Too many lemons to make lemonade? Disentangling mental health during the third wave of COVID-19 infections in Spain.

The study aimed to analyze the longitudinal change in mental health during the third wave of COVID-19 infections in Spain. Negative (e.g., emotional distress) and positive (e.g., positive functioning variables) outcomes were analyzed. Protective factors (e.g., resilience) as predictors of psychological adjustment (i.e., positive mental health, openness to the future, and low burden due to COVID-19) after ten months of the pandemic were also examined. The sample consisted of 164 participants, and self-reported questionnaires were administered at the beginning of the lockdown (March 2020), at the end of the lockdown (June 2020), and during the third wave (January 2021). Linear mixed models showed that individuals' emotional distress increased, and positive functioning variables (i.e., meaning in life, gratitude, resilience, and life satisfaction) decreased over time, but an increase was observed in some dimensions of posttraumatic growth. Regression analyses showed that resilience scores at all three data collection time points were significant predictors of positive mental health, openness to the future, and burden during the third wave. Mediation analyses showed that positive mental health and openness to the future were mediators of the effect of resilience on burden. The prolonged situation of the COVID-19 crisis had an important impact on positive and negative mental health. However, resilience may help to build up resources that can act as a buffer against adverse psychological effects.

How the COVID-19 Pandemic and its Consequences Affect the Presence of and Search for Meaning of Life: A Longitudinal Study.

The presence of meaning in life (PML) and the search for meaning in life (SML) are crucial when facing difficult times. Although several theoretical frameworks have tried to explain the dynamics of meaning in life during adversity, empirical evidence about interactions among both constructs using longitudinal designs is scarce. This study examined the trajectories of both PML and SML during the COVID-19 lockdown period in Spain. In total, 220 adults fulfilled an online survey during two periods: a strict and a relaxed lockdown period. Latent growth models showed that both PML and SML declined slightly during the strict lockdown, but they reached a plateau during the relaxed lockdown. Results also showed that age and having a partner predicted higher PML and lower SML at baseline, whereas being male predicted higher scores on PML. PML and SML were negatively associated at baseline, higher SML at baseline was related to a steeper decreasing PML slope during the strict lockdown, and the PML and SML slopes in the relaxed lockdown period were negatively related. This study contributes to better understanding longitudinal fluctuations of meaning in life in situations of adversity.

mHealth intervention to improve quality of life in patients with chronic diseases during the COVID-19 crisis in Paraguay: A study protocol for a randomized controlled trial.

BACKGROUND: Patients with chronic disease represent an at-risk group in the face of the COVID-19 crisis as they need to regularly monitor their lifestyle and emotional management. Coping with the illness becomes a challenge due to supply problems and lack of access to health care facilities. It is expected these limitations, along with lockdown and social distancing measures, have affected the routine disease management of these patients, being more pronounced in low- and middle-income countries with a flawed health care system. OBJECTIVES: The purpose of this study is to describe a protocol for a randomized controlled trial to test the efficacy of the Adhera® MejoraCare Digital Program, an mHealth intervention aimed at improving the quality of life of patients with chronic diseases during the COVID-19 outbreak in Paraguay. METHOD: A two-arm randomized controlled trial will be carried out, with repeated measures (baseline, 1-month, 3-month, 6-month, and 12-month) under two conditions: Adhera® MejoraCare Digital Program or waiting list. The primary outcome is a change in the quality of life on the EuroQol 5-Dimensions 3-Levels Questionnaire (EQ-5D-3L). Other secondary outcomes, as the effect on anxiety and health empowerment, will be considered. All participants must be 18 years of age or older and meet the criteria for chronic disease. A total of 96 participants will be recruited (48 per arm). CONCLUSIONS: It is expected that the Adhera® MejoraCare Digital Program will show significant improvements in quality of life and emotional distress compared to the waiting list condition. Additionally, it is hypothesized that this intervention will be positively evaluated by the participants in terms of usability and satisfaction. The findings will provide new insights into the viability and efficacy of mHealth solutions for chronic disease management in developing countries and in times of pandemic. TRIAL REGISTRATION: ClinicalTrials.gov NCT04659746.

How the COVID-19 Pandemic and its Consequences Affect the Presence of and Search for Meaning of Life: A Longitudinal Study

The presence of meaning in life (PML) and the search for meaning in life (SML) are crucial when facing difficult times. Although several theoretical frameworks have tried to explain the dynamics of meaning in life during adversity, empirical evidence about interactions among both constructs using longitudinal designs is scarce. This study examined the trajectories of both PML and SML during the COVID-19 lockdown period in Spain. In total, 220 adults fulfilled an online survey during two periods: a strict and a relaxed lockdown period. Latent growth models showed that both PML and SML declined slightly during the strict lockdown, but they reached a plateau during the relaxed lockdown. Results also showed that age and having a partner predicted higher PML and lower SML at baseline, whereas being male predicted higher scores on PML. PML and SML were negatively associated at baseline, higher SML at baseline was related to a steeper decreasing PML slope during the strict lockdown, and the PML and SML slopes in the relaxed lockdown period were negatively related. This study contributes to better understanding longitudinal fluctuations of meaning in life in situations of adversity.

