How does COVID stress vary across the anxiety-related disorders? Assessing factorial invariance and changes in COVID Stress Scale scores during the pandemic

Psychometric evaluation and item response theory analysis of the COVID Stress Scales in an older adult population

OBJECTIVES

The COVID Stress Scales (CSS) represent a widely used self-report measure of stress and anxiety-related responses to COVID-19. Although the CSS have been validated across various nations and languages, their psychometric properties have not been assessed at the factor- or item-level with older adults. We aimed to psychometrically evaluate the CSS in older adults.

METHOD

The CSS was examined with 486 North American older adults aged 65 years and older. Data were collected in January 2024 using Qualtrics Panels. Reliability was assessed using Cronbach's alpha and McDonald's omega coefficients, structural validity using confirmatory factor analysis, and discriminant validity using a social desirability measure. Item properties were examined using item response theory.

RESULTS

The CSS demonstrated robust internal consistency and a defensible five- and six-factor structure, with the six-factor providing the most optimal model of measurement. All items adequately discriminated among respondents with varying levels of COVID-related stress.

CONCLUSION

This study is first to demonstrate that the CSS functions as a reliable and valid tool for evaluating COVID-related stress among older adults, a necessary step for supporting its use in assessing mental health impacts of pandemics in a population at high risk of negative post-infection outcomes.

Mental Health in the Time of the COVID-19 Pandemic: A Scoping Review of Collateral Effects on Common Mental Disorders (CMDs)

It is unclear whether the COVID-19 pandemic has had consequences for common mental disorders (CMDs). This scoping review aims to examine direct infection-related (e.g., severe COVID-19 illness), psychosocial (e.g., social isolation), and indirect outcomes (e.g., changes in incidence) that have been particularly discussed so far. A literature search for clinically diagnosed adult CMDs was conducted using Pubmed, Web of Science, and PsycInfo (n = 5325). After completion of the screening process, 26 included studies remained for extraction. None of the included studies reported post-pandemic data. The effects appeared to be particularly pronounced for anxiety and obsessive-compulsive disorders in the first year of the pandemic. This was followed by a period of adjustment, during which rates of mental disease and its symptoms largely returned to pre-pandemic levels. Fluctuating rates of CMDs may have had COVID-related causes. Preventive temporary inpatient care could be a protective approach for those at risk or vulnerable, as well as establishing pandemic consultation and building resilience. A gap in the research is the lack of comparisons of CMD data before, during, and after the pandemic to distinguish transient disease rates from chronic disease requiring treatment.

Measuring Psychological Response to Pandemics: Further Psychometric Investigation of the COVID Stress Scales

The COVID Stress Scales (CSS; Taylor et al., 2020b) were developed as a measure of stress related to any pandemic, making it a valuable self-report measure for potential future large-scale infectious disease outbreaks. Although the initial validation study of the CSS indicated evidence of its psychometric strength, further assessment is warranted of the measure's retest reliability, the long-term stability of its five-factor structure, discriminant validity, and its relationship with pandemic-related risk and precautionary behaviors. We examined these psychometric elements of the CSS using longitudinal data collected from a nationally representative sample of adults (N = 205) during the COVID-19 pandemic. Results indicate moderate retest reliability that is consistent with changing rates of morbidity. Results also support the five-factor structure and demonstrate convergent validity, discriminant validity, and the ability to predict relevant behavioral responses to an active pandemic. Use of the CSS for future pandemics is discussed.

Co-rumination and intrapersonal cognitive processes predict distress: Longitudinal evidence from the COVID-19 pandemic

Perseverative thinking and catastrophizing have well established associations with fear and distress. However, less is known about the impact of interpersonal dynamics, such as co-rumination, on these intrapersonal cognitive processes and subsequent stress. The present study addresses this knowledge gap. A sample of 433 adults from across the United States was recruited online and completed measures of co-rumination, perseverative thinking, catastrophizing, and demographic characteristics early in the COVID-19 pandemic, and the COVID Stress Scales (CSS) at six month follow up. Co-rumination, perseverative thinking, catastrophizing, and CSS scores were correlated in the expected direction. Regression analyses revealed all three independently predicted CSS worry about the dangerousness of COVID-19 subscale. Co-rumination was the strongest predictor of CSS worry about the socioeconomic impact and CSS compulsive checking scales. Perseverative thinking and catastrophizing predicted CSS traumatic stress symptoms subscale. Finally, perseverative thinking was the strongest predictor of CSS xenophobia subscale. Structural equation modelling indicated that co-rumination had a significant indirect effect on CSS scores through perseverative thinking and catastrophizing. Interpersonal dynamics, such as co-rumination, are relevant for understanding stress and are promising targets for intervention research to prevent or attenuate fears and distress, in addition to traditional intrapersonal cognitive processes such as perseverative thinking and catastrophizing.

