Health Psychological Intervention Research Articles

Psychosocial factors in chronic disease management: Implications for health psychology

Chronic diseases present significant challenges to individual well-being, necessitating comprehensive management strategies that extend beyond medical treatments. This paper explores the crucial role of psychosocial factors in chronic disease management, highlighting their impact on treatment adherence, quality of life, and overall health outcomes. It delves into various psychosocial elements such as social support, coping mechanisms, health beliefs, and mental health comorbidities, discussing their implications for health psychology interventions. Through the synthesis of current research and illustrative case studies, this paper aims to deepen the understanding of these factors and advocate for holistic approaches in chronic disease management. By integrating psychosocial and medical interventions, healthcare providers can enhance patient well-being and optimize long-term health outcomes, ultimately fostering resilience and empowering individuals to effectively manage their chronic conditions.

Psychological Health Assessment and Intervention System for Chemical Engineering Students Based on Emotional Computing Technology

Emotional computing technology is revolutionizing health assessment by integrating emotional and psychological factors into traditional diagnostic processes. This innovative approach utilizes advanced algorithms and sensor technologies to analyze individuals' emotional states and mental well-being, providing valuable insights into their overall health. By detecting subtle changes in facial expressions, voice patterns, and physiological signals, emotional computing technology can assess stress levels, mood fluctuations, and mental health conditions with greater accuracy and sensitivity. This paper presents a novel Psychological Health Assessment and Intervention System tailored for chemical engineering students, leveraging Emotional Computing Technology enhanced by Cartesian Feature Weighted Emotional Classification (CFWEC). The system aims to assess students' psychological well-being by analyzing emotional cues extracted from various sources such as facial expressions, voice patterns, and text interactions. Through simulated experiments and empirical validations, the efficacy of CFWEC-enhanced emotional computing technology is evaluated in predicting and intervening in psychological health issues among chemical engineering students. Results demonstrate significant improvements in accuracy and sensitivity compared to traditional assessment methods. For instance, the CFWEC model achieved an average accuracy rate of 85% in identifying students at risk of psychological distress, enabling timely interventions. Additionally, the system provides personalized recommendations and interventions based on individual emotional profiles, leading to improved mental health outcomes. These findings underscore the potential of Emotional Computing Technology with CFWEC in promoting psychological health and well-being among chemical engineering students.

Opportunities and challenges in designing and evaluating complex multilevel, multi-stakeholder occupational health interventions in practice

ABSTRACT Extant research suggests the effectiveness of Occupational Health Psychology (OHP) interventions depends on their design in the broader organisational context. While the field recognises that pre- and posttest evaluation do not sufficiently capture the complex dynamics around OHP interventions, complex multi-level OHP interventions are still scarce in the literature. As established intervention implementation frameworks suggest, it remains difficult to address this complexity in practice. The present position paper re-evaluates lessons learned from two complex European OHP intervention projects, by applying the Integrated Process Evaluation Framework (IPEF) and related theories to bridge the gap between the theoretically recognised complexity and practical challenges. The re-evaluations emphasise that programme-multilevel theories rooted in OHP-perspectives contribute to adequately hypothesising around systemic factors and mechanisms relevant to OHP interventions. Concretely, middle range theories that outline how an intervention’s mechanisms work within a specific context to produce certain outcomes are crucial. Additionally, strategically and actively involving key stakeholders at all levels of the system and across the different intervention phases improves the embedding of OHP interventions in organisations. We elaborate on these insights with seven concrete recommendations for complex OHP intervention research.

Influencing factors on the psychosomatic health of medical staff since the normalized stage of COVID-19 in mainland China.

During the coronavirus disease 2019 (COVID-19)pandemic, there were under-recognized and unaddressed psychosomatic health problems among medical staff. The purpose of this study was to investigate their psychosomatic status. An online questionnaire was performed to the medical staff of major hospitals in Jinan in January 2023. In total, 1244 valid questionnaires were collected, and their psychosomatic status was assessed by the Psychosomatic Symptom Scale (PSSS) and Perceived Stress Scale-10 (PSS-10). Finally, we analyzed the influencing factors for their psychosomatic status. The psychological health of the medical staff was poor, and the level of stress perception was intense, accompanied by obvious psychosomatic symptoms. Regression analysis indicated that age, gender, frontline involvement, work experience, marriage, presence of disease history and COVID-19 infection history were risk factors for psychosomatic symptoms, while education, frontline involvement and presence of disease history were risk factors for stress feeling. Medical staff often showed obvious psychosomatic symptoms and intense stress. Psychological health education and intervention should be given in order to improve their working quality.

