Betrayal trauma and somatic symptoms among patients in a medically underserved primary care clinic.

OBJECTIVE: Betrayal Trauma Theory posits that victims of trauma are more prone to developing psychological and physical problems if the traumatic event includes the element of betrayal. We sought to evaluate the impact of betrayal trauma versus nonbetrayal trauma and no trauma exposure on the risk of patients' reporting somatic symptoms in six domains (gastrointestinal, cardiopulmonary, musculoskeletal, pseudoneurological, gynecological, or any symptom). METHOD: Medically underserved patients (N = 1,350) who presented to a primary care clinic in California completed a structured standardized interview that assessed trauma history (Diagnostic Interview Schedule) and somatization symptoms (Composite International Diagnostic Interview). Using Betrayal Trauma Theory as a guide, respondents were classified into "no trauma," "nonbetrayal trauma," and "betrayal trauma" groups. RESULTS: Compared to "no trauma" patients, patients who experienced nonbetrayal trauma were more likely to endorse all symptom domains (ORs = 1.30-1.50) except gastrointestinal and musculoskeletal; compared to "no trauma" patients, patients who experienced betrayal trauma were more likely to endorse all symptom domains (ORs = 1.61-3.12) except gynecological. Compared to patients who experienced nonbetrayal trauma, exposure to betrayal trauma increased the likelihood of reporting any (OR = 2.25), gastrointestinal (OR = 1.56), and pseudoneurological symptoms (OR = 1.71), as well as symptoms spanning multiple physiological systems (incidence rate ratio = 1.27). Each nonbetrayal trauma increased the likelihood of symptom reporting across all domains (ORs = 1.18-1.40); each betrayal trauma increased the likelihood across all domains (ORs = 1.41-2.31) except gynecological. CONCLUSION: Both nonbetrayal and betrayal trauma may predispose victims to somatization. Compared to nonbetrayal trauma, betrayal trauma confers a greater magnitude of risk for having a somatic symptom across each symptom domain except gynecological. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Contrasting Objective and Perceived Risk: Predicting COVID-19 Health Behaviors in a Nationally Representative U.S. Sample.

BACKGROUND: Individuals confronting health threats may display an optimistic bias such that judgments of their risk for illness or death are unrealistically positive given their objective circumstances. PURPOSE: We explored optimistic bias for health risks using k-means clustering in the context of COVID-19. We identified risk profiles using subjective and objective indicators of severity and susceptibility risk for COVID-19. METHODS: Between 3/18/2020-4/18/2020, a national probability sample of 6,514 U.S. residents reported both their subjective risk perceptions (e.g., perceived likelihood of illness or death) and objective risk indices (e.g., age, weight, pre-existing conditions) of COVID-19-related susceptibility and severity, alongside other pandemic-related experiences. Six months later, a subsample (N = 5,661) completed a follow-up survey with questions about their frequency of engagement in recommended health protective behaviors (social distancing, mask wearing, risk behaviors, vaccination intentions). RESULTS: The k-means clustering procedure identified five risk profiles in the Wave 1 sample; two of these demonstrated aspects of optimistic bias, representing almost 44% of the sample. In OLS regression models predicting health protective behavior adoption at Wave 2, clusters representing individuals with high perceived severity risk were most likely to report engagement in social distancing, but many individuals who were objectively at high risk for illness and death did not report engaging in self-protective behaviors. CONCLUSIONS: Objective risk of disease severity only inconsistently predicted health protective behavior. Risk profiles may help identify groups that need more targeted interventions to increase their support for public health policy and health enhancing recommendations more broadly.