Associations Among Emotion Regulation, COVID Stress, Alcohol Use, and Intimate Partner Aggression Among College Students During the COVID-19 Pandemic

Purpose

Intimate partner aggression (IPA) increased after the onset of the COVID-19 pandemic. Following the Vulnerability-Stress-Adaptation (VSA) model, the current study examined associations among emotion regulation (ER) difficulties (an enduring vulnerability), COVID stress (a current stressor), alcohol use (a maladaptive coping strategy), and physical, psychological, and cyber IPA perpetration during the first eight months of the pandemic.

Method

Participants were 215 college students in current relationships from three universities across the US.

Results

Results of generalized linear models controlling for pre-COVID IPA perpetration showed a main effect of ER difficulties on physical IPA perpetration (b = .56, p < .001), an ER difficulties X COVID stress X alcohol use interaction on psychological IPA perpetration (b = .01, p = .03), and an ER difficulties X COVID stress interaction on cyber IPA perpetration (b = -.02, p = .02). Specifically, when ER difficulties and alcohol use were low, individuals with high levels of COVID stress were at higher risk of perpetrating psychological IPA relative to individuals with low levels of COVID stress. However, the association between COVID stress and psychological IPA perpetration was not statistically significant when ER difficulties and alcohol use were high. Similarly, when ER difficulties were low, individuals with high levels of COVID stress were at higher risk for perpetrating cyber IPA relative to individuals with low levels of COVID stress. However, when ER difficulties were high, the association between COVID stress and cyber IPA perpetration was not statistically significant.

Conclusions

The current findings tentatively implicate COVID stress as a critical correlate of IPA perpetration and suggest that individuals who have fewer existing vulnerabilities (i.e., ER difficulties) and maladaptive processes (i.e., alcohol use) should not be overlooked.

Prospective exploration of the role of combined internalizing symptoms in self-reported memory among older adults during the COVID-19 pandemic

OBJECTIVES

A growing literature suggests depression and anxiety increase risk of cognitive decline. However, few studies have examined their combined effects on cognition, among older adults, especially during periods of high stress.

METHOD

Based on a sample of community dwelling older adults (N = 576), we evaluated the effects of pre-pandemic anxiety and depressive symptoms, obtained in September 2018, to changes in self-reported memory (SRM) assessed 3 months into the COVID-19 pandemic.

RESULTS

In separate models, we found participants with depression scores at least 1-SD above the mean and participants with anxiety scores at least 2-SD above the mean to report a significant decline in SRM. Moderation analyses revealed those with high depressive symptoms (at or above the mean) showed a decrease in SRM regardless of anxiety. The extent to which high pre-pandemic anxiety symptoms influenced SRM is dependent on whether pre-pandemic depression was at or above the mean.

CONCLUSIONS

Pre-pandemic depression predicted a decline in SRM regardless of anxiety. Moderation analyses revealed that the extent to which anxiety symptoms influenced SRM was dependent on depression being at or above the mean. Those with high anxiety and depression are at highest risk of experiencing cognitive consequences related to stressful exposures like COVID-19.

War-related stress scale

BACKGROUND

The current war in Ukraine has affected the well-being of people worldwide. In order to understand how difficult the situation is, specific stressors associated with war need to be measured. In response, an inventory of war-related stressors including its short form, has been developed.

METHODS

A list of potential war-related stressors was created, and the content validity of each item assessed. The list, along with other validated scales, was administered to a representative sample of the Slovak population (effective N = 1851). Exploratory factor analysis, confirmatory factor analysis, convergent validity analysis and network analysis were carried out to determine the optimal scale (long and short form) focused on war-related stressors.

RESULTS

The full version of the scale consists of 21 items, further divided into three factors: society-related stressors, person-related stressors, and security-related stressors. The short version of the scale comprises nine items loaded onto one factor. These items cover concerns for one's safety and future, access to necessities, potential worsening of the economic situation, and the risk of conflict escalation, including a nuclear threat. The results of the network analysis indicate that concern about escalation and fear of an economic crisis play a central role.

