Mental Health Vulnerability Research Articles

Alterations in the Experience of Time, Space, and Intersubjectivity and the Interaction with Pre-Existent Psychopathology during the COVID-19 Pandemic

Background: The COVID-19 pandemic and the measures to protect the physically vulnerable may disproportionately affect people with mental health vulnerabilities, who receive psychotherapeutic inpatient treatment, as many of these measures impact the (inter)subjective space crucial to psychotherapy. Objective: We investigate how people with pre-existing mental health conditions and healthcare professionals experienced changes linked to the COVID-19 pandemic. Methods: During the first COVID-19 outbreak and lockdown in spring 2020, we conducted semi-structured interviews with patients and healthcare professionals at a clinic for psychosomatic medicine in Germany and analyzed them following the principles of descriptive phenomenology focusing on social interactions, intersubjectivity, and the therapeutic space. Results: We conducted a total of >30 h of interviews with 19 patients and 17 healthcare professionals. Analyses revealed that the COVID-19 pandemic and the related measures have led to a sudden loss of a sense of normality. Participants experienced changes in the perception of time, space, self, and embodied interaction with others, resulting in a profound feeling of alienation and “unhomeliness” which seemed to magnify pre-existing psychopathology. The inpatient psychotherapeutic environment provided safety by offering spatial and temporal structures and opportunities for social interaction, supporting people to find new ways to be in a changed world. Conclusions: Our study shows that despite the threat of infection, it is vital to continue to provide people with psychological vulnerabilities with a safe therapeutic space in which to regain a sense of safety in a changed world. This is particularly important, as those people seem to suffer intensely from the collateral measures of a pandemic.

Special Report: Stress and Distress During Pregnancy—How to Protect Both Mother and Child

Special Report: Stress and Distress During Pregnancy—How to Protect Both Mother and Child

Emergency department presentations in the first weeks following release from prison among men with a history of injecting drug use in Victoria, Australia: A prospective cohort study.

Rates of emergency department (ED) use are higher among people released from prison than in the general population. However, little is known about ED presentations specifically among people with a history of injecting drug use (IDU) leaving prison. We measured the incidence of ED presentation in the three months following release from prison, among a cohort of men with histories of IDU, and determined pre-release characteristics associated with presenting to an ED during this period. We analysed linked survey and administrative data from the Prison and Transition Health (PATH) study (N=400) using multiple-failure survival analysis. Twenty-one percent (n=81/393) of the cohort presented to an ED at least once within the three months after release from prison. The incidence of ED presentation was highest in the first six days after release. Cox proportional hazards modelling showed that a history of in-patient psychiatric admission and housing instability were associated with increased hazard of an ED presentation, and identifying as Aboriginal and Torres Strait Islander was associated with decreased hazard. In our study, ED presentations following release from prison among people with a history of IDU was linked to acute health risks related to known mental health and social vulnerabilities in this population. Greater collaboration and systems integration between prison and community health and support services is needed to reduce presentations to ED and associated morbidities among people with a history of IDU after release from prison.

Prevalence and risk factors associated with mental health symptoms among anesthetists in Saudi Arabia during the COVID-19 pandemic

The involvement of anesthetists in high-risk interventions exposes them to a serious risk of acquiring an infection and therefore exacerbates their psychological pressure during the COVID-19 pandemic. This study aimed to evaluate mental health problems among anesthetists in Saudi Arabia by quantifying the severity of distress, anxiety, and depression symptoms. The study is a cross-sectional, hospital-based online survey. Distress symptoms were assessed using the Impact of Event Scale-Revised Questionnaires (IES-R), and depression and anxiety symptoms were assessed using the Patient Health Questionnaire-4 (PHQ-4). Multivariate logistic regression was used. A total of 296 respondents completed the survey. Overall, distress, anxiety, and depression symptoms were identified in 25.3%, 29.4%, and 30.7% of respondents, respectively. Anesthetists who were Saudi, single, under 50 years old, had a relative or friend with COVID-19, were dissatisfied with safety measures, felt stigmatized, smoked during the pandemic, and worked in secondary hospitals had higher degrees of severity on two or more measures of mental health symptoms than other respondents. Our findings highlight the mental health vulnerabilities of anesthetists in Saudi Arabia. Lack of confidence in infection control measures, as well as stigmatization, were found to be risk factors for distress, anxiety, and depression symptoms during the pandemic.

