Gratitude as Mood Mediates the Effects of a 6-Weeks Gratitude Intervention on Mental Well-Being: Post hoc Analysis of a Randomized Controlled Trial

There is a gap of knowledge about the extent to which gratitude is indeed the working mechanism of change in gratitude interventions aiming to promote mental well-being. This study explores the mediational role of gratitude as mood in the context of a recently conducted randomized controlled trial on the effects of a 6-week gratitude intervention on mental well-being in comparison with a waitlist control group. Gratitude as mood was measured at 2, 4, and 6 weeks. Both simple and multiple mediation models were conducted as well as various sensitivity analyses. Results showed a gradual increase of gratitude as mood during the intervention. The effects of the 6-week gratitude intervention on mental well-being were mediated by increases of gratitude as mood at 4 weeks but not at 2 weeks. These findings suggest a dose-response relationship for gratitude interventions, but more research is warranted.

Positive health during the COVID-19 pandemic: a survey among community-dwelling older individuals in the Netherlands

Background Coronavirus Disease 2019 (COVID-19) reached the Netherlands in February 2020. To minimize the spread of the virus, the Dutch government announced an “intelligent lockdown”. Older individuals were urged to socially isolate completely, because they are at risk of a severe disease course. Although isolation reduces the medical impact of the virus, the non-medical impact should also be considered. Aim To investigate the impact of COVID-19 pandemic and associated restrictive measures on the six dimensions of Positive Health in community-dwelling older individuals living in the Netherlands, and to identify differences within subgroups. Methods In May/June 2020, community-dwelling older individuals aged ≥ 65 years completed an online survey based on Huber’s model of Positive Health. Positive Health was measured regarding the appreciation of the six dimensions (categorized as poor/satisfactory/excellent) and a comparison with a year before (categorized as decreased/unchanged/increased) using frequencies (%) and a chi-square test. Results 834 older individuals participated (51% women, 38% aged ≥ 76 years, 35% living alone, 16% self-rated poor health). Most respondents assessed their bodily functions, mental well-being and daily functioning as satisfactory, their meaningfulness and quality of life (QoL) as excellent, and their social participation as poor. 12% of the respondents reported a deterioration of 4–6 dimensions and 73% in 1–3 dimensions, compared to the past year. Deterioration was most frequently experienced in the dimension social participation (73%), the dimension mental well-being was most frequently improved (37%) and quality of life was in 71% rated as unchanged. Women more often observed a deterioration of 4–6 dimensions than men (15% vs. 8%, p = 0.001), and individuals with self-rated poor health more often than individuals with self-rated good health (22% vs. 10%, p < 0.001). Older individuals living alone experienced more frequently a decrease in meaningfulness compared to older individuals living together. Conclusion The COVID-19 pandemic and associated restrictive measures had a substantial impact on all six dimensions of Positive Health in community-dwelling older individuals, especially in women, respondents living alone and respondents with self-rated poor general health.

Planning for mental wellbeing in an old age home during the Covid-19 pandemic by homoeopathic institution: Structuring the intervention

Objectives: During the on-going COVID-19 pandemic, the risk to the mental well-being of the elderly living in an old age home (OAH) has increased considerably. Dealing with this issue requires special measures. The current literature has very few examples of such programmes. We aimed to promote emotional balance and an independent living with positive outlook on life among the residents of the OAH facility during the pandemic based on action learning principles. This programme was conducted in an OAH that our institute has been associated with for several years. HelpAge India, a non-governmental organisation working in India to assist disadvantaged senior citizens, provided a programme that covered 12 themes. This article deals with the structuring process of the programme. Materials and Methods: The team comprised homoeopathic consultants and the faculty and students of a postgraduate homoeopathic institute. An extensive literature search and consultation with experts from various fields enabled the team to plan and build the final programme were evolved. Results: Broad themes gave rise to distinct modules and objectives were derived for each of these. Detailed action plans were worked out and a plan of evaluation for each of these modules was worked out. Conclusion: Planning a programme to ensure well-being needs a close and accurate identification of the needs of the residents of a particular OAH. A multidisciplinary approach can help in evolving effective strategies to formulate models for geriatric mental well-being.

