Maladaptive emotion regulation strategies in a vulnerable population predict increased anxiety during the Covid-19 pandemic: A pseudo-prospective study

Coping strategies and symptoms of Adjustment Disorder among adults with Attention Deficit Hyperactivity Disorder (ADHD) during the Covid-19 pandemic

BACKGROUND

The current study examined whether coping strategies and symptoms of Adjustment Disorder in adults with ADHD differed from what was observed in the general adult population during the Covid-19 pandemic, and compared the extent to which coping strategies and symptom levels of Adjustment Disorder were related to ADHD.

METHOD

This cross-sectional study was based on survey data collected during the spring of 2021 from 231 adult ADHD patients in specialist care and 1148 volunteers without ADHD in Sweden. The survey included questions about sociodemographic and clinical characteristics, along with the Brief-COPE and Adjustment Disorder-New Module 8 questionnaires. Regression models adjusting for sociodemographic and clinical characteristics were used for between-group comparisons of coping strategies and symptoms of Adjustment Disorder.

RESULTS

There were some notable differences in the use of coping strategies between persons with and without ADHD; however, many of these differences were not observed in the adjusted models. The use of behavioral disengagement was more frequently observed among individuals with ADHD, whereas planning was more common among individuals without ADHD. Individuals with ADHD appeared to show higher symptom levels of Adjustment Disorder during the pandemic. Passive coping strategies, such as denial, self-blame, and behavioral disengagement, were associated with higher symptom levels of adjustment disorder in both individuals with and without ADHD.

CONCLUSION

In conclusion, the results highlight that persons with ADHD may need more support to adjust to large societal changes than the general public. Potential targets for intervention towards members of this group include reducing resignation and maladaptive coping strategies.

The role of late adolescents' emotion regulation in the experience of COVID-19 lockdown: A longitudinal study

The COVID-19 pandemic may be considered a unique mass-trauma experience. This study examined the relations between Italian late adolescents' emotion regulation strategies, their anxiety states, and their experience of the lockdown (in terms of discomfort related to restrictions, capacities to create new functional daily routines, and to find positive changes in one's own life) during the first wave of this pandemic. We analysed how participants' reports of cognitive reappraisal and expressive suppression were associated with anxiety states during the 2020 Italian COVID-19 lockdown (large scale physical distancing and movement restrictions) and one month after the lockdown restrictions had been removed. We also examined how cognitive reappraisal, expressive suppression, and anxiety states were linked to late adolescents' experience of lockdown. The participants were 497 Italian adolescents, aged from 17 to 24 years (Mage = 21.11, SD = 1.83). A longitudinal structural equation modelling showed that emotion regulation strategies and anxiety states were not associated across time. Cognitive reappraisal was positively associated with routine reorganization and positive changes. In contrast, participants' expressive suppression was negatively related to their discomfort related to restrictions, ability to functionally reorganise their daily routine, and ability to find positive changes related to the COVID-19 emergency. Anxiety was positively linked to discomfort related to restrictions. The findings are discussed in light of the current literature related to emotion regulation and anxiety. Limitations and implications for practice are presented.

Coping Strategies and Their Relationship With Subjective Distress due to the COVID-19 Pandemic in Brazil

OBJECTIVES

To identify the strategies used by Brazilian adults for coping with the COVID-19 pandemic and to verify the effect of these strategies on subjective distress.

METHODS

This was a cross-sectional observational study with online data collection in May/June 2020, November/December 2020, and May/June 2021. The BriefCOPE Inventory and the Impact of Event Scale (IES-R) were used. The prevalence of strategies used at different time points was estimated with a 95% confidence interval and compared with a z-test. A multiple logistic regression model was constructed and the odds ratio (OR, 95%CI) was calculated to verify the probability of subjective distress according to the coping strategy used.

