Post-combat adaptation: improving social support and reaching constructive growth

How Can the Coping Strategies Mediate the Relationship Among COVID-19 Stress, Depression, and Anxiety?

OBJECTIVE

The coronavirus disease-2019 (COVID-19) pandemic has had a severe impact on mental health. To explore the underlying mechanisms that influence mental health, a critical question is whether different types of coping strategies may mediate the relationships between COVID-19 related stress and mental health.

METHODS

Recruited between October 19 and 24, 2021, a total of 500 participants aged 20 to 69 years completed an online survey to evaluate the COVID-19 stress, coping orientation, depression and state anxiety. The period corresponded to the highest level of COVID-19 restrictions (level 4) immediately before the adjusted restriction to level 3. Parallel mediation analyses were conducted using structural equation modeling.

RESULTS

Distinct mediation effects of the COVID-19 stress (i.e., fear of infection, difficulties of social distancing, anger toward others) through three types of coping strategies (i.e., functional, dysfunctional, seeking support) were found. Fear of infection was likely to be related to functional coping and dysfunctional coping. Social distancing model indicated dysfunctional coping and seeking support, while anger toward others model was associated with functional coping and seeking support.

CONCLUSION

The results highlight the different relationships between COVID-19 stress and mental health coping strategies. The identification of these mediation pathways offers guidance for designing effective interventions and support systems to promote psychological well-being during challenging times like the COVID-19 pandemic.

Impact of the COVID-19 pandemic on the self-care and health condition of the older adults. CUIDAMOS+75. A mixed methods study protocol

Aims

To assess the impact of the COVID-19 pandemic on the health condition of people ≥75 years of age and on their family caregivers in Spain.

Design

Multicentric, mixed method concurrent study.

Methods

This work, which will be conducted within the primary care setting in 11 administrative regions of Spain, will include three coordinated studies with different methodologies. The first is a population-based cohort study that will use real-life data to analyze the rates and evolution of health needs, care provision, and services utilization before, during, and after the pandemic. The second is a prospective cohort study with 18 months of follow-up that will evaluate the impact of COVID-19 disease on mortality, frailty, functional and cognitive capacity, and quality of life of the participants. Finally, the third will be a qualitative study with a critical social approach to understand and interpret the social, political, and economic dimensions associated with the use of health services during the pandemic. We have followed the SPIRIT Checklist to address trial protocol and related documents. This research is being funded by the Instituto de Salud Carlos III since 2021 and was approved by its ethics committee (June 2022).

Discussion

The study findings will reveal the long-term impact of the COVID-19 pandemic on the older adults and their caregivers. This information will serve policymakers to adapt health policies to the needs of this population in situations of maximum stress, such as that produced by the COVID-19 pandemic.

Trial Registration

Identifier: NCT05249868 [ClinicalTrials.gov].

Psychological predictors of the time perspective: The role of posttraumatic stress disorder, posttraumatic growth, and temporal triggers in a sample of bereaved adults

INTRODUCTION

The process of coping with loss and trauma is inextricably linked with subjective experiences and perceptions of time. The Time Perspective Framework, suggests that temporal frames influence an individual's actions, judgements, and the decisions that they make. Similarly, time perspective has been linked with psychosocial outcomes of trauma and loss (e.g. posttraumatic stress disorder). The aim of this study is to identify factors that may influence survivor's time perspective in order to determine if posttraumatic stress disorder (PTSD), posttraumatic growth (PTG), and temporal triggers (MIT) influenced different time perspective orientations.

METHODS

Data was collected via Qualtrics survey between July 2019 and July 2020. Measures included basic demographic characteristics, posttraumatic stress disorder checklist, posttraumatic growth inventory, an assessment of temporal triggers, and the Zimbardo time perspective inventory. A series of OLS regression analyses were estimated.

RESULTS

PTG was positively associated with future time perspective scores, whereas PTSD was associated with an increase in past negative orientation. The endorsement of temporal triggers like markers in time was negatively associated with present hedonistic scores and positively associated with future time perspective scores. Interestingly, PTSD, PTG and the endorsement of MIT were not associated with present time perspective scores.

DISCUSSION AND IMPLICATIONS

Identifying the relationship between PTSD, PTG, marker in time, and time perspective may offer important insights into treatment modalities that can improve outcomes for bereaved individuals. We discuss limitations of the current analysis and make recommendations for future research.

