Influence of hardiness, avoidance coping, and combat exposure on depression in returning war veterans: A moderated-mediation study

Stress, hardiness and eating disorder symptoms in military academy cadets

Eating disorders are a persistent and debilitating problem, especially among college age men and women. This problem is exacerbated in occupations such as the military, where maintenance of strict standards regarding weight, fitness and appearance is important for job retention and promotion. Also, previous research confirms that stress is a contributing element to eating disorders. It is thus important to identify factors that may assist individuals to remain resilient and avoid stress-related health and eating difficulties. The present study utilizes historical data to examine the impact of stress on health and eating disorder symptoms in a representative sample of West Point military academy cadets, while testing the role of gender and hardiness as stress moderators in this relation. A survey containing measures of stress, hardiness and eating disorders symptoms was completed by 387 cadets in the fall and spring of 2000-2001. Moderation effects were tested with advanced conditional process analysis procedures developed recently by Hayes (2022). Results show that hardiness was a significant moderator, with cadets low in hardiness showing increased eating disorder symptoms and more general health symptoms. While gender was not a significant moderator with respect to eating disorder symptoms, it was significant for general health symptoms; female cadets showed more stress-related health symptoms than their male counterparts. These results suggest that eating disorder symptoms in military academy cadets and college students more generally may be reduced through programs aimed at developing hardiness attitudes and stress coping approaches.

Tattooing Among Combat Soldiers as a Coping Resource With Their Military Service Experiences

This study aims to examine how former combat soldiers use tattoos as a coping resource in response to their military service experiences. Qualitative analysis of semi-structured interviews with eight combat soldiers identified two main themes: (a) the military events and distress as a background story of the tattoos; (b) the tattoos' meaning as a coping resource for military service experiences. The thematic analysis revealed two coping resources which the soldiers utilised through tattooing. The first is the emotional-relief coping resource, which allows combat soldiers to express and process their emotions in response to events experienced during their military service, and helps them reduce feelings of stress. The second is the positive-productive coping resource that enhances positive feelings, serves as an empowering, promoting and strengthening resource, and expresses a transformative process of change. The findings also revealed that both of the coping resources were adaptive coping resources. This study contributes to the limited research on tattooing among combat soldiers, expands the knowledge regarding tattoos as a coping resource with military service, and identifies two types of coping resources utilised by combat soldiers. On a practical level, our findings offer insights for interventions aimed at promoting awareness among combat soldiers about the effectiveness of tattooing.

The impact of moral injury on trajectories of depression: a five-year longitudinal study among recently discharged Israeli veterans

BACKGROUND

Perpetrating or witnessing acts that violate one's moral code are frequent among military personnel and active combatants. These events, termed potentially morally injurious events (PMIEs), were found to be associated with an increased risk of depression, in cross-sectional studies. However, the longitudinal contribution of PMIEs to depression among combatants remains unclear.

METHOD

Participants were 374 active-duty combatants who participated in a longitudinal study with four measurement points: T1-one year before enlistment, T2-at discharge from army service, and then again 6- and 12-months following discharge (T3 and T4, respectively). At T1, personal characteristics assessed through semi-structured interviews. At T2-T4, PMIEs and depressive symptoms were assessed.

RESULTS

At discharge (T2), a total of 48.7% of combatants reported experiencing PMIEs incident, compared with 42.4% at T3 and 30.7% at T4. We found a significant interaction effect in which combatants endorsing PMIEs at discharge reported higher severity of depression symptoms at discharge (T2) than combatants who reported no PMIEs. This effect decreased over time as depression levels were lower at T3 and T4.

CONCLUSIONS

PMIE experiences, and especially PMIE-Betrayal experiences, were found to be valid predictors of higher severity of depression symptoms after the first year following discharge.

Risk and protective correlates of suicidality in the military health and well-being project

Suicidality disproportionately affects Veterans, and in 2020 the Military Health and Well-Being Project was conducted in part to study the link between risk and protective constructs with suicidality among Veterans. In the present study, we investigate the relative contribution of risk (i.e., military self-stigma, daily stress, combat exposure, substance use, traumatic brain injury, and moral injury) and protective constructs (i.e., social integration, social contribution, public service motivation, purpose and meaning, and help-seeking) with suicidality. Using cross-sectional Pearson correlation and linear regression models, we studied the independent and relative contribution of risk and protective correlates in a sample of 1469 Veterans (male: n = 985, 67.1 %; female: n = 476, 32.4 %; transgender, non-binary, prefer not to say: n = 8, 0.5 %). When we investigated protective constructs individually as well as simultaneously, social contribution (β = -0.39, t = -15.59, p < 0.001) was the strongest protective construct against suicidality. Social integration (β = -0.13, t = -4.88, p < 0.001) additionally accounted for significant reduction in suicidality when all protective constructs were considered together. When we investigated the contribution of risk constructs towards suicidality, moral injury was most strongly associated with suicidality (r = 0.519, p < 0.001), yet when studied simultaneously for their relative contribution none of the constructs accounted for a significant amount of the variance in suicidality (|t|s ≤ 1.98, ps ≥ 0.07). These findings suggest that among Veterans it is possible that social contribution is protective against suicidality and could be a possible treatment target for the prevention or reduction of suicidality among Veterans.

The relationship between co-occurring traumatic experiences and co-occurring mental health domains for veterans resident in Northern Ireland

INTRODUCTION

Veterans residing in Northern Ireland (NI) likely experience higher levels of co-occurring lifetime trauma exposure and associated co-occurring mental health symptoms, due to the Troubles. As NI veterans have been subject to little exploration it is difficult to know how to support them. This exploratory study explored the co-occurrence of mental health symptoms as a function of co-occurring traumatic experiences.

METHODS

Two latent class analyses (LCA) were conducted on NI veteran data (n = 609). One LCA factored endorsements of 16-lifetime traumatic events, with a separate LCA exploring the co-occurrence of symptoms across six mental health domains. Mental health symptom classes were considered as a function of trauma classes, military-specific variables, gender and age.

