The association between the sense of control and depression during the COVID-19 pandemic: a systematic review and meta-analysis

Introduction

High levels of depression and low sense of control have been reported during the COVID-19 pandemic. The removal of typical freedoms through public health restrictions may have played an important role. The aim of this review was to examine data collected during the pandemic and (1) estimate the strength of the association between sense of control and depression, (2) examine whether the different types of control measures affected the strength of the association, and (3) whether this changed as a function of pandemic indicators.

Methods

We conducted a systematic review and meta-analysis of studies published in English between December 2019 and November 2022. A total of 993 articles were identified, of which 20 were included in the review and 16 in the meta-analysis after conducting a quality assessment using the standard NIH tool.

Results

The control-depression association gave a bias-independent pooled effect size of r = .41, and grew stronger over the 130 weeks covered by this review but did not change as a function of local COVID incidence rates. Subgroup analyses showed that external and overall control were more strongly related to depression than internal control.

Discussion

These findings emphasize that external factors are important to the sense of control and the importance of preserving the sense of control in situations where the removal of personal freedoms is necessary, such as public health emergencies.

Depression symptoms and the perception of public health restrictions during the COVID-19 pandemic in Saudi Arabia: The protective effect of sense of control

The psychological impact of public health restrictions may play a role in the increased depression levels reported since the COVID-19 pandemic began. Data further suggest that people’s sense of personal control has been reduced during the pandemic also producing psychological distress. This study aimed to test whether perceptions of public health restrictions predict depression under pandemic conditions and if the sense of control can serve as a protective factor. For this cross-sectional study, 641 residents in Saudi Arabia over the age of 17 years were recruited between November and December of 2020 to complete an online survey. The survey assessed depression levels (Beck Depression Inventory, BDI), the sense of control and perceptions of public health restrictions. Demographic information was also collected. Depression levels were higher compared to previous samples (d = 0.12). The number of restrictions perceived as distressing strongly predicted the probability of high BDI scores, β=0.92, with higher sense of control predicting lower levels of depression (constraints, β=-0.50, mastery, β=-0.71). A strong sense of control significantly reduced the impact of the perception of restrictions on depression. These results suggest that the perception of public health restrictions is part of the reason for increased levels of depression during the pandemic. A strong sense control reduced the impact of restrictions on depression. It is therefore possible that simple interventions enhancing the sense of control, such as the availability of choice, could support mental health in restricted situations.

Experiences of people with multiple sclerosis participating in a social cognitive behavior change physical activity intervention

BACKGROUND

Understanding the experiences of people with MS taking part in physical activity interventions is critical to inform future interventions.

AIM

The aim was to gain insight into the experiences of people with MS taking part in a behavior change group physical activity intervention with a novel social cognitive theory component.

METHODS

A qualitative semi-structured interview format was utilized. Questions focussed on expectations, views and beliefs at being involved in the study, beliefs on physical activity, and subjective evaluation of the trial content and delivery. Seventeen people were interviewed and data were analyzed using thematic analysis.

RESULTS

Three themes were generated: psychological and social factors, intervention processes, and MS identity. The acceptance of MS as an identity acted as an initial barrier to exercise, with a more positive, exercise-enabling identity post-intervention. Psychological factors such as self-efficacy and anxiety, as well as social factors such as social support, were found to play an important role in how participants experienced the program. Similarly, intervention processes included support for group-based activities and structure of exercise classes, and were also inter-linked to the other themes.

CONCLUSION

It appears that group-based exercise interventions are acceptable and feasible for people with MS. The qualitative findings support previously reported quantitative findings that the Step it Up intervention is effective at promoting physical activity and improving psychological outcomes.