Associations among posttraumatic growth, demographic characteristics, posttraumatic stress symptoms, and trauma type, with a focus on sexual violence

This study assessed posttraumatic growth (PTG) across multiple trauma types and by demographic characteristics (i.e., sex, age, education). Moreover, we examined the association between PTG and posttraumatic stress disorder (PTSD) symptoms as well as the characteristics and predictors of PTG after sexual violence. A phone survey was conducted in a nationally representative sample of 1,766 Icelandic adults. In total, 1,528 individuals reported having experienced some form of trauma and were included in the analysis, and 563 reported experiencing sexual violence. Interpersonal trauma (e.g., sexual violence, emotional abuse, and domestic violence) was associated with the highest levels of PTG. Moderate levels of PTSD symptoms were associated with the highest levels of PTG, whereas high- or low-level PTSD symptoms were related to less PTG. Women reported significantly more PTG than men, d = 0.16 and survivors of sexual violence reported significantly more PTG than individuals who reported other forms of trauma exposure, d = 0.28. Among sexual violence survivors, no demographic factors were associated with PTG, but cumulative trauma and positive social reactions were significantly related to higher levels of PTG. This study highlights that personal growth can result from aversive experiences and suggests a curvilinear association between PTG and PTSD symptoms.

Understanding the Relationship Between Peer Support and Grief/Growth in Chinese Shidu Parents: The Roles of Internalized Stigma and Stigma Resistance

In China, families who have lost their only child are called shidu families. Support from similar others, or peer support, can help bereaved individuals adapt by reducing negative consequences and promoting positive changes. However, no research has examined the mechanism that mediates the effect of peer support on postloss adaptation. This article investigates the mediating roles of internalized stigma and stigma resistance in the relationship between peer support and grief/growth among Chinese shidu parents. In total, 208 shidu parents completed the required measurements. Structural equation modeling was used to analyze the data. The results showed that peer support was negatively related to grief symptoms and positively linked with posttraumatic growth by reducing internalized stigma. The mediating effect existed only for informational support. The mediating role of stigma resistance was not significant. These findings provide valuable information for the mechanism of peer support and promote the development of interventions.

Improvements in Compassion and Fears of Compassion throughout the COVID-19 Pandemic: A Multinational Study

During large-scale disasters, social support, caring behaviours, and compassion are shown to protect against poor mental health outcomes. This multi-national study aimed to assess the fluctuations in compassion over time during the COVID-19 pandemic. Respondents (Time 1 n = 4156, Time 2 n = 980, Time 3 n = 825) from 23 countries completed online self-report questionnaires measuring the flows of compassion (i.e., Compassionate Engagement and Action Scales) and fears of compassion toward self and others and from others (i.e., Fears of Compassion Scales) and mental health at three time-points during a 10-month period. The results for the flows of compassion showed that self-compassion increased at Time 3. Compassion for others increased at Time 2 and 3 for the general population, but in contrast, it decreased in health professionals, possibly linked to burnout. Compassion from others did not change in Time 2, but it did increase significantly in Time 3. For fears of compassion, fears of self-compassion reduced over time, fears of compassion for others showed more variation, reducing for the general public but increasing for health professionals, whilst fears of compassion from others did not change over time. Health professionals, those with compassion training, older adults, and women showed greater flows of compassion and lower fears of compassion compared with the general population, those without compassion training, younger adults, and men. These findings highlight that, in a period of shared suffering, people from multiple countries and nationalities show a cumulative improvement in compassion and reduction in fears of compassion, suggesting that, when there is intense suffering, people become more compassionate to self and others and less afraid of, and resistant to, compassion.

Mechanisms of recovery: Community perceptions of change and growth following multiple disasters

INTRODUCTION AND PURPOSE

The geographic location of the Gulf South leaves communities in continuous threat, response, and recovery disaster cycles. Hurricane Katrina in 2005 provided an opportunity to study disaster mental health. Less than 5 years after the storm, many Hurricane Katrina survivors were impacted again by the Deepwater Horizon Gulf oil spill. Despite adversities impacting Gulf communities, over 90% of participants reported they were resilient. The purpose of this study was to improve the understanding of the mechanisms that contribute to strengths following adversity in communities affected by repeated disasters. Specifically, we focused on survivor perceptions of personal, spiritual, or community changes in efforts to describe community resilience and posttraumatic growth (PTG).

METHODS

Participants were recruited through a quantitative survey and community flyers. Participants represented southeastern Louisiana, in areas impacted by hurricanes and the oil spill-for a total of five focus groups and 41 participants. Focus groups began by asking each participant to provide a brief overview of their disaster survival story and three additional guiding strengths-based questions. Data were transcribed using Dragon Speech Recognition software. A total of 963 unique responses were analyzed and coded.

RESULTS

The following themes were identified: connectedness (n = 259), coping (n = 94), spirituality (n = 60), adaptability (n = 47), and self-reliance (n = 23). Participants noted a growth mindset from the disasters and also acknowledged coinciding negative experiences (n = 154) associated with community change and loss, where subthemes included change in connectedness (n = 97), crime (n = 26), and feeling like an outsider (n = 31).