RESULTS

Three trauma classes were identified: High Multi Trauma (10.84%); High Combat/Conflict (47.62%); Moderate Combat Conflict (41.54%), and three mental health symptom classes: High Co-occurring Mental Health (19.38%); High Depression Moderate Anxiety/Alcohol (24.63%); Moderate Alcohol/Normative (55.99%). Significant predictors of High Co-occurring Mental Health class membership were UDR service, 'Worst' military trauma and High Multi Trauma class membership. Both combat classes had a negative relationship with the High Co-occurring Mental Health. Predictors of the High Depression Moderate Anxiety/Alcohol class were High Multi Trauma class membership and UDR service, with Age and Moderate Combat Class membership having a negative relationship.

DISCUSSION

NI veterans could be labelled as 'traumatised' due to high levels of combat/conflict exposure, yet the two combat classes seemed unrelated to membership of poorer mental health classes. UDR membership indicated that living in one's theatre of war could have mental health implications. It was concerning that 45% experienced some co-occurring mental health symptoms with 19% experiencing the poorest symptoms. Hazardous alcohol use appeared unrelated to poor mental health. Further research is needed, utilising robust methods. No clinical inferences are to be made from this exploratory study.

Sex differences in hardiness, coping, and health in new West Point cadets

The U.S. Military Academy at West Point places young men and women in a highly demanding world of extreme mental and physical challenges. As such, it provides an excellent natural laboratory in which to study how people respond and adapt to highly stressful conditions. The present study explores the role of personality hardiness and coping as stress resilience resources in new (freshmen) cadets at West Point, while also considering sex differences. Using survey methods, N = 234 cadets were assessed during their first year at West Point. Measures included personality hardiness, coping strategies, health symptoms, and number of hospitalizations for all causes. Results show that female cadets are higher in hardiness and emotion-focused coping, as well as somewhat higher in symptoms reports. For the total group, hardiness is linked to better health, both in terms of symptoms reports and hospitalizations. Multiple regression results indicate symptoms are predicted by lower hardiness, higher avoidance coping, and female sex. Conditional process path analysis reveals that the effect of hardiness on symptoms is mediated by emotion-focused coping, and that emotion-focused coping can have both positive and negative effects. This study confirms hardiness is an important stress resilience resource for both men and women in the highly stressful first year at West Point. These findings lend further support to a growing body of evidence that hardiness influences health in part via the coping strategies that people choose to apply in dealing with stressful situations.

Coping Mechanisms and Posttraumatic Stress Exhibited by Children in Areas of Yemen's Armed Conflict in Southern Saudi Arabia

This study is an attempt to explore war-related trauma, its stressful effects, and the coping strategies of Saudi schoolchildren. The authors hypothesized that children exposed to war-related trauma will show higher levels of PTSD, and that those with higher levels of PTSD symptoms use more maladaptive coping strategies. The study describes the correlation between traumatic events and posttraumatic stress disorder (PTSD) as well as coping strategies. Five hundred twenty-seven intermediate and high school students, 12 to 18 years old, living in the conflict zone in southern Saudi Arabia completed three standardized self-reported scales: the War Zone Traumatic Events Checklist, the Child PTSD Symptom Scale, and the Children's Coping Strategies Checklist. Each participating student was randomly chosen. Analysis was based on two groups: the high-PTSD symptoms group (182 children) and the low-PTSD symptoms group (345 children). The study was conducted between September 2020 and April 2022 while the war was ongoing as part of an ongoing larger study. Children exposed to war-related traumatic events exhibited greater prevalence rates for PTSD. The children reported high levels of PTSD symptoms and applied a variety of coping strategies to manage related stress. Participants rarely reported that psychological or educational interventions had been used to manage the war-related traumatic experiences and PTSD or to improve related coping styles. The results are discussed in the context of mental health services needed for children in the conflict zone. To bridge the gap between health care services and the needs of children with PTSD, and for better understanding and interventions, health professionals are invited to develop a biopsychosocial model that identifies the risks of PTSD related to exposure to war-related traumatic events in school-aged children and, hence, provide a multidisciplinary intervention program that educates, encourages, and supports teachers and parents in following medical recommendations and goals.

Psychological Hardiness and Compassion Satisfaction Among the Turkish Red Crescent: The Case of 2023 Kahramanmaras Earthquake

OBJECTIVES

This study assessed psychological hardiness and compassion satisfaction among the Türk Kızılay (Turkish Red Crescent) personnel and volunteers involved in the 2023 Kahramanmaraş earthquake. Additionally, the relationship between compassion satisfaction and psychological hardiness was also investigated.

METHODS

This cross-sectional study was conducted between March and July 2023. Participants completed an online survey, which included the Sociodemographic Information Form, Psychological Hardiness Scale, and Compassion Satisfaction Scale. The data was analyzed with SPSS version 25 (IBM Corp., Armonk, New York, USA), using a significance level of 95% and p < 0.05.

RESULTS

The study involved 400 participants, comprising 84 (21%) personnel and 316 (79%) volunteers. Participants exhibited an average psychological hardiness level of 24.56 ± 7.25 and a compassion satisfaction level of 47.40 ± 17.28. A significant positive correlation was observed between compassion satisfaction and psychological hardiness (r = 0.571; p < 0.001). The results of logistics regression have revealed that the level of psychological hardiness is higher in males compared to females (OR = 1.930, CI = 1.115 - 3.340; P < 0.05) and is also higher in those with high compassion satisfaction compared to those with low compassion satisfaction (OR = 1.386, CI = 1.256 - 1.529; p < 0.001).

CONCLUSIONS

The findings of this study indicate that individuals involved in disaster response should consider compassion satisfaction as an important tool for enhancing psychological hardiness.

Willingness to reduce alcohol consumption predicted by short-form video exposure, media involvement, psychological bias, and cognitive factor

Introduction

Through previous studies, Chinese college students are known to be prone to alcohol consumption, which can lead to health-risk behaviors such as high blood pressure, heart disease, stroke, liver disease, and digestive problems. However, little is known about how popular social media platforms (e.g., short-form video applications) can positively impact their willingness to reduce alcohol consumption. This study was guided by the theory of optimistic bias; we investigated the direct, mediated, and moderating effects of exposure to anti-alcohol consumption short-form videos and short-form video involvement on Chinese college students' willingness to reduce their alcohol consumption.

