A longitudinal study of risk and protective factors for symptoms of adjustment disorder during the COVID-19 pandemic.

Background: The COVID-19 pandemic caused multiple stressors that may lead to symptoms of adjustment disorder.Objective: We longitudinally examined relationships between risk and protective factors, pandemic-related stressors and symptoms of adjustment disorder during the COVID-19 pandemic, as well as whether these relationships differed by the time of assessment.Method: The European Society for Traumatic Stress Studies (ESTSS) ADJUST Study included N = 15,169 participants aged 18 years and above. Participants from 11 European countries were recruited and screened three times at 6-month intervals from June 2020 to January 2022. Associations between risk and protective factors (e.g. gender), stressors (e.g. fear of infection), and symptoms of adjustment disorder (AjD, ADNM-8) and their interaction with time of assessment were examined using mixed linear regression.Results: The following predictors were significantly associated with higher AjD symptom levels: female or diverse gender; older age; pandemic-related news consumption >30 min a day; a current or previous mental health disorder; trauma exposure before or during the pandemic; a good, satisfactory or poor health status (vs. very good); burden related to governmental crisis management and communication; fear of infection; restricted social contact; work-related problems; restricted activity; and difficult housing conditions. The following predictors were associated with lower AjD levels: self-employment or retirement; working in healthcare; and face-to-face contact ≥ once a week with loved ones or friends. The effects of the following predictors on AjD symptoms differed by the time of assessment in the course of the pandemic: a current or previous mental disorder; burden related to governmental crisis management; income reduction; and a current trauma exposure.Conclusions: We identified risk factors and stressors predicting AjD symptom levels at different stages of the pandemic. For some predictors, the effects on mental health may change at different stages of a pandemic.

We longitudinally examined predictors of symptoms of adjustment disorder in 15,563 adults during the COVID-19 pandemic.We found stressors, risk, and protective factors predicting adjustment disorder symptom levels at different stages of the pandemic.For some predictors, the effects appear to change in different phases of a pandemic.

Trajectories of depressive and anxiety symptoms and associated risk factors during the COVID-19 pandemic in Germany: A longitudinal cohort study.

BACKGROUND: Most COVID-19-related mental health research focused on average levels of mental health parameters in the general population. However, considering heterogeneous groups and their long-term responses could deepen our understanding of mental health during community crises. This four-wave study aimed to (1) identify subgroups with different trajectories of depressive and anxiety symptoms in the German general population, and (2) investigate associated risk factors. METHODS: We analyzed self-report data from N = 1257 German adults participating in a European cohort study, assessed in summer 2020 (T1), and at 6 (T2), 12 (T3), and 30 months (T4). Depressive and anxiety symptoms were measured using the PHQ-4. Sociodemographic, health-related, and pandemic-related variables were assessed at baseline. We applied growth mixture modeling to identify subgroups of symptom trajectories and conducted multinomial logistic regression to examine factors associated with class membership. RESULTS: We identified six symptom trajectories: Low-stable (n = 971, 77.2 %), Continuous deterioration (n = 30, 2.4 %), Transient deterioration (n = 75, 6.0 %), Continuous improvement (n = 97, 7.7 %), Transient improvement (n = 38, 3.0 %) and Chronicity (n = 46, 3.7 %). Age, education, work status, mental health diagnoses, self-reported health, and pandemic-related news consumption were significantly associated with subgroup membership. LIMITATIONS: The generalizability of the study is constrained by an unrepresentative sampling method, a notable dropout rate, and limited consideration of risk factors. CONCLUSION: Most people experienced low symptoms or improvement during the pandemic, while others experienced chronic or transient symptoms. Specific risk factors were associated with these trajectories, revealing nuanced mental health dynamics.

Feasibility of a breath robot intervention to reduce sleep problems in posttraumatic stress disorder: protocol for a randomized controlled study.