Impact of the early 2020 COVID-19 crisis and lockdown on PrEP use among men who have sex with men (MSM) in France

ObjectiveTo describe changes in pre-exposure prophylaxis (PrEP) use during and following the COVID-19 lockdown in France (March–May 2020) and identify the factors associated with PrEP discontinuation among men who have...

Altered reward and effort processing in children with maltreatment experience: a potential indicator of mental health vulnerability

In this longitudinal study of children and adolescents with a documented history of maltreatment, we investigated the impact of maltreatment on behavioral and neural indices of effort-based decision making for reward and examined their associations with future internalizing symptoms. Thirty-seven children with a documented history of maltreatment (MT group) and a carefully matched group of 33 non-maltreated children (NMT group) aged 10–16, completed an effort-based decision-making task during functional magnetic resonance imaging (fMRI). Internalizing symptoms were assessed at baseline and again 18 months later. Computational models were implemented to extract individual estimates of reward and effort sensitivity, and neural signals during decision-making about different levels of reward and effort were analyzed. These were used to predict internalizing symptoms at follow-up. We identified lower effort-related activation in the anterior cingulate cortex (ACC), a prespecified region-of-interest, in the MT relative to the NMT group. No group differences were observed in the striatum, or in behavioral indices of reward and effort processing. Lower effort-related ACC activation significantly predicted elevated internalizing symptoms at follow-up in the MT group. These findings suggest that disrupted effort-related activation may index latent vulnerability to mental illness in children who have experienced maltreatment.

Socioeconomic predictors of COVID-19-related health disparities among United States workers: A structural equation modeling study.

The COVID-19 pandemic has disproportionately impacted the physical and mental health, and the economic stability, of specific population subgroups in different ways, deepening existing disparities. Essential workers have faced the greatest risk of exposure to COVID-19; women have been burdened by caretaking responsibilities; and rural residents have experienced healthcare access barriers. Each of these factors did not occur on their own. While most research has so far focused on individual factors related to COVID-19 disparities, few have explored the complex relationships between the multiple components of COVID-19 vulnerabilities. Using structural equation modeling on a sample of United States (U.S.) workers (N = 2800), we aimed to 1) identify factor clusters that make up specific COVID-19 vulnerabilities, and 2) explore how these vulnerabilities affected specific subgroups, specifically essential workers, women and rural residents. We identified 3 COVID-19 vulnerabilities: financial, mental health, and healthcare access; 9 out of 10 respondents experienced one; 15% reported all three. Essential workers [standardized coefficient (β) = 0.23; unstandardized coefficient (B) = 0.21, 95% CI = 0.17, 0.24] and rural residents (β = 0.13; B = 0.12, 95% CI = 0.09, 0.16) experienced more financial vulnerability than non-essential workers and non-rural residents, respectively. Women (β = 0.22; B = 0.65, 95% CI = 0.65, 0.74) experienced worse mental health than men; whereas essential workers reported better mental health (β = -0.08; B = -0.25, 95% CI = -0.38, -0.13) than other workers. Rural residents (β = 0.09; B = 0.15, 95% CI = 0.07, 0.24) experienced more healthcare access barriers than non-rural residents. Findings highlight how interrelated financial, mental health, and healthcare access vulnerabilities contribute to the disproportionate COVID-19-related burden among U.S. workers. Policies to secure employment conditions, including fixed income and paid sick leave, are urgently needed to mitigate pandemic-associated disparities.

The association of social factors and COVID-19-related resource loss with depression and anxiety among Arabs in Israel.