RESULTS

Younger individuals had a lower prevalence of adaptive strategies, which increased significantly with age. Participants with higher income levels had a higher prevalence of adaptive strategies, as did those who were never diagnosed with a mental health disorder. The prevalence of using only maladaptive strategies ranged from 6.1% to 5.4% (p > 0.05). The use of problem-centered strategies (Active Coping and Planning), venting of emotions, and substance use increased with time, while acceptance and behavioral disengagement decreased. In general, the population used problem-centered strategies, but the high prevalence of problem avoidance was striking. Positive reinterpretation and acceptance were protective factors for subjective distress, whereas maladaptive strategies increased the chance of distress. The presence of a negative valence component (problem- or emotion-centered) increased the chance of subjective distress, whereas strategies based on Problem Solving acted as a protective factor.

CONCLUSION

Coping strategies were significantly associated to subjective distress and have changed since the beginning of the pandemic. Strategies focused on emotion regulation may be relevant to minimize distress.

Catastrophizing Maladaptive Coping Affects the Association Between Viral Anxiety and Fear of Progression in Cancer Patients During COVID-19 Pandemic

OBJECTIVE

The aim of the present study was to explore whether or not cancer patients' viral anxiety and depression during the coronavirus-2019 (COVID-19) pandemic were associated with a fear of cancer progression. We also assessed whether coping strategies affected the relationship.

METHODS

The present cross-sectional survey included cancer patients who visited Ulsan University Hospital in Ulsan, Korea. The participants' demographic information and responses to the following symptoms rating scales were collected: Stress and Anxiety to Viral Epidemic-6; Patient Health Questionnaire-9; Cognitive Emotion Regulation Questionnaire-short version; or Fear of Progression Questionnaire-short version.

RESULTS

Of the 558 cancer patients surveyed, 25 (4.5%) reported that their treatment schedule was delayed during the COVID-19 pandemic. The patients' fear of progression was found to be related to age (β=-0.08; p=0.011), viral anxiety (β=0.40; p<0.001), depression (β=0.26; p<0.001), and catastrophizing coping strategies (β=0.15; p=0.004), for an overall adjusted R2 of 0.46 (F=66.8; p<0.001). Mediation analysis showed that viral anxiety and depression were directly associated with fear of progression, while catastrophizing mediated this relationship.

CONCLUSION

Fear of progression in cancer patients was associated with viral anxiety, depression, and maladaptive coping techniques, such as catastrophizing, during the COVID-19 pandemic.

Insights from COVID-19: Reflecting on the Promotion of Long-Term Health Policies in China

China announced the Healthy China Initiative (2019-2030) in 2019, an action program aimed to support the country's current long-term health policy, Healthy China 2030, which focuses on public health promotion and health awareness. Following the implementation of the policy, China had the COVID-19 pandemic, which had an influence on both the public's degree of health awareness and the adoption of the HCI. This research examines whether the COVID-19 epidemic has increased public understanding and acceptance of China's long-term health policy. In addition, it analyzes whether the Chinese public's awareness of health policy has been impacted by China's usage of smart healthcare in its response to the pandemic. To correspond to these study aims, we used a questionnaire based on the research questions and recent relevant research. The results of the study, based on an examination of 2488 data, demonstrate that the Healthy China Initiative is still poorly understood. More than 70% of respondents were unfamiliar with it. However, the results imply that respondents are becoming more aware of smart healthcare and that public acceptance of official health policies can be aided by the sharing of knowledge about this. As a result, we examine the situation and draw the conclusion that the spread of cutting-edge health-related technology can enhance the communication of health policy and provide participants and policymakers with fresh insights. Finally, this study also can provide lessons for other countries in the early stages of policy dissemination, particularly health policy advocacy and promotion during epidemics.