BACKGROUND: Many patients with posttraumatic stress disorder (PTSD) suffer from sleep problems. Robot-based interventions might be an innovative approach to reduce sleep problems and hyperarousal in PTSD. However, the feasibility and effectiveness of a breath robot in patients with PTSD have never been empirically tested. The aim of this study is to investigate the feasibility of a breath robot to reduce sleep problems and hyperarousal in patients with PTSD. METHODS: This randomized controlled feasibility study will include N = 30 adult patients with at least subsyndromal PTSD (PTSD Symptom Scale - Interview-5 (PSSI-5)) according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) and impaired sleep quality (Pittsburgh Sleep Quality Index (PSQI) > 5). Patients with organic sleep disorders or currently in psychotherapeutic treatment are excluded. Study participants are randomized to receive either a 4-week Somnox 2 robot intervention including simulation of human breath or a 4-week Somnox 2 robot intervention without human breath simulation. The primary outcome will be the proportion of randomized participants providing outcome data at post-treatment. We consider a proportion of > 50% to indicate feasibility. Additional feasibility outcomes include eligibility rate, recruitment speed, uptake, retention, treatment adherence, and dropout. Potential outcomes of effectiveness (sleep quality, PSQI; severity of PTSD symptoms, PSSI-5) will be assessed at two time points, before (T0) and after (T1) the intervention. Sleep characteristics (Consensus Sleep Diary (CSD)) are measured daily. DISCUSSION: This study is the first to investigate the feasibility of a novel breath robot intervention for reducing sleep problems and hyperarousal in PTSD patients, with effectiveness considered as a secondary outcome. If feasible and effective, the use of a breath robot could be a nonintrusive and flexible intervention to supplement psychotherapy or to bridge treatment gaps. TRIAL REGISTRATION: DRKS, DRKS00031063. Registered on 10/012023.

War-related stressors and ICD-11 (complex) post-traumatic stress disorders in Ukrainian students living in Kyiv during the Russian-Ukrainian war.

We estimated the prevalence of war-related stressors (Harvard Trauma Questionnaire-R), risk of ICD-11 posttraumatic stress disorder (PTSD), and complex posttraumatic stress disorder (CPTSD; International Trauma Questionnaire-R) in N = 563 Ukrainian students living in Kyiv, an active war zone between December 2022 and January 2023. Among trauma survivors (n = 381), we used multinomial logistic regression to examine whether different war-related traumatic events and cumulative trauma increased risk for ICD-11-PTSD and CPTSD after controlling for other traumatic events, age, and gender. Nine of ten Ukrainian students (91.5%) reported at least one war-related stressor, one of five (20.8%) reported four or more stressors. War-related combat situations were reported most frequently (59.5%), followed by forced separation from family members (54.5%), lack of shelter (53.3%), and murder or violent death of a family member or friend (15.6%). Rates for probable ICD-11 PTSD and CPTSD were 12.4% and 11.2%, respectively. Sexual violence and cumulative trauma exposure significantly increased the risk of CPTSD compared to other traumatic events. The high proportions of ICD-11-PTSD and CPTSD underscore the psychological burden of Ukrainian students living in an active war zone and the need for trauma-focused interventions for war-affected populations.

Trajectories of Adjustment Disorder and Well-Being in Austria and Croatia during 20 Months of the COVID-19 Pandemic.

The present study aimed to investigate the trajectories of adjustment disorder (AD) symptoms and well-being over 20 months of the COVID-19 pandemic in Austria and Croatia. Further objectives of this study were to examine whether sociodemographic characteristics and the symptoms of anxiety and depression could predict these trajectories. As part of the pan-European ESTSS ADJUST study, N = 1144 individuals were recruited using convenience sampling and assessed four times between June 2020 and January 2022 through an online survey. Latent growth curve modelling was applied to estimate the trajectories of AD symptoms and well-being. Over time, the prevalence of probable AD varied between 9.8% and 15.1%. The symptoms of AD tended to increase, whereas well-being tended to decrease. According to the majority of the models tested, women, participants from Austria and those with lower income had higher initial AD symptoms, whereas older participants and those from Croatia had higher initial well-being. In all models and at all timepoints, anxiety and depression significantly predicted AD and well-being scores. Overall, our study points to several predictors of AD and well-being and indicates high variability in people's reactions to the pandemic. Psychosocial support for the general population is needed during pandemics and similar crises, with a special focus on vulnerable groups.

Psychological treatment of PTSD with comorbid substance use disorder (SUD): expert recommendations of the European Society for Traumatic Stress Studies (ESTSS).

