key: cord- - sle d j authors: castillo-huitrón, nathalia m.; naranjo, eduardo j.; santos-fita, dídac; estrada-lugo, erin title: the importance of human emotions for wildlife conservation date: - - journal: front psychol doi: . /fpsyg. . sha: doc_id: cord_uid: sle d j animals have always been important for human life due to the ecological, cultural, and economic functions that they represent. this has allowed building several kinds of relationships that have promoted different emotions in human societies. the objective of this review was to identify the main emotions that humans show toward wildlife species and the impact of such emotions on animal population management. we reviewed academic databases to identify previous studies on this topic worldwide. an analysis of the emotions on wildlife and factors causing them is described in this study. we identified a controversy about these emotions. large predators such as wolves, coyotes, bears, big felids, and reptiles, such as snakes and geckos, promote mainly anger, fear, and disgust. this is likely due to the perceptions, beliefs, and experiences that societies have historically built around them. however, in some social groups these animals have promoted emotions such as happiness due to their values for people. likewise, sadness is an emotion expressed for the threatening situations that animals are currently facing. furthermore, we associated the conservation status of wildlife species identified in the study with human emotions to discuss their relevance for emerging conservation strategies, particularly focused on endangered species promoting ambiguous emotions in different social groups. since our origins, wildlife has always had a very important role in human life. the very diverse and continuous human-wildlife interactions can be seen from three main perspectives: ( ) utilitarian, in which wild species provide goods for human well-being, such as food, clothing, transport, tools, raw materials, and companionship, among others; ( ) affective, where human beings feel sympathy, admiration, and respect for animals because of religious, mystical, or philosophical reasons (kellert et al., ) , which has greatly contributed to cultural development worldwide (herzog and galvin, ; alves, ) ; and ( ) conflictive, because of the real or potential damage that wild species may inflict on people and their interests (e.g., attacks on humans, livestock predation, damage on crops, and infrastructure, among others; lescureux and linnell, ) . human-wildlife conflicts have motivated animal killings for centuries, which in many cases continue nowadays (woodroffe, ) . human-wildlife relationships have relied on the uses, values, and meanings that animals represent for people through time and space in different cultures (driscoll, ; . societies have developed a cultural predisposition for emotional reactions toward wild animals (kellert and wilson, ) , causing either positive or negative effects depending on the species (york and longo, ) . fear, anger, and disgust are emotions generating attitudes and behaviors against the presence of some species (fritts et al., ; jacobs, ) . in contrast, emotions, such as happiness, which comes out when cherished species are seen in a given place, or sadness before the vulnerability of others, may generate positive attitudes for their conservation (prinz, ) . this relationship between human emotions and attitudes has an effect on the presence, absence, and recovery of wildlife populations (herzog and burghardt, ) . understanding the transcendence of the emotional factors triggered by animals on human beings would improve our knowledge on the human dimensions of wildlife conservation. in this paper, we offer an overview of the influence that emotions have had on the relationships between wildlife and people through time. a substantial amount of the literature reviewed consists of studies conducted on large carnivores in europe, such as the brown bear (ursus arctos) and the wolf (canis lupus), as well as on snakes around the world. we analyze and discuss relevant aspects that could be considered in further studies on threatened and culturally relevant animal species across latin american countries. darwin ( ) recognized that emotions are manifested by all persons throughout their lifetime, but they vary in an individual between different moments of its life span. frijda and mesquita ( ) mentioned the main points characterizing the emotions in their theoretical perspective: ( ) emotions are considered individual responses to relevant events producing feelings of pleasure or pain; ( ) they help to find solutions to concerns that cannot be treated routinely; ( ) they are always about something, they are used to accept or decline the interaction with a real or imagined object, person, or wild animal in this case; ( ) they tend to control behaviors and thoughts (e.g., angry impulses, behaviors, and thoughts); and ( ) emotions are correlated with psychological, physiological, and social components establishing, changing, or maintaining a particular relationship with a specific object in a concrete situation. there is a wide array of studies analyzing human emotions, their origins, functions, and presence in human life (ekman, ; plutchik, a; nummenmaa et al., , among many others) . six basic emotions have been proposed: happiness, surprise, disgust, anger, fear, and sadness (ekman et al., ) . izard ( ) suggested classifying emotions into two groups: "positive, " representing interest and joy (happiness and surprise), and "negative, " including anger, disgust, fear, and sadness. this classification is an artifact of traditional psychology not informed about an evolutionary approach. here, we have focused on basic emotions to explain human-wildlife relationships because secondary emotions (the combination of basic emotions) are more useful for assessing social relationships among human beings (harelli and parkinson, ) . in this review, we consider two different approaches to explain the origins of basic emotions aiming to understand human-wildlife relationships through time. the first is the evolutionary approach, which suggests that emotions have evolved to solve adaptive problems in different environments (plutchik, b) , such as social communication, reproduction processes, and mechanisms for information processing leading to behavioral responses to specific events or objects (al-shawaf et al., ) . predator presence could have been one of such events contributing to the evolution of human emotions and the development of physiological, psychological, and morphological responses for survival (Öhman and mineka, ; prokop and randler, ) . in particular, fear and disgust are adaptive emotions helping to react toward something representing a risk for human life (ekman and cordaro, ) . fear and disgust, for instance, have been the most studied emotions due to their implications for human survival since the origin of our species . fear probably was a defense mechanism against dangerous animals, particularly large predators (Öhman, ; dalgleish, ) . it is believed that potential alert signals emitted by human groups facing predators, with whom they coexisted and sometimes competed for space, water, prey, and other resources, triggered physiological reactions such as heart rate increase, profuse sweating, and pupil dilation, allowing the generation of alert responses. in that way, human beings have historically developed greater awareness toward potentially perilous animals, such as snakes and spiders Öhman and mineka, ; lobue and deloache, ) . this adaptation mediated by fear has probably been genetically fixed throughout generations, provoking the innate physiological responses mentioned above when dangerous species are or could be present (Öhman, ) . the amygdala is the brain region where fear-generating stimuli are processed into a strong reaction that in some cases may affect human vision (phelps et al., ) . on the other side, disgust can help protect the individual against infections and disease (curtis et al., ) . disgust is saved in memory to avoid future exposure to the subject, in this case with potentially threatening animals (al-shawaf et al., ) . the second approach explaining the origins of basic emotions is the cultural context, where people integrate their physical environment with individual and collective experiences, perceptions, meanings, attitudes, and animal-related traditions to construct emotional diversification (prinz, ; johansson et al., ) . in this view, it can be said that human emotions associated with wildlife have evolved over time and continue to be gradually built and rooted in our societies all over the world. under the cultural context approach, emotions can be understood on two levels: ( ) the individual level, involving meanings, beliefs, attitudes, and behaviors based on personal experiences, knowledge, and perceptions, and ( ) the social level, where emotions are determined by collective factors such as experiences, meanings, beliefs, and myths typical of a certain region or culture, which are transmitted among individuals throughout generations (ekman, ; prinz, ) . physical characteristics of wildlife species and their "personalities" created by humans have generated a variety of emotions (kellert et al., ; kruuk, ; prokop and randler, ) . emotions such as fear and anger may be induced by predators that are bigger and heavier than persons, as in the case of large carnivores (e.g., bears, wolves, and big cats) (røskaft et al., ) or by those species unattractive for most people, like worms, small carnivores, bats, and reptiles, which are often perceived as harmful (knight, ; prokop and tunnicliffe, ; prokop et al., ) . in contrast, beloved animals such as colorful birds or small herbivore mammals (e.g., rabbits) may cause happiness providing they are not noxious for people or their livelihoods (prokop and kubiatko, ) . however, these animals are sometimes perceived in different ways. for some social groups (e.g., farmers), small mammals such as rabbits as rodents may represent a threat due the damage they can inflict on crops, cattle, properties, and human health (morzillo and merting, ; breed and moore, ) . actual or potential damage can promote negative attitudes motivated by emotions of anger, disgust, and fear. animal body shape is another physical feature that has been found to be important for the expression of emotions such as fear and disgust. in the case of class reptilia, two groups could be recognized by people according with their similar morphotype (with legs and legless). reptiles with legs (lizard, turtle, and crocodile) tend to cause fear in many people; crocodiles, specially generate intense fear in many people, in part because of the number of attacks occurring worldwide (crocbite, ) . in contrast, legless reptiles (e.g., amphisbaenia and larutia) that have thin bodies, smooth textures, small eyes, and dull colorations generate disgust rádlová et al., ) . specifically, snakes have long bodies, scales with contrasting patterns, bright coloration, and silent, rolling movements that immediately calls up human attention deloache, , ; rádlová et al., ) . it is likely that both fear and disgust can be simultaneously felt by a person observing a particular species . the ample diversity of snakes around the world makes it difficult to generalize emotions across cultures toward different taxa. species coloration has been an attribute to help identify dangerous animals (prokop and fančovičová, ) , allowing emotional responses in human beings (Öhman, ) . striking color ("aposematic") combinations such as bright red and black in some snakes and spiders intensify fearful reactions (Öhman and mineka, ; lobue and deloache, ; . on the other hand, it has been reported that striking coloration allowed perceiving snakes as beautiful animals in spite they are fearsome . it is noteworthy that aposematic species are simultaneously fearsome and attractive particularly for young persons between and years of age, promoting their interest in those animals (prokop and fančovičová, ) . on the other hand, animals' coloration could be attractive for humans and motivate "positive" feelings. in this sense, lišková et al. ( ) discovered that hues of blue and green in birds of the pittidae family promote human preference. psychologists have found that green is usually associated with happiness, relaxation, and comfort because it is related to nature, while blue elicit happiness, relaxation, and peacefulness, among other feelings (kaya and epps, ) . however, human affection for birds also represents a pressure for wild populations, especially for those charismatic species used as pets, promoting illegal trade (alves et al., ) . feeding habits of species may also influence emotions: large predators are usually regarded as hazardous and fearsome, while their prey provoke sadness (prokop and kubiatko, ) . large herbivores and omnivores in some places are often seen as less fearsome than strict carnivores. this is the case of the mainly vegetarian brown bear (ursus arctos) in some regions of europe (lescureux and linnell, ) . however, in other areas and cultures, large herbivores such as elephants (loxodonta africana) cause intense emotions of anger and fear because of the damage they inflict on crops and rural villages (lamarque et al., ) . although "dangerous" animals promote the attention of people (prokop and randler, ) , it is interesting to note that human emotions may vary depending on the life stage of the animal. for example, jaguar (panthera onca) cubs and lion (panthera leo) cubs are perceived as lovely and safe animals given their physical features, causing minor concern in societies, while adult jaguars and lions are generally considered less attractive and very dangerous, promoting fear (knight, ) . this trend is also reported for amphibians, for which people show more disgust toward the adult stage than for tadpoles (prokop and fančovičová, ) . venom in animal species is one of the most remarkable features triggering fear across cultural groups. as a consequence, snakes constitute an interesting case study in which most species produce fear all over the world, although particular species are in fact perceived as beneficial due to their role as controllers of agricultural pests, producing positive feelings in local farmers (ballouard et al., ) . in this regard, ballouard et al. ( ) observed different intensities of fear toward selected snake groups (cobras, vipers, and boas) depending on the nationality and cultural background of their interviewees. animal activity patterns constitute one more physical factor influencing human emotions toward wildlife. humans are not adapted for living in the darkness; they have a poor vision to act in this kind of environment, hence they may associate nocturnal species such as felines, some snakes, rodents, and bats with danger (buss, ) . in addition, these animals historically have been linked to "evil forces" damaging human beings worldwide (prokop et al., ) . contrastingly, many diurnal species (e.g., most of the birds and ungulates) are usually related to positive values such as peacefulness and wisdom that have inspired leaders and rulers to make better decisions (cano-contreras, ). physical characteristics have been useful to classify animals depending on the emotions they produce on people. in this sense, tarantulas, snakes, sharks, and mosquitoes have been categorized as perilous, generating agonistic emotions. contrastingly, large, charismatic species that have traditionally been regarded as dangerous but intelligent at the same time motivate emotions that may result in actions for their protection, as it has occurred for lions (panthera leo), tigers (panthera tigris), leopards (panthera pardus), and polar bears (ursus maritimus) (driscoll, ; landová et al., ) . these categories have emerged after the anthropomorphization of animals, a process in which cultural groups attribute human features and "personalities" to wildlife species (kruuk, ) . for instance, the panda bear (ailuropoda melanoleuca) inspires tenderness and happiness when it is observed, but those emotions are overcome by sadness after considering its high vulnerability to extinction. in this case, positive attributes facilitate particular species to become flagships for wildlife conservation (root-bernstein et al., ) . in rural communities where people frequently interact with wildlife, knowledge about the behavior of culturally relevant species develops better than in other areas. this facilitates the anthropomorphization of certain animals calling them "shy, " "noxious, " and "monstrous, " among other adjectives, which intensifies fear and rejection toward them (lescureux and linnell, ) . furthermore, if the presence of an animal implies economic losses for residents of a community, their predominant perception will be negative and will produce anger that may end in lethal management (naughton-treves, ). contrastingly, animals inspiring greatness and qualified as "kings" of the wilderness will likely motivate local people to feel happiness and pride because of their presence in the region (lescureux and linnell, ) . these examples help identifying the relevance of animal physical features in emotions, which transform throughout history according to the natural, social, and economic context of each human generation. in some cases, emotions produce attitudes against the conservation of unpopular species (knight, ) . therefore, we propose to highlight the ecological role of dangerous or disgusting species as a potential way to mitigate negative emotions toward them. emotions induced by wildlife differ among individuals according to variables such as their sex, age, cultural and natural environment, and perceived vulnerability to each species (johansson et al., ) . it has been shown that young children (under years of age) of both sexes take more time to detect a snake and react toward it than their parents (lobue and deloache, ). that behavior was explained by deloache and lobue ( ), proposing that fear and alert signals in front of this kind of animals develop later, when individuals start to explore their environment and link adult behaviors with animal species. fear and disgust have been the most studied emotions between genders. in general, women tend to express stronger negative emotions (fear and disgust) toward invertebrates, amphibians, predatory mammals like bears, wolves, lynx (lynx lynx), and wolverine (gulo gulo) and toward snakes compared to men (Öhman and mineka, ; røskaft et al., ; ballouard et al., ; bajwa et al., ; . this difference seems to be related to the female gender role taken since the start of human evolutionary history, where men developed skills for both hunting and escaping from predators (prokop and fančovičová, ) . likewise, men gradually reduced their fear of large animals, while women kept distance from those species in part because of their household activities and their care for children in safer places (røskaft et al., ; prokop et al., ) . however, differences within genders are usually present in different cultural and geographic contexts (kellert and berry, ; bjerke et al., ; de pinho et al., ) . in some societies, women, particularly adolescents, have a greater disposition to spend more time in wildlife related activities as compared to men (e.g., volunteer programs; kidd and kidd, ) . this information could be useful to direct conservation programs in spaces as zoos where experiences with uncharismatic and endanger animals could help to promote positive emotions and attitudes. age is a significant variable determining the presence and intensity of agonistic emotions toward animals, which may be related to personal experiences. childhood is the critical life stage when fear of predators starts and when attitudes and behaviors to avoid encounters with them develop (Öhman, ) . it is likely that fear of predators intensifies with learning from parents, given that as the child gets older, his/her reactions become faster when facing species such as snakes (lobue and deloache, ) . in this regard, fear of animals may either decrease (kaltenborn et al., ) or increase (røskaft et al., ) with age. besides age, the natural and cultural environments in which an individual grows determine the knowledge, perceptions, and emotions related to animals (frynta et al., ) . for a person raised in close contact with nature, an encounter with a wild animal can induce happiness, while the same species may produce fear in an individual that has always lived far away from natural spaces (kellert, ; manfredo, ; almarcha, ) . the presence or absence of different species in human territories has a role in the generation of emotions. residents of rural areas who frequently interact with wildlife are usually less fearful of animals than city dwellers. this is because closeness with native animals promotes knowledge about their ecology and behavior, allowing for building better management strategies and reactions toward them (røskaft et al., ) . likewise, recreational activities involving contact with wildlife such as hiking, bird watching, fishing, and hunting have direct influence in emotions, facilitating the overcoming of fears and phobias by promoting learning through first-hand experiences, although in some cases, these activities decrease with age (bjerke et al., ; røskaft et al., ; prokop et al., ) . in particular, emotions produced by hunting deserve further discussion. subsistence hunting as a traditional practice in many rural areas of the world usually involves local regulations to avoid overexploitation and feelings of respect by the hunters toward their prey (e.g., santos-fita et al., ) . in contrast, sport hunting is more focused on the pleasure of the hunter for finding and killing his target species, which has been a motive social dispute in different contexts, generating anger in broad sectors of society considering this an unacceptable practice (nelson et al., ) . some of these recreational activities involve parents and their children, who get used to those practices at an early age (amiot and bastian, ) . this can be an important inter-generational strategy to avoid negative attitudes toward fearsome and disgusting animals and promote positive emotions (i.e., happiness and surprise), especially in areas where humanwildlife conflicts may arise. significant differences have been found among people with different levels of study with respect to fear of wildlife species: individuals with higher levels of education are generally less fearful of wild animals than those with lower degrees of studies (røskaft et al., ) . it is likely that individuals with higher education had more opportunities to receive information on the environment and wild animals in particular, which may have reduced their negative prejudices and perceptions about non-charismatic species, maximizing their perspectives on the ecological benefits provided by those animals. the geographic space where an event occurs triggers distinct emotions, which have varied according to the lifestyles of societies (mesquita and frijda, ) . this argument could be used to understand emotions historically induced by wildlife, considering the different worldviews of each culture. for example, snakes were regarded as deities in mesoamerican cultures, including quetzalcoatl or kukulkan (the feathered serpent), which was the most important deity for the aztecs and the maya, respectively (díaz, ) . snakes were also given high rankings among the deities of the ancient greek, egyptian, hindu, and roman civilizations, where some of these reptiles were associated with values of wisdom, justice, and power (stanley, ; al-rawi, ) . these reptiles have also starred countless stories and myths around the world (ménez, ) , but for christians, muslims, and jews, snakes have traditionally represented evil and death (gonzález, ; al-rawi, ) . nowadays, myths about the damage caused by snakes are important elements to promote and intensify fear in rural communities (fita et al., ) . the social fear could be learned, inherited, and used by societies across generations, driving particular attitudes toward wild species (Öhman, ) . in this case, the relevant ecological role of snakes as predators and pest controllers has been largely neglected. another interesting example is that of wolves, which have been protagonists of many stories and myths worldwide. these carnivores have traditionally been portrayed as fearsome and dangerous animals, producing social rejection in most areas where they are present, nonetheless, in particular cases such as that of ancient rome (whose founders were suckled by a shewolf) and that of native north american cultures, for whom wolves were spiritual symbols related to power and intelligence (fritts et al., ; prokop et al., ) . beyond mythology, other elements that have facilitated the development of cultures (e.g., art, literature, symbolism, religion) have had their foundations in the relationships between humans and wildlife, involving emotions promoting respect and admiration (fritts et al., ; alves, ; almarcha, ) . these emotions frequently lead to attitudes favorable for animal care and conservation. other events that have always happened, but which have received special attention in recent decades because of the human population growth and expansion, are the attacks of large carnivores on people and livestock, and crop damage by large herbivores (inskip and zimmermann, ). these events make jaguars, tigers, lions, leopards (panthera pardus), hyenas (crocuta crocuta), african wild dogs (lycaon pictus), and african elephants (loxodonta africana), among others, be considered problems in rural communities, giving place to misunderstandings and false beliefs about their behavior (marchini and macdonald, ; dickman et al., ) . this situation has contributed to magnification of the actual damages of those species, stimulating even more fear, disgust, and rejection toward them (lescureux and linnell, ) . in this sense, the individual background and experiences of humans contribute to their emotions and behaviors. for example, the presence of large predators may produce fear and thoughts of escape in most people, while some others may feel encouraged to confront the danger (al-shawaf et al., ) . the context of the encounter with an animal may also be relevant for the emotions manifested. for a given person, the sighting of a carnivore such as a female puma with their offspring while hiking on a forest trail may produce fear and desire to escape. in contrast, the same person may feel surprised and delighted to have the same sighting from the safety of a car (narratives collected by the first author in chiapas, mexico). furthermore, local knowledge and the emotional links between people and wildlife could be useful to identify flagship species to foster interest in nature (bowen-jones and entwistle, ) . flagship species [e.g., giraffe (giraffa camelopardalis), elephants, and lions, among others] are usually charismatic and popular and may be relevant for promoting positive emotions in a public that has been distant from wild animals. differently, more complex sets of emotions (both positive and negative) are usually present where people are in constant interaction with these animal species (bowen-jones and entwistle, ; de pinho et al., ) . zoos represent spaces where emotional confrontations take place. for instance, marseille et al. ( ) observed visitors watching imposing and charismatic polar bears. the authors found that visitors felt happy in front of the bears, but at the same time they felt sad after recognizing the small size of the enclosures and the stereotyped behavior of the captive animals. interestingly, visitors' emotions transformed into fear and even greater sadness when they were told about observing polar bears in their natural habitat, which was associated with concerns about human safety and habitat vulnerability. another element that has an effect in the affection of children for wild animals is the presence of pets (bjerke et al., ) . pets can boost appreciation emotions, such as happiness, while naturalistic, ecological, humanistic, and moralistic attitudes may also be encouraged (prokop and tunnicliffe, ) . although knowledge about animals usually differs between urban and rural communities, the lack of accurate information about the species and their contribution to ecosystem services is persistent in both environments (gomes et al., ) . it promotes the intensification of emotions such as danger and disgust, especially for species that are unattractive to people. disgust has also been identified as one of the emotions inducing human rejection. it may arise when people perceive nasty odors in animals, or when unpleasant feelings emerge while touching (or thinking about) the fur of certain mammals (johansson et al., ) or the skins of amphibians such as frogs (lobue and deloache, ) . in other cases, disgust may be brought after linking animals such as spiders and rats with dirtiness, pollution, disease spreading, and potential crop damage (kellert, ; davey, ; prokop and tunnicliffe, ) . furthermore, animals that cause disgust are often perceived as ugly . contempt of human societies for amphibians and reptiles intensifies misinformation about them and favors negative attitudes toward them (manzano- garcía and martínez, ) . for example, it has been documented that non-venomous snakes are killed just because of their resemblance to poisonous species (breed and moore, ) . moreover, misinformation is an intensifier of disgust, for instance, when considering geckos (hemidactylus turcicus) as venomous animals or vectors of skin diseases (ceríaco et al., ) , or bats as a threat for fruit crops and responsible to infect people with parasites and viruses (musila et al., ) . in this sense, the case of bats and pangolins (pholidota) could be cited, which are considered the main transmitting agents of the novel coronavirus (covid- ; van staden, ). the respiratory illness has become a pandemic infecting million and killing many thousands of people around the world (nature, ). it is likely that the disease has a zoonotic origin as a result to the food and medicinal uses of animals (van staden, ). therefore, in some places there has been motivation to eliminate these animals (zhao, ) . this event might increase the negative perception and emotions of anger, disgust, and fear for this kind of animals and will encourage the eradication of populations without considering their importance in ecosystems. in this regard, it has been found that women and residents living near caves tend to believe in myths about bats more than men and people living far from caves (musila et al., ) . fearsome and disgusting species frequently induce rejection attitudes in social groups (Öhman and mineka, ), a phenomenon known as "biophobia" that is used to express the feeling of panic, fear, and disgust in front of a particular non-human living being. phobia for animals (agrizoophobia) is one of the most frequently reported biophobias in the general population (antony and mccabe, ) , but there are actually around twenty-five documented phobias to particular animal groups, such as that for snakes (ophidiophobia), spiders (arachnophobia), insects (entomophobia or insectophobia), ants (myrmecophobia), bees (apiphobia or melissophobia), and birds (ornithophobia), among others (fredrikson et al., ; antony and mccabe, ; prokop and fančovičová, ) . however, there are no specific phobias for carnivores, probably because the coevolution between humans and these animals has been too short in comparison with other groups such as snakes (prokop and randler, ) . biophobia may promote persecution and extermination attitudes (zhang et al., ) . avoiding contact with animals or killing them are the most frequent reactions without considering their long-term impacts on ecosystems (antony and mccabe, ; al-shawaf et al., ) . orr ( ) mentioned that one of the causes of biophobia is social distancing from nature. in a parallel way, biophilia has a genetic basis and consists of the interest and empathy of humans for other living beings (wilson, ) . as industrialization and urbanization increase around the world, lifestyles change in human societies, sometimes in radical ways (steffen et al., ) . these processes have contributed to the distancing of people from their natural environment even in rural communities (louv, ; lescureux and linnell, ) . however, there are still spaces such as zoos and natural parks facilitating social approach and understanding of wildlife in most of the cities and large towns all over the world. in those spaces, visitors are generally safe in front of animals that otherwise would be considered dangerous or harmful, and they may feel sadness and even culpability after recognizing the impact of the human population on those species. in this sense, vining ( ) suggested that visiting zoos and natural parks may represent opportunities for reconnecting people and wildlife to enhance social cooperation in conserving biodiversity. human emotions transcend over time. a specific emotion is saved by the individual as an experience that may be used in future behavior and decision-making (izard, ) . protection attitudes toward spiders, insects, amphibians, and reptiles are milder than those shown for other groups, such as birds and mammals due the sentiments of danger or disgust that these animal groups provoke in humans (prokop and fančovičová, ; . in addition, emotional experiences may have an effect on wildlife management techniques (larson et al., ) . this has occurred during experiences of invasive species management. one example is that of the house sparrow (passer domesticus), which competes for food and space with native birds and generates anger or disgust when managed through nest and egg removal, repellents, and traps. in contrast, bluebirds (sialia sialis) stimulate happiness in people watching them and listening to their songs, who at the same time feel sadness for these birds due to the negative impact of human activity on their populations. these feelings motivate protection attitudes favoring the persistence of the liking bird species (larson et al., ) . it is important to recognize that fear impacts human attitudes and behaviors toward keystone species, particularly those regarded as dangerous or harmful (e.g., wolves, bears, and big cats). fear may limit the involvement of local communities in managing predator populations because of the high costs implied or because the social acceptance of certain techniques, such as reintroduction, may be difficult (johansson et al., ) . examples of this include reintroducing wolves in mexico and the united states, where emotions have played fundamental roles in the acceptance of new wolf populations (straka et al., ) . mexican wolves (canis lupus baileyi) were eradicated from the mexican territory in the s because of conflicts with farmers and negative perceptions due to livestock predation (leopold, ; moctezuma et al., ) . wolf reintroduction projects have been started recently in northwestern mexico, where it has been clear that social acceptance is the primary limiting factor for their success (araiza et al., ; garcía, ; lara-díaz et al., ) . society's emotions toward wildlife may be key elements for decision-making on conservation issues. anger is one of the primary collective emotions that can lead to positive changes for natural resource management when social pressure is put on government leaders to improve and enforce environmental legislation. however, anger may have other implications and cause social fragmentation (buijs and lawrence, ) . in these cases, participation of wildlife management agencies is crucial given their social confidence. if the capacity of these agencies is not appropriate, collective distrust and fear of dangerous and disgusting animals may stimulate hostile environments for their proper management (johansson et al., ) . community confidence in environmental agencies is especially relevant where threatened species are under recovery, as is the case with wolves in different countries (swenson and andrén, ) , or where people take action by themselves, such as in the case of the killings of andean bears (tremarctos ornatus; figueroa, ) . it seems clear that some wildlife species are far more significant to humans than others (herzog and burghardt, ) , perhaps linked to their evolutionary closeness (e.g., primates, and particularly the great apes; gunnthorsdottir, ; miralles et al., ) or because of their cultural, aesthetic, or affective attributes favoring more interest and attention toward them. interest and attention favor people's attitudes for conserving these species, differently from others without a transcendental meaning for social groups. this idea highlights the relevance of designing conservation strategies fomenting interest for wildlife through generating affective links between humans and animals both in rural and urban areas. beautiful and attractive animals causing "positive" emotions (e.g., happiness and surprise) receive special attention driving in situ and ex situ conservation actions (gunnthorsdottir, ) . this could be a limitation for conservation efforts focused on species considered unattractive particularly in zoos. the preferences of human societies to watch specific animals have promoted that zoos keep attractive species more than those needing protection due to their conservation status (frynta et al., (frynta et al., , . mammals constitute the preferred group among zoo visitors around the world (moss and esson, ) . however, these spaces keep only , individuals belonging to , species (frynta et al., ) , which represent just . % of known living species (burgin et al., ) . this preference is strongly biased toward large, attractive, and active mammals belonging to the families ailuridae, felidae, phascolarctidae, ursidae, giraffidae, elephantidae, equidae, macropodidae, mephitidae, and cervidae, among others (frynta et al., ) . the same correlation between human preference and species kept in zoos was found for large, colorful, and long-tailed parrot species (frynta et al., ) . in contrast, small and unpopular species do not motivate the same appreciation, even if they are endangered. as a consequence, zoos generally keep a few of those local species (frynta et al., ) . in this sense, zoos and other places keeping wildlife need to implement exhibition strategies to promote human interest on less attractive but highly relevant animal species of threatened ecosystems (bitgood and patterson, ; frynta et al., ) . considering this distinction in preference, it is relevant to spread information about the ecological importance of animals in ecosystems, especially regarding native and endangered species (conde et al., ) , messages to promote "positive" emotions in people could be a way to support the appropriation of endangered species by societies and improve their attitudes toward them in the long term. massive media communication may be of utmost importance for these purposes, especially if the appropriate images of and messages about target species are transmitted to the general public (gunnthorsdottir, ) . following breed and moore ( ) , successful conservation projects require focusing on promoting wide social empathy for wildlife species, particularly those that generate fear and disgust (e.g., large predators, venomous species, and many amphibians) motivating their killing or removal (bishop et al., ; prokop and fančovičová, ; . individual and collective idiosyncrasies have promoted a diversity of attitudes toward wildlife species (herzog and burghardt, ) motivated in part by a diversification of emotions built with dynamic biological and cultural elements. identifying and understanding diversified emotions and their local precursors (e.g., in areas where protected areas and human presence are relevant) would allow analyzing wildlife problems and their solutions through multidisciplinary strategies. considering that knowledge is a relevant element for the expression of emotions, we propose that regional strategies to integrate information on the biology, ecology, and management of culturally important animal species (particularly those regarded as fearsome, dangerous, harmful, and disgusting) should be included in national education systems and massive media campaigns throughout the neotropics (espinosa and jacobson, ) . these strategies must be carefully designed by taking into account the impact of mass media (e.g., news, television shows, documentaries, films, and public text books, among others) may have on the public about