Arabs in Israel have been found to experience higher levels of mental distress compared to Jews due to COVID-19. However, the social mechanisms underlying mental health vulnerability in the context of mass crisis have been understudied. Based on the Conservation of Resources (COR) theory, the aim of the current study was to examine experiences of resource loss, social exclusion, ethnic discrimination, and social support and their association with depression and anxiety symptoms during the COVID-19 outbreak among Arabs in Israel. The sample included 665 adult Arabs in Israel who completed an online self-report questionnaire regarding background variables, resource loss due to COVID-19, social exclusion, ethnic discrimination, social support, and depression and anxiety symptoms. Participants reported on average mild depression and anxiety severity scores, and 15.2% met criteria for major depressive disorder. Many (43.1%) reported experiencing more than 1 loss due to COVID-19 in health, finances or occupation, and interpersonal relationships. Path analyses show that cumulative losses due to COVID-19 and social exclusion were directly associated with depression and anxiety symptom levels. Discrimination moderated the association between losses and both depression and anxiety symptom levels. Mental health is embedded in dynamic sociopolitical contexts. Arabs as a national minority in Israel have a perceived sense of social exclusion and discrimination and social and material resource deprivation, which relates to their vulnerability, especially in the face of crisis. It is our obligation as researchers and practitioners to illuminate the centrality of these oppressive mechanisms in shaping mental health vulnerability. Clinical Impact Statement: The present study suggests that social exclusion and cumulative resource losses due to COVID-19 in areas of health, occupation, finances, and social connections predict depression and anxiety among Arabs in Israel. In addition, ethnic discrimination moderates the relationship between cumulative losses and mental health outcomes. These results highlight the importance of developing and implementing context-informed health and social care policies and practices, especially in this time of crisis. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Offspring of mothers with bipolar disorder: a systematic review considering personality features.

Objective:To examine personality/temperament features and mental health vulnerability in offspring of mothers with bipolar disorders (BD), including dimensions which may impact psychological characteristics or therapeutic measures.Methods:A systematic review, following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, was conducted to search for original articles that investigated personality/temperament features of offspring of women with BD and emotional factors involved in the mother-child relationship. The electronic search was performed in the PubMed, Web of Science, and PsycINFO databases from February 2010 to February 2017.Results:Ten quantitative studies were included in the analysis: seven from the United States, two from Brazil, and one from Canada. The narrative synthesis was categorized into three dimensions: 1) reliability of instruments for prediction of future psychopathology in offspring; 2) environmental risk factors for offspring; and 3) early interventions. The findings showed impairments in the offspring’s lives, high rates of behavior and temperament problems, and psychiatric disorders.Conclusion:BD is a frequent psychiatric disorder, and the offspring of mothers with this condition are exposed to complex family relationships and psychosocial difficulties. If they are to ensure a good provision of mental health and psychosocial care to this unique population, early interventions must not neglect their contextual specificities.Systematic review registration:PROSPERO CRD-42017039010

Leveraging Longitudinal Pre-pandemic Data to Understand Mental Health Vulnerability and Resilience Among Young People During the Early Pandemic

Leveraging Longitudinal Pre-pandemic Data to Understand Mental Health Vulnerability and Resilience Among Young People During the Early Pandemic

Identifying group-based patterns of suicidal ideation over the first 10 years after moderate-to-severe TBI.

To identify group-based patterns in suicidal ideation (SI) over the first 10 years after traumatic brain injury (TBI). Participants included 9539 individuals in the TBIModel Systems National Database who responded to Patient Health Questionnaire-9 Item 9 assessing SI at 1, 2, 5, and/or 10 years post-injury. A k-means cluster analysis was conducted to determine group-based patterns of SI, and pre-injury variables were compared with ANOVAs and chi-square tests. SI and attempts decreased over time. Four group-based patterns emerged: Low, increasing, moderate, and decreasing SI. The low SI group comprised 89% of the sample, had the highest pre-injury employment, fewer mental health vulnerabilities, least severe injuries, and were oldest. The increasing SI group had the most severe TBIs, were youngest, and disproportionately Black or Asian/Pacific Islander. These findings reinforce the importance of mental health and suicide risk assessment during chronic recovery from TBI.

Changes in Healthcare Workers' Anxiety During Two Time Points of the COVID-19 Pandemic: Evidence From a Longitudinal Study.

Evidence on the within-person changes of healthcare workers’ mental health across waves of COVID-19 cases during this pandemic is absent. The aim of this study is to examine the within-person changes of anxiety in Argentinean healthcare workers, adjusting for main demographic factors, region of residence, mental disorder history, and COVID-19 contagion, during the COVID-19 pandemic. A longitudinal web survey (N = 305) was conducted during two time points of the pandemic, one of which was an infection peak. Anxiety significantly increased across time. However, there were significant interaction effects modulating anxiety levels. The largest anxiety increases occurred in healthcare workers who were not sure if they had contracted COVID-19 while symptomatic. Irrespective of the time point, anxiety was the highest in healthcare workers from a region inside the country who were not sure if they had contracted COVID-19, either asymptomatic or symptomatic. An interaction effect between the mental disorder history and the COVID-19 contagion suggested that the anxiety outcomes were mainly due to the concern about the COVID-19 contagion, rather than due to pre-existing mental health vulnerabilities. Regardless of the starting point in anxiety levels, an increasing anxiety outcome may be expected among healthcare workers as the pandemic progresses. The uncertainty regarding COVID-19 contagion is a preventable and modifiable interacting factor to produce the worst anxiety outcomes among healthcare workers.