As we move into an endemic stage of the COVID-19 pandemic, understanding engagement in health behaviors to curb the spread of disease remains critically important to manage COVID-19 and other health threats. However, peoples' perceptions about their risk of getting sick and having severe outcomes if they do fall ill are subject to bias. We studied a nationally representative probability sample of over 6,500 U.S. residents who completed surveys immediately after the COVID-19 pandemic began and approximately 6 months later. We used a computer processing (i.e., machine learning) approach to categorize participants based on both their actual risk factors for COVID-19 and their subjective understanding of that risk. Our analysis identified groups of individuals whose subjective perceptions of risk did not align with their actual risk characteristics. Specifically, almost 44% of our sample demonstrated an optimistic bias: they did not report higher risk of death from COVID-19 despite having one or more well-known risk factors for poor disease outcomes (e.g., older age, obesity). Six months later, membership in these risk groups prospectively predicted engagement in health protective and risky behaviors, as well as vaccine intentions, demonstrating how early risk perceptions may influence health behaviors over time.

They Saw a Hearing: Democrats' and Republicans' Perceptions of and Responses to the Ford-Kavanaugh Hearings.

In several highly publicized hearings, Dr. Christine Blasey Ford and Judge Brett Kavanaugh presented two opposing accounts of an alleged sexual assault. In the wake of these proceedings, partisans appeared similarly divided in how they regarded this political event. Using a U.S. national sample (N = 2,474) and a mixed-methods design, we investigated partisans' perceptions of, and responses to, the Ford-Kavanaugh hearings. Respondents reported their views of the hearings soon after they occurred. We used topic modeling to analyze these open-ended responses and found uniquely partisan topics emerged, including judicial impartiality and due process. Acute stress (AS) responses to the hearings were also related to partisan identities and perceptions; both Republicans (incidence rate ratio [IRR] = 0.81, 95% confidence interval [CI] = [0.78, 0.84]) and individuals who wrote more about Republican topics (IRR = 0.72, 95% CI = [0.56, 0.92]) reported lower AS than their Democratic counterparts. Results demonstrate different partisan perceptions with implications for mental health outcomes.

Parental Preconception Adversity and Offspring Mental Health in African Americans and Native Americans in the United States: A Systematic Review.

This systematic review examines the impact of parental preconception adversity on offspring mental health among African Americans (AAs) and Native Americans (NAs), two populations that have experienced historical trauma and currently experience ethnic/racial mental health disparities in the United States. PsycINFO, PubMed, CINAHL, Scopus, and Web of Science were searched for studies that included at least two generations of AAs or NAs from the same family, measured parental preconception adversity and their offspring's mental health, and examined the association between these variables. Over 3,200 articles were screened, and 18 articles representing 13 unique studies were included in this review. Among the studies with samples that included AAs (n = 12, 92%), 10 (83%) reported a significant association between parental preconception adversity and adverse offspring mental health. The only study with a sample of NAs (n = 1, 8%) also reported a significant association between these variables. Although the literature suggests that parental preconception adversity is associated with offspring mental health among AAs and NAs, it must be interpreted in the context of the small number of studies on this topic and the less-than-ideal samples utilized-just one study included a sample of NAs and several studies (n = 6, 46%) used multi-ethnic/racial samples without testing for ethnic/racial disparities in their results. A more rigorous body of literature on this topic is needed as it may help explain an important factor underlying ethnic/racial mental health disparities, with important implications for interventions and policy.

Lifetime and Acute Stress Predict Functional Outcomes Following Stroke: Findings From the Longitudinal STRONG Study.

