Times Of High Stress Research Articles

Evaluation of a pathology resident wellness initiative: Initial establishment and subsequent expansion through a time of high stress, the COVID-19 pandemic.

Recent studies have shown that the pathology workforce is at risk of decreased workplace well-being, which may lead to decreased job satisfaction, increased attrition, burnout, depression, anxiety, and suicidality, but there has been relatively little research on well-being initiatives designed for pathologists, pathology trainees, and laboratory professionals. Some studies have suggested that well-being initiatives may decrease burnout and increase workplace satisfaction and engagement. Here we describe the creation of a Pathology Wellness Committee in a large residency program. Interventions included emotional, social, and physical well-being interventions as well as system-based improvements. Additional initiatives were introduced in response to the increased stress, isolation, and social distancing guidelines during the height of the COVID-19 pandemic. The program's impact was measured by an annual House Staff Council Resident Wellness Survey over 4 years. The annual surveys showed improvements in workplace and residency program satisfaction and emotional well-being following system-based improvements and well-being initiatives. Physical and social well-being showed slight but not statistically significant decreases over the 4-year period. Results from the annual Accreditation Council for Graduate Medical Education Survey were also evaluated. We found that dedicated well-being initiatives in conjunction with system-based interventions may help improve overall well-being in pathology residents.

All-Inside Anterior Cruciate Ligament Reconstruction Using Full-Thickness All-Soft-Tissue Quadriceps Tendon Autograft With Independent Suture Tape Augmentation

The anterior cruciate ligament (ACL) is the most frequently injured knee ligament that requires surgical intervention. Surgical options to address ACL ruptures include reconstruction using autograft or allograft or performing primary repair. Subsequent ACL graft failure is a significant postoperative concern in the younger patient population. The addition of suture tape to the final construct is thought to protect the graft during moments of high stress by increasing graft stiffness under high load and preventing substantial graft elongation. Given the normal anatomic lengthening of the ACL from knee flexion to full extension, final fixation of both the suture tape and the graft is done with the knee hyperextended to avoid overconstraint. The use of adjustable loop fixation for both femoral and tibial fixation with the all-inside technique allows the graft to be retensioned after final suture tape fixation and subsequent knee cycling. This ensures that the suture tape is slightly laxer than the graft so that the graft experiences loads that are essential for its healing, with the suture tape sharing the load only during times of high stress.

Nonlinear network connectedness: Assessing financial risk transmission in MENA and influence of external financial conditions

This study investigates the influence of global financial market conditions on financial risk connectedness and transmission among the Middle East and North Africa (MENA) economies. Utilizing weekly realized stock market volatilities as a measure of risk and employing a smooth transition threshold vector autoregressive (STVAR) model to analyze risk transmission under varying levels of financial stress, the authors also examine the impact of external macroeconomic conditions on the risk connectedness of MENA economies. The results indicate that the overall connectedness, based on a standard VAR model, is moderate at 48.34%. However, in the low financial stress regime, overall connectedness increases to 52.79%, and in the high financial stress regime, it rises to 72.94%, indicating stronger risk interdependency among MENA countries during times of high stress. In the high financial stress regime, Kuwait, Oman, Qatar, Saudi Arabia, Turkey, and the United Arab Emirates are identified as net risk transmitters among MENA countries. The study also reveals that risk transmission across MENA is more pronounced in the regime-dependent model compared to the overall mean-based VAR model.