Methods

The current study has an empirical cross-sectional design and employed an online survey from September 1st, 2022, to November 1st, 2022. The survey specifically targeted Chinese college students, who are the most common users of short-form video applications. The accumulated data underwent rigorous examination, including hierarchical regression, mediation, and moderation analyses, all conducted using the PROCESS macro 4.0 within SPSS version 22.

Results

A total of 434 participants, aged 18-24 years, were included in this study. There were mediating effects regarding Chinese college students' exposure to anti-alcohol consumption short-form videos (β = 0.35, p < 0.01, 95% CI [0.17, 0.63]) and short-form video involvement (β = 0.44, p < 0.001, 95% CI [0.20, 0.65]) on their willingness to reduce alcohol consumption via reversed optimistic bias. Moreover, perceived prevention of heavy drinking control (β = 0.05, p < 0.001, 95% CI [0.01, 0.09]) played mediating roles in the relationship between exposure to anti-alcohol consumption short-form videos and willingness to reduce alcohol consumption.

Conclusion

This study is one of the earliest studies to examine the intricate effects of exposure to anti-alcohol consumption short-form videos and short-form video involvement on the willingness to reduce alcohol consumption among Chinese college students. In addition, this study confirms that regardless of whether Chinese college students are conscientious, exposure to anti-alcohol consumption short-form videos did not increase their level of reversed optimistic bias. The empirical findings of this study are critical and can provide practical insights for Chinese health departments that encourage Chinese college students to minimize alcohol consumption.

Psychological characteristics of the relationship between mental health and hardiness of Ukrainians during the war

Objectives

The aim of our survey is to identify psychological features for the relationship between mental health and hardiness of Ukrainians during the war.

Methods

The study involved 608 Ukrainians. We aimed to identify the relationship between mental health and hardiness and determine the differences in the peculiarities of mental health of people with different levels of hardiness. Also we looked for predictors for hardiness.

Results

Subjective hardiness was found to be related to specific manifestation of mental health in the Ukrainian population. Strong correlations were revealed for hardiness with adaptation (ρ = 0.818), emotional comfort (ρ = 0.786), internality (ρ = 0.672), self-perception (ρ = 0.656,), escapism (ρ = -0.632) and mental health (ρ = 0.629). A prognostic model based on linear regression analysis identified the main predictors of personal hardiness and confirmed correlational analysis. Mental health (0.341), emotional comfort (ρ = 0.786), and escapism (-0.576) were found to be good predictors. Altogether 40.1% of Ukrainians scored low, 54.6% medium, and 5.3% high on individual hardiness.

Conclusion

The study found that about every 4th Ukrainian demonstrates a low level of personal hardiness, which is accompanied by emotional discomfort and lack of internal locus of control, making them more susceptible to stress and illness. Additionally, they tend to distance themselves which significantly exacerbates the situation. It has been found that Ukrainians with low levels of personal hardiness exhibit escapism (with diversion of the mind to imaginative activity), a destructive defense mechanism that not only prevents effective problem solving but also has long-term negative consequences for their overall health. Consequently, especially people with low hardiness should receive specific support to stabilize their mental wellbeing and health overall.

Correlation analysis of salivary cytokines and hormones with resiliency

BACKGROUND

Frequent exposure to acute stress increases risk of suicide, posttraumatic stress disorder, and other stress-related disorders. Neuroendocrine and immunologic dysregulation associated with stress may underlie predispositions to psychological disorders and inflammatory disease processes in individuals, such as first-responders and other healthcare professionals, who function in high stress situations. The Hardiness Resilience Gauge (HRG) can be used to psychometrically measure resilience, a psychological modifier of the stress response. Using the HRG alongside salivary biomarker profiling, may help to identify low resilience phenotypes and allow mitigation and early therapeutic interventions. There is a paucity of knowledge regarding biomarkers of resilience. This study aims to evaluate the relationship between factors of resilience with salivary biomarker levels and fluctuations during and following acute stress.

METHODS

Sixty-three first responders underwent a standardized stress-inducing training exercise, providing salivary samples before (prestress), immediately after (post-stress), and 1 hour after the event (recovery). The HRG was administered before (initial) and after (final) the event. Multiplex ELISA panels quantified 42 cytokines and 6 hormones from the samples, which were analyzed for relationships to psychometric factors of resilience measured by the HRG.

RESULTS

Several biomarkers correlated with psychological resilience following the acute stress event. The HRG scores correlated ( p < 0.05) with a select set of biomarkers with moderate-to-strong correlations (|r| > 0.3). These included EGF, GROα, PDGFAA, TGFα, VEGFA, interleukin (IL)1Ra, TNFα, IL18, cortisol, FGF2, IL13, IL15, and IL6. Interestingly, fluctuations of EGF, GROα, and PDGFAA in post-stress compared with recovery were positively correlated with factors of resilience, which were negatively correlated from the pre-stress to post-stress period.

CONCLUSION

This exploratory analysis discovered a small subset of salivary biomarkers that are significantly correlated with acute stress and resilience. Further investigation of their specific roles in acute stress and associations with resiliency phenotypes is warranted.

Serially mediated effects of psychological inflexibility on quality of life of refugees in Uganda during coronavirus pandemic

The unexpected outbreak and rapid spread of COVID-19 necessitated radical and stringent control measures, consequently changing how people live globally. To vulnerable populations like refugees, who were already living a disrupted life, the outbreak of COVID-19 and accompanying control measures complicated their living conditions and drastically affected their mental health and, consequently, their quality of life. The current study aimed to test whether psychological inflexibility was a factor in lowering the quality of life of refugees in Uganda during the COVID-19 pandemic. The study further examines whether the effects of psychological inflexibility on quality of life were serially mediated by avoidance coping, perceived threat, adherence to COVID-19 control measures, and general mental health states. The study was conducted among refugees living in Kampala city suburbs and Bidibidi refugee settlement in Uganda. Data was collected using a survey questionnaire during the partial reopening of the economy in mid-2020, after the first lockdown. The analysis assesses a serial mediation model of the effects of psychological inflexibility on the quality of life of refugees through avoidance coping, perceived threat, adherence to COVID-19 control measures, and mental health using PROCESS Macro. The study involved 353 participants. Our analyses revealed that psychological inflexibility was negatively associated with the perceived threat, adherence, and quality of life. Psychological inflexibility was positively associated with avoidance coping and poor mental health. The data supported all hypothesized mediation paths. These findings support literature suggesting that psychological inflexibility is a maladaptive attribute that thwarts positive coping and behavior adjustment in times of crisis. Consequently, psychological inflexibility can worsen mental health problems and quality of life, especially in populations such as refugees in low-income countries who live in precarious conditions. Incorporating interventions that reduce psychological inflexibility in crisis management efforts can help refugees maintain good psychological functioning and quality of life.