CONCLUSIONS

The scale attempts to encompass a wide spectrum of areas that are affected by war and its potential consequences on individuals who reside outside the conflict zone. Given the complexity of the issue, researchers are invited to modify the scale, tailoring it to specific cultural, geographical, and temporal contexts.

COVID-19 anxiety and its relation to anxiety-related disorder symptoms and mechanisms

The COVID-19 pandemic had a significant impact on the mental health of individuals, particularly in the area of anxiety-related disorders. Anxiety regarding COVID-19 has been associated with health anxiety, panic disorder, and obsessive-compulsive disorder symptoms. Additionally, COVID-19 anxiety has been associated with anxiety sensitivity, disgust, maladaptive metacognitions, and intolerance of uncertainty. While researchers have established that anxiety disorders and anxiety-related mechanisms were associated with COVID-19 anxiety, which specific anxiety-related symptoms and mechanisms are primarily associated with COVID-19 anxiety needs to be more extensively explored. The current study sought to further this area by examining which particular anxiety-related disorder symptoms and mechanisms were uniquely associated with COVID-19 anxiety. A non-clinical sample of 593 Canadian undergraduate participants (Mage = 21.13 years; 67.7 % female) completed this cross-sectional study between September 2020 and February 2021. Participants completed online questionaries assessing anxiety-related disorder symptoms and mechanisms in addition to multiple scales of COVID-19 anxiety. When examining symptoms, health anxiety (prs = 0.17-0.29) and obsessive-compulsive disorder (prs = 0.16-0.35) symptoms had the strongest unique associations with COVID-19 anxiety. Among the anxiety-related mechanisms, disgust sensitivity (prs = 0.14-0.16) and health anxiety-specific intolerance of uncertainty (prs = 0.12-0.30) had the strongest unique associations with COVID-19 anxiety. Individuals experiencing these disorders and anxiety-related mechanisms may be at a heightened vulnerability to experiencing heightened anxiety during future pandemics. Mental health professionals should discuss COVID-19 anxiety with individuals experiencing health anxiety or obsessive-compulsive disorder symptoms. Lastly, the study highlights the significance of considering a variety of specific anxiety-related disorder symptoms and mechanisms when working to understand pandemic anxiety.

Is there evidence for factorial invariance of the COVID Stress Scales? an analysis of North American and cross-cultural populations

The COVID-19 pandemic impacted the mental health of more citizens globally than any previous modern viral outbreak. In response to the psychological challenges associated with COVID-19, the COVID Stress Scales (CSS) were developed to assess the presence and severity of COVID-related distress. The initial North American validation study of the CSS identified that the scale comprised five factors: danger and contamination fears, fear of socioeconomic consequences, xenophobia, checking and reassurance seeking, and traumatic stress symptoms. The CSS have since been validated across a multitude of international populations. However, findings support a five- and six-factor model. Methodological issues make interpreting most studies supporting a five-factor model challenging. The purpose of this study was to re-evaluate the factor structure of the CSS using data from North American samples, to assess for potential factorial invariance, and compare these results to cross-cultural findings. Multiple confirmatory factor analyses (mCFA) were conducted across 28 different groups (e.g., age, ethnicity/race, sex) from two large independent North American samples from 2020 (n = 6827) and 2021 (n = 5787), assessing the fit indices of the five-, six-, and alternative-factor model of the CSS. The current results provide evidence for factorial invariance of the six-factor model of the CSS across different North American demographics and highlight potential challenges in interpreting the results of studies that have supported a five-factor model of the CSS.