wildlife conservation (røskaft et al., ; knight, ; ceríaco et al., ; wieczorek, ) . when an animal species is projected as aggressive, a negative emotional experience can be produced in the public. this negative experience may in turn lead the individual to believe the species is a dangerous agent or threat to human life, bringing about attitudes against its conservation (prokop and fančovičová, ) . on the contrary, if wildlife species are positively seen by children through different media outlets, where the real facts about unpopular animals are shown, it is more likely that fear and disgust decrease, while empathy may grow (prokop et al., ) . ensuring the continuity of transmitting traditional ecological knowledge about animal species will be equally important to stimulate positive emotions and a long-term interest of the new generations in wildlife conservation (jacques-coper et al., ) . another strategy that could have a positive impact on emotions toward fearsome and disgusting animals is promoting physical interactions with them (e.g., touching snails, rays, amphibians, mice; randler et al., ; ; the new knowledge about the animals and physical contact with them could reduce the anxiety of danger. recognizing that emotions are culturally influenced, we propose developing outreach strategies by retrieving traditional aspects that formerly favored empathy with animal species, including the noncharismatic or unpopular ones, even if they are threatened. this review aimed to discuss the role of emotions in the conservation of species which a have been transcendent for the human 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biophobia and conservation attitude in china covid- drives new threat to bats in china mexico's national council of science and technology (conacyt) provided a scholarship to nc-h for her doctoral studies. we thank ph.d. angela may steward for reviewing and editing the manuscript. key: cord- - imi xz authors: lodha, surabhi; gupta, rashmi title: book review: stress less, accomplish more: meditation for extraordinary performance date: - - journal: front psychol doi: . /fpsyg. . sha: doc_id: cord_uid: imi xz nan while browsing through the internet, the authors tried to find a brief meditation technique to practice during the covid- pandemic. they came across the videos of emily fletcher teaching ziva meditation online. it drove them to her book titled "stress less, accomplish more." emily fletcher is the founder of ziva meditation and the creator of zivaonline, the world's first online meditation training program. a powerful meditation practice transitioned her from being a young but anxious and insomniac broadway actress to a dedicated practitioner and a flourishing meditation professional. in this book, she introduces a new technique called "z-technique, " adapted from her live, in-person ziva meditation. this technique is specially designed for high-performing, outcome-driven individuals, teaching them to be less stressed while increasing productivity and achieving success. the first chapter points out that people often cannot meditate because of super-busy schedules, fear of failure (the meditation shame spiral), or vagueness about the practice. it educates on how and how not to approach meditation. while introducing the z-technique, the author argues that investing only min twice a day to this technique could significantly improve the remaining hours qualitatively. chapters two and three explain that meditation gives us the control to regulate our response to perceived stress. the long-term effect of stress from work, family, relationships, etc., is toxic and debilitating, manifested in decreased work performance, reduced attention span, irritability, mood swings, etc. the concept of adaptation energy is reintroduced here (gorban et al., ) as a psychological measure of one's stress-coping capacity. this reservoir could be detoxified from accumulated stress and abundantly replenished with energy by de-exciting the nervous system through meditation. the fourth chapter further argues that this internet era, which equates rest or relaxation with laziness and stagnancy, has seen a spike in sleep-related problems like insomnia and restlessness. the author asserts that both sleep and meditation are equally crucial for a healthy life. while sleep cleans our brain by cleaning out toxic by-products (xie et al., ) , meditation rests our entire body, including the brain. adding to the further benefits of mediation, in the fifth and the sixth chapters, it is suggested that meditation revamps the body by eliminating the built-up stress in the form of disturbed sleep, organ inflammation, chronic acidity, dullness, and pain. moreover, regular meditation practice improves immune functions and treats disorders like burnout and chronic fatigue, depression, anxiety, infertility, irritable bowel syndrome, migraines, parkinson's disease, pain, etc. it improves longevity and quality of life combined with ayurveda-proper diet, exercise and yoga practices, and environmental harmony. the above claims are supported by providing neurological evidence like changes in the right and left-brain, amygdala, insula, corpus callosum, and telomere. the seventh chapter posits that, unfortunately, contemporary culture is built on the "i'll be happy when syndrome, " which is an abstract idea that one's happiness is based on future achievements. this far-fetched pursuit is exhausting and bewildering. but luckily, meditation helps us pull out of the future, settles into the present, and instills the fact that bliss and contentment are within us, independent of external situations. the explanation of the harmful effects of stress and how meditation eradicates them is followed by the description of ziva or the z-technique in chapter eight. ziva is born out of nishkam karma yoga of indian spiritual traditions, which requires no focused or effortful concentration or a forcible mind clearing (diwan and kamra, ) . the z-technique is a sequenced combination of three "ms": mindfulness, meditation, and manifesting. this simple -min technique begins with mindfulness of - min (aware and completely present), similar to the "open awareness meditation" style (lutz et al., ) . it is followed by - min of meditation (healing from the past), which includes the sub-vocalization of an impersonal word like "one." the author calls this "whisper of an echo, " which lets our body and mind drift into a deeply relaxed state spontaneously. the technique ends with - min of manifesting (consciously creating and planning our future). one offers gratitude to everything, accompanied by seeing dreams as unfolding in the present, and not merely magical thinking. the ninth and tenth chapters further explain that the ztechnique enables us to detect the subtleties and patterns in our daily lives as it expands consciousness, making us more attuned to the sensations, thoughts, and feelings. hence, we become more intuitive and insightful and able to enter the "flow state." this unveiling of full potential is termed as "up-leveling, " marked by extraordinary performance and fulfillment. the subsequent chapters explore the prospect of meditation as a tool for the development of collective consciousness. if one individual consciously learns to break the old habits by finding a gap between the trigger and impulsive reactions, this transformation in consciousness permeates other beings. keeping these in mind, we must make the z-technique a nonnegotiable daily practice. the author claims that, ultimately, this helps us become good in every sphere of life. for the contemporary fast-paced and stress-ridden society, the book serves as a foundational and practical guide for people who want to improve their physical and mental well-being but don't know where to begin. it is an amalgamation of ancient meditation practices, modern neuroscience, and pop psychology sans metaphysics or spirituality. it makes meditation accessible and understandable to all, not just high-achievers. the repetitive explanation of stress and lack of empirically investigated data to validate the technique is a bit unsettling. however, the book is simple, refreshing, and rewarding. in conclusion, the book addresses how meditation could remarkably improve productivity and efficiency in an overly stressed modern world. it emphasizes that meditation is much more than the austerity of a himalayan yogi. in meditation research, the issues of universality and secularity of a technique are not thoroughly addressed. such streamlined meditation practice could be easily adapted by anyone who has struggled with commencement, commitment, and consistency. the current need is to give equal emphasis to study such techniques of "meditation for the ordinary." the philosophy of "nishkam karma evolution of adaptation mechanisms: adaptation energy, stress, and oscillating death attention regulation and monitoring in meditation sleep drives metabolite clearance from the adult brain all authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication. the authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.copyright © lodha and gupta. this is an open-access article distributed under the terms of the creative commons attribution license (cc by). the use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. no use, distribution or reproduction is permitted which does not comply with these terms. key: cord- - opy z h authors: morelli, mara; cattelino, elena; baiocco, roberto; trumello, carmen; babore, alessandra; candelori, carla; chirumbolo, antonio title: parents and children during the covid- lockdown: the influence of parenting distress and parenting self-efficacy on children’s emotional well-being date: - - journal: front psychol doi: . /fpsyg. . sha: doc_id: cord_uid: opy z h on march , , italy went into lockdown due to the coronavirus disease- (covid- ) pandemic. the world health organization highlighted how the lockdown had negative consequences on psychological well-being, especially for children. the present study aimed to investigate parental correlates of children’s emotion regulation during the covid- lockdown. within the social cognitive theory framework, a path model in which parenting self-efficacy and parental regulatory emotional self-efficacy mediated the relationship between parents’ psychological distress and both children’s emotional regulation, and children’s lability/negativity, was investigated. a total of parents of children aged from to years completed an online survey that assessed their psychological distress, regulatory emotional self-efficacy, and parenting self-efficacy. parents reported also children’s emotional regulation and lability/negativity. a structural equation model (sem) using mplus . was tested. results showed that the hypothesized model exhibited excellent fit, chi-square ( ) = . , p < . , rmsea = . , cfi = . , tli = . , srmr = . . the influences of parents’ psychological distress and parents’ regulatory emotional self-efficacy on children’s emotional regulation and lability/negativity were mediated by parenting self-efficacy. the mediation model was invariant across children’s biological sex and age, and geographical residence area (high risk vs. low risk for covid- ). results suggested how parents’ beliefs to be competent in managing parental tasks might be a protective factor for their children’s emotional well-being. implications for intervention programs are discussed. the spread of the pandemic covid- in italy from february and the subsequent health emergency led to several restrictive measures. schools and universities have been closed at the end of february, and starting from march th, , a quarantine measure became necessary leading to a general closure of almost all public businesses and work activities. children and families have been deprived of their educational, work, and sport activities, but also from all their friendship and relational contacts. suddenly parents had to manage their children at home from school h a day and, at the same time, most of them had to start smart-working from home, still carrying out their children's school commitments. many parents also had to manage difficulties and pain related to having sick or dead relatives, having had wages reductions, or in some cases, having lost their work. it is easy to understand how italian families have been exposed to a very strong emotional and psychological stress. this situation had relevant repercussions on daily life of families, especially of children that have been deprived of their socialization and play spaces. the parents suddenly became the only point of reference for their children since the other references and educational figures were no longer available. as enlightened by the world health organization (who, a,b) , this situation could have long-term negative consequences on psychological well-being and there is a need to invest in mental health services and other services. a recent review stressed how people all over the world can show many different psychological disorder symptoms related to the pandemic (shahyad and mohammadi, ) . the who ( a) highlighted that children were also showing signs of mental illness. in fact, both international and domestic studies showed that, during the lockdown, children exhibited several problems, such as anxiety and emotional and behavioral disorders (jiao et al., ; spinelli et al., ; xie et al., ) . the european pediatric association-union of national european pediatric societies and associations (epaunepsa; jiao et al., ) has stressed the importance to address children's psychological needs during the pandemic due to the negative repercussions on their psychological well-being, highlighting the relevant protective role of parents in decreasing their fear and stress. research on psychological consequences of traumatic events, such as the terroristic attack of september , , showed how children can also experience long-term effects on psychological well-being, reporting mental disorders after months (hoven et al., ) . all these data highlight the importance of not underestimating the psychological risks that children and their families could face. in a report on may th, , the united nations also underlined how, during the covid- pandemic, the emotional problems of children and adolescents were exacerbated by family stress, social isolation, interruption of school and educational activity, and uncertainty for the future which occurred in critical moments of their emotional development (united nations, ) . understanding how to strengthen parents and families in this situation, with the aim to protect children, represents an important goal that researchers should have in this period because it is possible that other future pandemics will affect humanity (cluver et al., ) . the limited research conducted to date on the effects of the covid- pandemic on well-being of parents and their children both in china and in italy showed that covid- related risks, such as (a) living in a red zone (i.e., a high-risk zone like lombardia and veneto for italy), (b) being a parent positive to sars-cov- , (c) having relatives or friends positive to the sars-cov- or who died from the sars-cov- , and (d) living in a high-risk environment (i.e., not having an open space in the home during the lockdown, losing a job during the pandemic, having a low income, not having internet connection), did not have strong negative direct effects on families' well-being (spinelli et al., ) or on children's symptoms and problematic behaviors per se (jiao et al., ) . actually, the research conducted by spinelli et al. ( ) in italy showed that it was the parenting stress related to the health emergency, the pandemic, and the lockdown that increased children's psychological, emotional, and behavioral problems. in line with these findings, wang et al. ( ) suggested the need to deeply understand the family functioning and processes that can promote children's psychological wellbeing during the pandemic. for this reason, this study focused on identifying which parental psychological variables can mediate the relationship between parents' psychological distress during the pandemic and the lockdown and their children's emotional regulation, in order to understand which possible intervention should be implemented to ameliorate families' well-being. two recent meta-analyses highlighted the relevant role that the parent-child relationship can have in promoting children's effortful self-regulation (pallini et al., ) and in decreasing children's behavioral problems, specifically attention problems (pallini et al., ) . the stress of quarantine can affect psychological well-being of adults, as confirmed in a recent review (brooks et al., ) , and might also have long-term effects (liu et al., ) . a study conducted on parents and children quarantined in during the h n influenza showed that the high-stressful isolation increased parents' psychological distress that in turn had an impact on their children's well-being (sprang and silman, ) . children who have parents with high levels of stress showed more externalizing problems and developed less emotion regulation (deater-deckard and panneton, ) . as reported by leary and hoyle ( ) , psychological distress upsets the ability to self-regulate (tillema et al., ; scott and cervone, ) but regulatory emotional self-efficacy is crucial in the self-regulation of relationships and behavior (bandura et al., ) . according to bandura ( ) , psychological distress, such as lack of social support or parental depression, can affect parenting self-efficacy, which is the belief that parents have to be able to manage their parental tasks successfully and that it is, in turn, related to children's adjustment (jones and prinz, ) . some previous studies showed that the relationship between parental mental health and children's emotional and behavioral well-being is mediated by positive parenting strategies (giallo et al., ) . according to eisenèberg et al. ( ) , parents' positivity and warmth can promote effortful control in children, reducing their externalizing behaviors. likewise, self-efficacy, specifically parenting self-efficacy, can function as a mediator between environmental variables or psychological conditions related to an external situation (e.g., the stress related to the pandemic) and parenting competence. in fact, environmental aspects might also indirectly affect parents' belief to be competent in managing parental tasks, and this could lead to less psychological well-being of the children (jones and prinz, ) . for this reason, it is important that parents have a good parenting self-efficacy in order to display positive parenting strategies that can foster adaptive functioning and emotion regulation in children (stack et al., ) . within the theoretical framework of social cognitive theory (bandura, ) , the present study aimed to investigate a path model in which parenting self-efficacy and parents' regulatory emotional self-efficacy (related to covid- lockdown) mediated the relationship between parents' psychological distress and both children's emotional regulation, and children's lability/negativity, in line with a previous study that stressed how parenting self-efficacy can mediate the relationship between parents' psychological distress and children's adjustment (giallo et al., ) . additionally, in our model parents' psychological distress was also predicted by being exposed to several risks related to covid- quarantine and the pandemic. moreover, the second aim was to assess whether children's biological sex, children's age, and geographical area (northern italy, which is the most at-risk area for the spread of the pandemic and for the risk of contagion, vs. the rest of italy) moderated the structural paths of the model. there is evidence that children's biological sex can affect parents' way to respond to children (sanders and morawska, ) and that parenting selfefficacy can change over time (deater-deckard and panneton, ) , growing during early childhood (weaver et al., ) , and decreasing when children become adolescents (glatz and buchanan, ) . conversely, we did not expect to find any differences regarding living (or not living) in a high at-risk zone for the covid- (i.e., northern italy), as found by recent italian and chinese studies (jiao et al., ; spinelli et al., ) . the present study was conducted in italy, via an online survey, during april when there was a lockdown related to the health emergency due to the covid- pandemic. specifically, italian parents with a child aged between and years were recruited through a snowball sampling procedure to complete the online survey. at the time of data collection, italy had been in quarantine for more than month. a link to the survey was shared among parents using different social networks (e.g., facebook, whatsapp), also asking parents to share the link among their contacts. overall, parents have had access to the survey, and a total of valid questionnaires were used in the present investigation, yielding a response rate of . %. parents' age ranged from to years old (m age = . , sd age = . ) and the recruited sample mostly consisted of mothers (n = ; . %). as abovementioned, children were aged between and years (m age = . , sd age = . ) and were almost equally distributed for biological sex ( % were boys and % were girls). parents' socioeconomic status (ses) was predominantly medium-high ( . %; n = ). . % (n = ) lived alone at home with children during the quarantine. % (n = ) of parents were from northern italy, the italian area most affected by the pandemic, and . % (n = ) were from central and southern italy which were areas less affected by the pandemic (although they were also put in lockdown). regarding their work situation, parents ( . %) continued to work and earn as before the quarantine, while parents ( . %) lost their works or have had wage reductions or layoffs. . % (n = ) were health workers and . % (n = ) were health workers in a hospital department that treated sars-cov- -positive patients. . % of parents (n = ) did not have any relative tested positive for the sars-cov- , and . % (n = ) had at least one relative that tested positive for the sars-cov- . . % (n = ) have not-hospitalized relatives due to sars-cov- , and . % (n = ) have at least one hospitalized relative. finally, . % of parents (n = ) did not have any acquaintance or a loved one that tested positive to sars-cov- , and . % (n = ) had at least one acquaintance or a loved one that tested positive for sars-cov- . each parent gave his/her consent by clicking "yes, i accept to participate in the study" on the first page of the survey. this study was approved by the ethics committee of sapienza university of rome, department of developmental and social psychology, protocol number: , april , . two power analyses were conducted to determine the recommended minimum sample size: ( ) for detecting a significant bivariate effect and ( ) for conducting a structural equation model (sem; cohen, ) . a moderate effect size of . was anticipated with a power level set at . and a significant alpha level set at . . the minimum sample size necessary to detect a significant bivariate effect was n = . regarding the sem, with five latent and fifteen observed variables, using the software developed by soper ( ) , results indicated that the required minimum sample size to run a sem and detect a significant effect was n = . using a similar procedure as used by spinelli et al. ( ) , we created an ad hoc index that assessed risks related to the covid- pandemic. specifically, a composite index was created given one point for each of the following risk factors, if present: (a) relatives that tested positive for sars-cov- , (b) friends or acquaintances that tested positive for sars-cov- , (c) hospitalized relatives due to sars-cov- , (d) living in northern italy, which was the most at-risk area for the spread of the pandemic and for the risk of contagion, (e) being a health worker, and (f) being a health worker in hospital departments that treated sars-cov- positive patients. again, using a similar procedure as used by spinelli et al. ( ) , we created an ad hoc index that assessed risks related to family situation during the quarantine and the pandemic. specifically, a composite index was created given one point for each of the following risk factors if present: (a) a lower ses, (b) a worsened working situation during the quarantine, and (c) being a single or divorced parent who had to manage her/his own children at home alone during the quarantine. both the family risk index and the covid risk index are intended as summative rating scales that were created ad hoc for this research. parents' psychological distress during the lockdown was evaluated using the perceived stress scale (cohen et al., ; italian validation by mondo et al., ) . parents were asked to think about the last month. the scale is composed of items that parents rated on point-likert scales from (never) to (very often). an example item is "during last month how do you usually feel nervous and stressed?" the scale showed a good reliability and validity also in the italian validation (mondo et al., ) . in the present sample, the measure showed a good reliability, cronbach's alpha of . . the regulatory emotional self-efficacy scale (caprara et al., b ) is a -item scale that evaluates the belief of parents to be able to manage with their negative emotions (i.e., anger, sadness, fear, and guilt) during the covid- lockdown on a point-likert scale from (not able) to (able). the scale was modified asking parents to think about the quarantine period related to covid- health emergency, and the following item was added to the scale "how do you feel able to manage the anxiety caused by hearing the news about coronavirus that is given on tv or that you read on the internet?" the scale showed good validity and reliability (caprara et al., a,b) . in the present sample, the scale showed a good reliability: cronbach's alpha of . . parents completed the parenting self-agency measures (dumka et al., ; baiocco et al., ) which is an -item scale that evaluates the belief of parents to be able to manage with daily parental demands (i.e., feeling to be a good parent, working to face and solve difficulties with their children) during the month of lockdown on -point likert scales from (seldom) to (always). the scale was modified, asking parents to think about the quarantine period related to covid- health emergency, and three items were added to the original scale. these three items asked parents how they feel able to reassure their children about the health emergency, to organize their children's daily life during the quarantine, and to explain to their children what is happening. the scale showed good validity and reliability (baiocco et al., . in the present sample, the scale showed a good reliability: cronbach's alpha of . . parents were asked to think about their child during the quarantine and to complete a short version of the emotion regulation checklist (molina et al., ) . this is a -item scale that evaluates two sub-dimensions, namely, emotional regulation (i.e., positive emotions, being able to give voice to his/her negative emotions) and lability/negativity (i.e., anger, disruptive behaviors, excessive exuberance) of children during the covid- lockdown on a point-likert scale from (almost never) to (almost always). the scale showed good validity and reliability (molina et al., ; di maggio et al., ) . in the present sample, both emotional regulation and lability/negativity scores showed acceptable reliability, respectively cronbach's alpha of . and . . firstly, bivariate correlations among variables were calculated along with descriptives. afterward, a mediation analysis with latent variables was performed via sem, employing a parceling strategy (e.g., bagozzi and heatherton, ; little et al., ) . a parcel represents an aggregate of different items measuring a specific construct (little et al., ; coffman and maccallum, ) . two or three parcels were constructed for each of the latent variables using the "item-to-construct" balance approach (little et al., ) , which means building each parcel by examining the item-construct relationships as represented by factor loadings in the item-level factor analyses (for a detailed description of this procedure, see little et al., ) . in such a way, parcels typically contained a balanced number of items and had comparable reliabilities. therefore, our model comprised three latent variables with three parcels each and two latent variables with two parcels each. summative indexes (such as the cri and fri) were treated as manifest variables. model fit was evaluated with the following indices: (a) the comparative fit index (cfi); (b) the tucker-lewis index (tli); (c) the root mean squared error of approximation (rmsea); (d) and the standardized root mean square residual (srmr). in general, for tli and cfi, values between . and . are considered acceptable (e.g., bollen, ; byrne, ; marsh et al., ) and values above . are deemed to be very good (hu and bentler, ) . on the other hand, rmsea and srmr values smaller than (or equal to) . indicate a good fit (e.g., bollen, ; browne and cudeck, ; hu and bentler, ; marsh et al., ) . in order to evaluate the statistical significance of indirect effects, which represented the "mediated" effects, the bootstrapping procedure was used employing samples with replacement from the full sample to construct biascorrected percent confidence intervals (ci) (preacher and hayes, ; hayes, ) . mediation typically occurs if the indirect effect is significant, that is, the zero value is not included in the ci (preacher and hayes, ; hayes, ). finally, to test possible moderation effects of children's biological sex and age, and living in a geographical area with high covid- risk, a multigroup approach within sem was employed as suggested by baron and kenny ( ) . in this procedure, the invariance of the structural parameters of the proposed model was tested separately for (a) boys and girls; (b) different levels of children's age; (c) geographical residential area, that is, living (vs. not living) in northern italy. a detailed description of the procedure will be given in the "results" section (see also sauer and dick, ; cattelino et al., ) . all analyses were run with statistical software spss and mplus . . the family risk index was positively related with parents' psychological distress and positively with lability/negativity. parents' psychological distress was negatively related with parenting self-efficacy, parents' regulatory emotion self-efficacy, and children's emotion regulation and was positively related with children's lability/negativity. parenting self-efficacy was positively related with parents' regulatory emotion self-efficacy, and children's emotion regulation, and was negatively related with children's lability/negativity. parents' regulatory emotion selfefficacy was positively related with children's emotion regulation and negatively related with children's lability/negativity. finally, children's emotion regulation was negatively related with children's lability/negativity. correlations, means, and standard deviations are reported in table . a sem was employed to test the hypothesized mediation model in which parenting self-efficacy and parents' regulatory emotional self-efficacy (related to the covid- lockdown) mediated the relationship between parents' psychological distress and both children's emotional regulation and children's lability/negativity. moreover, parenting self-efficacy mediated the relationship between parents' regulatory emotional self-efficacy and both children's emotional regulation and children's lability/negativity. in the present paper, the mediation analysis strategy recommended by james et al. ( ) was followed. in the first step, the mediation model was tested (i.e., model without the direct effects, indicated with m med ). in the second step, a full model, including all the direct effects, was tested (indicated with m full ). the two nested models were compared via the chi-square difference test, contrasting m med with m full ( χ , satorra and bentler, ) . a non-significant χ would reveal that the full model does not significantly increase the fit and therefore the mediation model is to be preferred since it is more parsimonious. the mediation model (m med ) showed an overall good fit, chisquare ( ) = . , p < . , rmsea = . , cfi = . , tli = . , srmr = . . the full model including direct effects (m full ) did not apparently improve the model fit, chisquare ( ) = . , p < . , rmsea = . , cfi = . , tli = . , srmr = . . in fact, the two models were contrasted, and the chi-square difference test was not significant, χ ( ) = . , p = . . therefore, the mediation model (m med ) should be preferred due to being more parsimonious compared to the full model. in figure , all measurement and structural parameters of the mediated model (m med ) are reported. parents' psychological distress (ppd) was significantly, although modestly, affected by both covid and family risk indexes. in turn, parents' psychological distress significantly and negatively affected both parents' regulatory emotional self-efficacy (pser) and parenting self-efficacy (pse). parents' regulatory emotional self-efficacy significantly and positively affected parenting self-efficacy. finally, parenting self-efficacy positively and significantly influenced children's emotional regulation (er_c) and negatively children's lability/negativity (ln_c). more importantly, parenting self-efficacy mediated the effect of parents' psychological distress and parents' regulatory emotional self-efficacy on both children's emotional regulation and children's lability/negativity. with the exception of those involving the covid and family risk indexes, all other indirect effects were statistically significant, supporting the mediated model (see table ). in table , a full decomposition of total and specific indirect of the mediated model (m med ) are reported. the covid and family risk indexes displayed no significant effects on the other variables except for the aforementioned influence on parents' psychological distress. moreover, referring to the full model (m full ), we also decomposed total, direct and indirect effects (see table ) with the aim to report the ratio of indirect to the direct effect and the proportion of mediated effect (mackinnon et al., ) . in regard to the relationship between ppd and er_c, the ratio of indirect to the direct effect was . (− . /− . = . ), while with respect to the relationship between ppd and ln_c the ratio was . ( . / . = . ). in regard to the relationship between ppd and er_c, about the . % of the effect was mediated (− . /− . = . ), while with respect to the relationship between ppd and ln_c about the . % of the effect was mediated ( . / . = . ). in regard to the relationship between pser and er_c, the ratio of indirect to the direct effect was − . ( . /− . = − . ), while with respect to the relationship between pser and ln_c the ratio was − . (− . / . = − . ). more problematic was to estimate, in the same fashion, the amount of mediated effect regarding the relationship between pser with both er_c and ln_c since in those cases the indirect and the direct effects have opposite signs (as can be seen in table ) , and therefore, they tend to suppress each other, resulting in a reduced non-significant total effect (pser er_c: . = − . + . ; pser ln_c: − . = − . + . ). with respect to non-significant total effect, scholars have pointed out that mediation can occur also in the absence of a detectable total effect if the indirect effect is significant (e.g., mackinnon, ; all effects are standardized coefficients. if the zero value is not included in the bootstrap % ci, the effect is significant at p < . . ppd, parents' psychological distress; pser, parents' regulatory emotional self-efficacy; pse, parenting selfefficacy; er_c, emotion regulation of children; ln_c, lability/negativity of children. hayes, ) . this is apparently the case. in this perspective, although it cannot be absolutely claimed that effects were totally mediated and despite the presence of null total effects, it is worth to note that indirect effects were significant and that mediation has occurred. overall, we can conclude that the hypothesized mediation model (m med ), reported in figure , is consistent with the data. all effects are standardized coefficients. if the zero value is not included in the bootstrap % ci, the effect is significant at p < . . ppd, parents' psychological distress; pser, parents' regulatory emotional self-efficacy; er_c, emotion regulation of children; ln_c, lability/negativity of children. moreover, the mediation did not fit significantly worse than the full model (m full ) and therefore it was retained since it is more parsimonious (james et al., ) . additionally, all indirect effects of the mediated model (m med ) were significant, indicating that mediation has occurred (e.g., preacher and hayes, ; hayes, ). within sem, the test for a moderator effect can be performed using a multigroup analysis of the model in which the structural parameters are constrained equal across groups. firstly, the structural parameters are freely estimated across groups to test for the baseline model. secondly, the structural parameters are constrained to be equal across groups to test for the invariant model. in order to compare the fit of the two models, the chi-square difference test was used (satorra and bentler, ) . a non-significant chi-square indicates that the parameters cannot be ruled out to be equal, then the invariant model should be retained and no moderation occurs. instead, if the chi-square difference between the invariant and the baseline models is significant, which would mean that the invariant model fits significantly worse. therefore, parameters are not equal across the groups and there is a moderation effect. results of chi-square difference tests of multigroup analyses with sem are reported in table . regarding children's biological sex, the fit of the baseline model was chi-square ( ) = . , p < . , rmsea = . , cfi = . , tli = . , srmr = . , whereas the fit of the invariant model was chi-square ( ) = . , p < . , rmsea = . , cfi = . , tli = . , srmr = . . the chi-square difference test was not significant showing that the invariant model could not be rejected (table ). this finding suggests that biological sex of the children was not a moderator variable. in regard to children's age ( - y.o. vs. - y.o.) , the fit of the baseline model was chi-square ( ) = . , p < . , rmsea = . , cfi = . , tli = . , srmr = . ; conversely, the fit of the invariant model was chi-square ( ) = . , p < . , rmsea = . , cfi = . , tli = . , srmr = . . the chi-square difference test was not significant showing that the invariant model could not be rejected (table ) . therefore, children's age did not appear to moderate the mediational effects tested in our model. finally, turning to geographical area (northern italy vs. rest of italy), the fit of the baseline model was chi-square ( ) = . , p < . , rmsea = . , cfi = . , tli = . , srmr = . . instead, the fit of the invariant model was chisquare ( ) = . , p < . , rmsea = . , cfi = . , tli = . , srmr = . . the chi-square difference test was not significant, showing that the invariant model did not fit significantly worse and therefore could not be rejected (table ). this result suggested that living in a high at-risk area for covid- , as it was northern italy at the time of data collection, did not significantly affect the structural parameter of our hypothesized model. the health emergency related to the covid- pandemic and the consequent restrictive measures of quarantine have upset our lifestyles and our daily life. in particular, families with children had to face an unprecedented and completely new situation in which parents suddenly remained the only reference point for their children. results of the present study, indeed, showed that the covid risk index and the family risk index partially contributed to the psychological distress of parents, although their impact was modest in terms of accounted variance. specifically, parents with higher levels of psychological distress tendentially had a lower ses, had seen their working situation worsened during the quarantine, and were single or divorced parents who had to manage their children at home alone during the quarantine. furthermore, regarding the covid- risk index, parents with more psychological distress more likely had relatives, friends, or acquaintances tested positive for the sars-cov- , had hospitalized relatives because of the sars-cov- , lived