Too many lemons to make lemonade? Disentangling mental health during the third wave of COVID-19 infections in Spain

The study aimed to analyze the longitudinal change in mental health during the third wave of COVID-19 infections in Spain. Negative (e.g., emotional distress) and positive (e.g., positive functioning variables) outcomes were analyzed. Protective factors (e.g., resilience) as predictors of psychological adjustment (i.e., positive mental health, openness to the future, and low burden due to COVID-19) after ten months of the pandemic were also examined. The sample consisted of 164 participants, and self-reported questionnaires were administered at the beginning of the lockdown (March 2020), at the end of the lockdown (June 2020), and during the third wave (January 2021). Linear mixed models showed that individuals’ emotional distress increased, and positive functioning variables (i.e., meaning in life, gratitude, resilience, and life satisfaction) decreased over time, but an increase was observed in some dimensions of posttraumatic growth. Regression analyses showed that resilience scores at all three data collection time points were significant predictors of positive mental health, openness to the future, and burden during the third wave. Mediation analyses showed that positive mental health and openness to the future were mediators of the effect of resilience on burden. The prolonged situation of the COVID-19 crisis had an important impact on positive and negative mental health. However, resilience may help to build up resources that can act as a buffer against adverse psychological effects.

Exploring the Heterogeneity and Trajectories of Positive Functioning Variables, Emotional Distress, and Post-traumatic Growth During Strict Confinement Due to COVID-19.

COVID-19 pandemic-related confinement may be a fruitful opportunity to use individual resources to deal with it or experience psychological functioning changes. This study aimed to analyze the evolution of different psychological variables during the first coronavirus wave to identify the different psychological response clusters, as well as to keep a follow-up on the changes among these clusters. The sample included 459 Spanish residents (77.8% female, Mage = 35.21 years, SDage = 13.00). Participants completed several online self-reported questionnaires to assess positive functioning variables (MLQ, Steger et al. in J Loss Trauma 13(6):511-527, 2006. 10.1080/15325020802173660; GQ-6, McCullough et al. in J Person Soc Psychol 82:112-127, 2002. 10.1037/0022-3514.82.1.112; CD-RISC, Campbell-Sills and Stein in J Traum Stress 20(6):1019-1028, 2007. 10.1002/jts.20271; CLS-H, Chiesi et al. in BMC Psychol 8(1):1-9, 2020. 10.1186/s40359-020-0386-9; SWLS; Diener et al. in J Person Assess, 49(1), 71-75, 1985), emotional distress (PHQ-2, Kroenke et al. in Med Care 41(11):1284-1292, 2003. 10.1097/01.MLR.0000093487.78664.3C; GAD-2, Kroenke et al. in Ann Internal Med 146(5):317-325, 2007. 10.7326/0003-4819-146-5-200703060-00004; PANAS, Watson et al. in J Person Soc Psychol 47:1063-1070, 1988; Perceived Stress, ad hoc), and post-traumatic growth (PTGI-SF; Cann et al. in Anxiety Stress Coping 23(2):127-137, 2010. 10.1080/10615800903094273), four times throughout the 3 months of the confinement. Linear mixed models showed that the scores on positive functioning variables worsened from the beginning of the confinement, while emotional distress and personal strength improved by the end of the state of alarm. Clustering analyses revealed four different patterns of psychological response: "Survival", "Resurgent", "Resilient", and "Thriving" individuals. Four different profiles were identified during mandatory confinement and most participants remained in the same cluster. The "Resilient" cluster gathered the largest number of individuals (30-37%). We conclude that both the heterogeneity of psychological profiles and analysis of positive functioning variables, emotional distress, and post-traumatic growth must be considered to better understand the response to prolonged adverse situations. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10902-021-00469-z.

What is the Current and Future Status of Digital Mental Health Interventions?

The prevalence of mental disorders continues to increase, especially with the advent of the COVID-19 pandemic. Although we have evidence-based psychological treatments to address these conditions, most people encounter some barriers to receiving this help (e.g., stigma, geographical or time limitations). Digital mental health interventions (e.g., Internet-based interventions, smartphone apps, mixed realities -virtual and augmented reality) provide an opportunity to improve accessibility to these treatments. This article summarizes the main contributions of the different types of digital mental health solutions. It analyzes their limitations (e.g., drop-out rates, lack of engagement, lack of personalization, lack of cultural adaptations) and showcases the latest sophisticated and innovative technological advances under the umbrella of precision medicine (e.g., digital phenotyping, chatbots, or conversational agents). Finally, future challenges related to the need for real world implementation of these interventions, the use of predictive methodology, and hybrid models of care in clinical practice, among others, are discussed.

