoms.

Funding

This study was primarily supported by NordForsk (COVIDMENT, 105668) and Horizon 2020 (CoMorMent, 847776).

Using network models to explore the associations between posttraumatic stress disorder symptoms and subjective cognitive functioning

Several studies have identified relationships between posttraumatic stress disorder (PTSD) and cognitive functioning. Here, we aimed to elucidate the nature of this relationship by investigating cross-sectional associations between subjective cognitive functioning (SCF) and 1) the PTSD sum score, 2) symptom domains, and 3) individual symptoms. We also investigated temporal stability by testing whether results replicated over a 3-year period. We estimated partial correlation networks of DSM-5 PTSD symptoms (at baseline) and SCF (at baseline and follow-up, respectively), using data from the National Health and Resilience in Veterans Study (NHRVS; N = 1484; Mdn = 65 years). The PTSD sum score was negatively associated with SCF. SCF was consistently negatively associated with the PTSD symptom domains 'marked alterations in arousal and reactivity' and 'negative alterations in cognitions and mood', and showed robust relations with the specific symptoms 'having difficulty concentrating' and 'trouble experiencing positive feelings'. Results largely replicated at the 3-year follow-up, suggesting that some PTSD symptoms both temporally precede and are statistically associated with the development or maintenance of reduced SCF. We discuss the importance of examining links between specific PTSD domains and symptoms with SCF-relations obfuscated by focusing on PTSD diagnoses or sum scores-as well as investigating mechanisms underlying these relations. Registration Number: 37069 (https://aspredicted.org/n5sw7.pdf).

Anxiety and depressive symptoms among migrants during the COVID-19 pandemic in Norway: A two-wave longitudinal study

This study was designed to examine the impact of the COVID-19 pandemic on the mental health of migrants living in Norway. We conducted a longitudinal two-waves survey among a sample of 574 migrants and multilevel modelling was used to analyse anxiety, health anxiety and depressive symptoms. Demographic and psychological predictors were investigated. The levels of anxiety, health anxiety and depressive symptoms among migrants decreased from the lockdown (strict social distancing protocols) to phaseout. Reductions in maladaptive coping strategies were related to parallel reductions in anxiety, health anxiety, and depression, and a reduction in loneliness was related to a reduction in depression. The results indicate that the elevated levels of anxiety, health anxiety and depressive symptoms among migrants in the first phase of the pandemic may be temporary.

Viral mitigation and the COVID-19 pandemic: factors associated with adherence to social distancing protocols and hygienic behaviour

OBJECTIVE

To investigate the factors associated with adherence to viral mitigation protocols during the COVID-19 pandemic.

DESIGN

This epidemiological cross-sectional study examines adherence to behaviour in 4158 adults and its relationship with sources of information.

MAIN OUTCOME MEASURES

Adherence to social distancing protocols (SDPs) and adherence to hygienic behaviour (HB) recommendations.

RESULTS

Individuals aged 18-30 reported lowest adherence to SDPs and HB. Alcohol consumption was associated with lower adherence. Increased risk perception, fear of infection and altruistic attitude were associated with greater adherence. Males, single and childless individuals reported lower adherence. Extroverts and urban residents reported lower adherence to SDPs, but not HB. In contrast to earlier stages of the pandemic, voluntary social distancing was associated with greater adherence to SDPs as opposed to rule-enforced social distancing. Regarding information obtainment, increased time spent acquiring information from recognised newspapers had the strongest favourable association with adherence. Relying on information from friends and family was associated with decreased adherence to SDPs. Sensitivity analyses replicated the findings, supporting the stability and robustness of the proposed models.

CONCLUSION

This study identifies factors associated with favourable and detrimental adherence behaviour along with substantial dissemination routes, presenting strategies that may be of utility towards fostering adherence to contemporaneously implemented mitigation protocols.

Daily dynamics and mechanisms of anxious symptomatology in the general population: A network study during the COVID-19 pandemic

To understand the interplay between anxiety symptoms and their maintaining psychological processes in the population, an analysis of longitudinal within-person relationships is required. A sample of 1706 individuals completed daily measures during a 40-day period with strict mitigation protocols. Data of 1368 individuals who completed at least 30 assessments were analyzed with the multilevel vector autoregressive (mlVAR) model. This model estimates a temporal, a contemporaneous, and a between-person network. Uncontrollability of worry, generalized worry, fear of being infected, fear of significant others being infected, and threat monitoring had the highest outstrength within the temporal network, indicating that daily fluctuations in these components were the most predictive of next-day fluctuations in other components. Of specific connections, both fear of self and fear of close others being infected predicted generalized worry and threat monitoring. In turn, generalized worry and threat monitoring engaged in several positive feedback loops with other anxiety symptoms and processes. Also, intolerance of uncertainty was predictive of other components. The findings align with the mechanisms both in the metacognitive therapy (MCT) model and in the intolerance of uncertainty model of generalized anxiety disorder (GAD).

