Psychological Distress in Healthcare Workers between the First and Second COVID-19 Waves: The Role of Personality Traits, Attachment Style, and Metacognitive Functioning as Protective and Vulnerability Factors

The COVID-19 pandemic has impacted the mental health of healthcare workers (HCWs) since its outbreak, but little attention has been paid to person-level vulnerability and protective factors. This study aims to determine the prevalence of both general and pandemic-related psychological distress among HCWs between the first and second COVID-19 waves in Italy and analyze associations between psychological distress and personality traits, attachment style, and metacognitive functioning. Between June and October 2020, 235 Italian HCWs completed questionnaires concerning psychological stress, personality traits, attachment style, and metacognitive functioning; 26.5% of respondents presented with moderate to extremely severe levels of general psychological distress and 13.8% with moderate to extremely severe levels of pandemic-related psychological distress. After controlling for demographic and occupational variables, significant associations emerged among high emotional stability as a personality trait and both general (aOR: 0.58, 95% CI: 0.41–0.79) and pandemic-related psychological stress (aOR: 0.62, 95% CI: 0.41–0.90). Additionally, higher scores regarding one’s ability to understand others’ emotional states were associated with lower odds of developing psychological distress (aOR: 0.78, 95% CI: 0.63–0.93). Lastly, when comparing those with fearful attachment styles to those with secure attachments, the aOR for psychological distress was 4.73 (95% CI: 1.45–17.04). These results highlight the importance of conducting baseline assessments of HCWs’ person-level factors and providing regular screenings of psychological distress.

Predictive Factors of Mental Health in Survivors of Intimate Partner Violence in Chile

Studies about violence against women specific to the Chilean population are scarce. As a result, government treatment programs lack a local perspective. Predictor variables were analyzed in the mental health of Chilean women who have survived intimate partner abuse. Two hundred and two women who made regular visits to public Women’s Centers participated in the study; on average, they had survived 11 years of abuse. Logistic regression analyses were conducted to determine what variable/s in the history of violence best predicted the mental health variables. Among other protective factors, an increase in both resilience and the time since the last violent episode yielded a reduction in levels of general psychological distress ( B = –1.836, p < .001 and B = 1.117, p < .001 respectively), post-traumatic stress disorder ( B = –1.243, p = .002 and B = 1.221, p < .001 respectively), and depression ( B = –1.822, p < .001 and B = 1.433, p < .001 respectively). The study also noted risk factors such as a high level of additional stressors, which in turn led to increased levels of general psychological distress ( B = 1.007, p = .005), post-traumatic stress disorder ( B = 0.928, p = .013), and depression ( B = 1.061, p = .016). The Women’s Center is the place where women feel most supported. To improve the effectiveness of treatments at these centers and aid in the recovery of women who have suffered from intimate partner violence, the predictive factors significantly related to mental health should be taken into account. This means prioritizing cases where the last episode of violence was more recent, addressing additional stressors, and promoting resilience.

Emerging Adults’ Mental Health During the COVID-19 Pandemic: A Prospective Longitudinal Study on the Importance of Social Support

The aim of this longitudinal study was to investigate emerging adults’ mental health before and during the COVID-19 pandemic, and whether social support from mothers, fathers, and best friends moderated the change in mental health. Participants were 98 emerging adults (46% men) who were assessed prior to COVID-19 ( Mage = 20.60 years) and during the first lockdown ( Mage = 22.67 years). Results indicated that the pandemic did not uniformly lead to elevated levels of mental health problems, but instead depended on level of mental health problems prior to COVID-19 and the source of support. For emerging adults who already experienced more problems prior to COVID-19, more maternal support was related to decreases in general psychological distress and depressive symptoms, whereas more paternal support was related to increases in general psychological distress and depressive symptoms. Support from best friends were not associated with (changes in) mental health.

Psychometric examination of the Russian version of the Depression, Anxiety, and Stress scales-21

The Depression, Anxiety, and Stress Scales-21 (DASS-21) is one of the most common instruments for assessing psychological distress [2]. The aim of this study was to examine the psychometric properties of the Russian DASS-21. The participants were 1,153 Russian-speaking adults aged 18 to 84 years. In addition to the Russian DASS-21, the participants completed the Symptom Check List-90-Revised (SCL-90-R) and Short Form Health Survey (SF-36). A series of confirmatory factor analyses showed the bifactor structure of the Russian DASS-21, full invariance by gender and partial invariance by age. The Russian DASS-21 scores were negatively correlated with the SF-36 scores and positively associated with the SCL-90-R scores, suggesting the convergent validity. The Cronbach’s alpha coefficients were 0.90, 0.85 and 0.91 for the depression, anxiety, and stress subscales, and 0.95 for the general psychological distress score, indicating the internal reliability. Thus, the Russian DASS-21 is a valid and reliable instrument and can be used for screening and monitoring psychological distress in Russian-speaking respondents.