A mixed-methods evaluation of experiential intervention exercises for values and committed action from an Acceptance and Commitment Therapy (ACT) mental health promotion program for university students

The mental health vulnerabilities of university students is an emerging global public health crisis. Acceptance and Commitment Therapy (ACT) interventions, particularly those that are web-based, provide discrete, cost-effective, transdiagnostic support for university students. Whilst many studies have researched core ACT processes important for positive outcomes in university students, no published study has reported specific quantitative and qualitative user-responses to commonly used ACT values and committed action experiential exercises. The purpose of this study is to investigate responses to widely used ACT values and committed action exercises to serve three aims: 1) to delineate the values and goals of university students and their relative importance, 2) to assess engagement with exercises, and 3) to translate this data into recommendations for the design and refinement of future mental health programs. Reponses analysed were provided by 1,162 university students on ‘values and committed action’ experiential exercises that formed part of YOLO (You Only Live Once), a web-based ACT mental health promotion intervention for university students. Results showed that university students report a diverse array of personal values, although few students endorsed the values self-caring, healthy, relaxed, and flexible. Participant identified goals were performance-focused rather than task-focused. Results demonstrated that participants showed high engagement with the experiential values and committed action exercises. Responses to the exercises documented in this study add to the published data supporting the efficacy of ACT components in the effective treatment of mental health problems in university students. Findings also illuminate potential areas for development and refinement to improve models of care for university students.

Better off alone? Comparing the substance use, mental health and trauma risks of youth alcohol and other drug service users either living in out of home care, living with parents or experiencing homelessness.

All young people seeking assistance from youth alcohol and other drug services require support to help them minimise the harms from their substance use and continue to develop healthy and meaningful lives. A particular focus on young people in residential out of home care (OoHC) highlights the increased risks of substance use, mental health issues and continued vulnerabilities in this group. While in the past, research contrasted this group with young people living at home, this study contrasted young people in OoHC with homeless youths alongside those living with parents. The research contrasted these three groups of young people on substance use profiles, mental health and wellbeing and vulnerability to abuse (historic and current) in the Youth Needs Census conducted in Victoria and Queensland over 2013-2017. The results demonstrate a clear risk of increased casual and daily methamphetamine use in the homeless youth group and occasional heroin use in the OoHC group. Mental health measures for both the OoHC and homeless youths were worse than the young people living at home. Trauma was similarly higher in these groups, with both historical and ongoing risks of violent crime for homeless youths. The results demonstrate the similar and serious health and wellbeing risks facing both youths in residential OoHC and homeless youths. These results are concerning as one of these groups is ostensibly in the care of the community and government, while the other group is experiencing unstable accommodation and associated physical risks.

Adversity Over the Life Course: A Comparison Between Women and Men Who Died by Suicide.

Purpose: This study sets out to compare the presence of life events across different domains throughout the life course which may contribute to the burden of adversity experienced differently among men and women who died by suicide.Method: In a sample of 303 individuals (213 men and 90 women), data was derived from extensive clinical interviews conducted with informants. Models allowed the identification of patterns of life trajectories.Results: Overall, the burden of adversity was similar across the life course except for the 5–9, 25–29, and 30–34 age ranges, where a significant difference appeared between genders [t-test = 2.13 (p < 0.05), 2.16 (p < 0.05) and 3.08 (p < 0.005), respectively] that seems to disadvantage women. The early adversities of violence and neglect, between 0 and 19 years old, are important for both groups. During the life course, women were more exposed to interpersonal adverse events such as being victims of negligence and violence, relational difficulties or abuse from their spouse, as well as tension with their own children. Men encountered more academic difficulties, legal entanglements and financial difficulties, and were more than three times more likely to develop an alcohol/drug abuse problem than women.Conclusions: The data suggests some gender differences in exposure to longstanding and severe life problems contributing to suicide vulnerability. For women, the continuing burden emerges from chronic interpersonal adversities, whereas, for men, the adverse events are to a larger degree socially exposed, compounded with alcohol misuse. The adversities, especially those of a public or social nature, may be witnessed by others, which should favor the detection of vulnerability over the life course, and psychosocial or mental health services should be offered and provided earlier during the life course. Yet more men die by suicide than women. Resiliency and protective factors may benefit women to a greater degree. Future research should tackle the challenge of investigating these important elements. Meanwhile, from a public health perspective, access to psychosocial and mental health services and social acceptability of seeking services should be part of an ongoing effort in all institutional structures as a way of decreasing downstream mental health problems and vulnerability to suicide.