Intolerance of Uncertainty and Worry Prospectively Predict COVID-19 Anxiety and Distress: A 4-Year Longitudinal Study

The COVID-19 pandemic precipitated an uptick in poor mental health outcomes, including coronavirus-related anxiety and distress. Preliminary research has shown that intolerance of uncertainty (IU) and worry proneness, two transdiagnostic risk factors for anxiety and related disorders, are associated cross-sectionally with pandemic-related fear and distress. However, the extent to which IU and worry proneness prospectively predict coronavirus-related anxiety and distress is unclear. Whether IU and worry may also interact in prospectively predicting coronavirus-related anxiety and distress is also unknown. To address this knowledge gap, the present study examined IU and trait worry as prospective predictors of the level and trajectory of coronavirus anxiety and COVID stress syndrome over time, as well as the extent to which worry moderated the relation between IU and pandemic-related outcomes. Participants (n = 310) who completed self-report measures of IU and trait worry in 2016 were contacted following the onset of COVID-19 in 2020 and completed biweekly measures of coronavirus anxiety and COVID stress syndrome for 30 weeks. Multilevel models revealed that IU assessed in 2016 significantly predicted the severity of both coronavirus anxiety and COVID stress syndrome throughout the study period in 2020. Worry also moderated the link between IU and coronavirus anxiety, such that individuals with high levels of trait worry and high IU in 2016 experienced the most coronavirus anxiety in 2020. Results suggest that IU and worry functioned as independent and interactive vulnerability factors for subsequent adverse psychological reactions to COVID-19. Clinical implications and future directions are discussed.

The longitudinal association of stressful life events with depression remission among SHARP trial participants with depression and hypertension or diabetes in Malawi

Depressive disorders are leading contributors to morbidity in low- and middle-income countries and are particularly prevalent among people with non-communicable diseases (NCD). Stressful life events (SLEs) are risk factors for, and can help identify those at risk of, severe depressive illness requiring more aggressive treatment. Yet, research on the impact of SLEs on the trajectory of depressive symptoms among NCD patients indicated for depression treatment is lacking, especially in low resource settings. This study aims to estimate the longitudinal association of SLEs at baseline with depression remission achievement at three, six, and 12 months among adults with either hypertension or diabetes and comorbid depression identified as being eligible for depression treatment. Participants were recruited from 10 NCD clinics in Malawi from May 2019-December 2021. SLEs were measured by the Life Events Survey and depression remission was defined as achieving a Patient Health Questionaire-9 (PHQ-9) score <5 at follow-up. The study population (n = 737) consisted predominately of females aged 50 or higher with primary education and current employment. At baseline, participants reported a mean of 3.5 SLEs in the prior three months with 90% reporting ≥1 SLE. After adjustment, each additional SLE was associated with a lower probability of achieving depression remission at three months (cumulative incidence ratio (CIR) 0.94; 95% confidence interval: 0.90, 0.98, p = 0.002), six months (0.95; 0.92, 0.98, p = 0.002) and 12 months (0.96; 0.94, 0.99, p = 0.011). Re-expressed per 3-unit change, the probability of achieving depression remission at three, six, and 12 months was 0.82, 0.86, and 0.89 times lower per 3 SLEs (the median number of SLEs). Among NCD patients identified as eligible for depression treatment, recent SLEs at baseline were associated with lower probability of achieving depression remission at three, six, and 12 months. Findings suggest that interventions addressing SLEs during integrated NCD and depression care interventions (e.g., teaching and practicing SLE coping strategies) may improve success of depression treatment among adult patient populations in low-resource settings and may help identify those at risk of severe and treatment resistant depression.

Trends in non-fatal and fatal opioid overdoses during the first two years of the coronavirus disease-2019 pandemic

PURPOSE

This study assessed opioid-involved overdose rates by age, sex, and race-ethnicity across strict pandemic mitigation phases and how this varied across data systems.

METHODS

We examined opioid-involved overdoses using medical examiner and hospital data for Cook County, Illinois between 2016-2021. Multivariable segmented regression was used to assess weekly overdose rates across subgroups of age, sex and race/ethnicity and strict pandemic mitigation phases.

RESULTS

The overall rate of weekly opioid-involved overdoses increased when assessing the medical examiner (β = 0.01; 95% CI = 0.01,0.02; P ≤ .001) and emergency department visits data sources (β = 0.15; 95% CI = 0.09,0.20; P ≤ .001) but not for the hospital admissions data source. We found differences in overdose rates across subgroups and phases of pandemic mandates. Fatal overdoses increased during lockdown-1 while admissions and emergency department (ED) visits for opioid-involved overdoses generally decreased across all phases of pandemic mitigation mandates except for the period following lockdown-1. Across pandemic mitigation phases, Hispanics and individuals under 25 years did not demonstrate any change in admissions and ED visits for overdoses.

CONCLUSIONS

We underscore the importance of utilizing multiple sources of surveillance to better characterize opioid-involved overdoses and for public health planning.

