Emotional Disorders During the COVID-19 Outbreak in Spain: The Role of Sociodemographic Risk Factors and Cognitive Emotion Regulation Strategies.

BACKGROUND: Cognitive emotion regulation strategies (CERS) play a transdiagnostic role in emotional disorders, but the role of these strategies in coping with emotions during the coronavirus disease 2019 (COVID-19) pandemic remains poorly understood. AIMS: To assess the presence of emotional disorders in Spain and the association to sociodemographic characteristics and CERS during the COVID-19 outbreak. METHOD: Cross-sectional survey administered through an online platform. Sociodemographic variables and CERS (CERQ-Short) were collected and possible diagnoses of generalized anxiety disorder (GAD, GAD-7), major depression disorder (MDD; Patient Health Questionnaire-9 [PHQ-9]), panic attacks (PA; PHQ-PD), and panic disorders (PD; PHQ-PD) were assessed. Sociodemographic risk factors and CERS association to the possible diagnosis of emotional disorders were reported with hierarchical multivariate logistic regression analyses. RESULTS: A total of 1,753 respondents completed the questionnaire in Spain. Of these, most (76.8%) were female, with a mean (SD) age of 40.4 years (12.9). A high proportion of participants met diagnostic criteria for emotional disorders: 15.3% for GAD, 12.2% for MDD, 17.2% for PD, and 25.7% had experienced a PA. The contribution of sociodemographic variables to diagnoses of emotional disorders was modest, explaining from 3.1% to 5.7% of the variance; however, when CERS were added, the combination of sociodemographic and CERS explained from 15% to 29% of the variance. Rumination and catastrophizing were the most transdiagnostic maladaptive strategies and positive refocusing was another adaptive strategy. DISCUSSION: Although results from convenience samples should be handled with caution, the high prevalence of emotional disorders in this study suggests that the demand of mental health interventions will probably increase in Spain. Also, CERS play a clear role in the presence of these disorders. CONCLUSION: Intervention programs should focus on training CERS in populations at high risk, focusing on the reduction of maladaptive CERS and the reinforce of other more adaptive CERS.

Relationship between self-care activities, stress and well-being during COVID-19 lockdown: a cross-cultural mediation model.

OBJECTIVES: To examine the mediation role of self-care between stress and psychological well-being in the general population of four countries and to assess the impact of sociodemographic variables on this relationship. DESIGN: Cross-sectional, online survey. PARTICIPANTS: A stratified sample of confined general population (N=1082) from four Ibero-American countries-Chile (n=261), Colombia (n=268), Ecuador (n=282) and Spain (n=271)-balanced by age and gender. PRIMARY OUTCOMES MEASURES: Sociodemographic information (age, gender, country, education and income level), information related to COVID-19 lockdown (number of days in quarantine, number of people with whom the individuals live, absence/presence of adults and minors in charge and attitude towards the search of information related to COVID-19), Perceived Stress Scale-10, Ryff's Psychological Well-Being Scale-29 and Self-Care Activities Screening Scale-14. RESULTS: Self-care partially mediates the relationship between stress and well-being during COVID-19 confinement in the general population in the total sample (F (3,1078)=370.01, p<0.001, R2=0.507) and in each country. On the other hand, among the evaluated sociodemographic variables, only age affects this relationship. CONCLUSION: The results have broad implications for public health, highlighting the importance of promoting people's active role in their own care and health behaviour to improve psychological well-being if stress management and social determinants of health are jointly addressed first. The present study provides the first transnational evidence from the earlier stages of the COVID-19 lockdown, showing that the higher perception of stress, the less self-care activities are adopted, and in turn the lower the beneficial effects on well-being.

Is It Possible to Be Happy during the COVID-19 Lockdown? A Longitudinal Study of the Role of Emotional Regulation Strategies and Pleasant Activities in Happiness.

This study aimed to longitudinally analyze the role played by two emotional regulation strategies (cognitive reappraisal and expressive suppression), through the mediating effect of engagement in pleasant activities during lockdown, in changes in affective and cognitive happiness in comparison with pre-pandemic levels. Eighty-eight participants from a community sample were evaluated at two timepoints. At timepoint 1 (before the COVID-19 pandemic), participants were evaluated on emotional regulation and cognitive and affective happiness. At timepoint 2 (during the COVID-19 lockdown), participants were evaluated on cognitive and affective happiness and the frequency with which they engaged in pleasant activities. We found an optimal fit of the proposed model in which cognitive reappraisal was significantly related to engagement in more pleasant activities during the lockdown. In turn, these pleasant activities were related to more affective happiness during the lockdown (compared with pre-pandemic levels), and this affective happiness was associated with greater cognitive happiness. In conclusion, cognitive reappraisal was a protective factor for affective and cognitive happiness through the mediating role of engagement in pleasant activities during lockdown. Limitations and future lines of investigation are discussed.

Worry about COVID-19 contagion and general anxiety: Moderation and mediation effects of cognitive emotion regulation.

