Racial and socioeconomic status differences in stress, posttraumatic growth, and mental health in an older adult cohort during the COVID-19 pandemic

Background & Aims: Posttraumatic growth (PTG) refers to positive changes resulting from trauma. As a traumatic stressor, COVID-19 can affect various aspects of one’s life. The present study aimed to investigate the mediating role of coping strategies and defense mechanisms in the relationship of PTG and mental health, resilience, and perceived social support in COVID-19 survivors. Materials and Methods: This study was conducted using a path analysis method from the correlation matrix. The research population included all COVID-19 recovered patients in Golestan province, Iran. Using the convenience sampling method, 300 patients who recovered from COVID-19 were selected. The participants were given questionnaires online. The research instruments included the Posttraumatic Growth Inventory (PTGI), the General Health Questionnaire (GHQ-28), the Multidimensional Scale of Perceived Social Support (MSPSS), Connor-Davidson Resilience Scale (CD-RISC), the Defense Style Questionnaire (DSQ), and the Ways of Coping Questionnaire (WOC). The data were analyzed through structural equation modeling (SEM) using SPSS and AMOS version 25. Results: The findings of SEM revealed that the model fits the data. The relationship between problem-focused coping strategies and PTG, mental health, and perceived social support, the relationship between PTG and perceived social support, resilience, and mental health, and the relationship between mature defense mechanisms and PTG, mental health, resilience, and perceived social support were positive and significant (P<0.01). The relationship between emotion-focused strategies and PTG, resilience, and perceived social support, the relationship between neurotic defense mechanisms and mental health, resilience, PTG, and perceived social support, and the relationship between immature defense mechanisms and mental health, resilience, and PTG were negative and significant (P<0.01). Furthermore, the direct path analysis revealed that the relationships between mental health and emotion-focused strategies and between perceived social support and immature defense mechanisms were not significant. Conclusion: The study results suggested that mental health, resilience, perceived social support, as well as problem-focused coping strategies played a crucial role in increasing PTG in COVID-19 patients. Therefore, they can be utilized to reduce the mental damage caused by the COVID-19 pandemic.

The present study investigates the mediating roles of psychological inflexibility and differential coping strategies on perceived stress and post-traumatic symptoms and growth in the context of COVID-19. Study one recruited 662 participants (54.8% women; Mage = 40.64 years, SD = 13.04) who completed a cross-sectional questionnaire. It was proposed that orientation to the problem, avoidance strategies, psychological inflexibility, and positive attitude were mediators for the positive association between perceived stress and PTSD symptoms. The fit indices for the path model were excellent: CFI = 0.977, TLI = 0.950, RMSEA = 0.057 [90%CI = 0.043–0.081], and SRMS = 0.042. Gender and stressful events encountered had indirect effects on the endogenous variables. In study two, 128 participants (57.8% women; Mage = 42.30, SD = 12.08) were assessed for post-traumatic growth one year later. Psychological inflexibility and orientation acted as mediators between perceived stress and PTSD symptoms. Furthermore, a novel path model was constructed in which psychological inflexibility and orientation to the problem as mediators for perceived stress and PTSD symptoms. The indices for the path model were excellent: CFI = 0.99, TLI = 0.97, RMSEA = 0.055 [90%CI = 0.001–0.144], and SRMS = 0.49. Furthermore, PTSD symptoms, psychological inflexibility, and orientation to the problem predicted post-traumatic growth. Specifically, both orientation to the problem (β = .06 [90%CI: .01;.13]) and psychological inflexibility (β = .14 [90%CI: .08;.26]) had an indirect effect on post-traumatic growth. Overall, these results significantly contribute to the literature as orientation to the problem positively predicted PTSD symptoms and post-traumatic growth one year later while psychological inflexibility predicted PTSD symptoms and less post-traumatic growth one year later. These results underline the importance of assessing both symptomology and psychological growth to determine adaptive coping strategies in specific contexts.