Financial Toxicity among Patients with Breast Cancer during the COVID-19 Pandemic in the United States

This study reported the prevalence of financial distress (financial toxicity (FT)) and COVID-19-related economic stress in patients with breast cancer (BC). Patients with BC were recruited from the Ciitizen platform, Breastcancer.org, and patient advocacy groups between 30 March and 6 July 2021. FT was assessed with the COmprehensive Score for financial Toxicity (COST) instrument. COVID-19-related economic stress was assessed with the COVID-19 Stress Scale. Among the 669 patients, the mean age was 51.6 years; 9.4% reported a COVID-19 diagnosis. The prevalence rates of mild and moderate/severe FT were 36.8% and 22.4%, respectively. FT was more prevalent in patients with metastatic versus early BC (p < 0.001). The factors associated with FT included income ≤ USD 49,999 (adjusted odds ratio (adj OR) 6.271, p < 0.0001) and USD 50,000-USD 149,999 (adj OR 2.722, p < 0.0001); aged <50 years (adj OR 3.061, p = 0.0012) and 50-64 years (adj OR 3.444, p = 0.0002); living alone (adj OR 1.603, p = 0.0476); and greater depression severity (adj OR 1.155, p < 0.0001). Black patients (adj OR 2.165, p = 0.0133), patients with income ≤ USD 49,999 (adj OR 1.921, p = 0.0432), or greater depression severity (adj OR 1.090, p < 0.0001) were more likely to experience COVID-19-related economic stress. FT was common in patients with BC, particularly metastatic disease, during COVID-19. Multiple factors, especially lower income and greater depression severity were associated with financial difficulties during COVID-19.

A longitudinal examination of the protective effect of resilience against anxiety among older adults with high COVID-related worry

This longitudinal study of community dwelling older adults (N = 453) examined consequences of COVID-related worries on changes in anxiety symptoms before relative to during the pandemic. We further evaluated if pre-COVID psychological resilience (PR) buffered the impact of COVID-related worry. Pre-COVID data were collected in September 2018. COVID-related worry and COVID anxiety symptoms were collected in October 2020 (Wave 2). Controlling for pre-COVID anxiety symptoms, we examined if COVID-related worries (e.g. I'm worried that I might die from COVID-19) were associated with increased anxiety symptoms, and whether pre-COVID PR moderated the association between COVID-related worries and prospective increases in anxiety symptoms. COVID-related worries were associated with increased anxiety symptoms (β = 0.005, p < .01), whereas pre-COVID PR was associated with a decrease in anxiety symptoms (β = -0.029, p < .05). PR moderated the association; COVID-related worries were associated with greater increases in anxiety symptoms among those with low pre-COVID PR (Model η2 = 0.35). Thus, the extent to which COVID-related worries influenced psychological health was dependent on pre-COVID levels of PR. We conclude the combined vulnerabilities of low pre-COVID PR and high COVID-related worries significantly increased the psychological consequences of COVID-19 for our sample of older adults.

Anxiety Symptoms, COVID-19-Related Stress Reactions in the Italian General Population, and Validation of the Italian COVID Stress Scales (CSS-I)

Background. The COVID Stress Scales (CSS) assess COVID-related stress experienced in the past week related to danger and contamination fears, socioeconomic consequences, xenophobia, compulsive checking, and reassurance seeking, and traumatic stress symptoms. Our objective was to provide a translation into Italian, replication, and psychometric validation of the CSS in the general population. Moreover, we aimed to test the convergent and discriminant validity of the Italian CSS (CSS-I) with respect to anxiety, stress, and depressive symptoms in the general Italian population. Method. Adult participants (n = 935) over the age of 18 years were recruited from the general population in Italy. Psychological status was assessed using multiple validated measures, including the CSS, Depression, Anxiety and Stress Scales-21 (DASS-21), and the Prejudice Against Immigrants Scale (PAIS). Results. Our confirmatory factor analysis supported a 6-factor model, including danger fears (DAN), socioeconomic consequences (SEC), xenophobia (XEN), compulsive checking and reassurance seeking (CHE), contamination fears (CON), and traumatic stress symptoms (TSS). Strong reliability of the CSS-I (Cronbach's α = 0.863-0.936) and convergent validity with the DASS-21 and PAI were established with positive correlations between total and scale scores across measures. Conclusions. The CSS-I is a valid and reliable instrument to measure COVID-19-related distress in the Italian population.