in northern italy which was the most at-risk area for the spread of the pandemic and for the risk of contagion, were health workers, and worked in hospital departments that treated sars-cov- -positive patients. however, our sem showed that parents' psychological distress impacted on the emotional regulation and lability/negativity of their children passing through the mediators' effect of parenting self-efficacy and parents' regulatory emotion self-efficacy. these findings suggested that what could have a positive effect on children's well-being and positive emotional regulation was not just being exposed to low level of parents' psychological stress, but it was the fact that parents felt able to manage and carry out their parental role and the related tasks. our results suggest that self-confident parents can successfully activate many personal resources that in turn seem to prevent their children's emotional dysregulation, even in emergency situations such as the pandemic that increased their levels of psychological distress. furthermore, three multigroup analyses were performed to test the possible moderation effects of children's biological sex and age and of geographical area (i.e., living or not living in northern italy, which is the most at-risk area for the spread of the pandemic and for the risk of contagion). the multigroup analyses showed that the hypothesized model was robust and invariant across children's biological sex, and age, and living (or not living) in northern italy. thus, in line with spinelli et al. ( ) , parents' and children's psychological distress was not affected by living in the high at-risk zone for covid- (vs. not living in the high at-risk zone). we can speculate that, regardless of living in a more risky area, relationships among variables remained stable because this unprecedented situation characterized by the isolation and quarantine measures was perceived in the same way throughout italy. alternatively, it is also possible that our study did not have enough power to detect differences in parameters between groups. parents should be supported to improve their strengths and to feel able to manage their parental role and their emotions. during the quarantine, parents were the unique reference point for their children aged between and years who rely much on their parents in this life stage. it is important that parents know that they can protect their children, preventing their emotional dysregulation, using their strengths and self-confidence, even if they are experiencing fear and severe stress for the health emergency. moreover, even if parents are exposed to high levels of stress, they can still promote a positive emotional functioning in their children if they feel able to reassure their children about the health emergency, to organize their children's daily life during the quarantine, and to explain them what is happening. despite these important findings, this study had some limitations. we collected a convenience sample that was not representative of the italian population. moreover, emotion regulation and lability/negativity of children were reported by parents and this could be less informative. however, many other scholars have used this type of data collection which is very common in this kind of studies (e.g., trumello et al., ; spinelli et al., ) . moreover, our data are correlational and it is also conceivable that parental distress and self-efficacy could be affected by children's lack of emotion regulation and lability/negativity. furthermore, we assessed the parent's own judgment of their children's well-being and it is possible that parents who experience (according to themselves) a lot of distress also tend to judge their children's well-being more negatively irrespective of the children's actual well-being. finally, it is not possible to infer causal relationships among variables because of the correlational nature of data. future longitudinal study can be conducted in order to deeply test the possible long-term effects of parents' psychological distress related to the health emergency on their children's psychological well-being and the possible reverse causation effect. however, despite these limitations, the present study presents many implications for prevention and intervention programs. in order to prevent children's distress, intervention programs should start from family and parents. this programs should be aimed at increasing parents' regulatory emotional self-efficacy and parenting self-efficacy, by activating their adaptive strategies and resources to deal with daily tasks and reinforcing their strengths. these parents' skills could be taught and learned, representing an important resource even in emergency situations such as a pandemic, in which parents remain the only points of reference and education for their children. these prevention programs should be primarily addressed at (but not limited to) parents who are health workers, who lived alone with children during the quarantine, who have sick relatives, and who have a low ses and a worsened work situation, in order to prevent the impact of their psychological distress on their children, reinforcing their belief to be able to face this difficult situation and to manage both their parents tasks and their unavoidable negative emotions. these findings suggest how clinicians should give psychological support to parents remotely during a lockdown, reinforcing their personal strengths and working on effective parenting and regulatory efficacy strategies. indeed, parents with beliefs of self-efficacy in parenting behaviors and emotional regulation have children more emotionally regulated and psychologically healthy. likewise, the present results can be used to implement psychological and educational intervention for parents in order to prevent their children's psychological distress. these results can also give pediatricians and psychologists important indications on how to specifically support families during the quarantine due to a global pandemic, providing advice to parents who in this period turn to pediatricians or psychologists to understand what to do to improve the well-being of their children. telling parents that, even if they experience negative emotions, they can do a lot to help their children could empower parents, activating their skills and strategies. intervention programs should be aimed to explain parents how to communicate to their children what is happening in the world around them. using the correct words is more probable when parents have high levels of parental self-efficacy and emotional regulation self-efficacy (jones and prinz, ) , and this could be very useful for parents' and children's well-being. talking about the fear and the negative emotions related to the pandemic and the isolation would represent an important protective factor for families' well-being. if parents understand which is the right way to communicate about the pandemic with their children, they can probably feel more self-confident in managing their parental tasks and their children's emotion, and this aspect can have in turn positive effects on their children's positive adjustment. a general approach to representing multifaceted personality constructs: application to state self-esteem same-sex and different-sex parent families in italy: is parents' sexual orientation associated with child health outcomes and parental dimensions? same-sex and different-sex parent 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internet addiction policy brief: covid- and the need for action on mental health mitigate the effects of home confinement on children during the covid- outbreak parenting self-efficacy and problem behavior in children at high risk for early conduct problems: the mediating role of maternal depression mental health and psychosocial considerations during the covid- outbreak substantial investment needed to avert mental health crisis mental health status among children in home confinement during the coronavirus disease outbreak in hubei province the raw data supporting the conclusions of this article will be made available by the authors, without undue reservation. the studies involving human participants were reviewed and approved by the ethics committee of the department of developmental and social psychology, sapienza university of rome. written informed consent was not provided because data were collected via an online survey and participants were recruited via a snowball sampling. thus, participants gave their informed consent by clicking "yes, i accept to participate to this study" on the first page of the online survey. mm, ac, ec, and rb conceptualized the study and organized the data collection. mm, ac, ec, rb, ct, ab, and cc collected the data. ac and mm run the analyses and wrote the methodological and results section. mm wrote the first draft of the manuscript. ec, ct, ab, and cc contributed to revision of the final version of the manuscript. all authors contributed to the article and approved the submitted version. key: cord- -inv hsbr authors: wijngaards, indy; sisouw de zilwa, sophie c. m.; burger, martijn j. title: extraversion moderates the relationship between the stringency of covid- protective measures and depressive symptoms date: - - journal: front psychol doi: . /fpsyg. . sha: doc_id: cord_uid: inv hsbr from the start of the covid- pandemic, psychologists are theorizing that, as compared to introverts, extraverts experience more profound negative social consequences from protective measures (e.g., travel restrictions and bans on public gatherings). as the empirical evidence for this claim is lacking, this study tested the hypothesis that extraversion moderates the relationship between the stringency of covid- protective measures and depressive symptoms. our results were based on survey data from , respondents collected in the early stages of the covid- pandemic (march –april , ) across countries and publicly available data on measure stringency. findings demonstrate that extraversion moderates the relationship between measure stringency in the early days of the pandemic and depressive symptoms. for introverts, measure stringency has a negative effect on depressive symptoms, while for extraverts, it has a positive, but non-significant effect on depressive symptoms. this study suggests that, although stringent measures generally help people to worry less and feel safer, the lifestyle associated with such measures feels more natural to introverts than to extraverts. the covid- pandemic has a profound negative effect on the world population's physical and mental health (dong et al., ; van bavel et al., ; world health organization, ) . in varying degrees, governments all over the world imposed protective measures to contain the spread of the virus (anderson et al., ; hale et al., ) . for instance, the belarusian government dismissed the global coronavirus pandemic and imposed only a handful of measures. the swedish government installed a larger number of measures but refrained from imposing a lockdown. governments from china and italy swiftly installed a total lockdown of the entire country. recent research during the early stages of the pandemic suggests that stringent measures also function as safeguard of mental health; they cause citizens to worry less and feel safer (fetzer et al., ) . this does not mean that protective measures bring nothing but benefits. an increasing degree of stringency of covid- protective measures is typically accompanied by increased social distancing, the limiting of face-to-face contact with others by keeping space between oneself and other people outside of one's home. inherent by-products of social distancing are increased feelings of loneliness, frustration, worry and boredom-negative emotional states that, if left unattended, could lead to mental illness folk et al., ; galea et al., ) . yet, it is unlikely that the effects of social consequences of measure stringency on mental illness are universal across all people. drawing from pre-pandemic research, psychologists are proposing that extraversion-a personality trait characterized by sociability, assertiveness and high energy levels (john et al., ; soto and john, ) -is one individual characteristic that could moderate the negative relationship between measure stringency and mental illness (e.g., brogaard, ; brooks and moser, ; smillie and haslam, ; steele, ) . more specifically, they argue that there are potential advantages to being an introvert and potential disadvantages to being an extravert in countries where stringent measures are in place. the lifestyle associated with social distancing would feel more unnatural to extraverts than to introverts, as it inhibits extraverts to satisfy their strong urges to seek out social engagement (woodcock et al., ) , to experience pleasure and excitement (kämpfe and mitte, ) , and to live in new and exciting surroundings (oishi and choi, ) . introverts, in contrast, would fare better, as the lifestyle allows them to shamelessly be alone more often and decide when and where to connect with others. to date, however, the assumption that the social consequences of measure stringency are negative for extraverts and positive for introverts, remains largely untested. the first empirical tests based on data collected during the pandemic are inconclusive, with studies reporting negative (płomecka et al., ) , positive (folk et al., ) , or insignificant (elmer et al., ; weinstein and nguyen, ) associations between extraversion and mental illness. in this study, drawing on publicly available survey data from over , respondents across countries (fetzer et al., ) , we therefore empirically test the hypothesis that extraversion moderates the relationship between measure stringency and depressive symptoms. by looking at moderation effects, we aimed to further nuance fetzer et al.'s ( ) finding that measure stringency leads to reduced depressive symptoms. we also address a general calls for research on the mental health effects of covid- protective measures (holmes et al., ; van bavel et al., ) and more specific calls for investigations on the interplay between personality, the experience of social distancing and mental health (folk et al., ; oosterhoff et al., ) . in this study, we utilized fetzer et al.'s ( ) data. they used online snowball sampling to recruit respondents in the early stages of the covid- pandemic (march -april , ), a period in which the pandemic spread rapidly, and many consequential policy decisions were made. in total, , respondents from countries filled out the survey. following recommendations by fetzer et al. ( ) , we only included the countries in which more than people participated, resulting in countries and a sample of , respondents. in our sample, % was male, with an average age of . years (sd = . ) and average of . years of education (sd = . ). more details on the countries, the number of observations per day and respondents can be found in table , figure , and table , respectively. descriptive statistics on all variables and a description of all variables and can be found in tables , , respectively. the stringency of measures across country and time was measured using the covid- government response stringency index (grsi), that is up to date as of april , (hale et al., ) . the grsi is comprised of subindexes on nine categories of protective measures: workplace closings, cancelation of public events, restrictions on gathering size, closing of public transport, stay at home requirements, restrictions on internal movement, restrictions on international travel and presence of public information campaigns. all sub-indexes differed in their scaling. for example, cancelation of public events had three categories: (no measure), (recommend cancelling) and (require cancelling) and school closings had four categories: (no measures), (recommended closing), (require closing, only some levels or categories) and (require closing, require closing all levels or categories). therefore, all sub-index scores were re-coded onto a - scale. these scores were then averaged into a single aggregate score ranging from (no measures) to (total lockdown). for interpretability purposes, hale et al.'s ( ) original scale was recoded into a continuous scale from to . extraversion was measured using the two-item measure from the ten-item personality inventory [tipi; spearman's rho (ρ) = . , gosling et al., ]. the two items represent both poles of the extraversion dimension: "i see myself as extraverted, enthusiastic" and "i see myself as reserved, quiet." answer categories ranged from (disagree strongly) to (agree strongly). the measure was constructed by reverse coding the score on the "reversed, quiet" item and computing an average score of the two items. depressive symptoms were measured using the average score respondents scored on the -item personal health questionnaire (phq- ), e.g., "how often have you been bothered by the following over the past weeks?. . . little interest or pleasure in doing things" (α = . , ω = . , kroenke et al., ; for validation in the general population, see martin et al., ) . answer categories ranged from (not at all) to (nearly every day). we included several covariates that could confound the relationship between the stringency of measures, extraversion and depressive symptoms. in addition to typical demographic variables like age, gender, monthly household income, marital status and years of education, we also considered the -item tipi measures of neuroticism, openness, conscientiousness and agreeableness (ρs ranging from . to . ), trust in government, health problems, household composition, and participation in social gatherings over the past days as covariates. at the country-day level, we controlled for the number of and day-to-day change in covid- cases and the number of deaths per capita (see dong et al., ) . frontiers in psychology | www.frontiersin.org "extraverted, enthusiastic" and "reserved, quiet" (reversed item) "anxious, easily upset" and "calm, emotionally stable" (reversed item) "open to new experiences, complex" and "conventional, uncreative" (reversed item) "sympathetic, warm" and "critical, quarrelsome" (reversed item) "dependable, self-disciplined" and "disorganized, careless" (reversed item) (disagree strongly)- (agree strongly) day-to-day change in the total number of confirmed covid- cases in the country of residence on the day the respondent participated based on john hopkins covid- data. day-to-day change in the total number of confirmed covid- deaths in the country of residence on the day the respondent participated based on john hopkins covid- data. total number of confirmed covid- cases in the country of residence on the day the respondent participated based on john hopkins covid- data. number of covid- deaths total number of confirmed covid- deaths in the country of residence on the day the respondent participated based on john hopkins covid- data. age* which year were you born? gender* which gender do you identify with? (male), (female) years of education* how many years of education did you complete? *used for the creation of the fixed effects. frontiers in psychology | www.frontiersin.org to examine the moderating effect of extraversion on the relationship between measure stringency and depressive symptoms, we combine individual-level and country-level data and utilize a difference-in-difference analysis. following fetzer et al. ( ) , we use the reghdfe package in stata (correia, ) , which estimates linear regression models absorbing multiple levels (i.e., country-individual and time) of fixed effects. the advantage of a fixed model over a multilevel (random) effects model is that which takes out individual-specific heterogeneity (country-education and country-age-gender) at the country-level as well as (global) day-specific shocks. we estimate the following regressions for all individuals from countries with at least respondents who responded to the survey in the period march -april , : where depressive symptoms ijt is depressive symptoms score of individual i in country j that responded to the survey on day t, extraversion ijt is an individual's score on the extraversion index, and measure stringency jt is degree of restrictions citizens have to face in country j on day t. x ijt is a vector of individuallevel control variables including income-level, marital status, comorbidities, and other personality characteristics, while x it is a vector of country-level control variables including day-today change in covid- cases and deaths per capita and the number of covid- cases and the number of deaths per capita. in addition, we include country-education (v j ), country-agegender (v j ) and day fixed effects (v t ). accordingly, we utilize the within-variation of people with certain characteristics that live within a particular country over time. as some respondents filled out the questionnaire before strict measures were in place and others answered after countries' lockdown, we can gauge to what extent changes in stringency measures differently affect extraverts and introverts' mental health. in our estimations, standard errors are clustered by country-age and gender of the respondents. weights were included to correct for socio-demographic differences between survey respondents and the general population in each country and differences in population size between countries (also see, fetzer et al., ) . in line with our hypothesis and as exhibited in table , extraversion moderated the relationship between measure stringency and depressive symptoms (β = . , p < . ; table , model ). our conclusion holds when we control for individualcountry and country-level control variables (β = . , p < . ; table , model ). although extraversion is negatively related to depressive symptoms (β = − . , p < . ; table , model ), for introverts, measure stringency has a negative effect on depressive symptoms, whereas, for extraverts, measure stringency has a positive, but not statistically significant effect depressive symptoms (see figure ) . as an illustration, if the measure stringency index increases from to , the depressive symptoms of extreme introverts decrease with . points ( % ci: − . to − . ), while they increase with . points for extreme extraverts ( % ci: − . to . ). model in table also shows that being single or divorced, having health problems, having low trust in government, and having high degrees of neuroticism and conscientiousness (and to a lesser degree openness) are important correlates of reporting depressive symptoms in the early days of the pandemic. our findings provide support for the hypothesis that extraversion moderates the relationship between stringent covid- protective measures and depressive symptoms. the assumption that the stringent measures are beneficial for introverts and detrimental for extraverts received only partial support. the results indicated that introverts indeed fare substantially better when living in a country that has installed stringent protective measures than in countries that did not. however, even though the lifestyle associated with social distancing seems to feel more unnatural to extraverts than to introverts, the damaging effect of living in a country where the government imposed stringent measures appears to be limited for extraverts. this conclusion is underscored by the negative association between extraversion and depressive symptoms in our sample. indeed, psychological research indicates that, compared to introverts, extraverts are less susceptible for mental illnesses (malouff et al., ) , such as depression and anxiety (spinhoven et al., ) , and generally happier (steel et al., ; anglim et al., ) . these findings should be interpreted within the limitations of this research. first, we were not able to empirically test our assumption that it is the negative social consequences of stringent measures that explain the slight increase of depressive symptoms among extraverts. we, however, believe that this is the most plausible explanatory mechanism, as research suggests that it is the loss in social connection that causes extraverts to suffer more mentally during this pandemic (folk et al., ) . second, even though our analytical strategy allowed us to take out individual-specific heterogeneity, and extraversion is a relatively stable personality trait (damian et al., ) , the crosssectional nature of the survey data, collected in the early days of the pandemic, did not allow us to examine whether introverts' and extraverts' responses to the protective measures changed as the situation evolved. since the period of data collection, time has not stood still. for example, after the first wave of infections was contained, countries started relaxing protective measures. a while later, many of these countries again imposed protective measures to prevent a second wave of infections to crop up. testing our hypothesis on more recent data is an important direction for future research for, at least, two reasons. research on well-being set-points and coping in times of crisis suggests that people have the tendency to adapt to adversity as a crisis evolves (riolli et al., ; cummins and wooden, ) . if, in time, extraverts find new ways to satisfy their need for social connections (e.g., virtual communication), the interaction effect could disappear. furthermore, the charm of social distancing for introverts may be only temporal, because, if social distancing becomes the new normal, introverts may struggle with getting sufficient social support (blue, ) . third, with a broader set of measures, we would have been able to draw more robust conclusions. as extraversion is a multi-facetted construct (soto and john, ) and not all facets contribute to mental health in equal degrees (margolis et al., ) , it could be that measure stringency only significantly interacts with one or two facets of extraversion. in a similar vein, it could be that the moderating effect of extraversion effects would have be more apparent for more fluctuant mental health constructs, such as daily positive and negative affect (hudson et al., ) . in addition, type of house and living situation could be interesting variables to consider, as people living in a more spacious house or more rural areas might have had more opportunity to organize social gatherings at a safe distance and maintain a high degree of personal space vis-à-vis other household members and, in turn, suffered less from the social consequences of the pandemic. researching the role of daily time use would be a worthwhile endeavor too, as research conducted during the early days of covid- shows that activities vary drastically in the extent to which they make people happy (lades et al., ) . finally, we believe that studying the role of internet availability and familiarity with virtual communication media could be a fruitful research direction, as these factors could be essential for people to maintain social contacts when facing stringent measures. fourth, the surveying procedure may have influenced the external validity of our findings. first, fetzer et al.'s ( ) snowballing procedure may have resulted in certain populations to be overrepresented (e.g., women) or underrepresented in our sample (e.g., individuals in lower social strata). even though weights were used to correct for socio-demographic differences between survey respondents and the general population in each country, still some groups might be completely absent. most notably, by administrating a web-based survey, fetzer et al. ( ) excluded individuals that do not have access to the internet (e.g., underprivileged people) or lack the knowledge to use it (e.g., elderly people, baltar and brunet, ) . it is perhaps this overlooked proportion of the population that may have been most negatively affected by the social consequences of the pandemic, as it had limited opportunity to maintain social relationships when physical contact was infeasible. therefore, we recommend researchers to use data based on probability sampling methods and a variety of survey modes (e.g., paper or telephone survey) when replicating our study in future research. all in all, our results provide empirical evidence on a popular, but mostly unsubstantiated assumption that extraverts suffer more from covid- protective measures than introverts. nevertheless, as, in the end, extraverts and introverts both have an innate need for human connection (baumeister and leary, ) , it will be essential to develop and test interventions that help people to cope with the pandemic's social consequences (steele, ) . it may, for instance, be worthwhile to develop public information programs that incentive citizens to adhere the covid- protective measures and, at the same time, to help people maintain social relationships and stay mentally fit, e.g., combining outdoor activities with social interaction (lades et al., ) and making responsible use of virtual communication tools to stay in touch (garfin, ) . the data and code used for this study can be found at https://osf.io/vgkmd/. the original data from fetzer et al. ( ) can be found at https://osf.io/ sn k/. the data collection procedure was reviewed and approved by the massachusetts institute of technology (reference: e- , see fetzer et al., ) . the patients/participants provided their written informed consent to participate in this study. iw wrote most of the manuscript and verified the results. ss wrote a part of the manuscript and verified the results. mb ran most of the analyses and came up with the research question. all authors contributed to the article and approved the submitted version. this study was supported by the netherlands organization for scientific research (nwo) (grant no. . . ) . how will country-based mitigation measures influence the course of the covid- epidemic? predicting psychological and subjective well-being from personality: a metaanalysis social research . : virtual snowball sampling method using facebook the need to belong: desire for interpersonal attachments as a fundamental human motivation do introverts have the edge in social distancing? maybe not, psychologist says the introvert advantage during lockdown surviving or thriving? enduring covid- as an introvert and extrovert the psychological impact of quarantine and how to reduce it: rapid review of the evidence a feasible estimator for linear models with multi-way fixed effects personal resilience in times of crisis: the implications of swb homeostasis and set-points sixteen going on sixty-six: a longitudinal study of personality stability and change across years an interactive web-based dashboard to track covid- in real time students under lockdown: assessing change in students' social networks and mental health during the covid- crisis global behaviors and perceptions in the covid- pandemic did social connection decline during the first wave of covid- ?: the role of extraversion the mental health consequences of covid- and physical distancing: the need for prevention and early intervention technology as a coping tool during the covid- pandemic: implications and recommendations a very brief measure of the big-five personality domains variation in government responses to covid- multidisciplinary research priorities for the covid- pandemic: a call for action for mental health science day-to-day affect is surprisingly stable: a -year longitudinal study of well-being paradigm shift to the integrative big-five trait taxonomy: history, measurement, and conceptual issues what you wish is what you get? the meaning of individual variability in desired affect and affective discrepancy the phq- : validity of a brief depression severity measure daily emotional wellbeing during the covid- pandemic the relationship between the five-factor model of personality and symptoms of clinical disorders: a meta-analysis the association between extraversion and well-being is limited to one facet validity of the brief patient health questionnaire mood scale (phq- ) in the general population personality and space: introversion and seclusion adolescents' motivations to engage in social distancing during the covid- pandemic: associations with mental and social health mental health impact of covid- : a global study of risk and resilience factors resilience in the face of catastrophe: optimism, personality, and coping in the kosovo crisis personalities that thrive in isolation and what we can all learn from time alone the next big five inventory (bfi- ): developing and assessing a hierarchical model with facets to enhance bandwidth, fidelity, and predictive power a longitudinal study of facets of extraversion in depression and social anxiety refining the relationship between personality and subjective well-being be proactive about mental health during covid isolation using social and behavioural science to support covid- pandemic response motivation and preference in isolation: a test of their different influences on responses to self-isolation during the covid- outbreak person and thing orientations: psychological correlates and predictive utility world health organization ( ). mental health and psychosocial considerations during the covid- outbreak key: cord- -gzfs m u authors: shortland, neil; thompson, lisa; alison, laurence title: police perfection: examining the effect of trait maximization on police decision-making date: - - journal: front psychol doi: . /fpsyg. . sha: doc_id: cord_uid: gzfs m u police officers around the world must often select between equally unappealing, uncertain courses of action in an attempt to achieve the best outcome. despite the immense importance of such decisions, there remains a lack of understanding in the study of individual differences in police decision-making. here, using a sample of senior police officers recruited from decision-making training events across the united kingdom (n = ), we used the least-worst uncertain choice inventory for emergency responses (lucifer) to measure the effect of maximization on both domain-specific (police) and domain-general (military) decisions. in line with a wealth of research on traditional “consumer” decisions, we found that police officers who were “maximizers” found decisions more difficult. gender and previous military experience also influenced the process of decision-making. specifically, police officers with military experience took more time to assess the situation but were faster to choose a course of action and commit to it. female police officers also were slower to assess the situation. as recent events show, the outcomes of police decisions have significant consequences for the public, the officers involved, the police force as a whole, and the wider population, yet psychological research has yet to fully explore the role of individual differences in how such decisions are made. while this study does not seek to identify factors associated with “good” or “better” decision-makers, it provides strong support for the need to factor in perspectives of the individual when creating theory, or applied tools, in support of police decision-making. introduction "i'm being honest with you here. i was thinking, "hey, shit. frankly, i don"t want to be here, " and for a fleeting moment i just wanted to get the hell out of there. i remember thinking, "there"s something wrong with this guy. i want to get the hell out of here." he's coming at us with this weird sort of gait and these black eyes, and there's something wrong with him. he's not listening to us. let's get the hell out of here, but i knew i couldn't. so, for a fleeting moment we kind of retreat. i realized that, you know, you can't really run away. this is your job. you're going to have to handle it, but i would rather not have been there. unfortunately, that is my job, and i remember having to tell myself, "susan, this is your job. you have to handle this"." the above quote, collected by oberweis and musheno ( , p. ) , presents the realities of police decision-making. here, a potentially simple interaction manifests in a critical leastworst decision because of uncertainty about the individual they are dealing with, the motives of the individual, and the potential outcomes of this interaction. at the time of writing (june ), the importance of understanding the decisionmaking that occurs in these kinds of high-uncertainty situations cannot be underestimated. in the past few weeks alone, we have seen the aftermath of the several isolated incidents of police decision-making result in worldwide protests, calls to defund (and even disband) the police, and a new executive order signed by president donald trump focused on police reform. much of the debate has focused on the concept of "bad apples" vs., "bad barrels"; i.e., the idea that "bad" police decision-making stems from "bad" individuals and/or a "bad" culture that encourages certain types of decisions (see tator et al., ) . while the goal of this article is not to identify the antecedents of "bad apples, " there is a very pressing need to understand the role of individual differences in police decision-making. such knowledge is critical to inform effective theory, training, recruitment methods, and in those instances in which a police decision has a negative outcome, proper assessment of the nature of the decision, and who, or what, ultimately is to blame. psychologists who study decision-making in high-stakes situations (military operations, counter-terrorism operations, and emergency response situations) have reported that in many real-world decisions, the decision-maker is presented with equally unappealing options, concurrent with a need to choose between them (van den heuvel et al., ; alison et al., ; shortland et al., ) . in naturalistic decision-making, based on findings from research on decisions in real-life critical incidents, researchers have called these types of decisions "least-worst" (see power and alison, a,b) . least-worst decisions are those in which every course of action is high-risk and could (potentially) have negative consequences. further, and even more demanding, is the fact that the decision-maker considers that all anticipated outcomes appear equally aversive (or that choosing between the least-worst quickly is very difficult). examples of leastworst decisions range from emergency responses such as the california wildfire response, or grenfell tower in london, to international crises such as the syrian civil war (alison et al., ) . what all of these decisions have in common is the lack of "good" options, a need to make a decision within a given (and often short) timeframe, and significant personal, political, and societal consequences. naturalistic research -research which involves the observation of live decision-making (klein, ) -has taken two forms. firstly, researchers have observed the nature and occurrence of least-worst within real (or simulated) decision-making situations such as counter-terrorist operations, or responses to natural disasters (alison et al., b (alison et al., , van den heuvel et al., ; power and alison, a,b) . secondly, researchers have interviewed decision-makers about the process that they went through when making a leastworst decision. this work has identified the exogenous and endogenous sources of uncertainty that can influence the least-worst decision-making process (van den heuvel et al., ; shortland et al., ) . this latter method has also allowed researchers to propose theories of how least-worst decisions are made, such as the role of competing goals/priorities and/or sacred values (power and alison, ; . while each of these strands of research has been fruitful for the study of decision-making as it occurs in the real-world, both lack the ability to explore the role of individual differences in leastworst decision-making. even research in wider fields that make similar least-worst choices (such as the emergency room, medical fields, or emergency responses) has often focused on exploring the psychological process of making decisions and not the individual personality factors that govern individual differences in how well people make these decisions (e.g., shaban, ) . this leaves a significant gap in our understanding of least-worst decision-making given that the same naturalistic research has noted that some individuals and groups are better able to commit to least-worst choices than others (shortland et al., ) . much of the existing literature on police decision-making focuses primarily on decisions made throughout the investigative process, including what criminal investigations to prioritize and what strategies to use during interrogations and other inquiries into criminal cases (ask and alison, ) . while studying the investigative process is