Can a multicomponent positive psychological intervention promote well-being in parents of young children? A randomized controlled trial study in Hong Kong.

The present research examined the effects of an Early Advancement in Social-Emotional Health and Positivity (EASP) multicomponent positive psychological intervention on parents' well-being in Hong Kong. Participants were parents of young children (N = 120; Mage = 37.19 years, SD = 4.71, range = 24-53; female = 95.00%) who participated in the one-month randomized control trial. Participants were randomly assigned into the intervention (n = 50) and waitlist control groups (n = 70). Parents in the intervention group received two online workshops and an evidence-based smartphone application that targeted four positive psychological skills: (1) mindful parenting, (2) hope, (3) positive reappraisal, and (4) growth mindset. The results of the multivariate regression analysis revealed that the intervention significantly improved various dimensions of participants' positive psychological skills, subjective well-being, and psychological well-being immediately at the conclusion of the program. The findings of this study underscore the importance of the well-being payoffs linked to cultivating positive psychological skills among parents of young children.

Prevalence of depressive symptoms and correlates among individuals who self-reported SARS-CoV-2 infection after optimizing the COVID-19 response in China.

The burden of depression symptoms has increased among individuals infected with SARS-CoV-2 during COVID-19 pandemic. However, the prevalence and associated factors of depressive symptoms among individuals infected with SARS-CoV-2 remain uncertain after optimizing the COVID-19 response in China. An online cross-sectional survey was conducted among the public from January 6 to 30, 2023, using a convenience sampling method. Sociodemographic and COVID-19 pandemic-related factors were collected. The depression symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9). Logistic regression analysis was performed to explore the associated factors with depressive symptoms. A total of 2,726 participants completed the survey. The prevalence of depression symptoms was 35.3%. About 58% of the participants reported experiencing insufficient drug supply. More than 40% of participants reported that they had missed healthcare appointments or delayed treatment. One-third of participants responded experiencing a shortage of healthcare staff and a long waiting time during medical treatment. Logistic regression analysis revealed several factors that were associated with depression symptoms, including sleep difficulties (OR, 2.84; 95% CI, 2.34-3.44), chronic diseases (OR, 2.15; 95% CI, 1.64-2.82), inpatient treatment for COVID-19 (OR, 3.24; 95% CI, 2.19-4.77), with COVID-19 symptoms more than 13 days (OR, 1.30, 95% CI 1.04-1.63), re-infection with SARS-CoV-2 (OR, 1.52; 95% CI, 1.07-2.15), and the increased in demand for healthcare services (OR, 1.32; 95% CI, 1.08-1.61). This study reveals a moderate prevalence of depression symptoms among individuals infected with SARS-CoV-2. The findings underscore the importance of continued focus on depressive symptoms among vulnerable individuals, including those with sleeping difficulties, chronic diseases, and inpatient treatment for COVID-19. It is necessary to provide mental health services and psychological interventions for these vulnerable groups during the COVID-19 epidemic.

Emotional straying: Flux and management of women’s emotions in social media

In recent years, social media, which has emerged with the core focus on interaction within "acquaintance networks," has gradually been infiltrated by "strangers," leading to the disorientation of many users, especially women, amidst the diverse and intricate social platforms and emotional landscapes. Grounded in the experiential perspective of social media users, this study explores the correlations among woman emotions, satisfaction, and behavior, starting from the standpoint of the impact of social media. Through in-depth interviews with woman cohorts in China, various dimensions such as emotional fluctuations, satisfaction levels, and behaviors in social media were examined. The findings reveal that emotional expression serves as a primary motivation and purpose for users to sustain their engagement with social media. Additionally, emotional masking represents a proactive operational behavior induced by the needs for social relationship maintenance and the accumulation of social capital. Furthermore, emotional management manifests as user-initiated abandonment or shift of social media activities in response to perceived emotional stress. On this basis, a conceptual model integrating woman emotions, satisfaction, and behavior in the context of social media was constructed. The outcomes of this research hold significant theoretical and practical implications for future studies on woman emotions and behaviors, as well as for the development of social media functionalities, content management, public media usage, and psychological health interventions.

