Believing Processes during the COVID-19 Pandemic: A Qualitative Analysis.

Cognition, emotion, emotional regulation, and believing play a special role in psychosocial functioning, especially in times of crisis. So far, little is known about the process of believing during the COVID-19 pandemic. The aim of this study was to examine the process of believing (using the Model of Credition) and the associated psychosocial strain/stress during the first lockdown in the COVID-19 pandemic. An online survey via LimeSurvey was conducted using the Brief Symptom Inventory-18 (BSI-18), the Pittsburgh Sleep Quality Index (PSQI), and a dedicated Believing Questionnaire, which assesses four parameters of credition (propositions, certainty, emotion, mightiness) between April and June, 2020, in Austria. In total, n = 156 mentally healthy participants completed all questionnaires. Negative credition parameters were associated with higher global symptom load (from BSI-18): narratives: r = 0.29, p < 0.001; emotions r = 0.39, p < 0.001. These findings underline the importance of credition as a link between cognition and emotion and their impact on psychosocial functioning and stress regulation in implementing novel strategies to promote mental health.

Feeling Informed and Safe Are Important Factors in the Psychosomatic Health of Frontline Workers in the Health Sector during the COVID-19 Pandemic in Austria.

The global spread of the coronavirus disease (COVID-19) has created new challenges for the entire healthcare system, and those who work directly with the patients or even on the front lines with COVID-19 patients have been particularly stressed. Only a few studies are currently available investigating psychosomatic symptoms among healthcare workers, particularly frontline workers, over the entire pandemic period (2020-2022). There is also a lack of knowledge about strategies to prevent stress during and after a health crisis. METHODS: An online survey was conducted at three times (April 2020, winter 2020/2021, and winter 2021/2022) during the COVID-19 pandemic in Austria. The sample included 160 healthcare workers at screening time 1, 1.361 healthcare workers at screening time 2, and 1.134 healthcare workers at screening time 3. The survey included COVID-19 work-related fears, satisfaction with the frontline work, and standardized inventories to assess psychosomatic symptoms, such as the Patient Health Questionnaire (PHQ-D). RESULTS: Psychosomatic symptoms were more common among women compared to men, and among frontline workers compared to non-frontline workers, especially during the course of the pandemic at t2 and t3. Self-reported scores of COVID-19 work-related fears were significantly associated with psychosomatic symptoms. Furthermore, in frontline workers, there was a significant association between the feeling of being safe and well-informed and psychosomatic symptoms. CONCLUSION: COVID-19 work-related fears and psychosomatic symptoms have been prevalent among healthcare workers throughout the pandemic. Feeling safe and informed appears to be essential to prevent psychosomatic symptoms, leading to a recommendation for employers in the healthcare sector to focus on communication and information. As frontline workers are especially prone to psychosomatic symptoms, more stress prevention programs for them will be essential to maintain productivity and reduce sick days and fluctuations in the healthcare system.

[COVID-19 and Bipolar Affective Disorder: Subjective Changes in Lifestyle Variables During the First Lockdown During the COVID-19 Pandemic in Austria]. / COVID-19 und bipolare affektive Störung: Subjektive Veränderung der Lebensstilvariablen während des ersten Lockdowns in der COVID-19-Pandemie in Österreich.

INTRODUCTION: The COVID-19 pandemic with its protective measures (e. g. lockdown) had far-reaching effects on everyone's well-being. The aim of this study was to examine lifestyle variables during the first Austrian lockdown in patients with bipolar disorder in comparison to a healthy control group and to assess subjective changes caused by the pandemic. METHOD: At the beginning of April 2020, an online survey of n=75 participants (35 people with bipolar disorder and 40 healthy controls) with standardized questionnaires (Beck Depression Inventory-2, Food Craving Inventory, Altman Self Rating Mania Scale) as well as non-standardized COVID-19-specific questions on the subject of "Psychological stress and effects of the COVID-19 pandemic in bipolar disorder" was created and distributed via LimeSurvey. RESULTS: Both groups reported a negative impact on their mental health. The participants with bipolar disorder showed significantly higher values in the Beck Depression Inventory-2 score (p<0,001), in emotional distress due to social distancing (p=0,003) and significantly lower values in muscle-strengthening exercise (p=0,039) and in sport units (p=0,003) compared to the control group. In addition, patients with bipolar disorder smoked more often than individuals of the control group. People with bipolar disorder were 42,9% more likely to report they were less efficient during the pandemic, and 22,9% experienced weight gain compared to before the pandemic. The control group, on the other hand, was less efficient at 17,5% and 5,0% reported weight gain. However, a comparison with pre-pandemic data showed a decrease in food craving in both groups. CONCLUSION: This study provided first evidence of self-reported adverse effects on mental stress and lifestyle in people with bipolar disorder at the beginning of the COVID-19 pandemic. Psychiatric care and early interventions for patients with bipolar disorder would be particularly important in times of crisis in order to help maintain a healthy lifestyle and thus counteract unfavourable developments.