When and How Video Games Can Be Good: A Review of the Positive Effects of Video Games on Well-Being

Video games are a source of entertainment for a wide population and have varied effects on well-being. The purpose of this article is to comprehensively examine game-play research to identify the factors that contribute to these disparate well-being outcomes and to highlight the potential positive effects. On the basis of existing literature, we argue that the effects of gaming on well-being are moderated by other variables, such as motivations for gaming and video-game characteristics. Specifically, the inclusion of social activity can benefit prosocial behaviors and affect the relationship between violent video games and aggression that some studies have demonstrated. Moreover, the research on the relationship between violent video games and aggression depends greatly on individual and sociocontextual variables outside of game play. The inclusion of physical activity in games can provide an improvement in physical health with high levels of enjoyment, potentially increasing adherence rates. Overall, following our review, we determined that the effects of gaming on well-being are moderated by and depend on the motivation for gaming, outside variables, the presence of violence, social interaction, and physical activity. Thus, we argue that there is potential for an "optimal gaming profile" that can be used in the future for both academic- and industry-related research.

The impact of community-based mental health service provision on stigma and attitudes towards professional help-seeking

BACKGROUND

Stigma of mental ill-health and attitudes towards help-seeking are recognized barriers to seeking professional help, and have previously been linked to the type of support services available.

AIMS

This study examined if the introduction of community-based mental health services to an area impacts mental health stigma and attitudes towards professional help-seeking amongst local residents.

METHOD

A repeated cross-sectional study comprising of community surveys in two localities was carried out before and after community-based mental health services were introduced (N = 1074). Measures including perceived public and self-stigma of mental ill-health, and attitudes towards seeking professional help were compared across the two time points.

RESULTS

Both public and self-stigma were significantly lower, and attitudes towards seeking professional help significantly more positive, after community-based mental health services had been introduced in each locality.

CONCLUSIONS

The presence of local, accessible mental health services can positively impact help-seeking behaviour by reducing stigma and changing norms and attitudes around professional help-seeking.

Identification Reduces Stigma of Mental Ill-Health: A Community-Based Study

The stigma surrounding mental ill-health is an important issue that affects likelihood of diagnosis and uptake of services, as those affected may work to avoid exposure, judgment, or any perceived loss in status associated with their mental ill-health. In this study, we drew upon social identity theory to examine how social group membership might influence the stigma surrounding mental ill-health. Participants from two urban centers in Ireland (N = 626) completed a survey measuring stigma of mental health, perceived social support as well as identification with two different social groups (community and religion). Mediation analysis showed that subjective identification with religious and community groups led to greater perceived social support and consequently lower perceived stigma of mental ill-health. Furthermore, findings indicated that high identification with more than one social group can lead to enhanced social resources, and that identification with a religious group was associated with greater community identification. This study thus extends the evidence base of group identification by demonstrating its relationship with stigma of mental ill-health, while also reinforcing how multiple identities can interact to enhance social resources crucial for well-being.

The Perception of Threat from Emotions in Predicting Binge Eating Behaviours in People Who Are Obese and Seeking Treatment for Their Weight

OBJECTIVE

The affect regulation theory suggests that people binge eat to regulate negative emotional states. In this study, we used a basic emotions perspective to consider the role of perceived threat of emotions, emotional suppression and reduced emotional expressiveness in predicting binge eating behaviours in people who are obese.

METHOD

Treatment-seeking participants with obesity (N = 51, body mass index range from 30.8 to 60.2 kg m^-2 ) completed measures of 'perception of threat from emotion' as well as 'emotional expressiveness' and binge eating.

RESULTS

The results demonstrated that perceived threat of sadness predicted binge eating (β = .55, p < .05). Additionally, a mediation analysis revealed that reduced emotional expressiveness mediated the relationship between perceived threat of fear and binge eating (β = .25, 95%).

DISCUSSION

These findings are contextualized within a theoretical perspective that suggests that individuals who binge eat are threatened by certain emotional states and they use binge eating to suppress certain, but not all, emotional states. Copyright © 2015 John Wiley & Sons, Ltd.