From Holocaust to Anfal: The impact of genocide and cross-generational trauma on the mental health of Kurds.

Genocide attempts are among the most severe traumatic events that are transmitted across generations. However, it may also prove the strength and survivability as well as the vulnerability of the targeted group. Anfal and chemical attacks on Halabja on Iraqi Kurds that targeted their annihilation had a devastating impact. Many survivors and their generations are still dealing with their effects on psychological disorders such as posttraumatic stress disorder (PTSD) and depression. To address the psychological effects of these tragic events on survivors and their generations and propose the actions to be taken, this article explores the psychological trauma and problems caused by attempted genocide and chemical attacks in the case of Anfal campaign. These effects require more research to fully understand the long-term effects of these tragedies, as well as support and provision of comprehensive psychological and mental health interventions to their survivors and generations.

Resources and interventions to support psychological health and wellbeing in the pharmacy workforce: Analysis and use of a health worker ‘burnout’ toolkit

BackgroundPharmacists have experienced declines in psychological health and wellbeing post-pandemic. The phenomena of moral distress, disengagement and burnout are associated with workforce attrition, unfitness to practice and inferior quality of patient care. A working group of the Canadian Pharmacists Association (CPhA) was formed to identify resources and interventions (R&I) for occupational psychological health and wellbeing. ObjectiveTo characterize R&I from an evidence-based national health worker ‘burnout’ Toolkit with potential to support the pharmacy workforce. MethodsAll R&I included within a draft ‘burnout’ Toolkit from the Canadian Health Workforce Network (CHWN) were screened to determine relevancy and usefulness for the pharmacy workforce. R&I with higher grades were data-charted to capture information on topic and content delivery. Final R&I were determined through consensus meetings where ‘highly rated’ R&I were discussed and selected. ResultsOf 140 original CHWN Toolkit R&I, 53 (37.8%) were of potential relevance or usefulness to improve well-being for most in the pharmacy workforce. Of those 53 R&I, 28 (20% of original) were final selections. The majority of R&I at each stage were focused on ‘preventing burnout’ and ‘promoting mental health’ (>60%) rather than ‘addressing burnout’, ‘supporting recovery’ or managing specific issues in the workplace (i.e. stigma, discrimination, bullying, hostility, workload). No R&I were specifically developed or studied within the pharmacy workforce. ConclusionsHealth professions may benefit from the CHWN Toolkit and the knowledge translation activity described here. R&I relevant and useful to the pharmacy workforce generally require adaptation for dissemination and/or implementation. The set of final R&I form the basis for orchestrated plans to support the pharmacy workforce with respect to psychological health and wellbeing. There is a relative lack of R&I devoted to addressing and recovering from burnout and workload management issues.

Systematic review on the effectiveness of mobile health applications on mental health of breast cancer survivors.

Breast cancer survivors are more likely to report psychological distress and unmet need for support compared to healthy controls. Psychological mobile health interventions might be used in follow-up care of breast cancer patients to improve their mental health. We searched MEDLINE, PsychINFO, Cochrane and PROSPERO for articles on controlled trials examining the effectiveness of psychological mobile health interventions compared to routine care regarding mental health outcomes of adult breast cancer survivors. This review followed the PRISMA statement and was registered on PROSPERO (CRD42022312972). Two researchers independently reviewed publications, extracted data and assessed risk of bias. After screening 204 abstracts published from 2005 to February 2023, eleven randomised trials involving 2249 patients with a mean age between 43.9 and 56.2years met the inclusion criteria. All interventions used components of cognitive behavioural therapy. Most studies applied self-guided interventions. Five studies reported percentages of patients never started (range = 3-15%) or discontinued the intervention earlier (range = 3-36%). No long-term effect > 3months post intervention was reported. Three of seven studies reported a significant short-term intervention effect for distress. Only one study each showed an effect for depression (1/5), anxiety (1/5), fear of recurrence (1/4) and self-efficacy (1/3) compared to a control group. A wide variance of interventions was used. Future studies should follow guidelines in developing and reporting their mobile interventions and conduct long-term follow-up to achieve reliable and comparable results. No clear effect of psychological mobile health interventions on patients' mental health could be shown. PROSPERO ID 312972.