Parental burnout during the COVID-19 pandemic

Increased and long-term parental stress related to one's parental role can lead to parental burnout. In the early phase of the COVID-19 pandemic, families experienced intensified pressure due to the government-initiated contact restrictions applied to prevent the spread of the virus in the population. This study investigates the risk factors and predictors of parental burnout in a large sample of parents (N = 1488) during the COVID-19 pandemic in Norway. Demographic and psychosocial factors were assessed at two timepoints: at the beginning of the pandemic outbreak in March 2020 (T1) and at 3 months follow-up (T2). A hierarchical regression analysis was applied to identify the factors that contribute to parental burnout at T2. Parental burnout was additionally explored across subgroups. Findings revealed that younger age was associated with more parental burnout. Concurrent (T2) use of unhelpful coping strategies, insomnia symptoms, parental stress, and less parental satisfaction was significantly associated with the presence of greater parental burnout (T2). Additionally, parental stress and satisfaction measured in the earliest phase of the pandemic (T1) were associated with parental burnout 3 months later (T2) over and above concurrent parental stress/satisfaction. Unemployed parents and individuals with a mental health condition were identified as subgroups with substantially heightened levels of parental burnout.

Psychiatric symptoms in COVID-19-positive individuals in the general population: Trajectories of depression, anxiety, and insomnia

The present study investigates differences in the trajectories of anxiety, depression, and sleep problems among infected versus non-infected case-controlled individuals. Patients who tested positive for COVID-19 were selected from a representative sample in Norway (N > 10,000). In total, 126 of these individuals were infected during the project period, and this group was analyzed at T5 (May 2021). Of these positive cases, those who had completed both PHQ-9 and GAD-7 at all three measurement points were selected for longitudinal analysis using multilevel modeling. There was a significant difference at T5 between those who had tested positive for COVID-19 and matched controls. Anxiety and depression were reduced among those who tested positive, but there were no differences in trajectory when compared to matched controls. Limitations include the use of self-report measures and the assessment of symptoms at a time when strict virus mitigation protocols were in place. The present findings indicate that individuals who test positive for COVID-19 exhibit higher levels of depressive symptoms after restrictions are lifted. However, comparison of anxiety and depression symptom trajectories with matched controls reveals that both groups exhibited stable or slightly decreased symptoms.

A critical period for pandemic adaptation: The evolution of depressive symptomatology in a representative sample of adults across a 17-month period during COVID-19

This 17-month longitudinal study on a representative sample of 4,361 Norwegian adults employs an observational ABAB design across 6 repeated assessments and 3 pandemic waves to systematically investigate the evolution of depressive symptomatology across all modifications of social distancing protocols (SDPs) from their onset to termination. Using Latent Change Score Models to analyze 26,166 observations, the study empirically corroborates that critical fluctuations in depressive symptomatology within and across individuals occur during the first 3 months of the pandemic, after which symptom profiles are predominantly consolidated throughout the pandemic period. Contrary to established belief, female sex, young age, lower education and preexisting psychiatric diagnosis only served as adequate predictors of the initial shocks to symptomatology observed during the onset of the pandemic and did not adequately predict subsequent change observed in symptoms within and across individuals. Population-level analyses demonstrated that symptom levels strongly covaried with the presence and strictness of SDPs and were unrelated to COVID-19 incidence rates. Upon predominant termination of SDPs, population-level symptoms began declining, while large heterogeneity was present across the adult population. Detrimental long-term adversities were revealed by 10% of the adults. These individuals displayed chaotic adaptation to the pandemic and its SDPs, exhibiting substantial increases in clinical levels of symptomatology ensuing partial reopening of society and through the remainder of the pandemic, with these deleterious symptoms projected to remain heightened ahead. Frequency of quarantine exposure was incrementally tied with increases in contemporaneously experienced and long-term depressive adversities, with information obtainment through unmonitored sources further associated with contemporaneous and long-term states of heightened symptomatology. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Psychological well-being in times of COVID-19: Associated factors and levels in the general population

The COVID-19 pandemic and living under social distancing restrictions have been hypothesized to impact well-being and mental health in the general population. This study investigated the general Norwegian adult population's well-being after implementing and lifting strict social distancing restrictions. The study was conducted through digital surveys; during the implementation of strict social distancing restrictions in March 2020 (T1) and 3 months later, when the preponderance of strict distancing restrictions was discontinued (T2). Well-being was measured at T2. Four thousand nine hundred twenty-one individuals participated, and a sensitivity analysis was conducted to ensure that the sample reflects the true Norwegian adult population. Hierarchical regression analyses show that contemporaneous employment status and positive metacognitions at T2 were associated with higher well-being. Negative metacognitions and the use of unhelpful coping strategies at T2 had a contemporaneous association with lower mental well-being. Negative metacognitions at T1 were associated with lower well-being scores, while positive metacognitions at T1 were positively associated with higher well-being. An indirect association between social distancing and lower well-being was found through heightened depressive symptoms. These results contribute to understanding how social distancing restrictions relate to general well-being, which may further contribute to designing proper strategies to strengthen mental health and well-being during challenging and unavoidable societal conditions.

