The impact of government actions and risk perception on the promotion of self-protective behaviors during the COVID-19 pandemic.

INTRODUCTION: We aim to understand the factors that drive citizens of different countries to adhere to recommended self-protective behaviors during the COVID-19 pandemic. METHODS: Survey data was obtained through the COVID-19 Impact project. We selected countries that presented a sufficiently complete time series and a statistically relevant sample for running the analysis: Cyprus, Germany, Greece, Ireland, Latvia, Spain, Switzerland, the United Kingdom, and the United States of America. To identify country-specific differences in self-protective behaviors, we used previous evidence and change-point detection analysis to establish variations across participating countries whose effect was then assessed by means of interrupted series analysis. RESULTS: A high level of compliance with health and governmental authorities' recommendations were generally observed in all included countries. The level of stress decreased near the period when countries such as Cyprus, Greece or the United Kingdom relaxed their prevention behavior recommendations. However, this relaxation of behaviors did not occur in countries such as Germany, Ireland, or the United States. As observed in the change-point detection analysis, when the daily number of recorded COVID-19 cases decreased, people relaxed their protective behaviors (Cyprus, Greece, Ireland), although the opposite trend was observed in Switzerland. DISCUSSION: COVID-19 self-protective behaviors were heterogeneous across countries examined. Our findings show that there is probably no single winning strategy for exiting future health crises, as similar interventions, aimed to promote self-protective behaviors, may be received differently depending on the specific population groups and on the particular geographical context in which they are implemented.

Predictors of changing patterns of adherence to containment measures during the early stage of COVID-19 pandemic: an international longitudinal study.

BACKGROUND: Identifying common factors that affect public adherence to COVID-19 containment measures can directly inform the development of official public health communication strategies. The present international longitudinal study aimed to examine whether prosociality, together with other theoretically derived motivating factors (self-efficacy, perceived susceptibility and severity of COVID-19, perceived social support) predict the change in adherence to COVID-19 containment strategies. METHOD: In wave 1 of data collection, adults from eight geographical regions completed online surveys beginning in April 2020, and wave 2 began in June and ended in September 2020. Hypothesized predictors included prosociality, self-efficacy in following COVID-19 containment measures, perceived susceptibility to COVID-19, perceived severity of COVID-19 and perceived social support. Baseline covariates included age, sex, history of COVID-19 infection and geographical regions. Participants who reported adhering to specific containment measures, including physical distancing, avoidance of non-essential travel and hand hygiene, were classified as adherence. The dependent variable was the category of adherence, which was constructed based on changes in adherence across the survey period and included four categories: non-adherence, less adherence, greater adherence and sustained adherence (which was designated as the reference category). RESULTS: In total, 2189 adult participants (82% female, 57.2% aged 31-59 years) from East Asia (217 [9.7%]), West Asia (246 [11.2%]), North and South America (131 [6.0%]), Northern Europe (600 [27.4%]), Western Europe (322 [14.7%]), Southern Europe (433 [19.8%]), Eastern Europe (148 [6.8%]) and other regions (96 [4.4%]) were analyzed. Adjusted multinomial logistic regression analyses showed that prosociality, self-efficacy, perceived susceptibility and severity of COVID-19 were significant factors affecting adherence. Participants with greater self-efficacy at wave 1 were less likely to become non-adherence at wave 2 by 26% (adjusted odds ratio [aOR], 0.74; 95% CI, 0.71 to 0.77; P < .001), while those with greater prosociality at wave 1 were less likely to become less adherence at wave 2 by 23% (aOR, 0.77; 95% CI, 0.75 to 0.79; P = .04). CONCLUSIONS: This study provides evidence that in addition to emphasizing the potential severity of COVID-19 and the potential susceptibility to contact with the virus, fostering self-efficacy in following containment strategies and prosociality appears to be a viable public health education or communication strategy to combat COVID-19.