Hardiness and Zoom Fatigue on Nursing Students: A Cross-Sectional Study in Indonesia During Online Learning

Introduction

The Covid-19 pandemic caused a change in learning methods to online learning. Zoom fatigue is a problem that many students experience during online learning. Zoom fatigue has an impact on physical and psychological problems so that it disrupts the online learning process. Hardiness is needed by students in order to adapt to online learning.

Aim

The purpose of this study was to determine the relationship between hardiness and zoom fatigue in nursing students at Universitas Padjadjaran.

Methods

This study used a quantitative approach with a cross-sectional study design. The sample technique used total sampling. Respondents were 480 nursing students at Universitas Padjadjaran. The research instrument used the Zoom Exhaustion & Fatigue Scale questionnaire and the Hardiness Instrument for the Online Learning.

Results

This study shows that almost half of the respondents have a medium hardiness level category (45%) and a zoom level of medium fatigue category (46.67%). The results of the analysis show that there is a significant negative relationship between hardiness and zoom fatigue in nursing students at Universitas Padjadjaran. The higher the student's hardiness level, the lower the student's zoom fatigue level. High hardiness can increase focus during the learning process, increase student participation, and reduce stress and fatigue in students during online learning.

Conclusion

Lecturers and students need to collaborate to improve the learning process and repeat mental health problems during online learning. This data forms the basis for university and school nurses in providing interventions for nursing students to reduce the problem of zoom fatigue.

Mental health and resilience in the Irish defense forces during the COVID-19 global pandemic

The Irish Defense Forces (DF) responded to the COVID-19 pandemic and national public health crisis by deploying personnel to aid domestic civil authorities in medical and care settings, contact tracing, logistics, and operations. Current research on COVID-19 reveals increased psychological distress among frontline workers and the general public. Resilience has previously been associated with lower levels of psychological distress. This study sets out to test these associations, and to examine mental health differences between DF personnel deployed in Ireland on pandemic-related duties (DIPD) and non-DIPD. Participants were 231 DF members who completed the: Connor-Davidson Resilience Scale-10, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Perceived Coronavirus Threat Questionnaire, Brief Trauma Questionnaire, Post-traumatic Stress Disorder Checklist-5, and Alcohol Use Disorder Identification Test. Independent t-tests revealed no differences between DIPD and non-DIPD on measures of psychological distress or on self-rated mental health prior to COVID-19 (PC19) and during COVID-19 (DC19). Results of multiple hierarchical regression analyses revealed that depression predicted lower levels of resilience, while multiple traumatic events predicted higher levels of resilience. The total adjusted variance explained by the model was 25%. Clinical and policy implications for improving access to psychological support within the DF and military populations are discussed.

Depression and anxiety in peruvian military personnel during the pandemic context: a cross-sectional study

BACKGROUND

During the COVID-19 pandemic, increased workload and stress could have increased mental health problems (anxiety and depression) in military personnel. However, the number of studies in military members is scarce, especially in regard to mental health. The objective of this study was determine the prevalence and factors associated with depression and anxiety in Peruvian military personnel.

METHODS

We undertook an analytical cross-sectional study. The survey was distributed face to face between November 02 and 09, 2021, during the second wave of the COVID-19 pandemic among the military personnel. We used some instruments to measure depression (Patient Health Questionnaire, PHQ-9), anxiety (Generalized Anxiety Disorder, GAD-7), insomnia (Insomnia Severity Index, ISI), food insecurity (Household Food Insecurity Access Scale, HFIAS), physical activity (International Physical Activity Questionnaires, IPAQ-S), resilience (abbreviated CD-RISC), and fear of COVID-19 scale. The exclusion criteria included those who did not completely fill out the evaluation instruments.

RESULTS

We analyzed the data of 615 military personnel that participated in the survey. Of them, 93.7% were male and the median age was 22 years old. There was a prevalence of 29.9% and 22.0% in regard to depression and anxiety symptoms, respectively. In addition, it was found that being married (PR: 0.63; 95% IC: 0.42-0.94), having a relative with mental health problems (PR: 2.16), having experienced food insecurity (PR: 1.48), insomnia (PR: 2.71), fear of COVID-19 (PR: 1.48), and a high level of resilience (PR: 0.65) were factors associated with depression. In regard to anxiety, the factors associated were working for more than 18 months since the beginning of the COVID-19 pandemic (PR: 0.52), a high level of resilience (PR: 0.50; 95% IC: 0.33-0.77), insomnia (PR: 3.32), fear of COVID-19 (PR: 2.43).

CONCLUSION

We found a prevalence of symptoms of depression and anxiety of 29.9% and 22.0%, respectively. In regard to the factors that attenuate depression, we can mention being married and having resilience; and among the aggravating factors, having a relative with mental health problems, food insecurity, insomnia, and fear of COVID-19. Finally, anxiety increased through working time, insomnia, and fear of COVID-19.