Despite the indisputable negative psychosocial consequences of the COVID-19 pandemic, positive consequences are also possible. Resilience and coping strategies have been assumed to contribute to these outcomes. However, findings are still scarce and inconclusive. The study aimed to examine the role of resilience and coping strategies in the secondary stress for the Greek healthcare workers (HCWs) and in the posttraumatic growth following the COVID-19 lockdown in Greece. A sample of 673 HCWs coming from Greece were recruited. A convenience and snowball mixed sampling procedure were used. A questionnaire was distributed through social networking sites, webpages, and personal contacts of the author. Participants were asked to distribute it to their own contacts. Recruitment occurred during April 5 - 30, 2000, amid the lockdown (March 23-May 03), when people were asked to follow the stringent lockdown constraint enforced by the Greek government. Sociodemographic data were collected. The Secondary Traumatic Stress Scale measured secondary traumatic stress (STS) for the HCWs. The Post-Traumatic Growth Inventory, the Brief Resilience Scale, and the Coping Orientation to Problems Experienced Inventory measured posttraumatic growth, resilience, and coping strategies, respectively. Regression analyses demonstrated that resilience and coping strategies were differentially associated with positive and negative (stress/growth) lockdown outcomes. Resilience and mostly maladaptive coping strategies predicted STS. A mixture of adaptive and maladaptive coping strategies predicted PTG. The so-called "second wave" of the outbreak that started in August 2020 indicates that the study of the psychosocial impact of the COVID-19 pandemic and lockdown and of the internal resources (resilience and coping) to deal with, is necessary. The findings contribute to a more comprehensive understanding of the coping strategies used by population subgroups (e.g., HCWs) in dealing with the COVID-19 lockdown in Greece. Enhancing internal resources through supportive services will ameliorate HCWs ability to withstand, recover, and thrive with benefits in their psychological health and well-being. Despite the indisputable negative psychosocial consequences of the COVID-19 pandemic, positive consequences are also possible. Resilience and coping strategies have been assumed to contribute to these outcomes. However, findings are still scarce and inconclusive. The study aimed to examine the role of resilience and coping strategies in the secondary stress for the Greek healthcare workers (HCWs) and in the posttraumatic growth following the COVID-19 lockdown in Greece. A sample of 673 HCWs coming from Greece were recruited. A convenience and snowball mixed sampling procedure were used. A questionnaire was distributed through social networking sites, webpages, and personal contacts of the author. Participants were asked to distribute it to their own contacts. Recruitment occurred during April 5 - 30, 2000, amid the lockdown (March 23-May 03), when people were asked to follow the stringent lockdown constraint enforced by the Greek government. Sociodemographic data were collected. The Secondary Traumatic Stress Scale measured secondary traumatic stress (STS) for the HCWs. The Post-Traumatic Growth Inventory, the Brief Resilience Scale, and the Coping Orientation to Problems Experienced Inventory measured posttraumatic growth, resilience, and coping strategies, respectively. Regression analyses demonstrated that resilience and coping strategies were differentially associated with positive and negative (stress/growth) lockdown outcomes. Resilience and mostly maladaptive coping strategies predicted STS. A mixture of adaptive and maladaptive coping strategies predicted PTG. The so-called "second wave" of the outbreak that started in August 2020 indicates that the study of the psychosocial impact of the COVID-19 pandemic and lockdown and of the internal resources (resilience and coping) to deal with, is necessary. The findings contribute to a more comprehensive understanding of the coping strategies used by population subgroups (e.g., HCWs) in dealing with the COVID-19 lockdown in Greece. Enhancing internal resources through supportive services will ameliorate HCWs ability to withstand, recover, and thrive with benefits in their psychological health and well-being.

The uncertainties of the pandemic and the restrictions on social life have a strong impact on mental well-being, and especially on the expression of schizotypal traits, which are further boosted by excessive media consumption.

