Pre-pandemic resilience to trauma and mental health outcomes during COVID-19

COVID-19 hardship and mental health in Chilean parents: the role of disaster exposure and family resilience

Background: The negative mental health effects of the pandemic on families are well documented, while factors that buffer or increase such effects still need further investigation. Previous exposure to adversity might increase the negative impact of pandemic experiences. On the other hand, family resilience may protect against these negative effects, and may also be regarded as a mediator explaining the negative association between pandemic hardship and mental health.Objective: The current study focused on the effects of COVID-19-related hardship on parental mental health. We evaluated the impact of the individual experiences with the COVID-19 pandemic on mental health among Chilean parents from a community sample, who were exposed in varying levels to a destructive earthquake and tsunami approximately 10 years earlier.Method: Participants (N = 219) completed online measures of pandemic hardship, mental health, disaster hardship related to the past earthquake, and family resilience. We examined the moderating role of disaster exposure and the moderating and mediating role of family resilience on the current impact of the pandemic on mental health.Results: Individual exposure levels of COVID-19 hardship were associated with mental health complaints. Both previous disaster hardship and family resilience were associated with mental health complaints. However, previous disaster hardship did not moderate the relationship between pandemic hardship and mental health complaints, nor did family resilience moderate or mediate it.Conclusions: These results align with the evidence of the negative emotional impact of pandemic-related stressors, and propose family resilience and past disaster exposure as relevant predictors of mental health during the sanitary emergency. Findings are discussed in the broader social context in Chile and warrant adjusting public policies towards those underserved groups heavily affected by the pandemic.

Psychological resilience to trauma and longitudinal sleep outcomes among current and former nurses

OBJECTIVE

A life-disrupting stressor (e.g. pandemic) may cause or exacerbate poor sleep health; resilience may offset impacts. We assessed relationships between pre-pandemic psychological resilience to trauma and sleep-related outcomes during the first year of the pandemic among current and former nurses.

METHODS

Using data from 18,670 women in the Nurses' Health Study II, we characterized pre-pandemic resilience by cross-classifying experiences of higher versus lower lifetime trauma burden with unfavorable, adequate, and favorable psychological health (through January 2020). Sleep was measured before (2017) and during the pandemic, including: changes, quality, and duration. We modeled trajectories of sleep duration assessed at five time points (pre-pandemic in 2017, and then in four COVID-19-related surveys, 2020-2021) using latent class growth analysis.

RESULTS

We observed four trajectories of sleep duration, all showing stable patterns, with averages ranging from 5.5 to 6 to 8.5-9 h of sleep per 24 h. Women with higher trauma/unfavorable psychological health had the highest risk for all poor sleep outcomes (e.g., RR for being in the shortest sleep trajectory versus healthy sleep duration: 2.53; 95 % CI: 2.21, 2.91). Relative to women categorized as most resilient, only women with lower trauma/favorable psychological health showed lower risk of getting less sleep after the pandemic started compared to no change (RR: 0.76; 95 % CI: 0.70, 0.83). This same pattern was observed for poor sleep quality.

CONCLUSION

Higher pre-pandemic resilience may have protected women against poor sleep outcomes during the pandemic. Findings could have long-term health implications, particularly if they generalize to other stressors.

Interactions of chronic stress exposure and stress appraisal on vascular endothelial function among young adults