BACKGROUND: Stroke is a sudden-onset, uncontrollable event; stroke-related stress may impede rehabilitation and recovery. Lifetime stress may sensitize patients to experiencing greater stroke-related stress and indirectly affect outcomes. We examine lifetime stress as predictor of poststroke acute stress and examine lifetime and acute stress as predictors of 3- and 12-month functional status. We also compare acute stress and baseline National Institutes of Health Stroke Scale as predictors of poststroke functional status. METHODS: Between 2016 and 2020 the STRONG Study (Stroke, Stress, Rehabilitation, and Genetics) enrolled adults with new radiologically confirmed stroke 2 to 10 days poststroke onset at 28 acute care US hospitals. Participants were interviewed 3 times: acute admission (acute stress; Acute Stress Disorder Interview), 3 months (Fugl-Meyer Upper Extremity motor impairment [Fugl-Meyer Upper Arm Assessment; N=431], modified Rankin Scale [3 months; N=542], Stroke Impact Scale-Activities of Daily Living [3 months; N=511], Lifetime Stress Exposure Inventory), and 12 months (modified Rankin Scale, N=533; Stroke Impact Scale 3.0 Activities of Daily Living; N=485; Telephone Montreal Cognitive Assessment; N=484) poststroke. Structural equation models examined whether acute stress predicted 3- and 12-month functional outcomes, and mediated an association between lifetime stress and outcomes controlling for demographics and initial National Institutes of Health Stroke Scale. Standardized betas are reported. RESULTS: Sample (N=763) was 19 to 95 years old (mean=63; SD=14.9); 448 (58.7%) were male. Acute stress scores ranged from 0 to 14 (mean, 3.52 [95% CI, 3.31-3.73]). Controlling for age, gender, baseline National Institutes of Health Stroke Scale, and race and ethnicity, higher lifetime stress predicted higher acute stress (ß=0.18, P<0.001), which predicted lower 3-month Fugl-Meyer Upper Arm Assessment scores (ß=-0.19, P<0.001), lower Stroke Impact Scale 3.0 Activities of Daily Living scores at 3 months (ß=-0.21, P<0.001) and 12 months (ß=-0.21, P<0.001), higher modified Rankin Scale scores at 3 months (ß=0.23, P<0.001) and 12 months (ß=0.22, P<0.001), and lower 12-month Telephone Montreal Cognitive Assessment scores (ß=-0.20, P<0.001). Acute stress predicted 12-month tMoCA (χ2[1]=5.29, P=0.022) more strongly, 3-month and 12-month modified Rankin Scale and SIS scores as strongly (all Ps>0.18), but Fugl-Meyer scores (χ2[1]=7.01, P=0.008) less strongly than baseline National Institutes of Health Stroke Scale. CONCLUSIONS: Lifetime stress/trauma is associated with more poststroke acute stress, which is associated with greater motor and cognitive impairment and disability 3 and 12 months poststroke. Poststroke interventions for acute stress may help mitigate stroke-related disability.

Shared social identity and media transmission of trauma.

When an individual or group trauma becomes a shared public experience through widespread media coverage (e.g., mass violence, being publicly outed), sharing a social identity with a targeted individual or group of victims may amplify feelings of personal vulnerability. This heightened perceived threat may draw people to engage with trauma-related media because of increased vigilance for self-relevant threats, which can, in turn, amplify distress. We studied this possibility among two U.S. national samples following the 2016 Pulse nightclub massacre in Orlando, FL (N = 4675) and the 2018 Dr. Christine Blasey Ford and Judge Brett Kavanaugh Supreme Court Senate hearings (N = 4894). Participants who shared LGBT or Hispanic identities with Pulse massacre victims reported greater exposure to massacre-related media and acute stress. Participants who shared Dr. Blasey Ford's identities as a victim of interpersonal violence and a Democrat reported more hearings-related media exposure and acute stress. Indirect effects of shared single identity on acute stress through self-reported event-related media exposure emerged in both studies. Results for sharing dual identities with victims were mixed. These findings have implications for media use and public health.

Idiosyncratic media exposures during a pandemic and their link to well-being, cognition, and behavior over time.