Nursing students’ clinical practice education experience during the COVID-19 pandemic: a qualitative study

BackgroundNursing education, including some elements of clinical practice, has largely been conducted online during the coronavirus disease 2019 (COVID-19) pandemic. Numerous studies have examined the experiences of nursing students in academia during the pandemic. However, research on nursing students’ clinical practice experiences is limited. This study aimed to analyze nursing students’ clinical practice experiences during the COVID-19 pandemic.MethodsThis study used a qualitative research design and performed thematic analysis. Participants comprised 13 nursing university students with clinical practice experience at a hospital during the COVID-19 pandemic. Interviews were conducted either online or face-to-face. Data were collected during June‒July 2021.ResultsFour themes and eight subthemes were generated through thematic analysis. Theme 1 was “Nursing students’ anxiety and strict adherence to quarantine practices,” with the subthemes of “Fear of infection” and “Protecting themselves.” Theme 2 was “Nursing students’ belief that their organization is protecting them,” with the subthemes of “Strict quarantine rules at hospitals and universities” and “The nursing students regretted the limited scope of practice but felt safe.” Theme 3 was “Learning through valuable practice,” with the subthemes of “Recognizing the importance of practice” and “Realizing the benefits of practice.” Theme 4 was “A sense of duty as a prospective nurse,” with the subthemes of “Accepting a sense of duty as a nurse” and “Establishing the expanded role of a nurse.”ConclusionsThe nursing students recognized the importance of nursing practice during the pandemic and worked harder. A better understanding of the experiences of nursing university students who completed their clinical practice during the COVID-19 pandemic can help nursing professors and managers more effectively train students during times of high stress.

All board members—not just the chair—have a role to play in curbing conflicts

It's common for nonprofit boards to experience turmoil and conflict among members from time to time—and especially during times of high stress and unusual circumstances. And while the board chair—as the most senior leader of the board—has a central role to play in helping to resolve such disputes, each individual board member shares some responsibility for limiting conflict to begin with, according to Jeremy Barlow of BoardEffect.

Social support buffers the impact of pregnancy stress on perceptions of parent-infant closeness during the COVID-19 pandemic.

Pregnant individuals and parents have experienced elevated mental health problems and stress during COVID-19. Stress during pregnancy can be harmful to the fetus and detrimental to the parent-child relationship. However, social support is known to act as a protective factor, buffering against the adverse effects of stress. The present study examined whether (1) prenatal stress during COVID-19 was associated with parent-infant closeness at 6 months postpartum, and (2) social support moderated the effect of prenatal stress on the parent-infant relationship. In total, 181 participants completed questionnaires during pregnancy and at 6 months postpartum. A hierarchical linear regression analysis was conducted to assess whether social support moderated the effect of stress during pregnancy on parent-infant closeness at 6 months postpartum. Results indicated a significant interaction between prenatal stress and social support on parents' perceptions of closeness with their infants at 6 months postpartum (β=.805, p=.029); parents who experienced high prenatal stress with high social support reported greater parent-infant closeness, compared to those who reported high levels of stress and low social support. Findings underscore the importance of social support in protecting the parent-infant relationship, particularly in times of high stress, such as during the COVID-19 pandemic.

Math anxiety and math motivation in online learning during stress: The role of fearful and avoidance temperament and implications for STEM education

Students’ math motivation can predict engagement, achievement, and career interest in science, technology, engineering, and mathematics (STEM). However, it is not well understood how personality traits and math anxiety may be linked to different types or qualities of math motivation, particularly during high-stress times such as the COVID-19 pandemic. In this study, we examined how fearful or avoidant temperaments contribute to math anxiety and math motivations for college students during the COVID-19 pandemic. Ninety-six undergraduate students from a large public university were assessed on temperamental fear, math anxiety, and math motivation in an online math course. Results showed that higher levels of temperamental fear are directly linked to higher levels of math anxiety. In addition, temperamental fear is indirectly linked to higher levels of autonomous motivation (i.e., intrinsic motivation and identified regulation) and lower levels of controlled motivation (i.e., external regulation) through math anxiety. Results have implications for helping students at high risk for both high math anxiety and for low motivation to engage in math learning.

Who Do Farmers Trust? Identifying Farmer Support Systems During Times of Stress and Suicide Risk

Farmers experience high stress and elevated suicide risk. Using surveys distributed at a regional agricultural exposition, our study identified those who are closest to farmers and trusted during times of high stress, and how to communicate stress-related information to farmers. We found farmers were most likely to trust spouses, other farmers, friends, and faith leaders and preferred information from other farmers, agricultural publications, social media, churches, and Extension offices. Farmers and non-farmers differed significantly in views on these questions. This work identifies potential partners for Extension programming on farmer stress, highlighting the importance of including farmers in program development/delivery.