KEY PRACTITIONER MESSAGE

Considering basic emotions within binge eating should be a part of a psychological assessment and treatment. This should consider how emotions could often be perceived as being threatening and their expression is limited. It is possible that the emotions of fear and sadness appear to be particularly threatening within binge eating/obese populations.

The effects of cognitive load during intertrial intervals on judgements of control: The role of working memory and contextual learning

When there is no contingency between actions and outcomes, but outcomes occur frequently, people tend to judge that they have control over those outcomes, a phenomenon known as the outcome density (OD) effect. Recent studies show that the OD effect depends on the duration of the temporal interval between action-outcome conjunctions, with longer intervals inducing stronger effects. However, under some circumstances OD effect is reduced, for example when participants are mildly depressed. We reasoned that working memory (WM) plays an important role in learning of context; with reduced WM capacity to process contextual information during intertrial intervals (ITIs) during contingency learning might lead to reduced OD effects (limited capacity hypothesis). To test this, we used a novel dual-task procedure that increases the WM load during the ITIs of an operant (e.g., action-outcome) contingency learning task to impact contextual learning. We tested our hypotheses in groups of students with zero (Experiments 1, N=34), and positive contingencies (Experiment 2, N=34). The findings indicated that WM load during the ITIs reduced the OD effects compared to no load conditions (Experiment 1 and 2). In Experiment 2, we observed reduced OD effects on action judgements under high load in zero and positive contingencies. However, the participants' judgements were still sensitive to the difference between zero and positive contingencies. We discuss the implications of our findings for the effects of depression and context in contingency learning.

Enhanced attention to context: An intervention that increases perceived control in mild depression

People perceive that they have control over events to the extent that the same events do not occur outside of their control, randomly, in the environment or context. Therefore, perceived control should be enhanced if there is a large contrast between one's own control and the control that the context itself seems to exert over events. Given that depression is associated with low perceived control, we tested the hypothesis that enhanced attentional focus to context will increase perceived control in people with and without depression. A total of 106 non-depressed and mildly depressed participants completed a no control zero-contingency task with low and high outcome probability conditions. In the experimental context-focus group, participants were instructed to attend to the context, whereas in the control group, participants were instructed to attend to their thoughts. Irrespective of attentional focus, non-depressed participants displayed illusory control. However, people with mild depression responded strongly to the attention focus manipulation. In the control group, they evidenced low perceived control with classic depressive realism effects. In the experimental group, when asked to focus on the context in which events took place, participants with mild depression displayed enhanced perceived control or illusory control, similar to non-depressed participants. Findings are discussed in relation to whether depression effects on perceived control represent tendencies towards realism or attentional aspects of depressive thoughts.

The relationship between mood state and perceived control in contingency learning: effects of individualist and collectivist values

Perceived control in contingency learning is linked to psychological wellbeing with low levels of perceived control thought to be a cause or consequence of depression and high levels of control considered to be the hallmark of mental healthiness. However, it is not clear whether this is a universal phenomenon or whether the value that people ascribe to control influences these relationships. Here we hypothesize that values affect learning about control contingencies and influence the relationship between perceived control and symptoms of mood disorders. We tested these hypotheses with European university samples who were categorized as endorsing (or not) values relevant to control-individualist and collectivist values. Three online experimental contingency learning studies (N 1 = 127, N 2 = 324, N 3 = 272) were carried out. Evidence suggested that individualist values influenced basic learning processes via an effect on learning about the context in which events took place. Participants who endorsed individualist values made control judgments that were more in line with an elemental associative learning model, whilst those who were ambivalent about individualist values made judgments that were more consistent with a configural process. High levels of perceived control and individualist values were directly associated with increased euphoric symptoms of bipolar disorder, and such values completely mediated the relation between perceived control and symptoms. The effect of low perceived control on depression was moderated by collectivist values. Anxiety created by dissonance between values and task may be a catalyst for developing mood symptoms. Conclusions are that values play a significant intermediary role in the relation between perceived control and symptoms of mood disturbance.