Perspectives of service agencies on factors influencing immigrants’ mental health in Alberta, Canada

Newcomers to Canada experience resettlement challenges that affect their mental well-being. Guided by an intersectionality theoretical framework, we sought the perspectives of immigrant service agencies on factors influencing immigrants’ mental health in Alberta, Canada. Data were collected by means of qualitative interviews and focus groups with immigrant service providers. Our data analysis identified seven themes – precarious immigration status, employment discrimination, social isolation, socioeconomic pressures, sociocultural stress, gender and age-related vulnerabilities, and lack of appropriate mental health supports – reflecting the major intersecting determinants of immigrants’ mental health. We propose policy interventions for addressing the mental health vulnerabilities of immigrants.

Incidence of Early Police Contact Among Children With Emerging Mental Health Problems in Australia

In adulthood and adolescence, mental health vulnerability is known to be associated with risk of criminal justice system contact as both a perpetrator and survivor of crime, but whether this association is apparent early in child development is unknown. Prevention of poor outcomes, including repeated contact with the criminal justice system, relies on the identification of vulnerability early in life and at the start of such contact. To ascertain whether children with emotional or behavioral problems and general developmental vulnerabilities are at an increased risk of subsequent contact with police as a person of interest, a survivor of crime, or a witness. This cohort study used routinely collected data from the New South Wales Child Development Study in Australia. The cohort was composed of children who entered full-time schooling in New South Wales in 2009, had complete data for the emotional maturity domain of the Australian Early Development Census, and had no police contact before January 1, 2009. The children in the cohort were followed up until the age of 13 years. Data were analyzed from October 17, 2019, to May 13, 2020. Emotional or behavioral problems and developmental risk profiles derived from the teacher-rated Australian Early Development Census. Incidence rates of police contact (as a person of interest, survivor of crime, or witness) were derived from the New South Wales Police Force Computerised Operational Policing System. A total of 79 801 children (40 584 boys [50.9%]; 2009 mean [SD] age, 5.2 [0.37] years) were included. Children with teacher-identified emotional or behavioral problems at school entry had an incidence rate of police contact (for any reason) that was twice that of children without such problems (unadjusted hazard ratio [HR], 2.14; 95% CI, 1.94-2.37). Contact with police as a survivor of crime was most commonly recorded (7350 [9.2%]), but the strength of the association was greatest between emotional or behavioral problems and police contact as a person of interest (unadjusted HR, 4.75; 95% CI, 3.64-6.19). Incidence of police contact as a person of interest was high for children with a pervasive developmental risk profile (unadjusted HR, 13.80; 95% CI, 9.79-19.45). This study found an association of emerging emotional or behavioral problems and developmental vulnerabilities with increased risk of police contact for any reason among young children, suggesting that this well-known association in adults and adolescents can be identified at an earlier developmental stage. These findings support primary and secondary interventions to prevent police contact early in life and to target the earliest contacts with the criminal justice and educational systems.