Parenting in a Pandemic: Parental stress, anxiety and depression among parents during the government-initiated physical distancing measures following the first wave of COVID-19

Drawing on the tenets of family stress theory, the aim of this study is to examine parents' perceived stress, symptoms of anxiety, depression, and associated risk- and protective factors across demographic subgroups during in the first wave of the COVID-19 pandemic. Norwegian parents (N = 2868; 79.5% mothers) with >1 child under 18 years of age completed an online survey two weeks after the implementation of government-initiated distancing measures. The survey includes measures of COVID-related risk factors (parental stress, burnout, depression, anxiety, anger of parents towards children, difficulty working from home, and positive beliefs about worry) and protective factors (self-efficacy and social support). Mothers, parents living with more than one child, and parents with a psychiatric diagnosis reported greater levels of parental stress, more burnout, and more anger towards their children, as well as less social support. Almost 25% of the parents reported anxiety and depression that are clinically significant. Parents who followed distancing measures reported significantly higher distress. Anger of parents towards children explains 41% of the variation in parental stress. These findings indicate that parents have experienced symptoms of deteriorated mental health due to the COVID- 19 pandemic, including parental stress, anxiety, and depression. The study presents practical implications for meso- and macro-level policymaking and offers support to further the potential aims of public health and clinical interventions. Future studies to monitor long-term aversive mental health outcomes among parents are warranted.

Metacognitive beliefs, maladaptive coping strategies, and depressive symptoms: A two-wave network study of the COVID-19 lockdown and reopening

To address the increased levels of depressive symptoms during the COVID-19 and other pandemics, it is useful to identify the psychological processes that may explain the relationship between pandemic-related stressors and symptoms. In this study, both the combined network of metacognitions and maladaptive coping strategies-derived from the metacognitive therapy model-and the depressive symptoms were studied during the COVID-19 related lockdown and the partial reopening of the Norwegian society about 3 months later. In an online survey, 4936 participants responded at both these time points. They completed the Cognitive Attentional Syndrome-1 and the Patient Health Questionnaire-9. The combined process and symptom networks were estimated. The maladaptive coping strategies worry/rumination, avoidance, and thought suppression and the symptoms depressed mood and worthlessness showed both high strength centrality at the lockdown and, at least, moderate correlations between their change and overall symptom change from the lockdown to the reopening. None of the metacognitive beliefs attained these criteria. From the lockdown to the reopening, no change in strength centrality was observed. The network structure, however, was significantly different across the periods and several different connections (edge weights) between variables were revealed. For instance, low energy showed a stronger connection to anhedonia and a weaker connection to sleep problems during the reopening than during the lockdown. In conclusion, worry/rumination, avoidance, and thought suppression may maintain central depressive symptoms such as depressed mood and worthlessness during the COVID-19 pandemic. These propositions are actionable as they give access to well-established interventions.

Back to life, back to reality: A multi-level dynamic network analysis of student mental health upon return to campus during the COVID-19 pandemic

Lockdown measures during the COVID-19 pandemic resulted in drastic disruptions of university students' everyday life and study mode, such as marked reductions in face-to-face teaching activities. Previous research on student mental health during the pandemic found that prolonged campus relocation had negative effects on students' mental well-being. However, these studies focussed on the initial lockdown period, or periods of active lockdown measures. This longitudinal study collected 456 observations of 23 undergraduate students in the Netherlands using ecological momentary assessment data on mental health related items (anxiety, stress, social context) during the first two weeks of on-campus teaching after prolonged lockdown measures. Using multi-level dynamic network modelling, we analysed the temporal and contemporaneous interplay of students' mental health factors following the return to campus in September 2021. On average, students reported low to medium scores on stress and anxiety both before and after the assessment period. Results of network analyses showed that students experienced social unease in relation to accumulating difficulties at university and vice versa. Furthermore, there were clusters of different states of social unease next to clusters of stress, anger, loss of control, and feeling upset. Lastly, we found beneficial effects of self-efficacy on experiencing social comfort in university. We discuss implications and concrete examples of interventions in universities, such as the promotion of self-efficacy, providing guidance in structuring study load, as well as help with stress management.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-022-03196-7.