Understanding help-seeking amongst university students: the role of group identity, stigma, and exposure to suicide and help-seeking

Background: Despite a high prevalence of suicide ideation and mental health issues amongst university students, the stigma of help-seeking remains a barrier to those who are in real need of professional support. Social identity theory states that help received from an ingroup source is more welcome and less threatening to one's identity than that from a source perceived as outgroup. Therefore, we hypothesized that students' stigma toward seeking help from their university mental health service would differ based on the strength of their identification with the university.

Method: An online survey including measures of stigma of suicide, group identification, experience with help-seeking and exposure to suicide was administered to Irish university students (N = 493).

Results: Group identification was a significant predictor of help-seeking attitudes after controlling for already known predictors. Contrary to our expectations, those who identified more strongly with their university demonstrated a higher stigma of seeking help from their university mental health service.

Conclusions: Results are discussed in relation to self-categorization theory and the concept of normative fit. Practical implications for mental health service provision in universities are also addressed, specifically the need for a range of different mental health services both on and off-campus.

Two pathways to causal control: use and availability of information in the environment in people with and without signs of depression

Perceiving one's causal control is important for adaptive behavior. Studying depression and other individual differences has provided insight into typical as well as pathological causal processing. We set out to study factors that have been shown to distinguish those with and without signs of depression and affect perceptions of causal control: levels of behavior, the availability of outcomes and learning about the environment or context. Two experiments were carried out in which participants, scoring low and high on the Beck Depression Inventory using established cutoffs, completed a causal control task, in which outcomes occurred with a low (.25) or high probability (.75). Behavior levels were either constrained (N1=73) or unconstrained (N2=74). Overall, findings showed that levels of behavior influenced people's experiences of the context in which events occurred. For all participants, very high behavior levels eliminated sensitivity to levels of outcomes occurring in the environment and lead to judgments that were consistent with conditional probabilities as opposed to the experimenter programmed contingency. Thus increased behavior increased perceived control via influence on context experience. This effect was also evident for those scoring high on the BDI. Overall conclusions are that behavior and context provide two important interlinked psychological pathways to perceived control. However, situations that constrain people's ability to respond freely can prevent people with signs of depression from taking control of a situation that would otherwise be uncontrollable.

Time perception and depressive realism: judgment type, psychophysical functions and bias

The effect of mild depression on time estimation and production was investigated. Participants made both magnitude estimation and magnitude production judgments for five time intervals (specified in seconds) from 3 sec to 65 sec. The parameters of the best fitting psychophysical function (power law exponent, intercept, and threshold) were determined individually for each participant in every condition. There were no significant effects of mood (high BDI, low BDI) or judgment (estimation, production) on the mean exponent, n = .98, 95% confidence interval (.96-1.04) or on the threshold. However, the intercept showed a 'depressive realism' effect, where high BDI participants had a smaller deviation from accuracy and a smaller difference between estimation and judgment than low BDI participants. Accuracy bias was assessed using three measures of accuracy: difference, defined as psychological time minus physical time, ratio, defined as psychological time divided by physical time, and a new logarithmic accuracy measure defined as ln (ratio). The ln (ratio) measure was shown to have approximately normal residuals when subjected to a mixed ANOVA with mood as a between groups explanatory factor and judgment and time category as repeated measures explanatory factors. The residuals of the other two accuracy measures flagrantly violated normality. The mixed ANOVAs of accuracy also showed a strong depressive realism effect, just like the intercepts of the psychophysical functions. There was also a strong negative correlation between estimation and production judgments. Taken together these findings support a clock model of time estimation, combined with additional cognitive mechanisms to account for the depressive realism effect. The findings also suggest strong methodological recommendations.