Background: Post-traumatic stress disorder (PTSD) and substance use disorder (SUD) are often comorbid and difficult to treat. The availability of evidence-based treatment guidelines is very limited and there is significant uncertainty about what best practice looks like.Objective: This paper describes the methodology used to develop expert recommendations for the assessment and psychological treatment of PTSD and comorbid SUD and presents the final recommendations.Methodology: A small committee of experts in the field of PTSD and SUD was formed on behalf of the European Society for Traumatic Stress Studies (ESTSS) Board. The committee developed recommendations based on a two-stage process. In the first stage a systematic review of randomised controlled trials of psychological interventions aimed at treating PTSD-SUD comorbidity was completed, and other recent relevant reviews systematic were also considered. To complement the recommendations based on systematic review, the second stage involved the review and collation of existing guidance, good practice and consensus recommendations made in methodologically rigorous clinical practice guidelines.Results: The two-stage process resulted in 9 recommendations related to assessment and 21 recommendations related to treatment planning and delivery.Conclusions: To our knowledge, this is the first attempt to provide expert recommendations based on a systematic review of the literature and through collation of guidance provided in other authoritative and reliable sources. These expert recommendations will provide helpful guidance to clinicians and service providers in both addiction and mental health settings about appropriate clinical care for those with PTSD SUD comorbidity.

This project aimed to develop expert recommendations for the assessment and psychological treatment of PTSD and comorbid substance use disorder.Trauma-focused psychological intervention combined with treatment for SUD is the most effective treatment for PTSD symptoms and for alcohol use disorder treatment benefits appear to be strongest when combined with alcohol targeted pharmacotherapy.The presence of co-occurring SUD should not prevent or exclude individuals from receiving established evidence-based treatments for PTSD and readiness to engage in evidence-based treatment should be evaluated on an individual basis.

[Domestic violence and its psychological consequences during the COVID-19 pandemic-key findings from German-speaking countries]. / Häusliche Gewalt und ihre psychischen Folgen während der COVID-19-Pandemie ­ Zentrale Befunde aus dem deutschsprachigen Raum.

The impact of traumatic experiences on mental health during the COVID-19 pandemic has been insufficiently discussed in the German-speaking countries. Against this background, a working group of scientifically and clinically active colleagues was formed on behalf of the German-Speaking Society for Psychotraumatology (DeGPT). The aim of the working group was to summarize central research findings on the incidence of domestic violence and associated psychological distress during the COVID-19 pandemic in German-speaking countries and to discuss their implications. In addition, associations between pre-existing childhood trauma and psychological distress during the pandemic should be illuminated. The present narrative review was prepared for this purpose.The results of the studies conducted indicate high prevalences of domestic violence during the COVID-19 pandemic, which, however, predominantly correspond to pre-pandemic prevalences. Adults with current or pre-existing interpersonal traumatic experiences during childhood or adolescence reported increased psychological distress during the pandemic compared with adults without such experiences. A number of risk factors (e.g., female gender, lower frequency of social contacts) increased the risk of psychological distress and posttraumatic stress disorder symptoms during the pandemic. According to these findings, people with current or past interpersonal trauma exposure represent a vulnerable group with special support needs during pandemic contexts.

Networks of pandemic-specific stressors, risk factors, and clinical symptoms: A comparison between women and men during the early phase of the COVID-19 pandemic.

BACKGROUND: During the COVID-19 pandemic, female gender was a robust factor associated with mental health problems. This study aimed to investigate associations between pandemic-related risk factors, stressors, and clinical symptoms, with special reference to gender and possible differential gender effects. METHODS: Participants were recruited from June to September 2020 through an online survey (ESTSS ADJUST study). Women (N = 796) and men (N = 796) were matched on age, education, income, and living community. Symptoms of depression (PHQ-9), anxiety (PHQ-4), adjustment disorder (ADNM-8), and PTSD (PC-PTSD-5) and different risk factors including pandemic-specific stressors (PaSS) were assessed. Separate network analyses for men and women were conducted and compared followed by a joint network analysis including gender. RESULTS: The networks of women and men did not differ in their structure (M = 0.14, p = .174) or strength of associations (S = 1.22, p = .126). Few relationships differed significantly between genders e.g., the connection between burden through work-related problems and anxiety was stronger in women. In the joint network, single factors were related to gender e.g., men felt more burdened through work-related problems and women through conflicts at home. LIMITATIONS: We cannot imply causal relationships due to the cross-sectional data of our study. The findings cannot be generalized as the sample is not representative. CONCLUSION: Men and women seem to show comparable networks of risk factors, stressors, and clinical symptoms, although differences in individual connections and in levels of clinical symptoms and burdens were found.

Psychometric properties of the Patient Health Questionnaire-4 (PHQ-4) in 9230 adults across seven European countries: Findings from the ESTSS ADJUST study.