Coping with global uncertainty: Perceptions of COVID-19 psychological distress, relationship quality, and dyadic coping for romantic partners across 27 countries

[Correction Notice: An Erratum for this article was reported in Vol 39(1) of Journal of Social and Personal Relationships (see record 2022-18336-005). Three new authors (Adnan Adil, Emmanuel Asampong, and Rahmattullah Khan Abdul Wahab Khan) were not initially listed in the Epub ahead of print. Table 1 also contained some errors. The corrections are given in the erratum.] Following the global outbreak of COVID-19 in March 2020, individuals report psychological distress associated with the "new normal"-social distancing, financial hardships, and increased responsibilities while working from home. Given the interpersonal nature of stress and coping responses between romantic partners, based on the systemic transactional model this study posits that perceived partner dyadic coping may be an important moderator between experiences of COVID-19 psychological distress and relationship quality. To examine these associations, self-report data from 14,020 people across 27 countries were collected during the early phases of the COVID-19 pandemic (March-July, 2020). It was hypothesized that higher symptoms of psychological distress would be reported post-COVID-19 compared to pre-COVID-19 restrictions (Hypothesis 1), reports of post-COVID-19 psychological distress would be negatively associated with relationship quality (Hypothesis 2), and perceived partner DC would moderate these associations (Hypothesis 3). While hypotheses were generally supported, results also showed interesting between-country variability. Limitations and future directions are presented. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Illness Perceptions of COVID-19 in Europe: Predictors, Impacts and Temporal Evolution.

Objective: Illness perceptions (IP) are important predictors of emotional and behavioral responses in many diseases. The current study aims to investigate the COVID-19-related IP throughout Europe. The specific goals are to understand the temporal development, identify predictors (within demographics and contact with COVID-19) and examine the impacts of IP on perceived stress and preventive behaviors. Methods: This was a time-series-cross-section study of 7,032 participants from 16 European countries using multilevel modeling from April to June 2020. IP were measured with the Brief Illness Perception Questionnaire. Temporal patterns were observed considering the date of participation and the date recoded to account the epidemiological evolution of each country. The outcomes considered were perceived stress and COVID-19 preventive behaviors. Results: There were significant trends, over time, for several IP, suggesting a small decrease in negativity in the perception of COVID-19 in the community. Age, gender, and education level related to some, but not all, IP. Considering the self-regulation model, perceptions consistently predicted general stress and were less consistently related to preventive behaviors. Country showed no effect in the predictive model, suggesting that national differences may have little relevance for IP, in this context. Conclusion: The present study provides a comprehensive picture of COVID-19 IP in Europe in an early stage of the pandemic. The results shed light on the process of IP formation with implications for health-related outcomes and their evolution.

Satisfaction with telemedicine-delivered inflammatory bowel disease care depends on disease activity, personality and economic factors.

Objective: Patients with inflammatory bowel disease (IBD) traditionally receive follow-up care at face-to-face outpatient clinics. During the COVID-19 pandemic, gastroenterology societies recommended IBD clinics to be carried out remotely where possible using telephone or telemedicine-delivered virtual clinics. Previous studies have demonstrated patient satisfaction with virtual clinics but few studies have examined factors that impact satisfaction or assessed patient's personal perception of the virtual clinic experience. Design/method: Patients who had their IBD clinic appointment changed from face-to-face to telephone virtual clinic completed a questionnaire relating to their clinical experience and preference for future care. Qualitative data were also collected and evaluated using content analysis to identify major themes associated with the patient experience. Results: 141 patients were included for analysis. The virtual clinic satisfaction questionnaire was found to be valid while patients expressed high-satisfaction levels with virtual clinics (median satisfaction score 18, range 0-20). Multivariate analysis identified open personality type (p=0.004), short disease duration (p=0.047) and higher cost to attend clinic (p=0.047) as predictors of high-satisfaction levels, with active disease (p=0.035) and an agreeable personality type (p=0.042) associated with low satisfaction levels. Content analysis of the qualitative data identified three major themes connected to virtual clinic convenience, lack of physical interaction and disease activity. Conclusion: Patients expressed high levels of satisfaction with telemedicine-delivered IBD clinics, with most wishing to continue their use. Personality type should be recognised as an important variable affecting clinical satisfaction, in addition to socioeconomic and disease-related factors.