Measuring What Counts in Life: The Development and Initial Validation of the Fulfilled Life Scale (FLS)

In a recent work, we introduced a theoretical model for fulfillment in life that covers cognitive and affective components and distinguishes different time frames. The present study evaluates this model and describes the construction of the Fulfilled Life Scale (FLS) to assess fulfillment regarding the whole lived life retrospectively. We investigated the scale in two samples (Sample 1: N = 282 adults aged 50–93 years; Sample 2: N = 406 adults aged 40–85 years). The model of the cognitive component combines three sources of fulfillment (self, life, impact/legacy) with three criteria (wholeness, fit, value), yielding nine facets. Employing hierarchical factor analysis, we inspected all solutions between one and nine. We identified three optimal factors, which we labeled unfolded self and life, the worthwhile life, and positive impact and legacy. Next, we selected marker items and replicated the factor structure in Sample 2. The three scales were positively intercorrelated and showed good internal consistency in both samples. For the affective component, exploratory and confirmatory factor analyses established a one-factor structure in both samples, and high internal consistency was obtained. Across a range of related constructs, we demonstrated construct and criterion validity. Notably, cognitive and affective fulfillment incrementally predicted a global rating of a fulfilled life and mental well-being, even after controlling for subjective and eudaimonic well-being. Overall, the study proves that the FLS is necessary to capture people’s experience of a fulfilled life, which could not be assessed sufficiently with previous well-being measures. Both cognitive and affective fulfillment were able to predict additional variance in mental well-being. Moreover, the study reveals psychometric support for the FLS and presents the first evidence on its validity. Lastly, applications in research and practice are discussed, especially in the context of living and aging well in the second half of life.

Global Adversities, the Media, and Mental Health

Global communities are currently confronted with a number of complex problems and threats, the reality of which is amplified by the media. These environmental and socio-political stressors have been accompanied by the spread of problematic psychological and behavioural tendencies, such as the growing polarisation of opinions and values, online radicalisation and extremism, deepening xenophobia and nationalism, the proliferation of irrational beliefs and conspiracy theories, and resistance to rational public policy measures. Here we argue that although they fall outside the scope of psychopathology, they nevertheless currently constitute a major challenge for psychiatry as a research domain and a clinical practise. To substantiate this claim, we outline the mechanisms by which media-transmitted stressors impact mental well-being and possibly psychopathology. The common denominator of these global problems and the media's construction of reality is the increase in uncertainty, unpredictability, and uncontrollability, which prompts defensive responding and, in predisposed individuals, functions as a potent source of chronic stress. These contribute to cognitive inflexibility, a strong predisposing factor for the development of rigid beliefs and attitudes, which to varying degrees underlie the adverse psychological and behavioural tendencies mentioned above. We suggest that the tightening of beliefs and ideas that is the result of cognitive rigidity may correspond to the clinical characteristics of induced delusional disorder. This can be seen as a (ultimately maladaptive) defensive strategy for coping with a high degree of uncertainty and unpredictability. We conclude by briefly outlining the possible ways in which psychiatry can face this challenge.

Parents’ economic migration and the psychological well-being of their Polish children

Aim: The aim of the study was to analyze mental well-being, especially anxiety and a sense of loneliness of Polish children temporarily separated from their parent or parents who are migrating for economic reasons, and children who went abroad with their parents. Methods: Explicit Anxiety Scale was used to measure anxiety “Jaki Jesteś?” (“What are you like?” by Skrzypek and Choynowski) (textbook by Zwierzyńska, Matuszewski, 2007) and the Polish versions of the UCLA Loneliness Scale were used to measure loneliness (by Russell, Peplau, & Cutrona, adapted by Rembowski, 1992). Test results were supplemented with an interview with children. 320 children from different types of migrant families participated in the study. Results: the highest level of anxiety is felt by children temporarily separated from their mother, and children who, together with their parents, went abroad and find it difficult to adapt to the new environment. The duration of emigration was an important factor. Most children in the sample ‒ regardless of the type of migratory family ‒ feel lonely, do not feel strong ties with close relatives, do not feel understood by them, do not feel associated with a peer group. Conclusion: The results of the research indicate the necessity to take actions in the area of institutional and legal as well as psychological support for families and children both in the situation of going abroad and returning from migration. The most important directions of activities concerning the creation of environmental forms of separation compensation and the environmental assistance system for the migration family are indicated at the stage of prevention related to people planning trips.