COVID-19 Related Negative Life Events and Psychological Distress: The Role of Emotion and Cognitive Emotion Regulation Strategies

This cross-sectional study was conducted to determine the potential role of hopelessness, helplessness, and cognitive emotion regulation strategies in the relationship between adverse life events and psychological distress among Turkish adults. Participants' ages ranged from 18 to 64 years old. The majority were female. From June 21, 2021, to August 18, 2021, 432 participants responded to an online questionnaire that included the Negative Life Events List (NLEs), the Helplessness, and Hopelessness, and the Cognitive Emotion Regulation Strategies Scale (CERS) and General Health Questionnaire-12. The findings suggest that the NLEs, directly and indirectly, predict psychological distress through helplessness and hopelessness. The direct and indirect predictive effects of the NLEs on psychological distress varied depending on the level of CERS. The current study's findings have contributed to our understanding of the mechanisms underlying the relationship between the NLEs and psychological distress during pandemics.

Emotion Dysregulation and Conspiracy Beliefs about COVID-19: The Moderating Role of Critical Social Media Use

As COVID-19 has spread worldwide, conspiracy theories have proliferated rapidly on social media platforms, adversely affecting public health. For this reason, media literacy interventions have been highly recommended, although the impact of critical social media use on the development of COVID-19 conspiracy theories has not yet been empirically studied. Moreover, emotional dysregulation may play another crucial role in the development of such theories, as they are often associated with stress, anxiety, lack of control, and other negative emotions. Therefore, the aim of this study was to test the hypothesis that emotion dysregulation would be positively associated with conspiracy beliefs about COVID-19 and that critical use of social media would attenuate this association. Data from 930 Italian participants (339 men and 591 women) were collected online during the third wave of the COVID-19 outbreak. A moderated model was tested using the PROCESS Macro for SPSS. Results showed that: (1) emotion dysregulation and critical social media use accounted for a significant proportion of the variance in conspiracy beliefs about COVID-19; and (2) critical social media use moderated the effect of emotion dysregulation on conspiracy beliefs about COVID-19. Implications for preventing the spread of conspiracy theories are discussed.

Emotion Regulation and Distress During the COVID-19 Pandemic: The Role of Childhood Abuse

The COVID-19 pandemic may be experienced as traumatogenic and may fuel or exacerbate psychological distress and trauma-related symptoms. Based on trauma research, one might expect that survivors of childhood abuse would be susceptible to these negative outcomes during the pandemic, and that among this population a stronger relation between emotion regulation difficulties and symptomatology would be found. Aiming to explore these suppositions, an online survey was conducted among 710 Israeli adults. Of them, 370 were childhood abuse survivors. A history of childhood abuse, COVID-19-related stressors, overall psychological distress, and peritraumatic stress symptoms during the pandemic were assessed via self-report measures. Participants with a history of childhood abuse had elevated overall psychological distress as well as peritraumatic stress symptoms during the pandemic, compared to nonabused participants, above and beyond demographic characteristics and COVID-19-related stressors. Emotion regulation difficulties were related to elevated psychological distress and peritraumatic stress symptoms among both childhood abuse survivors and nonabused participants. Nonetheless, a history of childhood abuse moderated the relations between the emotion regulation difficulty of being unable to engage in goal-directed behaviors when distressed (on one hand) and mental outcomes (on the other): Although the associations between inability to engage in goal-directed behaviors, overall psychological distress, and peritraumatic stress symptoms were nonsignificant among nonabused participants, they were significant among childhood abuse survivors. The current findings suggest that a history of childhood abuse might be a risk factor for distress in the face of COVID-19, and that childhood abuse survivors would benefit from clinical interventions that promote emotion regulation skills during this ongoing global health crisis.

The psychological impact of the COVID-19 lockdown in Italy: The moderating role of gender and emotion regulation

Many researchers suggest that the COVID-19 pandemic may have more negative effects on women than men. Accordingly, we hypothesized that women would experience greater COVID-19 related distress and more psychopathological symptoms than men during the first COVID-19 lockdown in Italy. Moreover, we expected emotion regulation strategies (cognitive reappraisal and expressive suppression, as protective and risk factors respectively) to interact with gender in shaping psychological health. We administered an online questionnaire to 1519 participants during the first national COVID-19 lockdown in Italy. As predicted, women reported greater COVID-19 related distress and more psychopathological symptoms than men. Furthermore, women who made greater use of reappraisal reported lower levels of distress and fewer psychopathological symptoms. Suppression was associated with more psychopathological symptoms, but there were no interaction effects with gender. Our findings have implications for policymakers wishing to sustain women's health during stressful situations such as the COVID-19 outbreak and beyond.