Psychological Capital and Quality of life of Refugees in Uganda During COVID-19 Pandemic: A Serial Mediation Model

Background: The COVID-19 pandemic has in the past two years caused and continues to cause enormous effects on lifestyle, mental health, and quality of life. With no known treatment and vaccination, behavioral control measures became central in controlling the pandemic. However, the intensity of the pandemic and the stringent control measures were immensely stressful. The control measures became an added psychological burden to people living in precarious situations such as refugees in low-income countries. Purpose: Given the benefits of psychological capital, the present study aimed at investigating the role of psychological capital in enhancing the quality of life among refugees in Uganda during the COVID-19 pandemic. It was hypothesized that the effects of psychological capital on quality of life are serially mediated through coping strategies, adherence to COVID-19 control measures, and mental health. Methods: Data was collected using a self-administered questionnaire in July and August 2020 after the first lockdown. Participants were 353 South Sudanese and Somali refugees living in Kampala city suburbs and Bidibidi refugee settlement. Findings: Psychological capital was positively associated with approach coping, mental health, and quality of life. However, psychological capital was negatively associated with adherence to COVID-19 control measures. Significant indirect effects of psychological capital on quality of life through approach coping, mental health, and adherence were found. However, serial mediation effects were only substantial via approach coping and mental health. Conclusion: Psychological capital is an important resource in coping with the challenges posed by COVID-19 and maintaining a good level of psychological functioning and quality of life. Preserving and boosting psychological capital is essential in responding to COVID-19 and other related disasters and crises, which are common in vulnerable populations such as refugee communities in low-income countries.

Toward a Positive Life beyond COVID-19: Problem-Solving Appraisal as a Resistance Resource in the Relationship between Stress and Well-Being in Students

The COVID-19 pandemic is a major global stressor that has been associated with elevated risk of negative mental health symptoms. As a helping profession, our main task should be identifying factors that may shield individuals from the negative consequences of stress, rather than only focusing on the causes and symptoms of stress. One such factor, identified in the literature, is an individual's perception of their problem-solving skills. In this study we investigate the role of problem-solving appraisal in the association between perceived stress and psychological well-being. Participants were students (n = 322) who completed the Problem Solving Inventory, the Perceived Stress Scale, the short forms of the trait scale of the State-Trait Anxiety Inventory, and the Beck Hopelessness Scale. The results demonstrate the health-sustaining benefits of problem-solving appraisal, as all dimensions of problem-solving appraisal (problem-solving confidence, approach-avoidance style, and problem-solving control) were directly associated with hopelessness and anxiety. The stress-buffering role of problem-solving appraisal with respect to hopelessness was demonstrated through the interaction between perceived stress and problem-solving appraisal. However, problem-solving appraisal did not buffer the effects of stress on anxiety. The findings indicate that problem-solving appraisal may be an important protective resource that could be beneficial for coping with other negative events and experiences beyond COVID-19. The implications of these findings for interventions are discussed.

Exposure to potentially morally injurious events, disruption in assumptive world, moral injury symptoms, and psychological distress among Israeli female veterans

Exposure to potentially morally injurious events (PMIEs) during military service is associated with mental health problems. However, knowledge about these associations and possible mechanisms of effect among female combat veterans is sparse. This study examines associations between PMIEs, posttraumatic stress disorder (PTSD), complex PTSD, depression and anxiety symptoms among female veterans, as well as the mediating role of disruption in assumptive world and moral injury (MI) symptoms. A volunteer sample of Israeli female combat veterans (n = 885) and non-combat veterans (n = 728) responded to self-report questionnaires in a cross-sectional design study. Results show that combat veterans reported higher levels of PMIEs, PTSD and MI symptoms, but not CPTSD, depression and anxiety symptoms, as compared to non-combat veterans. Importantly, PMIEs was indirectly associated with PTSD, complex PTSD, depression and anxiety symptoms through serial mediators of disruption in assumptive world and MI symptoms. This study emphasized the exposure to PMIEs and its posttraumatic sequelae among female combat veterans as compared to non-combat veterans. Our findings also suggest that future longitudinal studies should examine the mediating role of disruption in assumptive world and MI symptoms for the deleterious effects of exposure to PMIEs during military service.

Hardiness moderates the effects of COVID-19 stress on anxiety and depression

The COVID-19 pandemic has led to sharp increases in mental health problems around the world, most notably in anxiety and depression. The present study examines hardiness and age as potential protective factors against the mental health effects of COVID-related stress. A sample of Canadians balanced across age and gender, completed an online survey including measures of COVID related stressors, hardiness, depression, and anxiety, along with age, gender, and other demographics. Conditional PROCESS analysis showed that COVID stressors led to significant increases in anxiety and depression. Hardiness moderated these relations, with those high in hardiness showing less anxiety and depression. Age was negatively related to anxiety and depression, with highest levels observed among the younger respondents. At the same time, a moderating effect of age was found with respect to depression, with older people showing sharper increases in depression as COVID-related stress goes up. Gender was not a significant factor in any of these relations, meaning that the results apply equally well to both women and men. This study provides evidence that younger people who are also low in hardiness are most vulnerable to developing anxiety and depression while under COVID stress, and so would likely benefit from preventive intervention strategies. While anxiety and depression symptoms are highest among the young, older age groups appear more vulnerable to increasing rates of depression symptoms related to COVID stress. Clinicians and practitioners should thus be especially vigilant for COVID related increases in depression among older people, and those low in psychological hardiness.

The relationship between coping strategies and life quality in major depressed patients

Background

The present study aimed to explore, for a better understanding, the relationship between dysfunctional coping mechanisms, functionality, and quality of life in patients with major depression, during an acute episode and euthymic phase. 65 patients diagnosed with recurrent major depressive disorder were included in a longitudinal study, during which they were evaluated twice, clinically, for coping mechanisms, and also for different life quality areas. For the first time, all patients were assessed during an acute depressive episode and for the second time after 6 months of euthymia. Coping mechanisms were assessed with the Brief COPE scale, the severity of depression was evaluated by the Hamilton Depression Rating Scale-17 items, the quality of life with the WHOQOL-Bref, and the functionality with GAF.

Results

The coping mechanisms, represented by self-distraction and self-blame, were identified as being significantly correlated with the areas of life quality, mental health, and general environment, for patients having an acute depressive episode. In the euthymic phase of major depression, all dysfunctional coping strategies showed statistically significant associations with the quality-of-life domains and the coping mechanism represented by disengagement was significantly correlated with the global functionality.

Conclusions

Regardless of the current mood state, acute depression or euthymic phase, the dysfunctional coping mechanisms influence the level of life quality domains.