Over the past two decades of research, increased media consumption in the context of collective traumas has been cross-sectionally and longitudinally linked to negative psychological outcomes. However, little is known about the specific information channels that may drive these patterns of response. The current longitudinal investigation uses a probability-based sample of 5,661 Americans measured at the onset of the COVID-19 pandemic to identify a) distinct patterns of information-channel use (i.e., dimensions) for COVID-related information, b) demographic correlates of these patterns, and c) prospective associations of these information channel dimensions with distress (i.e., worry, global distress, and emotional exhaustion), cognition (e.g., beliefs about the seriousness of COVID-19, response efficacy, and dismissive attitudes), and behavior (e.g., engaging in health-protective behaviors and risk-taking behaviors) 6 mo later. Four distinct information-channel dimensions emerged: journalistic complexity; ideologically focused news; domestically focused news; and nonnews. Results indicate that journalistic complexity was prospectively associated with more emotional exhaustion, belief in the seriousness of the coronavirus, response efficacy, engaging in health-protective behaviors, and less dismissiveness of the pandemic. A reliance on conservative-leaning media was prospectively associated with less psychological distress, taking the pandemic less seriously, and engaging in more risk-taking behaviors. We discuss the implications of this work for the public, policy makers, and future research.

Rehabilitation Therapy Doses Are Low After Stroke and Predicted by Clinical Factors.

BACKGROUND: Stroke is a leading cause of long-term disability. Greater rehabilitation therapy after stroke is known to improve functional outcomes. This study examined therapy doses during the first year of stroke recovery and identified factors that predict rehabilitation therapy dose. METHODS: Adults with new radiologically confirmed stroke were enrolled 2 to 10 days after stroke onset at 28 acute care hospitals across the United States. Following an initial assessment during acute hospitalization, the number of physical therapy, occupational therapy, and speech therapy sessions were determined at visits occurring 3, 6, and 12 months following stroke. Negative binomial regression examined whether clinical and demographic factors were associated with therapy counts. False discovery rate was used to correct for multiple comparisons. RESULTS: Of 763 patients enrolled during acute stroke admission, 510 were available for follow-up. Therapy counts were low overall, with most therapy delivered within the first 3 months; 35.0% of patients received no physical therapy; 48.8%, no occupational therapy, and 61.7%, no speech therapy. Discharge destination was significantly related to cumulative therapy; the percentage of patients discharged to an inpatient rehabilitation facility varied across sites, from 0% to 71%. Most demographic factors did not predict therapy dose, although Hispanic patients received a lower cumulative amount of physical therapy and occupational therapy. Acutely, the severity of clinical factors (grip strength and National Institutes of Health Stroke Scale score, as well as National Institutes of Health Stroke Scale subscores for aphasia and neglect) predicted higher subsequent therapy doses. Measures of impairment and function (Fugl-Meyer, modified Rankin Scale, and Stroke Impact Scale Activities of Daily Living) assessed 3 months after stroke also predicted subsequent cumulative therapy doses. CONCLUSIONS: Rehabilitative therapy doses during the first year poststroke are low in the United States. This is the first US-wide study to demonstrate that behavioral deficits predict therapy dose, with patients having more severe deficits receiving higher doses. Findings suggest directions for identifying groups at risk of receiving disproportionately low rehabilitation doses.

A scoping review of the literature addressing psychological well-being of racial and ethnic minority nurses during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has affected the well-being of nursing professionals, especially long-term and acute care nurses, many of whom are nurses of color. PURPOSE: We examine the evidence and gaps in the literature addressing psychological well-being of racial/ethnic minority RNs in the United States during COVID-19. METHODS: We searched eight databases during March 2022 and used Joanna Briggs' Scoping Review Methodology and PRISMA-ScR reporting standards. DISCUSSION: Seven studies met inclusion criteria. Two exclusively examined nurses; five reported findings from heterogeneous samples of health care workers. No significant racial/ethnic differences in well-being were reported among health care workers. Among nurses, if a difference existed, White nurses reported decreased psychological well-being relative to ethnic and racial minority nurses. Two studies report modest racial/ethnic differences in nurses' psychological well-being. CONCLUSION: Significant gaps in the literature remain; future studies should analyze groups of health care workers separately, clearly identify racial and ethnic groups, and examine the role of respondents' work setting.

Distortions in time perception during collective trauma: Insights from a national longitudinal study during the COVID-19 pandemic.