an essential aspect of understanding police decision-making, these investigations often take place over a longer stretch of time, thus allowing more information to be gathered prior to making a decision (e.g., an arrest), when compared to a critical incident (e.g., a terrorist attack), in which less time can be allocated for law enforcement to gather all of the details before taking action. in these different types of situations, the amount of time available impacts whether risk assessments can effectively be made using an analytical versus intuitive approach. other police decision-making research includes the effects of race, gender, and age on decision-making patterns during traffic stops (schafer et al., ) , or how extralegal factors impact decision-making policies for when to make an arrest for spousal abuse (waaland and keeley, ; kane, ) . in a study that applied a naturalistic decision-making paradigm when studying use-of-force during encounters with civilians, hine et al. ( ) found that officers' decisionmaking was more aligned with an intuitive style (i.e., automatic, unconscious decision-making, and heuristics), although an analytical approach was used to conduct mental simulations of possible outcomes. furthermore, officers also experienced various cognitive, perceptual, and physiological impairments that affected their ability to successfully use force techniques, thus increasing the potential for risk of injury to either the officer or suspect (hine et al., ) . prior research has also shown that police officers managed uncertainty in dynamic, high-risk situations by seeking out additional information and updating their assessments of a given situation based on their previous experience, as a way to reduce the levels of uncertainty experienced during three phases of the decision-making process: situation assessment, plan formulation, and plan execution. in the event that uncertainty persisted to the time when a plan would be executed, it would be further "reduced" by either relying on standard operating procedures or by purposefully deferring the execution of a plan while also preparing for potential "worst-case scenarios" (van den heuvel et al., ) . other work has used a naturalistic decision-making approach to study police decision-making during simulations of major events, such as political or sporting events (pais and felgueiras, ) . faced with time pressure, as well as incomplete knowledge and limited capability to process information, effective decisionmakers tended to satisfice and focused on attaining acceptable solutions for managing traffic control and monitoring operations (pais and felgueiras, ) . two recent studies have elucidated the important role that individual differences in personality traits associated with decision-making may play in police decisionmaking. first, alison et al. ( a) used a series of simulated rape cases to examine the effects of (a) internal time urgency, (b) experience, and (c) fluid mental ability on diagnostic hypotheses and an officer's ability to prioritize information. in an experimental simulation in which half of the subjects were subjected to a time pressure manipulation (although both groups had equal amounts of time), the subjective perception of having less time caused participants to generate a reduced number of hypotheses. what is more important is that this effect was moderated by individual differences in time urgency. specifically, individuals who tended to perceive time to pass more slowly (low time urgency) continued to generate hypotheses despite the presence of time pressure. time pressure also increased action prioritization, but only in those officers with low time urgency or high fluid ability. in a second study by kim et al. ( ) , korean detectives participated in a series of simulated investigative scenarios to investigate the extent to which individual differences in (a) domain-specific experience, (b) fluid intelligence, (c) need for closure (nfc), and (d) time urgency moderated the effect of time pressure on investigative hypothesis generation. here, time pressure directly decreased the quantity and quality of hypotheses generated and, again, low time urgency moderated the effect of time pressure on the number and quality of hypotheses generated. low nfc also moderated the impact of time pressure on the number of hypotheses generated. these studies together reinforce the importance role that individual differences in traits associated with decision-making can play on police decision-making during operationally relevant tasks. recent work with members of the military has emphasized the importance of individual differences in trait maximization in least-worst decisions because they require the individual to satisfice in choosing the least-worst option . maximization moderates the "paradox of choice" in that when people are attracted to a larger number of alternatives they are often more dissatisfied with their eventual choice (dar-nimrod et al., ; see also schwartz, ) . individual differences in maximization reflect peoples' tendencies to seek out the "best" possible option vs., satisficing for an option that is "good enough, " according to their personal standard (schwartz, ) . maximization has been extensively studied by psychologists, and differences in decision-making strategies and decision-making outcomes have been found between maximizers (the term for those who score high on scales of maximization) and satisficers (the term for those who score low on maximization). maximizers are more likely to procrastinate (osiurak et al., ) and to engage in counterfactual thinking and "what if " thoughts about decisions (roese, ; kahneman, ; schwartz et al., ) . maximizers also prefer different types of decisions (i.e., those with high numbers of possible alternatives) and are more likely to adopt decision-making strategies that reflect rational-cognitive models (cheeks and schwartz, ) . thus, the past wealth of research reinforces that maximization is a key psychological variable when examining individual differences in decisionmaking (see cheeks and schwartz, ) . maximizing is not only associated with the process of decision-making, but also the outcomes. for example, maximizers have lower overall self-esteem (schwartz et al., ) , maximizers report lower levels of happiness (schwartz et al., ; polman, ) and also lower life satisfaction (schwartz et al., ; dahling and thompson, ) . postdecision, maximizers are more prone to express regret (parker et al., ; moyano-díaz et al., ; besharat et al., ) , and report that they are more of a "perfectionist" (schwartz et al., ; bergman et al., ; chang et al., ; dahling and thompson, ) . maximizers are also less optimistic (schwartz et al., ) ; maximizers report that they are greedier (seuntjens et al., ) and that they are more neurotic than those who do not consistently seek to maximize a given decision (schwartz et al., ; purvis et al., ) . maximization studies continually focus on decisions pertaining to consumer goods (e.g., diab et al., ; weaver et al., ; kokkoris, ) , yet from an applied perspective, there are many benefits of integrating maximization into the study of high-uncertainty least-worst decisions. first and foremost, least-worst decision-making is often shown to become de-railed, resulting in decision inertia. decision inertia involves the delaying of the decision-making process through either avoidance, redundant deliberation, or failure to implement a decision (alison et al., ) . in many applied situations the failure to make a decision in time (or at all), is as damaging, if not worse, than an incorrect decision (shortland et al., ) . from a theoretical perspective maximization may play a critical role in the emergence of decision inertia given that current theories of least-worst decision-making emphasize that decisions become de-railed through a failed commitment to making the "best" choice (van den heuvel et al., ; power and alison, b; . this puts a precedent on efforts to explore the potential role that maximization may play in applied samples and instances of applied decision-making, in support of both theoretical advances in the study of decision-making, as well as applied issues of selection, training, and recovery. based on the stated importance of maximization and the lack of theoretical input into the role of individual differences in the process of police decision-making, this study utilized a recently developed measure of least-worst decision-making in highuncertainty environments to an applied sample of police officers from the united kingdom to explore the effect of individual differences in maximization on police decision-making. based on a review of extant literature of maximization (see above) we hypothesize that: h : individuals with greater maximization tendencies will find decisions to be more difficult. h : individuals with higher levels of maximization will be slower to decide. h : individuals with higher levels of maximization will be more likely to make choices that reflect tendencies of avoidance. the sample for this study comprised of senior police officers recruited from several different constabularies of the united kingdom police forces ( . % male), with an age range of - years (m = . , sd = . ). on average officers had over years' experience serving as a police officer (m = . ). all participants were serving as active members of the united kingdom police force when they completed this study. the current study uses turner et al.'s ( ) -item maximization inventory. turner et al. ( ) measures three components of maximization: satisficing ( items), decision difficulty ( items), and alternative search ( items). each item is scored using a -point scale ranging from "strongly disagree" ( ) to "strongly agree" ( ). satisficing measures the degree to which someone chooses outcomes that reach the threshold of "acceptability, " rather than ones much closer to optimal. this subscale includes items such as, "at some point you need to make a decision about things." decision difficulty measures the frustration-or difficulty-that one experiences when making a choice. example items in this subscale include, "i am usually worried about making a wrong decision." finally, alternative search measures an individual's tendency to seek all available options before committing to a choice. items in this subscale include, "i take the time to consider all alternatives before making a decision." the research used the lucifer (least-worst uncertain choice inventory for emergency responses; decision-making measure. the following dependent variables are collected by the lucifer research method (both on average across the scenarios, and per scenario): . situational awareness time (sat): the amount of time it takes the participant to declare that they are "ready" to make a decision after they have listened to an audio inject that outlines the situation. . choice time (ct): participants are required to choose between two courses of action. the amount of time it takes them to decide between a and b is recorded in lucifer. lucifer operationalizes ct by measuring the amount of time it takes a participant to make their last "click" on an option on the page (both first and last page clicks are recorded for each step of the scenario). . decision time (dt): the overall time it takes a participant to declare they are ready to "commit" to their choice (i.e., submit). . commitment time (comt): comt is calculated as the difference between choosing (ct) and submitting (dt). comt was therefore calculated as comt = dt -ct. . decision difficulty (dd): participants complete a five-item decision difficulty scale (see hanselmann and tanner, ) . this dd measure included the items, "for me this decision is. . ." "very easy" ( ) to "very difficult" ( ). four additional items ask the participant to rate their level of agreement with statements regarding the time they needed, how certain they were and how committed they were to their choice ("strongly disagree" [ ] to "strongly agree" [ ]). each item was scored using a -point likert scale. . approach/avoidance (aa): each decision offered two choices. one choice was an approach outcome, in which they could actively seeking to make a positive impact on the situation. the second choice was an avoidance outcome, that allowed them to withdraw and prevent further harm (see power, ) . summing the total number of approach decisions made (maximum score: ) across the scenarios gave an overall approach/avoidance tendency (high score: approach, low score: avoid). based on previous research, which has shown the role of nfc in decision-making (kim et al., ; , this study controlled for need for closure (nfc). nfc measures the degree to which an individual wants to obtain definitive answers and their comfort with uncertainty (kruglanski, , p. ) . nfc was measured via the five-facet scale proposed by kruglanski et al. ( ) . the research team (first and third author) collected data in person at a range of training events hosted throughout the country. the study was administered to participants via apple ipad and or a personal computer. the study was hosted on qualtrics, and all data was collected and held on the qualtrics server. before completing the lucifer task, all participants completed the psychometric battery (maximization and nfc). informed consent was provided digitally before beginning the study. participants were reminded of their ability to end testing at any time and were supervised by a test proctor throughout their testing. they were asked to complete the battery in a single session. lucifer is a decision-making task that was developed to support on-going research into the how individuals make leastworst decisions under conditions of uncertainty . lucifer was developed in collaboration with the army research institute foundational science research unit. to date, lucifer has been used with a range of applied groups (soldiers, police officers, firefighters, etc.). decision-making scenarios used in lucifer were developed from data collected from qualitative interviews with police officers and soldiers (see shortland et al., ; . these scenarios were then condensed down to two critical decision points, which are then presented to the participant via a recorded audio feed with corresponding background noise. the individual is then presented with a -alternative forced choice ( afc) which represent either an approach choice (make a positive impact on the situation), or an avoidance approach (avoid a negative impact on the situation). all audio feeds are recorded by either members of the armed forces or paid actors and provide the participant with an assessment of the situation and a required action. all scenarios have been "civilianized" and piloted with a sample of undergraduate students to ensure than they can be comprehended by those with no specialized knowledge of the situation (i.e., the scenarios contain no specialized language). after making their first decision, participants are exposed to a second inject (second-step) that either tests their commitment to the course of action they chose, or presents a further step in the scenario. again, after being exposed to this second audio inject, the participant is asked to choose their course of action. after completing both steps, the participant records their confidence level and completes the decision difficulty questionnaire outlined above. the version of lucifer used in this study involves police scenarios and non-police (military) scenarios. on average, participants took s to understand the situation and declare themselves "ready" to decide (m = . , sd = . ; see table ). on average, participants took just over s to decide (dt, m = . , sd = . ). committing to this decision took participants, on average, s (ct, m = . , sd = . ). on average, participants scored the scenarios as 'medium' difficulty (m = . , sd = . ), and there was a slight tendency to make "approach" choices (m = . , sd = . ). overall, participants' maximization scores ranged from . to . (m = . , sd = . ). preliminary analyses included a series of pearson's correlations that indicated that maximization was positively correlated with decision difficulty (r = . , n = , p = . ), need for closure (r = . , n = , p = . ), and age (r = . , n = , p = . ). all other correlations were not statistically significant. multi-level modeling (mlm) tested the effect of maximization on decision-making while controlling for nfc and other variables and nesting decision-making across scenarios by the individual participant. scenarios, with ten total decisions, and participants resulted in a total of data points per dependent variable. multi-level modeling for each of the dependent variables thus organized the total data points both by the random effects of the five scenarios (ten decisions) and by the participants. using this structure, a two-level mlm was used to estimate the main effect of maximization on sat, dt, *p < . , **p < . , ***p < . . a series of models were also run examining interaction effects between maximization scores and scenario type on each of the outcome variables, but there was no evidence to suggest that there was a significant interaction. ct, comt, dd, and aa (see table ), controlling for need for closure, scenario type, military experience, age, and gender. overall, across these models, "maximizers" (those who score high on trait maximization) appear to perceive lucifer decisions as more difficult, with an average increase of . points in difficulty scores for every one-point increase in maximization score (p = . ). the type of scenario also affected decision difficulty, with the odds of perceived difficulty being higher for military scenarios compared to non-military scenarios (or = . , p = . ). situational awareness time was positively associated with having military experience, with officers with military experience taking longer to assess a situation on average (or = . * , p = . ). males also tended to take less time to assess a situation (or = . * − , p = . ). on average, police officers with military experience tended to have faster choice times than officers with no military experience (or = . , p = . ). decision time was positively associated with having military experience, with officers with military experience taking longer to make a decision on average (or = . * − , p < . ). on average, police officers with military experience tended to take less time to commit to a choice than officers with no military experience (or = . , p = . ). tendency to avoid did not appear to be significantly associated with any of the model variables. within the total sample, we fail to reject our first hypothesis, with higher maximization scores positively associated with increased decision difficulty within a given scenario. there did not appear to be any empirical support for our second or third hypotheses, with maximization having no statistically significant impact on either reaction times or tendency to avoid. within the total sample, we fail to reject our first hypothesis, with higher maximization scores positively associated with increased decision difficulty within a given scenario. there did not appear to be any empirical support for our second or third hypotheses, with maximization having no statistically significant impact on either reaction times or tendency to avoid. while the full discussion of these results will occur in the proceeding overall discussion section, there is one finding that warrants further attention and exploration: the role of participant membership in the military. in this study, those who served in the military alongside the police force were overall slower to assess the situation, but faster to decide than those who had no military experience. to date, there has been no investigation of the role of having military experience on police decision-making. such work is especially prudent given that emerging work on leastworst decision-making has argued that military personnel are less prone to redundant deliberation (a form of indecision) in the face of least-worst decisions (see shortland et al., ; . that said, this hypothesis has not been experimentally tested. thus, below we offer a preliminary test of the role of military experience on police decision-making (using data from the sample collected for study ). when comparing between police officers who had served as military personnel and those who had military experience took, on average, . s longer to assess the situation, t( . ) = − . , p = . , but . s less time to make a decision, t( . ) = . , p = . , and . s less time to commit to their choice, t( . ) = . , p = . . there were no significant group differences in maximization scores, perceived decision difficulty, need for closure, tendency to avoid, or age. however, there was a significant group difference in years of police experience, with police only samples reporting an average of . years more experience in law enforcement than the hybrid police/military sample, t( . ) = . , p < . . for gender, males were distributed evenly between those with military experience and those without, while only % of female participants reported any military experience (see table ). across these different models, as presented in table , maximization appears to have a positive association with perceived decision difficulty, with an average increase of . points in difficulty scores for every one-point increase in maximization score (p < . ); scenario type also affected decision difficulty, with the odds of perceived difficulty being higher for military scenarios compared to non-military scenarios (or = . , p = . ). situational awareness time was significantly associated with gender, and males tended to take less time to assess a situation (or = . * − , p = . ). no other reaction time outcomes appeared to be associated with any of the model variables. tendency to avoid was negatively associated with police experience, with every year of experience leading to an average decrease of . points in avoidance score. within the police only sample, we fail to reject our first hypothesis, with higher maximization scores positively associated with increased decision difficulty within a given scenario. there did not appear to be any empirical support for our second or third hypotheses, with maximization having no statistically significant impact on either reaction times or tendency to avoid. these findings are consistent with the findings for the total sample used in the study. across these different models (see table ), maximization appears to have a negative association with tendency to avoid, with an average decrease of . points in avoidance scores for every one-point increase in maximization score (p < . ). tendency to avoid was also positively associated with nfc, with an average increase in avoidance score of . points for every one-point increase in nfc (p < . ). likewise, tendency to avoid was positively associated with police experience, with an average increase in avoidance score of . points for every extra year of experience (p = . ). additionally, tendency to avoid was affected by gender, with males being more likely to have a higher avoidance score than females (or = . , p < . ). situational awareness time was positively associated with need for closure, with an average increase in sat of . s for every one-point increase in nfc (p = . ). scenario type affected decision difficulty, with the odds of perceived difficulty being higher for military scenarios compared to non-military scenarios (or = . , p < . ). neither choice time, decision time, nor commitment time appeared to be associated with any of the model variables. within the hybrid sample of individuals with experience in both law enforcement and military service, we reject our first and second hypotheses, with higher maximization scores having no statistically significant impact on either decision difficulty or reaction times. however, unlike the total sample or police only subsample, we fail to reject our third hypothesis, with individuals with higher maximization scores showing less of a tendency to avoid. in terms of the psychology of decision-making, there is an urgent need to understand how people make decisions in the face of high uncertainty. at the time of writing, political leaders, ceos, medical staff, and police officers are making a range of decisions in the face of the unprecedented covid- global pandemic, and the decision-making of police officers in the line of duty is coming under increased scrutiny. several recent cases of police decision-making have resulted in global protests, riots, the disbanding of some police departments, and executive orders focused on police reform. now, more than ever, psychologists need to begin to understand the realities of police decisionmaking and the processes that underpin the ability of police officers, in the face of immense strain and uncertainty, to navigate non-ideal options and commit to a course of action. to date, the majority of research on police decision-making has focused on prioritization of certain criminal cases and the employment of interrogation techniques (ask and alison, ) , the effects of salient demographic markers (i.e., age, race, and gender) on decision-making patterns during traffic stops (schafer et al., ) , or how external factors impact decision-making policies for domestic violence arrests (waaland and keeley, ; kane, ) . however, several recent studies have emphasized the potential importance of factoring individual differences in personality variables associated with decision-making into our analyses (alison et al., b; kim et al., ) . in this study, we sought to extend the study of individual differences in police decision-making by examining the effect of individual differences police experience (years) − . . . . *** *p < . , ***p < . . a series of models were also run examining interaction effects between maximization scores and scenario type on each of the outcome variables, but there was no evidence to suggest that there was a significant interaction. *p < . ; ***p < . . a series of models were also run examining interaction effects between maximization scores and scenario type on each of the outcome variables, but there was no evidence to suggest that there was a significant interaction. a "age" was removed as a model variable due to multicollinearity issues with "police experience" in the avoidance score model. in trait maximization on a range of police-related (and nonpolice related) decisions. in doing so, we identified several interesting tendencies associated with both personality, and experience related traits. first and foremost, confirming our first hypothesis, police officers who were maximizers found decisions harder, though their decision-making speed was unaffected. however, this study also highlighted important decision-making differences between those who had military experience and those who did not. specifically, those senior officers with military experience were slower to assess the situation, but faster to decide. male officers were also faster to assess the situation than females. these findings show the importance of considering experiential and personality based individual differences in how police officers make decisions under conditions of high-uncertainty and leastworst options. maximization is the individual tendency to "maximize" outcomes by seeking the best possible choice, rather than settling for a "acceptable" choice (for reviews, see cheeks and schwartz, ; misuraca and fasolo, ) , and the effect of maximization on decision-making styles and outcomes has been studied by psychologists for the past several decades. in line with this previous research, this study hypothesized that individual differences in trait maximization would influence police officers when making high-uncertainty decisions. the types of decisions that police officers face place an immense strain on the person, and indeed our own psychological theories of how decisions are made. while the majority of naturalistic research has focused on the processes through which these decisions are made (e.g., alison et al., a) , what is often missing is a focus on the individual traits that may explain how and why people show differences in their ability to make effective decisions in these situations. this is why maximization is so important because it provides a metric of the observable tendency that people have to try and make the best of a bad situation (shortland et al., ) . in line with our hypotheses police officers with high trait maximization found decisions harder. they did not, however, take to comprehend the situation and be "ready" to decide, take longer to select a course of action (when presented with a binary a or b choice), or take longer to commit to a course of action. this supports the notion that maximizers find decisions more difficult (kim and miller, ) , though we did not find that maximizers were slower, or more inclined to make avoidant choices (parker et al., ) . it is especially interesting to see that these findings extend into a sample of police officers who have face such decisions frequently (power, ) . this shows the potential theoretical and practical utility of maximization. it is also important to consider why some of our hypotheses were rejected by this research; namely that maximizers should be slower and more prone to avoidant decisions. one reason for this may be the nature of the group, and how this sample differs from the "usual" sample of research on maximization. police officers are subjected to rigorous training, especially in decision-making, and it is very viable to propose that decisionmaking and/or wider training experienced as a police officer alters the natural effect of maximization on the process of making a decision under conditions of uncertainty. it is viable thus that with training the conscious tendency to seek alternatives could be overridden in situations in which there is time pressure and a need to act. future work manipulating time pressure (e.g., kim et al., ) should explore this. this work also identified differences between those police officers who have military experience and those who do not. this finding is in accordance with an oft-observed comment by those who study decision-making under uncertainty that there are differences between those who work in emergency services and those who operate within the military (shortland et al., ) . through a series of interviews with members of the armed forces, previous research suggests that military personnel, when compared to non-military personnel, are generally more resistant to decision inertia and better able to commit to least-worst choice under uncertainty (shortland et al., ) . to be clear, in this study we are not saying that police officers with military experience make "better" decisions, just that in this study they were slower to assess the situation, but once they had assessed the situation they were universally faster throughout the remaining stages of the decision-making process. this finding implies that officers with military experience may process decisions differently and this could, in turn, make them better equipped to make certain types of decisions in certain types of environment. despite the potential limitations of the comparison here (differences in overall experience, small sample size), what this work does support is the potential utility of focusing on the psychological differences between police officers who have military experience in terms of performance. this is a highly relevant issue within industrial/organizational psychology in which we would look to the matching of people to tasks. a wealth of future research is needed in this area, but it is warranted to propose that police officers with military experience may be suited to certain types of tasks depending on the nature of the decisions they are facing. the nature of decisions that police officers face are immensely diverse, ranging from slow-bun investigative decisions, to sudden shoot/don't shot decisions. this research implies that significant psychological support can be provided by factoring in the interaction of individual differences in decision-making process and the nature of the decisions that the individual is likely to face in the field. despite the potential utility of these findings, it is important to consider the limitations of this study. first and foremost, this is a small, and selective sample of police officers who are not representative of the police forces as a whole, nor may their culture transition globally. for example, authors are increasingly commenting on the "unique" aspects of police culture in certain countries (such as the united states; see demirkol and nalla, ) . these findings should thus be treated with caution, and indeed replicated cross-culturally and indeed within different countries and across forces to examine the boundaries of maximization (as well as identify unique aspects that may mitigate the effect of this trait). that said, a recent study also found that maximization also affected military decision-making with a military sample . taken together, and in extension to the wealth of general research on maximization, despite the small sample size here, a body of evidence is building which shows that maximization impacts decision-making in applied, high-uncertainty settings. from a theoretical sense, those same maximizers who struggle to pick phone plans, may also struggle with decisions under pressure when it really counts. while such bold assertions require significant future research, this paper, along with those before it at the very least show the importance of maximization outside of "the lab." another potential limitation is the inclusion of military scenarios in the lucifer battery. while these scenarios deviate the user from situations that they are familiar with, or potentially trained on, this is an important benefit of lucifer in that it allows a test of effect across both domain-specific and domaingeneral scenarios. for example, it is possible that in the domaingeneral decisions (in this instance, police decisions), the decisionmaker could be incorporating wider exogenous and endogenous concerns such as accountability and police blame-culture (alison et al., a) . in this study then the inclusion of domaingeneral decisions allowed us to focus on the role of maximization writ large. that said, it is evident that varying scenario types does, de facto, increase the diversity of the decisions that were made. in response to this, we would encourage future research to better adopt a research methodology that is able to closely match the decision being made to the types of decision that the decision-maker frequently makes. this would allow future explorations pertaining to the interaction of trait maximization with experience, training and expertise. the national institute of justice strategic research plan for policing ( - ) specifies the need to identify the factors that inform police decision-making. here we have identified one such factor that may play a central role in police decision-making. while likely one of many relevant personality variables that will predict individual differences in decision-making, maximization may be particularly relevant. pais and felgueiras ( ) work showed that time pressure and incomplete knowledge increased decision makers' tendency to satisfice, to achieve an acceptable solution for traffic control and monitoring management. again, this emphasizes the potential utility of satisficing in a police context. thus, while previous research has explored the processes through which police officers overcome uncertainty (van den heuvel et al., ) , what this work adds is the potential role of individual decision-making traits may have on how individuals overcome uncertainty and commit to courses of action. the implications of this line of research should not be minimized. increasing at the academic, political, and societal level, we are embroiled in discussions about the nature of modern policing, fueled by the outcomes of several high-profile decisions that have been made in the field. a few recent examples of which include the handling of george floyd, the shooting of breonna taylor, the killing of ahmaud arbery, and the policing of the ensuing "black lives matter" protests. one of the central discussions has been around police officers' use of power and the decisions that they make when interacting with the public. these discussions include calls for increased officer training or more officer education (see rydberg and terrill, ) , and more recently to "defund" the police (e.g., hegarty, ) . this paper supports that an alternate area of focus should be the matching of person to task (here, this would represent personality in terms of maximization, and experience in terms of potential service with the armed forces). this matching of person to task is a central aspect of the wider field of industrial/organizational psychology and in other high-uncertainty roles (e.g., the military), recruitment, selection, training and promotions all incorporate elements of personality (matthews, ) . based on the results of this study, we could cautiously hypothesize that individuals who are maximizers may be less suited for roles that require high-uncertainty least-worst decisions as they will, by their nature, require the individual to forego maximization in favor of a satisfactory choice. as such, we would argue that focusing police organizations around the role of personality should be considered alongside calls for focusing on training and education (rydberg and terrill, ) . the raw data supporting the conclusions of this article will be made available by the authors, without undue reservation, to any qualified researcher. the studies involving human participants were reviewed and approved by the university of massachusetts institutional review board and the army research institute foundational science research unit. written informed consent for participation was not required for these studies in accordance with national legislation and institutional requirements. ns: conceptualization, methodology, data curation, and writing original draft. lt: writing original draft, data curation, and formal analysis. la: conceptualization, methodology, supervision, and review. all authors contributed to the article and approved the submitted version. the researchers would like to thank dr. maureen mccusker, dr. nikki blacksmith, and dr. gregory ruark for their assistance in the execution of this research project. the effects of subjective time pressure and individual differences on hypotheses generation and action prioritization in police investigations immersive simulated learning 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and omission bias police decision making in wife abuse: the impact of legal and extralegal factors the role of social comparison for maximizers and satisficers: wanting the best or wanting to be the best? key: cord- - xav u u authors: manzi, federico; peretti, giulia; di dio, cinzia; cangelosi, angelo; itakura, shoji; kanda, takayuki; ishiguro, hiroshi; massaro, davide; marchetti, antonella title: a robot is not worth another: exploring children’s mental state attribution to different humanoid robots date: - - journal: front psychol doi: . /fpsyg. . sha: doc_id: cord_uid: xav u u recent technological developments in robotics has driven the design and production of different humanoid robots. several studies have highlighted that the presence of human-like physical features could lead both adults and children to anthropomorphize the robots. in the present study we aimed to compare the attribution of mental states to two humanoid robots, nao and robovie, which differed in the degree of anthropomorphism. children aged , , and years were required to attribute mental states to the nao robot, which presents more human-like characteristics compared to the robovie robot, whose physical features look more mechanical. the results on mental state attribution as a function of children’s age and robot type showed that -year-olds have a greater tendency to anthropomorphize robots than older children, regardless of the type of robot. moreover, the findings revealed that, although children aged and years attributed a certain degree of human-like mental features to both robots, they attributed greater mental states to nao than robovie compared to younger children. these results generally show that children tend to anthropomorphize humanoid robots that also present some mechanical characteristics, such as robovie. nevertheless, age-related differences showed that they should be endowed with physical characteristics closely