Context and time in causal learning: contingency and mood dependent effects

Defining cues for instrumental causality are the temporal, spatial and contingency relationships between actions and their effects. In this study, we carried out a series of causal learning experiments that systematically manipulated time and context in positive and negative contingency conditions. In addition, we tested participants categorized as non-dysphoric and mildly dysphoric because depressed mood has been shown to affect the processing of all these causal cues. Findings showed that causal judgements made by non-dysphoric participants were contextualized at baseline and were affected by the temporal spacing of actions and effects only with generative, but not preventative, contingency relationships. Participants categorized as dysphoric made less contextualized causal ratings at baseline but were more sensitive than others to temporal manipulations across the contingencies. These effects were consistent with depression affecting causal learning through the effects of slowed time experience on accrued exposure to the context in which causal events took place. Taken together, these findings are consistent with associative approaches to causal judgement.

Dysphoric Mood States are Related to Sensitivity to Temporal Changes in Contingency

A controversial finding in the field of causal learning is that mood contributes to the accuracy of perceptions of uncorrelated relationships. When asked to report the degree of control between an action and its outcome, people with dysphoria or depression are claimed to be more realistic in reporting non-contingency (e.g., Alloy and Abramson, 1979). The strongest evidence for this depressive realism (DR) effect is derived from data collected with experimental procedures in which the dependent variables are verbal or written ratings of contingency or cause, and, perhaps more importantly, the independent variable in these procedures may be ambiguous and difficult to define. In order to address these possible confounds, we used a two-response free-operant causal learning task in which the dependent measures were performance based. Participants were required to respond to maximize the occurrence of a temporally contiguous outcome that was programmed with different probabilities, which also varied temporally across two responses. Dysphoric participants were more sensitive to the changing outcome contingencies than controls even though they responded at a similar rate. During probe trials, in which the outcome was masked, their performance recovered more quickly than that of the control group. These data provide unexpected support for the DR hypothesis suggesting that dysphoria is associated with heightened sensitivity to temporal shifts in contingency.

The effect of mild depression on time discrimination

Depressed mood states affect subjective perceptions of time but it is not clear whether this is due to changes in the underlying timing mechanisms, such as the speed of the internal clock. In order to study depression effects on time perception, two experiments using time discrimination methods with short (<300 ms) and long (>1,000 ms) durations were conducted. Student participants who were categorized as mildly depressed by their scores on the Beck Depression Inventory were less able than controls to discriminate between two longer durations but were equally able to discriminate shorter intervals. The results suggest that mildly depressed or dysphoric moods do not affect pacemaker speed. It is more likely that depression affects the ability to maintain attention to elapsing duration.

Parent perspectives of clinical psychology access when experiencing distress

Around 20 to 30% of parents experience mental health difficulties within their child's first year, but only a small proportion go on to access specialist services. This is despite growing evidence around the positive benefits of psychosocial interventions for both parents and children. Previous research highlights facilitators and barriers to generic healthcare services for mothers with postnatal depression. The current study adopted a qualitative methodology to explore parents' own perceptions of the barriers and facilitators to clinical psychology specifically. Seven women took part in the study, most of whom had no previous involvement with specialist mental health services. A thematic analysis of interview data suggested six key themes in relation to the research question: 'The importance of connecting', 'Pressing the danger button', 'I'm not mad', 'More round care', 'Psychological distress as barrier' and 'Making space, making sense'. These are presented alongside a consideration of the clinical implications for community-based practitioners, including clinical psychologists.

Vicarious exposure to trauma and growth in therapists: the moderating effects of sense of coherence, organizational support, and empathy

Therapists who work with traumatized individuals can experience psychological growth following this vicarious exposure to trauma. The purpose of the present study is to examine the variables that may moderate such vicarious posttraumatic growth. Therapists (N = 118) completed measures of vicarious exposure to trauma and growth, as well as empathy, sense of coherence, and perceived organizational support. Results showed that having a strong sense of coherence negatively predicted growth (β = -.28, p = .001), whereas empathy was a positive predictor (β = .37, p < .001). Empathy also moderated the exposure to growth relationship when growth involved relating to others (β = -.20; p = .018). Organizational support did not predict growth. The results have implications for the recruitment, training, and supervision of therapists working with individuals who have experienced trauma.