Trends in assault-related hospitalizations during the SARS-CoV-2 pandemic

INTRODUCTION

Violence remains a priority issue in the United States (US) requiring public health input to discern the magnitude and impact of violence on the health system. Concerns over violence and the injuries resulting from violence have increased following the SARS-CoV-2 pandemic which exacerbated an array of individual and economic stressors related to violence including increased unemployment, alcohol intake, social isolation, anxiety and panic and decreased access to health services. The aim of this study was to analyze the trends in violence-related injuries in the state of Illinois during the SARS-CoV-2 lockdown periods and post-lockdown in order to inform future public health policy.

MATERIAL AND METHODS

Outpatient and inpatient assault related injuries treated in Illinois hospitals from 2016 through March 2022 were analyzed. Segmented regression models evaluating change in time trends were adjusted for seasonality, serial correlation, overall trend and economic variables.

RESULTS

The annual rate of assault related hospitalizations per one million Illinois residents decreased from 3857.8 pre-pandemic to 3458.7 pandemic period. However, during the pandemic there was an increase in deaths and in the proportion of injuries involving open wounds, internal injuries, and fractures, while there was a reduction in less serious injuries. Segmented regression time series models demonstrated significant increase in firearm violence in all four pandemic periods examined. Firearm violence increased particularly in subgroups including African-American victims, 15-34-year-olds, and Chicago residents.

CONCLUSION

During SARS-CoV-2, we saw an overall reduction in assault related hospitalization, however, findings demonstrated an increase in serious injuries which may be associated with social and economic stressors of the pandemic, increased gun-violence while decrease in less serious injuries may be linked to hospital avoidance for non-lethal injuries during the peak waves of the pandemic. Our findings have implications for ongoing surveillance, service planning and management of the increased gunshot and penetrating assault cases and further demonstrate the need for public health input into the violence epidemic in the US.

The Moderating Role of Intolerance of Uncertainty in the Relationship Between Health Anxiety and Pandemic-Related Stress

Background and Objectives

Global pandemics, including COVID-19, have a significant effect on mental health, and this may be especially true for individuals with health anxiety. Although health anxiety is related to both pandemic-related fears and perceptions of health risks, there is a paucity of research on individual difference variables that might exert an influence on these relationships. The present study examined intolerance of uncertainty (IU) as a potential moderator of the relationship between health anxiety and COVID-related stress, and the relationship between health anxiety and perceived risk of contracting COVID.

Design and Methods

A nationally representative sample of North American adults (N = 204) completed self-report measures of health anxiety, IU, COVID-related stress, and perceived risk of contracting COVID.

Results

Prospective IU moderated the positive relationship between health anxiety and COVID-related stress, as the relationship was strengthened at average and higher levels of prospective IU. Neither IU subscale moderated the relationship between health anxiety and perceived risk.

Conclusion

These results suggest that individuals with elevated health anxiety and high prospective IU may be at higher risk of experiencing COVID-related stress, illuminating the interplay of risk factors that place anxious populations at an increased risk of experiencing stress during acute health risks.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10608-023-10365-w.

Measuring various aspects of coronavirus anxiety: a psychometric evaluation of Pandemic anxiety and Coronophobia scales from the latent and network perspective

Since the outbreak of COVID-19, understanding and describing the changes in experiences related to the pandemic and its correlates have become crucial. The current study aims to provide a psychometric evaluation and examination of the relationship of two COVID-related anxiety scales through the latent and network approach. The data was collected from the same participants at two time points (Nwave 1 = 1283; Nwave 2 = 1326). The study examined the psychometric properties of the Pandemic Anxiety Scale and Coronaphobia scale. It also examined the factor structure, invariance and relationship with selected variables through both the latent and network approach. The results revealed that both scales provided good fit and psychometric properties-PAS (wave1: CFI = 0.97, TLI = 0.95, RMSEA = 0.05 [0.04, 0.07], SRMR = 0.048; wave2: CFI = 0.97, TLI = 0.95, RMSEA = 0.05 [0.04, 0.07], SRMR = 0.049), and Coronaphobia scale (wave1: CFI = 0.99, TLI = 0.98, RMSEA = 0.05 [0.03, 0.07], SRMR = 0.027; wave2: CFI ~ 1, TLI = 0.99, RMSEA = 0.03 [0.002, 0.06], SRMR = 0.015). The results also indicated that distinguishing between them is crucial as they were related differently to various variables. The global network models provided a more complex insight in their connections with the set of selected variables. The PAS and Coronaphobia scales are brief and valid measures that can be used in research looking at mental health issues related to the pandemic. The present study shows a unique pattern of relationships of these scales with other variables, extending previous studies into the topic of COVID-related anxiety.