OBJECTIVE: During the protracted collective trauma of the COVID-19 pandemic, lay of distorted perceptions of time (e.g., time slowing, days blurring together, uncertainty about the future) have been widespread. Known as "temporal disintegration" in psychiatric literature, these distortions are associated with negative mental health consequences. However, the prevalence and predictors of temporal disintegration are poorly understood. We examined perceptions of time passing and their associations with lifetime stress and trauma and pandemic-related secondary stress as COVID-19 spread across the United States. METHOD: A probability-based national sample (N = 5,661) from the NORC AmeriSpeak online panel, which had completed a mental and physical health survey prior to the pandemic, completed two surveys online during March 18-April 18, 2020, and September 26-October 16, 2020. Distorted time perceptions and other pandemic-related experiences were assessed. RESULTS: Present focus, blurring weekdays and weekdays together, and uncertainty about the future were common experiences reported by over 65% of the sample 6 months into the pandemic. Half of the sample reported time speeding up or slowing down. Predictors of temporal disintegration include prepandemic mental health diagnoses, daily pandemic-related media exposure and secondary stress (e.g., school closures, lockdown), financial stress, and lifetime stress and trauma exposure. CONCLUSION: During the first 6 months of the COVID-19 pandemic, distortions in time perception were very common and associated with prepandemic mental health, lifetime stress and trauma exposure, and pandemic-related media exposure and stressors. Given that temporal disintegration is a risk factor for mental health challenges, these findings have potential implications for public mental health. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Psychological responses to U.S. statewide restrictions and COVID-19 exposures: A longitudinal study.

OBJECTIVE: The COVID-19 pandemic has generated debate as to whether community-level behavioral restrictions are worth the emotional costs of such restrictions. Using a longitudinal design, we juxtaposed the relative impacts of state-level restrictions and case counts with person-level direct and media-based exposures on distress, loneliness, and traumatic stress symptoms (TSS) during the COVID-19 pandemic in the United States. METHOD: From March 18, 2020 to April 18, 2020 and September 9, 2020 to October 16, 2020, a representative probability sample of U.S. adults (N = 5,594) completed surveys of their psychological responses and personal direct and media-based exposures to the COVID-19 pandemic. Survey data were merged with publicly available data on the stringency of state-level mitigation policies (e.g., school/business closures) during this period and longitudinal case/death counts for each state. RESULTS: Three multilevel models (outcomes: distress, loneliness, TSS) were constructed. Measurements of dependent variables (Level 1) were nested within respondents (Level 2) who were nested within states (Level 3). State-level mitigation, cases, or deaths were not associated with any dependent variables (all p's > .05). However, person-level exposures, including having contracted COVID-19 oneself (distress b = .22, p < .001; loneliness b = .13, p = .03; TSS b = .18, p = .001), knowing others who were sick (distress b = .04, p < .001; loneliness b = .02, p < .001; TSS b = .05, p < .001) or died (distress b = .10, p = .001; loneliness b = .10, p = .003; TSS b = .16, p < .001), and exposure to pandemic-related media (distress b = .12, p < .001; loneliness b = .09, p < .001; TSS b = .16, p < .001), were positively associated with outcomes. CONCLUSIONS: Personal exposures to COVID-19 are more strongly associated with psychological outcomes than statewide mitigations levied to stop disease spread. Results may inform public health response planning for future disease outbreaks. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Association Between Repeated Exposure to Hurricanes and Mental Health in a Representative Sample of Florida Residents.