Exploring the relationships between rule-governed behavior and adherence to guidelines aiming to reduce the spread of COVID-19.

Research demonstrates that socially mediated consequences impact adherence to health mandates during pandemics. However, no published research has examined whether adherence varies based on the extent to which an individual relies on arbitrary social approval (i.e., displays generalized pliance). The present study explored the relationships between adherence to COVID-19 public health measures, two types of rule-following (pliance and tracking), and perceived peer behavior in a sample of adults (n = 288). Findings revealed that adherence was negatively correlated with generalized pliance and tracking was unrelated to adherence. Pliance did not moderate the relationship between peer adherence and individual adherence. Findings are discussed with reference to the need to develop easily adaptable and context sensitive measures of types of rule-following, in addition to a measure of social tracking.

Brief and Telehealth Acceptance and Commitment Therapy (ACT) Interventions for Stress in Inflammatory Bowel Disease (IBD): A Series of Single Case Experimental Design (SCED) Studies.

Psychological intervention targeting distress is now considered an integral component of inflammatory bowel disease (IBD) management. However, significant barriers to access exist which necessitate the development of effective, economic, and accessible brief and remote interventions. Acceptance and commitment therapy (ACT) is a therapy with demonstrated acceptability and a growing evidence base for the treatment of distress in IBD populations. The present paper trialled two brief ACT interventions via randomized multiple baseline designs. Study 1 trialled a single-session ACT intervention (delivered face-to-face and lasting approximately two hours) targeting stress and experiential avoidance, respectively. Participants were seven people with an IBD diagnosis who presented with moderate to extremely severe stress (five females, two males; M age = 39.57, SD = 5.74). The findings of study 1 indicate that a single-session ACT intervention represented an insufficient dosage to reduce stress and experiential avoidance. Study 2 investigated a brief telehealth ACT intervention (delivered via a video conferencing platform and lasting approximately four hours) targeting stress and increased psychological flexibility. Participants (N = 12 people with an IBD diagnosis and mild to extremely severe stress) completed baselines lasting from 21 to 66 days before receiving a two-session ACT telehealth intervention supplemented by a workbook and phone consultation. Approximately half of participants experienced reduced stress, increased engagement in valued action, and increased functioning. Despite shortcomings such as missing data and the context of COVID-19, the present findings suggest that brief ACT interventions in this population may be effective and economic, though further research and replications are necessary.

To Help or Not to Help? Prosocial Behavior, Its Association With Well-Being, and Predictors of Prosocial Behavior During the Coronavirus Disease Pandemic.

The coronavirus disease (COVID-19) pandemic fundamentally disrupted humans' social life and behavior. Public health measures may have inadvertently impacted how people care for each other. This study investigated prosocial behavior, its association well-being, and predictors of prosocial behavior during the first COVID-19 pandemic lockdown and sought to understand whether region-specific differences exist. Participants (N = 9,496) from eight regions clustering multiple countries around the world responded to a cross-sectional online-survey investigating the psychological consequences of the first upsurge of lockdowns in spring 2020. Prosocial behavior was reported to occur frequently. Multiple regression analyses showed that prosocial behavior was associated with better well-being consistently across regions. With regard to predictors of prosocial behavior, high levels of perceived social support were most strongly associated with prosocial behavior, followed by high levels of perceived stress, positive affect and psychological flexibility. Sociodemographic and psychosocial predictors of prosocial behavior were similar across regions.

Psychological Flexibility Mediates Wellbeing for People with Adverse Childhood Experiences during COVID-19.