Personality traits and hardiness as risk- and protective factors for mental distress during the COVID-19 pandemic: a Norwegian two-wave study

BACKGROUND

Several risk factors for anxious-depressive symptomatology during the COVID-19 pandemic have been established. However, few studies have examined the relationship between personality traits, hardiness, and such symptomatology during the pandemic. These constructs might serve as risk- and/or protective factors for such mental distress through the pandemic.

METHODS

A sample of 5783 Norwegians responded to a survey at two time points within the first year of the pandemic. The first data collection was in April 2020 (T1) and the second in December 2020 (T2). Measures included the Ten-Item Personality-Inventory, the Revised Norwegian Dispositional Resilience Scale, and the Patient Health Questionnaire Anxiety and Depression Scale. Analyses were performed using Pearson's correlations, multiple linear regression, and a moderation analysis.

RESULTS

Anxious-depressive symptomatology in early phases (T1) of the pandemic was the strongest predictor for the presence of such symptomatology 9 months after the outbreak (T2). Personality and hardiness correlated significantly with mental distress at T1 and T2. Personality traits explained 5% variance in symptoms when controlling for age, gender, solitary living, negative economic impact, and mental distress at baseline. Higher neuroticism predicted higher mental distress, whereas higher conscientiousness and extraversion predicted less mental distress. Hardiness did not explain variance in outcome beyond personality traits. Hardiness did not significantly moderate the relationship between neuroticism and mental distress.

CONCLUSION

Individuals with high levels of neuroticism had greater difficulties adapting to the circumstances of the COVID-19 pandemic and were more prone to mental distress. Contrastingly, higher conscientiousness and extraversion may have served as protective factors for mental distress during the pandemic. The current findings might aid identification of vulnerable individuals and groups. Consequently, preventive interventions could be offered to those who need it the most.

Emergency Stress, Hardiness, Coping Strategies and Burnout in Health Care and Emergency Response Workers During the COVID-19 Pandemic

Objective

Stress is a growing problem in the general population, but most especially for workers responding to the COVID-19 crisis. The present study examines stress and Burnout in Health Care workers and Emergency Responders during the third COVID wave in Italy. In addition, we explore the value of psychological Hardiness and positive coping strategies as protective factors against the ill-effects of stress.

Methods

Over a 5-month period in 2021, surveys were administered across all Italian regions to several groups including Health Care workers (N = 220), Emergency Responders (firefighters, civil protection, ambulance personnel; N = 121), volunteer Italian Red Cross workers (N = 328), and a comparison group (N = 400) drawn from the General Population of Italy.

Results

Results showed that among the groups, Health Care workers had the highest levels of Emergency Stress, while the Red Cross volunteers had relatively lower stress levels. Hardiness and positive coping levels were highest among Red Cross workers, and lowest in the General Population sample. The biggest impact on Burnout was seen among health care workers, especially on Emotional Exhaustion and Depersonalization. Multiple regression results showed that Hardiness operates as a moderator of the effects of Emergency Stress on Emotional Exhaustion and Depersonalization aspects of Burnout, while problem focused coping and Stopping Negative Thoughts-Emotions also showed moderating effects.

Conclusion

These results suggest that Health Care workers and Emergency Responders would benefit from additional training in hardiness and positive coping skills.

Development and Validation of an Improved Hardiness Measure

Abstract. Previous research shows that psychological hardiness is an important factor contributing to stress resilience in individuals. Of the various instruments available to measure hardiness, the most commonly used is the Dispositional Resilience Scale (DRS). Despite its demonstrated utility, the DRS-15 still has a number of serious limitations, including low subscale reliability and limited construct validity. The present work aims to create a new hardiness scale that addresses these limitations. A pool of new items plus the original DRS item set was administered to a census-matched stratified sample of N = 2,021 men and women across the United States. Items for the new scale were selected based on item distribution characteristics, item response theory plots, scale reliabilities, item-total correlations, and confirmatory factor analysis (CFA). CFA results showed the best fitting model reflected a hierarchical structure with three factors (commitment, control, and challenge) nested under a broad hardiness factor. This factor structure is replicated in two independent validation samples and also holds invariant across gender and age. The new scale shows much improved reliability coefficients (e.g., Cronbach’s α of .93, .85, .84, and .89 for total hardiness, challenge, control, and commitment, respectively), as well as structural equivalence across gender and age. Validity is demonstrated in multiple samples via predictive associations of hardiness scores with theoretically relevant outcome measures, including coping, life satisfaction, anxiety, and depression. The Hardiness Resilience Gauge (HRG) possesses excellent reliability and validity and appears to be a more effective tool for measuring hardiness in adult populations.

Cybervictimization and Depression among Adolescents: Coping Strategies as Mediators

Studies have shown the relationships among cybervictimization, coping strategies, and depression, but no study has examined the mechanism that links the three variables. Accordingly, this study used the transactional model of stress and coping theory as a conceptual framework and proposed that coping strategies are mediators for the effects of cybervictimization on depression. A total of 387 adolescents were recruited by using the purposive sampling method. The results showed that cybervictimization is not directly associated with depression. All the coping strategies are found to be associated with cybervictimization, but only the avoidant coping strategy is the statistical mediator for the effects of cybervictimization on depression. This study’s findings suggest that the transactional model of stress and coping theory may provide a framework in the area of cyberbullying and recommend more actions to be taken in order to reduce the use of avoidance coping strategies among victims of cyberbullying.