Developmental trajectories of depression, anxiety, and stress among college students: a piecewise growth mixture model analysis

Mental health issues are becoming increasingly common among college students, but not all students follow the same developmental trends of mental health. This study aims to identify the developmental trajectories of depression, anxiety, and stress among college students and the related factors for different trajectory classes. The data were collected from a longitudinal survey of college students over four consecutive years, and 2473 students were included in the analysis. The study used a piecewise growth mixture model to determine the subtrajectories, and a multinomial logistic regression model was constructed to investigate the related factors affecting students in subtrajectories. The results revealed that subtrajectories include the low and stable class, increasing class, decreasing then stable class, increasing then decreasing class, and decreasing and high class. The decreasing and high class only presents in the trajectories of anxiety and stress. Regarding related factors, high BMI and high sleep hours were identified as related factors for the increasing class of depression; gender and high sleep hours were associated with the increasing class of anxiety; and hometown location was related to the increasing class of stress. Extroversion personality, relationship with classmates, siblings, and father’s education level are related factors for other subtrajectories. Considering that college students experience multiple trajectories of depression, anxiety, and stress, mental health education and psychological intervention should be carried out for students in each class.

Law education reform in universities on reducing college students’ learning anxiety

BackgroundWith the rapid development of society, the learning anxiety of college students is gradually increasing. Law education emphasizes rational thinking and behavioral norms, enabling college students to establish a correct outlook on life. Therefore, law education should be an important part of psychological health interventions for college students.Subjects and MethodsThe study selected 120 students with learning anxiety and randomly divided them into two groups. One group is a blank group, which only uses traditional legal education. The other group is the experimental group, which adopts an educational approach that combines psychology and law to reform. The experimental period lasted for one semester, and the course arrangements of the two groups were consistent. Before and after the experiment, a questionnaire survey was conducted using the Self Rating Anxiety Scale (SAS). Based on the experimental results, the psychological relief of anxiety in the two groups was analyzed.ResultsThe number of students in the blank group who had mild, moderate, or severe learning anxiety before the experiment began was 64, 53, and 3, respectively. In the experimental group, there were 62, 54, and 4 students who had mild, moderate, and severe cases of learning anxiety, respectively. After the test, there were 71, 47, and 2 students in the control group who had mild, moderate, or severe learning anxiety, respectively. In the experimental group, there were 81, 27, and 0 students who did not have learning anxiety, respectively. The number of students with mild to severe learning anxiety increased.ConclusionsThe integration of psychological reform in law teaching can effectively alleviate the learning anxiety of college students.AcknowledgementThe Fundamental Research Funds for the Central Universities (No.3132022297); National Social Science Fund of China (No.21CFX055).

Effect of depressive symptoms on quality of work life in female nurses: a cross-sectional study using propensity score matching.

Female nurses have been considered as a vulnerable population in the context of mental health, due to the nature of their work, which can be stressful and emotionally taxing. Understanding the relationship between depressive symptoms and quality of work life (QWL) can contribute to improving mental health and job performance. However, limited studies have focused on the effect of depressive symptoms on QWL in female nurses. The present study aimed to assess the effect of depressive symptoms on female nurses' QWL using propensity score matching (PSM). A cross-sectional, online study using convenience sampling was conducted among 1,401 female nurses in China. PSM was used to minimize the impact of potential confounders between no depressive symptoms and depressive symptoms. Stepwise multiple linear regression analyses were performed on the PSM samples to explore the effects of depressive symptoms on the QWL. The results revealed there were 33.5% of the female nurses reported depressive symptoms before PSM. And female nurses in this study had a moderate level of QWL before PSM (122.11 ± 18.15), which remained steady after PSM (118.33 ± 18.04). After PSM, the final sample contained 864 female nurses. Stepwise multiple linear regression results indicated that depressive symptoms were the most strongly associated with QWL (β = -0.454, p < 0.001). This study highlights the importance of developing mental health plans and psychological interventions for female nurses to maintain mental health and QWL, which is critical to the nursing workforce's sustainability.

Psychological Toll of the COVID-19 Pandemic: An In-Depth Exploration of Anxiety, Depression, and Insomnia and the Influence of Quarantine Measures on Daily Life.