DISCUSSION AND IMPLICATIONS

These findings help scholars and mental health practitioners better understand the lived experiences of PTG in a community of survivors impacted by recurring traumatic experiences. In keeping with previous literature, PTG and negative experiences associated with trauma are not mutually exclusive, but occur simultaneously. Our results offer a holistic picture of coping with cumulative or repeated traumas and suggest that connectedness, coping, and spirituality provide important buffers to negative psychosocial outcomes.

Identity-based social support predicts mental and physical health outcomes during COVID-19

During the COVID-19 pandemic, the United Kingdom implemented physical distancing measures to minimize viral transmission, which may have adversely impacted health and wellbeing. Evidence suggests that social support may be key to mitigating against adverse health impacts of such measures, particularly when such social support is identity-based. In this longitudinal study, we examined the role of social identity and perceived social support in mental and physical health outcomes during the COVID-19 pandemic. Participants completed a survey at 4 time points during the first year of the pandemic: May/June 2020 (T1; N = 443); September/October 2020 (T2; N = 235); December 2020/January 2021 (T3; N = 243); and April 2021 (T4; N = 206). Results showed that at each time point, social support was predicted by identification with multiple groups before COVID-19, identity continuity, and identification with communities. Higher identity continuity and identification with communities both predicted greater mental and physical health at the same time point, mediated by perceived social support. Interestingly, higher identity continuity and identification with communities predicted higher social support at the same time point, which in turn predicted worse mental and physical health outcomes at the subsequent time point. Findings are discussed in relation to the context of the first year of the pandemic and the changing nature of societal restrictions across the four survey time points.

Peace of mind: Promoting psychological growth and reducing the suffering of combat veterans

The Peace of Mind (POM) program was designed to enable combat veterans in Israel to process their combat experience, address difficulties in the transition to civilian life and facilitate psychological growth as a result of their military experience. During the course of the program, 1068 participants were studied at four time points. Post-traumatic symptoms were measured using the PTSD checklist for DSM-5 (PCL-5), and post-traumatic growth (PTG) was measured using the Post Traumatic Growth Inventory (PTGI). Multilevel Modeling (MLM) was used to assess symptom and psychological trajectories for all participants and for those who began with and without PTSD symptoms, respectively. The results demonstrated that those who began the program with elevated PTSD symptoms experienced a significant reduction in PTSD symptoms following the completion of the intensive element of the program. Additionally, all participants demonstrated an increase in PTG following the intensive section of the program and this was maintained throughout follow-up. The findings indicate that the POM program is beneficial in relation to both positive and negative outcomes of traumatic military experiences though it is clear that the transition from combat to civilian life is more complex than the current measures identify and that further research needs to examine the distinct lifestyle and functional changes which occur following the program.

The role of social connection on the experience of COVID-19 related post-traumatic growth and stress

BACKGROUND

Historically social connection has been an important way through which humans have coped with large-scale threatening events. In the context of the COVID-19 pandemic, lockdowns have deprived people of major sources of social support and coping, with others representing threats. Hence, a major stressor during the pandemic has been a sense of social disconnection and loneliness. This study explores how people's experience of compassion and feeling socially safe and connected, in contrast to feeling socially disconnected, lonely and fearful of compassion, effects the impact of perceived threat of COVID-19 on post-traumatic growth and post-traumatic stress.

METHODS

Adult participants from the general population (N = 4057) across 21 countries worldwide, completed self-report measures of social connection (compassion for self, from others, for others; social safeness), social disconnection (fears of compassion for self, from others, for others; loneliness), perceived threat of COVID-19, post-traumatic growth and traumatic stress.

RESULTS

Perceived threat of COVID-19 predicted increased post-traumatic growth and traumatic stress. Social connection (compassion and social safeness) predicted higher post-traumatic growth and traumatic stress, whereas social disconnection (fears of compassion and loneliness) predicted increased traumatic symptoms only. Social connection heightened the impact of perceived threat of COVID-19 on post-traumatic growth, while social disconnection weakened this impact. Social disconnection magnified the impact of the perceived threat of COVID-19 on traumatic stress. These effects were consistent across all countries.

CONCLUSIONS

Social connection is key to how people adapt and cope with the worldwide COVID-19 crisis and may facilitate post-traumatic growth in the context of the threat experienced during the pandemic. In contrast, social disconnection increases vulnerability to develop post-traumatic stress in this threatening context. Public health and Government organizations could implement interventions to foster compassion and feelings of social safeness and reduce experiences of social disconnection, thus promoting growth, resilience and mental wellbeing during and following the pandemic.