BACKGROUND: The four-item Patient Health Questionnaire-4 (PHQ-4) is a widely used screening measure for depression and anxiety. OBJECTIVES: This study aimed to test factor structure and measurement invariance in an adult sample of the general population across seven European countries. METHOD: A total sample of 9230 adults, 71.3 % female, Mage = 44.35 (SD = 14.11) from seven countries (Austria, Croatia, Georgia, Germany, Lithuania, Portugal, and Sweden) participated in the study. We applied confirmatory factor analysis (CFA) to examine the factor structure and measurement invariance testing to evaluate measurement equivalence across countries, gender, and age groups. RESULTS: The CFA yielded that a two-factor PHQ-4 model with separate depression and anxiety factors had the best fit. Partial scalar measurement invariance was established across different groups based on gender, age, and country. CONCLUSIONS: The PHQ-4 is a valid and reliable measure that can be applied to screen for depression and anxiety in the general population. LIMITATIONS: The limitation of the study includes the sampling, which resulted in the sample structure with the majority of females, predominantly of high education and from urban communities.

Promoting Recovery from Disasters, Pandemics, and Trauma: A Systematic Review of Brief Psychological Interventions to Reduce Distress in Adults, Children, and Adolescents.

A substantial number of survivors of disasters, pandemics, and other severe stressors develop persistent distress that impairs mental health and well-being. However, only a few brief psychological interventions target distress or subclinical symptoms. This systematic review aimed to identify and describe brief psychological interventions to reduce distress or subclinical symptoms in survivors of disasters, pandemics, and other severe stressors. Based on a systematic literature search (MEDLINE, PsycINFO, PSYNDEX, PTSDpubs, and Web of Science), we reviewed published studies and study protocols on self-help, psychosocial support, or brief psychotherapeutic interventions to reduce distress and/or subclinical symptoms following natural hazards and man-made disasters, pandemics, or other traumatic events. We included 27 published studies or study protocols (n = 15 RCTs, n = 3 controlled pre-post studies, and n = 9 uncontrolled pre-post studies) describing 22 interventions. We found evidence for reducing psychological distress and/or subclinical symptoms in 9 out of 15 RCTs, 2 out of 3 controlled pre-post studies, and 9 out of 9 uncontrolled pre-post studies. One RCT provided evidence of increasing well-being. Innovative brief interventions have been developed to reduce distress and/or subclinical symptoms that have an emerging evidence base.

Shaped by the COVID-19 pandemic: Psychological responses from a subjective perspective-A longitudinal mixed-methods study across five European countries.

BACKGROUND: Contextual factors are essential for understanding long-term adjustment to the COVID-19 pandemic. Therefore, the present study investigated changes in mental health outcomes and subjective pandemic-related experiences over time and across countries. The main objective was to explore how psychological responses vary in relation to individual and environmental factors. METHODS: The sample consisted of N = 1070 participants from the general population of Austria, Croatia, Georgia, Greece, and Portugal. We applied a longitudinal mixed-methods approach, with baseline assessment in summer and autumn 2020 (T1) and follow-up assessment 12 months later (T2). Qualitative content analysis by Mayring was used to analyse open-ended questions about stressful events, positive and negative aspects of the pandemic, and recommendations on how to cope. Mental health outcomes were assessed with the Adjustment Disorder-New Module 8 (ADNM-8), the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5), the Patient Health Questionnaire-2 (PHQ-2), and the 5-item World Health Organization Well-Being Index (WHO-5). The analyses were performed with SPSS Statistics Version 26 and MAXQDA 2022. RESULTS: The mental health outcomes significantly differed over time and across countries, with e.g. Greek participants showing decrease in adjustment disorder symptoms (p = .007) between T1 and T2. Compared with other countries, we found better mental health outcomes in the Austrian and the Croatian sample at both timepoints (p < .05). Regarding qualitative data, some themes were equally represented at both timepoints (e.g. Restrictions and changes in daily life), while others were more prominent at T1 (e.g. Work and finances) or T2 (e.g. Vaccination issues). CONCLUSIONS: Our findings indicate that people's reactions to the pandemic are largely shaped by the shifting context of the pandemic, country-specific factors, and individual characteristics and circumstances. Resource-oriented interventions focusing on psychological flexibility might promote resilience and mental health amidst the COVID-19 pandemic and other global crises.

Profiles of risk factors for depressive and anxiety symptoms during the COVID-19 pandemic: A latent class analysis.

