Mental health: COVID-19, stress, and coping

Pandemics (i.e., large-scale epidemics) are defined as outbreaks of disease over a large geographic area or over the entire world. Pandemics result in large-scale stress given the uncertainty around the duration of disease risk (Taylor, 2019). The severe acute respiratory syndrome coronavirus two (SARS-CoV-2) pandemic of 2019, referred to typically as COVID-19, represents a public health emergency with widespread psychological consequences. In addition to job and housing insecurity, extant research on the mental health impact of the pandemic points to significant emotional distress and dysfunctional behaviors across the lifespan, difficulty coping, and increased suicidal ideation (Duan et al., 2020;Innocentiet al., 2020;Shah et al., 2020;Taylor et al., 2020a;Wang et al., 2020). The developing research on COVID-19 is well in-line with research on prior pandemics, which found that these events may trigger or exacerbate adverse mental health symptoms, particularly those related to anxiety, depressed mood, and post-traumatic stress (Taylor, 2019). Furthermore, the psychological impact of a pandemic can persist beyond the medical effects of the disease, both in the short and long term (Douglas et al., 2009;Gardner & Moallef, 2015), suggesting that the mental health consequences of the COVID-19 pandemic may last long after the disease has run its course. This chapter will explore the psychological impacts of pandemics, COVID-19 Stress Syndrome, and proposed strategies for navigating the pandemic in an attempt to provide a cursory look into the breadth and scope of pandemic-related mental health research. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Psychological Correlates of Health anxiety in Response to the Coronavirus (COVID-19) Pandemic: a Cross-Sectional Online Study in Iran.

Current models suggest health anxiety as a fundamental variable associated with fear and anxiety related to COVID-19. The investigation was carried out in separate two studies on the Iranian population. The first study aims to test the COVID-19 Anxiety Inventory (N = 202). The findings indicate a two-factor structure of the scale. Participants (N = 1638) completed the online survey anonymously in the second study, including the COVID-19 Anxiety Inventory, Short Health Anxiety Inventory, The Intolerance of Uncertainty Scale, Anxiety Sensitivity Index-3, Body Vigilance Scale, Depression Anxiety Stress Scales 21, and Contamination Cognitions Scale. Results showed that health anxiety, anxiety sensitivity, and body vigilance would significantly contribute to fears of contracting COVID-19. Moreover, the findings support a central role of intolerance of uncertainty in predicting COVID-19 anxiety. The study results provided both theoretical and practical implications for understanding psychosocial predictors during the COVID-19 pandemic.

Mental health: COVID-19, stress, and coping

Pandemics (i.e., large-scale epidemics) are defined as outbreaks of disease over a large geographic area or over the entire world. Pandemics result in large-scale stress given the uncertainty around the duration of disease risk (Taylor, 2019). The severe acute respiratory syndrome coronavirus two (SARS-CoV-2) pandemic of 2019, referred to typically as COVID-19, represents a public health emergency with widespread psychological consequences. In addition to job and housing insecurity, extant research on the mental health impact of the pandemic points to significant emotional distress and dysfunctional behaviors across the lifespan, difficulty coping, and increased suicidal ideation (Duan et al., 2020;Innocentiet al., 2020;Shah et al., 2020;Taylor et al., 2020a;Wang et al., 2020). The developing research on COVID-19 is well in-line with research on prior pandemics, which found that these events may trigger or exacerbate adverse mental health symptoms, particularly those related to anxiety, depressed mood, and post-traumatic stress (Taylor, 2019). Furthermore, the psychological impact of a pandemic can persist beyond the medical effects of the disease, both in the short and long term (Douglas et al., 2009;Gardner & Moallef, 2015), suggesting that the mental health consequences of the COVID-19 pandemic may last long after the disease has run its course. This chapter will explore the psychological impacts of pandemics, COVID-19 Stress Syndrome, and proposed strategies for navigating the pandemic in an attempt to provide a cursory look into the breadth and scope of pandemic-related mental health research. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Medical Mistrust, COVID-19 Stress, and Intent to Vaccinate in Racial–Ethnic Minorities