Prefrontal Cortical Thickness, Emotion Regulation Strategy use and Covid-19 Mental Health

Coronavirus disease 2019 (COVID-19) and associated restrictions have been linked to negative mental health outcomes across the globe. Cognitive emotion regulation strategies, neurally supported by prefrontal and limbic regions, constitute means to mitigate negative affects resulting from adverse life experiences. Variations in cognitive emotion regulation strategy use, anxiety, and depression were assessed in 43 adults (31♀/12♂, age = 35.14 ± 9.20 years) during the first months following COVID-19 onset and at the end of 2020 (seven assessments). Direct and indirect effects of emotion regulatory brain structures assessed prior to the pandemic and emotion regulation strategy use during the pandemic were assessed in relation to mental well-being. Varying levels of anxiety and depression were observed. While adaptive emotion regulation strategies were most frequently employed, maladaptive strategies explained the highest variation in anxiety and depression scores. The effectiveness of specific emotion regulation strategies varied. Momentary emotion regulation strategy use mediated the association between cortical thickness in right lateral prefrontal cortex assessed prior to the pandemic and mental health during the pandemic. Early mental health measures impacted later mental well-being. Maladaptive strategies have a negative effect on mental health during prolonged stress as induced by pandemics, providing possible targets for intervention.

Factors related to compliance with the COVID-19 health regulations among young people

The coronavirus pandemic has affected all facets of our lives and all ages and social strata worldwide. Measures have been taken to protect against the spread of the virus, such as more rigorous hand hygiene, the use of face masks and social distancing. However, the focus has often been on young people, who have been seen as a group lacking sufficient respect for government-imposed measures. This review outlines the preventive measures that have been taken in different countries and discusses their specific impact on young people and adolescents, taking into account the developmental stage and concrete needs of this age group. It summarizes those studies that have provided information on compliance with preventive measures by young people and adolescents, concluding that although compliance levels among this age group are lower than among older adults, the general view of youths as non-compliant is not consistent with real, objective data. The review also summarizes different views regarding the possible reasons for this lower level of compliance, taking into account both social (gender and age) and personal factors (personality, empathy, prosociality, self-control, cognitive styles and motivations), and discusses the practical implications of these findings for the future.

Effects of COVID-19 on maternal anxiety and depressive disease: a literature review

The coronavirus SARS-CoV-2 (COVID-19) infection is a public health emergency of international concern. Pandemics pose a challenge to psychological resilience and can have an adverse impact on mental health. The impact of the ensuing social isolation and loneliness imposed by quarantine along with the worries about the risks of the infection and its economic fallout would appear likely to affect the mental health of the population. It has been reported that women are more likely to experience anxiety and depression symptoms during COVID-19 than men. COVID-19 pandemic had a profound impact on the level of anxiety and depression of pregnant women according to their basal level and pregnancy characteristics. Antenatal mental disorders may be a risk factor for maternal mental health problems such as an increased likelihood of postnatal depression and adverse obstetric and developmental outcomes. Effective coping strategies are associated with better psychological wellbeing during the COVID-19 pandemic, including reduced anxiety and depression. The increased risk of mental disorders due to COVID-19 requires policies to be developed to address prenatal and postpartum care to promote maternal-child wellbeing outcomes.

