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      Psychological Inflexibility and Intolerance of Uncertainty Moderate the Relationship Between Social Isolation and Mental Health Outcomes During COVID-19

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          Abstract

          The COVID-19 pandemic has had an enormous impact on human activity worldwide, in part due to many governments issuing stay-at-home orders and limiting the types of social interactions in which citizens can engage. Previous research has shown that social isolation can contribute to psychological distress. The impact of increased social isolation on mental health functioning during the COVID-19 crisis, as well as potential mechanisms to buffer this impact, have yet to be investigated. The current study explored the moderating role of psychological flexibility and related constructs on the relationships between social isolation and mental health outcomes during the COVID-19 pandemic. Cross-sectional data from 278 participants, the majority residing in the United States, were collected during a 3-week period from mid-April to early May, 2020 via online survey. A series of hierarchical linear regression analyses indicated statistically significant relationships between social isolation and psychological distress (depression, anxiety, and stress), well-being, and valued living. Psychological inflexibility, intolerance of uncertainty, and emotional suppression significantly moderated these relationships in a number of instances. Greater psychological flexibility and acceptance of difficult experiences appeared to act as a buffer against the negative effects of increased social isolation, while amplifying the benefits of social connectedness. Implications for promoting mental health and buffering against the harmful effects of social isolation during the COVID-19 pandemic and beyond are discussed.

          Highlights

          • •

            Social isolation predicts negative psychological distress during COVID-19.

          • •

            Psychological flexibility buffers negative impacts of isolation on distress.

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            Tolerance of uncertainty buffers negative impacts of social isolation on distress.

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            Psychological flexibility enhances beneficial effects of connectedness.

          • •

            Psychological flexibility is a promising treatment target during COVID-19.

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          Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China

          Cuiyan Wang, Riyu Pan, Xiaoyang Wan … (2020)
          Background: The 2019 coronavirus disease (COVID-19) epidemic is a public health emergency of international concern and poses a challenge to psychological resilience. Research data are needed to develop evidence-driven strategies to reduce adverse psychological impacts and psychiatric symptoms during the epidemic. The aim of this study was to survey the general public in China to better understand their levels of psychological impact, anxiety, depression, and stress during the initial stage of the COVID-19 outbreak. The data will be used for future reference. Methods: From 31 January to 2 February 2020, we conducted an online survey using snowball sampling techniques. The online survey collected information on demographic data, physical symptoms in the past 14 days, contact history with COVID-19, knowledge and concerns about COVID-19, precautionary measures against COVID-19, and additional information required with respect to COVID-19. Psychological impact was assessed by the Impact of Event Scale-Revised (IES-R), and mental health status was assessed by the Depression, Anxiety and Stress Scale (DASS-21). Results: This study included 1210 respondents from 194 cities in China. In total, 53.8% of respondents rated the psychological impact of the outbreak as moderate or severe; 16.5% reported moderate to severe depressive symptoms; 28.8% reported moderate to severe anxiety symptoms; and 8.1% reported moderate to severe stress levels. Most respondents spent 20–24 h per day at home (84.7%); were worried about their family members contracting COVID-19 (75.2%); and were satisfied with the amount of health information available (75.1%). Female gender, student status, specific physical symptoms (e.g., myalgia, dizziness, coryza), and poor self-rated health status were significantly associated with a greater psychological impact of the outbreak and higher levels of stress, anxiety, and depression (p < 0.05). Specific up-to-date and accurate health information (e.g., treatment, local outbreak situation) and particular precautionary measures (e.g., hand hygiene, wearing a mask) were associated with a lower psychological impact of the outbreak and lower levels of stress, anxiety, and depression (p < 0.05). Conclusions: During the initial phase of the COVID-19 outbreak in China, more than half of the respondents rated the psychological impact as moderate-to-severe, and about one-third reported moderate-to-severe anxiety. Our findings identify factors associated with a lower level of psychological impact and better mental health status that can be used to formulate psychological interventions to improve the mental health of vulnerable groups during the COVID-19 epidemic.
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            Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019