The COVID-19 pandemic, on a global scale, has prompted multifaceted challenges, including a notable psychological toll on the general population. This study uses mixed-method approach for a nuanced exploration of these experiences. Using a phenomenological strategy, qualitative responses from 999 participants were analyzed regarding their pandemic-induced anxiety and the influence of quarantine measures on their lives. Quantitative measures, including the revised Impact of Event Scale (IES-R), patient health questionnaire-9 (PHQ-9), the seven-item generalized anxiety disorder assessment (GAD-7), and Insomnia Severity Index (ISI), were used to quantify trauma, depression, anxiety, and insomnia attributed to COVID-19. Partial least squares structural equation modeling (PLS-SEM) was utilized for quantitative data analysis. The anxiety-related responses were mainly clustered into four themes: life threats, support shortage, economic consequences, and disruptions to family and social life. Subthemes that addressed the perceived effects encapsulated disruptions to academic and professional lives, familial and social relationships, psychopathological stress, and movement limitations. The findings from quantitative analysis revealed the significant associations between COVID-19-related trauma and symptoms of anxiety, depression, and insomnia, as indicated by coefficients exceeding 0.10 (all z-values > 1.96; p-values < 0.05). In conclusion, the findings underscore COVID-19's role in escalating anxiety, influenced by various factors, and its disruptive effects on daily life due to quarantine measures. The strong associations between the pandemic and the symptoms of depression, anxiety, and insomnia underscore the urgency of comprehensive psychological and public health interventions to alleviate these impacts.

I Cancervive: Exploring the Modern Travails of Cancer-Stricken Adolescents in the Pandemic New Normal

Currently, the world faces two critical challenges: the COVID-19 pandemic and surging cancer cases. Healthcare systems worldwide, including the Philippines, struggle to cope with rising cancer patient mortality. Urgent action and innovative solutions are vital to managing cancer care amidst the ongoing pandemic. Hence, this study explored the journey of adolescent cancer patients who are receiving treatment during the pandemic particularly the present challenges with cancer treatment, its holistic repercussions, the patient's coping mechanisms, and their significant life breakthroughs. It employed a qualitative multiple-case study, utilizing semi-structured interviews to collect data from four (4) pediatric hematology-oncology cases. The data was analyzed using content analysis wherein the narratives of the participants were compared. The findings of the study revealed themes that represent the challenges experienced by cancer patients namely, (1) treatment and other medical services disruption; (2) reduced social support; and (3) increased contamination-related anxieties. The immediate repercussions included (1) psychological disturbance, stress, and depression; (2) uncertainty and emotional distress; (3) stronger behavioral adherence to COVID-19 prevention measures; (4) increased gadget usage/gadget dependence, and (5) decreased scholastic involvement. Further, the participants’ coping mechanisms include (1) active coping strategies via engaging activities; (2) awareness and acceptance of the current situation; (3) strong social and spiritual support, and (4) positive and active mind setting. The insights gathered from the analysis are (1) the need for better access to cancer-related services and assistance, and (2) the call for more psychological health intervention programs. The findings showed that the insights and realizations of participants emphasized the need for better access to cancer-related services and assistance and a calling for psycho-oncological therapeutic interventions for fellow cancer patients.

'I became more aware of my actions'-A qualitative longitudinal study of a health psychological group intervention for patients with myalgic encephalomyelitis/chronic fatigue syndrome.

To explore myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) patients' experiences of a health psychological group intervention and its usefulness, non-usefulness or harmfulness for illness management and adjustment. A qualitative longitudinal study using inductive content analysis. Semistructured interviews were conducted with 10 adults. Interviews were conducted before the 16-week intervention, immediately after its completion, and at 3 months after completion. Participants reported that the intervention was useful and not harmful. The model improved their ability to cope with ME/CFS by providing them with useful information about the illness along with peer support and professional guidance. Participants reported improved illness management and adjustment, which they perceived as an outcome of achieving new ways of thinking, feeling and acting. Participants viewed the health psychological approach to group intervention as meeting their needs. To achieve better illness management and adjustment, more consideration should be given to supportive interactional processes with peers and healthcare professionals. The intervention was developed to meet patients' needs of finding ways to manage their illness. The research team consulted eight patients with ME/CFS and three clinical centres working with ME/CFS treatment and rehabilitation at the intervention planning stage. Their comments influenced the planning and content of the intervention as well as ethical issues that should be considered, such as potential harm to participants. All participants were informed about the theoretical foundations of the study and the principles guiding the intervention. Participants were not involved in the data analysis. NCT04151693.