Abstract 014: Posttraumatic Stress Disorder, Mental Stress-induced Myocardial Ischemia And Cardiovascular Outcomes In Patients With CAD

Introduction: Mental stress-induced myocardial ischemia (MSI) is a risk marker for adverse outcomes among coronary artery disease (CAD) that is more prevalent among patients with posttraumatic stress disorder (PTSD). Hypothesis: CAD patients with PTSD who develop MSI experience a higher risk of adverse cardiovascular events compared with those who do not develop MSI. Methods: We studied 995 individuals with stable CAD who participated in two contemporary cohort studies with similar protocols, the Mental Stress Ischemia Prognosis Study (MIPS), and the Myocardial Infarction and Mental Stress Study (MIMS). Provocation of myocardial ischemia with a standardized mental stress test (speech task) was assessed with single-photon emission computed tomography. PTSD was assessed with the structured clinical interviews for DSM-IV. Participants were categorized into four groups based on their MSI and PTSD status. The primary endpoint was a composite outcome of cardiovascular death or nonfatal myocardial infarction (MI), stroke, or heart failure hospitalization. Cox regression models were used to investigate the interaction of PTSD and MSI on the study endpoint in the two samples pooled with meta-analysis. Results: In total, 603 participants in MIPS and 392 in MIMS were included. MSI occurred in 16% of the patients in MIPS and 17% in MIMS. Over a 5-year median follow-up, there were 126 outcome events in MIPS and 117 in MIMS. In Cox regression models with adjustment for demographic and clinical risk factors, participants with both MSI and PTSD had a higher risk for the study endpoint, compared to those with neither. In contrast, participants with PTSD or MSI but not both were not at a higher risk ( p interaction=0.01). Separate analyses in the two studies were consistent. Conclusions: There is a synergistic association of PTSD and MSI on adverse outcomes in CAD patients. These findings support the confluence of chronic mental health vulnerability with acute stress responses in defining elevated risk in CAD patients.patients.

Worry and mental health in the Covid-19 pandemic: vulnerability factors in the general Norwegian population

BackgroundThere is an urgent need for knowledge about the mental health consequences of the ongoing pandemic. The aim of this study was to identify vulnerability factors for psychological distress and reduced life satisfaction in the general population. Furthermore, we aimed to assess the role of COVID-related worries for psychological distress and life satisfaction.MethodsA presumed representative sample for the Norwegian population (n = 1041, response rate = 39.9%) responded to a web-survey in May 2020. The participants were asked about potential vulnerability factors including increased risk for severe illness from COVID-19 (underlying illness, older age), socioeconomic disadvantage (living alone, unemployment, economic problems), and pre-existing mental health vulnerability (recent exposure to violence, previous mental health challenges). Additional measures included COVID-related worry, psychological distress, and life satisfaction.ResultsMore than one out of four reported current psychological distress over the threshold for clinically significant symptoms. Socioeconomic disadvantages, including living alone and pre-existing economic challenges, and pre-existing mental health vulnerabilities, including recent exposure to violence and previous mental health problems, were associated with a higher level of psychological distress and a lower level of life satisfaction. A higher level of COVID-related worry was significantly associated with a higher level of psychological distress, and a lower level of life satisfaction, even when adjusting for all the vulnerability factors.ConclusionThis study identified several vulnerability factors for mental health problems in the pandemic. Individuals recently exposed to violence and individuals with pre-existing mental health problems are at particular risk. Worrying about the consequences of the pandemic contributes negatively to current mental health. However, worry cannot explain the excess distress in vulnerable groups. Future research should focus on how COVID-related strains contribute to mental health problems for vulnerable groups.

A Model of the Effects of Parental Illness on Youth Adjustment and Family Functioning: The Moderating Effects of Psychological Flexibility on Youth Caregiving and Stress

Parental chronic illness may adversely impact youth and family functioning. This study examined a moderated mediation model of the effects of parental illness on youth and family functioning derived from the Family Ecology Framework. Consistent with this model, we predicted that youth caregiving and stress would serially mediate the adverse impacts of parental illness on youth adjustment and family functioning and that psychological flexibility would moderate these mediational mechanisms. A total of 387 youth, with parents affected by chronic illness, completed a questionnaire assessing parental illness severity, youth caregiving and stress, psychological flexibility, youth adjustment (i.e., internalizing and externalizing problems and psychological wellbeing), and family functioning. Path analyses indicated that the adverse effects of parental illness on youth adjustment and family functioning were serially mediated by youth caregiving and stress. Psychological flexibility buffered the adverse effects of these serial mediators on youth internalizing problems and psychological wellbeing. These findings identified three potential intervention targets: youth caregiving, related stress appraisals, and psychological flexibility. Given the large body of evidence showing that acceptance and commitment therapy fosters psychological flexibility, this intervention approach has the potential to address the psychosocial and mental health vulnerabilities of youth in the context of parental illness, which constitutes a serious public health issue.