Resilience and mental health during the COVID-19 pandemic: psychological risk and protective factors

Mental resilience is the resistance to stressors. The coronavirus disease 2019 (COVID-19) pandemic was a considerable stressor in 2020 and 2021, affecting large parts of the population. In two complementary studies, we investigated possible determinants of resilient responses to the pandemic by focusing on possible psycho-social resilience factors. Study 1 cross-sectionally investigated the relationship of several proposed psycho-social resilience factors with outcome resilience in an international convenience sample (n=15,790) surveyed in March and April of 2020. Using multiple linear regressions, we identified perceived good stress recovery, positive appraisal specifically of the COVID-19 pandemic, optimism, perceived social support, general self-efficacy, perceived increase in social support during COVID-19, positive appraisal style, and behavioral coping as resilience factors, whereas neuroticism was identified as a risk factor. LASSO regularised regression determined perceived good stress recovery, positive appraisal specifically of the COVID-19 pandemic, and neuroticism as statistically most important predictors. Mediation analyses showed that the relationship between perceived social support and outcome resilience was mediated by positive appraisal style and that the relationship between positive appraisal style and outcome resilience was mediated by perceived good stress recovery. Study 2 investigated psychological factors associated with changes in psychological distress using panel data representative of the German household population (n=6,684) with two peri-pandemic survey waves spanning from April-June of 2020 and January-February of 2021. Survey-weighted linear regressions with changes in psychological distress from pre-pandemic baseline levels as the outcome identified perceived good stress recovery as the most consistent protective factor, with positive re-appraisal and optimism partly also being related to smaller increases or larger decreases in psychological distress. Catastrophising and neuroticism were the most consistent risk factors. LASSO regularized regression confirmed the relative importance of perceived good stress recovery, catastrophizing, and neuroticism. Both studies thus identified several psychological factors that are related to outcome resilience and/or changes in psychological distress during a period of increased stressor exposure. Given that the hypotheses of the reported studies were derived from evidence stemming from pre-pandemic contexts, these resilience factors seem to be global factors that are essential beyond the COVID-19 pandemic. Importantly, several of these factors are possibly malleable and therefore offer potential foci for targeted interventions aiming at increasing resilience in stressful times.Psychische Resilienz ist die Widerstandsfähigkeit gegenüber Stress. Die COVID-19-Pandemie war in den Jahren 2020 und 2021 ein erheblicher Stressor, der große Teile der Bevölkerung betraf. In zwei sich ergänzenden Studien untersuchten wir potenzielle Determinanten der Resilienz im Kontext der Pandemie, indem wir uns auf mögliche psychosoziale Resilienzfaktoren konzentrierten. Studie 1 untersuchte im März und April 2020 die Beziehung zwischen mehreren psychosozialen Faktoren und Resilienz in einer querschnittlichen internationalen Zufallsstichprobe (n=15.790). Mithilfe multipler linearer Regressionen identifizierten wir wahrgenommene Stressbewältigung, positive Bewertung der Pandemie, Optimismus, wahrgenommene soziale Unterstützung, allgemeine Selbstwirksamkeit, wahrgenommene Zunahme der sozialen Unterstützung während COVID-19, positiven Bewer-tungsstil und verhaltensbezogene Bewältigung als Resilienzfaktoren, während Neurotizismus als Risikofaktor identifiziert wurde. Mithilfe einer regularisierten Regression ermittelten wir wahrgenommene Stressbewältigung, positive Bewertung speziell der COVID-19-Pandemie und Neurotizismus als statistisch wichtigste Prädiktoren. Mediationsanalysen zeigten, dass die Beziehung zwischen wahrgenommener sozialer Unterstützung und Resilienz durch positiven Bewertungsstil mediiert wurde, dessen Zusammenhang mit Resilienz wiederum durch die wahrgenommene Stresserholung mediiert wurde. Studie 2 untersuchte psychologische Prädiktoren für Veränderungen der psychischen Belastung während der Pandemie in Bezug zum prä-pandemischen Ausgangsniveau. Hierfür nutzten wir für die deutsche Haushaltsbevölkerung repräsentative Paneldaten (n=6.684) mit zwei peri-pandemischen Erhebungswellen, die von April-Juni 2020 und Januar-Februar 2021 stattfanden. In umfragegewichteten linearen Regressionen kristallisierte sich eine wahrgenommene gute Stressbewältigung als konsistentester Schutzfaktor, wobei positive Neubewertung und Optimismus teilweise auch mit einem geringeren Anstieg oder einer stärkeren Abnahme der psychischen Belastung verbunden waren. Katastrophisieren und Neurotizismus waren die konsistentesten Risikofaktoren. Eine regularisierte Regression bestätigte die relative Bedeutung der wahrgenommenen guten Stressbewältigung, des Katastrophisierens und des Neurotizismus. In beiden Studien wurden somit mehrere psychologische Faktoren identifiziert, die mit Resilienz und/oder den Veränderungen der psychischen Belastung während einer Periode erhöhter Stressor-Exposition in Zusammenhang stehen. Angesichts der Tatsache, dass die Hypothesen der berichteten Studien aus Erkenntnissen abgeleitet wurden, die aus der Zeit vor der Pandemie stammen, scheint es sich bei diesen Resilienzfaktoren um globale Faktoren zu handeln, die über die Pandemie hinaus bedeutsam sind. Maßgeblich ist, dass mehrere dieser Faktoren möglicherweise veränderbar sind und somit potenzielle Ziele für Interventionen zur Stärkung der Resilienz in belastenden Zeiten bieten