The COVID-19 pandemic has caused a high burden in the general population. The exposure to an accumulation of risk factors, as opposed to a single risk, may have been associated with higher levels of depressive and anxiety symptoms during the pandemic. This study aimed to (1) identify subgroups of individuals with distinct constellations of risk factors during the COVID-19 pandemic and (2) investigate differences in levels of depressive and anxiety symptoms. German participants (N = 2245) were recruited between June-September 2020 through an online survey (ADJUST study). Latent class analysis (LCA) and multiple group analyses (Wald-tests) were conducted to identify profiles of risk factors and examine differences in symptoms of depression (PHQ-9) and anxiety (GAD-2). The LCA included 14 robust risk factors of different domains, for example, sociodemographic (e.g., age), health-related (e.g., trauma), and pandemic-related (e.g., reduced income) factors. The LCA identified three risk profiles: High sociodemographic risk (11.7%), high social and moderate health-related risk (18.0%), and low general risk (70.3%). Individuals with high sociodemographic risk reported significantly higher symptom levels of depression and anxiety than the remaining groups. A better understanding of risk factor profiles could help to develop targeted prevention and intervention programs during pandemics.

Coping profiles and differences in well-being during the COVID-19 pandemic: A latent profile analysis.

During the current COVID-19 pandemic, people need to cope with multiple stressors which may affect their well-being. This study aimed (1) to identify latent coping profiles in the German general population, and (2) to investigate differences between these profiles in well-being. In total, N = 2326 German participants were recruited as part of the European Society of Traumatic Stress Studies (ESTSS) ADJUST study from June to September 2020 using an online survey. Coping strategies were assessed using the Brief-COPE and the Pandemic Coping Scale; well-being was assessed using the WHO-5 Well-Being Index. Coping profiles were identified using latent profile analysis; differences between profiles were examined using the automatic BCH method and multiple group analyses. Five coping profiles were identified that included different types and numbers of coping strategies: (1) High functional coping (17.84%), (2) Moderate functional coping (40.63%), (3) High functional and religious coping (9.07%), (4) Low functional coping (22.06%), (5) Moderate functional and dysfunctional coping (10.40%). The identified profiles significantly differed in well-being (χ2  = 503.68, p <0.001). Coping profiles indicating high functional coping were associated with greater well-being compared to coping profiles indicating low (χ2  = 82.21, p <0.001) or primarily dysfunctional (χ2  = 354.33, p <0.001) coping. These results provide insight into how people differ in their coping strategies when dealing with stressors in an early phase of the COVID-19 pandemic. The study indicates higher levels of well-being in coping profiles with more frequent use of functional strategies. To promote well-being in the general population, it might be beneficial to train functional coping strategies in appropriate interventions that are associated with increased well-being.

Effects of current treatments for trauma survivors with posttraumatic stress disorder on reducing a negative self-concept: a systematic review and meta-analysis.

Background: A negative self-concept is characterised by dysfunctional cognitions about the self and has been suggested to be a key factor involved in the development and maintenance of posttraumatic stress disorder (PTSD). In addition, the current definitions of PTSD according to DSM-5 and the new ICD-11 diagnosis of Complex PTSD (CPTSD) include aspects of negative self-concept in their diagnostic criteria. Objective: The aim of this meta-analysis was to synthesise the currently available evidence on the effects of psychological interventions for PTSD on negative self-concept. Methods: PubMed, PsychINFO, PSYNDEX, PTSDpubs and Cochrane Library were searched for randomised controlled trials (RCTs) of psychological treatments for PTSD symptoms in adults, published up to February 2021. A systematic review and meta-analysis were conducted, with risk of bias assessed by the Cochrane Risk of Bias Assessment Tool. Results: A total of 25 RCTs (N = 2585) were included in the meta-analysis. Results showed that psychological interventions significantly improve a negative self-concept with a moderate to large controlled effect size (k = 30, g = 0.67, 95% CI [0.31, 1.02], p < .001) at post-treatment. Heterogeneity between studies was large but could not be accounted for by moderators included in the current analysis, i.e. different types of interventions (e.g. with vs. without a cognitive restructuring component, trauma-focused vs. not). Conclusions: Current treatments for PTSD are effective in reducing a negative self-concept. However, more research is needed to identify moderators of this effect and identify interventions that are most effective for reducing negative self-concept.