COVID-19 vaccination motivation and underlying believing processes: A comparison study between individuals with affective disorder and healthy controls.

Background: Believing processes represent fundamental brain functions between cognition and emotion. Shortly before the introduction of a compulsory vaccination against COVID-19 in Austria, motives and underlying believing processes regarding the vaccination were collected in individuals with affective disorder (AD) and healthy controls (HC). Methods: 79 individuals with AD and 173 HC were surveyed online to assess believing processes with the parameters of the credition model (narratives, certainty, emotion, mightiness) about (1) the coronavirus itself and (2) why someone is vaccinated or not. In addition, we calculated congruence scores between content of narrative and type of emotion and divided the narrative content into positive, negative, and indifferent. Results: There were no differences in vaccination status between AD and HC. Higher levels of certainty were observed in HC compared to AD in both vaccinated and unvaccinated individuals. The effects were higher when asked about the motivation to vaccinate or not than about the coronavirus itself. In HC, more positive emotions and more congruence between emotions and narratives were reported during believing in their vaccination motives. No group differences were found in mightiness for both items. Independently from diagnosis, unvaccinated people had high levels of certainty and more negative emotions and narratives while believing in their motives for not getting vaccinated. Conclusion: When believing about the COVID-19 vaccination, individuals with AD were more uncertain and experienced fewer positive emotions than HC, although both groups did not differ in vaccination status. These effects were not that strong when believing about the coronavirus in general.

Influences of COVID-19 Work-Related Fears and Anhedonia on Resilience of Workers in the Health Sector during the COVID-19 Pandemic

Background: During the peak of the COVID-19 pandemic, healthcare workers worked under stressful conditions, challenging their individual resilience. Therefore, we explored the bidirectional influence of resilience and the factors of COVID-19 work-related fears and anhedonia in Austrian healthcare workers. Methods: Healthcare workers in Austria completed an online survey at two points in time. The first measurement started in winter 2020/2021 (t1), and a second measurement began approximately 1.5 years later (t2). One hundred and eight six individuals completed both surveys and were investigated in a longitudinal design. We applied the Resilience Scale, the Snaith-Hamilton Pleasure Scale, and a self-created questionnaire assessing COVID-19 work-related fears. We used a repeated measures analysis of variance and applied Pearson-Correlations as well as univariate and multivariate analyses of covariance. Results: Resilience was significantly correlated with COVID-19 work-related fears and anhedonia at both points in time in all participants. We found no significant differences for frontline vs. non-frontline workers at t1 and t2. Resilience decreased significantly over time. Limitations: Most subjects were examined cross-sectionally. Frontline workers were underrepresented in our sample. Conclusion: Our findings highlight the importance of resilience in healthcare providers. Steps must be taken to maintain and promote resilience in healthcare workers. We suggest that the improvement of resilience, dealing with fears and uncertainty, and the ability to experience joy might have a beneficial influence on the respective other categories as well.

Believing processes around COVID-19 vaccination: An exploratory study investigating workers in the health sector.