Acute COVID-19 severity and mental health morbidity trajectories in patient populations of six nations: an observational study

Background

Methods

Findings

Interpretation

Funding

Mechanisms associated with the trajectory of depressive and anxiety symptoms: A linear mixed-effects model during the COVID-19 Pandemic

With the fluctuations in anxious and depressive symptomatology accompanied by the pandemic crises, studies on the trajectories of these symptom domains are warranted to monitor the development of mental health problems in the population. This pre-registered longitudinal study examines stable factors and mechanistic processes covarying with the trajectory of anxiety and depressive symptoms using linear-mixed effects models in 4936 adults from the pandemic's onset to four months into the COVID-19 pandemic in Norway. Prevalence estimates of moderate to severe levels of clinically impairing symptoms of anxiety and depression revealed high but reduced occurrence four months into the pandemic where social distancing protocols were substantially lightened in severity, revealing associations between symptoms and viral mitigation protocols after stringent control of plausible confounders. Subgroups at risk at the onset of the pandemic sustained their relative position compared to their counterparts four months into the pandemic, indicating prolonged suffering of these subgroups. Among mechanistic processes, key differences were identified regarding the trajectory of anxiety and depressive symptoms. Physical exercise was associated with long-term but not momentaneous alleviations in anxiety. In contrast, reductions in depressive symptoms were associated with both the simultaneous exertion as well as dose-increases in exercise over time. Increased knowledge about how to best cope with pandemic challenges was associated with greater improvement in depressive but not anxiety symptoms. Reductions in maladaptive coping strategies and negative metacognitive beliefs was substantially associated with greater improvement of both anxious and depressive symptomatology. Mechanistic processes divergently relate to the trajectory of depressive and anxious symptomatology, yielding domain-specific information of utility for preventive and interventive efforts aimed at impeding deleterious symptom levels.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s12144-022-02732-9.

Heterogeneity of Prevalence of Social Media Addiction Across Multiple Classification Schemes: Latent Profile Analysis

Background

As social media is a major channel of interpersonal communication in the digital age, social media addiction has emerged as a novel mental health issue that has raised considerable concerns among researchers, health professionals, policy makers, mass media, and the general public.

Objective

The aim of this study is to examine the prevalence of social media addiction derived from 4 major classification schemes (strict monothetic, strict polythetic, monothetic, and polythetic), with latent profiles embedded in the empirical data adopted as the benchmark for comparison. The extent of matching between the classification of each scheme and the actual data pattern was evaluated using sensitivity and specificity analyses. The associations between social media addiction and 2 comorbid mental health conditions—depression and anxiety—were investigated.

Methods

A cross-sectional web-based survey was conducted, and the replicability of findings was assessed in 2 independent samples comprising 573 adults from the United Kingdom (261/573, 45.6% men; mean age 43.62 years, SD 12.24 years) and 474 adults from the United States (224/474, 47.4% men; mean age 44.67 years, SD 12.99 years). The demographic characteristics of both samples were similar to those of their respective populations.

Results

The prevalence estimates of social media addiction varied across the classification schemes, ranging from 1% to 15% for the UK sample and 0% to 11% for the US sample. The latent profile analysis identified 3 latent groups for both samples: low-risk, at-risk, and high-risk. The sensitivity, specificity, and negative predictive values were high (83%-100%) for all classification schemes, except for the relatively lower sensitivity (73%-74%) for the polythetic scheme. However, the polythetic scheme had high positive predictive values (88%-94%), whereas such values were low (2%-43%) for the other 3 classification schemes. The group membership yielded by the polythetic scheme was largely consistent (95%-96%) with that of the benchmark.

Conclusions

Among the classification schemes, the polythetic scheme is more well-balanced across all 4 indices.

Pandemic Information Dissemination and Its Associations With the Symptoms of Mental Distress During the COVID-19 Pandemic: Cross-sectional Study

BACKGROUND

The 2020-2021 COVID-19 pandemic has added to the mental health strain on individuals and groups across the world in a variety of ways. Viral mitigation protocols and viral spread affect people on all continents every day, but at widely different degrees. To understand more about the mental health consequences of the pandemic, it is important to investigate whether or how people gather pandemic-related information and how obtaining this information differentially affects individuals.

OBJECTIVE

This study aimed to investigate whether and to what extent higher levels of COVID-19-related media consumption across information sources are associated with the symptoms of anxiety, health anxiety, and depression, and whether and to what extent using social media and online interactive platforms versus traditional media platforms is associated with the symptoms of anxiety, health anxiety, and depression. Additionally, we aimed to investigate whether and to what extent avoidance of COVID-19-related information is associated with the aforementioned symptoms.

METHODS

In a cross-sectional preregistered survey, 4936 participants responded between June 22 and July 13, 2020. Eligible participants were adults currently residing in Norway and were thus subjected to identical viral mitigation protocols. This sample was representative of the Norwegian population after utilizing an iterative raking algorithm to conduct poststratification. As 2 subgroups (transgender and intersex individuals) were too small to be analyzed, the final sample for descriptive statistics and regressions included 4921 participants. Multiple regressions were used to investigate associations between the symptoms of psychopathology and COVID-19-related information dissemination. Part correlations were calculated as measures of the effect size for each predictor variable. Due to the large anticipated sample size, the preregistered criterion for significance was set at P<.01.