Antecedentes: El autoconcepto negativo se caracteriza por cogniciones disfuncionales sobre uno mismo y se ha sugerido que es un factor clave involucrado en el desarrollo y mantención del trastorno de estrés postraumático (TEPT). Además, la definición actual de TEPT según el DSM-5 y el nuevo diagnóstico de TEPT complejo (TEPTC) de la CIE-11 incluyen aspectos del autoconcepto negativo en sus criterios diagnósticos.Objetivo: El objetivo de este meta-análisis fue sintetizar la evidencia actualmente disponible sobre los efectos de las intervenciones psicológicas para el TEPT sobre el autoconcepto negativo.Métodos: Se realizaron búsquedas en PubMed, PsychINFO, PSYNDEX, PTSDpubs y Cochrane Library de ensayos controlados aleatorizados (ECA) de tratamientos psicológicos para los síntomas de TEPT en adultos, publicados hasta febrero de 2021. Se realizó una revisión sistemática y un meta-análisis, con riesgo de sesgo evaluado por la Herramienta Cochrane de Evaluación del Riesgo de Sesgo.Resultados: Se incluyeron un total de 25 ECA (N = 2585) en el meta-análisis. Los resultados mostraron que las intervenciones psicológicas mejoran significativamente el autoconcepto negativo con un tamaño del efecto controlado de moderado a grande (k = 30, g = 0,67, IC del 95% [0,31, 1,02], p < 0,001) después del tratamiento. La heterogeneidad entre los estudios fue grande, pero los moderadores incluidos en el análisis actual no pudieron explicarla, es decir, diferentes tipos de intervenciones (p. ej., presencia vs. ausencia de un componente de reestructuración cognitiva, centrada en el trauma vs. no centrada en el trauma).Conclusiones: Los tratamientos actuales para el TEPT son efectivos para reducir el autoconcepto negativo. Sin embargo, se necesita de más investigaciones para identificar moderadores de este efecto e identificar intervenciones que sean más efectivas para reducir el autoconcepto negativo.

A multicenter, randomized controlled trial to compare the effectiveness of STARC-SUD (Skills Training in Affect Regulation - a Culture-sensitive approach) versus treatment as usual in trauma-exposed refugees with substance use problems.

BACKGROUND: Refugees often report high levels of psychological distress due to traumatic experiences before and during flight as well as many post-migration stressors. Refugees with hazardous substance use or existing substance use disorder (SUD) are a particularly vulnerable group for whom few preventive and therapeutic measures are available. The aim of this study is to investigate the effectiveness of an integrative culturally sensitive group therapy approach (STARC-SUD) to improve affect regulation in refugees with substance-related problems. METHODS: The study aims to include N = 286 male refugees with psychological distress (GHQ-12 > 13) and hazardous substance use or SUD (AUDIT > 7 or DUDIT > 6). Therapists working supported by interpreters will deliver the STARC-SUD intervention in addiction aid facilities in six metropolitan regions of Germany. The primary endpoint is severity of psychological distress (GHQ-12). The effectiveness of STARC-SUD is compared with treatment as usual (TAU) post-intervention and 3 months later. DISCUSSION: This trial will be one of the first RCTs on a culturally sensitive transdiagnostic intervention for trauma-exposed refugees with hazardous substances or SUD. The trial might gain new insights into the efficacy of such an intervention. TRIAL REGISTRATION: OSF Registry osf.io/nhxd4 . Registered prospectively on September 22, 2020, doi: 10.17605/OSF.IO/NHXD4. DRKS DRKS00017668.

The pandemic coping scale - validity and reliability of a brief measure of coping during a pandemic.

This study assessed the validity and reliability of the Pandemic Coping Scale (PCS), a new brief measure of coping with pandemic-related stressors. Methods: The PCS was administered to N = 2316 German participants during the COVID-19 pandemic. Exploratory and confirmatory factor analysis was applied among random splits of the sample. Global goodness of fit (χ 2, RMSEA, SRMR, CFI, TLI), local goodness of fit (factor loadings, communalities, factor reliability, discriminant validity) and additional test quality criteria (internal consistency, item discrimination and difficulty) were evaluated for a four-factor model vs. a four-factor model combined with a second-order general factor. Convergent and divergent validity were examined by Pearson correlations of the PCS subscales with the Brief-COPE subscales; criterion validity was evaluated by correlations with wellbeing (WHO-5), depressive (PHQ-9) and anxiety symptoms (GAD-2). Results: Exploratory factor analysis suggested a four-factor solution ('Healthy Lifestyle', 'Joyful Activities', 'Daily Structure', 'Prevention Adherence'). Confirmatory factor analysis showed a sufficient global fit for both specified models which did not differ in their fit to the data. Local goodness of fit indices showed moderate to large factor loadings and good factor reliabilities except for the subscale 'Prevention Adherence'. Internal consistencies were good for the PCS total scale (α = .83), the 'Healthy Lifestyle' (α = .79) and the 'Daily Structure' (α = .86) subscales, acceptable for 'Joyful Activities' (α = .60), and low for 'Prevention Adherence' (α = .52). The four subscales evidenced convergent and divergent validity with the Brief-COPE subscales. The subscales 'Healthy lifestyle', 'Joyful activities' and 'Daily structure' showed criterion validity with wellbeing, depressive and anxiety symptoms. Conclusions: The PCS is a reliable and valid measure to assess pandemic-specific coping behavior in the domains of 'Healthy Lifestyle', 'Joyful Activities', and 'Daily Structure'. The PCS subscale 'Prevention Adherence' might be improved by adding items with varying item difficulties.