Editor's evaluation: Investigating the relationship of COVID-19 related stress and media consumption with schizotypy, depression, and anxiety in cross-sectional surveys repeated throughout the pandemic in Germany and the UK

Although many studies on mental health have been conducted among various populations during the COVID-19 pandemic, few studies have focused on post-traumatic growth (PTG) in the general population. The current study aimed to explore whether perceived social support, personality, and coping strategies are associated with PTG in the COVID-19 pandemic period. The study also investigated whether coping strategies mediate the relations between perceived social support, personality, and PTG. A total of 181 participants (Mage = 24) completed the self-report questionnaire online, which was distributed via various online channels, mainly in China and Sweden. The relations between the study variables were examined with correlation analyses and a multiple mediation analysis. Results showed that more than half of the participants (60.8%) reported experiences of PTG during the pandemic. Additionally, perceived social support, personality traits (extraversion, emotional stability, agreeableness, and conscientiousness) and coping strategies (problem-focused coping, emotion-focused coping, and social support coping) were positively correlated with PTG. In addition, coping strategies (problem-focused coping, emotion-focused coping, and avoidance coping) mediated the relations between perceived social support, personality traits and PTG. Theoretical and practical implications of this study are discussed, concluding that the findings of this study have the potential to guide intervention efforts to promote positive change during the pandemic.

IntroductionThe COVID-19 pandemic is a healthcare crisis, with unprecedented impact on healthcare services, notable morbidity and mortality of the public and healthcare workers, economic impact and significant psychosocial impact. Besides, this pandemic has had a profound negative effect on the mental health of people worldwide, particularly among those who are faced with combating the virus.ObjectivesThe aim of this research was to examine the impact of the COVID-19 pandemic on healthcare workers’ mental health (HCWs), as they are on the front line of the pandemic.MethodsAn internet-based questionnaire was created including the following scales: (1)Posttraumatic Stress Disorder Checklist (PCL-5), (2) Secondary Traumatic Stress Scale (STSS) (3) Quality of Professional Life (ProQOL) (4) Post-Traumatic Growth Inventory, (PTGI), (5) Brief Resilience Scale (BRS), (6) Brief Orientation to Problems Experienced Inventory (Brief Cope)], (7) Self-Compassion Scale (SCS-SF). It was distributed to 120 Greek health professionals, including nurses, doctors, midwives and physiotherapists.ResultsMost of the participants were female with an average age of 46 years. HCWs had low levels of both primary and secondary traumatic stress . They presented post-traumatic growth in the dimension of relationship with others. They used predominantly the coping strategies of positive reframing, acceptance of the situation, venting, and instrumental support.Females had statistically significant higher levels of post-traumatic growth, better quality of life, and used more positive coping strategies compared to males. Humor and acceptance were coping strategies used mainly by physicians. Nurses and midwives had worse quality of professional life potentially due to increased workload. HCWs with more functional ways of coping were more resilient and seemed to have better quality of life, such as higher compassion, satisfaction, lower burnout, and lower post-traumatic stress.ConclusionsThe experience of the COVID-19 pandemic highlights the need to implement some strategies to protect health care workers’ mental health and to take extensive prevention measures in highly stressful situations.Further research is needed to clarify the long-term negative and positive psychological effects of the pandemic on healthcare personnel’s mental health.Disclosure of InterestNone Declared

Objective The COVID-19 pandemic has brought negative and positive changes in the general population, with some people experiencing post-traumatic growth after the first wave. Little research has focused, however, on personal factors potentially helping individuals cope with COVID-related difficulties. This study investigates the relations between character strengths, mental health, and post-traumatic growth. Design Longitudinal (T1: April 2020; T2: December 2020–January 2021). Main outcome measures 254 Italian adults (54 males; mean age = 36.05, SD = 14.04) completed questionnaires on character and mental health at T1, and on mental health and post-traumatic growth at T2. Results General mental health was worse at T2 than at T1. Structural equation modelling showed that character, as a whole, had a significant direct effect on post-traumatic growth and mental health at T2, and an indirect effect mediated by post-traumatic growth. Furthermore, regression analyses evidenced that the virtue of transcendence was uniquely related to mental health at T2, while humanity was specifically associated with post-traumatic growth (after accounting for the other virtues). Conclusion Individuals’ character strengths related to their mental health and post-traumatic growth during the COVID-19 pandemic, with evidence of post-traumatic growth mediating the relation between character and mental health.