resembling human ones to increase older children’s perception of human likeness. these findings have important implications for the design of robots, which also needs to consider the user’s target age, as well as for the generalizability issue of research findings that are commonly associated with the use of specific types of robots. currently, we are witnessing an increasing deployment of social robots (bartneck and forlizzi, ) in various contexts, from occupational to clinical to educational (murashov et al., ; belpaeme et al., ; marchetti et al., in press) . humanoid social robots (hsrs), in particular, have proven to be effective social partners, possibly due to their physical human likeness (dario et al., ) . humanoid social robots can vary in the degree of their anthropomorphic physical characteristics, often depending on the target user (children, adults, elderly, students, clinical populations, etc.) and the context (household, education, commercial, and rehabilitation) . for example, the humanoid kaspar robot that resembles a young child (with face, arms and hands, legs and feet), was specifically built for children with autism spectrum disorder (dautenhahn et al., ; wainer et al., ) . in other instances, however, the same hsrs are used both for different purposes and different populations, like the nao robot, which is largely used both with clinical and non-clinical populations (shamsuddin et al., ; mubin et al., ; begum et al., ; belpaeme et al., ) , or the robovie robot, that is employed both with adults and children (shiomi et al., ; kahn et al., ) . a recent review of the literature by marchetti et al. ( ) showed that different physical characteristics of hsrs may significantly affect the quality of interaction between humans and robots at different ages. the construction of robots that integrate and expand the specific biological abilities of our species led to two different directions in robotic development based on different, though related, theoretical perspectives: developmental cybernetics (dc; itakura, ; itakura et al., ; moriguchi et al., ; kannegiesser et al., ; okanda et al., ; di dio et al., ; wang et al., ; manzi et al., a) and developmental robotics (dr; de la cruz et al., ; schlesinger, , ; lyon et al., ; morse and cangelosi, ; vinanzi et al., ; zhong et al., ; di dio et al., a,b) . the first perspective (dc) consists of creating a human-like system, by simulating human psychological processes and prosthetic functions in the robot (enhancing the function and lifestyle of persons) to observe people's behavioral response toward the robot. the second perspective (dr) is related to the development of cognitive neural networks in the robot that would allow it to autonomously gain sensorimotor and mental capabilities with growing complexity, starting from intricate evolutionary principles. from these premises, the next two paragraphs briefly outline current findings concerning the effect that physical features of the hsrs have on human perception, thus outlining the phenomenon of anthropomorphism, and a recent methodology devised to measure it. anthropomorphism is a widely observed phenomenon in human-robot interaction (hri; fink et al., ; airenti, ; złotowski et al., ) , and it is also greatly considered in the design of robots (dario et al., ; kiesler et al., ; bartneck et al., ; sharkey and sharkey, ; zanatto et al., zanatto et al., , . in psychological terms, anthropomorphism is the tendency to attribute human characteristics, physical and/or psychological, to non-human agents (duffy, ; epley et al., ) . several studies have shown that humans may perceive non-anthropomorphic robots as anthropomorphic, such as roomba (a vacuum cleaner with a semi-autonomous system; fink et al., ) . although anthropomorphism seems to be a widespread phenomenon, the attribution of human traits to anthropomorphic robots is significantly greater compared to non-anthropomorphic robots. a study by krach et al. ( ) compared four different agents (computer, functional robot, anthropomorphic robot, and human confederate) in a prisoner's dilemma game, and showed that the more the interactive partner displayed human-like characteristics, the more the participants appreciated the interaction and ascribed intelligence to the game partner. what characteristics of anthropomorphic robots (i.e., the hsrs) increase the perception of anthropomorphism? the hsrs can elicit the perception of anthropomorphism mainly at two levels: physical and behavioral . working on the physical level is clearly easier than on intrinsic psychological features, and -although anthropomorphic physical features of robots are not the only answer to enhance the quality of interactions with humans -the implementation of these characteristics can positively affect hris (duffy, ; for a review see marchetti et al., ) . it should be stated, however, that extreme human-likeness can result in the known uncanny valley effect, according to which hris are negatively influenced by robots that are too similar to the human (mori, ; macdorman and ishiguro, ; mori et al., ) . thus, the hsrs' appearance represents an important social affordance for hris, as further demonstrated by the psychological research on racial and disability prejudice (todd et al., ; macdonald et al., ; sarti et al., ; manzi et al., b) . the anthropomorphic features of the hsrs can increase humans' perception of humanness, such as mind attribution and personality, and influence other psychological mechanisms and processes (kiesler and goetz, ; macdorman et al., ; powers and kiesler, ; bartneck et al., ; broadbent et al., ; złotowski et al., ; marchetti et al., ) . the study of the design of physical characteristics of the hsrs and their classification has been already investigated in hri, but not systematically. a pioneering study by disalvo et al. ( ) explored the perception of humanness using images of different heads of hsrs, and showed that three features are particularly important for the robot's design: the nose, eyes, and mouth. furthermore, a study by duffy ( ) categorized different robots' head in a diagram composed of three extremities: "human head" (as-close-as-possible to a human head), "iconic head" (a very minimum set of features) and "abstract head" (a more mechanistic design with minimal human-like aesthetics). also, in this instance, human likeness was associated with greater mental abilities. furthermore, a study by macdorman ( ) analyzed the categorization of types of robots (mainly androids and humanoids) in adults. it was shown that humanoid robots displaying some mechanical characteristics -such as the robovie robot -were classified average on a "humanness" scale and rated lower on the uncanny valley scale. recent studies compared one of the most widely used hsrs, the nao robot, with different types of robots. it was shown that the nao robot is perceived less human-like than an android -which is a highly anthropomorphic robot in both appearance and behavior (broadbent, ) -, but more anthropomorphic than a mechanical robot, i.e., the baxter robot (yogeeswaran et al., ; zanatto et al., ) . however, there were no differences in perceived ability to perform physical and mental tasks between nao and the android (yogeeswaran et al., ) , indicating that human-likeness (and not "human-exactness") is sufficient to trigger the attribution of psychological features to a robot. in addition, a database has recently been created that collects more than hsrs classified according to their level of human likeness (phillips et al., ) . in this study the nao robot was classified with a score of about / , in particular thanks to the characteristics of its face and body. robovie and other similar robots were classified with a score ranging between and / , deriving mainly from body characteristics. these findings corroborate the hypothesis that nao and robovie are two hsrs with different levels of human-likeness due to their physical anthropomorphic features. the interest in observing the effect of different physical characteristics of robots in terms of attribution of intentions, understanding, and emotions has also been investigated in children (bumby and dautenhahn, ; woods et al., ; woods, ) . in particular, a study by woods ( ) , comparing different robots, revealed that children experience greater discomfort with robots that look too similar to humans, favoring robots with mixed human-mechanical characteristics. these results were confirmed in a recent study by tung ( ) showing that children preferred robots with not too many human-like features over robots with many human characteristics. overall, these results suggested that an anthropomorphic design of hsrs may increase children's preference toward them. still, an excessive implementation of human features can negatively affect the attribution of positive qualities to the robot, again in line with the uncanny valley effect above. different scales were developed to measure psychological anthropomorphism toward robots in adults. these scales typically assess attribution of intelligence, personality and emotions, only to mention a few. in particular, the attribution of internal states to the robot, i.e., to have a mind, is widely used and very promising in hri (broadbent et al., ; stafford et al., ) . in psychology, the ability to ascribe mental states to others is defined as the theory of mind (tom). theory of mind is the ability to understand one's own and others' mental states (intentions, emotions, desires, beliefs), and to predict and interpret one's own and others' behaviors on the basis of such meta-representation (premack and woodruff, ; wimmer and perner, ; perner and wimmer, ) . theory of mind abilities develop around four years of age, becoming more sophisticated with development (wellman et al., ) . theory of mind is active not only during humans' relationships but also during interactions with robots (for a review, see marchetti et al., ) . recent studies have shown that adults tend to ascribe greater mental abilities to robots that have a human appearance (hackel et al., ; martini et al., ) . this tendency to attribute human mental states to robots was also observed in children. generally, children are inclined to anthropomorphize robots by attributing psychological and biological characteristics to them (katayama et al., ; okanda et al., ) . still, they do differentiate between humans and robots' abilities. a pioneering study by itakura ( ) investigating the attribution of mental verbs to a human and a robot showed that children did not attribute the epistemic verb "think" to the robot. more recent studies have further shown that already from three years of age, children fairly differentiate a human from a robot in terms of mental abilities , although younger children appear to be more inclined to anthropomorphize robots compared to older children. this effect may be due to the phenomenon of animism, particularly active at three years of age (di dio et al., a,b) . the present study aimed to investigate the attribution of mental states (ams) in children aged - years to two humanoid robots, nao and robovie, varying in their anthropomorphic physical features (disalvo et al., ; duffy, ) . differences in the attribution of mental qualities to the two robots were then explored using the robots' degree of physical anthropomorphism and the child's chronological age. the two humanoid robots, nao and robovie, have been selected for two main reasons: ( ) in relation to their physical appearance, both robots belong to the category of hsrs, but differ for their degree of anthropomorphism (for a detailed description of the robots, see section "materials"); ( ) both robots are largely used in experiments with children (kanda et al., ; kose and yorganci, ; kahn et al., ; shamsuddin et al., ; okumura et al., a,b; tielman et al., ; schlesinger, , ; hood et al., ; di dio et al., a,b) . in light of previous findings associated with the use of these specific robots described above, we hypothesized the following: ( ) independent of age, children would distinguish between humans and robots in terms of mental states by ascribing lower mental attributes to the robots; ( ) children would tend to attribute greater mental qualities to nao compared to robovie because of its greater human-likeness; and ( ) younger children would tend to attribute more human characteristics to robots (i.e., to anthropomorphize more) than older children. data were acquired on italian children from kindergarten and primary school age. the children were divided into three age groups for each robot as follows: ( ) . the children's parents received a written explanation of the procedure of the study, the measurement items, and gave their written consent. the children were not reported by teachers or parents for learning and/or socio-relational difficulties. the study was approved by the local ethic committee (università cattolica del sacro cuore, milan). the two hsrs selected for this study were the robovie robot (hiroshi ishiguro laboratories, atr; figure b ) and the nao robot (aldebaran robotics, figure c ). we chose these two robots because, although they both belong to the category of hsrs, they differ in their degree of anthropomorphic features (disalvo et al., ; duffy, ; macdorman, ; zhang et al., ; phillips et al., ) . robovie is a hsr with more abstract anthropomorphic features: no legs but two driving wheels to move, two arms without hands. in particular, the head can be considered "abstract" (duffy, ) because of two important human-like features: two eyes and a microphone that looks like a mouth (disalvo et al., ) . robovie is an hsr that can be rated as average in the continuum of mechanical-humanlike (ishiguro et al., ; kanda et al., ; macdorman, ) . nao is a hsr with more pronounced anthropomorphic features compared to robovie: two legs, two arms, and two hands with three moving fingers ( figure c) . besides, the face can be classified as "iconic" and consists of three cameras suggesting two eyes and a mouth. however, considering the whole body and the more detailed shape of the face, nao is a hsr that can be rated as more human-like than robovie (disalvo et al., ; macdorman, ; phillips et al., ) . the ams questionnaire is a measure of mental states that participants attribute to when they look at images depicting specific characters, in this case a human (female or male based on the participant's gender; figure a) , and, according to the group condition, the robovie or the nao robot (figures b,c) . the ams questionnaire was inspired by the methodology described in martini et al. ( ) and is already used in several experiments with children (manzi et al., ; di dio et al., . the construction of the content of the questionnaire is based on the theoretical model of slaughter et al. ( ) on the categorization of children's mental verbs resulting from communication exchanges between mother and child. this classification divides mental verbs into four categories: perceptive, volitional, cognitive, and dispositional. for the creation of the ams questionnaire an additional category related to imaginative verbs has been added. we considered it necessary to distinguish between cognitive, epistemic, and imaginative states, since -especially for the robot -this specification enables the analysis of different psychological processes in terms of development. the ams therefore consists of five dimensions: perceptive, emotive, desires and intentional, imaginative, and epistemic. the human condition was used as a baseline measure to evaluate children's ability to attribute mental states. in fact, as described in the results below, children scored quite high when ascribing mental attributes to the human character, thus supporting children's competence in performing the mental states attribution task. also, the human condition was used as a comparison measure against which the level of psychological anthropomorphism of nao and robovie was evaluated. the cronbach's alfa for each category is as follows: perceptive (α = . ), emotive (α = . ), desires and intentional (α = . ), imaginative (α = . ), and epistemic (α = . ). children answered questions grouped into the five different state categories described above (see appendix for the specific items). the child had to answer "yes" or "no" to each question, obtaining when the response is "yes" and when the response is "no". the sum of all responses (range = - ) gave the total score (α = . ); the five partial scores were the sum of the responses within each category (range = - ). the children were tested individually in a quiet room inside their school. data acquisition was carried out by a single researcher during the normal school activities. the experimenter showed each child the image on a paper depicting a human -gender matched -and one of the two robots, nao or robovie. the presentation order of the imagehuman and robot-was randomized. afterward, the experimenter asked children the questions on the five categories of the ams (perceptive, emotive, intentions and desires, imaginative, and epistemic). the presentation order of the five categories was also randomized. the total time required to complete the test was approximately min. to evaluate the effect of age, gender, states, agent, and type of robots on children's mental state attribution to robots, a glm analysis was carried out with five levels of states (perceptive, emotive, intentions and desires, imaginative, and epistemic) and two levels of agent (human, robot) as within-subjects factors, and age ( -, -, -year-olds), gender (male, female) and robot (robovie, nao) as the between-subjects factor. the greenhouse-geisser correction was used for violations of mauchly's test of sphericity (p < . ). post hoc comparisons were bonferroni corrected. the results showed ( ) a main effect of agent, f( , ) = . , p < . , partial-η = . , δ = , indicating that children attributed greater mental states to the human (m = . , sd = . ) compared to the robot (m = . , sd = . ; mdiff = . , se = . ); ( ) a main effect of states, f( , ) = . , p < . , partial-η = . , δ = , mainly indicating that children attributed greater intention and desires and lower imaginative states (for a full description of the statistics, see table a two-way interaction was also found between ( ) states and agent, f( , ) = . , p < . , partial-η = . , δ = (for a detailed description of the differences see table ), and ( ) agent and age, f( , ) = . , p < . , partial-η = . , δ = , showing that -year-old children attributed greater mental states to the robotic agents compared to older children (see table ). additionally, we found a three-way interaction between states, age, and robot, f( , ) = . , p < . , partial-η = . , δ = . the planned comparisons on the three-way interaction revealed that children attributed greater mental states to nao compared to robovie, with the youngest children differentiating on the perceptive and epistemic dimensions, and with this difference spreading to all dimensions (but imaginative) in the older children (see figure ). in the present study we compared the ams in children aged - years between two hsrs, nao and robovie, also with respect to a human. the aim was to explore children's patterns of mental attribution to different types of hsrs, varying in their degree of physical anthropomorphism, from a developmental perspective. our results on the ams to the human and robot generally confirmed the tendency of children to ascribe lower human mental qualities to the robots, thus supporting previous findings (manzi et al., ; di dio et al., . in addition, children generally attributed greater mental states to the nao robot than to the robovie robot, although differences were found in the quality of mental states attribution as a function of age, with older children discriminating more between the types of robots that the younger ones. as a matter of fact, the important role played by the type of robot in influencing children's ams can be appreciated by evaluating differences in state attribution developmentally. firstly, -year-old children generally attributed greater human-like mental states to the robotic agents compared to older children. additionally, while -year-old children discriminated between robots' mental attribution only on the perceptive and epistemic dimensions -with the nao robot being regarded as more anthropomorphic than robovie -, children aged and years were particularly sensitive to the type of robots, and attributed greater mental states to nao than robovie on most of the tested mental state dimensions. from a table | statistics comparing the attribution of all ams dimensions (perceptive, emotive, intentions and desires, imaginative, epistemic) and the ams for the two agents (human, robot) across ages ( -, -and -years). developmental perspective, the tendency of younger children to anthropomorphize hsrs could be reasonably explained by the phenomenon of animism (piaget, ) . already piaget in suggested that children younger than years tend to attribute a consciousness to objects, i.e., the phenomenon of animism, and that this fades around years of age. recently, this phenomenon has been defined as a cognitive error in children (okanda et al., ) , i.e., animism error, characterized by a lack of differentiation between living and non-living things. in this respect, several studies showed that, although children are generally able to discriminate between humans and robots, children aged - years tend to overuse animistic interpretations for inanimate things, and to attribute biological and psychological properties to robots (katayama et al., ; di dio et al., , in line with the results of this study. interestingly, we further found a difference in emotional attribution to nao between -year-olds and -and -year-old children: younger children attributed lower emotions to nao compared to the older ones. this result may seem counterintuitive in light of what we discussed above; however, by finely looking at the scores obtained from the -year-olds for each single emotional question, we found that younger children attributed significantly lower negative emotions to nao compared to the other age groups, favoring positive emotions (χ < . ). this resulted in an overall decrease of scores in the emotional dimension for the young children. therefore, not only does this result not contradict the idea of a greater tendency to anthropomorphize robots in younger children compared to older ones, but also highlights that -years-olds perceive nao as a positive entity that cannot express negative emotions such as anger, sadness, and fear: the "good" play-partner. from the age of , children's belief of the robots' mind is significantly affected by a sensitivity to the type of the robot, as shown by differences between nao and robovie on most mental dimensions, except for imaginative. the lack of differences between robots on the imaginative dimension (for all age-groups), which encompasses psychological processes like pretending, and making jokes, appears to be regarded by children as a human prerogative. interestingly, this result supports findings from a previous study (di dio et al., ) that compared -year-old children's mental state attribution to different entities (human, dog, robot, and god) . also, in that study, imagination was specific to the human entity. generally, the findings for older children indicate that the robot's appearance does affect mental state attribution to the robot, and this is increasingly evident with age. however, the judgment of older children could also be significantly influenced by the robot's behavioral characteristics, as demonstrated in figure | (a-e) children's scores on the attribution of mental states (ams) scale. ams mean scores for the human (white bar), for robovie robot (black bar), and nao robot (gray bar) for each state (perceptive, emotions, intentions and desires, imagination, and epistemic) as a function of age group ( -, -, and -year-olds). the bars represent the standard error of the mean. *indicates significant differences. the red lines indicate the differences between agents (human, robot); the blue lines indicate the differences between ages ( -, -, and -year-olds); the black lines indicate the differences between robots (robovie, nao). a long-term study conducted with children aged - years (ahmad et al., ) . in this study, children played a snakes and ladders game with a nao robot three times across days, whose behavior in terms of personality for a social robot in education was adapted to maintain and create long-term engagement and acceptance. it was found that children positively reacted to the use of the robot in education, stressing a need to implement robots that are able to adapt based on previous experiences in real time. of course, this is very much in line with the great vision of disciplines such dr (cangelosi and schlesinger, ) and dc (itakura, ) . in this respect, it is also important to consider further aspects related to the effectiveness in human relations of constructs such as understanding the perspective of others (e.g., marchetti et al., ) and empathy, on which several research groups are actively working. for example, in an exploratory study serholt et al. ( ) highlighted the perceived need both for teachers and learners to deal with robots showing such a competence. in the same vein, other studies that used robovie as an interactive partner in educational contexts, have also shown that when the robot is programed to facilitate interactional dynamics with children, it can be considered by the children as a group member and even part of the friendship circle. in these studies, the robot is typically programed to act as an effective social communicative partner using strategies, like calling children by their name, or adapting the interactive behaviors for each child by means of behavioral patterns drawn from developmental psychology (kanda et al., ; see also, kahn et al., ) . the study by kahn et al. ( ) further showed that after interacting with robovie, most children believed that robovie had mental states (e.g., was intelligent and had feelings) and was a social being (e.g., could be a friend, offer comfort, and be trusted with secrets). the above studies highlight the prospective use of robots, particularly in the educational field. however, in reality, today's robots are not yet able to sustain autonomous behavior in the long term, even though research is actively laying a good foundation for this. what we can certainly work on with direct effects on children's perception of the mental abilities of robots are their physical attributes. by outlining differences in mental states attribution to different types of humanoid robots across ages based on robots' physical appearance, our findings could help map the design of humanoid robots for children: in early ages, robots can display more abstract and mechanical features (possibly also due to the phenomenon of animism as described above); conversely, in older ages, the tendency to anthropomorphize robots is at least partially affected by the design of the robot. however, it has to be kept in mind that excessive human-likeness may be felt as uncomfortable, as suggested by findings showing that children experience less discomfort with robots displaying both human and mechanical features compared to robots whose physical features markedly evoke human ones (bumby and dautenhahn, ; woods et al., ; woods, ) . excessive resemblance to the human triggers the uncanny valley effect (the more the appearance of robots is similar to humans, the higher the sense of eeriness). these data suggest that a well-designed hsr for children should combine both human and mechanical dimensions, which, in our study, seems to be better represented by the nao robot. this study enabled us to analyze the ams to two types of hsrs, highlighting how different types of robot can evoke different attributions of mental states in children. more specifically, our findings suggest that children's age is an important factor to consider when designing a robot, and provided us with at least two important insights associated with the phenomenon of anthropomorphism from a development perspective, and the design of hsrs for children. anthropomorphism seems to be a widespread phenomenon in -year-olds, while it becomes more dependent on physical features of the robot in older children, with a preference ascribed to the nao robot that is perceived as more human-like. this effect may then influence the design of robots, which can be more flexible in terms of physical features, as with robovie, when targeted to young children. overall, our results suggest that the assessment of hsrs in terms of mental states attribution may represent a useful measure for studying the effect of different robots' design for children. however, it has to be noted that the current results involved only two types of hsrs. therefore, future studies will have to evaluate the mental attribution to a greater variety of robots by also comparing anthropomorphic and non-anthropomorphic robots, and across different cultures. in addition, in future studies it will be important to assess children's socio-cognitive abilities such as language, executive functions, and tom, to analyze the effect of these abilities on the ams to robots developmentally. finally, this study explored the mental attributions through images depicting robots. future studies should include a condition where children interact with the robots in vivo to explore the intersectional effect between the robot's physical appearance and its behavioral patterns. this would enable us to highlight the relative weight of each factor on children's perception of the robots' mental competences. the datasets generated for this study are available on request to the corresponding author. the studies involving human participants were reviewed and approved by the ethic committee, università cattolica del sacro cuore, milano, italy. written informed consent to participate in this study was provided by the participants' legal guardian/next of kin. all the authors conceived and designed the experiment. fm and gp conducted the experiments in schools. am, fm, and gp secured ethical approval. fm and cdd carried out the statistical analyses. all authors contributed to the writing of the manuscript. this publication was granted by università cattolica del sacro cuore of milan. children views' on social robot's adaptations in education the cognitive bases of anthropomorphism: from relatedness to empathy measuring the anthropomorphism, animacy, likeability, perceived intelligence and perceived safety of robots a design-centered framework for social human-robot interaction does the design of a robot influence its animacy and perceived intelligence? 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(± . ) and . (± . ), respectively. the domain of anxiety/depression had the highest proportion of reporting any problems among dimensions of eq- d- l ( . %). being female, having chronic conditions and living in the family with – members were associated with lower hrqol scores. a comprehensive assessment of the influence of covid- along with public health interventions, especially mental health programs, should be implemented to mitigate the negative effects of this pandemic on the economic status and quality of life of citizens. emerging from december in wuhan, china, coronavirus disease has posed one of the greatest challenge to humankind within years since world war two (undp, ) . as of july , , there have been more than million confirmed cases and , people lost their lives because of severe acute respiratory syndrome coronavirus (sars-cov- ) (johns hopkins university, ). while a specific treatment for this disease is still lacking (harvard medical school, ) , the world health organization recommended that every nation plan and take comprehensive public health actions to suppress the spread of covid- (who, ) . in addition to medical-related measures such as testing and treating for patients, most countries are implementing temporary mobility restriction, social distancing, and large-scale gathering cancelation. these strategies have shown their effectiveness in slowing the transmission speed of sars-cov- , however, they also have side effects on many aspects of citizen's lives (undp, ) . the international labor organization estimates that million jobs could be lost in the second quarter of as a result of covid- (international labour organization, ) . more than . billion students have been affected by the closure of educational institutions, reported by the united nations educational scientific and cultural organization (unesco, ) . people living in poverty, the elderly, youth, and indigenous persons are among the most vulnerable population in terms of suffering detrimental effects from the sars-cov- virus (undesa, ) . it is imperative for every government to implement impact mitigation programs, not only interventions for healthcare or business but also consider improving both socioeconomic status and quality of life (qol) of the general population, especially the vulnerable groups. a pandemic can cause economic disruption in different ways. human behavioral changes, such as fear-induced aversion to places of work and public gatherings, are a major cause of economic damage, besides the impact of mitigation measures (madhav et al., ) . previous literature has documented the negative effects of different pandemics on the family income of residents. wuqi qui et al. conducted a case comparison study in china and concluded that the severe acute respiratory syndrome (sars) epidemic caused the average annual revenue of households to fall to us$ . , . % below what was anticipated, whereas the h n pandemic had a less severe impact on the economy in comparison with sars (qiu et al., ) . the ebola epidemic, which mostly occurred in africa, was reported to cause massive income deficits in numerous countries of this continent. within just months, this disease had resulted in a significant amount of household income loss in liberia ( . %) and sierra leone ( . %) (undp, ) with the rates of reporting a decline in family income of % (mercy corps, ) and . % (michael et al., ) . in terms of covid- impact on household income, a recent survey in late march with , respondents from g countries has indicated that % of participants reported that "coronavirus has already impacted my household income" and % thought that "coronavirus has not yet impacted my household income, but i expect it to in the future" (duffin, ) . while in india, the proportion of people reporting a decline in income escalated from % in late february to . % in mid-april (keelery, ) . however, the magnitude of the economic loss for each household due to sars-cov- has not been fully understood; therefore, more studies are needed to fill this gap. in addition to causing severe consequences on the economy, covid- also produced negative effects on the quality of life of residents, yet there are few studies on this topic and they only focus on a specific subject, not the general public. a study in italy using a questionnaire to measure health-related quality of life (hrqol) of adults with common variable immune deficiency (cvid_qol) has illustrated that covid- disease generated negative effects on health-related quality of life and the risk of anxiety/depression among primary antibody deficiencies patients (pulvirenti et al., ) . utilizing -item short form survey (sf- ) to determine the influence of covid- on health-related quality of life among people with suspected covid- symptoms (s-covid- -s) from provinces of vietnam, hoang et al. concluded that participants with s-covid- -s had a lower hrqol-score (b, − . ; p < . ) than those without s-covid- -s . to date, there is a lack of study using the standardized toolkit for measuring the impact of sars-cov- on qol of the general population. vietnam is among the most vulnerable countries to covid- on both economic and health aspects. the vietnamese economy heavily relies on china as china is currently the second largest export market of this country and production in vietnam always depends on imported raw materials, primarily from china (vietnamcredit, ). on health perspective, because of sharing a long border with china and limited healthcare resources, vietnam had a higher likelihood of having covid- imported cases as well as high risk of large-scale community transmission (vietnamcredit, ; ebbighausen, ; fleming, ) . although having a small number of confirmed cases and zero deaths related to covid- , the vietnamese government decided to impose the nationwide partial lockdown at the early stage, starting from april st, . this strategy has shown the effectiveness in stopping the spread of covid- (vu and tran, ) , however, it is freezing the economy and producing adverse impacts on inhabitants' life. this study targets to provide empirical evidence about the influence of this national social distancing on quality of life and household income of vietnamese citizens avid covid- , with the ultimate goal to inform the policymakers to take appropriate and timely actions for controlling the disease while ensuring both health and socioeconomic wellbeing of the general population. a cross-sectional study using a web-based approach on qualified, well-known surveymonkey platform was conducted from april - , , week after the first national partial lockdown was imposed by the government of vietnam. during this time interval, all vietnamese people were told to stay indoors and could only go out for essential services, such as buying food, medicine, and other emergency case. the citizens were required to maintain a two-meter distance between individuals; gathering in groups of more than two people in public places were prohibited; and all non-essential business were shut down (vov, ) . this maximum social distancing strategy was implemented in the second stage of fighting covid- in this country with most of the cases imported from overseas and community transmission emerged (le, ; manh and dinh, ) . the inclusion criteria of respondents in our study including ( ) agreeing to participate in the study by approving the online consent form; ( ) having the ability to access the online questionnaire; ( ) having full capacity to answer the questions. participants were recruited by snowball sampling technique. initially, a core group of members including lecturers, students, and staff from hanoi medical university was set up. these persons had a higher probability of knowing other individuals from other medical universities and health facilities in vietnam. this group was selected to reflect the diversity of research subjects, for example age, gender, educational level, and occupation throughout the country. core-group members accessed the survey link via their computers, tablets, or smartphones and shared research invitation to their relatives and friends through email or social media. after people completed the questionnaire, they were encouraged to spread the link of the online survey to invite others residing in all regions of vietnam to join. a total of respondents involved in our study after week of collecting data. a structured questionnaire was developed based on the validated tools and piloted on lecturers and students of hanoi medical university prior to the data collection throughout vietnam. the information collected from this survey included: socio-economic data included age, gender, living area, marital status, living area, religion, family size, educational level, occupation, employment status, and having health insurance. the impact of covid- on household income was examined by two questions: ( ) "how has your family's monthly income changed due to the impact of covid- ?" with three answer options (a) decreased; (b) increased; (c) unchanged; ( ) "please estimate the percentage of your family income's change compared with the month before covid- started to occur in vietnam?" with six choices of answering: (a) %; (b) < %; (c) - %; (d) - %; (e) - %; and (f) - %. people were classified in "changed income" if they reported their income as "decreased" or "increased." respondents were classified "no income change" if they replied their income "unchanged" under the impact of covid- . respondents also reported the influence of this pandemic on their jobs, which is classified in options including ( ) fired; ( ) reduce working hours/shifts; ( ) have to work overtime; and ( ) no effect. the health condition of participants was investigated based on criteria: having outpatient examinations in the last days; having covid- test in the last days; being isolated in the last days; having chronic conditions. in this study, we