Appraisal and coping predict health and well-being during the COVID-19 pandemic: An international approach

Exploring coping strategies among caregivers of children who have survived paediatric cancer in Jordan

OBJECTIVE

To explore the coping strategies of caregivers of children who have survived paediatric cancer in Jordan.

MATERIALS AND METHODS

This study used a cross-sectional survey design and convenient sampling. The sample included 102 caregivers of children who have survived cancer, and outcome measures included the Arabic-translated Brief COPE, and caregiver and child demographic and condition questionnaire. Data analyses included descriptive statistics, analysis of frequencies, Spearman-rank order correlations and linear regression.

RESULTS

Caregivers most frequently used religion coping (mean=6.42, SD=1.85), followed by acceptance (mean=5.95, SD=1.96) and planning (mean=5.05, SD=1.94). The least used coping strategies were humour (mean=2.98, SD=1.24) and behavioural disengagement as coping strategies (mean=3.01, SD=1.42). Having a female child predicted more self-distraction utilisation (β=0.265, p=0.007).

CONCLUSION

Caregivers of children who have survived cancer in Jordan frequently use passive coping strategies like religion and acceptance coping to overcome daily life stressors. Caregivers might benefit from psychosocial occupational therapy interventions to support their engagement in more active or problem-focused coping strategies.

Fear of COVID-19 and PTSD: The Protective Function of Problem-Solving Appraisals in Mental Health

The COVID-19 pandemic was experienced by many people as a major traumatic event, and it contributed to high levels of fear, anxiety, and PTSD. Negative cognitive appraisals have been consistently implicated in the onset and maintenance of psychological distress, but there is far less research on the protective role of adaptive appraisals in mental health outcomes. The current study aimed to address this gap by investigating the role of problem-solving appraisals in the relationship between fear of COVID-19 and PTSD. Participants were students (n = 322) who completed the Fear of COVID-19 Scale, the Problem-Solving Inventory, the PTSD Checklist for DSM-5, and the five-item short version of the trait scale of the State-Trait Anxiety Inventory. Participants had a mean age of 26 years (±10.2; range 17-63). The results revealed that problem-solving appraisal mediated the effects of fear of COVID-19 on all the dimensions of PTSD. However, moderated mediation analysis demonstrated that the mediation effect was moderated by anxiety. In this regard, the indirect effects of fear of COVID-19 on PTSD were only significant for respondents with low anxiety levels. Our findings suggest that intervention efforts need to focus on identifying and actively targeting maladaptive appraisals of the problem-solving ability as well as addressing anxiety-related symptoms that may impede coping.

Patient experiences with SARS-CoV-2: Associations between patient experience of disease and coping profiles

INTRODUCTION

Severe acute respiratory syndrome coronavirus 2, (SARS-CoV-2,) caused an influx of patients with acute disease characterized by a variety of symptoms termed COVID-19 disease, with some patients going on to develop post-acute COVID-19 syndrome. Individual factors like sex or coping styles are associated with a person's disease experience and quality of life. Individual differences in coping styles used to manage COVID-19 related stress correlate with physical and mental health outcomes. Our study sought to understand the relationship between COVID-19 symptoms, severity of acute disease, and coping profiles.

METHODS

An online survey to assess symptoms, functional status, and recovery in a large group of patients was nationally distributed online. The survey asked about symptoms, course of illness, and included the Brief-COPE and the adapted Social Relationship Inventory. We used descriptive and cluster analyses to characterize patterns of survey responses.

RESULTS

976 patients were included in the analysis. The most common symptoms reported by the patients were fatigue (72%), cough (71%), body aches/joint pain (66%), headache (62%), and fever/chills (62%). 284 participants reported PACS. We described three different coping profiles: outward, inward, and dynamic copers.

DISCUSSION

Fatigue, cough, and body aches/joint pains were the most frequently reported symptoms. PACS patients were sicker, more likely to have been hospitalized. Of the three coping profiles, outward copers were more likely to be admitted to the hospital and had the healthiest coping strategies. Dynamic copers activated several coping strategies both positive and negative; they were also younger and more likely to report PACS.

CONCLUSION

Cough, fatigue, and body aches/joint pain are common and most important to patients with acute COVID-19, while shortness of breath defined the experience for patients with PACS. Of the three coping profiles, dynamic copers were more likely to report PACS. Additional investigations into coping profiles in general, and the experience of COVID-19 and PACS is needed.