Background and aims: Post-traumatic growth refers to the positive psychological changes experienced after an incident. Coronavirus disease 2019 (COVID-19) is seen as a traumatic incident that impacts many aspects of a person's life. The present study aimed to investigate the association between perceived social support and mental health with the post-traumatic growth model through the mediating role of coping strategies in COVID-19 recovered patients. Methods: This study was conducted using a path analysis method from the correlation matrix. The research population included all COVID-19 recovered patients in Golestan Province. Using the convenience sampling method, 300 patients who recovered from COVID-19 were selected. The research instruments included the Post-Traumatic Growth Inventory, the General Health Questionnaire, the Multidimensional Scale of Perceived Social Support, and the Ways of Coping Questionnaire. The data was analyzed through structural equation modeling (SEM) using SPSS and AMOS software version 25. Results: The findings revealed that the suggested model fit the data. The relationship between post-traumatic growth, perceived social support, and mental health with problem-focused coping strategies were positive and significant (P<0.01). The relations between mental health and perceived social support with post-traumatic growth were positive and significant. Post-traumatic growth and perceived social support had a negative and significant relationship with emotion-focused strategies (P<0.01). Furthermore, the relationship between mental health and emotion-focused strategies was not significant. Conclusion: Mental health, perceived social support, and problem-focused strategies play an essential role in COVID-19 patients' post-traumatic growth. As a result, they might be helpful in minimizing the psychological impact of COVID-19.

ObjectiveThis study aimed to explore coping strategies, distress, and post-traumatic growth among Australians with and without a history of a mental health diagnosis during the COVID-19 pandemic.Materials and methodsAustralians (N = 381) completed an online survey between 4-August 2020 and 25-October-2020. Coping strategies, distress, and post-traumatic growth were ascertained via the Brief COPE, Depression Anxiety and Stress Scale (DASS-21), and Post-Traumatic Growth Inventory (PTGI), respectively. Linear regression was conducted to examine the relationship between the Brief COPE, DASS-21, and PTGI, adjusting for sociodemographic factors. Models were conducted separately for those with/without a history of a mental health diagnosis.ResultsHigher distress was found among those with a history of a mental health diagnosis. Significant differences in the types of coping strategies associated with distress and post-traumatic growth were identified between the groups, however, behavioral disengagement and self-blame consistently predicted depression, anxiety, and stress. For those with a history of a mental health diagnosis, positive reframing decreased anxiety. Self-distraction was associated with post-traumatic growth across both groups.ConclusionThere are important differences in the way people with and without a history of a mental health diagnosis cope with the COVID-19 pandemic.

Posttraumatic growth at end of life, a positive psychological consequence of dealing with a life crisis, may be catalyzed by the trauma of facing mortality. Studies on cancer patients' posttraumatic growth have overwhelmingly examined early-stage survivors. Of the few studies on advanced cancer patients, none anchored posttraumatic growth with the patient's death. Therefore, the purposes of this study were to describe longitudinal changes in and to identify determinants of posttraumatic growth over the dying process. A convenience sample of 313 cancer patients was recruited and followed until death. Posttraumatic growth was measured by the Posttraumatic Growth Inventory. Determinants were evaluated from sociodemographics, cancer characteristics, social context variables, and coping strategies using a multiple linear regression model. The dying process may be too threatening and stressful for cancer patients to experience profound posttraumatic growth as manifested by low Posttraumatic Growth Inventory scores (26.13 ± 21.59 to 40.33 ± 27.71 on a 0-105 scale) without significant changes as death approached. However, terminally ill cancer patients who were not defeated by the initial threat of death experienced posttraumatic growth. Patients were at risk for low-level posttraumatic growth if they were male, were non-middle aged, had low educational attainment, had a non-metastatic disease, recently recognized terminally ill status, had severe symptom distress, had high functional dependence and weak social support, and were unaware or had low acceptance of their prognosis. Interventions are needed to appropriately relieve symptom distress, facilitate functional independence, enhance social support, and improve prognostic awareness and acceptance to inspire positive changes for cancer patients at end of life.