            Jianbo Lai, Simeng Ma, Ying Wang … (2020)
            Key Points Question What factors are associated with mental health outcomes among health care workers in China who are treating patients with coronavirus disease 2019 (COVID-19)? Findings In this cross-sectional study of 1257 health care workers in 34 hospitals equipped with fever clinics or wards for patients with COVID-19 in multiple regions of China, a considerable proportion of health care workers reported experiencing symptoms of depression, anxiety, insomnia, and distress, especially women, nurses, those in Wuhan, and front-line health care workers directly engaged in diagnosing, treating, or providing nursing care to patients with suspected or confirmed COVID-19. Meaning These findings suggest that, among Chinese health care workers exposed to COVID-19, women, nurses, those in Wuhan, and front-line health care workers have a high risk of developing unfavorable mental health outcomes and may need psychological support or interventions.
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              Measuring well-being rather than the absence of distress symptoms: a comparison of the SF-36 Mental Health subscale and the WHO-Five well-being scale

              Mette Kjoller, Per Bech, Lis Olsen … (2003)
              The health status questionnaire Short‐Form 36 (SF‐36) includes subscales measuring both physical health and mental health. Psychometrically, the mental health subscale contains a mixture of mental symptoms and psychological well‐being items, among other things, to prevent a ceiling effect when used in general population studies. Three of the mental health well‐being items are also included in the WHO‐Five well‐being scale. In a Danish general population study, the mental health subscale was compared psychometrically with the WHO‐Five in order to evaluate the ceiling effect. Tests for unidimensionality were used in the psychometric analyses, and the sensitivity of the scales in differentiating between changes in self‐reported health over the past year has been tested. The results of the study on 9,542 respondents showed that, although the WHO‐Five and the mental health subscale were found to be unidimensional, the WHO‐Five had a significantly lower ceiling effect than the mental health subscale. The analysis identified the three depression symptoms in the mental health subscale as responsible for the ceiling effect. The WHO‐Five was also found to be significantly superior to the mental health subscale in terms of its sensitivity in differentiating between those persons whose health had deteriorated over the past year and those whose health had not. In conclusion, the WHO‐Five, which measures psychological well‐being, reflects aspects other than just the absence of depressive symptoms. Copyright © 2003 Whurr Publishers Ltd.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Contextual Behav Sci
                Journal ID (iso-abbrev): J Contextual Behav Sci
                Title: Journal of Contextual Behavioral Science
                Publisher: Association for Contextual Behavioral Science. Published by Elsevier Inc.
                ISSN (Print): 2212-1447
                ISSN (Electronic): 2212-1455
                Publication date PMC-release: 14 September 2020
                Publication date (Electronic): 14 September 2020
                Affiliations
                [1 ]Department of Psychology, Western Michigan University, 1903 W. Michigan Ave. Mail Stop 5439 Kalamazoo, MI 49008, United States
                [2 ]Applied Behavioral Analysis Department, The Chicago School of Professional Psychology, 325 N. Wells Street Chicago, IL 60654, USA
                Author notes
                [∗ ]Corresponding author. concerning this article should be addressed to Brooke M. Smith,
                Article
                Publisher ID: S2212-1447(20)30190-3
                DOI: 10.1016/j.jcbs.2020.09.005
                PMC ID: 7489247
                PubMed ID: 32953435
                SO-VID: 3ced4983-208f-422f-b5c3-f27e2befa801
                Copyright © © 2020 Association for Contextual Behavioral Science. Published by Elsevier Inc. All rights reserved.
                License:

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                Date received : 9 June 2020
                Date revision received : 3 September 2020
                Date accepted : 9 September 2020
                Categories
                Subject: Empirical Research

                Keywords: covid-19,social isolation,psychological flexibility,intolerance of uncertainty,emotion suppression,moderation
                Data availability:
                Keywords: covid-19, social isolation, psychological flexibility, intolerance of uncertainty, emotion suppression, moderation

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