Exploring the Relationship Between Social Ties and Resilience From Evolutionary Framework

This conceptual paper examines the necessity and importance of social bonds and networks in building resilience to fight the COVID-19. Resilience is a quality that energizes an individual’s actions and acts as a buffer to stressful events. The current article is intended to explore the evolutionary programmed behavior of the human mind to make social ties and structure. Humans have a strong need to connect and relate with other individuals by developing cooperation and perspective-taking. The ability to make social connections, group living, and sharing resources had a selective advantage in coping with physical and psychological stress. Social bonds provide resilience to people’s approach while making adjustments and adapting to situations, thus presents fitness benefits at both group and individual levels. An attempt has also been made to address how social isolation as a strategy to contain the infection adversely influence body homeostasis. Finally, this article recommends health practitioners, clinicians, and researchers to encourage research on the impact of social isolation/social interaction on mental and physical health indicators.

Impact of the COVID-19 Pandemic on Long-Term Recovery from Traumatic Injury

OBJECTIVE

Determine the proportion and characteristics of traumatic injury survivors who perceive a negative impact of the COVID-19 pandemic on their recovery and to define post-injury outcomes for this cohort.

BACKGROUND

The COVID-19 pandemic has precipitated physical, psychological, and social stressors that may create a uniquely difficult recovery and reintegration environment for injured patients.

METHODS

Adult (≥18 years) survivors of moderate-to-severe injury completed a survey 6-14 months post-injury during the COVID-19 pandemic. This survey queried individuals about the perceived impact of the COVID-19 pandemic on injury recovery and assessed post-injury functional and mental health outcomes. Regression models were built to identify factors associated with a perceived negative impact of the pandemic on injury recovery, and to define the relationship between these perceptions and long-term outcomes.

RESULTS

Of 597 eligible trauma survivors who were contacted, 403 (67.5%) completed the survey. Twenty-nine percent reported that the COVID-19 pandemic negatively impacted their recovery and 24% reported difficulty accessing needed healthcare. Younger age, lower perceived-socioeconomic status (SES), extremity injury, and prior psychiatric illness were independently associated with negative perceived impact of the COVID-19 pandemic on injury recovery. In adjusted analyses, patients who reported a negative impact of the pandemic on their recovery were more likely to have new functional limitations, daily pain, lower physical and mental component scores of the SF-12 and to screen positive for PTSD and depression.

CONCLUSIONS

The COVID-19 pandemic is negatively impacting the recovery of trauma survivors. It is essential that we recognize the impact of the pandemic on injured patients while focusing on directed efforts to improve the long-term outcomes of this already at-risk population.

COVID-19 Mental Health Disparities

Communities of color in the United States have been disproportionately impacted by the COVID-19 pandemic. Studies exploring the mental health implications of these disparities have only just begun to emerge. The purpose of this study is to better understand mental health concerns and test whether social determinants of health and COVID-19-related experiences influence these concerns. In April 2020, we launched a community-based survey for adults across the United States. A total of 341 respondents completed the survey, which included questions about demographics, depression, social isolation, work environment, and preexisting mental health conditions. We generated matched controls by adding county data from the Robert Wood Johnson Foundation to our survey. Chi square, Pearson product-moment correlation, point biserial correlation, and logistic regression were estimated. Our analysis revealed that respondents who identified as Latinx, Latin@, or Hispanic were 10 times more likely to meet the threshold score for depression. Similarly, individuals with prior mental health conditions and those who expressed feelings of social isolation due to COVID-19 were 3 times more likely to meet the threshold score for depression. These results confirm our hypothesis that communities of color will likely experience disproportionate mental health impacts of COVID-19-specifically, the mental health sequela that emerge from exposure, cumulative burden, and social isolation. We discuss the implications for expanding access and quality of health and mental health services to address current inequities.

The Role of Event-Related Rumination and Perceived Social Support on Psychological Distress during the COVID-19 Pandemic: Results from Greater Daegu Region in South Korea

OBJECTIVE

Research on psychological distress from the coronavirus disease 2019 (COVID-19) crisis has increased significantly, but the factors that can exacerbate or mitigate such distress have remained underexplored. To address the research gap, this study examined whether two types of rumination and perceived social support predict psychological distress during the pandemic.

METHODS

Participants were recruited from communities of the greater Daegu area (n=316) where the first massive outbreak in South Korea occurred and most residents underwent substantial disruption of daily life. They completed self-report questionnaires that included measures of psychological distress, event-related rumination, and social support.

RESULTS

The hierarchical regression analysis showed that maladaptive intrusive rumination and perceived social support predicted increases and decreases in psychological distress, respectively, even when subjective severity of COVID-19-related experiences was controlled. Putatively adaptive type of rumination (i.e., deliberate rumination) was not a significant predictor concurrently.

CONCLUSION

This is among the early endeavors to comprehensively understand risk and protective factors associated with an effective coping strategy against the COVID-19 crisis. Our results indicate that intrusive rumination aggravates but social support mitigates psychological distress during the pandemic, indicating that we can better adapt by differently attending to recent experiences and maintaining perceived social support.