Exploring the health impacts and inequalities of the new way of working: findings from a cross-sectional study.

Aim To explore the working Welsh adult population's ability to work from home, their preferences for the future, and the self-reported health impacts of home-working. Subject and Method: A nationally-representative household survey was undertaken across Wales (Public Health Wales' COVID-19, Employment and Health in Wales study), with cross-sectional data on home-working being collected between November 2020 and January 2021 from 615 employed working-aged adults in Wales (63.7% female, 32.7% aged 50-59). Respondents were asked about their ability to work from home, their perceptions of its impact on their health and their preferences for time spent home-working in future. Results Over 50% were able to work from home, and showed a preference towards home-working to some capacity, with over a third wishing to work from home at least half the time. However, those living in the most deprived areas, in atypical employment, with high wage precarity or with limiting pre-existing conditions were less likely to report being able to work from home. Of those that could work from home, over 40% reported that it worsened their mental well-being and loneliness, and for people in poorer health, home-working negatively impacted their diet, physical activity, smoking and alcohol use. People aged 30 to 39 and those who lived alone were more likely to report wanting to spend some time working in an office/base instead of at home. Conclusion The inequity in the ability to work from home reflects underlying inequalities in Wales, with those facing the greatest insecurity (e.g. those living in most deprived areas, those with more precarious work or financial circumstances) being less able to participate in home-working. Working from home offers greater flexibility, reduces the financial and time costs associated with commuting, and protects individuals from exposure to communicable diseases. However, working from home presents an enormous challenge to preserving the mental-wellbeing of the workforce, particularly for younger individuals and those with low mental well-being. Younger respondents and those in poorer health who could work from home were also more likely to engage in health-harming behaviours, and reduce their engagement in health-protective behaviours such as eating well and moving more. Reflecting on the future, providing pathways for accessing work from home arrangements, integrating hybrid models and preparing targeted health support for at risk groups may be best suited to the working population's preferences and needs.

The impact of a demand-side sanitation and hygiene promotion intervention on sustained behavior change and health in Amhara, Ethiopia: A cluster-randomized trial

Behaviors related to water, sanitation, and hygiene (WASH) are key drivers of infectious disease transmission, and experiences of WASH are potential influencers of mental well-being. Important knowledge gaps exist related to the content and delivery of effective WASH programs and their associated health impacts, particularly within the contexts of government programs implemented at scale. We developed and tested a demand-side intervention called Andilaye, which aimed to change behaviors related to sanitation, personal hygiene, and household environmental sanitation. This theory-informed intervention was delivered through the existing Ethiopian Health Extension Programme (HEP). It was a multilevel intervention with a catalyzing event at the community level and behavior change activities at group and household levels. We randomly selected and assigned 50 kebeles (sub-districts) from three woredas (districts), half to receive the Andilaye intervention, and half the standard of care sanitation and hygiene programming (i.e., community-led total sanitation and hygiene [CLTSH]). We collected data on WASH access, behavioral outcomes, and mental well-being. A total of 1,589 households were enrolled into the study at baseline; 1,472 households (94%) participated in an endline assessment two years after baseline, and approximately 14 months after the initiation of a multi-level intervention. The intervention did not improve construction of latrines (prevalence ratio [PR]: 0.99; 95% CI: 0.82, 1.21) or handwashing stations with water (PR: 0.96; 95% CI: 0.72, 1.26), or the removal of animal feces from the compound (PR: 1.10; 95% CI: 0.95, 1.28). Nor did it impact anxiety (PR: 0.90; 95% CI: 0.72, 1.11), depression (PR: 0.83; 95% CI: 0.64, 1.07), emotional distress (PR: 0.86; 95% CI: 0.67, 1.09) or well-being (PR: 0.90; 95% CI: 0.74, 1.10) scores. We report limited impact of the intervention, as delivered, on changes in behavior and mental well-being. The effectiveness of the intervention was limited by poor intervention fidelity. While sanitation and hygiene improvements have been documented in Ethiopia, behavioral slippage, or regression to unimproved practices, in communities previously declared open defecation free is widespread. Evidence from this trial may help address knowledge gaps related to challenges associated with scalable alternatives to CLTSH and inform sanitation and hygiene programming and policy in Ethiopia and beyond. Trial registration: This trial was registered with clinicaltrials.gov (NCT03075436) on March 9, 2017.