Members of the Black, Asian, and Latinx community have been particularly vulnerable to the COVID-19 pandemic but may be hesitant to vaccinate. In a December 2020 study in Black, Asian, and Latinx adults in the U.S. (n = 779), only 50% of Black respondents endorsed intending to vaccinate against COVID-19, followed by 65% and 75% of Latinx and Asian participants, respectively. Medical mistrust, fears about COVID-19 contamination, and a proclivity for compulsive checking behaviors related to COVID-19 were significant predictors of intent to vaccinate in Black respondents. Similarly, Asian respondents’ intent to vaccinate was predicted by medical mistrust, fears of the dangerous nature of the virus, and xenophobic concerns about viral spread. In Latinx participants, medical mistrust and compulsive checking for COVID-19-related information were significant predictors of intent to vaccinate. Our findings identify specific behaviors, attitudes, and beliefs we can target to inform community-wide outreach and increase the uptake of COVID-19 vaccines.

Anxiety Regarding COVID-19 Is Related to Attentional Control: The Mediating Role of Anxiety Sensitivity.

Background: As an emergent public health event, COVID-19 has had a significant impact on mental health, particularly causing anxiety. Some cognitive-affective related studies have demonstrated that attentional control is related to levels of anxiety. More specifically, recent research has shown that anxiety sensitivity is uniquely associated with mental health responses to COVID-19. The aim of the current study was to investigate the role of anxiety sensitivity during COVID-19 outbreak period, especially physical and cognitive concerns, in relation to attentional control and anxiety. Methods: It is a questionnaire study. A total of 464 participants were recruited through online sampling between February and March, 2020. They were surveyed by the Attentional Control Scale (ATTC), Anxiety Sensitivity Index-3 (ASI-3) and Depression Anxiety Stress Scale-21 (DASS-21). Data were analyzed using descriptive statistics and correlation analysis. We also tested the mediating effect. Results: The results showed that attentional control is negatively correlated with physical concern, cognitive concern and anxiety. And results support that physical and cognitive concerns play a mediating role between attentional control and anxiety. Conclusions: Anxiety sensitivity plays a mediating role between attentional control and anxiety. These findings can help effective prevention and intervention of anxiety.

A bibliometric analysis of COVID-19 publications in the ten psychology-related Web of Science categories in the social science citation index.

OBJECTIVE: The aim of this study was to analyze the characteristics of the COVID-19 publications in the ten psychology-related Web of Science categories in the social science citation index 10-month following the COVID-19 outbreak. METHODS: Six publication indicators were examined across authors, institutions, and countries. RESULTS: Analyses showed that the United States has produced the highest number of empirical investigations into the psychological impact of COVID-19, and the majority of the research across all countries was in clinical and psychopathology. Distribution of journals and psychology-related Web of Science categories were analyzed. Frequently used words in article title, author keywords, and KeyWords Plus were also presented. CONCLUSIONS: The findings suggest that there are substantial clinical implications associated with COVID-19. There are recommendations offered for future research and clinical practice.

Substance use and abuse associated with the behavioral immune system during COVID-19: The special case of healthcare workers and essential workers

The article discusses the risks of substance use and abuse facing healthcare and essential workers in the U.S. due to changes to their behavioral immune system (BIS) during the COVID-19 pandemic. Other topics include the categories of stressors during the pandemic like social and economic stress, traumatic stress symptoms, and danger and contamination fear, as well as xenophobia as a unique factor of COVID Stress Syndrome.

The associations of obsessive-compulsive symptom dimensions and general severity with suicidal ideation in patients with obsessive-compulsive disorder: The role of specific stress responses to COVID-19.

Suicidal ideation is prevalent in patients with obsessive-compulsive disorder (OCD); but, during COVID-19, it may be increased. The present study aimed to examine the effects of obsessive-compulsive (OC) symptom dimensions and OCD severity on suicidal ideation by considering the role of stress responses in reaction to COVID-19 in a clinical sample of patients with OCD. In a cross-sectional study, 304 patients with OCD completed measures of OC symptom dimensions, OCD severity, general mental health (depression and anxiety), and COVID-19-related stress. Results showed that after controlling for depression, anxiety, comorbidity, and lifetime suicide attempts, the OC symptom dimensions of responsibility for harm and unacceptable obsessional thoughts as well as general severity had indirect effects on suicidal ideation through the specific stress responses to COVID-19, including traumatic stress and compulsive checking. The study shows that OCD patients with specific OC symptom dimensions and severe OCD are more likely to have suicidal ideation during the pandemic. Further, the specific stress responses to COVID-19 may be an underlying mechanism. Clinicians should carefully assess suicidal ideation in patients with OCD who experience responsibility for harm and unacceptable thoughts, particularly during the pandemic.