Reasoning in people with obsessive-compulsive disorder

OBJECTIVES

The aim of this study was to investigate the inductive and deductive reasoning abilities of people with obsessive-compulsive disorder (OCD). Following previous research, it was predicted that people with OCD would show different abilities on inductive reasoning tasks but similar abilities to controls on deductive reasoning tasks.

DESIGN

A two-group comparison was used with both groups matched on a range of demographic variables. Where appropriate, unmatched variables were entered into the analyses as covariates.

METHODS

Twenty-three people with OCD and 25 control participants were assessed on two tasks: an inductive reasoning task (the 20-questions task) and a deductive reasoning task (a syllogistic reasoning task with a content-neutral and content-emotional manipulation).

RESULTS

While no group differences emerged on several of the parameters of the inductive reasoning task, the OCD group did differ on one, and arguably the most important, parameter by asking fewer correct direct-hypothesis questions. The syllogistic reasoning task results were analysed using both correct response and conclusion acceptance data. While no main effects of group were evident, significant interactions indicated important differences in the way the OCD group reasoned with content neutral and emotional syllogisms.

CONCLUSIONS

It was argued that the OCD group's patterns of response on both tasks were characterized by the need for more information, states of uncertainty, and doubt and postponement of a final decision.

Short article: Impaired context maintenance in mild to moderately depressed students

We test the hypothesis that people with depression experience difficulties in maintaining task-relevant context information over longer periods of time using the AX version of the continuous performance task (AX-CPT). The AX-CPT requires that participants maintain a context cue (A) in an active state in order to respond correctly to a target cue (X) presented after a short delay. A total of 40 nondepressed and mild to moderately depressed students completed versions of the task with short (1-s) or long (10-s) interstimulus intervals (ISIs). Mildly depressed participants made significantly more context-dependent (BX) errors, unlike controls who made more errors on trials where good context processing would impair performance (AY). This pattern of errors was only evident in the long ISI condition, suggesting poor maintenance of contextual information.

Depressive realism and the effect of intertrial interval on judgements of zero, positive, and negative contingencies

In three experiments we tested how the spacing of trials during acquisition of zero, positive, and negative response-outcome contingencies differentially affected depressed and nondepressed students' judgements. Experiment 1 found that nondepressed participants' judgements of zero contingencies increased with longer intertrial intervals (ITIs) but not simply longer procedure durations. Depressed groups' judgements were not sensitive to either manipulation, producing an effect known as depressive realism only with long ITIs. Experiments 2 and 3 tested predictions of Cheng's (1997) Power PC theory and the Rescorla-Wagner (1972) model, that the increase in context exposure experienced during the ITI might influence judgements most with negative contingencies and least with positive contingencies. Results suggested that depressed people were less sensitive to differences in contingency and contextual exposure. We propose that a context-processing difference between depressed and nondepressed people removes any objective notion of "realism" that was originally employed to explain the depressive realism effect (Alloy & Abramson, 1979).

Depressive realism and outcome density bias in contingency judgments: the effect of the context and intertrial interval

The perception of the effectiveness of instrumental actions is influenced by depressed mood. Depressive realism (DR) is the claim that depressed people are particularly accurate in evaluating instrumentality. In two experiments, the authors tested the DR hypothesis using an action-outcome contingency judgment task. DR effects were a function of intertrial interval length and outcome density, suggesting that depressed mood is accompanied by reduced contextual processing rather than increased judgment accuracy. The DR effect was observed only when participants were exposed to extended periods in which no actions or outcomes occurred. This implies that DR may result from an impairment in contextual processing rather than accurate but negative expectations. Therefore, DR is consistent with a cognitive distortion view of depression.