We investigated the associations of ongoing, chronic stress exposure and stress appraisal on vascular endothelial function (VEF) in young adults. In 72 healthy young adults (74% female; age = 25 ± 1 yr), we assessed chronic stress exposure and appraisal with a measure that quantified chronic stress exposure and chronic stress appraisal related to eight specific stressors over the last year. Participants completed the perceived stress scale (PSS) as a measure of global, proximal stress appraisal. VEF was assessed using the brachial artery flow-mediated dilation technique. We examined relations among ongoing, chronic stress exposure and stress appraisal versus VEF adjusted for age and sex, and then assessed whether stress appraisal moderated the effect of chronic stress exposure on VEF. Chronic stress exposure (β = -0.24, P = 0.045), but not chronic stress appraisal (β = 0.07, P = 0.56) or perceived stress (β = -0.20, P = 0.11), was related to VEF. Perceived stress (P = 0.046), but not chronic stress appraisal (P = 0.54), moderated the association between chronic stress exposure and VEF. The effect of chronic stress exposure on VEF ceased to be significant at a PSS score of ∼22. Subsequent exploratory stratified analysis indicated that those with PSS ≥22 had increased exposure to adverse childhood experiences (+1.6 ± 0.6, P = 0.01), greater depressive symptoms (+10.2 ± 2.7, P < 0.001), and reduced psychological resilience (-7.6 ± 3.5, P = 0.036). Chronic stress exposure significantly predicts impaired VEF among young adults. Furthermore, this relation is influenced by proximal perceived stress, such that the association of chronic stress exposure on VEF may be obscured at high levels of proximal perceived stress.NEW & NOTEWORTHY Our findings indicate that ongoing chronic stress exposure over the last year is significantly associated with reduced vascular endothelial function among apparently healthy young adults. Our data provide important insights into the interplay of chronic stress exposure versus proximal perceived stress and may also support the hypothesis that young adults who are sensitized to stress may be particularly vulnerable to stress-related impairments in vascular endothelial function.

Psychological resilience, resilient coping, and health behaviors among adults in Puerto Rico after multiple adverse events

Objective: Residents of Puerto Rico have recently experienced multiple adverse events, including hurricanes, earthquakes, and political unrest. Such adversity is associated with worse mental and physical health. Psychological resilience and effective coping may mitigate these relations by fostering positive health behaviors, like consuming a high-quality diet and being physically active. However, empirical evidence for these relationships is limited. Methods: We assessed psychological resilience, resilient coping, and health behaviors among two groups of adults in Puerto Rico, before and during the pandemic, in 2019-2023 (total N = 1,342). Resilience and resilient coping were assessed using the Brief Resilience Scale and Brief Resilient Coping Scale. Diet quality was defined by the Alternate Healthy Eating Index from a food frequency questionnaire. We collected data on sleep, physical activity, alcohol intake, and tobacco use using validated questionnaires. Results: Adjusting for confounders, higher resilience z-scores were associated with being in the highest category of diet quality [OR: 1.25, 95 % CI: 1.04, 1.50]; getting 7-8 h of sleep per night [OR: 1.15, 95 % CI: 1.02,1.30]; and reporting moderate or heavy physical activity (vs. light or sedentary) [OR: 1.17, 95 % CI: 1.02,1.34]. The same patterns were observed for higher resilient coping z-scores, and for categorical measures of resilience and resilient coping. These relationships were stronger among participants interviewed during (vs. before) the COVID-19 pandemic, suggesting that resilience and resilient coping may be particularly relevant during an ongoing stressor. Conclusion: Identifying supportive strategies to cultivate resilience and effective coping mechanisms may contribute to healthier behaviors, particularly in a vulnerable population.

Internet-Based Trauma Recovery Intervention for Nurses: A Randomized Controlled Trial

Introduction

Nurses, who care for patients with various traumas, may also experience post-traumatic stress disorder due to indirect or direct exposure to traumatic situations. This study examined the effectiveness of an Internet-based trauma recovery intervention for Korean nurses.

Methods

This randomized controlled trial was conducted with 112 nurses aged 23-40 years who were randomly assigned to the intervention (n = 56) or control group (n = 56) from May 7 to December 20, 2020. Nurses in the intervention group attended eight sessions, and the same intervention was administered to the control group. Repeated measures were collected at pre-test, post-test 1 (immediately after the intervention), and post-test 2 (4 weeks after the intervention). A total of 102 nurses (intervention group: n = 49; control group: n = 53) were completed because 10 nurses dropped out before the first session. Data were analyzed using the χ2 test, Fisher's exact test, t-test, Mann-Whitney U test, and repeated measures ANOVA (intention-to-treat and per protocol).

Results

There were significant changes in functional health, resilience, post-traumatic stress, depressive symptoms, state anxiety, and trait anxiety over time and in the group-by-time interactions (intention-to-treat and per protocol). There was a significant difference in social support in the group-by-time interactions, but there were no significant changes between the two groups or over time (intention-to-treat and per protocol).

Conclusion

The Internet-based trauma recovery nursing intervention is effective in clinical and community settings for nurses who cannot participate in fixed-schedule programs due to shift work. This study's findings are relevant for implementing Internet-based trauma recovery programs for nurses and the general population, including survivors and relatives of patients who suffered from COVID-19. This program will also be very useful for people in other high-stress situations. Nurse leaders should consider different populations and situations when offering effective coping strategies suitable for changing environments.