Effects of anxiety sensitivity, disgust, and intolerance of uncertainty on the COVID stress syndrome: a longitudinal assessment of transdiagnostic constructs and the behavioural immune system.

Excessive fear and worry in response to the COVID-19 pandemic (e.g., COVID stress syndrome) is prevalent and associated with various adverse outcomes. Research from the current and past pandemics supports the association between transdiagnostic constructs-anxiety sensitivity (AS), disgust, and intolerance of uncertainty (IU)-and pandemic-related distress. Recent research suggests a moderating effect of disgust on the relationship of AS-physical concerns and COVID-19-related distress, suggesting that transdiagnostic constructs underlie individual differences in activation of the behavioral immune system (BIS). No previous study has examined the independent and conjoint effects of pre-COVID-19 AS-physical concerns, disgust propensity (DP), disgust sensitivity (DS), and IU in this context; thus, we did so using longitudinal survey data (N = 3,062 Canadian and American adults) with simple and moderated moderations controlling for gender, mental health diagnosis, and COVID-19 diagnosis. Greater AS-physical concerns, DP, and DS predicted more severe COVID stress syndrome assessed one month later. Either DP or DS further amplified the effect of AS-physical concerns on COVID stress syndrome, except danger and contamination fears. IU did not interact with AS-physical concerns and DS or DP. Theoretical and clinical implications pertaining to delivery of cognitive behavioural therapy for pandemic-related distress are discussed.

Modeling anxiety and fear of COVID-19 using machine learning in a sample of Chinese adults: associations with psychopathology, sociodemographic, and exposure variables.

OBJECTIVES: Research during prior virus outbreaks has examined vulnerability factors associated with increased anxiety and fear. DESIGN: We explored numerous psychopathology, sociodemographic, and virus exposure-related variables associated with anxiety and perceived threat of death regarding COVID-19. METHOD: We recruited 908 adults from Eastern China for a cross-sectional web survey, from 24 February to 15 March 2020, when social distancing was heavily enforced in China. We used several machine learning algorithms to train our statistical model of predictor variables in modeling COVID-19-related anxiety, and perceived threat of death, separately. We trained the model using many simulated replications on a random subset of participants, and subsequently externally tested on the remaining subset of participants. RESULTS: Shrinkage machine learning algorithms performed best, indicating that stress and rumination were the most important variables in modeling COVID-19-related anxiety severity. Health anxiety was the most potent predictor of perceived threat of death from COVID-19. CONCLUSIONS: Results are discussed in the context of research on anxiety and fear from prior virus outbreaks, and from theory on outbreak-related emotional vulnerability. Implications regarding COVID-19-related anxiety are also discussed.

Mental health and clinical psychological science in the time of COVID-19: Challenges, opportunities, and a call to action.

COVID-19 presents significant social, economic, and medical challenges. Because COVID-19 has already begun to precipitate huge increases in mental health problems, clinical psychological science must assert a leadership role in guiding a national response to this secondary crisis. In this article, COVID-19 is conceptualized as a unique, compounding, multidimensional stressor that will create a vast need for intervention and necessitate new paradigms for mental health service delivery and training. Urgent challenge areas across developmental periods are discussed, followed by a review of psychological symptoms that likely will increase in prevalence and require innovative solutions in both science and practice. Implications for new research directions, clinical approaches, and policy issues are discussed to highlight the opportunities for clinical psychological science to emerge as an updated, contemporary field capable of addressing the burden of mental illness and distress in the wake of COVID-19 and beyond. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Health anxiety related to problematic smartphone use and gaming disorder severity during COVID-19: Fear of missing out as a mediator.