Importance: During the past century, more than 100 catastrophic hurricanes have impacted the Florida coast; climate change will likely be associated with increases in the intensity of future storms. Despite these annual threats to residents, to our knowledge, no longitudinal studies of representative samples at risk of hurricane exposure have examined psychological outcomes associated with repeated exposure. Objective: To assess psychosocial and mental health outcomes and functional impairment associated with repeated hurricane exposure. Design, Setting, and Participants: In this survey study, a demographically representative sample of Florida residents was assessed in the 60 hours prior to Hurricane Irma (wave 1: September 8-11, 2017). A second survey was administered 1 month after Hurricane Irma (wave 2: October 12-29, 2017), and a third survey was administered after Hurricane Michael (wave 3: October 22 to November 6, 2018). Data were analyzed from July 19 to 23, 2021. Exposure: Hurricanes Irma and Michael. Main Outcomes and Measures: The main outcomes were posttraumatic stress symptoms (PTSS), global distress, worry about future events (generalized worries), and functional impairment. Path models were used to assess associations of individual-level factors (prior mental health, recent adversity), prior storm exposures (loss and/or injury, evacuation), and direct, indirect, and media-based exposures to hurricanes Irma and Michael with those outcomes. Poststratification weights were applied to facilitate population-based inferences. Results: Of 2873 individuals administered the survey in wave 1, 1637 responded (57.0% completion rate) (894 [54.6%, weighted] women; mean [SD] age, 51.31 [17.50] years); 1478 in wave 2 (90.3% retention from wave 1) and 1113 in wave 3 (75.3% retention from wave 2) responded. Prior mental health ailments (b, 0.18; 95% CI, 0.07-0.28), prior hurricane-related loss and/or injury (b, 0.09; 95% CI, 0.02-0.17), hours of Hurricane Irma-related media exposure (b, 0.03; 95% CI, 0.02-0.04), being in an evacuation zone during Hurricane Irma and not evacuating (b, 0.14; 95% CI, 0.02-0.27), and loss and/or injury in Hurricane Irma (b, 0.35; 95% CI, 0.25-0.44) were positively associated with PTSS after Hurricane Irma; most associations persisted and were associated with responses to Hurricane Michael. Prior mental health ailments (b, 0.10; 95% CI, 0.03-0.17), hours of Hurricane Michael-related media exposure (b, 0.01; 95% CI, 0.003-0.02), hurricane Irma-related PTSS (b, 0.42; 95% CI, 0.34-0.50), recent individual-level adversity (b, 0.03; 95% CI, 0.005-0.05), being in an evacuation zone during Hurricane Irma and evacuating (b, 0.10; 95% CI, 0.002-0.19), and direct (b, 0.36; 95% CI, 0.16-0.55) and indirect (b, 0.12; 95% CI, 0.05-0.18) Hurricane Michael-related exposures were directly associated with Hurricane Michael-related PTSS. After Hurricane Michael, prior mental health ailments (b, 0.17; 95% CI, 0.06-0.28), and PTSS related to hurricanes Irma (b, 0.11; 95% CI, 0.001-0.22) and Michael (b, 0.58; 95% CI, 0.47-0.69) were associated with respondents' functional impairment. Analogous analyses using global distress and generalized worries as mediators of functional impairment yielded a similar pattern of results. Conclusions and Relevance: In this survey study, repeated direct, indirect, and media-based exposures to hurricanes were associated with increased mental health symptoms among Florida residents who experienced hurricanes Irma and Michael, suggesting that people were sensitized to respond with more psychological symptoms over time. These results may inform targeted public health intervention efforts for natural disasters.

Racial and ethnic differences in perseverative cognition at the onset of the COVID-19 pandemic.