RESULTS

The symptoms of anxiety and health anxiety were significantly associated with obtaining information from newspapers (P<.001), social media (P<.001), and the broader categories of online interactive (P<.001) and traditional media (P<.001). The symptoms of depression were significantly associated with obtaining information from newspapers (P=.003), social media (P=.009), and the broader category of online interactive media (P<.001). Additionally, avoidance of COVID-19-related information showed a significant association in all 3 domains of psychopathological symptoms (anxiety and depression, P<.001; health anxiety, P=.007).

CONCLUSIONS

This study found significant associations between the symptoms of psychopathology and the use of media for obtaining information related to the COVID-19 pandemic. Significant findings for obtaining information through newspapers, social media, and online interactive media were seen across all 3 measures of psychopathology. Avoidance of COVID-19-related information and associations with the symptoms of psychopathology emerged as core findings, with generally higher effect sizes compared with information attainment.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04442360; https://clinicaltrials.gov/ct2/show/NCT04442360.

Within- and across-day patterns of interplay between depressive symptoms and related psychopathological processes: a dynamic network approach during the COVID-19 pandemic

BACKGROUND

In order to understand the intricate patterns of interplay connected to the formation and maintenance of depressive symptomatology, repeated measures investigations focusing on within-person relationships between psychopathological mechanisms and depressive components are required.

METHODS

This large-scale preregistered intensive longitudinal study conducted 68,240 observations of 1706 individuals in the general adult population across a 40-day period during the COVID-19 pandemic to identify the detrimental processes involved in depressive states. Daily responses were modeled using multi-level dynamic network analysis to investigate the temporal associations across days, in addition to contemporaneous relationships between depressive components within a daily window.

RESULTS

Among the investigated psychopathological mechanisms, helplessness predicted the strongest across-day influence on depressive symptoms, while emotion regulation difficulties displayed more proximal interactions with symptomatology. Helplessness was further involved in the amplification of other theorized psychopathological mechanisms including rumination, the latter of which to a greater extent was susceptible toward being influenced rather than temporally influencing other components of depressive states. Distinctive symptoms of depression behaved differently, with depressed mood and anhedonia most prone to being impacted, while lethargy and worthlessness were more strongly associated with outgoing activity in the network.

CONCLUSIONS

The main mechanism predicting the amplifications of detrimental symptomatology was helplessness. Lethargy and worthlessness revealed greater within-person carry-over effects across days, providing preliminary indications that these symptoms may be more strongly associated with pushing individuals toward prolonged depressive state experiences. The psychopathological processes of rumination, helplessness, and emotion regulation only exhibited interactions with the depressed mood and worthlessness component of depression, being unrelated to lethargy and anhedonia. The findings have implications for the impediment of depressive symptomatology during and beyond the pandemic period. They further outline the gaps in the literature concerning the identification of psychopathological processes intertwined with lethargy and anhedonia on the within-person level.

The network of stress-related states and depression and anxiety symptoms during the COVID-19 lockdown

BACKGROUND

The coronavirus (COVID-19) pandemic and the social distancing protocols used to impede the spread of the virus may have severe mental health consequences. The purpose of this study was to investigate the network of components of pandemic-related negative psychological states (i.e., fear of infection, financial worries, loneliness) and symptoms of major depressive disorder (MDD) and generalized anxiety disorder (GAD).

METHODS

Data from 10,061 Norwegian adults recruited through an online survey during a period of strict social distancing protocols were analyzed by cross-sectional network methods.

RESULTS

Of the infection fears, fear of being infected, fear of dying from the coronavirus and fear of significant others dying from it had notable connections to the GAD symptoms anxiety and/or fear of awful events. The financial worry component worry about personal economy was connected to the MDD symptom sleep problems and to the GAD symptom generalized worry. Each of the loneliness components was connected to a specific MDD symptom. Depressed mood, low energy and worthlessness had the highest strength centrality among the MDD symptoms; generalized worry, uncontrollability of worry, and trouble relaxing among the GAD symptoms; fear of dying from the virus among the fear of infection components; and feeling isolated among the loneliness components.

LIMITATIONS

Full random sampling was not conducted, although the sample turned out to be relatively representative of the Norwegian population.

CONCLUSIONS

Some components of the pandemic-related distressing states of fear of infection, financial worry and loneliness seem to be associated with specific symptoms of MDD and GAD.