Health anxiety has been linked with fear and anxiety regarding COVID-19. Higher levels of health anxiety likely increased social distancing and self-isolating during the pandemic. We investigated relations among health anxiety, fear of missing out (FOMO) on rewarding social experiences from social distancing, and consequential levels of problematic smartphone use (PSU) and gaming disorder (GD). We surveyed a broad sample of 812 U.S. and Canadian participants during the pandemic, in late-May 2020, using the Short Health Anxiety Inventory, FOMO Scale, Smartphone Addiction Scale-Short Version, and GD test. Significant bivariate relationships were found among health anxiety, FOMO, PSU, and GD severity. Using structural equation modeling, FOMO mediated relations between health anxiety and both PSU and GD severity. We discuss FOMO as an important variable explaining problematic digital technology use to compensate for unmet social needs from social distancing. We discuss these findings within the context of the Interaction of Person-Affect-Cognition-Execution theoretical model of problematic internet use. Results offer novel insight into the role of health anxiety on FOMO from unmet social needs during the COVID-19 pandemic, and consequential problematic internet use.

Substance use and abuse, COVID-19-related distress, and disregard for social distancing: A network analysis.

Research shows that there has been a substantial increase in substance use and abuse during the COVID-19 pandemic, and that substance use/abuse is a commonly reported way of coping with anxiety concerning COVID-19. Anxiety about COVID-19 is more than simply worry about infection. Research provides evidence of a COVID Stress Syndrome characterized by (1) worry about the dangers of COVID-19 and worry about coming into contact with coronavirus contaminated objects or surfaces, (2) worry about the personal socioeconomic impact of COVID-19, (3) xenophobic worries that foreigners are spreading COVID-19, (4) COVID-19-related traumatic stress symptoms (e.g., nightmares), and (5) COVID-19-related compulsive checking and reassurance-seeking. These form a network of interrelated nodes. Research also provides evidence of another constellation or "syndrome", characterized by (1) belief that one has robust physical health against COVID-19, (2) belief that the threat of COVID-19 has been exaggerated, and (3) disregard for social distancing. These also form a network of nodes known as a COVID-19 Disregard Syndrome. The present study, based on a population-representative sample of 3075 American and Canadian adults, sought to investigate how these syndromes are related to substance use and abuse. We found substantial COVID-19-related increases in alcohol and drug use. Network analyses indicated that although the two syndromes are negatively correlated with one another, they both have positive links to alcohol and drug abuse. More specifically, COVID-19-related traumatic stress symptoms and the tendency to disregard social distancing were both linked to substance abuse. Clinical and public health implications are discussed.

COVID-19 and OCD: Potential impact of exposure and response prevention therapy.

This brief clinical review critically assesses the use of exposure and response prevention therapy (ERP) for patients with obsessive-compulsive disorder (OCD) in light of the COVID-19 pandemic. We discuss the ethical and practical considerations that clinicians employed in past infectious disease outbreaks, as well as general safety measures routinely practiced in the conduct of exposure therapy. During this time, concerns regarding the feasibility of ERP have emerged, especially with strict guidelines on social distancing and on following other preventative behaviors. While ERP may have to be modified to follow public health guidelines, this review outlines a) how ERP has been adapted in the context of other infectious triggers; b) the potential impacts on OCD patients of attenuated ERP, and c) minimizing concerns related to litigation. A case report is provided detailing ERP personalized given COVID-19 related considerations. In all, we advise against modifying therapies in ways that may jeopardize the efficacy of patient care or progress.

Do pre-existing anxiety-related and mood disorders differentially impact COVID-19 stress responses and coping?

BACKGROUND: People with pre-existing mental health conditions may be more susceptible to stressors associated with COVID-19 relative to the general population; however, no studies have assessed whether susceptibility differs between classes of mental health disorders. We assessed COVID-19-related stress, self-isolation stressors, and coping in those with a primary anxiety-related disorder diagnosis, a primary mood disorder diagnosis, and no mental health disorder. METHODS: Adults from a population-representative sample from the United States and Canada who reported current (past year) anxiety-related (n = 700) or mood (n = 368) disorders were compared to a random sample of respondents who did not report a current mental health diagnosis (n = 500) on COVID-19-related stress, self-isolation stress, and coping. RESULTS: The anxiety-related disorders group exhibited higher COVID Stress Scales total scores and higher scores on its fears about danger and contamination, socioeconomic consequences, xenophobia, and traumatic stress symptoms scales than the other groups. The mood disorders group had higher scores on the traumatic stress symptoms and socioeconomic consequences scales than those with no current mental disorder. Those with current anxiety-related or mood disorders were more likely to voluntarily self-isolate and were more likely to report greater self-isolation stressors and distress than those without a mental health disorder. Yet, there were no major differences in perceived effectiveness of coping strategies across groups. CONCLUSION: People with anxiety-related or mood disorders were more negatively affected by COVID-19 compared to those with no mental health disorder; however, adding to psychological burden, those with anxiety-related disorders reported greater fears about danger and contamination, socioeconomic consequences, xenophobia, and traumatic stress symptoms than the other groups. These findings suggest the need for tailoring COVID-19-related mental health interventions to meet the specific needs of people with pre-existing mental health conditions.