Background: The processes underlying believing have been labeled "creditions", which are important brain functions between emotion and cognition. Creditions are influenced by both internal and external factors, one of which is the coronavirus disease 2019 (COVID-19) pandemic and the vaccination against the disease. Methods: To investigate believing processes shortly before the implementation of a mandatory vaccination in Austria, both vaccinated and unvaccinated workers in the health sector (WHS) were surveyed in December 2021/January 2022. In total, 1,062 vaccinated and 97 unvaccinated WHS (920 females) completed the online survey. Beliefs were assessed using the parameters of the credition model (narrative, certainty, emotion, and mightiness) with regard to (1) the COVID-19 pandemic in general, and (2) the vaccination. Type of emotion and narrative were divided into positive, negative, and indifferent. Moreover, the congruence between emotion and narrative was calculated. Results: The vaccination rate of the sample was 91.6%, with a significantly higher percentage of men being in the group of vaccinated (21.1%) as compared to unvaccinated individuals (12.4%). Pertaining beliefs about the COVID-19 vaccination, unvaccinated WHS reported more negative and less positive emotions as well as content of narrative than vaccinated WHS. In addition, they showed higher levels of certainty as well as mightiness while believing and felt less sufficiently informed about governmental and workplace-related COVID-19 measures. The groups did not differ in the type of emotion or content of narrative in their beliefs about the pandemic in general. Conclusion: In conclusion, unvaccinated WHS had more negative and less positive emotions and thoughts than vaccinated WHS in their beliefs about the COVID-19 vaccination and their motivations for not having received it. They were more certain about their beliefs and felt stronger negative emotions in their beliefs compared to vaccinated individuals. Providing unvaccinated WHS with adequate information might be helpful in reducing their mental burden.

Believing processes around COVID-19 vaccination: An exploratory study investigating workers in the health sector

Background The processes underlying believing have been labeled “creditions”, which are important brain functions between emotion and cognition. Creditions are influenced by both internal and external factors, one of which is the coronavirus disease 2019 (COVID-19) pandemic and the vaccination against the disease. Methods To investigate believing processes shortly before the implementation of a mandatory vaccination in Austria, both vaccinated and unvaccinated workers in the health sector (WHS) were surveyed in December 2021/January 2022. In total, 1,062 vaccinated and 97 unvaccinated WHS (920 females) completed the online survey. Beliefs were assessed using the parameters of the credition model (narrative, certainty, emotion, and mightiness) with regard to (1) the COVID-19 pandemic in general, and (2) the vaccination. Type of emotion and narrative were divided into positive, negative, and indifferent. Moreover, the congruence between emotion and narrative was calculated. Results The vaccination rate of the sample was 91.6%, with a significantly higher percentage of men being in the group of vaccinated (21.1%) as compared to unvaccinated individuals (12.4%). Pertaining beliefs about the COVID-19 vaccination, unvaccinated WHS reported more negative and less positive emotions as well as content of narrative than vaccinated WHS. In addition, they showed higher levels of certainty as well as mightiness while believing and felt less sufficiently informed about governmental and workplace-related COVID-19 measures. The groups did not differ in the type of emotion or content of narrative in their beliefs about the pandemic in general. Conclusion In conclusion, unvaccinated WHS had more negative and less positive emotions and thoughts than vaccinated WHS in their beliefs about the COVID-19 vaccination and their motivations for not having received it. They were more certain about their beliefs and felt stronger negative emotions in their beliefs compared to vaccinated individuals. Providing unvaccinated WHS with adequate information might be helpful in reducing their mental burden.

The PROVIT Study-Effects of Multispecies Probiotic Add-on Treatment on Metabolomics in Major Depressive Disorder-A Randomized, Placebo-Controlled Trial.

The gut-brain axis plays a role in major depressive disorder (MDD). Gut-bacterial metabolites are suspected to reduce low-grade inflammation and influence brain function. Nevertheless, randomized, placebo-controlled probiotic intervention studies investigating metabolomic changes in patients with MDD are scarce. The PROVIT study (registered at clinicaltrials.com NCT03300440) aims to close this scientific gap. PROVIT was conducted as a randomized, single-center, double-blind, placebo-controlled multispecies probiotic intervention study in individuals with MDD (n = 57). In addition to clinical assessments, metabolomics analyses (1H Nuclear Magnetic Resonance Spectroscopy) of stool and serum, and microbiome analyses (16S rRNA sequencing) were performed. After 4 weeks of probiotic add-on therapy, no significant changes in serum samples were observed, whereas the probiotic groups' (n = 28) stool metabolome shifted towards significantly higher concentrations of butyrate, alanine, valine, isoleucine, sarcosine, methylamine, and lysine. Gallic acid was significantly decreased in the probiotic group. In contrast, and as expected, no significant changes resulted in the stool metabolome of the placebo group. Strong correlations between bacterial species and significantly altered stool metabolites were obtained. In summary, the treatment with multispecies probiotics affects the stool metabolomic profile in patients with MDD, which sets the foundation for further elucidation of the mechanistic impact of probiotics on depression.