Loneliness during the COVID-19 pandemic: change and predictors of change from strict to discontinued social distancing protocols

BACKGROUND AND OBJECTIVES

The COVID-19 pandemic and the social distancing protocols designed to impede transmission of the corona virus have severe mental health consequences. This study examine changes in loneliness in the general adult population when the corona-related social distancing protocols were largely discontinued (T2) following a period of strict protocols (T1), predictors and correlates of these changes, and the associations between loneliness and depression and anxiety symptoms.

DESIGN

In an online survey, 10,061 responded at T1. At T2, these respondents were asked to complete the survey again, and 4936 (49.1%) of them responded.

RESULTS

Loneliness decreased from T1 to T2, but only to a minor extent. Using a multilevel approach, younger age was found to be related to more reduction of loneliness from T1 to T2. Higher health anxiety was found to predict less reduction of loneliness across time. Reduction of maladaptive coping strategies and negative metacognitive beliefs from T1 to T2 were both associated with reduction in loneliness. In turn, reductions in loneliness were associated with reductions of depression and anxiety symptoms.

CONCLUSIONS

The results suggest that health anxiety, maladaptive coping strategies and negative meta-beliefs are potential targets of intervention to alleviate loneliness.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT04444115.

Feelings of worthlessness links depressive symptoms and parental stress: A network analysis during the COVID-19 pandemic

BACKGROUND

The prevalent co-occurrence between parental stress and depression has been established prior to and during the COVID-19 pandemic outbreak. However, no studies to date have identified the connections through which these symptom domains interact with each other to emerge into a complex and detrimental mental health state, along with the plausible mechanistic variables that may play key roles in maintaining parental stress and depression. The aim of this research is to uncover these interactions in a period where parents experience heightened demands and stress because of the strict social distancing protocols.

METHODS

Network analysis is utilized to examine parental stress and depressive symptoms during the COVID-19 pandemic in a large cross-sectional study (N = 2,868) of parents. Two graphical Gaussian graphical network models were estimated, one in which only parental stress and depression symptoms were included, and another in which several mechanistic variables were added.

RESULTS

Expected influence and bridge expected influence revealed that feeling worthless was the most influential node in the symptoms network and bridged the two psychological states. Among the mechanistic variables, worry and rumination was specifically relevant in the depressive cluster of symptoms, and self-criticism was connected to both constructs.

CONCLUSION

The study displays that the co-occurrence of parental stress and depression has specific pathways, was manifested through feelings of worthlessness, and has specific patterns of connection to important mechanisms of psychopathology. The results are of utility when aiming to avoid the constellation of co-occurring parental stress and depressive symptoms during the pandemic.

Risk, Trust, and Flawed Assumptions: Vaccine Hesitancy During the COVID-19 Pandemic

Background: The pace at which the present pandemic and future public health crises involving viral infections are eradicated heavily depends on the availability and routine implementation of vaccines. This process is further affected by a willingness to vaccinate, embedded in the phenomenon of vaccine hesitancy. The World Health Organization has listed vaccine hesitancy among the greatest threats to global health, calling for research to identify the factors associated with this phenomenon. Methods: The present cross-sectional study seeks to investigate the psychological, contextual, and sociodemographic factors associated with vaccination hesitancy in a large sample of the adult population. 4,571 Norwegian adults were recruited through an online survey between January 23 to February 2, 2021. Subgroup analyzes and multiple logistic regression was utilized to identify the covariates of vaccine hesitancy. Results: Several subgroups hesitant toward vaccination were identified, including males, rural residents, and parents with children below 18 years of age. No differences were found between natives and non-natives, across education or age groups. Individuals preferring unmonitored media platforms (e.g., information from peers, social media, online forums, and blogs) more frequently reported hesitance toward vaccination than those relying on information obtainment from source-verified platforms. Perceived risk of vaccination, belief in the superiority of natural immunity, fear concerning significant others being infected by the virus, and trust in health officials' dissemination of vaccine-related information were identified as key variables related to vaccine hesitancy. Conclusion: Given the heterogeneous range of variables associated with vaccine hesitancy, additional strategies to eradicate vaccination fears are called for aside from campaigns targeting the spread of false information. Responding to affective reactions in addition to involving other community leaders besides government and health officials present promising approaches that may aid in combating vaccination hesitation.

Insomnia Symptoms in the General Population During the COVID-19 Pandemic

This empirical study aims to investigate factors associated with insomnia symptoms during the COVID-19 pandemic in 4,921 Norwegian adults. Participants were queried across two time-points, between March 31^st and April the 7th 2020, and between June 22nd and July 13th, 2020. Relevant risk factors and psychological correlates at the first time-point and insomnia symptoms were measured 3 months later, allowing for the investigation of concurrent associations as well as associations across time. Insomnia symptoms were measured with the Bergen Insomnia Scale. The results revealed that individuals reported higher mean levels of insomnia symptoms during the COVID-19 lockdown, compared to pre-pandemic surveys from 2008 (p < 0.0001, Cohen's d = 0.29). Individuals who predominantly socially distanced reported higher mean levels of insomnia symptoms than those who did not predominantly distance. Females, individuals with lower education levels, individuals who had lost their job, and individuals who declared having been diagnosed with an unspecified pre-existing psychiatric disorder reported the most symptoms. The regression model (R² = 0.44) showed that physical exercise, was associated with less symptoms of insomnia. Symptoms of health Anxiety, symptoms of depression, unhelpful coping strategies, worry about job and economy, and older age were all associated with higher levels of insomnia symptoms. These findings highlight particularly vulnerable subgroups, as well as providing clinicians with key areas of intervention to help individuals suffering from insomnia symptoms.