BACKGROUND: The psychological impact of COVID-19 is multifaceted, both acute and chronic, and has not affected everyone equally. METHOD: This longitudinal study compared those with and without Adverse Childhood Experiences (ACEs) on measures of psychological distress and wellbeing over time. RESULTS: All groups (No ACE, Low ACE, and High ACE) had similar levels of distress at Time 1, with significant increases in psychological distress for those with ACEs over time, but not for those without. Psychological Flexibility was strongly and significantly associated with decreases in psychological distress and improved wellbeing. It significantly mediated the relationship between ACE and wellbeing. CONCLUSIONS: Those with ACEs report significantly increased psychological distress over time, compared to those without ACE during the COVID-19 pandemic. Evidence-based interventions using Psychological Flexibility may improve mental health and wellbeing to help further mediate its effects.

The Dynamics of Fear at the Time of Covid-19: A Contextual Behavioral Science Perspective.

COVID-19 is the relevant disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmitted via close contact between persons. On March 12th, 2020, WHO announced COVID-19 outbreak a pandemic, in view of its worldwide escalation. As the pandemic disease explodes, a parallel outbreak of fear and worry is also spreading. We react to fear symbolically, by arbitrarily relating it to other objects and events through derived verbal relations, so language may alter the way we experience events and consequently affects how we are functionally or dysfunctionally oriented to the world around us. In this paper we will outline the different human learning processes connected to fear responding, from the simplest type to the more complex cognitive ones, approaching them from the point of view of contextual behavioral science, a modern form of behavioral thinking. We will outline a model of intervention to foster psychological flexibility and more functional value-based actions. We will argue that in a pandemic and in the post-pandemic phase it could be a key for adapting to new and changed circumstances.

Mental Health and Adherence to COVID-19 Protective Behaviors among Cancer Patients during the COVID-19 Pandemic: An International, Multinational Cross-Sectional Study.

A population-based cross-sectional study was conducted during the first COVID-19 wave, to examine the impact of COVID-19 on mental health using an anonymous online survey, enrolling 9565 individuals in 78 countries. The current sub-study examined the impact of the pandemic and the associated lockdown measures on the mental health, and protective behaviors of cancer patients in comparison to non-cancer participants. Furthermore, 264 participants from 30 different countries reported being cancer patients. The median age was 51.5 years, 79.9% were female, and 28% had breast cancer. Cancer participants reported higher self-efficacy to follow recommended national guidelines regarding COVID-19 protective behaviors compared to non-cancer participants (p < 0.01). They were less stressed (p < 0.01), more psychologically flexible (p < 0.01), and had higher levels of positive affect compared to non-cancer participants. Amongst cancer participants, the majority (80.3%) reported COVID-19, not their cancer, as their priority during the first wave of the pandemic and females reported higher levels of stress compared to males. In conclusion, cancer participants appeared to have handled the unpredictable nature of the first wave of the pandemic efficiently, with a positive attitude towards an unknown and otherwise frightening situation. Larger, cancer population specific and longitudinal studies are warranted to ensure adequate medical and psychological care for cancer patients.

Coping with global uncertainty: Perceptions of COVID-19 psychological distress, relationship quality, and dyadic coping for romantic partners across 27 countries

Following the global outbreak of COVID-19 in March 2020, individuals report psychological distress associated with the ?new normal??social distancing, financial hardships, and increased responsibilities while working from home. Given the interpersonal nature of stress and coping responses between romantic partners, based on the systemic transactional model this study posits that perceived partner dyadic coping may be an important moderator between experiences of COVID-19 psychological distress and relationship quality. To examine these associations, self-report data from 14,020 people across 27 countries were collected during the early phases of the COVID-19 pandemic (March?July, 2020). It was hypothesized that higher symptoms of psychological distress would be reported post-COVID-19 compared to pre-COVID-19 restrictions (Hypothesis 1), reports of post-COVID-19 psychological distress would be negatively associated with relationship quality (Hypothesis 2), and perceived partner DC would moderate these associations (Hypothesis 3). While hypotheses were generally supported, results also showed interesting between-country variability. Limitations and future directions are presented.

Comorbidity and COVID-19: investigating the relationship between medical and psychological well-being.

