Relationships between stress appraisals and intolerance of uncertainty with psychological health during early COVID-19 in the USA.

BACKGROUND AND OBJECTIVES: The COVID-19 pandemic has caused increased psychological distress and decreased quality of life (QoL), but limited research has evaluated cognitive appraisals of COVID-19. This study aimed to examine the role of three stress appraisals of the COVID-19 pandemic - threat appraisal, harm/loss appraisal, and challenge appraisal - and the interaction between these appraisals and intolerance of uncertainty (IU) on psychological distress and QoL. DESIGN: This was a cross-sectional survey study using Amazon's Mechanical Turk. METHODS: A sample of 327 adults living in the U.S. completed a series of questionnaires investigating IU, appraisal of the pandemic, psychological distress, and QoL in May 2020 during the first wave of the COVID-19 pandemic. RESULTS: Controlling for demographic variables, IU and harm/loss appraisal positively related to psychological distress and negatively related to QoL. Challenge appraisals negatively related to distress and positively related to QoL. Moderation analyses revealed that higher levels of IU led to stronger positive relationships between threat appraisal and psychological distress. CONCLUSIONS: Cognitive appraisals of COVID-19 are associated with psychological health, though the relationship between threat appraisal and psychological distress are strongest for those with difficulty tolerating uncertainty. Theoretical and practical implications are discussed.

Assessing the predictors of adaptive and maladaptive Covid-19 preventive behaviours: an application of protection motivation theory.

Despite the high death toll of the COVID-19 pandemic, reported rates of adherence to adaptive preventive health behaviours during the early wave of the pandemic were suboptimal for reducing the risk of disease spread. Additionally, some have adopted practices with the intention of preventing infection that have harmful consequences. Protection Motivation Theory (PMT), consisting of perceived vulnerability, severity, response efficacy, and self-efficacy, has been used to predict intentions to engage in behaviours in past pandemics, and can be extended to the COVID-19 outbreak. Three hundred and thirty-three American adults completed a survey in May 2020 through Amazon's Mechanical Turk. Ten behaviours recommended by the CDC and WHO and two 'maladaptive' behaviours presented in the media were selected for investigation. Binary logistic regressions were conducted to assess the impacts of demographic variables and PMT constructs on behaviour frequency. Perceived severity and vulnerability were not significant predictors of behaviour frequency. Behaviour specific response efficacy and self-efficacy were significant predictors of 11/12 (odds ratios: 2.70-6.22) and 10/12 (odds ratios: 2.59-4.64) behaviours, respectively. Age, gender, education, political ideology, perceived severity, and perceived vulnerability were generally unimportant predictors. Beliefs about the effectiveness of the behaviour and one's ability to carry out that behaviour consistently seem to be more important in predicting how often someone engages in that behaviour than the perceived dangerousness of COVID-19 and one's believed susceptibility to infection. These results suggest that interventions trying to modulate the likelihood of engaging in preventive behaviours should focus on the effectiveness of these behaviours in reducing risk of spread and the individual's ability to engage in these behaviours frequently rather than the dangerousness of the COVID-19 pandemic and the individual's risk of becoming infected.

Approach and Avoidance Coping Dynamics during the COVID-19 Pandemic.

Approach-avoidance conflicts were one of the earliest applications of catastrophe theory. Empirical studies evaluating the cusp catastrophe model for approach-avoidance dynamics have only started to appear recently, however. The present study reviews the extant research and expands the concept to approach and avoidance coping styles. Research participants were 333 adults from the general population recruited through Amazon Mechanical Turk. They completed measures of psychological symptoms, quality of life (QOL), approach and avoidance coping styles, and COVID-related stress. Cusp models for symptoms (R2 = .84) and QOL (R2 = .89) illustrated approach and avoidance functioning as bifurcation gradients for both psychological symptoms and QOL. Both models provided more accurate representations of the data than the linear alternatives (R2 = .54 and .24 respectively), thus providing further support for the cusp dynamics. The cusp catastrophe model has extensive applicability to approach-avoidance behaviors. There was greater variability (hysteresis) in outcomes for people who used fewer coping strategies of either the approach or avoidance types.

Predictors of professional burnout and fulfilment in a longitudinal analysis on nurses and healthcare workers in the COVID-19 pandemic.

AIMS AND OBJECTIVES: (1) To investigate the vulnerability of nurses to experiencing professional burnout and low fulfilment across 5 months of the COVID-19 pandemic. (2) To identify modifiable variables in hospital leadership and individual vulnerabilities that may mitigate these effects. BACKGROUND: Nurses were at increased risk for burnout and low fulfilment prior to the COVID-19 pandemic. Hospital leadership factors such as organisational structure and open communication and consideration of employee opinions are known to have positive impacts on work attitudes. Personal risk factors for burnout include symptoms of depression and anxiety. METHODS: Healthcare workers (n = 406 at baseline, n = 234 longitudinal), including doctors (n = 102), nurses (n = 94), technicians (n = 90) and non-clinical administrative staff (n = 120), completed 5 online questionnaires, once per month, for 5 months. Participants completed self-report questionnaires on professional fulfilment and burnout, perceptions of healthcare leadership, and symptoms of anxiety and depression. Participants were recruited from various healthcare settings in the southeastern United States. The STROBE checklist was used to report the present study. RESULTS: Both at baseline and across the 5 months, nurses working during the COVID-19 pandemic reported increased burnout and decreased fulfilment relative to doctors. For all participants, burnout remained largely steady and fulfilment decreased slightly. The strongest predictors of both burnout and fulfilment were organisational structure and depressive symptoms. Leadership consideration and anxiety symptoms had smaller, yet significant, relationships to burnout and fulfilment in longitudinal analyses. CONCLUSIONS: Burnout and reduced fulfilment remain a problem for healthcare workers, especially nurses. Leadership styles and employee symptoms of depression and anxiety are appropriate targets for intervention. RELEVANCE TO CLINICAL PRACTICE: Leadership wishing to reduce burnout and increase fulfilment among employees should increase levels of organisational support and consideration and expand supports to employees seeking treatment for depression and anxiety.

Morally Distressing Experiences, Moral Injury, and Burnout in Florida Healthcare Providers during the COVID-19 Pandemic.

Because healthcare providers may be experiencing moral injury (MI), we inquired about their healthcare morally distressing experiences (HMDEs), MI perpetrated by self (Self MI) or others (Others MI), and burnout during the COVID-19 pandemic. Participants were 265 healthcare providers in North Central Florida (81.9% female, Mage = 37.62) recruited via flyers and emailed brochures that completed online surveys monthly for four months. Logistic regression analyses investigated whether MI was associated with specific HMDEs, risk factors (demographic characteristics, prior mental/medical health adversity, COVID-19 protection concern, health worry, and work impact), protective factors (personal resilience and leadership support), and psychiatric symptomatology (depression, anxiety, and PTSD). Linear regression analyses explored how Self/Others MI, psychiatric symptomatology, and the risk/protective factors related to burnout. We found consistently high rates of MI and burnout, and that both Self and Others MI were associated with specific HMDEs, COVID-19 work impact, COVID-19 protection concern, and leadership support. Others MI was also related to prior adversity, nurse role, COVID-19 health worry, and COVID-19 diagnosis. Predictors of burnout included Self MI, depression symptoms, COVID-19 work impact, and leadership support. Hospital administrators/supervisors should recognize the importance of supporting the HCPs they supervise, particularly those at greatest risk of MI and burnout.