Coping with COVID: Risk and Resilience Factors for Mental Health in a German Representative Panel Study

The COVID-19 pandemic might affect mental health. Data from population-representative panel surveys with multiple waves including pre-COVID data investigating risk and protective factors are still rare. Methods: In a stratified random sample of the German household population (n=6,684), we conducted survey-weighted multiple linear regressions to determine the association of various psychological risk and protective factors assessed between 2015 and 2020 with changes in psychological distress (PD; measured via PHQ-4) from pre-pandemic (average of 2016 and 2019) to peri-pandemic (both 2020 and 2021) time points. Control analyses on PD change between two pre-pandemic time points (2016 and 2019) were conducted. Regularized regressions were computed to inform on which factors were statistically most influential in the multicollinear setting. Results: PHQ-4 scores in 2020 (M=2.45) and 2021 (M=2.21) were elevated compared to 2019 (M=1.79). Several risk factors (catastrophizing, neuroticism, asking for instrumental support) and protective factors (perceived stress recovery, positive reappraisal, optimism) were identified for the peri-pandemic outcomes. Control analyses revealed that in pre-pandemic times, neuroticism and optimism were predominantly related to PD changes. Regularized regression mostly confirmed the results and highlighted perceived stress recovery as most consistent influential protective factor across peri-pandemic outcomes. Conclusions: We identified several psychological risk and protective factors related to PD outcomes during the COVID-19 pandemic. Comparison to pre-pandemic data stress the relevance of longitudinal assessments to potentially reconcile contradictory findings. Implications and suggestions for targeted prevention and intervention programs during highly stressful times such as pandemics are discussedThis project has received funding from the European Union’s Horizon 2020 research and innovation program under Grant Agreement numbers 777084 (DynaMORE) and 101016127 (RESPOND). ‘SOEP-CoV: The Spread of the Coronavirus in Germany: Socio-Economic Factors and Consequences’ was funded by the German Federal Ministry of Education and Research (BMBF). AR was supported by Studienstiftung des deutschen Volkes. HK was supported by the Deutsche Forschungsgemeinschaft (DFG, German Science Foundation) Grants – 415809395, 427279591, and 40965412. The data can be accessed via the research data center of the SOE

Impact of work arrangements during the COVID-19 pandemic on mental health in France

• Symptoms of anxiety/depression were found in 28.8% of the participants at least once. • Unemployment and financial difficulties were associated with anxiety/depression. • Targeted mental health support could lessen mental health impact

Psycho-social factors associated with mental resilience in the Corona lockdown.