chose the euroqol dimensions levels (eq- d- l), which is a short, simple, validated questionnaire, and widely used in vietnam for measuring the hrqol of the general population. this tool comprises of five domains including mobility, self-care, usual activities, pain/discomfort, and anxiety/depression, which are assessed under levels of answer from no problems (code ) to extreme problems (code ). the responses of each dimension were incorporated to determine the health state of participants with representing the best health and meaning the worst health. each health state interpreted in one single "utility" score, which can be converted by using the interim scoring for the eq- d- l (euroqol research foundation, ). in the present study, we utilized the vietnamese value set with the score ranging from - . to (mai et al., ) . in addition, another element of eq- d- l is euroqol visual analogue scale (eq-vas), was also used for participants to self-rate their health with the value ranging from (worst imaginable health) to (best imaginable health) (euroqol research foundation, ). the recall period for both eq- d- l and eq-vas was "today" -the day that respondents answered the online questionnaire. the extracted data from the online survey were analyzed by stata . software. we described data characteristics that covered frequency, percent, mean, and standard deviation. to compare differences between people having household income change due to the impact of covid- and people who were not affected, we used t-test or mann whitney test for ordinal variables and fisher-exact test or chi-square test for nominal variables. ordered logistic regression was employed to examine factors correlated with the impact of covid- on respondents' family income. a multivariable tobit regression model was applied to identify factors associated with hrqol score. a forward stepwise strategy was applied to obtain the final regression model with a threshold of the p-value is less than . . a p-value of less than . was considered as statistical significance. the institutional review board of institute for preventive medicine and public health, hanoi medical university, approved the protocol of this study (code. qd /qd-yhdp&yhdp dated march ). the research' objectives and informed consent were provided on the online survey at the first page before the respondents make a decision to participate or not. no incentives were provided to participants and they could withdraw from the survey at any time. the respondents' information was kept confidentially and was only for research purposes. of participants with a mean age of . , the majority of them were female ( . %), living in northern vietnam ( . %) with a family size of - people ( . %), no religion ( %), holding undergraduate degrees ( %), having fulltime jobs ( . %) and having health insurance ( . %). in terms of occupation, students registered the highest proportion ( . %), followed by white-collar workers ( . %) and health professionals ( . %) ( table ) . table shows that most of the respondents reported a decline in household income ( . %), and only one person replied that there was an increase in family income because of covid- . among those having a decreased income, the change level at under % accounted for the highest proportion ( . %), and the lowest went to - % ( . %). more than half of people ( . %) answered that covid- had no impact on their occupational status, while . % had a reduction in working hours/shifts, and . % lost their jobs as a result of sars-cov- . it can be seen from table that in the last days, only . % of participants reported outpatient examinations, . % sars-cov- testing, and % being separated from the other people. there were . % of respondents living with chronic diseases, including hypertension ( . %), diabetes ( . %), and others. the mean score of eq- d and eq-vas was . (± . ) and . (± . ), respectively. participants with family income changed due to covid- had a significantly lower score of eq- d ( . ± . ) than the remaining group ( . ± . ) (p = . ). among dimensions of the eq- d- l scale, the aspect with the highest proportion of having any problems was anxiety/depression ( . %), followed by pain/discomfort ( . %), usual activities ( . %), while the lowest percentage went to self-care ( . %). a significant difference was found in the rate of having any problems in anxiety/depression between people with household income changed because of covid- ( . %) and those with no income change ( . %) (p < . ). table indicated some associated factors with the change of household income and quality of life among participants due to covid- . the family income of people having health insurance (or = . ; % ci = . ; . ) and being years and above were less likely to be affected, whereas persons with undergraduate degree (or = . ; % ci = . ; . ), working in other sectors rather than healthcare (or = . ; % ci = . ; . ), and having definite-term contract (or = . ; % ci = . ; . ) had a higher likelihood of income reduction. participants having chronic diseases were significantly associated with lower quality of life in both eq- d index (coefficient = − . ; % ci = − . ; − . ) and eq-vas (coefficient = − . ; % ci = − . ; − . ). respondents being female (coefficient = − . ; % ci = − . ; − . ) and living with family of - people (coefficient = − . ; % ci = - . ; − . ) had a lower qol likelihood in terms of eq-vas scale. our study featured a high rate of household income loss as well as impairment on some quality of life domains among the general population in vietnam due to the impact of the covid- pandemic. we also found some potential factors associated with the change in family earnings and qol of vietnamese citizens, implying for future interventions and programs to enhance the socioeconomic status and well-being of the residents suffering from the epidemic in resource-constrained settings. the findings of this research showed that more than twothirds ( . %) of vietnamese participants reporting a reduction in their family income as a result of covid- . this figure is higher than those in india ( . %) (keelery, ) and g countries ( %) (duffin, ) . the disparity could be attributable to the difference in economic structures and major markets between countries. the economy of vietnam heavily relied on exports, whereas china is the second largest export destination and the main consumer of agriculture products of this country (b&company, ; the observatory of economic complexity, ). the magnitude of income deficit due to covid- is the new contribution of our study to enrich the evidence related to the influence of sars-cov- on the economic status of the general public. based on the assessment of household revenue damage stated by all respondents, we understand that this disease caused disparate (qiu et al., ) , the ebola in african countries caused the deficit in -month household income in liberia and sierra leone of . and . %, respectively (undp, ). hence, our study suggested a new direction for future research, which is discovering the influence magnitude of pandemics on the economic well-being of the general population. in the current study, the family income of people holding undergraduate degrees, working in other sectors rather than healthcare, and having definite-term contracts had a higher likelihood of being changed as a result of covid- . this may be due to the downsizing or closure of businesses following the requirement of strict social distancing in vietnam. according to the estimation by the general statistics office of vietnam, as of mid-april , nearly million people have lost their jobs because of this epidemic (nguyen, ) . the most affected sectors are tourism, services, aviation, transportation, leather, and footwear (trong quynh, ). to mitigate the economic impact of this pandemic, on april th, , the prime minister of vietnam has approved the relief packet of us $ . billion, targeting about . million victims who are hardest hit by covid- (minh, ; vietnam news, ) . however, the main beneficiaries of this policy are mostly the poor and near-poor, people with records of meritorious services to the country, household businesses, employers, freelance labors and blue-collar workers, and the list of recipients only based on the reports from local authorities (prime minister, ), while employees with higher educational degrees seemed to be neglected. scientific evidence is still lacking to advise this policy and our research was one of the first studies to contribute important information for decision-makers to consider their actions. as our finding had pointed out, the income of employees having advanced education even more affected than those only have high school diplomas or lower, therefore, the policymakers should develop appropriate strategies to reduce the inequality in accessing financial support during the time of covid- . regarding the quality of life aspect, the average score of eq- d index ( . ) and eq-vas ( . ) calculated from our study were consistent with previous research among the general population of vietnam in the context without the influence of pandemic ( . and . , respectively), however, the rate of having anxiety/depression in this study ( . %) was much higher than that in the compared research ( . %) (nguyen et al., ) . banned outdoor recreation, fear of being infected sars-cov- , and concerns of impact of this disease might be the reasons leading to a higher proportion of anxiety/depression in our study. other studies in china also emphasized the high prevalence of mental health disorders among the general public under the influence of covid- (huang and zhao, ; ni et al., ; wang c. et al., ; wang y. et al., b) . this high rate calls for the implementation of mental health strategies to minimize the negative impact of this disease on the mental health of residents (ho et al., ) . on the other hand, our analysis reveals that those being women and having chronic conditions were found to have lower hrqol scores, which was in line with previous studies (ha et al., ; nguyen et al., nguyen et al., , pham et al., ) . the participants living in a family with - members had a higher risk of impaired qol than those in households with a smaller size. the possible explanation is that during the nationwide partial lockdown, people were forced to stay at home and had no income to pay for living expenses; thus, the more people in the family, the higher the financial burden. several implications can be derived from our study. first, as our study provided preliminary findings at the early stage of national partial lockdown in vietnam, it is critically necessary to have a comprehensive assessment on the effect of covid- among different subjects in the next periods which can inform the government on policies for easing economic pain of the most affected populations. second, public health interventions, especially mental health programs, should be implemented to address the psychological impacts of this pandemic on the quality of life of the general population. finally, the evidence from our study can contribute to the development of more effective preparedness and response strategies to diminish the impact of future pandemics in vietnam and other low-and middleincome countries. the interpretations of the findings from our study should consider the following limitations. since the authors did not collect the information on how many people the respondents have invited to participate in this survey, and it is possible that several individuals may invite the same person, we were not able to know exactly the number of people actually invited and the response rate in this online survey. the nature of the crosssectional study restricts the ability to draw the causal relationship between the change in household income, quality of life, and their associated factors. the online survey could be seen as one of the best methods to collect data from a large sample size with low cost and time-saving, however, the disadvantages of this approach are possible bias of self-report and high homogeneity of data as no strict supervision is performed. another consideration is the small sample size, which limits the generalizability for the other populations. despite the above restraints, our research has some strengths that should be acknowledged. in the context of the national lockdown to be implemented for the first time in vietnam, this paper provided up-to-the-minute evidence for the vietnamese government and other low-resource settings to develop timely strategies to minimize the impact of covid- pandemic on socioeconomic status and well-being of their citizens. moreover, utilizing standard tools (eq- d, eq-vas) to measure the quality of life of people has increased the validity of this study. in conclusion, this study depicted a high rate of household income loss as well as impairment on some quality of life domains among the general population in vietnam due to the impact of covid- . it is critically necessary to have a comprehensive assessment of the effect of covid- among different subjects in the next periods, which can inform the government to impose suitable policies for easing economic pain of the most affected populations. public health interventions, especially mental health programs, should be implemented to address the psychological impacts of this pandemic on the quality of life of citizens. the raw data supporting the conclusions of this article will be made available by the authors, without undue reservation, to any qualified researcher. the studies involving human participants were reviewed and approved by the institutional review board of institute for preventive medicine and public health, hanoi medical university. the patients/participants provided their written informed 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mental health of general population during the covid- epidemic in china study on the public psychological states and its related factors during the outbreak of coronavirus disease (covid- ) in some regions of china covid- strategy update key: cord- - qajibci authors: mcalaney, john; hills, peter j. title: understanding phishing email processing and perceived trustworthiness through eye tracking date: - - journal: front psychol doi: . /fpsyg. . sha: doc_id: cord_uid: qajibci social engineering attacks in the form of phishing emails represent one of the biggest risks to cybersecurity. there is a lack of research on how the common elements of phishing emails, such as the presence of misspellings and the use of urgency and threatening language, influences how the email is processed and judged by individuals. eye tracking technology may provide insight into this. in this exploratory study a sample of participants viewed a series of emails with or without indicators associated with phishing emails, whilst their eye movements were recorded using a smi red eye-tracker. participants were also asked to give a numerical rating of how trustworthy they deemed each email to be. overall, it was found that participants looked more frequently at the indicators associated with phishing than would be expected by chance but spent less overall time viewing these elements than would be expected by chance. the emails that included indicators associated with phishing were rated as less trustworthy on average, with the presence of misspellings or threatening language being associated with the lowest trustworthiness ratings. in addition, it was noted that phishing indicators relating to threatening language or urgency were viewed before misspellings. however, there was no significant interaction between the trustworthiness ratings of the emails and the amount of scanning time for phishing indicators within the emails. these results suggest that there is a complex relationship between the presence of indicators associated with phishing within an email and how trustworthy that email is judged to be. this study also demonstrates that eye tracking technology is a feasible method with which to identify and record how phishing emails are processed visually by individuals, which may contribute toward the design of future mitigation approaches. internet browsers, email systems and other socio-technical systems require input from individual users. such systems may be designed in a way that aims to protect users and organizations from external attackers as much as is possible (das et al., ) . how successful they are in doing so is highly reliant on the user (pfeffel et al., ) . the user may not fully attend to the cues and prompts that the system provides them with to encourage them to use the system in a safe way (miyamoto et al., ) . similarly, users may fail to detect and respond to potential threats, even if the system provides prominent indicators of these threats (miyamoto et al., ) . an example of this is phishing websites, links to which are sent to potential victims through phishing emails. phishing emails are one form of social engineering, which refers to the use of manipulation and trickery to cause an individual to gain sensitive information or access to a system (hadnagy, ) . this type of attack has been described as the single biggest threat to cybersecurity (salahdine and kaabouch, ) . individuals who engage in cyber-crime do not need to possess programming or technological skills in order to be able to create phishing emails; software packages that can be used to create phishing emails can be downloaded online (mccalley et al., ) . this reliance on user engagement in many sociotechnical systems is potentially problematic. as is well established in psychological research people often do not fully processes all the information that is available to them in any given situation (gigerenzer and brighton, ) . that is, people are not always rationale decision makers. instead they make use of decisionmaking heuristics, a form of a mental shortcut, to come to a quick decision based on a limited number of cues. this is known as the cognitive miser approach and contrasts with the naïve scientist approach in which individuals make decisions based on a more comprehensive and thorough evaluation of the information available (fiske and taylor, ) . it has been argued that people are motivated tacticians, in which whether they apply a cognitive miser or naïve scientist approach is in part determined by the urgency, perceived importance and complexity of the situation (kruglanski, ) . this strategy reflects limitations in how much information individuals can process at any one time. if we were to attempt to fully process all the information that is available in every situation, we encounter each day, as in the naïve scientist approach, then this would become extremely time consuming (sweller, ) . on the other hand, using the cognitive miser approach may be quicker and less cognitively demanding, but is at greater risk of error, as the individual is basing their decision on a limited number of factors. as such individuals switch between strategies based on which they think will be the most optimal for the situation they are facing, an approach which will not always necessarily be correct (gigerenzer and brighton, ). the tactics used by social engineers are often based on exploiting heuristics, by including elements that encourage the target to engage the cognitive miser approach and make quick, less analytical decisions (hadnagy, ) . examples of this within the social engineering technique of phishing emails can include the use of language that contains emotive elements such as threat, urgency, or financial information (hadnagy, ) . however, research connecting information processing to the characteristics of phishing emails is lacking. to fully understand how an individual engages with aspects of a socio-technical system such as phishing emails it is necessary therefore to explore how much and what information they are processing. one way in which this can be achieved is through eye trackers. eye tracking technologies are used to measure an individual's eye movements and in turn to determine what they are looking at. this is known as the point of regard and is an indication of where the individual's attention lies. by measuring several factors such as duration of fixations (when the eyes are relatively stationary), the length of saccades (when the eyes move between areas of interest), number of regressions (where the eyes return to a previously fixated point) inferences can be made about much cognitive processing the individual is giving to any part of the stimulus. this information can be combined to explore the scanpath. this refers to the sequence of fixations and eye movements over an image. for example, an eye tracker may be used to determine the scanpath of an individual viewing a web page, which could provide information about the order in which the individual views different parts of the website. this approach has been used extensively in human-computer interaction studies, such as to assess website usability (cowen et al., ) . related technologies can also be used to measure pupil dilation and blink rate, which can measure cognitive overload and fatigue, respectively (stern et al., ; hossain and yeasin, ) . this can be used to help identify possible risk factors, such as if an individual may not be fully processing information being delivered by a complex or sensitive system. a range of techniques have been used to record eye movements for research since work began in the early th century, including methods such as attaching electrodes to the skin around the eye or using contact lenses with an embedded metal coil that can be used to detect eye movements (poole and ball, ) . more recent technologies are less invasive and often involve use of an infra-red camera to infer point-of-regard from the reflection that is given from the cornea, which is the outermost layer of the eye. these cameras can be placed beneath or next to a computer monitor in a way that is unobtrusive. mobile eye trackers operate using the same principles but are worn in the same manner as a pair of spectacles, which allows for the individual to navigate their environment in a naturalistic style (cristina and camilleri, ) . in the case of cybersecurity this could for instance involve exploring what a social engineer pays attention to when entering the reception area of a company, such as the location of security cameras or the presence of a pc at the reception desk. this technology has been used to understand user behavior in relation to phishing websites. these are fraudulent websites designed to appear as genuine website, such as for example an internet banking page. research suggests that only a quarter of people can reliably discriminate between genuine websites and fraudulent websites more than % of the time (iuga et al., ) . technological approaches such as spam filters and machine learning may mitigate some of the risk posed by phishing attacks, but it has been argued that technology alone cannot completely prevent this issue (pfeffel et al., ) . this highlights the need to better understand the mechanisms behind a successful phishing attack. by using eye tracking it is possible to explore what factors predict whether someone will be tricked by a phishing website, by considering the interaction between the structure of the website and what the person looks at, or indeed fails to look at (miyamoto et al., ) . this has been used for example to understand how and if users pay attention to web browser security indicators, such as the firefox mozilla ssl certificate (sobey et al., ) . research in this areas has revealed several techniques that have been identified in such phishing websites (darwish and bataineh, ) each of which can be researched through the use of eye tracking (miyamoto et al., ) . this includes the use of similar or related domain names (e.g., replacing a "w" in a website address with a "vv"), the use of high quality of animations to give fraudulent websites a professional feel and the presentation of fake digital certificates. further uses of eye tracking in cybersecurity have become evident as the research field and technology have continued to develop. for instance it has been demonstrated that the technology can be used to change risky behaviors, such as for example by preventing a user from continuing with use of input forms in a website unless an eye tracker has determined that the individual has looked at the address bar (miyamoto et al., ) . similarly, eye trackers can be used to detect anomalous user behavior. the way in which an individual navigates a system that they are highly familiar with will be different from someone who is less familiar with a system: from work on expertise in visual processing (miyamoto et al., ) . eye movement patterns are highly specialized and detectable when viewing scenes and objects that we are experts at processing (liversedge et al., ) . this difference in style will be reflected in eye movements, and could be used as a basis for detecting illicit behavior (biedert et al., ) . recently it has been claimed that eye tracking machines themselves may not be necessary, and that webcams built into phones, laptops and tablets may be sufficient (krafka et al., ) for many of the purposes discussed here. if this is the case, then it removes a major barrier for the adoption of eye tracking related cybersecurity measures in real life situations such as the workplace. as has been noted any technology that is used to protect users from cyber-attack is most effective then it is unobtrusive (miyamoto et al., ) . whilst there has been research using eye trackers to understand engagement with phishing website there is less research applying this technology to phishing emails (baki et al., ) , which are one vector through which targets may be directed to a phishing website in the first instance. there are recommendations made to the public by various organizations around what is likely to denote something as being a phishing email, such as the national cyber security centre advice to look for misspellings, the use of urgency and the use of threatening language (national cyber security centre, ), which reflects the typical features of phishing emails identified in the literature (pfeffel et al., ) . there is a lack of academic research that has explored the relationship between these features, including how trustworthy such emails are rated and how eye-movements may moderate this relationship. to address this we conducted an exploratory study in which we created phishing emails that employed characteristics and techniques evident in phishing emails, including the presence of misspellings in the sender address, the mention of financial information, the use of threatening language (for example that legal action will be taken if an email is not responded to) and the use of urgency. twenty-two psychology undergraduates ( % female, age range = to , mean age = . ) were recruited from a sample responding to an online advertisement. participants were awarded course credits for their participation. a within-subjects design was employed in which participants were shown emails that either did or did not include a phishing indicator. there were four types of phishing indicator: financial information, urgency, misspelling, and threat. stimuli were presented in a random order. eye-tracking measures used were total dwell time, mean fixation count (denoting interest in a particular content), number of regressions (revisits, indicating that the item required further scrutiny because it drew attention), mean glance duration (denoting depth of processing), entry time and entry sequence (the time and fixation number that an area was attended to, denoting ease of attentional capture). thirty-two emails were constructed based upon typical phishing type emails. these were split between the four types of email (misspelling, threatening, urgency, and financial) with four variations of each email type and either containing the phishing email indicator or not. this reflected the elements identified in public guidance from the national cyber security centre on what may be an indicator that an email is a phishing one (national cyber security centre, ). these emails were created by the researchers to be relevant to the study sample in terms of names of local organizations and national companies that the email purported to have been sent from. a publicly accessible database of suspected phishing emails was used to guide the creation of the study materials to ensure that these were consistent with phishing emails currently in circulation. the phishing emails created in this study were simple word documents structured according to emails in microsoft outlook. these contained a from line with email address, a subject line, the main content with roughly four sentences of text and a by-line. areas of interest (aois) were mapped onto the emails post hoc in begaze. this software is used to specify the areas of an image upon which the analysis will be based. these areas of interest were non-overlapping and focused on the core textual information. aois were: the email address, subject line, the addressee, the instruction line, any detail (hyperlinks, tracking numbers), and the phishing indicator (financial information, misspelling, threat, and urgency). aois were invisible to participants. stimuli were presented on an smi red eye-tracker with in-built infrared cameras detecting eye movements. the screen was a -inch high-resolution lcd. eye movements were recorded at hz with an accuracy of . • of visual angle using smi iview. piloting was conducted with a sample of postgraduate research students. the purpose of this was to test the feasibility of using the eye tracker facilities for the intended purposes of the study. these trials involved participants using the same equipment to view examples of phishing emails. these emails were not split by type and participants were not asked to provide any rating of the emails. no technological or methodological problems were identified during this piloting phase. once piloting was completed the main study commenced. after providing informed consent, participants were told that they would be viewing a series of emails and that they would be asked to give a rating of how trustworthy they felt each email appeared to be. participants' eyes were then calibrated to the eye tracker using the standard in-built -point calibration procedure. following calibration, the eye tracking was validated, to ensure consistent and accurate tracking. validation consisted of the standard smi calibration and validation procedure. participants were requested to follow a ball around to -pseudo random locations around the screen. calibration was considered successful if the eyes were calibrated within • of visual angle. if calibration failed, the participant was recalibrated once, otherwise they were removed from the analysis. the calibration was validated using the default procedure -participants eyes fixated on the center of the screen and if this was recording accurately, the trial proceeded. this validation was repeated after every trials. following this, participants began the experimental task. there were identical trials. in each trial, participants saw a blank fixation screen lasting ms. following this, participants saw the email. for each, participants were tasked with reading the email ready to rate it for trustability. each email was on screen for s. this time was chosen to represent the rather short amount of time that is devoted to reading each email that individuals receive (hart, ) . after the email, participants were given the rating screen, in which they were visually asked to rate how trustworthy the preceding email was on an -point likert-type scale with the anchor points "not at all trustworthy" and "highly trustworthy." participants notified the researcher verbally of their choice, who then entered their answer into a numerical keypad. this was done to avoid unnecessary head movements by the participant. following completion of all trials, participants were thanked and debriefed. we assessed first whether the aoi containing the phishing indicator was scanned. to assess this, we analyzed whether the phishing indicator aoi was scanned more than would be expected by chance. for this, we ran a series of bonferronicorrected (α = . ) one-subjects t-tests (two-tailed) comparing to a chance value for the region (which was based on the aoi size relative to the size of the screen). secondly, we analyzed the amount of scanning to the other aois with and without the phishing indicator. because the aois filled proportionally less of the screen in the phishing frontiers in psychology | www.frontiersin.org indicator present conditions, we area-normalized the aois by calculating the proportion of the screen that the aois occupied in each screen. our secondary analysis concerned which type of phishing indicator was most detectable. this was assessed with a oneway-anova on the area-normalized phishing aois. for all analyses, the assumptions of parametric data were tested: whenever mauchley's test of sphericity was significant, the huynh-feldt correction was applied to the degrees of freedom. if tests of normality were violated, a non-parametric test was used. for post hoc tests, the p-values were adjusted for multiple comparisons. figures - show a series of heat maps indicating where participants scanned images, split into the four pairs of emails either with or without the phishing email indicator (financial information, misspelling, threat, and urgency). we present an example of each category of phishing email with and without the phishing content for ease of understanding. our analysis protocol was applied, and summary statistics for the one-sample t-tests are shown in table . specifically, these results show that while the phishing aois were scanned (denoted by fixation count) and revisited (regression count) more frequently with more intense scanning (glance duration) than one would expect by chance, the total duration of scanning (dwell time) was less then would be expected by chance. in other words, less time was spent viewing the phishing indicators even though they required greater attentional resources paid to them. our second analysis focused on exploring whether the presence of the phishing indicator affected the scanning of the other content. the presence of each type of phishing indicator did not significantly affect normalized dwell time, f( , ) = . , mse = , p = . , η p < . . figure shows the mean dwell duration to each of the area-normalized aois for those with and without the phishing content. our final analysis concerned which type of phishing indicator would be more noticeable. table specifically, financial indicators were viewed for less time than threat indicators (mean difference = , p = . , r = . ) and urgency indicators (mean difference = , p = . , r = . ). further, they were viewed less frequently with less regressions than threatening indicators (mean difference fixationcount = . , p < . , r = . , mean difference regressioncount = . , p < . , r = . ) and urgency indicators (mean difference fixationcount = . , p < . , r = . , mean difference regressioncount = . , p < . , r = . ). glance duration was shorter for threat indicators than financial indicators (mean difference = . , p = . , r = . ). threat and urgency indicators were viewed earlier than misspelling indicators (threat: mean difference entrytime = p < . , r = . , mean difference sequence = . , p < . , r = . ; urgency: mean difference entry time = , p < . , r = . and mean difference sequence = . , p = . , r = . ). a further set of analyses were run on the trustability ratings, shown in figure . these were subjected to a × within-subjects anova. this revealed a main effect of phishing indicator, f( , ) = . , mse = . , p < . , η p = . . emails with misspelling and threatening phishing indicators were rated as less trustworthy than financial (mean difference = . , p < . , r = . , mean difference = . , p < . , r = . ) and urgency (mean difference = . , p < . , r = . , mean difference = . , p = . , r = . ) scams. there was also a main effect of presence of phishing indicator, finally, we assessed whether the trustability rating influenced the amount of scanning to the phishing indicators of the emails. we used two protocols to assess this. in the first we ran a series of correlations between the dwell time for each email type and the trustability rating given. none of these correlations were significant: financial phishing indicators, r( ) = . , p = . ; misspelling, r( ) = − . , p = . ; threat, r( ) = . , p = . ; and urgency, r( ) = − . , p = . . in the second, we analyzed whether dwell time to the phishing indicator item was different for emails rated as trustable (scoring higher than ) compared to those rated as untrustable (rated or lower) split by type of phishing indicator, shown in figure . this analysis was done by-item. the resulting × mixed anova showed no significant effect of trustability, f( , ) = . , mse = , p = . , η p = . , nor an interaction with phishing indicator type, f( , ) = . mse = , p = . , η p = . . the results of the study were notable in several ways. participants spent less time overall looking at indicators of phishing than they would be expected to by chance. in addition, the presence of phishing indicators did not significantly impact on how much time is spent looking at the rest of the email. overall, this may suggest that individuals require little processing time to recognize elements that relate to phishing. the phishing variants of each email were also rated as being less trustworthy than the non-phishing variants, suggesting that participants have some ability to recognize that the selected features are associated with fraudulent emails. yet there was no statistically significant association between the trustworthiness rating and the total scanning time for the phishing indicators within the emails. as such whilst emails with phishing indicators were rated as less trustworthy than those without, this does not appear to be explained by how much time is spent attending to those phishing indicators. this makes it unclear whether the features of phishing emails that would appear to be designed to capture attention, exploit heuristics and invoke a cognitive miser style of processing are achieving this. an interpretation of this could be that the relationship between the presence of features related to phishing emails and how trustworthy that email is seen to be is more complex than expected. similar unexpected, complex and inconsistent results have been found in relation to susceptibility to phishing emails and other factors including personality, knowledge of computers and gender (kleitman et al., ) . other aspects of the results were more in keeping with previous research. for instance, it was noted that participants would tend to look first at phishing indicators relating to urgency and threats before looking at misspellings and financial information. this could be a reflection of survival information bias (nairne, ) , in which individuals place priority on processing information that may relates to their well-being. emails containing misspelling were also rated as being less trustworthy than the other emails, which may be due to the presence of misspelling being a more categorical factor than the use of urgency or threatening language, which are open to interpretation. financial phishing email indicators were associated with the least frequent number of fixations and the least amount of overall dwell time, as compared to the phishing indicators in the misspelling, urgency, and threat email variations. emails with financial phishing indicators were also rated as being more trustworthy than emails with misspelling or threat phishing indicators. this suggests that the inclusion of financial information within phishing emails has a lower impact of how that email is processed and to what degree it is trusted. there were limitations to this study. a relatively small sample size was used, although this is not atypical when compared to other eye-tracking studies (tecce et al., ; libben and titone, ; choi et al., ) . while the sample size was consistent with previous eye-tracking research, it is not sufficient to explore individual variability in how well eye movements predict ability to spot phishing emails. further recruitment of participants was not possible due to constraints caused by the covid- situation. the participants consisted of a narrow demographic from a single geographical location. the sample was also predominantly female. there is no evidence of gender differences in eye movements (klein and ettinger, ) and a lack of consistent research on