Occupational Stress, Psychological Distress, Physical Symptoms, and their Interrelationships among Frontline Nurses Treating Patients with COVID-19

Background: The COVID-19 pandemic has presented mental health challenges to healthcare workers. Because of the urgency of the situation, this study was done to determine the amount of COVID-19-related occupational stress, psychosomatic symptoms, psychological distress, and their correlations among frontline nurses during and after the peak of the outbreak in Japan. Methods: Sixteen frontline nurses, aged 25-52 years, working in a ward with COVID-19 patients participated. Two months after the peak of the first wave of the COVID-19 outbreak in Japan, the COVID-19-related occupational stress scale (COS, questionnaire items: fear of infection, increased workload) and physical symptom scale (PS, questionnaire items: gastrointestinal symptoms, pain, appetite loss, insomnia) were assessed. The degree of general psychological distress was evaluated using the 6-item Kessler Scale (K6). At the same time, the participants were asked to recall their condition during the peak period of the first wave and to rate it using the same scale. Results: The COS, PS, and K6 scores during the peak period were all significantly higher than those two months after the peak. There were positive correlations between K6 and COS scores and between K6 and PS scores during the peak period (rs=.574, P=.020 and rs=.587, P=.017, respectively). However, these correlations were not significant two months after the peak. The correlation analysis including COS and K6 or PS showed that increased workload was positively correlated with K6 and PS scores during the peak period (rs=.869, P<.001; rs=.519, P=.040, respectively). In the post-peak period, a positive correlation was found only between increased workload and K6 score (rs=.686, P=.005). Insomnia was positively correlated with the K6 score both in the peak and post-peak periods (rs=.656, P=.006 and rs=.565, P=. 028). Conclusions: Among these Japanese nurses working in COVID-19 wards, COVID-19-related occupational stress, psychological distress, and physical symptoms were all decreased after the peak period compared with the peak period. During the peak period, associations were found between COVID-19-related occupational stress and psychological distress and between psychological distress and physical symptoms. Increased workload and insomnia were associated with psychological distress in both the peak and post-peak periods, and increased workload was associated with physical symptoms during the peak period.

Structural Validity of the Hospital Anxiety and Depression Scale Among Family Members of Critically Ill Patients

Background The Hospital Anxiety and Depression Scale (HADS) is commonly used clinically and scientifically among surrogate decision makers for critically ill patients. The validity of the HADS has been scrutinized, but its use among surrogate decision makers has not been examined. Objective To examine the structural validity of the HADS. Methods This study was a secondary analysis of data obtained from a 3-arm randomized controlled trial of a decision support intervention. Participants were recruited from 6 intensive care units at a tertiary medical center in Northeast Ohio. Participants were adult surrogate decision makers for critically ill, cognitively impaired adults who were not expected to be discharged from the intensive care unit within the subsequent 48 hours. The fit of 2-factor, 3-factor, and bifactor structures of the HADS was tested with confirmatory factor analysis. Results The bifactor structure, possessing a general psychological distress factor and anxiety and depression group factors, showed a superior fit and met a priori thresholds for acceptable model fit. The general psychological distress factor accounted for more than 75% of the common variance in the HADS items. Conclusion Confirmatory factor analysis provided evidence supporting a bifactor structure of the HADS. In this sample, the instrument validly measures psychological distress rather than distinct symptoms of anxiety and depression. Replication of these results is encouraged, and use of alternative measures is recommended when measuring distinct symptoms of anxiety and depression among surrogate decision makers for critically ill patients.