Believing processes during the COVID-19 pandemic in individuals with bipolar disorder: An exploratory study.

BACKGROUND: Believing or "credition" refers to psychological processes that integrate the cognitions and emotions that influence our behavior. In the credition model by Angel and Seitz, four parameters are postulated: proposition, certainty, emotion and mightiness. It is assumed that believing processes are influenced by both the individual as well as socio-cultural factors and external circumstances. External or environmental circumstances can include threatening situations such as the ongoing pandemic. It has been hypothesized that believing processes related to the pandemic differ between individuals with bipolar disorder (BD) and healthy controls (HC). AIM: To investigate credition in individuals with BD during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: Psychiatrically stable individuals with BD (n = 52) and age- and sex matched HC (n = 52) participated in an online survey during the first lockdown of the COVID-19 pandemic. The survey took place between April 9th and June 4th, 2020, in Austria. Participants completed the Brief Symptom Inventory-18, the Beck Depression Inventory-II, the Altman Self-Rating Mania Scale, the Pittsburgh Sleep Quality Index and a dedicated Believing Questionnaire assessing four parameters of credition (proposition, certainty, emotion and mightiness). The MAXQDA software was used to analyze the qualitative data. Statistical analyses included analyses of variance, a multivariate analysis of variance and a multivariate analysis of co-variance. RESULTS: Individuals with BD reported significantly more negative propositions [F (1,102) = 8.89, P = 0.004, η2 p = 0.08] and negative emotions [Welch´s F (1,82.46) = 18.23, P < 0.001, η2 p = 0.18], while HC showed significantly more positive propositions [F (1,102) = 7.78, P = 0.006, η2 p = 0.07] and emotions [F (1,102) = 14.31, P < 0.001, η2 p = 0.12]. In addition, individuals with BD showed a higher incongruence between their propositions and their emotions [F (1,102) = 9.42, P = 0.003, η2 p = 0.08] and showed strong correlations between the parameters of the Believing Questionnaire and their psychiatric symptoms (r = 0.51-0.77, all P < 0.001). Positive as well as negative emotions and propositions were associated with scores measuring symptoms of depression, anxiety and sleep quality. CONCLUSION: Believing parameters were associated with psychiatric symptoms in BD during the pandemic. Findings broaden knowledge about the susceptibility of believing processes for ambient challenges in individuals with BD.

Anxious Temperament Predicts Poor Acceptance of Self and Life in Bipolar Disorder during the COVID-19 Pandemic

The coronavirus disease (COVID-19) pandemic and the social distancing resulting thereof are having a great impact on psychological well-being. Studies investigating resilience found that it impacts mental health during crises. This study aimed to evaluate the influence of pre-crisis temperament on resilience in individuals with bipolar disorder during the COVID-19 pandemic. An online survey was conducted in Austria between April and June 2020, including 36 individuals with bipolar disorder and 39 healthy controls. Resilience was assessed with the 13-item resilience scale, and temperament was measured with the Temperament Evaluation of Memphis, Pisa, Paris and San Diego-autoquestionnaire (TEMPS-A). The bipolar disorder group showed lower resilience than the control group, and scored higher on the TEMPS-A for depressive, cyclothymic, and anxious temperaments. Resilience could be predicted by anxious temperament in individuals with bipolar disorder, and correlated negatively with depressive symptoms in both groups. The results suggest that anxious temperament influences the resilience of individuals with bipolar disorder, likely more than temporary hardships, such as the first months of the COVID-19 crisis. It is therefore important to improve the resilience of individuals with bipolar disorder not only by short-term interventions, but by strengthening resilience and reducing anxious temperament in the long term.