Corrigendum: Elena+ Care for COVID-19, a Pandemic Lifestyle Care Intervention: Intervention Design and Study Protocol.

[This corrects the article DOI: 10.3389/fpubh.2021.625640.].

Elena+ Care for COVID-19, a Pandemic Lifestyle Care Intervention: Intervention Design and Study Protocol.

Background: The current COVID-19 coronavirus pandemic is an emergency on a global scale, with huge swathes of the population required to remain indoors for prolonged periods to tackle the virus. In this new context, individuals' health-promoting routines are under greater strain, contributing to poorer mental and physical health. Additionally, individuals are required to keep up to date with latest health guidelines about the virus, which may be confusing in an age of social-media disinformation and shifting guidelines. To tackle these factors, we developed Elena+, a smartphone-based and conversational agent (CA) delivered pandemic lifestyle care intervention. Methods: Elena+ utilizes varied intervention components to deliver a psychoeducation-focused coaching program on the topics of: COVID-19 information, physical activity, mental health (anxiety, loneliness, mental resources), sleep and diet and nutrition. Over 43 subtopics, a CA guides individuals through content and tracks progress over time, such as changes in health outcome assessments per topic, alongside user-set behavioral intentions and user-reported actual behaviors. Ratings of the usage experience, social demographics and the user profile are also captured. Elena+ is available for public download on iOS and Android devices in English, European Spanish and Latin American Spanish with future languages and launch countries planned, and no limits on planned recruitment. Panel data methods will be used to track user progress over time in subsequent analyses. The Elena+ intervention is open-source under the Apache 2 license (MobileCoach software) and the Creative Commons 4.0 license CC BY-NC-SA (intervention logic and content), allowing future collaborations; such as cultural adaptions, integration of new sensor-related features or the development of new topics. Discussion: Digital health applications offer a low-cost and scalable route to meet challenges to public health. As Elena+ was developed by an international and interdisciplinary team in a short time frame to meet the COVID-19 pandemic, empirical data are required to discern how effective such solutions can be in meeting real world, emergent health crises. Additionally, clustering Elena+ users based on characteristics and usage behaviors could help public health practitioners understand how population-level digital health interventions can reach at-risk and sub-populations.

Exploring the Heterogeneity and Trajectories of Positive Functioning Variables, Emotional Distress, and Post-traumatic Growth During Strict Confinement Due to COVID-19

Abstract  COVID-19 pandemic-related confinement may be a fruitful opportunity to use individual resources to deal with it or experience psychological functioning changes. This study aimed to analyze the evolution of different psychological variables during the first coronavirus wave to identify the different psychological response clusters, as well as to keep a follow-up on the changes among these clusters. The sample included 459 Spanish residents (77.8% female, Mage = 35.21 years, SDage = 13.00). Participants completed several online self-reported questionnaires to assess positive functioning variables (MLQ, Steger et al. in J Loss Trauma 13(6):511–527, 2006. 10.1080/15325020802173660;GQ-6, McCullough et al. in J Person Soc Psychol 82:112–127, 2002. 10.1037/0022-3514.82.1.112;CD-RISC, Campbell-Sills and Stein in J Traum Stress 20(6):1019–1028, 2007. 10.1002/jts.20271;CLS-H, Chiesi et al. in BMC Psychol 8(1):1–9, 2020. 10.1186/s40359-020-0386-9;SWLS;Diener et al. in J Person Assess, 49(1), 71–75, 1985), emotional distress (PHQ-2, Kroenke et al. in Med Care 41(11):1284–1292, 2003. 10.1097/01.MLR.0000093487.78664.3C;GAD-2, Kroenke et al. in Ann Internal Med 146(5):317–325, 2007. 10.7326/0003-4819-146-5-200703060-00004;PANAS, Watson et al. in J Person Soc Psychol 47:1063–1070, 1988;Perceived Stress, ad hoc), and post-traumatic growth (PTGI-SF;Cann et al. in Anxiety Stress Coping 23(2):127–137, 2010. 10.1080/10615800903094273), four times throughout the 3 months of the confinement. Linear mixed models showed that the scores on positive functioning variables worsened from the beginning of the confinement, while emotional distress and personal strength improved by the end of the state of alarm. Clustering analyses revealed four different patterns of psychological response: “Survival”, “Resurgent”, “Resilient”, and “Thriving” individuals. Four different profiles were identified during mandatory confinement and most participants remained in the same cluster. The “Resilient” cluster gathered the largest number of individuals (30–37%). We conclude that both the heterogeneity of psychological profiles and analysis of positive functioning variables, emotional distress, and post-traumatic growth must be considered to better understand the response to prolonged adverse situations. Supplementary Information The online version contains supplementary material available at 10.1007/s10902-021-00469-z.