RATIONALE: Coronavirus (COVID-19) disproportionately affects people of color (e.g., Black and Latinx individuals) in the U.S., increasing their morbidity and mortality relative to White people. Despite this greater threat to their well-being, the mental health impact of COVID-19 on people of color remains poorly understood. Perseverative cognition (PC; i.e., excessive worry and/or rumination), is a common psychological response to such threats that independently associates with poor mental and physical health. OBJECTIVE: To examine patterns of PC across race/ethnicity when the COVID-19 pandemic began. METHODS: This study surveyed 6,514 respondents from the NORC AmeriSpeak panel, a probability-based representative national sample of U.S. adults between 3/18/20-4/18/20. We employed traditional statistical analyses and natural language processing of open-ended data to examine pandemic-related worries. RESULTS: Weighted regression analyses with relevant covariates revealed group differences across specific domains of COVID-related worry. Relative to White respondents, Hispanic/Latino respondents reported more worries about social disarray, meeting basic needs, experiencing economic impacts, obtaining healthcare, and contracting COVID-19. Black respondents reported more worry about economic impacts relative to Whites. Additional group differences in worry emerged in open-ended data: Black respondents perseverated about death from COVID-19, whereas Hispanic/Latino respondents reported concerns about COVID-19 spread, and people refusing to uphold mitigation mandates. In contrast, White respondents expressed worry over compromised immune systems and economic collapse. CONCLUSIONS: Results identify significant group differences in COVID-19 related PC, suggesting that people of color faced greater threat to mental well-being at the onset of the pandemic, and may be at greater risk for downstream PC-related physical health consequences.

The Role of Behavioral Medicine in Addressing Climate Change-Related Health Inequities.

Climate change is the greatest threat to global health in human history. It has been declared a public health emergency by the World Health Organization and leading researchers from academic institutions around the globe. Structural racism disproportionately exposes communities targeted for marginalization to the harmful consequences of climate change through greater risk of exposure and sensitivity to climate hazards and less adaptive capacity to the health threats of climate change. Given its interdisciplinary approach to integrating behavioral, psychosocial, and biomedical knowledge, the discipline of behavioral medicine is uniquely qualified to address the systemic causes of climate change-related health inequities and can offer a perspective that is currently missing from many climate and health equity efforts. In this article, we summarize relevant concepts, describe how climate change and structural racism intersect to exacerbate health inequities, and recommend six strategies with the greatest potential for addressing climate-related health inequities.

Acute stress, worry, and impairment in health care and non-health care essential workers during the COVID-19 pandemic.

OBJECTIVE: Health care and non-health care essential workers working in face-to-face interactions during the coronavirus disease 2019 (COVID-19) pandemic may be vulnerable to psychosocial distress. Limited empirical research on COVID-19-related psychosocial outcomes has utilized probability-based samples including both health care and non-health care essential workers. METHOD: We surveyed a sample of 1,821 United States self-identified essential workers, collected using probability-based methods, working in face-to-face interactions during the early phase of the COVID-19 outbreak (March 18, 2020 through April 18, 2020), in three consecutive 10-day cohorts. We assessed acute stress, health-related worries, and functional impairment. Demographics, secondary stressors (lack of childcare or health care, lost wages), and pre-COVID-19 mental and physical health were examined as predictors of psychological outcomes. RESULTS: Acute stress (ß = .08, p = .001), health-related worries (ß = .09, p = .001), and functional impairment (ß = .05, p = .034) increased over time in the early weeks of the outbreak. Health care essential workers reported lower functional impairment (ß = -.06, p = .009) and acute stress (ß = -.06, p = .015) compared with non-health care essential workers. Across the sample, prior mental and physical health ailments, inability to obtain health care, lost wages, younger age, female gender, and Hispanic ethnicity were associated with acute stress (ßs = -.14 to .15, ps ≤ .001), health-related worries (ßs = -.09 to .14, ps ≤ .001), and functional impairment (ßs = -.08 to .16, ps ≤ .006). Lack of childcare (ß = .09, p < .001) was positively associated with acute stress. CONCLUSION: Non-health care essential workers may be vulnerable to negative psychosocial outcomes. Targeted training and support may help facilitate coping with the effects of working in-person during the ongoing COVID-19 pandemic. Findings may help inform intervention efforts, critical as COVID-19 becomes endemic and society must learn to live with its evolving variants. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Media exposure, risk perceptions, and fear: Americans' behavioral responses to the Ebola public health crisis.