Studies have indicated that trauma exposure is a common factor in posttraumatic stress symptoms (PTSSs) and posttraumatic growth (PTG), but it is unclear whether PTSSs and PTG share a common underlying mechanism related to trauma exposure. To explore this issue, this study examined the mediating role of feelings of safety, hope, and coping strategies between trauma exposure and both PTSSs and PTG to elucidate differences in their underlying mechanisms. One year following the Jiuzhaigou earthquake in Sichuan province, China, 620 adolescents were selected to answer self-report questionnaires, and a structural equation model was used to test the hypotheses. Trauma exposure was positively associated with PTSSs by two 1-step indirect paths of feelings of safety and emotion-focused coping strategies, and by two 2-step indirect paths of feelings of safety to both hope and emotion-focused coping strategies. Trauma exposure was positively associated with PTG by a 1-step indirect path of problem-focused coping strategies but negatively associated with PTG by two 2-step indirect paths of feelings of safety to both hope and problem-focused coping strategies, and by one 3-step indirect path of feelings of safety to hope to problem-focused coping strategies. Trauma exposure is common to PTSSs and PTG but affects these differently via feelings of safety, feelings of hope, and coping strategies. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

IntroductionThe COVID-19 pandemic is an enormous stressor that can impact various dimensions of health, including sleep health. Older adults may be particularly vulnerable. Coping strategies to manage stress can also impact health outcomes by modifying the relationships between perceived stress and health outcomes. This study examined concurrent and longitudinal associations between perceived stress and sleep health, mental health, physical health, and overall perceived health outcomes among older adults. We also examined whether coping strategies moderate these associations.MethodsOlder adults (n = 115; Mage = 68.62, 58.3% female) reported perceived stress (PSS), coping strategies (Brief COPE), global sleep quality (PSQI global sleep quality score and dichotomous good/poor sleep quality), depressive symptoms (CES-D), and perceived mental, physical, and overall health (RAND-12) before and during the COVID-19 pandemic.ResultsThe number of individuals with poor sleep quality was greater during the COVID-19 pandemic than before (50% vs. 36.5%). Participants also reported poorer physical health during the COVID-19 pandemic than before. Hierarchical linear regression and hierarchical logistic regression revealed that higher perceived stress was cross-sectionally associated with poorer sleep (e.g., higher total PSQI score and dichotomous sleep quality category). Higher perceived stress was associated with worse depressive symptoms and global mental health concurrently and longitudinally. Coping strategies moderated the relationships between perceived stress and physical health and overall perceived health. For example, higher perceived stress was associated with poorer overall perceived health for those who have lower problem-focused coping—but not for those with higher problem-focused coping—both concurrently and longitudinally.ConclusionPerceived stress influences cross-sectional and longitudinal measures of sleep health and general health among older adults during the COVID-19 pandemic. Coping strategies can moderate the effects of perceived stress on health outcomes. Older adults may benefit from prevention and intervention strategies targeting stress management and problem-focused coping strategies.Support (if any)This research was supported by the National Institute of Aging (R01AG047139), the National Heart, Lung, and Blood Institute (T32HL007560; T32HL082610), and the National Institute of Mental Health (T32MH019986)

Family Caregivers of Liver Transplant Recipients: Coping Strategies Associated With Different Levels of Post-traumatic Growth

The aim of the present study was to see the predictive role of coping strategies in psychological distress and Post Traumatic Growth among 1862 individuals exposed to floods 2010 in Pakistan. The age range of the participants was 15 to 66 years (M = 28.25, SD = 9.59), with participation of both men and women. Data was collected during midmarch 2013 to May 2013. Brief Cope inventory, Depression, Anxiety, Stress Scale (DASS) Scale and Post Traumatic Growth Inventory were used to measure the Coping Strategies, Psychological Distress and Post Traumatic Growth (PTG), respectively. Hierarchical multiple regression demonstrated that after controlling the effect of gender, age, education, and marital status; coping strategies such as, self-distraction, denial, substance use coping, behavioural disengagement, venting, humour and self-blame coping accounted for 33 % of the variance in psychological distress. While, active coping, use instrumental support coping, positive reframing, planning, religious coping, and acceptance coping accounted for 31% of the variance in PTG. Moreover, psychological distress and Post Traumatic Growth were marginally correlated. Findings have implications for clinical interventions. Interventions for flood affected individuals ought to be planned while keeping in mind coping strategies. Cross sectional nature of the study, use of self-report measures and non-probability sampling are the limitations of the study.