Electroanalytical Measurement of Steroid Hormone with Carbon Electrode Sensor

Cortisol is a vital steroid hormone that has been known as the “stress hormone,” which is elevated during times of high stress and anxiety. The improved detection of cortisol is critically important as it will help further our understanding of stress during several physiological states. Several methods exist to detect cortisol, however, they suffer from low biocompatibility, spatiotemporal resolution, and are relatively slow. In this study, we developed an assay to measure cortisol with carbon fiber microelectrodes (CFMEs) and fast-scan cyclic voltammetry (FSCV). FSCV is typically utilized to measure small molecule neurotransmitters by producing a readout CV for the specific detection of biomolecules on a fast, subsecond timescale with biocompatible CFMEs. It has seen enhanced utility in measuring peptides and other larger and more complex molecules. We developed a waveform to electro-reduce cortisol at the surface of CFMEs. The sensitivity of cortisol was found to be 5 nA/uM and was adsorption controlled on the surface of CFMEs and stable over several hours. Cortisol was co-detected with several other biomolecules such as dopamine and serotonin, and the waveform was fouling resistant to repeated injections of cortisol on the surface of the CFMEs. Furthermore, we also measured exogenously applied cortisol onto brain tissue and simulated urine to demonstrate biocompatibility and potential use in vivo. The specific biocompatible detection of cortisol with high spatiotemporal resolution will help further elucidate its biological significance and further understand its physiological importance in the brain.

Women's social experiences before and during the COVID‐19 pandemic: A 3‐part measurement burst study among women in midlife with health risks

AbstractWomen in midlife (ages 40–60) with elevated risk for cardiovascular disease (CVD) often rely on social networks during times of high stress. Precautions against the spread of COVID‐19—particularly stay‐at‐home‐orders—could have limited positive social experiences during a stressful time, but also could have reduced unwanted negative social experiences. This report presents findings from an ecological momentary assessment study that used 3 bursts of 5 surveys per day for 5 days, to test for changes in women's social experiences: prior to COVID‐19 (2019), during stay‐at‐home‐orders (April‐May 2020), and during initial reopening (August‐September 2020). Participants were women aged 40–60 with one or more CVD risk factors (e.g., hypertension; N = 35, MAge = 51, MBMI = 32.2 kg/m2). Momentary reports showed that the number of positive interactions experienced in daily life did not significantly change from before to during the pandemic; positive interactions were more variable during stay‐at‐home orders than pre‐COVID, but rebounded by initial reopening (to pre‐COVID levels). In contrast, the number of negative social interactions and social comparisons decreased from before COVID to stay‐at‐home orders, and remained lower during initial reopening; these experiences were also less variable during stay‐at‐home orders and initial reopening than before COVID‐19. Thus, in a vulnerable group of women with health risks, there is little evidence that social experiences worsened during the first 6 months of the COVID‐19 pandemic; decreases in (potentially) negative social experiences may be a small but beneficial side effect of short‐term public health precautions.

Carbon Electrode Sensor for the Measurement of Cortisol with Fast-Scan Cyclic Voltammetry.