Greater Emotional Distress Due to Social Distancing and Greater Symptom Severity during the COVID-19 Pandemic in Individuals with Bipolar Disorder: A Multicenter Study in Austria, Germany, and Denmark.

Throughout the COVID-19 pandemic, mental health of individuals with bipolar disorders (BD) is potentially more vulnerable, especially regarding COVID-19-related regulations and associated symptomatic changes. A multicentric online study was conducted in Austria, Germany, and Denmark during the COVID-19 pandemic. Overall, data from 494 participants were collected (203 individuals with BD, 291 healthy controls (HC)). Participants filled out questionnaires surveying emotional distress due to social distancing, fear of COVID-19, and the Brief Symptom Inventory-18 to assess symptom severity at four points of measurement between 2020 and 2021. General linear mixed models were calculated to determine the difference between the groups in these pandemic specific factors. Individuals with BD reported higher distress due to social distancing than HC, independently of measurement times. Fear of COVID-19 did not differ between groups; however, it was elevated in times of higher infection and mortality due to COVID-19. Individuals with BD reported higher psychiatric symptom severity than HC; however, symptom severity decreased throughout the measured time in the pandemic. Overall, individuals with BD experienced more distress due to the COVID-19 situation than HC. A supportive mental health system is thus recommended to ensure enhanced care, especially in times of strict COVID-19-related regulations.

Psychological and behavioral response on the COVID-19 pandemic in individuals with bipolar disorder: A multicenter study.

The COVID-19 pandemic affects both mentally healthy and ill individuals. Individuals with bipolar disorder (BD) constitute an especially vulnerable group. A multicentric online study was conducted in Austria, Denmark, and Germany after the first lockdown phase in 2020. In total, 117 healthy controls (HC) were matched according to age and sex to 117 individuals with BD. The survey included the Brief Symptom Inventory-18, Beck Depression Inventory-2, Pittsburgh Sleep Quality Index, and a self-constructed questionnaire assessing COVID-19 fears, emotional distress due to social distancing, lifestyle, and compliance to governmental measures. In individuals with BD, increased symptoms of depression, somatization, anxiety, distress due to social distancing, and poorer sleep quality were related to emotional distress due to social distancing. The correlation between emotional distress due to social distancing and anxiety showed 26% of shared variance in BD and 11% in HC. Negative lifestyle changes and lower compliance with COVID-19 regulatory measures were more likely to be observed in individuals with BD than in HC. These findings underscore the need for ongoing mental health support during the pandemic. Individuals with BD should be continuously supported during periods of social distancing to maintain a stable lifestyle and employ strategies to cope with COVID-19 fears.

Physical Health Profile and Associated Behavior During the COVID-19 Pandemic in Patients With Bipolar Disorder.

Background: The COVID-19 pandemic has led to an increased psychological strain on public mental health and may impact behavioral, mental, and physical health, presumably with effects on patients with severe mental disorders. This study examines pandemic-related physical and mental health and (compensatory) behavioral changes, in patients with BD as compared to healthy control individuals. Method: Physical and mental health and self-reported changes in daily structure and behavior due to the pandemic were assessed using a self-constructed questionnaire and the brief symptom inventory (BSI) in Germany, Austria, and Denmark in individuals with BD and a healthy control group. Results: The present study included 118 individuals with BD and 215 healthy controls. Individuals with BD reported statistically significant higher physical risk burden, increased weight gain, more physical comorbidities, and a decrease in physical activity and they further reported higher rates of COVID-19 testing, had more worries concerning health, and experienced more anxiety but less social distancing. Conclusion: The COVID-19 pandemic seems to have a greater impact on physical health in individuals with BD than in healthy controls. Individuals with BD appear to be having more difficulties compensating their behavior due to the pandemic which could amplify the effect of risk factors associated with poorer physical health. This highlights the necessity for optimizing and targeting the overall treatment of both mental and physical health in patients with BD during periods with far-reaching changes such as the COVID-19 pandemic. Limitations: Sampling issues and self-report forms, selectivity (missing elderly, and those lacking access or knowledge of technology).