Adjustment to a "New Normal:" Coping Flexibility and Mental Health Issues During the COVID-19 Pandemic

The Coronavirus Disease 2019 (COVID-19) pandemic is an unprecedented health crisis in terms of the scope of its impact on well-being. The sudden need to navigate this "new normal" has compromised the mental health of many people. Coping flexibility, defined as the astute deployment of coping strategies to meet specific situational demands, is proposed as an adaptive quality during this period of upheaval. The present study investigated the associations between coping flexibility and two common mental health problems: COVID-19 anxiety and depression. The respondents were 481 Hong Kong adults (41% men; mean age = 45.09) who took part in a population-based telephone survey conducted from April to May 2020. Self-report data were assessed with the Coping Flexibility Interview Schedule, COVID-19-Related Perception and Anxiety Scale, and Center for Epidemiological Studies Depression Scale. Slightly more than half (52%) of the sample met the criteria for probable depression. Four types of COVID-19 anxiety were identified: anxiety over personal health, others' reactions, societal health, and economic problems. The results consistently revealed coping flexibility to be inversely associated with depression and all four types of COVID-19 anxiety. More importantly, there was a significant interaction between perceived likelihood of COVID-19 infection and coping flexibility on COVID-19 anxiety over personal health. These findings shed light on the beneficial role of coping flexibility in adjusting to the "new normal" amid the COVID-19 pandemic.

Maladaptive coping with the infodemic and sleep disturbance in the COVID-19 pandemic

COVID-19 is caused by a novel virus with an unknown aetiology. People across the globe are dealing with not only a health crisis but also an 'infodemic', a term coined by the World Health Organization to refer to the avalanche of contradictory information that is arousing widespread confusion and anxiety. This study aimed to examine the prevalence of anxiety and sleep disturbance at the early stage of the pandemic, and unveil the information coping process underlying differential susceptibility to COVID-19 infection anxiety and sleep disturbance. The participants were 1,270 adults (47% men, M_age  = 42.82) from the UK and US who completed initial (Time 1) and follow-up (Time 2) surveys from 16 to 22 March and 18 to 24 May 2020, respectively. The prevalence of probable clinically relevant anxiety was 61% and 45% at the first and second time points, and more than half of the participants in this anxiety group also reported mild to severe sleep disturbance. Moreover, 41% of the participants perceived themselves as not having enough COVID-19-related information and reported higher levels of COVID-19 infection anxiety and sleep disturbance over time than those who perceived themselves as having enough of such information. Moderated mediation analysis identified two groups who were more vulnerable to both psychological problems: high blunters who sought COVID-19-related information online more frequently and high monitors who sought such information offline less frequently. These findings highlight the importance of a good match between information coping style and strategy deployment in dealing with an infodemic surrounding a novel disease.

Loneliness and Social Distancing During the COVID-19 Pandemic: Risk Factors and Associations With Psychopathology

Background: The mitigation strategies employed against the COVID-19 pandemic have severe mental health consequences. In particular, as a result of the social distancing protocols, loneliness is likely to increase. This study investigates (a) potential risk and resilience factors for loneliness in the Norwegian population during the strict social distancing non-pharmacological interventions (NPIs) implemented against the pandemic and (b) the associations between loneliness and psychopathology symptoms. Methods: A survey was disseminated online to the adult Norwegian population when strict social distancing measures had been implemented for 2 weeks. The resulting sample of 10,061 respondents was unproportionate in terms of gender and educational level and thus sensitivity analyses were conducted. The levels of loneliness were compared across demographic sub-groups, and regression analyses were conducted to identify potential risk and resilience factors for loneliness and associations between loneliness and psychopathology symptoms. Results: Among the stable factors, being single and having a psychiatric diagnosis were related to more loneliness with small effect sizes. Among the state risk factors, more rumination and worry in general were associated with stronger loneliness, showing a medium effect size. Among the coping behaviors examined, doing new things at home not done otherwise was negatively related to loneliness, with a small effect size. Loneliness was associated with both depression and anxiety with small effect sizes when all potential confounders and psychiatric diagnosis were controlled for. The relationship to depression was more marked than the relationship to anxiety. Conclusions: The findings suggest that singles and those with a psychiatric diagnosis were most affected by loneliness during the implementation of social distancing measures to impede the coronavirus. The results support the link between loneliness and depression and anxiety symptoms. The results of the analysis of potential risk and resilience factors point to intervention targets for reducing loneliness during pandemic crises.