The SARS-CoV-2 pandemic is not only a threat to physical health but is also having severe impacts on mental health. Although increases in stress-related symptomatology and other adverse psycho-social outcomes, as well as their most important risk factors have been described, hardly anything is known about potential protective factors. Resilience refers to the maintenance of mental health despite adversity. To gain mechanistic insights about the relationship between described psycho-social resilience factors and resilience specifically in the current crisis, we assessed resilience factors, exposure to Corona crisis-specific and general stressors, as well as internalizing symptoms in a cross-sectional online survey conducted in 24 languages during the most intense phase of the lockdown in Europe (22 March to 19 April) in a convenience sample of N = 15,970 adults. Resilience, as an outcome, was conceptualized as good mental health despite stressor exposure and measured as the inverse residual between actual and predicted symptom total score. Preregistered hypotheses (osf.io/r6btn) were tested with multiple regression models and mediation analyses. Results confirmed our primary hypothesis that positive appraisal style (PAS) is positively associated with resilience (p < 0.0001). The resilience factor PAS also partly mediated the positive association between perceived social support and resilience, and its association with resilience was in turn partly mediated by the ability to easily recover from stress (both p < 0.0001). In comparison with other resilience factors, good stress response recovery and positive appraisal specifically of the consequences of the Corona crisis were the strongest factors. Preregistered exploratory subgroup analyses (osf.io/thka9) showed that all tested resilience factors generalize across major socio-demographic categories. This research identifies modifiable protective factors that can be targeted by public mental health efforts in this and in future pandemics

Positive Cognitive Reappraisal in Stress Resilience, Mental Health, and Well-Being: A Comprehensive Systematic Review

Stress-related psychopathology is on the rise, and there is a pressing need for improved prevention strategies. Positive appraisal style, the tendency to appraise potentially threatening situations in a positive way, has been proposed to act as a key resilience mechanism and therefore offers a potential target for preventive approaches. In this article, we review n = 99 studies investigating associations of positive cognitive reappraisal, an important sub-facet of positive appraisal style, with outcome-based resilience and relevant other outcomes, which are considered resilience-related. According to the studies reviewed, positive cognitive reappraisal moderates the relation between stressors and negative outcomes and is positively related to several resilience-related outcomes. It also mediates between other resilience factors and resilience, suggesting it is a proximal resilience factor

Healthy women with severe early life trauma show altered neural facilitation of emotion inhibition under acute stress

BackgroundAcross psychopathologies, trauma-exposed individuals suffer from difficulties in inhibiting emotions and regulating attention. In trauma-exposed individuals without psychopathology, only subtle alterations of neural activity involved in regulating emotions have been reported. It remains unclear how these neural systems react to demanding environments, when acute (non-traumatic but ordinary) stress serves to perturbate the system. Moreover, associations with subthreshold clinical symptoms are poorly understood.MethodsThe present fMRI study investigated response inhibition of emotional faces before and after psychosocial stress situations. Specifically, it compared 25 women (mean age 31.5 ± 9.7 years) who had suffered severe early life trauma but who did not have a history of or current psychiatric disorder, with 25 age- and education-matched trauma-naïve women.ResultsUnder stress, response inhibition related to fearful faces was reduced in both groups. Compared to controls, trauma-exposed women showed decreased left inferior frontal gyrus (IFG) activation under stress when inhibiting responses to fearful faces, while activation of the right anterior insula was slightly increased. Also, groups differed in brain–behaviour correlations. Whereas stress-induced false alarm rates on fearful stimuli negatively correlated with stress-induced IFG signal in controls, in trauma-exposed participants, they positively correlated with stress-induced insula activation.ConclusionNeural facilitation of emotion inhibition during stress appears to be altered in trauma-exposed women, even without a history of or current psychopathology. Decreased activation of the IFG in concert with heightened bottom-up salience of fear related cues may increase vulnerability to stress-related diseases.publishe

Psychological Resilience Factors and Their Association With Weekly Stressor Reactivity During the COVID-19 Outbreak in Europe: Prospective Longitudinal Study