the role of gender in phishing email susceptibility (kleitman et al., ) . nevertheless, having a more diverse sample may help identify if there are certain types of phishing email that are more impactful on different demographic groups. due to the limited research in this area there was also a lack of baseline evidence to use to inform the creation of phishing email materials. examples of phishing emails available on websites such as www.phishtank.com are not ideally suited to experimental designs, as they often include conflation of different phishing techniques, such as a combination of threat and urgency. we opted to create our own stimuli in this study to reduce the influence of such possible confounders, however, it is difficult to do so completely whilst keeping the stimuli realistic. further refinement of these stimuli may also help clarify the relationship between content and how phishing emails are read and judged. finally, we note that asking participants to provide a trustworthiness rating of the stimuli may have alerted them that the study related to phishing emails. as demonstrated by parsons et al. ( ) participants may be more successful at identifying phishing emails when they are aware in advance that they may be about to do so. the results of this study demonstrate some important points. it provides evidence that eye tracking technology can be used to determine whether people look at the common indicators of phishing emails, and also inform us on the order in which these are attended to. in doing so it also demonstrated some unexpected patterns, including that individuals look at phishing indicators more frequently than would be expected by chance but, counterintuitively, spend less overall time doing so than would be expected by chance. building upon this research may provide more avenues for the understanding and mitigation of the serious threat that phishing emails pose to cybersecurity. the datasets generated for this study are available on request to the corresponding author. the studies involving human participants were reviewed and approved by the science, technology & health research ethics panel, bournemouth university. the patients/participants provided their written informed consent to participate in this study. jm contributed to the content relating to phishing emails and social engineering. ph contributed to the content on eye-tracking technology and led the analysis. all authors contributed to the article and approved the submitted version. scaling and effectiveness of email masquerade attacks: exploiting natural language generation stimuli for gaze based intrusion detection effects of word predictability and preview lexicality on eye movements during reading: a comparison between young and older adults an eye movement analysis of web page usability unobtrusive and pervasive video-based eye-gaze tracking eye tracking analysis of browser security indicators sok: a comprehensive reexamination of phishing research from the security perspective social cognition: from brains to culture, nd edn homo heuristicus: why biased minds make better inferences social engineering: the science of human hacking average email reading time increase understanding effects of cognitive load from pupillary responses using hilbert analytic phase baiting the hook: factors impacting susceptibility to phishing attacks eye movement research: an introduction to its scientific foundations and applications it's the deceiver and the receiver: individual differences in phishing susceptibility and false positives with item profiling eye tracking for everyone motivated social cognition: principles of the interface bilingual lexical access in context: evidence from eye movements during reading the oxford handbook of eye movements analysis of back-doored phishing kits eye can tell: on the correlation between eye movement and phishing identification eyebit: eye-tracking approach for enforcing phishing prevention habits adaptive memory: evolutionary constraints on remembering i've received a suspicious email: our guide to spotting and dealing with phishing emails the design of phishing studies: challenges for researchers where the user does look when reading phishing mails -an eye-tracking study eye tracking in human-computer interaction and usability research: current status and future prospects social engineering attacks: a survey exploring user reactions to new browser cues for extended validation certificates blink rate: a possible measure of fatigue cognitive load during problem solving: effects on learning eye movement control of computer functions the authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.copyright © mcalaney and hills. this is an open-access article distributed under the terms of the creative commons attribution license (cc by). the use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. no use, distribution or reproduction is permitted which does not comply with these terms. key: cord- -qipyqtsi authors: kokkoris, michail d.; kamleitner, bernadette title: would you sacrifice your privacy to protect public health? prosocial responsibility in a pandemic paves the way for digital surveillance date: - - journal: front psychol doi: . /fpsyg. . sha: doc_id: cord_uid: qipyqtsi digital surveillance methods, such as location tracking apps on smartphones, have been implemented in many countries during the covid- pandemic, but not much is known about predictors of their acceptance. could it be that prosocial responsibility, to which authorities appealed in order to enhance compliance with quarantine measures, also increases acceptance of digital surveillance and restrictions of privacy? in their fight against the covid- pandemic, governments around the world communicated that self-isolation and social distancing measures are every citizen’s duty in order to protect the health not only of oneself but also of vulnerable others. we suggest that prosocial responsibility besides motivating people to comply with anti-pandemic measures also undermines people’s valuation of privacy. in an online research conducted with us participants, we examined correlates of people’s willingness to sacrifice individual rights and succumb to surveillance with a particular focus on prosocial responsibility. first, replicating prior research, we found that perceived prosocial responsibility was a powerful predictor of compliance with self-isolation and social distancing measures. second, going beyond prior research, we found that perceived prosocial responsibility also predicted willingness to accept restrictions of individual rights and privacy, as well as to accept digital surveillance for the sake of public health. while we identify a range of additional predictors, the effects of prosocial responsibility hold after controlling for alternative processes, such as perceived self-risk, impact of the pandemic on oneself, or personal value of freedom. these findings suggest that prosocial responsibility may act as a trojan horse for privacy compromises. digital surveillance methods, such as location tracking apps on smartphones, have been implemented in many countries during the covid- pandemic, but not much is known about predictors of their acceptance. could it be that prosocial responsibility, to which authorities appealed in order to enhance compliance with quarantine measures, also increases acceptance of digital surveillance and restrictions of privacy? in their fight against the covid- pandemic, governments around the world communicated that self-isolation and social distancing measures are every citizen's duty in order to protect the health not only of oneself but also of vulnerable others. we suggest that prosocial responsibility besides motivating people to comply with anti-pandemic measures also undermines people's valuation of privacy. in an online research conducted with us participants, we examined correlates of people's willingness to sacrifice individual rights and succumb to surveillance with a particular focus on prosocial responsibility. first, replicating prior research, we found that perceived prosocial responsibility was a powerful predictor of compliance with self-isolation and social distancing measures. second, going beyond prior research, we found that perceived prosocial responsibility also predicted willingness to accept restrictions of individual rights and privacy, as well as to accept digital surveillance for the sake of public health. while we identify a range of additional predictors, the effects of prosocial responsibility hold after controlling for alternative processes, such as perceived self-risk, impact of the pandemic on oneself, or personal value of freedom. these findings suggest that prosocial responsibility may act as a trojan horse for privacy compromises. in response to the covid- pandemic, governments around the world besides appealing to people to comply with self-isolation and social distancing recommendations have also resorted to digital surveillance measures (calvo et al., ) . one of the most common forms of surveillance implemented is the use of smartphone location data (amit et al., ; heaven, , march ) . for example, israel has been using a technology originally developed for counterterrorism purposes to track the mobile phones of civilians in order to contain the spread of the virus (livni, , march ) . china has been tracking citizens in many cities through a smartphone app that assigns a green, yellow, or red color code as indication of one's health status (mozur et al., , march ) . even in privacy-conscious europe, austrian health authorities encouraged citizens to download a contact-tracing app developed for the pandemic by the austrian red cross (birnbaum and spolar, , april ) . although these measures have been imposed for the protection of public health, they have stirred controversy due to potential threats to personal privacy and civil rights (abbas et al., ; calvo et al., ; roth et al., ; singer and sang-hun, , april ) . essentially, their implementation may result in the protection of public health at the price of a loss of individual freedoms. in this research, we explore factors that make people accept such losses of individual freedoms. in particular, we focus on perceptions of prosocial responsibility as a factor that makes people willing to pay that price in a pandemic and accept an increase in digital surveillance. in the context of this research, we define prosocial responsibility as a state of heightened awareness that one's behavior has consequences for others coupled with concerns about their well-being. in the covid- pandemic, authorities have extensively appealed to prosocial responsibility as a way to motivate people to adhere to self-isolation and social distancing measures. compliance with these measures is crucial in the fight of the pandemic. literature shows that feeling responsible for others can have a large impact on people's motivation and behavior. for example, consumers are willing to incur costs to buy products if they believe that these have a positive impact on society (small and cryder, ) , or taxpayers support taxation if they recognize that their tax contributions help fellow citizens (thornton et al., ) . research in ethical decision-making suggests that people do not want others to think about them that they are behaving selfishly; instead, they enjoy reputational benefits, such as respect and admiration, if they behave in line with what is considered normatively 'good' (van bavel et al., ) . more specific to the topic of the present investigation, the covid- pandemic, a recent review of , papers on the psychological impact of quarantine demonstrated the power of appeals to benefits for others (brooks et al., ) . reminding the public about the benefits of self-isolation to society can buffer against the negative consequences of quarantine. specifically, it has been argued that "reinforcing that quarantine is helping to keep others safe, including those particularly vulnerable . . . can only help to reduce the mental health effect and adherence in those quarantined" (brooks et al., , p. ) . apparently, feeling that others will benefit from one's behavior increases the willingness to endure stressful situations such as self-isolation and makes these situations easier to bear. but do people's feelings of prosocial responsibility also affect their acceptance of flanking surveillance measures? in this research, we argue that perceived prosocial responsibility increases both compliance with anti-pandemic measures and support for surveillance, and civil rights and privacy restrictions. regardless of whether an elevated sense of prosocial responsibility implicitly shifts mental weights from individual to public rights or whether it operates at an affective level that is fueled by the desire to avoid the emotional burden of feeling responsible for others' suffering, people might feel that the protection of their individual rights matters less than the protection of a common good, such as public health. a sense of prosocial responsibility may act as a blanket measure that heightens a person's focus on others' well-being at the expense of tuning down the fight for individual rights. thus, we predict that people with higher prosocial responsibility both comply more with quarantine measures, and are also more willing to accept radical measures restricting individual rights in general and privacy more specifically. we tested these predictions with an online study conducted during the covid- pandemic in the us. specifically, we examined whether prosocial responsibility predicts on the one hand compliance with self-isolation and self-distancing measures, as prior literature suggests, and on the other hand acceptance of digital surveillance and restrictions of individual rights and privacy, as we propose. in addition, we add valuable insights by assessing and controlling for several relevant variables that could also play a role. specifically, we included variables that address vulnerability to covid- (perceived self-risk, perceived close other-risk, covid- health status, perceived impact on various facets of one's life, and perceived impact on state), potentially relevant personality traits (narcissism, belief in free will, helplessness, and value of freedom), and demographic variables (age, sex, urban/rural area, and political affiliation). we recruited us residents online (prolific). four participants who failed an attention check (to select a specific answer in one question) were excluded from further analyses. the final sample comprised participants ( men, women, age - , m = . , sd = . ). a sensitivity power analysis showed that this sample size can reliably detect small to medium effect sizes of ρ = . (two-tailed) with an alpha level of . and power of . . the study was conducted online on may , . the following predictor and outcome variables were assessed. it was assessed with six items (α = . ): "in this covid- pandemic, i feel responsible for the health and life of others, " "in this covid- pandemic, i am doing everything i can to minimize the chances of putting others at risk, " "in this covid- pandemic, i would have a bad conscience if i did something that puts vulnerable people's health at risk, " "in this covid- pandemic, i feel that my acts have consequences on the lives of others, " "in this covid- pandemic, i would hate it if i did anything that risks vulnerable people's lives, " and "in this covid- pandemic, not complying with the measures would make me feel almost like a criminal" ( = strongly disagree; = strongly agree). we included several variables that broadly tap vulnerability to the virus. vulnerability has been shown to be a factor making people susceptible to conformity (murray and schaller, ; wu and chang, ) and, thus, might also increase acceptance of restrictions of individual freedoms. it was assessed with four items (α = . ): "i consider myself to belong to a high-risk group regarding covid- , " "i think i would be severely affected if i am infected with covid- , " "i think my life would be at risk if i am infected with covid- , " and "in general, i worry about my health with regards to covid- " ( = strongly disagree; = strongly agree). it was assessed with four items similar to perceived self-risk (α = . ): "i have close others (family, friends, or relatives) who belong to a high-risk group regarding covid- , " "some of my close others (family, friends, or relatives) might be severely affected if they are infected with covid- , " "the life of some of my close others (family, friends, or relatives) might be at risk if they are infected with covid- , " "in general, i worry about the health of some of my close others (family, friends, or relatives) with regards to covid- " ( = strongly disagree; = strongly agree). participants indicated whether they had been tested positive for coronavirus themselves ( = yes; = no; = rather not say), and the same for any of their close relations (family, close friends). participants were asked how negatively or positively the covid- pandemic has affected each one of the following facets of their lives: job, income, emotional well-being, physical well-being, personal relationships ( = very negatively; = very positively). we measured how badly the state where they had been during lockdown was hit by covid- ( = not at all badly; = very badly). additionally, we included the following potentially relevant personality traits. narcissists are self-absorbed and manipulative individuals with a strong sense of specialness and entitlement, a lack of empathy, and a proclivity to exploitation (thomaes et al., ) . therefore, it is reasonable to assume that narcissists should be less likely to comply with measures that stress the protection of others (grover, , april ) , let alone limit their own freedoms for the common good. narcissism was assessed with a scale adopted from webster and jonason ( ) , which comprises four items (α = . ; e.g., "i tend to want others to admire me"; = strongly disagree; = strongly agree). this is another relevant predictor because it corresponds to a combination of responsibility and autonomy (nahmias et al., ) . believing in free will entails acceptance that individuals are autonomous and responsible and have the capacity to act in different ways in the same situation. belief in free will was assessed with the free will subscale of the fad-plus (paulhus and carey, ) , which comprises seven items (α = . ; e.g., "people must take full responsibility for any bad choices they make, " "people have complete free will"; = strongly disagree; = strongly agree). it refers to the feeling that one has no control over a situation due to repeated experiences with aversive stimuli, which can lead to failure to use opportunities to avoid these stimuli, even when control is possible (seligman, ) . privacy is essentially linked to personal control (brandimarte et al., ) . therefore, people who feel helpless and deprived of personal control might also be less motivated to protect their privacy and safeguard their individual rights, even when they have the opportunity to do so. helplessness was assessed with the perceived helplessness subscale of the depressive attributions questionnaire (kleim et al., ) , which comprises four items (α = . ; e.g., "i feel helpless when bad things happen"; = strongly disagree; = strongly agree). individual differences in the value of freedom might also predict the extent to which individuals are willing to sacrifice privacy and individual rights. participants ranked nine values taken from the rokeach value survey (rokeach, ) into an order of importance to them, as guiding principles in their life. of interest to this study were the values "freedom (independence, free choice)" and "national security (protection from attack)." we created a new variable that indicates how much higher freedom is ranked compared to national security by subtracting the freedom rank from the national security rank. we collected information about sex, age, area ( = rural; = urban), and political affiliation ( = democrat; = republican). compliance with measures against covid- ("to what extent have you been following these measures in the past months?") was measured with two items in two domains (α = . ) : "selfisolation (staying home even without having any symptoms)" and "social distancing (maintaining a safe distance from others)" ( = never; = rarely; = sometimes; = about half the time; = frequently; = most of the time; = always). it was measured with two items (α = . ) following a short explanation that "as a way to deal with the covid- pandemic, several countries have adopted measures that require extensive surveillance (e.g., through collecting data on people's mobile phones and monitoring their movements)": "in your opinion, do governments have the right to limit people's privacy and impose surveillance for the protection of public health?" and "are you willing to sacrifice your privacy and accept surveillance for the sake of public health?" ( = definitely no; = definitely yes). it was assessed by summing up how many of the following seven actions participants have already done as a way to combat the pandemic (α = . ) : "install an app on your mobile phone that monitors information about your movements (e.g., where you are going), " "install an app on your mobile phone that monitors information about your physical contacts (e.g., with whom you are in contact), " "wear a bracelet that monitors information about your movements (e.g., where you are going), " "wear a bracelet that monitors information about your physical contacts (e.g., with whom you are in contact), " "wear a bracelet that monitors information about your health (e.g., your temperature), " "allow companies (e.g., airlines, your employer) to have access to your medical records, " "allow companies (e.g., cafes and restaurants, stores) to measure your temperature before entering a venue." it was assessed with seven items (α = . ) asking participants to indicate their willingness to accept the same measures as in past surveillance acceptance in the future ("how willing are you to do the following in order to fight against the current pandemic or other similar pandemics in the future?"; = not willing at all; = very willing). participants first read that "in times of crises, leaders and policy-makers sometimes have to take decisions that require a trade-off between individual rights (freedom, autonomy, privacy, self-determination) and public health." as an example, it was mentioned that "in the current pandemic, world leaders restricted some individual rights for the sake of protecting all citizens' health." then, participants indicated what they would prioritize if such a trade-off were inevitable with a single item ("in your opinion, whenever such a trade-off is inevitable, what should be prioritized, individual freedoms or public health?"; = definitely individual freedoms; = definitely public health). descriptive statistics and inter-correlations of all variables are presented in table . inspection of correlation coefficients indicates that prosocial responsibility was positively correlated with compliance with measures to fight covid- , r = . , p < . ; willingness to sacrifice privacy, r = . , p < . ; past surveillance acceptance, r = . , p = . ; willingness to accept surveillance, r = . , p < . ; and prioritizing public health over individual freedoms when a trade-off between the two is inevitable, r = . , p < . . we first examined whether a higher sense of prosocial responsibility is associated with higher compliance with selfisolation and social distancing measures after accounting for all control variables in a step-wise linear regression analysis. in the first step, prosocial responsibility served as predictor and compliance with measures as outcome variable. results showed that prosocial responsibility was a significant predictor of compliance, b = . , se = . , β = . , p < . . in step two, we entered as control variables all additional predictors listed in section "method." results showed that prosocial responsibility remained a significant predictor of compliance after controlling for these variables, b = . , se = . , β = . , p < . (see detailed results in table ). in line with prior research (brooks et al., ) , people who feel more responsible toward others were more likely to comply with the measures that have been imposed to combat the pandemic. we then tested whether a higher sense of prosocial responsibility is associated also with a higher willingness to sacrifice privacy for the sake of public health. results showed that prosocial responsibility was a significant predictor of willingness to sacrifice privacy, b = . , se = . , β = . , p < . . moreover, prosocial responsibility remained a significant predictor of willingness to sacrifice privacy after entering all control variables, b = . , se = . , β = . , p < . (see detailed results in table ). therefore, people higher in prosocial responsibility were more willing to sacrifice their privacy for the sake of public health. another linear regression showed that prosocial responsibility was a marginally significant predictor of past surveillance acceptance, b = . , se = . , β = . , p = . . after controlling for the same variables as above, prosocial maximum . . . . . . . . - . . * p < . ; * * p < . ; = rural, = urban; = democrat, = republican. frontiers in psychology | www.frontiersin.org unstandardized coefficients are provided. * p < . ; * * p < . ; dummy coded ( = yes); dummy coded ( = male); = rural, = urban; = democrat, = republican. responsibility became a significant predictor of past surveillance acceptance, b = . , se = . , β = . , p = . (see detailed results in table ). therefore, people who feel more responsible toward others in the pandemic have already accepted more surveillance measures. results of a linear regression analysis indicated that prosocial responsibility also predicted willingness to accept surveillance in the future, b = . , se = . , β = . , p < . . the effect of prosocial responsibility on willingness to accept surveillance remained significant after entering the control variables, b = . , se = . , β = . , p < . (see detailed results in table ). thus, prosocial responsibility did not only predict past surveillance acceptance but also willingness to accept surveillance in the future. we conducted another regression with prosocial responsibility as predictor and the dilemma between individual freedoms and public health as outcome variable. results showed that prosocial responsibility was significantly associated with a preference for public health over individual freedoms, b = . , se = . , β = . , p < . . this association remained significant after controlling for the same variables as before, b = . , se = . , β = . , p < . (see detailed results in table ). that is, the stronger a person's sense of prosocial responsibility, the more likely that person prioritizes public health over individual freedoms. during the covid- pandemic, governments around the world emphasized responsibility toward others as a way to enforce selfisolation and social distancing. in line with a recent review of the literature, which advises public health officials to emphatically communicate the benefits of self-isolation for others (brooks et al., ) , we found that a stronger sense of prosocial responsibility predicted compliance with self-isolation and social distancing measures. at the same time, our findings suggest that prosocial responsibility is also associated with acceptance of restrictions of privacy and individual rights. apparently, feeling responsible for others leads people to devalue their own rights. critically, this holds over and above a host of alternative explanations and related variables, such as how much they believe that they personally or their close others are at risk, how much they value freedom, or how negatively various facets of their lives have been affected by the pandemic. this finding implies that prosocial responsibility can be a double-edged sword. on the one hand, it enhances compliance with self-isolation and social distancing, which is of paramount importance in pandemic crises. on the other hand, prosocial responsibility might constitute a trojan horse for privacy undercuts because it makes people generally accept a loss of individual rights. this finding echoes growing concerns about the potential misuse of digital surveillance methods during the pandemic (e.g., abbas et al., ; calvo et al., ; roth et al., ) and highlights a potential long-term side-effect that may eventually turn out detrimental for all individuals. our research contributes to the literature on the effectiveness of prosocial appeals more broadly (e.g., small and cryder, ; thornton et al., ) , by highlighting the role of prosocial responsibility in the fight against a pandemic (brooks et al., ) . moreover, our findings contribute to the privacy literature. thus far, the privacy literature has focused on the individual when examining predictors of privacy behavior, such as desire for control over personal information (phelps et al., ) , knowledge about risks (park et al., ) , and privacy concerns (gerber et al., ) . our research adds a novel social dimension to recent research, which has begun to investigate the interdependent aspects of privacy (kamleitner and mitchell, ) . in many situations, individuals endanger others' privacy for their self-interest (e.g., when allowing apps access to their contacts). here, we show the opposite. out of concern about others, individuals might endanger their own privacy. both studies underscore the role of social context in people's privacyrelated behaviors and point out the need for more research in this direction. besides the crucial role of prosocial responsibility, the current research provides insights into the role of other variables in the pandemic. in terms of covid- -related variables, we found that perceived vulnerability in its various forms (perceived self-risk or close other-risk, age, covid- impact on state) was consistently associated with both higher compliance with the measures against covid- and higher acceptance of surveillance and privacy restrictions, converging with prior research showing that vulnerability increases conformity (murray and schaller, ; wu and chang, ) . in terms of demographic variables, compliance with measures as well as acceptance of surveillance and privacy restrictions were higher among democrats (vs. republicans) and among people living in urban (vs. rural) areas. in terms of personality traits, we found that narcissism was associated with lower compliance, confirming the assumption that in this situation, too, narcissists might indeed behave selfishly and disregard the consequences of their behavior on others (grover, , april ) . moreover, a higher belief in free will was marginally associated with lower prosocial responsibility and lower prioritization of public health vis-a-vis individual freedoms. extending prior findings that belief in free will is associated with a more punitive attitude toward wrongdoers (baumeister and brewer, ) , our findings suggest that belief in free will might also imply that everyone is responsible only for themselves and not for others. a higher value of freedom was also associated with lower acceptance of privacy restrictions. however, contrary to predictions, feeling helpless was unrelated with the willingness to make sacrifices in one's privacy or accept surveillance. by investigating and controlling for a range of relevant predictors of people's willingness to accept a loss of individual rights, our research adds several novel but preliminary insights to the study of this timely phenomenon. future research should follow up on the multiple leads this initial exploration provides. most importantly, our research is the first to demonstrate a robust link between people's sense of prosocial responsibility and their willingness to sacrifice individual rights, in particular privacy. future research is needed to corroborate this link in other cultural contexts and with measures that are not dependent on self-reports. should results be as robust as we expect, then the prosocial appeals used to fight the pandemic might come at a potential long-term price to individual rights. the raw data supporting the conclusions of this article will be made available by the authors, without undue reservation. ethical review and approval was not required for the study on human participants in accordance with the local legislation and institutional requirements. the patients/participants provided their written informed consent to participate in this study. mk conducted the study and analyzed the data in consultation 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permitted which does not comply with these terms. key: cord- -gf lf authors: bottemanne, hugo; morlaàs, orphée; fossati, philippe; schmidt, liane title: does the coronavirus epidemic take advantage of human optimism bias? date: - - journal: front psychol doi: . /fpsyg. . sha: doc_id: cord_uid: gf lf nan on march , the sars-cov outbreak had affected more than , people worldwide and , people had died. while the world health organization had declared a public health emergency as early as the th of january, and subsequent evidence had highlighted the threat of a global pandemic, it took many more weeks for many governments and individuals to put into place and adopt precautionary measures. some observers were therefore surprised about the discrepancy between the available official warnings and individual perceptions of the risks associated with covid- . when confronted with novel pathogens, humans generate several beliefs about the shortand long-term consequences of the new threat. for example, they estimate their likelihood of being exposed, getting infected or infecting others, but also the severity of the emerging event, the controllability of the epidemic, and the efficiency of psychological and physiological coping responses (rogers, ) . numerous studies have shown that protective measures-in terms of containment or body protection-are largely dependent upon individuals' ability to accurately perceive these consequences (rogers, ) . due to the absence of treatment and vaccination for covid- , the success of these measures is particularly critical. building on evidence from past epidemics and three decades of research in psychology suggesting that various cognitive biases influence beliefs about life hazards, we propose that such cognitive biases have contributed to the discrepancy between early warnings about the danger of sars-cov- and slow growth of consideration for these warnings. specifically, we focus on belief updating biases, which result from the way the human brain creates and updates beliefs about the world in the face of evidence. we critically discuss this idea with respect to other types of cognitive biases such as oversensitivity to rare events, cognitive myopia, and risk aversion. our mind is woven by our beliefs about the world. at every moment, our beliefs define what we expect, what we perceive and what we choose. an influential theory, known as the bayesian brain and predictive coding theory, proposes that our brain continuously develops predictive models about its environment (friston et al., ) . these models are compared to incoming sensory evidence in order to generate inferences, which are in turn used to filter perception and guide our actions. when our brain detects a difference between what it predicts and what it perceives, it generates a prediction error that is then used to update the predictive model. the brain thus continuously learns from changes in its environment, thereby improving its predictions of the world (moutsiana et al., ) . the predictive coding theory has initially been proposed as a mechanism for the way in which the brain processes sensory information in the visual cortex (friston et al., ) . since then, it has been applied in various fields of research, and offers a plausible framework for explaining how the brain creates our mental world through perpetual cycles of inferences (i.e., we perceive and act according to our beliefs) and updates (i.e., we modify our beliefs according to what we perceive, what we do, and how our actions affect our perceived environment) (friston et al., ) . however, the cycle between predictions and their update is often asymmetrical. research has shown that positive illusions about control, superiority and unrealistic optimism [see jefferson et al. ( ) for review] can determine beliefs about health, romantic relationships, or professional success (scheier and carver, ) . unrealistic optimism is defined by a general tendency to overestimate the probability of experiencing positive life events, and to underestimate the probability of experiencing adverse life events compared to a similar other person's risk (weinstein, ; weinstein et al., ) . while unrealistic optimism is one of the most robust phenomena in human psychology, many have challenged its existence by highlighting confounds such as ceiling or flooring effects, regression to the mean and under-estimation of rare events. all of those effects can indeed obscure the phenomenon when being inferred solely on a group level (harris and hahn, ) . others consider that unrealistic optimism is a personality trait rather than a cognitive bias, and as such is most frequently expressed in specific groups of people such as smokers or gamblers (shah et al., ) . however, more recent research from cognitive and computational neuroscience is using a novel approach to understand such biased prospective beliefs: it assesses on the individual level how much a person changes their belief about the probability of experiencing adverse life events (moutsiana et al., ) . these studies show that such belief updating is "optimistically" biased because favorable information is more considered than unfavorable information, which tends to be neglected (sharot et al., ; moutsiana et al., ; kuzmanovic and rigoux, ) . this valence-dependent bias influences beliefs about the future, but also beliefs about oneself and the world (sharot et al., ) . importantly, this line of research has re-validated the concept of unrealistic optimism as a cognitive bias in human judgement and decision-making by providing a mathematical formalization and a neurobiological basis for it (moutsiana et al., ; kuzmanovic and rigoux, ) . in january, when the chinese city of wuhan was quarantined, there were only a few cases detected in europe and the usa. an increasingly dramatic contrast grew between the rigorous measures taken in china against covid- and the beliefs people held about the virus in unaffected western countries. as early as january , renowned epidemiologists like gabriel leung or marc lipsitch had highlighted the threat of a global pandemic (wu et al., ) . they announced that more than - % of the world population could be infected within the end of the year. however, survey data collected in february during the early phases of the outbreak in france, italy, the united kingdom, and switzerland showed that a large majority of citizens estimated their risk of catching the virus to be around % (raude et al., ) . similar findings from the french international market research group reported that only % of french citizens said they were worried about the virus, % of them did not wash their hands after taking public transportation, % continued to shake hands, and % still kissed their loved ones. at that very same time, sars-cov- had affected more than , people worldwide and killed , . it then evolved within a few weeks from a rare, distant threat into an omnipresent health hazard affecting more than . people worldwide and killing , at the end of april . importantly, data collected in western countries during the peak of the covid pandemic provides direct evidence favoring the hypothesis that unrealistic optimism has played a role in the apparent discrepancy between official warnings and individual beliefs about the consequences of the pandemic for oneself: when getting infected and infecting others became frequent events as the number of cases and deaths sharply increased, citizens in the us, europe and the united kingdom estimated their probability of getting infected with the virus and of subsequently infecting others as lower for themselves than for someone else (dolinski et al., ; kuper-smith et al., ) . these findings strikingly echo similar patterns observed during past epidemics such as severe acute respiratory syndrome coronavirus (sars), influenza a virus subtype h n (h n ) and middle east respiratory syndrome (mers-cov). during the influenza a virus subtype h n pandemic for