Perceived Social Support, Coping Strategies and Psychological Distress among University Students during the COVID-19 Pandemic: An Exploration Study for Social Sustainability in Sabah, Malaysia

Social Sustainability among university students, especially how students deal with psychological distress, is important during the COVID-19 pandemic. This study examines the relationship between perceived social support and coping strategies and the psychological distress of depression, anxiety, and stress among the students of the Public University in Sabah during the COVID-19 pandemic, and to determine the level of depression, anxiety, and stress among the students. The inclusion criteria were: (1) currently an active status university student; (2) absent of visual disability; (3) absent of network coverage issues; and (4) absent of clinical symptoms of psychological distress. The total respondents were 385 students from this university who ranged from 20 to 23 years of age and were collected from all the faculties available at the main campus of Public University in Kota Kinabalu, Sabah, Malaysia. The research method applied was a survey method, collecting the data through an online questionnaire platform. Three instruments were used: (1) Depression, Anxiety and Stress Scale (DASS-21); (2) Brief COPE Scale (Brief COPE); and (3) Multidimensional Scale of Perceived Social Support (MSPSS). The result of the descriptive analysis indicated that the levels of both depression and anxiety in students of the Public University in Sabah were mild. In contrast, the stress level was moderate during the pandemic. The results of the inferential analysis indicated the relationship between perceived social support and psychological distress, which focused on depression, anxiety and stress among the university students, to overall having a significantly negative correlation between its subscales (r = between −0.148 and −0.359; p < 0.05). Based on the findings, it is clear how vulnerable university students are to psychological distress during the COVID-19 pandemic, but it can be overcome with social support and suitable types of coping strategy. Besides, a negative link between depression and problem-focused coping was reported (r = −0.274, p < 0.05). These findings also contribute to social sustainability and the wellbeing of students at the Public University in Sabah, Malaysia.

Combat Deployment Experiences and Soldier Mental Health: Examining the Factor Structure of a Combat Experiences Scale

INTRODUCTION

Researchers and practitioners are invested in understanding how deployment experiences impact the nearly 193,000 U.S. service members who deploy in a given year. Yet, there remains a need to adequately identify salient deployment experiences through survey measurement tools and understand how differential experiences are uniquely related to mental health outcomes. Therefore, this study examined the factor structure of an established combat experiences measure from the Army Study to Assess Risk and Resilience in Service members (Army STARRS) dataset to identify underlying survey constructs that reflect nuanced deployment experiences. Then, we examined the association between diverse combat experiences and current mental health symptoms (i.e., anxiety and depressive symptoms) and the mediating role of coping.

MATERIALS AND METHODS

Data were drawn from the Army STARRS data (N = 14,860 soldiers), specifically the All Army Study component. A principal component analysis (PCA) was conducted to examine the dimensionality of the combat experiences scale, and then a path model was conducted to examine the relationships between combat experiences, coping with stress following a deployment, and mental health symptoms while controlling for relevant individual and interpersonal factors.

RESULTS

Results from the principal component analysis suggested that the Army STARRS combat experiences scale encompasses two components, specifically: "Expected combat experiences" and "Responsible for non-enemy deaths." Both "Expected combat experiences" and "Responsible for non-enemy deaths" were associated with higher levels of anxiety and depressive symptoms, respectively, and "Responsible for non-enemy deaths" was also indirectly linked to these mental health outcomes through coping with stress after deployment.

CONCLUSIONS

These findings provide insight into the dimensionality of combat experiences and offer practitioners a more nuanced understanding of how to process unique combat experiences that differentially relate to mental health symptoms.

Fear of COVID-19 and Life Satisfaction: The Role of the Health-Related Hardiness and Sense of Coherence

Introduction: The COVID-19 pandemic is contributing to increased fear and anxiety throughout society, which may affect life satisfaction. Health-related hardiness and sense of coherence (SOC) are personal resources that help people adapt to difficult circumstances. The purpose of this study was to investigate the relationship between fear of COVID-19, SOC, health-related hardiness, and life satisfaction. Methods: A total of 907 Polish people (522 women and 385 men) participated in this study. The Fear of COVID-19 Scale (FOC-6), the Health-Related Hardiness Scale, the Sense of Coherence Scale (SOC-29), and the Satisfaction with Life Scale were used. Results: Correlation showed that fear of COVID-19 was negatively related to health-related hardiness, SOC, and life satisfaction. Health-related hardiness and SOC were positively related to life satisfaction. Both SOC and hardiness were mediators between fear of COVID-19 and life satisfaction during the current pandemic. Conclusion: SOC and health-related hardiness are personal resources that are important for dealing with the effects of the COVID-19 pandemic. According to our study, SOC and hardiness can mediate between fear of COVID-19 and life satisfaction. Presented cross-sectional results have to be verified in future longitudinal studies in order to strengthen the conclusions presented in this manuscript. This study verified the role of only two personal resources, so more research is needed on the role of other personal resources during COVID-19 pandemic.

Avoidance coping mediates the effect of hardiness on mental distress symptoms for both male and female subjects

The personality disposition hardiness has been shown to be associated with adaptive coping strategies and is considered an important protective factor against development of mental health symptoms. One of the criticisms found in the hardiness literature concerns the question whether the construct is equally important for men and women. Using a prospective design in a moderated mediation model, regression analyses were performed to examine the effect of avoidance coping in the association between hardiness and mental distress. The effect of biological sex was examined in the association between hardiness and avoidance coping. Our sample included 410 civilian personnel employed in a military organization. The results showed that higher hardiness levels were associated with lower reported use of avoidance coping, which in turn was associated with lower levels of distress symptoms. Avoidance coping mediated the effect of hardiness on anxiety symptoms and this indirect effect was not moderated by biological sex. These results indicate that hardiness operates similarly for women and men as a factor influencing mental distress symptoms.

Self-Handicapping in Chinese Medical Students During the COVID-19 Pandemic: The Role of Academic Anxiety, Procrastination and Hardiness

Background: In the face of the 2019 Coronavirus Disease (COVID-19) outbreak, Chinese medical students worried about their future studies which might make them more susceptible to academic anxiety. Previous studies have shown that academic anxiety is an important risk factor for self-handicapping, but there are few studies to explore the relationship between the two which may be mediated or moderated by other variables. Therefore, this study investigated how Chinese medical students' academic anxiety is correlated to their self-handicapping in time of COVID-19 epidemic, and explored the moderating and mediating effects of hardiness and procrastination. Methods: In this study, 320 Chinese medical students' psychological traits were measured with Academic Anxiety Questionnaire, Self-Handicapping Scale, General Procrastination Scale and Hardiness Scale to explore the potential associations between these variables. Results: The most obvious finding to emerge from this study was that self- handicapping had a positive correlation with academic anxiety and procrastination, but had a negative correlation with hardiness; hardiness had a negative association with academic anxiety and procrastination; and academic anxiety and procrastination were positively correlated. In addition, the relationship between academic anxiety and self-handicapping of Chinese medical students was not only partially mediated by procrastination, but also moderated by hardiness. Furthermore, medical students who had lower hardiness had stronger direct effect, while the indirect effect was strong at high and low conditions of hardiness. Conclusion: In time of the COVID-19 epidemic, the academic anxiety and self-handicapping of medical students are influenced by procrastination and hardiness to a great extent. Thus, in addition to suggesting that more attention should be paid to the academic anxiety and procrastination of medical students, in the future, more attention should be paid to cultivating the hardiness of medical students and exerting its interventional role in self-handicapping.