Developing a mobile psychological health intervention app for health professionals in Nigeria: The process, challenges and lessons learnt

Developing a mobile psychological health intervention app for health professionals in Nigeria: The process, challenges and lessons learnt

NOVEL TARGETED HEALTH PSYCHOLOGY CLINIC REFERRAL IMPROVES BLOOD PRESSURE: PRELIMINARY RESULTS OF A RETROSPECTIVE STUDY

Objective: Despite hypertension medications being widely available, many patients do not have adequately controlled blood pressure. Consequently, alternative interventions are required to support patients. Recently, we have established a novel health psychology clinic to provide additional support to help patients improve blood pressure control. This retrospective study compared outcomes before and after referral to a targeted health psychology clinic. Our aim was to determine the effectiveness of this novel clinic on patient outcomes with a view to improving the service and support rollout in other departments. Design and method: Patient notes referred to the Health Psychology clinic were reviewed from October 2020 to December 2022 (audit number: 11703). Patient data was linked anonymised and details reflecting key outcomes, demographics and specific psychology interventions were extracted. Results: In the preliminary findings, 11 patients were included for analysis. Patient age ranged from 28-79 years, 18% were female and 45% were White. Patients were prescribed a mean of 3.1 hypertension medications. The mean time between the first blood pressure reading and final reading was 44.1±27.8 weeks, with a mean number of 6.6±6 visits to the clinic. Interventions were tailored to each patient's need. Four patients were supported with anxiety management, three used biofeedback and three used breathing techniques. Two patients were supported with weight management, with one patient losing 31.7kg in 6 months. The mean systolic blood pressure (SBP) change was -11.55±17.78 mmHg (P = 0.0568), and diastolic blood pressure (DBP) was -5.80±13.15 mmHg (P = 0.1965). Two patients had increased blood pressure for unknown reasons. When these two cases were removed from analysis, the overall mean changes for SBP were -18.11±11.30 mmHg (P = 0.0013) and -9.88± 11.03mmHg for DBP (P = 0.0690). Of these blood pressure readings, 7 were conducted in the office, 2 at home, and 1 with 24hour ABPM. Conclusions: Our preliminary findings show that targeted psychological support for hypertensive patients experiencing difficulties with anxiety or depression may improve blood pressure. Health psychology interventions may be suitable to support patients where medication alone does not support optimum hypertension management. Further large prospective studies are needed to confirm these findings.

A Systematic Review on Psychological Interventions for Sexual Health in Older Age

Objectives The present review aims to identify the existing evidence on outcome-treatment studies of psychological sexual health interventions in older age. Methods A systematic search was conducted for studies published until October 2022. Data search was conducted on EBSCO, MEDLINE, Web of Science, and Cochrane Central Register of Controlled Trials databases. Results From 30,840 screened records, 12 reports were selected. Results were grouped into four categories according to the intervention that was implemented. Conclusions Despite results presenting some bias concerns, this review suggests that educational and cognitive-behavioral approaches seem to be effective for promoting sexual health in older age.

Psychosocial and behavioural predictors of immune response to influenza vaccination: a systematic review and meta-analysis

ABSTRACT High variability of influenza vaccine efficacy requires the identification of modulators of immunisation that may be targeted as adjuvants in health psychology interventions. Psychosocial and behavioural variables such as psychological stress, greater negative and lower positive affectivity, poor sleep, loneliness, and lack of social support, have been associated with abnormal immune and inflammatory responses and negative health outcomes, yet their effects in modulating vaccine efficacy are yet to be fully understood. We conducted an updated systematic review of longitudinal and experimental studies examining the effects of such variables in predicting immune response to influenza vaccine. PubMed, Medline, PsycINFO, CINAHL and Scopus were searched up to November 2022. Twenty-five studies met the inclusion criteria for qualitative synthesis and 16 provided data for meta-analysis. Low positive and high negative affect were associated with low antibodies and weak cell-mediated immunity following vaccination in qualitative synthesis. Literature on sleep disturbance, loneliness and social support was limited and yielded inconsistent results. Psychological stress was associated with poorer antibody response in meta-analysis. In conclusion, findings from this review suggest a need for further longitudinal and experimental studies on these factors to support their inclusion as target variables in vaccine adjuvant interventions.