We examined media exposure, psychological fear and worry, perceptions of risk, and health protective behaviors surrounding the 2014 Ebola virus outbreak in a probability-based, representative, national sample of Americans (N = 3447). Structural equation models examined relationships between amount (hours/day) and content (e.g., graphic images of dead bodies) of media exposure and counts of self-reported health protective behaviors that participants performed or would perform if Ebola spread to their community. Ebola-related risk perceptions and fear and worry were potential mediators. Greater total hours and more graphic media exposure positively correlated with more fear and worry; greater total hours of media exposure also positively correlated with higher perceived risk. Higher risk perceptions were associated with more health protective behaviors performed and intended. Greater fear and worry were associated with more behaviors performed. Amount and content of media exposure exhibited indirect effects on behaviors performed; amount of media exposure had indirect effects on intentions. Media may help promote health protective behaviors during public health threats; the amount and content should be congruent with threat to minimize distress and maximize resources.

Risk perceptions and health behaviors as COVID-19 emerged in the United States: Results from a probability-based nationally representative sample.

Understanding psychosocial correlates of engaging in health-protective behaviors during an infectious disease outbreak can inform targeted intervention strategies. We surveyed a national probability-based sample of 6,514 Americans, with three separate, consecutive representative cohorts between March 18, 2020 and April 18, 2020, as the U.S. COVID-19 epidemic began. Americans adopted many health-protective behaviors (e.g., hand hygiene, social distancing) early, performing them, on average, "most of the time," with frequency increasing over time. In covariate-adjusted models, self-reported female gender (ß = .16, p < .001), older age (ß = .13, p < .001), more COVID-related secondary stressors (ß = .17, p < .001), and greater perceptions of the risks of catching (ß = .07, p = .001) and dying (ß = .09, p < .001) from Coronavirus were associated with greater frequency of social-distancing behaviors. Wearing face masks and/or gloves was positively associated with female gender (ß = .07, p < .001), older age (ß = .14, p < .001), Black (ß = .14, p < .001) and Hispanic (ß = .07, p = .002) ethnicity, personal-COVID-19 exposure (ß = .06, p < .001), reporting secondary stressors (ß = .11, p < .001), and higher perceived risk of dying from Coronavirus (ß = .13, p < .001). Participants in Cohorts 2 and 3 (compared to Cohort 1) wore face masks and gloves and engaged in social distancing more frequently. Overall, early in the U.S. COVID-19 outbreak, despite the novelty and uncertainty, Americans were responsive to guidelines, adopting them early and following them frequently. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The unfolding COVID-19 pandemic: A probability-based, nationally representative study of mental health in the United States.

The COVID-19 (coronavirus disease 2019) pandemic is a collective stressor unfolding over time; yet, rigorous empirical studies addressing its mental health consequences among large probability-based national samples are rare. Between 18 March and 18 April 2020, as illness and death escalated in the United States, we assessed acute stress, depressive symptoms, and direct, community, and media-based exposures to COVID-19 in three consecutive representative samples from the U.S. probability-based nationally representative NORC AmeriSpeak panel across three 10-day periods (total N = 6514). Acute stress and depressive symptoms increased significantly over time as COVID-19 deaths increased across the United States. Preexisting mental and physical health diagnoses, daily COVID-19-related media exposure, conflicting COVID-19 information in media, and secondary stressors were all associated with acute stress and depressive symptoms. Results have implications for targeting public health interventions and risk communication efforts to promote community resilience as the pandemic waxes and wanes over time.

When time falls apart: The public health implications of distorted time perception in the age of COVID-19.

Collective trauma, like the COVID-19 pandemic, can dramatically alter how we perceive time and view our futures. Indeed, the pandemic has challenged us to cope with an ambiguous, invisible threat that has changed our way of life and made our futures, both near and far, less certain. In this commentary, we review existing literature on time perception in the context of stress and trauma and discuss its implications for mental health and well-being. (PsycInfo Database Record (c) 2020 APA, all rights reserved).