PTSD symptoms among health workers and public service providers during the COVID-19 outbreak

In the frontline of the pandemic stand healthcare workers and public service providers, occupations which have proven to be associated with increased mental health problems during pandemic crises. This cross-sectional, survey-based study collected data from 1773 healthcare workers and public service providers throughout Norway between March 31, 2020 and April 7, 2020, which encompasses a timeframe where all non-pharmacological interventions (NPIs) were held constant. Post-traumatic stress disorder (PTSD), anxiety and depression were assessed by the Norwegian version of the PTSD checklist (PCL-5), General Anxiety Disorder -7, and Patient Health Questionnaire-9 (PHQ-9), respectively. Health anxiety and specific predictors were assessed with specific items. Multiple regression analysis was used for predictor analysis. A total of 28.9% of the sample had clinical or subclinical symptoms of PTSD, and 21.2% and 20.5% were above the established cut-offs for anxiety and depression. Those working directly in contrast to indirectly with COVID-19 patients had significantly higher PTSD symptoms. Worries about job and economy, negative metacognitions, burnout, health anxiety and emotional support were significantly associated with PTSD symptoms, after controlling for demographic variables and psychological symptoms. Health workers and public service providers are experiencing high levels of PTSD symptoms, anxiety and depression during the COVID-19 pandemic. Health workers working directly with COVID-19 patients have significantly higher levels of PTSD symptoms and depression compared to those working indirectly. Appropriate action to monitor and reduce PTSD, anxiety, and depression among these groups of individuals working in the frontline of pandemic with crucial societal roles should be taken immediately.

Psychological Interventions for the Fear of Public Speaking: A Meta-Analysis

Background: Fear of Public Speaking (FoPS) or public speaking anxiety is a type of social anxiety and the single most commonly feared situation in the population. FoPS is disabling with negative occupational, academic, and social consequences, reported by up to one third of the population. FoPS in adolescence and adulthood is associated with an increased risk of developing generalized social anxiety disorder with further impairments. Since the last review on FoPS, a significant number of randomized controlled trials (RCTs) have been conducted assessing the effects of novel interventions with innovative modes of delivery.

Objectives: The objectives of the present meta-analysis are to (1) examine the short and long-term effects of psychological interventions aimed at FoPS on FoPS and generalized social anxiety; (2) assess whether differences exist between technology-assisted modes of delivery (e.g., Internet-delivered therapies) and more traditional modes of delivering treatment (e.g., face-to-face therapies); (3) investigate whether differences in effect exist between theoretical frameworks; (4) inspect the differences in effect size between self-report measures and other measures (i.e., physiological and behavioral); (5) examine the effects of psychological interventions aimed at FoPS on secondary outcome measures (e.g., depression); and (6) investigate whether a “sleeper effect” is present for psychological interventions for FoPS and generalized social anxiety.

Methods: The study investigates the effects of psychological interventions for FoPS through a quantitative meta-analysis of RCTs, using a random-effects model.

Results: A total of 30 RCTs with 1,355 participants were included through systematic searches of PsycINFO, MEDLINE, Web of Science, and Cochrane Library. The majority of the studies investigated the effects of cognitive or behavioral interventions. Nearly half of the studies used active control groups (e.g., attention placebo), whereas the other half used passive (e.g., waitlist) controls. The overall effect of psychological interventions for FoPS across 62 interventions was 0.74 (Hedges g; 95% CI: 0.61–0.87) with low to moderate heterogeneity. No difference in effect was found across theoretical frameworks. The effects based on self-report measures were larger compared to physiological and behavioral outcomes. Effects were robust against both active and passive control groups. Furthermore, psychological interventions for FoPS had a small to moderate effect on generalized social anxiety disorder (g = 0.35; 95% CI: 0.22–0.48). The effect of psychological interventions aimed at FoPS at follow-up was large (g = 1.11, 95% CI: 0.90–1.31) and moderate to large for generalized social anxiety (g = 0.70, 95% CI: 0.59–0.80). A sleeper effect was found for cognitive and behavioral interventions, indicating that patients continued to improve after treatment termination. There were some indications of publication bias.

Conclusions: Psychological interventions are effective in reducing FoPS. Interventions using technology-assisted modes of delivery are equally effective as traditional face-to-face interventions in reducing FoPS. This finding highlights an opportunity to increase access to evidence-based treatments through technology-delivered interventions, which can be implemented at schools, in primary care and specialist mental health care. Moreover, psychological interventions aimed at FoPS have an effect on generalized social anxiety. Further implications are discussed.