Prevention and control of violence and aggression in football fans: Implications for sport psychologists, fans, and policymakers

This research was conducted to design an interpretive structural model of factors affecting the prevention and control of violence and aggression in football fans. The statistical population of this study was entirely composed of sport experts, executive managers, sociologists, and management professors in Iran. Thirteen individuals were accordingly selected as the research sample using non-probability purposeful sampling. The effective factors were identified through library study and reviewing the theoretical foundations and research background. Confirming the content validity of these factors by considering experts' opinions, 14 factors were finally identified. The interrelationships between the factors were determined using Interpretive Structural Modeling (ISM), and network analysis based on Decision Making and Trial Evaluation Laboratory (DEMATEL) was also employed to measure their importance, ranking them accordingly. The factors were categorized into four levels according to ISM. The highest level (first level) includes "match day service quality," "fair refereeing," "consolidation of social ties," and "cognitive reconstruction of fans." The second level contains "design, protection, and security of stadiums," "patterning and identification," and "use of calming techniques." "Awareness and informing" and "anger control training" belong to the third level, while the lowest level (fourth level) includes "media," "fan organizations," "laws, regulations, and security solutions," "moral education or persuasion," and "teaching communication skills to fans." Among them, the last level is fundamental, influencing the other factors. The results obtained in this work can be used as a basis for policymaking to reduce violence and aggression among football fans.

Positivity and coping as key to well-being and psychological adjustment during the pandemic of COVID-19: A follow-up study in Portugal

This follow-up study aimed to analyze the protective role of positivity and coping strategies on the well-being and psychological distress levels reported during Portugal's first and third waves of COVID-19. The total sample consisted of 135 participants (82.0% women) with ages ranging from 20 to 72 years (M = 39.29, SD = 11.46). Results suggested a significant decrease in well-being levels but no changes in psychological distress were observed. Positivity was a strong and significant predictor of well-being and psychological distress during the pandemic crisis. Among the set of strategies used by individuals at the first wave, denial, self-blame, and self-distraction predicted a poorer adaptation with more significant mental health impairment, with self-blame standing out as the most harmful. This study highlighted the key role of positivity in adjusting to the current pandemic crisis and the lasting detrimental impact of specific coping strategies.

Using imagination in response to stress and uncertainty in the time of COVID-19: further validation of the Fantastic Reality Ability Measurement (FRAME) Scale

Fantastic reality ability (FRA) is defined as the capacity to use imagination in response to stress or trauma. With the emergence of COVID-19 and associated social restrictions, there has been an uptick in imagination use as a coping strategy. This has allowed us to further validate the Fantastic Reality Ability Measurement (FRAME) Scale at this time of stress and uncertainty. Initial exploratory factor analyses (EFA) suggested that FRAME responses are measured by four first-order factors. Using confirmatory factor analyses (CFA), this study set out to confirm this finding and to ascertain if: First-order factors are correlated; or map onto a second or higher-order, fantastic reality ability latent construct. Also, FRAME responses are compared to established scales to demonstrate concurrent and discriminant validity. In accord with previous research and theory, CFA results indicate that each four factors (coping, control, transcendence, playfulness), contribute significantly to the measurement of a higher-order FRA latent construct (N = 437 Israeli adults). We also report robust correlations between FRAME and measures of resiliency and imagination abilities of complexity, directedness and frequency. Both adaptive and maladaptive applications of imagination use in relation to stress are discussed with focus on those who could foster resiliency. The FRAME enables one to briefly measure imagination use in response to stress and could serve as part of questionnaire batteries measuring individual differences and clinical research. Future research should assess the stability of this instrument across different populations over extended periods, specifically those at risk for trauma.

COVID-19-related uncertainty: fertility staff experiences of its sources, processing, responses, and consequences

STUDY QUESTION

What are fertility staff experiences of managing COVID-19-related uncertainty after fertility clinics re-opened?

SUMMARY ANSWER

Staff identified many COVID-19-related uncertainty sources, the main being the COVID-19 health threat, to which most clinics and staff responded effectively by implementing safety protocols and building strong collaborative environments that facilitated the acquisition and application of information to guide organizational responses during a rapidly changing situation, but with costs for staff and patients.

WHAT IS KNOWN ALREADY

COVID-19 created significant disruption in fertility care delivery, including temporary clinic closure and treatment delay. Patients experienced significant distress, including concerns regarding the impact of COVID-19 and its vaccine on fertility and pregnancy. Multiple studies show that COVID-19-related uncertainty is a major threat and burden for healthcare staff, but this has not been investigated in reproductive medicine.