Background!#!Cross-sectional relationships between psychosocial resilience factors (RFs) and resilience, operationalized as the outcome of low mental health reactivity to stressor exposure (low 'stressor reactivity' [SR]), were reported during the first wave of the COVID-19 pandemic in 2020.!##!Objective!#!Extending these findings, we here examined prospective relationships and weekly dynamics between the same RFs and SR in a longitudinal sample during the aftermath of the first wave in several European countries.!##!Methods!#!Over 5 weeks of app-based assessments, participants reported weekly stressor exposure, mental health problems, RFs, and demographic data in 1 of 6 different languages. As (partly) preregistered, hypotheses were tested cross-sectionally at baseline (N=558), and longitudinally (n=200), using mixed effects models and mediation analyses.!##!Results!#!RFs at baseline, including positive appraisal style (PAS), optimism (OPT), general self-efficacy (GSE), perceived good stress recovery (REC), and perceived social support (PSS), were negatively associated with SR scores, not only cross-sectionally (baseline SR scores; all P&amp;lt;.001) but also prospectively (average SR scores across subsequent weeks; positive appraisal (PA), P=.008; OPT, P&amp;lt;.001; GSE, P=.01; REC, P&amp;lt;.001; and PSS, P=.002). In both associations, PAS mediated the effects of PSS on SR (cross-sectionally: 95% CI -0.064 to -0.013; prospectively: 95% CI -0.074 to -0.0008). In the analyses of weekly RF-SR dynamics, the RFs PA of stressors generally and specifically related to the COVID-19 pandemic, and GSE were negatively associated with SR in a contemporaneous fashion (PA, P&amp;lt;.001; PAC,P=.03; and GSE, P&amp;lt;.001), but not in a lagged fashion (PA, P=.36; PAC, P=.52; and GSE, P=.06).!##!Conclusions!#!We identified psychological RFs that prospectively predict resilience and cofluctuate with weekly SR within individuals. These prospective results endorse that the previously reported RF-SR associations do not exclusively reflect mood congruency or other temporal bias effects. We further confirm the important role of PA in resilience

Dynamic Modelling of Mental Resilience in Young Adults: Protocol for a Longitudinal Observational Study (DynaM-OBS)

Background!#!Stress-related mental disorders are highly prevalent and pose a substantial burden on individuals and society. Improving strategies for the prevention and treatment of mental disorders requires a better understanding of their risk and resilience factors. This multicenter study aims to contribute to this endeavor by investigating psychological resilience in healthy but susceptible young adults over 9 months. Resilience is conceptualized in this study as the maintenance of mental health or quick recovery from mental health perturbations upon exposure to stressors, assessed longitudinally via frequent monitoring of stressors and mental health.!##!Objective!#!This study aims to investigate the factors predicting mental resilience and adaptive processes and mechanisms contributing to mental resilience and to provide a methodological and evidence-based framework for later intervention studies.!##!Methods!#!In a multicenter setting, across 5 research sites, a sample with a total target size of 250 young male and female adults was assessed longitudinally over 9 months. Participants were included if they reported at least 3 past stressful life events and an elevated level of (internalizing) mental health problems but were not presently affected by any mental disorder other than mild depression. At baseline, sociodemographic, psychological, neuropsychological, structural, and functional brain imaging; salivary cortisol and α-amylase levels; and cardiovascular data were acquired. In a 6-month longitudinal phase 1, stressor exposure, mental health problems, and perceived positive appraisal were monitored biweekly in a web-based environment, while ecological momentary assessments and ecological physiological assessments took place once per month for 1 week, using mobile phones and wristbands. In a subsequent 3-month longitudinal phase 2, web-based monitoring was reduced to once a month, and psychological resilience and risk factors were assessed again at the end of the 9-month period. In addition, samples for genetic, epigenetic, and microbiome analyses were collected at baseline and at months 3 and 6. As an approximation of resilience, an individual stressor reactivity score will be calculated. Using regularized regression methods, network modeling, ordinary differential equations, landmarking methods, and neural net-based methods for imputation and dimension reduction, we will identify the predictors and mechanisms of stressor reactivity and thus be able to identify resilience factors and mechanisms that facilitate adaptation to stressors.!##!Results!#!Participant inclusion began in October 2020, and data acquisition was completed in June 2022. A total of 249 participants were assessed at baseline, 209 finished longitudinal phase 1, and 153 finished longitudinal phase 2.!##!Conclusions!#!The Dynamic Modelling of Resilience-Observational Study provides a methodological framework and data set to identify predictors and mechanisms of mental resilience, which are intended to serve as an empirical foundation for future intervention studies.!##!International registered report identifier (irrid)!#!DERR1-10.2196/39817