Depression and Anxiety in Times of COVID-19: How Coping Strategies and Loneliness Relate to Mental Health Outcomes and Academic Performance

The link between depression, anxiety, and loneliness has been well established in the literature. Yet, the performance consequences of these negative mental health outcomes and the role of coping behaviors, as well as behavioral consequences such as procrastination as mediators have received far less research attention. Due to the COVID-19 social isolation restrictions, people are at risk of falling into a negative mental health spiral that can also affect their performance over time. The purpose of this longitudinal study among 881 first-year bachelor students is to explore the mechanisms by which loneliness, coping strategies in the context of COVID-19, mental health outcomes and procrastination sequentially mediate the relationship depression and anxiety on the one hand, and academic performance on the other hand. We measured mental health variables several times during the COVID-19 crisis and assessed how this translates into academic performance at the end of the academic year. By performing exploratory and confirmatory factor analyses, three high-order factors for the coping strategies in the context of the COVID-19 crisis were identified, namely maladaptive coping, adaptive coping, and supportive coping. Structural equation modeling was used to test the sequential mediational model. The results showed that maladaptive coping strategies employed at T2 during the lockdown, but not adaptive or supportive coping partially mediate the trajectories of depression (T1) and anxiety (T1). Loneliness (T2) partially mediated the trajectory of depression and anxiety (T1), and procrastination fully mediated the impact of depression (T3) on academic performance (T4). These results help understand the mechanisms that influence mental health and academic performance outcomes in response to the COVID-19 crisis. Based on the study outcomes, educational researchers can test strategies to reduce the adverse effects of stressful situations in learning environments by targeting maladaptive coping behaviors and procrastination.

Profiles in COVID-19: peritraumatic stress symptoms and their relation with death anxiety, anxiety sensitivity, and emotion dysregulation

Background

The COVID-19 pandemic might be experienced as an ongoing traumatic event and could result in peritraumatic stress symptoms. Evidence implies that individuals' levels of death anxiety, anxiety sensitivity, and difficulties in emotion regulation may contribute to their peritraumatic stress symptomatology in the aftermath of trauma exposure.

Objective

The current study aimed to explore these hypotheses in the context of the COVID-19 pandemic.

Method

An online survey was conducted among a convenience sample of 846 Israeli adults from April 2 to 19 April 2020. COVID-19-related stressors, death anxiety, anxiety sensitivity, difficulties in emotion regulation, and peritraumatic stress symptoms were assessed via self-report questionnaires.

Results

Analyses indicated significant relations between death anxiety, anxiety sensitivity, and emotion regulation difficulties, on the one hand, and peritraumatic stress symptoms, on the other. Three distinct profiles were identified. Furthermore, profile type - namely having low, medium, and high levels of death anxiety, anxiety sensitivity, and emotion dysregulation - had a significant effect in explaining peritraumatic stress symptoms.

Conclusions

Results suggest that during the pandemic, levels of death anxiety, anxiety sensitivity, and emotion dysregulation may explain heterogeneity in individuals' trauma-related symptomatology.

Coping strategies mediate the associations between COVID-19 experiences and mental health outcomes in pregnancy

The COVID-19 pandemic has resulted in elevated mental health problems for pregnant women. Effective coping strategies likely reduce the impact of COVID-19 on mental health. This study aimed to (1) understand how COVID-19 stressors are related to different coping strategies and (2) identify whether coping strategies act as mechanisms accounting for the associations between COVID-19 stressful experiences and mental health problems in pregnancy. Participants were 304 pregnant women from Ontario, Canada. Depression, anxiety, insomnia, and perceived stress were assessed using validated measures. COVID-related stressors (i.e., financial difficulties, social isolation), subjective negative impact of COVID-19, and coping strategies used in response to COVID-19 were assessed by questionnaires. Results indicated that the subjective negative impact of COVID-19 was associated with more dysfunctional coping and less emotion-focused coping, whereas specific COVID-19 stressors, namely financial difficulties and social isolation, were associated with more dysfunctional coping and problem-focused coping. Dysfunctional coping was linked to elevated mental health problems and emotion-focused coping was linked to less mental health problems. Dysfunctional coping and emotion-focused coping partially mediated the effects of specific COVID-19 stressors on mental health outcomes. Findings indicate that coping is one pathway through which the COVID-19 pandemic impacts mental health in pregnancy. Supports and interventions for pregnant women during the pandemic should focus on bolstering coping skills, in order to minimize the mental health consequences of COVID-19.