Is the Association between Postpartum Depression and Early Maternal-Infant Relationships Contextually Determined by Avoidant Coping in the Mother?

This study analyzes the moderating role of avoidant coping (in early pregnancy) in the relationship between postpartum depressive (PPD) symptoms and maternal perceptions about mother-baby relations and self-confidence. Participants were 116 low-risk obstetric mothers (mean age = 31.2 years, SD = 3.95, range 23-42) who received care and gave birth at a Spanish public hospital. Measurements were made at two points in time: at first trimester of pregnancy (maternal avoidance coping) and four months after childbirth (PPD and maternal perceptions). Avoidant coping was associated with the perception of the baby as irritable and unstable (p = 0.003), including irritability during lactation (p = 0.041). Interaction effects of avoidant coping and postpartum depression were observed on the perception of the baby as irritable (p = 0.031) and with easy temperament (p = 0.002). Regarding the mother's self-confidence, avoidant coping was related to a lack of security in caring for the baby (p < 0.001) and had a moderating effect between PPD and mother's self-confidence (i.e., lack of security in caring for the baby, p =0.027; general security, p = 0.007). Interaction effects showed that the use of avoidant coping in the mother exacerbated the impact of PPD on the early mother-infant relationship.

Personal Accomplishment and Hardiness in Reducing Emergency Stress and Burnout among COVID-19 Emergency Workers

During the severe phase of the pandemic, COVID-19 emergency workers were engaged in long and numerous shifts of duty, resulting in exposure to various stress factors. A high stress level is associated with risk of burnout. Resilience and personal accomplishment can effectively help mitigate and reduce emergency stress levels and emotional exhaustion. The main aim of this study was to analyze the relationship of emergency stress and hardiness with burnout among emergency workers. The participants included 494 emergency volunteers from the Red Cross Committee in Veneto, Italy, engaged in various health, emergency, and social activities aimed at COVID-19 patients and people at risk of contracting the virus. Questionnaires used to measure emergency stress, hardiness and burnout were administered on an online platform. We analyzed the influence of age, sex, weekly hours of service, stress risk factors, and use of personal protective equipment. To verify the predictive effects of risk and protective factors on burnout, correlational and multivariate analyses, and regressions were conducted. Hardiness showed an effect in reducing emergency stress levels, emotional exhaustion, and depersonalization and simultaneously increased personal accomplishment.

A Multi-Study Exploration of Factors That Optimize Hardiness in Sport Coaches and the Role of Reflective Practice in Facilitating Hardy Attitudes

Hardiness has been identified as a key personal characteristic that may moderate the ill-effects of stress on health and performance. However, little is known about how hardiness might be developed, particularly in sport coaches. To systematically address this gap, we present two linked studies. First, interviews were conducted with pre-determined high-hardy, elite coaches (n = 13) to explore how they had developed their hardy dispositions through the associated attitudinal sub-components of control, commitment, and challenge. Utilizing thematic analysis, we identified that hardiness was developed through experiential learning, external support, and the use of specific coping mechanisms. Key to all of these themes was the concept of reflective practice, which was thought to facilitate more meaningful learning from the participants' experiences and, subsequently, enhance the self-awareness and insight required to augment hardiness and its sub-components. To investigate further the potential relationship between coaches' reflective practices and their level of hardiness, we conducted a follow-up study. Specifically, a sample of 402 sports coaches completed the Dispositional Resilience Scale-15, the Self-Reflection and Insight Scale, and the Questionnaire for Reflective Thinking. Using latent profile analysis (LPA), we clustered participants into groups based on their reflective profiles (e.g., type of engagement, level of reflective thinking). We then examined differences in hardiness between the five latent sub-groups using multinomial regression. Findings revealed that the sub-group of highly engaged, intentionally critical reflective thinkers reported significantly higher levels of all three hardiness sub-components than all other sub-groups; these effect sizes were typically moderate-to-large in magnitude (standardized mean differences = -1.50 to -0.10). Conversely, the profile of highly disengaged, non-reflective, habitual actors reported the lowest level of all three dimensions. Collectively, our findings offer novel insights into the potential factors that may influence a coaches' level of hardiness. We provide particular support for the importance of reflective practice as a meta-cognitive strategy that helps coaches to develop hardy dispositions through augmenting its attitudinal sub-components. Consequently, our research makes a significant contribution by providing a comprehensive insight into how we might better train and support coaches to demonstrate the adaptive qualities required to thrive in demanding situations.

Opportunities at the intersection of work and health: Developing the occupational data for health information model

OBJECTIVE

The study sought to develop an information model of data describing a person's work for use by health information technology (IT) systems to support clinical care, population health, and public health.

MATERIALS AND METHODS

Researchers from the National Institute for Occupational Safety and Health worked with stakeholders to define relationships and structure, vocabulary, and interoperability standards that would be useful and collectable in health IT systems.

RESULTS

The Occupational Data for Health (ODH) information model illustrates relationships and attributes for a person's employment status, retirement dates, past and present jobs, usual work, and combat zone periods. Key data about the work of a household member that could be relevant to the health of a minor were also modeled. Existing occupation and industry classification systems were extended to create more detailed value sets that enable self-reporting and support patient care. An ODH code system, available in the Public Health Information Network Vocabulary Access and Distribution System, was established to identify the remaining value sets. ODH templates were prepared in all 3 Health Level 7 Internationalinteroperability standard formats.

DISCUSSION

The ODH information model suggests data elements ready for use by health IT systems in the United States. As new data elements and values are better defined and refined by stakeholders and feedback is obtained through experience using ODH in clinical settings, the model will be updated.

CONCLUSION

The ODH information model suggests standardized work information for trial use in health IT systems to support patient care, population health, and public health.