Coping with COVID: risk and resilience factors for mental health in a German representative panel study

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic might affect mental health. Data from population-representative panel surveys with multiple waves including pre-COVID data investigating risk and protective factors are still rare. METHODS: In a stratified random sample of the German household population (n = 6684), we conducted survey-weighted multiple linear regressions to determine the association of various psychological risk and protective factors assessed between 2015 and 2020 with changes in psychological distress [(PD; measured via Patient Health Questionnaire for Depression and Anxiety (PHQ-4)] from pre-pandemic (average of 2016 and 2019) to peri-pandemic (both 2020 and 2021) time points. Control analyses on PD change between two pre-pandemic time points (2016 and 2019) were conducted. Regularized regressions were computed to inform on which factors were statistically most influential in the multicollinear setting. RESULTS: PHQ-4 scores in 2020 (M = 2.45) and 2021 (M = 2.21) were elevated compared to 2019 (M = 1.79). Several risk factors (catastrophizing, neuroticism, and asking for instrumental support) and protective factors (perceived stress recovery, positive reappraisal, and optimism) were identified for the peri-pandemic outcomes. Control analyses revealed that in pre-pandemic times, neuroticism and optimism were predominantly related to PD changes. Regularized regression mostly confirmed the results and highlighted perceived stress recovery as most consistent influential protective factor across peri-pandemic outcomes. CONCLUSIONS: We identified several psychological risk and protective factors related to PD outcomes during the COVID-19 pandemic. A comparison of pre-pandemic data stresses the relevance of longitudinal assessments to potentially reconcile contradictory findings. Implications and suggestions for targeted prevention and intervention programs during highly stressful times such as pandemics are discussed

Coping With COVID: Risk and Resilience Factors for Mental Health in a German Representative Panel Study

Background: The COVID-19 pandemic might affect mental health. Data from population-representative panel surveys with multiple waves including pre-COVID data investigating risk and protective factors are still rare. Methods: In a stratified random sample of the German household population (n=6,684), we conducted survey-weighted multiple linear regressions to determine the association of various psychological risk and protective factors assessed between 2015 and 2020 with changes in psychological distress (PD; measured via PHQ-4) from pre-pandemic (average of 2016 and 2019) to peri-pandemic (both 2020 and 2021) time points. Control analyses on PD change between two pre-pandemic time points (2016 and 2019) were conducted. Regularized regressions were computed to inform on which factors were statistically most influential in the multicollinear setting. Results: PHQ-4 scores in 2020 (M=2.45) and 2021 (M=2.21) were elevated compared to 2019 (M=1.79). Several risk factors (catastrophizing, neuroticism, asking for instrumental support) and protective factors (perceived stress recovery, positive reappraisal, optimism) were identified for the peri-pandemic outcomes. Control analyses revealed that in pre-pandemic times, neuroticism and optimism were predominantly related to PD changes. Regularized regression mostly confirmed the results and highlighted perceived stress recovery as most consistent influential protective factor across peri-pandemic outcomes. Conclusions: We identified several psychological risk and protective factors related to PD outcomes during the COVID-19 pandemic. Comparison to pre-pandemic data stress the relevance of longitudinal assessments to potentially reconcile contradictory findings. Implications and suggestions for targeted prevention and intervention programs during highly stressful times such as pandemics are discusse