STUDY DESIGN, SIZE, DURATION

A cross-sectional, online mixed-method bilingual (English, Spanish) survey (active 25 January-23 May 2021) was distributed to fertility staff across the UK, Latin America, and Africa.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Eligibility criteria were being a healthcare worker at a fertility clinic that had re-opened since its COVID-19-related closure, 18 years of age or older and ability to respond in English or Spanish. The survey was created in English, translated to Spanish, made available using Qualtrics, and consisted of four parts: (i) background and physical and mental wellbeing, (ii) open-ended questions regarding COVID-19 uncertainty, (iii) appraisal items regarding perceptions and impact of uncertainty, and (iv) changes in the workplace. The British Fertility Society and the African Network and Registry of Assisted Reproduction circulated the survey across the UK and Africa via email hyperlinks and social media platforms. The Argentinian Society of Reproductive Medicine and the Latin American Network of Assisted Reproduction distributed the survey across Latin America in the same manner. Thematic analysis was performed on responses from open-ended question to produce basic codes. Deductive coding grouped sub-themes across questions into themes related to the theory of uncertainty management. Descriptive statistics and repeated measures analysis of variance were used on the quantitative data.

MAIN RESULTS AND THE ROLE OF CHANCE

In total, 382 staff consented to the survey, 107 did not complete (28% attrition), and 275 completed. Sixty-three percent were women, 69% were physicians, and 79% worked at private clinics. Thematic analysis produced 727 codes, organized in 92 sub-themes, and abstracted into 18 themes and one meta-theme reflecting that uncertainty is stressful but manageable. The types of uncertainties related to the threat of COVID-19 (20.6%), unpredictability of the future (19.5%), failure of communication (11.4%), and change in the workplace (8.4%). Staff appraisals of negative and positive impact of uncertainty were significantly lower (P < 0.001) than appraisals of stress, controllability, and having what it takes to cope with uncertainty. To process uncertainty, clinics focused on information dissemination (30.8%) and building a collaborative work environment (5.8%), while staff employed proactive coping (41.8%) and emotional and cognitive processing (9.6%). Main organizational responses consisted on work restructuring (41.3%, e.g. safety protocols), adapting to adversity (9.5%, e.g. supplies, preparation), and welfare support (13.8%), though staff perceived lack of support (17.5%). Negative consequences of uncertainty were worse self- and patient welfare (12.1%) and worse communication due to virtual medicine and use of mask (9.6%). Positive consequences were work improvements (8.3%), organizational adaptation (8.3%), improved relationships (5.6%), and individual adaptation (3.2%). Ninety-two percent of participants thought changes experienced in the workplace due to COVID-19 were negative, 9.1% nor negative nor positive, and 14.9% positive. Most staff thought that their physical (92.4%) and mental health (89.5%) were good to excellent.

LIMITATIONS, REASONS FOR CAUTION

Participants were self-selected, and most were physicians and embryologists working at private clinics based in Latin America. The study did not account for how variability in national and regional COVID-19 policy shaped staff experiences of uncertainty.

WIDER IMPLICATIONS OF THE FINDINGS

To address COVID-19 uncertainty, clinics need to promote collaborative (clinic, staff, patients) processing of uncertainty, clear team coordination and communication, organizational flexibility, and provision of support to staff and patients, with an emphasis on cognitive coping to decrease threat of and increase tolerance to uncertainty. Uncertainty management interventions bespoke to fertility care that integrate these components may increase clinics resilience to COVID-19-related and other types of uncertainty.

STUDY FUNDING/COMPETING INTERESTS

Cardiff University funded this research. S.G. reports consultancy fees from Ferring Pharmaceuticals A/S, speaker fees from Access Fertility, SONA-Pharm LLC, Meridiano Congress International, and Gedeon Richter, and grants from Merck Serono Ltd. F.Z.-H. reports speaker fees from Ferring Pharmaceuticals A/S and that he is a chair of the Latin American Registry of ART, Committee of Ethic and Public Policies, and Chilean Society of Obstetrics and Gynecology and a vice chair of the International Committee for monitoring ART. K.A., N.C., G.B., and J.B. report no conflict in relation to this work.

TRIAL REGISTRATION NUMBER

N/A.

Coping profiles and differences in well‐being during the COVID‐19 pandemic: A latent profile analysis