COVID-19 stress syndrome in the German general population: Validation of a German version of the COVID Stress Scales

The COVID Stress Scales (CSS) are a new self-report instrument for multidimensional assessment of psychological stress in the context of the pandemic. The CSS have now been translated and validated in over 20 languages, but a validated German version has not yet been available. Therefore, the aim was to develop a German version of the CSS, to test its factor structure, reliability, and validity, and to compare it with international studies. In an online survey (08/2020-06/2021), N = 1774 individuals from the German general population (71.5% female; Mage = 41.2 years, SD = 14.2) completed the CSS as well as questionnaires on related constructs and psychopathology. After eight weeks, participants were asked to participate again for the purpose of calculating retest reliability (N = 806). For the German version, the 6-factor structure with good model fit (Root Mean Square Error of Approximation, RMSEA = 0.06) was confirmed, with the six subscales: Danger, Socio-Economic Consequences, Xenophobia, Contamination, Traumatic Stress, and Compulsive Checking. Internal consistencies ranged from ω = .82-.94 (except Compulsive Checking ω = .70), and retest reliability from rtt = .62-.82. Convergent and discriminant validity were confirmed for the German version. Related constructs such as health anxiety, general xenophobia, obsessive-compulsive behavior, and posttraumatic stress disorder symptoms correlated moderately with the respective subscale and lower with the other scales. With anxiety and depression, Traumatic Stress showed the strongest correlation. Overall, there was a high degree of agreement in an international comparison. The CSS can help to identify pandemic-related psychological stress and to derive appropriate interventions.

The Influence of the COVID-19 Pandemic on Social Anxiety: A Systematic Review

The COVID-19 pandemic has resulted in negative mental health outcomes throughout the world, and its impact on social interactions and relationships is likely to be evident in problematic social anxiety. This systematic review qualitatively synthesized data from studies that have reported on the effects of the pandemic on social anxiety. A systematic search of Web of Science Core Collection, Embase, PsychINFO, Scopus, EBSCOhost, Cochrane Central Register of Controlled Trials, and Proquest Central-Dissertations and Theses was conducted, with thirty-three studies meeting the inclusion criteria. The results suggest that social anxiety has been heightened in the general population due to the pandemic, with women and low-income earners being especially vulnerable. Other contributing factors include impaired coping strategies, lower socio-emotional well-being, limited support networks, and contraction of the SARS-CoV-2 virus. Individuals with a Social Anxiety Disorder diagnosis may be at risk of a deterioration of mental health in general. Limitations of the literature reviewed include the predominance of cross-sectional study designs, which limit causal inferences are limited. Additionally, associations may be inflated as many studies have not accounted for mediating variables. Taken together, the research suggests that social anxiety, either pre-pandemic or arising due to the pandemic environment, has contributed to a variety of negative mental health outcomes related to social anxiety.

Mental health during the COVID-19 pandemic: Stress and strain profiles in the German population

Clinical observations indicate that people frequently display stress-related behavior during the COVID-19 pandemic. Although numerous studies have been published concerning pandemic-related psychological distress, systematic data on the interrelationships between stress sensitivity, personality, and behavioral characteristics of people are still lacking. In the present cross-sectional online survey study, we applied a German version of the COVID Stress Scales (CSS) and standard psychological questionnaires to systematically identify the complex interplay between stress sensitivity, gender, and personality in the modulation of quality of life and mental health in the German population (N = 1774; age ≥ 16 years). A CSS-based cluster analysis revealed two clusters characterized by higher and lower stress levels. Study participants in each cluster differed significantly with respect to neuroticism, extraversion, agreeableness, quality of life, depression, and anxiety. Females were significantly overrepresented in the higher stress cluster, while there was an overrepresentation of males in the lower stress cluster. Neuroticism was identified as a risk factor and extraversion as a protective factor for enhanced pandemic-related stress responses. For the first time our data show a taxonomy of factors, which modulate pandemic-related stress sensitivity and warrant consideration as key indicators of quality of life and psychological distress during the COVID-19 pandemic. We suggest that our data may advise governmental regulation of pandemic-related public health measures, to optimize quality of life and psychological health in different groups of the population.