Two Years of COVID-19 in Austria-Exploratory Longitudinal Study of Mental Health Outcomes and Coping Behaviors in the General Population.

Since the long-term mental health impact of COVID-19 is not yet fully understood, the present study explored changes in mental health outcomes and pandemic-related coping behaviors across four pandemic stages. The main objective was to gain insights into the dynamics of mental health and coping, considering different pandemic features at different assessment waves. The final sample consisted of N = 243 adults from the Austrian general population. Data were collected at four timepoints (between June 2020 and December 2021) via LimeSurvey, an open-source online survey tool. Symptoms of posttraumatic stress disorder (PTSD), adjustment disorder (AD), anxiety, and depression were assessed using validated instruments: Primary Care PTSD Screen for DSM-5 (PC-PTSD-5), AD-New Module 8 (ADNM-8), and Patient Health Questionnaire (PHQ4). We also administered the Pandemic Coping Scale (PCS) to address pandemic-related coping behaviors. Cochran's Q test and repeated measures ANOVAs were applied to assess changes over time. The results indicated that prevalence rates of AD (χ2(2) = 16.88, p = 0.001), depression (χ2(3) = 18.69, p < 0.001), and anxiety (χ2(3) = 19.10, p < 0.001) significantly changed across four assessment waves. Changes in mean scores of the assessed mental health outcomes were also observed. For pandemic-related coping, we found differences in the subscales: healthy lifestyle: F(3, 651) = 5.11, prevention adherence: F(2.73, 592.35) = 21.88, and joyful activities: F(3, 651) = 5.03. Taken together, our study showed a higher mental health burden in wintertime than in summertime, indicating an increased need for psychosocial support in times of stricter measures, higher incidences, and higher death rates. Furthermore, the observed decrease in adaptive coping behaviors suggests that easy-to-implement coping strategies should be actively promoted in order to maintain mental health during and in the aftermath of pandemics.

You can't do anything about it, but you can make the best of it: a qualitative analysis of pandemic-related experiences in six European countries.

Background: The complex system of stressors related to the coronavirus disease 2019 (COVID-19) pandemic has affected the global population, provoking a broad range of psychological reactions. Although numerous studies have investigated the mental health impact of COVID-19, qualitative research and cross-country comparisons are still rare. Objective: This qualitative study aimed to explore self-perceived challenges and opportunities related to COVID-19 across six European countries. The overall objective was to provide a differentiated picture of individual subjective experiences in the early stages of the pandemic. Method: The present study included 7309 participants from Austria, Croatia, Georgia, Greece, Poland, and Portugal. We performed qualitative content analysis according to Mayring analyse open-ended questions regarding stressful events, positive and negative aspects of the pandemic, and recommendations to cope with the pandemic situation. MAXQDA software was used for data management and analysis. Results: Participants' accounts were moderately consistent across the countries. The most prominent themes regarding stressful and negative pandemic aspects included: Restrictions and changes in daily life, Emotional distress, and Work and finances. Answers about positive pandemic consequences were mainly centred around the themes Reflection and growth, Opportunity for meaningful/enjoyable activities, and Benefits on interpersonal level. Key themes identified from participants' recommendations to cope with the pandemic included Beneficial behavioural adjustment, Beneficial cognitive-emotional strategies, and Social support. Conclusions: Participants experienced various challenges, but also shared several positive pandemic consequences and recommendations to cope with the pandemic. These first-hand data could inform mental health practices to promote well-being during COVID-19 and similar global challenges in the participating countries and possibly beyond. HIGHLIGHTS: We examined COVID-19-related experiences in 7309 adults from six European countries.Besides challenges, participants identified many positive pandemic consequences.Participants' recommendations to cope with COVID-19 included behavioural and cognitive-emotional strategies.

A systematic review and meta-analysis of psychological interventions for comorbid post-traumatic stress disorder and substance use disorder.