Cortisol is a vital steroid hormone that has been known as the "stress hormone", which is elevated during times of high stress and anxiety and has a significant impact on neurochemistry and brain health. The improved detection of cortisol is critically important as it will help further our understanding of stress during several physiological states. Several methods exist to detect cortisol; however, they suffer from low biocompatibility and spatiotemporal resolution, and they are relatively slow. In this study, we developed an assay to measure cortisol with carbon fiber microelectrodes (CFMEs) and fast-scan cyclic voltammetry (FSCV). FSCV is typically utilized to measure small molecule neurotransmitters by producing a readout cyclic voltammogram (CV) for the specific detection of biomolecules on a fast, subsecond timescale with biocompatible CFMEs. It has seen enhanced utility in measuring peptides and other larger compounds. We developed a waveform that scanned from -0.5 to -1.2 V at 400 V/s to electro-reduce cortisol at the surface of CFMEs. The sensitivity of cortisol was found to be 0.87 ± 0.055 nA/μM (n = 5) and was found to be adsorption controlled on the surface of CFMEs and stable over several hours. Cortisol was co-detected with several other biomolecules such as dopamine, and the waveform was fouling resistant to repeated injections of cortisol on the surface of the CFMEs. Furthermore, we also measured exogenously applied cortisol into simulated urine to demonstrate biocompatibility and potential use in vivo. The specific and biocompatible detection of cortisol with high spatiotemporal resolution will help further elucidate its biological significance and further understand its physiological importance and impact on brain health.

0918 Elevated stress during the first-year of medical school negatively impacts sleep quality

Abstract Introduction Poor sleep health is widespread within healthcare and is notoriously neglected during residency; however, little is known about sleep quality during the pre-clinical years of medical school. Stress contributes to poor sleep quality and is commonplace in medical education. This study sought to understand how stress impacts sleep among first-year medical students. Methods A one-time, 130-item survey was distributed to the first-year medical school class three months into the first semester. Quantitative and open-text questions sought to understand student demographics, mental health, sleep quality, and sleep-related behaviors, beliefs, and knowledge. Highly prevalent anxiety was defined as feeling nervous/anxious/on edge for more than half of the days during the previous two weeks. Odds ratios (OR) include 95% confidence intervals and were determined using binary logistic regression. Statistical significance was considered a p-value ≤0.05. Results 138 of the 209 students (66%) in the first-year medical school class completed the survey. Demographics mirrored those of the whole class: 46% male, 54% female, and average age 23.5. Short sleep was prevalent with a mean (standard deviation) sleep time of 6.85 (0.86) hours. Additionally, more than three-quarters reported suboptimal sleep: 56% rated quality as average, and 21% rated quality as poor/very poor. 33% of respondents reported difficulty falling asleep at least once per week. A lack of restorative sleep was also common: 38% felt that sleep was rarely or never refreshing. Over half of respondents (51%) attributed poor sleep to either stress or school, and 29% of students reported elevated or highly prevalent anxiety. Elevated anxiety predicted suboptimal sleep quality (OR 14.67, 1.70-126.76, p=0.015) and a lack of restorative sleep (OR 6.00, 1.52-23.71, p=0.011). Similarly, suboptimal sleep quality was associated with highly prevalent anxiety (OR 44.0, 4.62-418.93, p< 0.001) and difficulty falling asleep (OR 4.14, 1.76-9.75, p=0.001). Conclusion Poor sleep and stress are both prevalent during the first year of medical school, with students directly linking stress from their academic workload to impaired sleep quality and insufficient sleep duration. Due to the pervasiveness of stress within medical education, future interventions should help students improve their sleep during both low and high stress time periods. Support (if any)

Both overwhelmed or in it together? Similarity in COVID‐19‐related stress and romantic relationship quality

AbstractStress tends to be negatively associated with romantic relationship quality, but shared stress can bond romantic partners and may actually have a positive effect on relationships. Thus, are similar levels of pandemic‐related stress during the COVID‐19 pandemic—a time of high stress for many couples—associated with better or worse relationship quality? In this study, we investigated whether similarity in COVID‐19‐related stress was associated with romantic relationship outcomes in two dyadic samples (N = 300 couples). Generally, we found little evidence that similarity in COVID‐19‐related stress was associated with relationship outcomes. We did find that similarity in general worry about the pandemic was associated with lower overall relationship quality; however, it was also associated with lower levels of viewing the pandemic as a source of conflict. Therefore, more research is needed to understand the nuances of when and how stress similarity is associated with romantic relationship quality.

