Depression and social isolation during the COVID-19 pandemic in a student population: the effects of establishing and relaxing social restrictions

Introduction

In a quasi-naturalistic study design, we evaluate the change in psychopathological syndromes and general well-being after the alleviation of social restrictions. The aim of this study was to investigate the specific relationship between social isolation and depressive syndromes.

Methods

At two timepoints, the first during maximal social restrictions, the second after social restrictions had widely ended for 9 months, depressive and other syndromes were measured in an online survey addressing the total cohort of students registered at Heidelberg University, Germany via e-mail (n = 27,162). The complete Patient Health Questionnaire (PHQ) was used with nine items for depressive syndromes. In addition, well-being was measured by the Well-Being Index WHO-5. In the quantitative and qualitative part of the study psychopathological syndromes and well-being were related to social isolation and feelings of loneliness.

Results

After 1.5 years of pandemic-related social restrictions, "major" depressive syndromes were reported by 40.16% of the respondents to the PHQ in a sample of 2,318 university students. 72.52% showed a severely reduced Well-Being-Index. Nine months after the end of social restrictions, "major" depressive syndromes were reported by 28.50% of the participants. Well-being improved after the alleviation of social restrictions, as well: 53.96% showed a Well-Being Index of below 50 vs. 72.52% in the first study. The quantitative and qualitative analysis of the free texts of the respondents suggest that a significant amount of depressive syndromes and reduced well-being are related to social isolation and loneliness. While in the times of the pandemic restrictions the participants mostly reported "loneliness and social isolation" (24.2%) as their main problem, only 7.7% described these as their main problem after social restrictions had been loosened for 9 months. The qualitative analysis hints that at t2 participants were more likely to mention possible ways to actively deal with loneliness than at t1, which might be interpreted along the lines of the decrease in depressive syndromes.

Discussion

Keeping the self-selection bias in mind our study results suggest that one third of "major" depressive syndromes and one quarter of severely reduced well-being accompany social restrictions or are even caused by them, with loneliness being an important factor. These results should be taken into account by health policies when coping with future pandemics.

Creativity and positive psychology in psychotherapy

Creativity is the ability to produce something novel and useful that is a valuable contribution to a specific domain. It is a significant common factor in most forms of psychotherapy. Accordingly, it is essential to investigate its role both in psychotherapy in general and in specific approaches like relational, cognitive-behavioural, psychodynamic, systemic, and existential psychotherapy. Positive psychology in particular has pointed up the usefulness of creativity in psychotherapy. Here we draw upon a case example to show how the creative discovery of novel and useful solutions takes place in different dimensions: relational, behavioural, psychodynamic, systemic and existential. The case description demonstrates how principles of positive psychology are useful in many realms of psychotherapy. We propose an integrated model of psychotherapy that brings together different psychotherapeutic methods and is based on interdisciplinary creativity research. The integration of neuroscientific, psychological and cultural findings produced by creativity research can be expected to lead to a deeper understanding of psychotherapeutic, positive-psychological, and creative processes.

[Changes in Sense of Coherence, Mental Distress and Satisfaction with Life and Studies in the Course of Psychosocial Counselling]

"Sense of coherence" (SOC) plays an essential role in the maintenance or recovery of health, according to the salutogenetic approach of Aaron Antonovsky. Empirical studies provide evidence of significant links between sense of coherence and different indicators of mental health. In the present study, the effectivity of an integrative counselling concept for the promotion of sense of coherence, reduction of mental distress and improvement of satisfaction with life was tested in a sample of 153 clients and patients. Correlations of SOC with mental distress and satisfaction with life and studies indicate a strong association. After psychosocial counselling according to the integrative ABCDE-model, significant pre-/post- changes with moderate to high effect sizes could be achieved. These findings bring important implications for the modifiability of the sense of coherence and provide evidence that the integrative ABCDE-model of psychosocial counseling might be effective. Correlations between ratings of the dimensions of the model and pre-/post changes are discussed.

Bipolar Disorder and/or Creative Bipolarity: Robert Schumann's Exemplary Psychopathology - Combining Symptomatological and Psychosocial Perspectives with Creativity Research

The psychopathological condition of Robert Schumann has been a prominent object of study in psychiatry since his hospitalization in 1854. Renowned psychiatrists have diagnosed Schumann with syphilis, schizophrenia, and bipolar and personality disorders. Until today, these analyses of his symptomatology have led to contradictory results. Recent discussion has suggested that his hospitalization was due to professional failure and separation wishes on the part of his wife, her family, and her friends. In line with this hypothesis is the opinion that the separation insisted upon by Clara Schumann was reinforced by the economic interests of the psychiatrist who kept Schumann in custody for 2 years until his death in 1856. In this article, we trace the complex interaction of bipolar vulnerability and pathogenic life events with hypersensitive talent and "creative bipolarity," defined as the capacity, motivation, and resilience to transform emotional stress and cognitive inconsistency into coherent artistic products. Finally, we present our conclusions about comprehensive psychiatric and psychotherapeutic treatment with respect to "creative bipolarity."

Psychoanalysis as a creative shaping process

The author first explains the concepts of creativity, play and aesthetic experience. He then outlines the psychoanalytic process as a creative one that shapes reality. Making a link between psychoanalysis and the humanities, he demonstrates that creative play is a fundamental aspect of the human experience of reality. Aesthetic experiences during the psychoanalytic process are comparable to the play by which children structure their world and artists' activity in following their urge to shape. Furthermore it is shown that creative actualisation testifies to a quasi-biological need for coherence and structure. Through modern hermeneutics, the truth claims of aesthetic shaping can be established in epistemological terms. The basic principles of hermeneutics--historicity, linguisticity and communicative experience--find their psychoanalytic counterparts in memory, representational shaping and transference-countertransference. Psychoanalysis is demonstrated to be simultaneously a science and an art. On the basis of a case history, aesthetic experience is shown to constitute a specific and unique form of access to psychic reality. Aesthetic experience and creativity do not only aid recovery from 'bad psychological states', they are also indispensable for the entire understanding of internal and external reality. It is possible to develop this understanding through a creative psychoanalytic attitude.