During the current COVID-19 pandemic, people need to cope with multiple stressors which may affect their well-being. This study aimed (1) to identify latent coping profiles in the German general population, and (2) to investigate differences between these profiles in well-being. In total, N = 2326 German participants were recruited as part of the European Society of Traumatic Stress Studies (ESTSS) ADJUST study from June to September 2020 using an online survey. Coping strategies were assessed using the Brief-COPE and the Pandemic Coping Scale; well-being was assessed using the WHO-5 Well-Being Index. Coping profiles were identified using latent profile analysis; differences between profiles were examined using the automatic BCH method and multiple group analyses. Five coping profiles were identified that included different types and numbers of coping strategies: (1) High functional coping (17.84%), (2) Moderate functional coping (40.63%), (3) High functional and religious coping (9.07%), (4) Low functional coping (22.06%), (5) Moderate functional and dysfunctional coping (10.40%). The identified profiles significantly differed in well-being (χ²  = 503.68, p <0.001). Coping profiles indicating high functional coping were associated with greater well-being compared to coping profiles indicating low (χ²  = 82.21, p <0.001) or primarily dysfunctional (χ²  = 354.33, p <0.001) coping. These results provide insight into how people differ in their coping strategies when dealing with stressors in an early phase of the COVID-19 pandemic. The study indicates higher levels of well-being in coping profiles with more frequent use of functional strategies. To promote well-being in the general population, it might be beneficial to train functional coping strategies in appropriate interventions that are associated with increased well-being.

Active and avoidant coping profiles in children and their relationship with anxiety and depression during the COVID-19 pandemic

Active and avoidant coping styles are important dispositional factors in the development of anxiety and depression symptoms. Children use both active and avoidant coping strategies together in daily life. No studies have investigated the relationship between active–avoidant coping profiles and internalizing symptoms in children. The present study aimed to investigate children’s active–avoidant coping profiles and assess the relationship that active–avoidant coping profiles have with anxiety and depression symptoms. A two-wave longitudinal study was conducted among 322 Chinese children in the People’s Republic of China during the COVID-19 pandemic. Participants completed the Children’s Coping Strategies Checklist-Revised 1 at Time 1 and the Revised Child Anxiety and Depression Scale at Time 1 and 6 months later (Time 2). Four active–avoidant coping profiles were revealed: low active copers, high active copers, balanced copers, and avoidant copers. Low and high active copers had lower levels of anxiety and depression symptoms than balanced copers and avoidant copers. Avoidant copers showed a larger decrease in depression symptoms than balanced copers and high active copers during the COVID-19 pandemic. It is important to improve children’s active–avoidant coping profiles to relieve anxiety and depression symptoms.

Feeling grateful to be optimistic: The influence of recalling special moments on feelings of gratitude and optimism during the COVID-19 pandemic

In one experiment, we tested the influence of bringing to mind the memory of a special moment versus an ordinary moment from high school on gratitude and the relationship between gratitude and optimism. Participants were first asked to report how the current pandemic has affected their lives. After, participants were randomly assigned to either recalling a special moment from their high school years or recalling an ordinary event from the same life period. Participants then completed a battery of questionnaires assessing gratitude, optimism and some demographics. Results showed a positive influence of bringing to mind the memory of a special moment on gratitude. Gratitude was then positively related to optimism. Hence, the positive relationship between recalling a special event and optimism was mediated by gratitude. Our results showed that brief interventions might help individuals see a brighter future under the current difficult conditions of prolonged lockdowns.

The relationship between active coping and hope during the COVID-19 pandemic: The mediating role of meaning in life

This study aims to examine the relationship between active coping and hope during the COVID-19 pandemic and investigate the underlying mechanism based on meaning making theory. We conducted a two-wave survey and recruited 521 Chinese adults (aged 18-65). Results show that all three active coping strategies (personal hygiene practice, support seeking, and positive reappraisal) at T1 was positively associated with T2 hope. Importantly, T2 meaning in life serves as a mediator between T1 active coping and T2 hope. Our findings suggest that active coping could be an effective approach to maintain mental health by making meaning and promoting hope.

COVID-19 Pandemic and Personality: Agreeable People Are More Stressed by the Feeling of Missing

The COVID-19 pandemic and the measures taken to contain it have substantial consequences for many people, resulting in negative effects on individual well-being and mental health. In the current study, we examined whether individual changes in perceived stress relative to pre-pandemic levels depended on differences in behavior, appraisal, and experience of pandemic-related constraints. In addition, we tested whether this potential relationship was moderated by personality traits. We conducted an online survey during the end of the first lockdown in Germany in spring 2020, and assessed pandemic-related individual consequences as well as perceived stress. These data were related to the big five personality traits and to ratings of perceived stress obtained from the same participants in a study conducted before the outbreak of the pandemic, using the same standardized stress questionnaires. There was no overall increase, but a large interindividual variety in perceived stress relative to pre-pandemic levels. Increased stress was associated especially with strong feelings of missing. This relationship was moderated by agreeableness, with more agreeable people showing a higher association of the feeling of missing and the increase of perceived stress. In addition, openness and conscientiousness were positively correlated with an increase in stress. The results highlight the importance of considering personality and individual appraisals when examining the consequences of the COVID-19 pandemic on perceived stress and well-being.