The global pandemic caused by coronavirus disease 2019 (COVID-19) occasioned that most of the population in Spain was confined to home to reduce the risk of contagion. This affected mental health, increasing anxiety and worry about COVID-19 contagion. The aim of this study was assessing the moderation and mediation effect of cognitive emotion regulation strategies (CERS) on general anxiety and whether the mediation effect was moderated by gender and/or age. A total of 1753 Spanish adults (78,6% female; M = 40.4 years, SD = 12.9) participated in an online survey that was available from March 26 to April 25 (2020) during the time period in which the population in Spain was confined. Participants completed measures of worry about COVID-19 contagion, the Cognitive Emotion Regulation Questionnaire-Short (CERQ-Short) and the Generalized Anxiety Disorder-7 (GAD-7). Several models were tested through structural equation modelling. Moderation analyses reported that maladaptive strategies moderated positively anxiety, whereas adaptive strategies moderated negatively anxiety. Also, the best fitted mediation model found that worry about COVID-19 contagion and general anxiety was mediated by CERS in different directions. Maladaptive CERS increased anxiety, whereas adaptive CERS reduced anxiety. Age (not gender) also moderated this mediation, were younger adults presented an indirect effect only through maladaptive CERS, but older adults through both adaptive and maladaptive. Limitations are related to the study design which was a convenience sample. CERS moderated and mediated between worry about COVID-19 contagion and general anxiety. Prevention programs for mental health problems during the pandemic must be provided, especially for younger adults.

Different Responses to Stress, Health Practices, and Self-Care during COVID-19 Lockdown: A Stratified Analysis.

The aim of the present cross-sectional study was to analyze the differential impact of the first COVID-19 lockdown (3 April 2020) on stress, health practices, and self-care activities across different Hispanic countries, age range, and gender groups. One thousand and eighty-two participants from Spain, Chile, Colombia, and Ecuador took part in this study. Irrespective of the country, and controlling for income level, young people, especially females, suffered a greater level of stress, perceived the situation as more severe, showed less adherence to health guidelines, and reported lower levels of health consciousness, in comparison to their male peers and older groups. However, in the case of self-care, it seems that older and female groups are generally more involved in self-care activities and adopt more healthy daily routines. These results are mostly similar between Colombia, Ecuador, and Spain. However, Chile showed some different tendencies, as males reported higher levels of healthy daily routines and better adherence to health guidelines compared to females and people over the age of 60. Differences between countries, genders, and age ranges should be considered in order to improve health recommendations and adherence to guidelines. Moreover, developing community action and intersectoral strategies with a gender-based approach could help to reduce health inequalities and increase the success of people's adherence to health guidelines and self-care-promoting interventions. Future studies should be addressed to explore the possible causations of such differences in more cultural-distant samples and at later stages of the current outbreak.

A longitudinal study of the influence of concerns about contagion on negative affect during the COVID-19 lockdown in adults: The moderating effect of gender and resilience.

The COVID-19 global pandemic has had psychological consequences worldwide. The aim of the present study was to analyze the effect of concerns about contagion on negative affect (NA) according to resilience, gender and age by using a longitudinal methodology that evaluated the participants 4 months before the COVID-19 outbreak and during the resulting lockdown situation imposed by the Spanish government. About 102 participants from a community sample were assessed. The results revealed higher levels of NA during the lockdown, as well as a positive relationship between age and the increase in NA. In addition, we found that a positive relationship between contagion concern and increase in NA was only observed in women with low resilience.

The role of emotional intelligence and self-care in the stress perception during COVID-19 outbreak: An intercultural moderated mediation analysis.

Background: The relationship between emotional intelligence (EI) and stress has been widely studied, as well as the beneficial role of self-care to maintain health and wellbeing. However, the joint contribution of EI and self-care in predicting stress has not been examined during COVID-19 lockdown. This study aimed to examine the mediating role of self-care in the relationship between EI and stress and the potential moderator role of gender. Methods: A sample of 1082 participants from four Hispanic countries completed measures related to socio-demographic, trait emotional intelligence (Trait Meta-Mood Scale), self-care activities (Self-care Activities Screening Scale) and stress (Perceived Stress Scale). Results: Mediation analyses revealed that self-care increased the explained variance of the prediction of stress by EI dimensions after controlling gender and age. However, gender only moderated the relationship between self-care and stress in the mediation model corresponding to emotional attention. Conclusions: Data supported a general model for the interaction of EI and self-care as contributing factors of stress. Further research is needed to replicate it in more culturally distant samples and to fully explore the potential role of gender differences. Future intervention programs should include a balanced combination of EI and self-care to increase their benefits on people's health.

Validity and reliability of the Self-Care Activities Screening Scale (SASS-14) during COVID-19 lockdown.

BACKGROUND: In a context where there is no treatment for the current COVID-19 virus, the combination of self-care behaviours together with confinement, are strategies to decrease the risk of contagion and remain healthy. However, there are no self-care measures to screen self-care activities in general population and which, could be briefly in a lockdown situation. This research aims to build and validate a psychometric tool to screen self-care activities in general population. METHODS: Firstly, an exploratory factor analysis was performed in a sample of 226 participants to discover the underlying factorial structure and to reduce the number of items in the original tool into a significant pool of items related to self-care. Later a confirmatory factor analyses were performed in a new sample of 261 participants to test for the fit and goodness of factor solutions. Internal validity, reliability, and convergent validity between its score with perceived stress and psychological well-being measures were examined on this sample. RESULTS: The exploratory analyses suggested a four-factor solution, corresponding to health consciousness, nutrition and physical activity, sleep, and intra-personal and inter-personal coping skills (14 items). Then, the four-factor structure was confirmed as the best model fit for self-care activities. The tool demonstrated good reliability, predictive validity of individuals' perception of coping with COVID-19 lockdown, and convergent validity with well-being and perceived stress. CONCLUSIONS: This screening tool could be helpful to address future evaluations and interventions to promote healthy behaviours. Likewise, this tool can be targeted to specific population self-care's needs during a scalable situation.