One Month in One Hundred Degrees: Caring for High-Risk Populations During Extreme Weather Events

Introduction:In August 2021, Hurricane Ida struck Louisiana as a near-category five storm, bringing massive devastation to the region’s healthcare infrastructure. In its aftermath, extreme heat coincided with record COVID-19 hospitalizations in the state, leaving minimal healthcare surge capacity remaining and medically vulnerable populations unprotected. Meanwhile, sparse pre-storm evacuations exposed prominent gaps in existing medical response plans designed to serve high-risk groups. Subsequently, Louisiana rapidly established a 250-bed alternative care site (ACS) within hard-hit New Orleans. This presentation highlights key considerations in the operation of the site and discusses which patient populations are most in need of medical support following tropical weather events.Method:The findings of this discussion are the result of after-action reviews, brief literature reviews, and the experiences of responders during Hurricane Ida. The presentation also draws on retrospective patient chart reviews from Louisiana’s prior alternative care sites.Results:Following Hurricane Ida, a post-storm alternative care site was rapidly established in New Orleans in partnership with a US Disaster Medical Assistance Team (DMAT). Operationalized in less than 72-hours, this site provided inpatient care to displaced persons with major chronic medical needs (e.g. home ventilators, hemodialysis, respiratory therapies), significant mobility impairment, wound care, and psychiatric illnesses. Incorporating Louisiana’s experience with a COVID-19 alternative care site, this facility far-exceeded the typical scope of medical shelters, simultaneously lessening medical surge on already-overburdened hospitals and meeting post-storm needs in the region.Conclusion:Following extreme weather events in metropolitan areas, traumatic injuries and acute illness comprise a small proportion of the medical needs after the event. Accordingly, disaster medical responses must prepare to treat large numbers of chronic illness exacerbations that result from a loss of access to primary care, home health support, and auxiliary services. This approach efficiently leverages resources into lifesaving interventions and protects healthcare systems during times of high stress.

Motivational Profiles and Associations With Physical Activity Before, During, and After the COVID-19 Pandemic: Retrospective Study.

In March 2020, the World Health Organization declared the worldwide COVID-19 outbreak a pandemic, triggering many countries, including Canada, to issue stay-at-home orders to their citizens. Research indicates that these stay-at-home orders are associated with a decline in physical activity (PA), a behavior that can reduce disease risk and improve the quality of life. Many behavioral change theories, such as the self-determination theory (SDT) of motivation, state that PA engagement is mediated by psychological constructs, such as motivation. According to the SDT, motivation exists on a continuum from more controlled (external or coerced) to more autonomous (volitional) regulatory forms. Individuals move along the continuum from more controlled to more autonomous forms through the fulfillment of 3 psychological needs: autonomy, competence, and relatedness. Research indicates that moderate-to-vigorous physical activity (MVPA) is positively associated with the autonomous regulatory form of motivation. Recently, researchers have speculated that a better method to describe motivation than movement along the continuum is to generate motivational profiles, which represent combinations of differing levels of controlled and autonomous regulation existing simultaneously. We aimed to identify distinct motivational profiles and determine their association with MVPA before, during, and after the COVID-19 pandemic. Using a cross-sectional, retrospective design, we surveyed 977 Canadian adults. We assessed motivation for PA using the Behavioral Regulations in Exercise Questionnaire-3 (BREQ-3). We assessed PA pre-, during, and post-COVID-19 stay-at-home orders in Canada using the International Physical Activity Questionnaire (IPAQ). We derived motivational profiles using latent profile analysis (LPA). Using motivational profiles as an independent variable, we assessed their effect on PA at all 3 time points with multilevel models that included the participant ID as a random variable. We identified 4 profiles: high controlled and high autonomous (HCHA), low overall motivation (LOM), high autonomous and introjected (HAI), and high amotivation and external (HAE). The HCHA profile had the highest levels of weekly MVPA minutes at all 3 time points, followed by the HAI profile. Our results suggest that a combination of both autonomous and controlled regulatory forms may be more effective in influencing MVPA than the controlled or autonomous forms alone, particularly during times of high stress, such as a worldwide pandemic. Although the odds of another global pandemic are low, these results may also be applied to other times of stress, such as job transitions, relationship changes (eg, change in marital status), or the death of a loved one. We suggest that clinicians and practitioners consider developing PA interventions that seek to increase both controlled and autonomous regulatory forms instead of aiming to reduce controlled forms.