Background: The psychological treatment of comorbid post-traumatic stress disorder (PTSD) and substance use disorder (SUD) is clinically challenging, and outcomes are often poor. Objective: This paper describes a systematic review and meta-analysis which sought to establish the current efficacy for a number of established psychological approaches for adults and adolescents, in comparison to interventions for SUD alone, or other active approaches, following a pre-registered protocol. Method: This review followed PRISMA and Cochrane Collaboration guidelines. Data extraction and risk of bias judgements using Cochrane criteria were undertaken by all authors. Primary outcomes were PTSD severity and substance use post-treatment. The quality of findings was assessed using GRADE. Following a comprehensive search, conducted to 13 September 2021, 27 studies were included. Results: We found a relatively high level of dropout across studies. In our main comparisons, we found no benefits for present-focused treatment approaches aimed at improving coping skills beyond those for SUD-only interventions. We found modest benefits for trauma-focused intervention plus SUD intervention post-treatment for PTSD (standardized mean difference (SMD) = -0.36, 95% confidence interval (CI) -0.64, -0.08), and at 6-13 months for PTSD (SMD = -0.48, 95% CI -0.81, -0.15) and alcohol use (SMD = -0.23, 95% CI -0.44, -0.02). There were no benefits for cognitive restructuring interventions as a group, but we found a modest effect for integrated cognitive behavioural therapy (ICBT) for PTSD post-treatment (SMD = -0.33, 95% CI -0.62, -0.04). There was evidence of some benefit for trauma-focused intervention over present-focused intervention for PTSD from a single study and for reduction in dropout for incentivized attendance for trauma-focused intervention from another single study. Most findings were of very low quality. Conclusion: There is evidence that trauma-focused therapy and ICBT can improve PTSD for some individuals, but many patients do not fully engage with treatment and average treatment effects are modest. HIGHLIGHTS: For PTSD, evidence was strongest for trauma-focused CBT-based approaches, but effects were modest.There was little evidence of any added benefit on substance use, beyond that of standard addiction treatments, for any included intervention.Dropout from treatment was high.

Antecedentes: El tratamiento psicológico del trastorno de estrés postraumático (TEPT) comórbido con trastorno por uso de sustancias (TUS) es un desafío clínico y los resultados suelen ser deficientes. Objetivo: Este artículo describe una revisión sistemática y meta-análisis, los cuales buscaron establecer la eficacia actual para un determinado número de enfoques psicológicos para adultos y adolescentes, en comparación con intervenciones sólo para TUS, y otros enfoques activos, siguiendo un protocolo previamente registrado. Método: Esta revisión siguió las guías PRISMA y de Colaboración de Cochrane. Todos los autores realizaron extracción de datos y evaluación de riesgo de sesgos usando los criterios de Cochrane. Los resultados primarios fueron severidad de TEPT y uso de sustancias post-tratamiento. La calidad de los hallazgos fue evaluada utilizando GRADE. Luego de una búsqueda exhaustiva, realizada el 13 de septiembre del 2021, se incluyeron 27 estudios. Resultados: Encontramos un nivel de abandono relativamente alto en los estudios. En nuestras principales comparaciones no encontramos mayores beneficios en los actuales abordajes de tratamiento focalizados en mejorar las habilidades de afrontamiento en comparación con las intervenciones exclusivas para TUS. Encontramos beneficios modestos para intervenciones centradas en trauma sumada a intervención para TUS post-tratamiento de TEPT (DMP = −0.36 CI-0.64, −0.08), y a los 6­13 meses para TEPT (DMP = −0.48 CI-0.81, −0.15) y uso de alcohol (DMP = −0.23 CI −0.44, −0.02). No hubo beneficios para las intervenciones para reestructuración cognitiva como grupo, pero encontramos un efecto modesto post-tratamiento para la terapia cognitivo conductual integrada (TCCI) para el TEPT (DMP = −0.33 CI −0.62, −0.04). Hubo evidencia de algún beneficio para intervenciones enfocadas en trauma sobre las intervenciones centradas en el presente para TEPT de un solo estudio y para la reducción del abandono para la participación incentivada para la intervención centrada en el trauma de otro estudio aislado. La mayoría de los hallazgos fueron de muy baja calidad. Conclusión: Concluimos que existe evidencia de que la terapia centrada en el trauma y la TCCI pueden mejorar el TEPT para algunos individuos, pero muchos pacientes no se comprometen totalmente con el tratamiento y los efectos de tratamiento promedio son modestos.