OBJECTIVE: The unprecedented occurrence of a global pandemic is accompanied by both physical and psychological burdens that may impair quality of life. Research relating to COVID-19 aims to determine the effects of the pandemic on vulnerable populations who are at high risk of developing negative health or psychosocial outcomes. Having an ongoing medical condition during a pandemic may lead to greater psychological distress. Increased psychological distress may be due to preventative public health measures (e.g. lockdown), having an ongoing medical condition, or a combination of these factors. METHODS: This study analyses data from an online cross-sectional national survey of adults in Ireland and investigates the relationship between comorbidity and psychological distress. Those with a medical condition (n = 128) were compared to a control group without a medical condition (n = 128) and matched according to age, gender, annual income, education, and work status during COVID-19. Participants and data were obtained during the first public lockdown in Ireland (27 March 2020-8 June 2020). RESULTS: Individuals with existing medical conditions reported significantly higher levels of anxiety (p < .01) and felt less gratitude (p ≤ .001). Exploratory analysis indicated that anxiety levels were significantly associated with illness perceptions specific to COVID-19. Post hoc analysis revealed that psychological well-being was not significantly related to condition type (e.g. respiratory disorders). CONCLUSION: This research supports individualised supports for people with ongoing medical conditions during the COVID-19 pandemic, and has implications for the consideration of follow-up care specifically for mental health. Findings may also inform future public health policies and post-vaccine support strategies for vulnerable populations.

Impact of COVID-19 pandemic on mental health: An international study.

BACKGROUND: The COVID-19 pandemic triggered vast governmental lockdowns. The impact of these lockdowns on mental health is inadequately understood. On the one hand such drastic changes in daily routines could be detrimental to mental health. On the other hand, it might not be experienced negatively, especially because the entire population was affected. METHODS: The aim of this study was to determine mental health outcomes during pandemic induced lockdowns and to examine known predictors of mental health outcomes. We therefore surveyed n = 9,565 people from 78 countries and 18 languages. Outcomes assessed were stress, depression, affect, and wellbeing. Predictors included country, sociodemographic factors, lockdown characteristics, social factors, and psychological factors. RESULTS: Results indicated that on average about 10% of the sample was languishing from low levels of mental health and about 50% had only moderate mental health. Importantly, three consistent predictors of mental health emerged: social support, education level, and psychologically flexible (vs. rigid) responding. Poorer outcomes were most strongly predicted by a worsening of finances and not having access to basic supplies. CONCLUSIONS: These results suggest that on whole, respondents were moderately mentally healthy at the time of a population-wide lockdown. The highest level of mental health difficulties were found in approximately 10% of the population. Findings suggest that public health initiatives should target people without social support and those whose finances worsen as a result of the lockdown. Interventions that promote psychological flexibility may mitigate the impact of the pandemic.

Increased Psychological Distress during COVID-19 and Quarantine in Ireland: A National Survey.

BACKGROUND: The emergence of the coronavirus pneumonia (COVID-19) resulted in a global pandemic. The psychological impact of an epidemic is multifaceted and acute, with long-term consequences. METHODS: A cross-sectional online survey-based design was employed, assessing the psychological impact of COVID-19 on members of the Irish public during the quarantine period of COVID-19 in Ireland. Participants were invited to complete the Depression, Anxiety, and Stress Scale-21 (DASS-21) retrospectively (prior to quarantine) and during the quarantine period, as well as measures of illness perceptions, well-being, and a bespoke measure (the Effects of COVID Questionnaire, ECQ), which assessed perceptions of COVID-related stresses associated with personal concerns, caring for children, caring for aging parents, as well as gratitude. RESULTS: A total of n = 1620 entered the survey platform, with a total of n = 847 surveys completed by members of the Irish public. Entry into COVID-19 quarantine was associated with significant increases in clinically significant symptoms of depression, stress, and anxiety. The ECQ reliably assessed a range of COVID-19-related stresses and had large and significant correlations with the DASS-21. CONCLUSIONS: The COVID-19 quarantine was associated with stresses and significant increases in symptoms of depression, anxiety, and stress in a national Irish cohort. The public require increased access to mental health services to meet this increase in COVID-19-related psychological distress.