Associations between trait and state perceived stress and daily moods: COVID-19 stressful experiences as a moderator

Drastically disrupting daily routines, the global pandemic of COVID-19 has posed critical mental health threats to adolescents and young adults worldwide. Many of the extant empirical findings, however, have focused on individuals' psychological adjustment during the initial phase of the pandemic. It is less clear how COVID-19 stressful experiences impact young people's daily lives in the post-pandemic "new normal." Drawing on 7-day diary reports, the present study fills this gap by examining: (1) how daily perceived stress impacted daily emotional adjustment; and (2) the moderating effects of COVID-19 stressful experiences on these associations among 582 Chinese young adults (M age = 18.12, SD = .65; 69% females). Results indicated that higher levels of both trait (i.e., average levels) and state (i.e., daily fluctuations) perceived stress were associated with greater negative and anxious moods, and that prior pandemic-related experiences exacerbated the adverse impact of both trait and state perceived stress on daily moods. Specifically, young adults reporting greater COVID-19 stressful experiences demonstrated poorer emotional adjustment (i.e., lower levels of positive mood and higher levels of negative mood) on days when they had more fluctuations in perceived stress; the aggravating impact was stronger when the average levels of perceived stress were higher. By illuminating the moderating effects of COVID-19 stressful experiences, this study contributes to the limited, but burgeoning, research examining the prolonged impact of the COVID-19 health crisis on daily emotional adjustment in post-pandemic life.

Determinants of Stress Levels and Behavioral Reactions in Individuals With Affective or Anxiety Disorders During the COVID-19 Pandemic in Russia

INTRODUCTION

Individuals with affective and anxiety disorders are among those most vulnerable to the negative effects of the COVID-19 pandemic.

AIM

This study aims to analyze the determinants of stress levels and protective behavioral strategies associated with the COVID-19 pandemic in Russian-speaking people with affective or anxiety disorders (AADs).

MATERIALS AND METHODS

In this cross-sectional online survey, the psychological distress and behavioral patterns of respondents with self-reported AAD (n = 1,375) and without disorders (n = 4,278) were evaluated during three periods of restrictive measures in Russia (March-May 2020). Distress levels were verified using the Psychological Stress Measure (PSM-25).

RESULTS

Stress levels among respondents with AAD were higher at all study periods than for those with no mental disorder (Cohen's d 0.8-1.6). The stress level increased (Cohen's d = 0.4) in adolescents (16-18 years) with AAD and remained the same in those without disorders; in youths (19-24 years) with and without disorders, an increase (Cohen's d = 0.3) and a decrease (Cohen's d = 0.3) in the stress were observed, correspondingly; the stress in adults (25-44 years) with disorders did not change and decreased in those without disorders (Cohen's d = 0.4). Individuals with bipolar disorders demonstrated lower stress than individuals with depressive (Cohen's d = 0.15) and anxiety disorders (Cohen's d = 0.27). Respondents with depressive and bipolar disorders employed fewer protective measures simultaneously and were less likely to search for information about COVID-19.

CONCLUSION

The presence of affective or anxiety disorders is associated with a more acute response to the COVID-19 pandemic. Apparently, the type of mental disorder influenced stress levels and protective behavior patterns.

Slovak parents' mental health and socioeconomic changes during the COVID-19 pandemic

The changes in people's mental health have become one of the hot topics during the COVID-19 pandemic. Parents have been said to be among the most vulnerable groups in terms of the imposed anti-pandemic measures. The present paper analyzes the trends in mental health indicators in a sample of Slovak parents (N = 363) who participated in four waves of data collection over a year and a half of the COVID-19 pandemic. The mental health indicators were represented by general levels of depression and anxiety as well as COVID-related stress and anxiety. While there were only minor changes in depression and anxiety, the dynamic in COVID-related stress and especially anxiety was more noteworthy. Besides some exceptions, the results hold even after controlling for the socioeconomic situation. The gender differences in the mental health trends were found to be negligible. Overall, we observed no substantial deterioration in the mental health indicators across the four waves of the study.