COVID stress syndrome: Concept, structure, and correlates.

BACKGROUND: Research shows that the COVID Stress Scales have a robust multifactorial structure, representing five correlated facets of COVID-19-related distress: (a) Fear of the dangerousness of COVID-19, which includes fear of coming into contact with fomites potentially contaminated with SARSCoV2, (b) worry about socioeconomic costs of COVID-19 (e.g., worry about personal finances and disruption in the supply chain), (c) xenophobic fears that foreigners are spreading SARSCoV2, (d) traumatic stress symptoms associated with direct or vicarious traumatic exposure to COVID-19 (nightmares, intrusive thoughts, or images related to COVID-19), and (e) COVID-19-related compulsive checking and reassurance seeking. These factors cohere to form a COVID stress syndrome, which we sought to further delineate in the present study. METHODS: A population-representative sample of 6,854 American and Canadian adults completed a self-report survey comprising questions about current mental health and COVID-19-related experiences, distress, and coping. RESULTS: Network analysis revealed that worry about the dangerousness of COVID-19 is the central feature of the syndrome. Latent class analysis indicated that the syndrome is quasi-dimensional, comprising five classes differing in syndrome severity. Sixteen percent of participants were in the most severe class and possibly needing mental health services. Syndrome severity was correlated with preexisting psychopathology and with excessive COVID-19-related avoidance, panic buying, and coping difficulties during self-isolation. CONCLUSION: The findings provide new information about the structure and correlates of COVID stress syndrome. Further research is needed to determine whether the syndrome will abate once the pandemic has passed or whether, for some individuals, it becomes a chronic condition.

Conducting exposure and response prevention treatment for contamination fears during COVID-19: The behavioral immune system impact on clinician approaches to treatment.

The coronavirus disease 2019 (COVID-19) pandemic sparked significant anxiety regarding viral rates and means of transmission. Heightened concerns about contamination have prompted new hygienic strategies to vigilantly guard against infection, including hand washing immediately after touching foreign objects or suspected contaminants. This has presented a critical challenge for the delivery of exposure and response prevention (ERP) therapy to individuals with contamination fears due to Obsessive Compulsive Disorder (OCD), as providers must manage not only their clients' attitudes and reactions but their own as well. In this investigation, self-identified anxiety and OCD treatment specialists (N = 139) provided demographic information, including their anxiety and OCD caseloads, and completed measures related to intolerance of uncertainty (IUS-SF; Carlton et al., 2007), beliefs about exposure therapy (TBES; Deacon et al., 2013), and emotional reactions to physical sensations (The Chills; Maruskin et al., 2012). We tested the hypothesis that intolerance of uncertainty and activation of the behavioral immune system (BIS; Schaller & Park, 2011), a mechanism theoretically activated by the prominent emergence of pathogens to protect against illness would predict attitudes toward exposure. The Chills Scale was used to assess BIS activation, a broad assessment of vasoconstriction responses associated with different emotional reactions, and includes a subscale (coldness) that evaluates vasoconstriction associated with defense against pathogens. Both coldness and OCD caseload, but not anxiety caseload or subscales of intolerance of uncertainty, emerged as significant predictors of clinicians' beliefs about exposure; increases in OCD caseload were also related to decreases in negative beliefs about exposure. Findings are useful in determining methods for aiding clinicians in developing effective approaches to contamination fears during and post-pandemic that include addressing their own BIS-related concerns and mapping out means for social behavioral norms associated with engaging in exposure treatment.