Fear of COVID-19, Perceived Stress, and PTSD: The Serial Mediating Role of Sense of Coherence

The literature has identified that a sense of coherence plays a protective role in the relationship between adverse events and mental health. The current study examines the role of a sense of coherence (SOC) in the relationship between fear of COVID-19, perceived stress, and dimensions of post-traumatic stress disorder (PTSD). Participants (n = 322) were students at a metropolitan university in South Africa who completed the Fear of COVID-19 Scale, the Perceived Stress Scale, the 13-item Sense of Coherence Scale, and the PTSD Checklist. Path analysis was used to conduct a serial mediation analysis. The results show that SOC mediates the relationship between perceived stress and the dimensions of PTSD but does not mediate the relationship between fear of COVID-19 and PTSD. Furthermore, the relationship between fear of COVID-19 and dimensions of PTSD was mediated by serial perceived stress and sense of coherence, supporting the hypothesis that higher levels of fear of COVID-19 leads to higher levels of perceived stress. However, while high levels of fear of COVID-19 increase perceived stress, SOC significantly mediates the subsequent impact on PTSD symptoms.

Did Resilience and Socioeconomic Status Predict Older Adults' Finding a Silver Lining in COVID?

Background and Objectives

The coronavirus disease 2019 (COVID-19) pandemic stretched our limits-physically, mentally, and economically. However, some older adults report that it led to positive changes. This study aims to understand whether prepandemic resilience, education, or income predicted older adults' subsequent likelihood of reporting positive changes in their lives during the pandemic.

Research Design and Methods

We use data from the National Social Life, Heath, and Aging Project, an ongoing panel study with a COVID-19 ancillary supplement (N = 2,650).

Results

The study results aligned with the fundamental cause theory. In demographically adjusted models including resilience, education, and income, as well as the effect of the pandemic on employment and a COVID-disruption score, the odds of reporting any positive change were 2.6 times higher for those with an associate degree (p < .01) and 4.7 times higher for those with a bachelor's or higher (p < .001), compared to those without a high school degree. In contrast, neither resilience nor income was significantly associated with endorsing a positive change. We also categorize specific changes thematically coded from open-ended responses and examine their demographic distributions. Categories include spirituality, home organization, hygiene practices, and increased quality time with others.

Discussion and Implications

These findings show that older adults with more education could navigate COVID-19 challenges in a way that improved their perspectives on at least one aspect of their lives.

The Association between Resilience and Psychological Distress during the COVID-19 Pandemic: A Systematic Review and Meta-Analysis

This study examined the association between resilience and psychological distress in healthcare workers, the general population, and patients during the COVID-19 pandemic. We searched the PubMed, Web of Science, PsycInfo, Science Direct, and Nursing and Allied Health databases. Included articles examined healthcare workers (e.g., physicians and nurses), the general population, and patients during the COVID-19 pandemic. Studies of exposure to other infectious diseases related to epidemics or pandemics (e.g., SARS and MERS) were excluded. This study was performed following the Cooper matrix review method and PRISMA guidelines, followed by a meta-analysis of study results using R version 4.1.2. A random effect model was used for the pooled analysis. This study was registered with PROSPERO (registration No. CRD42021261429). Based on the meta-analysis, we found a moderate negative relationship between overall resilience and psychological distress (r = -0.42, 95% confidence interval [CI]: -0.45 to -0.38, p < 0.001). For the subgroup analysis, a moderately significant negative relationship between overall resilience and psychological distress was found among healthcare workers (r = -0.39, 95% CI: -0.44 to -0.33, p < 0.001), which was weaker than in the general population (r = -0.45, 95% CI: -0.50 to -0.39, p < 0.001) and in patients (r = -0.43; 95% CI: -0.52 to -0.33; p < 0.001). This association was robust, although the heterogeneity among individual effect sizes was substantial (I2 = 94%, 99%, and 74%, respectively). This study revealed a moderate negative relationship between resilience and psychological distress in healthcare workers, the general population, and patients. For all these populations, interventions and resources are needed to improve individuals' resilience and ability to cope with psychological distress during the COVID-19 pandemic and in future disease outbreaks.