Feasibility of Present-Centered Therapy for Prolonged Grief Disorder: Results of a Pilot Study

Present-centered therapy (PCT) was originally developed as a strong comparator for the non-specific effects of psychotherapy in the treatment of posttraumatic stress disorder. PCT qualifies as a not strictly supportive treatment as it is structured and homework is assigned between sessions. It does not focus on cognitive restructuring or exposure. A growing body of literature supports its beneficial effects. For example, it demonstrated only slightly inferior effect sizes and lower dropout rates compared to that of trauma-focused cognitive behavioral therapy in several trials with patients suffering from posttraumatic stress disorder. The current study is the first to evaluate the feasibility and the treatment effects of PCT in adults with prolonged grief disorder (PGD). Meta-analyses on psychotherapy for PGD have yielded moderate effect sizes. N = 20 individuals suffering from PGD were treated with PCT by novice therapists as part of a preparation phase for an upcoming RCT in an outpatient setting. Treatment consisted of 20–24 sessions á 50 min. All outcomes were assessed before treatment, at post-treatment, and at the 3-month follow-up. The primary outcome, PGD symptom severity, was assessed using the Interview for Prolonged Grief-13. Secondary outcomes were self-reported PGD severity, depression, general psychological distress, and somatic symptom severity. Furthermore, therapists evaluated their experiences with their first PCT patient and the treatment manual. In intent-to-treat analyses of all patients we found a significant decrease in interview-based PGD symptom severity at post-treatment (d = 1.26). Decreases were maintained up to the 3-month follow-up assessment (d = 1.25). There were also significant decreases in self-reported PGD symptoms, depression, and general psychological distress. No changes were observed for somatic symptoms. The completion rate was 85%. Therapists deemed PCT to be a learnable treatment program that can be adapted to the patient's individual needs. The preliminary results of PCT as a treatment for PGD demonstrate large effects and indicate good feasibility in outpatient settings. The treatment effects were larger than those reported in meta-analyses. Thus, PCT is a promising treatment for PGD. Possible future research directions are discussed.

Excessive smartphone use symptoms associated with psychological distress as consequence of early phase COVID-19 restrictions

Coronavirus disease (COVID-19) has been associated to various mental health problems and its consequences such as lock-down and social distancing were linked to various adaptations forms including increased smartphone usage. The purpose of the present study was to determine the prevalence of symptoms related to smartphone excessive use and to detect smartphone addiction symptoms related to general psychological distress. Participants were (N=260) surveyed during the first two weeks of lockdown measure. Online measures were introduced including sociodemographic background, Smartphone Addiction Scale Short Version (SAS-SV), and the Brief Symptoms Inventory (BSI). Among 260 Moroccan adults, the prevalence of excessive smartphone use was 48.4% (women: 59.6% / men: 40.4%). Withdrawal, preoccupation, simultaneous presence of withdrawal and tolerance, with or without preoccupation, were significantly more observed among female users (p=.019, p=.042, p=.023 and p=.003; respectively). Comparing excessive smartphone users to non-excessive users, GSI and all BSI dimensions, showed higher significant difference in mean scores (r ranging from .15 to .31). SAS-SV total score was positively correlated with general distress (rho=.19, p<.05), depression (rho=.27, p<.01), and paranoid ideation (rho=.20, p<.05) in excessive smartphone users. Smartphone excessive use appears strongly associated with general distress, regardless of the circumstances. The results of this work provide sufficient evidence for the implementation of psychological interventions in general population during possible lock down measures or potential quarantine for potential next pandemic waves.

Psychometric Evaluation of the Swedish Version of the Prolonged Grief Disorder-13 (PG-13) in a Bereaved Mixed Trauma Sample

Background: This study aimed to examine the psychometric properties of the Swedish PG-13 in a bereaved trauma exposed sample. A second aim was to examine the latent structure of prolonged grief using the PG-13.Methods: The participants were adults (n = 123) taking part in an ongoing longitudinal study regarding the effects of potentially traumatic events. Participants had experienced a potentially traumatic event in the past 5 years and had reported a death of a significant other either as their primary traumatic event or in addition to another traumatic event. Assessment included self-report of prolonged grief, posttraumatic stress, and general psychological distress. Clinical interviews were used to assess depression, posttraumatic stress disorder, and disability level. The psychometric properties of the Swedish PG-13 were examined through reliability tests and assessment of associations with symptoms of posttraumatic stress, depression, general psychological distress, and disability level. Principal component analysis (PCA) and confirmatory factor analyses (CFA) were used to assess the latent structure.Results: The internal consistency (Cronbach's α = 0.86) and test-retest (r = 0.86) reliability were good. PCA suggested a three-factor model as descriptive of the latent structure of the instrument. Therefore, the CFA used this model, as well as two models suggested in the literature. The three-factor model had the best fit to data. Support of concurrent validity of PG-13 was shown by moderate positive associations with measures of posttraumatic stress, depression, and general psychological distress.Conclusions: The Swedish PG-13 demonstrated good psychometric properties, and its use in research and practice to assess prolonged grief was supported. The factor analyses provided stronger support for models with two or three factors, as compared with a unidimensional model of prolonged grief, with the three-factor model having the best fit.