Analisis Risiko Bunuh Diri pada Mahasiswa Kesehatan di Kota Banda Aceh

Background: Suicide is the main cause of death for students. Some studies report that half of college students have felt so depressed that they were useful. College life can be a time of high stress. This study aims to describe the risk of suicide in health students in Banda Aceh.Methods: This type of research is a quantitative research using a descriptive correlative method. The sampling technique in this study used purposive sampling with a sample of 171 students. Data collection method using Adult Suicidal Ideation Questionnaire (ASIQ).Result: The majority of respondents were health students from the Faculty of Nursing (67.3%), female (88.9%), 2016 class (50.9%), adult (90.6%), from high school (84 ,8%), both parents are still alive (85.4%), have parents who work as civil servants (52.6%), and live in a boarding house/rent (50.3%). The age of the students in this study was between 18 years to 23 years. The majority of health students at Syiah Kuala University experienced a low risk of suicide (87.7%).Conclusion : It can be concluded that health students have a suicide risk which is characterized by thoughts related to suicidal ideation, but these ideas rarely appear so that their suicide risk category is low.

Coping Strategies and Quality of life: Reaction to the COVID-19 Pandemic Among Romanian physicians

IntroductionThe COVID‑19 pandemic has raised multiple psychological challenges among most healthcare workers, from anxiety to depression, burnout, sleep disorders, and substance use disorders. Thus, the burden caused by this prolonged medical crisis has inevitably drastically lowered the quality of life of the medical staff. In order to mitigate the negative effects of the pandemic, healthcare workers resorted to various coping strategies, with better or worse outcomes.ObjectivesThe present study aims to identify Romanian physicians’ main coping mechanisms and evaluate the role of positive and negative stress-reducing strategies on quality of life.MethodsA cross‑sectional national survey was conducted using a web-based questionnaire among physicians practicing in Romania (n=265). In addition to socio-demographic and professional information, the questionnaire addressed participants’ coping mechanisms using the COPE inventory and quality of life with the WHOQOL-Brief scale. Descriptive statistics, Pearson correlations, and multiple linear regressions were used in the statistical analysis.ResultsIn total, 265 physicians consented to their participation in the survey. Of those who responded, 84.5% identified as female, 92.1% had a permanent residence in a urban setting, 63.8% were married and 55.1% attained a master’s degree, a PhD diploma or equivalent level of education. The results showed that optimism was higher in male professionals, while avoidance coping was higher in female health professionals. The mean values of QoL subscales were: 74.7± 18.3 for the general quality of life, 70.8± 20.7 for health satisfaction, 64.0± 14.2 for the physical area, 61.7± 16.2 for the psychological area, 61.2± 20.3 for the social relationships area and 64.7± 12.7 for the environment area. Specific coping mechanisms (emotional venting, behavioral and mental disengagement) were associated with lower quality of life. In contrast, emotion-focused (positive reinterpretation and acceptance), problem-focused strategies (planning, active coping, suppression of competing activities) and humor were associated positively with most QoL subscales scores.ConclusionsOur data points to specific protective characteristics and some detrimental factors on physicians’ quality of life during the pandemic, with the implication that these factors may be important considerations for mitigating distress and psychiatric disorders for healthcare workers during times of high stress. Concerted initiatives to improve wellness in healthcare workers ought to develop targeted programs to ensure adequate psychological support.Disclosure of InterestNone Declared

CARING FOR OLDER ADULTS ACROSS THE CARE CONTINUUM: EXPERIENCES OF OLDER ADULTS AND FORMAL CAREGIVERS

Abstract As individuals age, they are at risk of experiencing health challenges that can contribute to poorer health outcomes and increase health care costs. During acute care crises and through the continuum of dealing with chronic diseases, older adults rely on formal caregivers to provide care and support. Formal caregivers’ delivery of care can be challenged during difficult patient cases (e.g., providing wound care to a person exhibiting behavioral and psychological symptoms of dementia) and during high stress times, such as working through a pandemic. However, during difficult times, resilience among formal caregivers can have a positive affect on care delivery. This symposium identifies some of the health challenges experienced by aging adults, challenging experiences of nurses, levels of resilience among formal caregivers, and discusses the implications for nursing care and future research. Ms. Coates examines trends in adverse drug admissions among older adults in the United States using the 2018 Healthcare Cost and Utilization Project’s National Inpatient Sample. Dr. Hwang explores the relationship between nutrition, inflammation, and physical and mental health in aging adults with chronic leg wounds. Dr. Sefcik discusses nurses’ experiences caring for community-dwelling persons living with dementia and chronic wounds. Mr. Hathaway examines factors that contribute to resilience in staff of a continuing care retirement community during the late stage of the COVID-19 pandemic. Dr. DiMaria-Ghalili, discussant, will synthesize these findings and offer insights on designing interventions to address health challenges and recommendations for supporting formal caregivers.

Health-oriented leadership: Antecedents of leaders’ awareness regarding warning signals of emerging depression and burnout

Due to growing demands, there is an increase in depression and burnout causing sickness absence and early retirement. Detecting depression and burnout at an early stage is a crucial task for leaders to allow for early support and prevent more severe illnesses. Within the health-oriented leadership concept, awareness is the ability to recognize followers’ warning signals as a potential health risk. Although it is widely accepted that awareness is a precondition to taking appropriate action, it is yet unclear to what extent leaders recognize the warning signals of followers and which factors facilitate or impede awareness. In an experimental study ( N = 54) and a survey study ( N = 215) we examined antecedents of awareness in followers and leaders: (a) clarity of displayed warning signals in followers, (b) leaders’ stressors, (c) leaders’ autonomy. Even under favorable conditions, only about half of the leaders recognized warning signals as a health risk. Leaders showed lower awareness during times of high stress and low autonomy and when followers displayed less clear warning signals. Autonomy moderated the effect of stress (workload) on awareness, but there was no buffering effect as expected. The findings deepen the theoretical understanding of awareness and suggest that leaders need to know how their awareness may be impeded. We provide practical recommendations for human resource management on how leaders’ awareness can be fostered.

Maternal Functioning and Psychological Distress During the COVID-19 Pandemic.

Background: Our objective was to understand maternal functioning and psychological distress among mothers of young children in the United States during April/May 2020, early in the coronavirus disease 2019 (COVID-19) pandemic. Materials and Methods: Participants were 862 moms of children aged 0-3 years old who completed an online survey. We examined maternal functioning (maternal competency and self-care subscales from the Barkin Index of Maternal Functioning) and psychological distress (depression, anxiety, and stress subscales of the DASS-21), and then examined interaction effects of COVID-19 impact and socioeconomic status (SES; represented by income and education). Results: Mothers' reports of higher maternal functioning correlated with lower psychological distress and both sets of factors varied substantially by SES and COVID-19 Impact. Higher COVID-19 Impact was associated with lower functioning and greater distress. Higher income and education were associated with better maternal self-care, but not maternal competency. Although we expected high SES to buffer mothers from a higher impact of COVID-19, we found that mothers with high SES reported a lower level of maternal competence and more stress than low-SES mothers. Interactions between COVID-19 impact and SES predicting maternal functioning and psychological distress revealed that when COVID-19 impact was low, high SES was associated with high functioning scores and less distress. Conclusions: This work challenges the assumptions that a stressful event will be uniformly experienced by mothers of young children as well as the stress-buffering role of higher SES. This study highlights the importance of considering SES when characterizing maternal functioning and psychological distress during times of high stress. Further research is needed to examine the processes contributing to these discrepancies.