example, epidemiologists pointed out risks of infection ranging from to %. however, the majority of people believed that they were unlikely to get infected and to infect others (xu and peng, ) , and felt that the outbreak did not affect their daily lives (lau et al., ) . these findings strikingly echo the sars outbreak (brug et al., ; jun et al., ) . during the early phases of a pandemic, when only a few cases are reported and case numbers vary greatly across the world, beliefs about risks of infection may have been shaped by other cognitive biases, too. in the context of an outbreak, beliefs are generated within a collective, massive, and chaotic set of evidence from local and global sources such as personal connections and the media (rogers, ) . here, we argue that it is the degree to which people use this information to update their beliefs about the consequences of the pandemic that is asymmetrical, even though the beliefs in themselves differ much across individuals on whether they were under-or overestimations. for example, people vary in how much they discount risks, as these risks are still temporarily and spatially distant. the variability in temporal and spatial discounting influences various beliefs including health-related ones, which are most relevant in the context of a pandemic (peake, ; lee et al., ) . moreover, exponentially growth is often perceived in linear terms, which is also known as the exponential growth bias, and has recently been shown to have played a role in the misperception of the sars-cov- outbreak (lammers et al., ) . in the context of a pandemic psychological myopia can provide another explanation for the slow adoption of cautious behavior such as social distancing. on the short term putting in place strict, mandatory measures of social distancing involves psychological, social, and economic costs (i.e., risks). avoiding these short-term risks could come at the expense of the long-term health benefits of containing the outbreak (thaler et al., ) . moreover, it is possible that overgeneralization from past epidemics has influenced people's beliefs about the danger of sars-cov- . recent epidemics such as the sars outbreak were overcome relatively easier. for example the virus rapidly spread across countries, but was contained within about months. while the who warned that the problem was not completely solved, and future outbreaks remained a possibility, any official transmissions were reported since the end of june (world health organization., ) . this experience might have generated an underestimation of the dangers of the novel sars-cov- virus despite official warnings. another bias that could have played a role is linked to the fact that rare, adverse life events such as getting infected with a novel pathogen are more salient, and thus easier to retrieve from memory. this can have various effects on the beliefs about the likelihood of experiencing rare, adverse life events. more specifically, the coexistence hypothesis proposed by barron and yechiam predicts that people overestimate the likelihood of rare, adverse events (e.g., overestimate the probability of an uncertain loss of a large amount of money) and at the same time concurrently to their judgement underweight these events during decision-making (e.g., choose to loose the uncertain large amount rather than the certain loss of a small amount, despite equivalent expected value) (barron and yechiam, ). this hypothesis consolidates contradictory findings from judgement and decision-making from experience under both field and controlled laboratory conditions [see (barron and yechiam, ) for review]. in the context of a real-world problem such as a pandemic this line of research suggests that people overestimate the likelihood of short-and long-term consequences of the pandemic for themselves and for others, and at the same time underweight these likelihoods when adopting precautionary behaviors (barron and yechiam, ) . prospect theory also offers another relevant explanation for beliefs generated in the context of a pandemic. it predicts that equivalent information has different effects on beliefs and precautionary behavior if it is framed either in terms of losses or of gains (kahneman and tversky, ; tversky and kahnemann, ) . for example, loss-framed information, such as the number of death or negative societal consequences of an outbreak, has been shown to be not especially effective in promoting risk avoidance behaviors like hand washing, containment, or social isolation (hameleers, ) . taken together these alternative explanations stand in contrast to the idea that discrepancies between official warnings and individual assessments were due to optimistically biased beliefs. it is therefore important to distinguish if and how the beliefs in themselves and/or the update of these beliefs were biased during the early phases of the pandemic growth. for example, an initial overestimation of the risk could lead to a positive prediction error when being presented with case numbers that are lower than thought, especially in the beginning of a pandemic. on the behavioral level, such a positive prediction error could lead to considering less the need for social distancing (e.g., because the situation is less bad than initially thought), which may correspond to an underweighting of the initial probability judgment. on the other hand side, an initial underestimation is less used to update beliefs, and could lead to neglect on the behavioral level. here we propose that the difference in the absolute update of beliefs, and not whether these beliefs were over-or underestimations, has influenced risk assessment during early phases of the sars-cov- outbreak characterized by great uncertainty of information nurturing such updating biases (johnson and fowler, ) . from an evolutionary perspective, biased beliefs represent a conundrum. on the one hand, unrealistic optimism appears to be a good coping mechanism in environments where the rewards are higher than the costs. maintaining deflationary beliefs about risk is a kind of coping mechanism that allows individuals to protect themselves from the emotional manifestations associated with a threat, which is adaptive when the threat is distant and ambiguous. on the other hand, it can become dangerous when the costs are higher than the rewards. our ancestral environment was strewn with great dangers and an error in judgment could quickly prove fatal. it is therefore plausible that the human brain is equipped with feedback mechanisms allowing is to adapt to situations in which an overly positive perspective would be harmful. interestingly, unrealistic optimism bias in belief updating diminishes when there is an immediate threat in the environment (garrett et al., ) . in other words, faced with an immediate threat, in a kind of risk adverse response humans devalue unfavorable information less, and use it more easily to update beliefs and form a mental model of the world. as covid- is spreading rapidly throughout the world, the initially ambiguous and distant threat has become immediate and long lasting. hence, we could expect that as infection risk increases and becomes ubiquitous, awareness improves, and potentially changes the ways in which beliefs are updated. risk perception could thus become more accurate, as the unrealistic optimism bias in belief updating is dampened down. consistent with this idea, a study carried out in the usa has shown that the perceived risk of getting covid- increased dramatically over the course of days after the who declared covid- a pandemic (wise et al., ) . this study further found that engagement in preventive measures was strongly predicted by the perceived likelihood of personally being infected: the higher it was, the more people engaged in protective behaviors (wise et al., ) . the challenge today is to maintain relatively high individual risk perceptions despite the prolongation of the crisis. it has been shown that a prolonged exposure to a threat increases feelings of familiarity, progressively reducing perceived risk (chaudhary et al., ) , as observed during the h n , and mers-cov epidemic (cowling et al., ; jang et al., ) . maintaining a consistent and relatively unbiased risk assessment is crucial for sustaining protective individual behavior, and will surely represent the main challenge for the coming months. this effort should go along with more research in social and cognitive neuroscience. for example, future work in this field could shed light on how the evolution of distant to immediate health risks affects human beliefs about risk, and how the brain encodes the updating of these beliefs. it is also completely unknown how individual differences in temporal and spatial discounting moderate belief updating about risks of infection and of infecting others in the context of a pandemic and its evolution. on another level, public health policies must maintain a good level of information and explanation, so that the population upholds appropriate beliefs about the risks associated with this crisis. for example, nudge theory applications propose using cognitive biases to influence individuals' behaviors, and may play a major role in guiding worldwide health strategies against the coronavirus (thaler, ) . these applications include a range of techniques such as scratch landmarks on the ground to promote social distancing, perfumed hydroalcoholic gels to encourage hand washing, or enhancing perceived risk by conveying information through popular peers together with expert advice. after falling victims to our cognitive biases, they may very well be what will save us. as the previous health, geopolitical, and climatic cataclysms, this epidemic challenges neurocognitive models about economic power, industrial independence, or even the solidity of our healthcare systems. we call for more research to shed light on how humans around the world are adjusting their way of understanding the dangers associated with the pandemic. this is important to understand if and how this unprecedented health crisis in the st century opens the window into the human brain's remarkable capacities for adaptation, and to detect potential cognitive traps that can potentially hinder preparations for future waves of outbreaks and the adoption of early precautionary measures. hb wrote the first draft of the manuscript. all authors contributed to the final text. the coexistence of overestimation and underweighting of rare events and the contingent recency effect sars risk perception, knowledge, precautions, and information sources, the netherlands the relationship between perceived risk of being ticketed and 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framing of decisions and the psychology of choice unrealistic optimism about future life events smokers' unrealistic optimism about their risk changes in risk perception and protective behavior during the first week of the covid- pandemic in the united states sars outbreak contained worldwide. geneva: world health organization nowcasting and forecasting the potential domestic and international spread of the -ncov outbreak originating in wuhan, china: a modelling study people at risk of influenza pandemics: the evolution of perception and behavior the authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.copyright © bottemanne, morlaàs, fossati and schmidt. this is an open-access article distributed under the terms of the creative commons attribution license (cc by). the use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. no use, distribution or reproduction is permitted which does not comply with these terms. key: cord- -zj jt cz authors: chang, lennon y. c.; zhu, jinxin title: taking justice into their own hands: predictors of netilantism among cyber citizens in hong kong date: - - journal: front psychol doi: . /fpsyg. . sha: doc_id: cord_uid: zj jt cz this research examined the characteristics and predicting indicators of netizens which contribute to “human flesh searching” and internet vigilantism. human flesh searching (hfs) is a form of collective online behavior where netizens contribute information to social media and/or networking platforms about a certain event or a target individual or group to achieve what they regard as justice. it has been used to identify and investigate crime. some netizens go further and take justice into their own hands by punishing alleged criminals and deviants through online shaming. using the results of a survey conducted in hong kong, the research found both gender and time spent online are not significant variables to predict netizens’ intention to contribute to hfs. a positive attitude toward hfs was the strongest predictor of hfs intention. vigilantism was also a strong predictor of hfs intention. vigilantism not only affects hfs intention directly, but also indirectly through a positive attitude on hfs. fairness might negatively influence people’s hfs intention and attitude toward hfs; however, this influence was found to be weak in the present study. social justice might not affect hfs intention directly, yet it might exert its effect via a positive attitude toward hfs. that is, netizens who intend to contribute to hfs are those who have less confidence in the criminal justice system and believe highly that people should take justice into their own hands. technology has changed every aspect of our everyday lives. people now do a lot of things through the internet without physical contact. during the covid- lockdown, we saw how people sought to maintain their normal lives without going out. people talked to each other online via social media such as facebook, line, whatsapp, and wechat. conferencing apps such as zoom made it possible for people to organize not only meetings but also parties online. thanks to these conferencing applications such as zoom and cisco webex, online teaching and working from home became a "new normal" during the period of lockdown and people even organized virtual social activities such as drinks and parties using new technologies. we also see netizens using the internet, social media and online platforms to investigate crime, to report issues as online journalists and to pass judgment. using the skill of cyber-crowdsourcing, "netizens" (citizens actively involved in the online community) can provide information and clues about crime or deviant behavior. fellow netizens may then conduct further investigations to dig out more information based on the initial information and clues provided. examples can be seen in online responses which identify crime (for example, anti-corruption activities in china), investigate crime or deviant behavior (e.g., the boston marathon bombing in the united states and police brutality cases in hong kong), and/or punish criminals through naming and public shaming (e.g., naming and shaming alleged cyberbullies and online child-predators). as chang and grabosky ( : ) argued, cyber crowdsourcing "has been shown to be a formidable form of private regulation." human flesh searching (hfs), known as "renrou sousou, " or "qi-di" in chinese, is a good example of how technology is being used to achieve "justice" as perceived by netizens. hfs is a collective online behavior where netizens contribute knowledge and information through social media or networking platforms to expose alleged facts related to certain events and/or to publish information on a target individual or group. it emerged first in china in early and has become common in the greater china region, i.e., the people's republic of china (china), hong kong and taiwan. since , it has become common throughout the world (chang and poon, ) . while some hfs is undertaken just for fun or to fulfill one's curiosity (such as gossip about a celebrity), most hfs is undertaken with the aim of exposing crime and deviant behavior, and to shame and punish alleged criminals and deviant individuals (ong, ; hatton, ; chang and leung, ) . chang and poon ( ) coined the term "netilantism" (internet vigilantism) to describe the latter behavior. according to chang and poon ( ) , netilantism included behaviors such as ( ) online activities to identify/disclose crime (such as identifying corrupt officials in china); ( ) to investigate crime or deviant behavior (such as netizens trying to disclose the identity of police involved in violent behavior during the anti-extradition protests in hong kong or sunflower movement in taiwan); and ( ) to punish criminals or deviants through public shaming and naming (such as public shaming of alleged child predators). social media and networking platforms such as facebook, youtube, weibo, and telegram are used by internet vigilantes (netilantes) to post information and conduct cyber-crowdsourcing. traditional police-initiated requests for information from the public (such as america's most wanted, crime stoppers and ad hoc requests) about, for example, the identity of individuals captured on cctv imagery, do not disclose what information the police have already gathered. the information provided by police is controlled and the information provided to them is not publicly shared. netilantism differs from this. it provides peer-to-peer, multi-directional information sharing that can be aggregated. we also see that technology and networking platforms are being used increasingly for "sousveillance" in which netizens record and share alleged misbehavior by authorities (mann, ) . although netilantism can contribute to co-production of security and cyber security, it is important to address and mitigate the risks that come with it such as the legitimacy of the information provided, the provision of false or misleading information intended to interfere with or mislead the crime investigation and the consequences that might be caused by identifying the wrong suspect (chang, ; chang et al., ) . most research on hfs has been focused on hfs in china and has been published in chinese (li, ; wang, ; zhu and liu, ). there has also been research on internet vigilantism that categorizes the motives of netilantes (herold, ) . nhan et al. ( ) , using the boston marathon bombing as a case study, analyzed how cyber-crowdsourcing contributed to the investigation of the event and argued more research needs to be done on the forms and interaction between the police and the public. recently, a systematic review of hfs cases in the greater china region was conducted by academics in hong kong (chang and leung, ; chia, a) . chang and leung ( ) identified differences in types of hfs in hong kong, taiwan, and china. chia ( a), using similar methods, reviewed cases in the same region in - , through the lens of media studies. trottier ( trottier ( , argued that weaponized visibility has become a norm in our digital era and proposed a conceptual model of digital vigilantism. nonetheless, despite the discussion on the impact of hfs on society and how netizens use hfs to realize their so-called "justice, " there are only a few empirical studies examining why netizens contribute to hfs. skoric et al. ( ) , using an online survey with singaporeans, investigated the relationships between personal characteristics (extroversion, neuroticism, agreeableness, conscientiousness, and openness), asian values and the contribution to online shaming. chang and poon ( ) , using empowerment theory, tested the differences between netilantes, bystanders, and victims. chia ( b) examined the relationship between media coverage and netilantism and found favorable media coverage is essential to netilantism. there is still little understanding of why people contribute to netilantism. do netilantes have similar personal characteristics as vigilantes? are they engaging in hfs to offset the inadequacy of the formal justice system? do they have confidence in the current criminal justice system and social justice? this research will contribute to our knowledge of netilantism from a criminological lens, seeking to understand the relationship between netizens' attitudes toward social justice, fairness and criminal justice systems, and their intention to become netilantes. the theory of planned behavior (tpb) was developed to predict people's intention to engage in certain behavior. as suggested by the tpb, behavioral intention can be predicted by perceived control, that is, "a person's perception of control over behavioral performance" (montaño and kasprzyk, : ) . montaño and kasprzyk ( ) indicated that the ease or difficulty of behavioral performance will affect a person's behavioral intention. guided by the tpb and based on the discussion above, the hypothesized model of this research is presented in figure . this study used data from a larger study on people's online behavior. the current study focused on hfs. the sample comprised chinese-speaking respondents in hong kong. in the sample, there were ( . %) male and ( . %) female respondents. there were respondents ( . %) who did not provide their gender and they were marked as missing values. the age of the respondents ranged from to years, mainly ( . %) in the range of to years, and ( . %) respondents did not provide their age, with the mean age of . years. the survey questionnaire for the current study was administered in chinese. it comprised five scales, i.e., social justice, vigilantism, hfs intention, positive attitude toward hfs, and fair (described in detail below). the scales of social justice, vigilantism, positive attitude toward hfs, and fair all comprised five likert-type response options, namely, "strongly disagree, " "disagree, " "neutral, " "agree, " and "strongly agree, " which were coded as , , , , and , respectively. the scale of hfs intention comprised five likert-type response options of "strongly unwilling to, " "unwilling to, " "neutral, " "willing to, " and "strongly willing to, " which were also coded as , , , , and , respectively. for each question, respondents were instructed to "please choose one answer and tick where appropriate." respondents also indicated their daily online time with nine categories: "never, " "less than h, " " - h, " " - h, " " - h, " " - h, " " - h, " " - h, " and "more than h, " which were coded as h, . h, . h, . h, . h, . h, . h, . h, and h, respectively. both gender and daily time spent online were used as control variables in this research. participants were asked their likelihood to contribute to certain hfs activities ("items"). we adopted the items created by chang and leung ( ) after reviewing the hfs cases in the greater china region in - . the twelve items were: ( ) corruption activities among government officials; ( ) misconduct of government officials' family members; ( ) sex scandals of government officials; ( ) minor crime issues; ( ) immoral activities; ( ) finding missing people; ( ) helping others to save life; ( ) sex scandals of artists; ( ) incidents about business activities; ( ) expression of personal negative emotions; ( ) helping police to solve certain crimes, and ( ) news about celebrities. most of the situations were crime or deviant related scenarios. the cronbach's alpha was found in the current study to be . . five items were used to test participants' attitudes toward social justice. these items were adopted from the social justice scale developed by torres-harding et al. ( ) and included: ( ) it is important to make sure that all individuals and groups have a chance to speak and be heard, especially those from traditionally ignored, or marginalized groups; ( ) it is important to talk to others about societal systems of power, privilege, and oppression; ( ) it is important to try to change larger social conditions that cause individual suffering and impede well-being; ( ) it is important to help individuals and groups to pursue their chosen goals in life; ( ) it is important to support community organizations and institutions that help individuals and groups achieve their aims. the reliability was also tested, and the cronbach's alpha was . . participants were asked about their attitude toward vigilantism. seven questions relating to vigilantism were selected from the confidence of criminal justice systems scales developed by haas ( ) . participants were asked to answer whether they agree or disagree with statements below: ( ) people who kill armed robbers should not be blamed; ( ) it is sometimes ok for people to take justice into their own hands if they feel the police are unable to protect them; ( ) communities should organize themselves against criminals even if the police disagree with that; ( ) if the government is not successful in their fight against crime, citizens are justified to take the law into their own hands; ( ) citizens should take the law into their own hands more frequently; ( ) it is pointless to hand over a suspected criminal to the police because they will not bring the offender to justice, and ( ) i feel that taking the law into my own hands is justified by circumstances. the cronbach's alpha was . . there were seventeen items used to evaluate participants' attitude toward the fairness of the criminal justice system. again, they were retrieved from the confidence of criminal justice systems scales developed by haas ( ) . participants were asked whether they agree to seventeen statements relating to judges and the police: ( ) judges treat people fairly; ( ) judges are trustworthy; ( ) i can count on the judges to take decisions that are best for society; ( ) i respect judges; ( ) judges deserve respect among citizens; ( ) if a judge passes a light sentence, he will have a good reason for that; ( ) judges' verdicts are well deliberated; ( ) judges do their job well; ( ) judges know what is going on in society; ( ) the police are trustworthy; ( ) the police care about the well-being of every citizen; ( ) i can count on the police to take decisions that are best for society; ( ) the police take citizens seriously; ( ) if the police decide not to arrest someone, they will have a good reason; ( ) the police do their job well; ( ) the police are effective in combating crime, and ( ) the police are there when i need them. we conducted a two-factor (judges and police) model for the fairness scale and found that the correlation between these two factors is. . also, in the one-factor model, the item loadings were more than . . as a result, the one-factor model was employed in this study. the cronbach's alpha was . . six items were used in this research to test participants' positive attitude toward hfs. chang and leung ( ) developed the original scale after they reviewed all the literature related to hfs in the greater china region in - . the six items were ( ) hfs can maintain justice; ( ) hfs can reveal the truth; ( ) hfs can punish the bad guys; ( ) hfs is very important; ( ) hfs can compensate for the inadequacy of the current legal system and, ( ) hfs serves justice by neglecting the influence of social hierarchy. the cronbach's alpha was . . the data was collected using a face-to-face survey. the survey questionnaire was designed by the research team and was administered in chinese. the questionnaire interviewers were trained before they started collecting the data. university students in hong kong were invited to participate in this survey (see section "data and sample"). the survey was conducted one to one or in a small group at university public spaces, mainly at the student canteen. students participated in this research voluntarily and using their private time. before the survey started, participants were provided an information sheet describing the project, the interview process, advantages and disadvantages of taking part in the research, information on de-identifying of the data and how the data will be used. the project was approved by the human ethical review committee at the city university of hong kong. the measurement model was conducted using the multidimensional graded response model (samejima, ) with mplus (version . ) and the responses to items measuring the five latent variables were specified as ordered categorical. to test the hypothesized model, a two-step analysis was conducted. in the first step, the measurement model was conducted for the five latent variables with daily online time and gender as covariates using mplus (version . ); meanwhile, sets of plausible values for each latent variable were generated. there were ( . %) cases with missing values for daily online time or gender. these data were excluded when generating plausible values. the bayesian estimation approach was adopted for the above mentioned two analyses. in the second step, a path analysis was conducted using these sets of plausible values, as well as the observed values of online time and gender, using mplus (version . ). by using plausible values, the measurement error was taken into consideration. the standard analysis for plausible value was conducted automatically using mplus, with the parameter estimates averaged over analyses. however, the indirect effect and total effect of the dependent variables were calculated using the command of "model constraint." the following equations describe the hypothesized path model used in the current study: hfs intention = β + β (positive hfs attitude)+ a path analysis was conducted to test the hypothesized model using mplus. the results showed that the hypothesized model was just identified [degree of freedom [d.f.] = ] and no useful fit information was provided ( table ) . to release the degree of freedom, the non-significant effects were fixed at zero with the backward stepwise method based on the largest p values. according to the hypothesized model (model ) result, the effect of gender on hfs intention β was - . , with the largest p value of . . therefore, in model the β was fixed at zero. likewise, β , with the largest p value of . in model , was fixed at zero in model . by this analogy, all the nonsignificant coefficients were fixed at zero in model , with β as the estimate with the largest p value of . , which is significant at . level. the detailed information of the model constraint information is shown in table . as is shown in the table, model was accompanied with the lowest aic, bic, and abic, which suggested that it was the best model. also, the chi-square tests for the change of chi-square for adjacent models were all non-significant, which indicated later models cannot be rejected. furthermore, the non-significant chi-squared test of the model fit for model showed that the data fitted the model well. this result, on the other hand, showed that gender and daily online time had no significant effect on hfs intention and hfs positive attitude. the result of the final path model is shown in figure , and the total effect, direct, and indirect effect of social justice, vigilantism and fair on hfs intention and positive hfs attitude are shown in table . as is shown in the result, the effect of positive attitude toward hfs intention, among the concerned variables, was the strongest (standardized coefficient = . ). vigilantism was also a strong predictor of hfs intention. the total effect of vigilantism to hfs intention is . , with direct effect as . and indirect effect via positive hfs attitude as . . the effect of fair to hfs intention was found to be negative (total effect = - . , direct effect = - . , and indirect effect via positive hfs attitude = - . ). however, no direct effect of social justice on hfs intention was found. social justice exerted its effect via the positive attitude toward hfs, with a total effect (indirect) of . . similarly, vigilantism was the strongest predictor of positive attitude toward hfs (standardized coefficient = . ). social justice was also a positive predictor, with a standardized coefficient of . . the effect of fair to positive hfs attitude was negative (standardized coefficient = - . ). in addition, the r-squared for positive attitude toward hfs was . , and that for hfs intention was . . from the results, we can argue that netizens who have an intention to contribute to hfs are those who have less confidence in the fairness of the criminal justice system and would take justice into their own hands, irrespective of gender and time spent accessing the internet. similarly, for those who believe in social justice, if they are provided a tool that they think is efficient for them to realize justice, they also will tend to take justice into their own hands. the results show that those who have less confidence in the criminal justice system are the ones with a higher intention to contribute to hfs and become netilantes. this is aligned with the result of existing research such as chang and poon ( ) , chia ( b) , and the concept model developed by trottier ( ) . these are the groups of people who do not have trust in judges and police and believe that people should take justice into their own hands if the legal system cannot protect them. while some of them might already be vigilantes in the real world, the internet provides netizens a new platform to realize the justice which they believe the criminal justice system will not be able to achieve. the intention will be reinforced if they have a positive attitude toward hfs and believe that hfs can help realize justice. aligned with the tpb, this research found that a positive attitude toward hfs is the strongest predictor of hfs intention. the hfs platform provides a space for netizens to speak out and contribute to their "justice." those who believe that the hfs platform provides them with a good way to maintain social justice, reveal truth, punish bad guys, and which can complement the inadequacy of the current legal system have a higher intention to conduct hfs. indeed, as gao ( ) argued, the internet has provided a platform for ordinary people to expose information that they were not able to do through traditional media. the hfs platform also provides a good medium for people to pursue their justice outside the traditional criminal justice system, especially for minor local cases that might not receive police attention. the positive attitude toward hfs also works as a mediator. as mentioned earlier, it empowers those who do not have confidence in their current criminal justice system to take justice into their own hands online. for those who want to build their online reputation, they can publish their identity (real or fake) while disclosing crucial information. as some cases attract attention by traditional media (such as the boston marathon bombing case and corruption cases in china), the netilante's contribution to hfs will also be recognized online and possibly also in the media. the beauty of the hfs platform is that netizens can choose to be identified or to remain anonymous by using a nickname or fake id. the hfs platform provides those who do not want their real identity to appear on the platform, a channel to provide information. netizens can hide behind the computer and not have to worry that they will be identified. this might explain why those who tend to have a higher attitude of social justice might not have an intention to contribute to hfs without the mediation of their positive attitude toward the hfs platform. that is, with confidence in the hfs, those who believe in social justice are empowered to contribute without worrying about being identified. this research shows that for chinese-speaking respondents in hong kong who want to contribute to "justice, " technology has provided them a good channel to do so. people, male and female, can take justice into their own hands using the hfs platform. it shows also that not all netizens are netilantes. hfs can be seen as a planned behavior by those netizens who see injustice and unfairness in society and/or who believe they can contribute to realize justice. the hfs platform gives them a good conduit to identify, investigate and even punish a suspect using their own means. however, it is important that we be wary of the negative effect and ethical concerns that might come with hfs. cases have already been reported of the wrong person targeted, causing serious damage to the reputation of the person and even leading to suicide . while hfs can fulfill the public's right to know, it can only be regarded as legitimate when there is a balance between "the public's right to know" and "the individual's right to privacy" (bu, ; chang and poon, ) . as chang and poon ( ) argued, "over-justice" of netilantism can develop into a tyranny when the victim's privacy is exploited in an incontrollable manner with no chance for self-defense." as zetter ( ) argues, activities in cyberspace are too hard to control once they have been initiated. therefore, while netizens taking "justice" into their own hands might contribute to crime investigation, it is also important to have a second thought before contributing to such activities. there is a need for further studies into mitigation of the damage caused by netilantism. there is also a need for further research to establish whether people who conduct netilantism in western societies have similar characteristics and motivations as those identified in this study of participants in hong kong. the raw data supporting the conclusions of this article will be made available by the authors, without undue reservation. the studies involving human participants were reviewed and approved by the ethics committee at the city university of hong kong. the patients/participants provided their written informed consent to participate in this study. a study of renrou sousou and the invasion of privacy internet vigilantism: co-production of security and compliance in the digital age the governance of cyberspace an introduction to cyber-crowdsourcing (human flesh searching) in the greater china region internet vigilantism: attitudes and experiences of university students in hong kong citizen co-production of cyber security: self-help, vigilantes, and cybercrime crowd-sourcing justice: tracking a decade's news coverage of cyber vigilantism throughout the greater china region seeking justice on the web: how news media and social norms drive the practice of cyber vigilantism the emergence of the human flesh search engine and political protest in china: exploring the internet and online collective action public support for vigilantism china's internet vigilantes and the 'human flesh search engine human flesh search engines: carnivalesque riots as components of a 'chinese democracy from violent "human flesh search engine" to friendly "humancomputer search engine": a new cognizing the communication value of "human flesh search engine sousveillance: inverse surveillance in multimedia imaging theory of reasoned action, theory of planned behavior, and the intergrated behaviour model digilantism: an analysis of crowdsourcing and the boston marathon bombings online vigilante justice chinese style and privacy in china graded response model online shaming in the asian context: community empowerment or civic vigilantism? development and psychometric evaluation of the social justice scale (sjs) digital vigilantism as weaponisation of visibility denunciation and doxing: towards a conceptual model of digital vigilantism reflection on "human flesh search cyberbullying suicide stokes the internet fury machine upset conventional thought: the powerful and horrible "human flesh search engine both authors contributed to the article and approved the submitted version. the authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. key: cord- -bj db j authors: tomczyk, samuel; rahn, maxi; schmidt, silke title: social distancing and stigma: association between compliance with behavioral recommendations, risk perception, and stigmatizing attitudes during the covid- outbreak date: - - journal: front psychol doi: . /fpsyg. . sha: doc_id: cord_uid: bj db j introduction: following behavioral recommendations is key to successful containment of the covid- pandemic. therefore, it is important to identify causes and patterns of non-compliance in the population to further optimize risk and health communication. methods: a total of participants [ % female; mean age = . years (sd = . )] were surveyed regarding their intention to comply with behavioral recommendations issued by the german government. latent class analysis examined patterns of compliance, and subsequent multinomial logistic regression models tested sociodemographic (age, gender, country of origin, level of education, region, and number of persons per household) and psychosocial (knowledge about preventive behaviors, risk perception, stigmatizing attitudes) predictors. results: three latent classes were identified: high compliance ( %) with all recommendations; public compliance ( %), with high compliance regarding public but not personal behaviors; and low compliance ( %) with most recommendations. compared to high compliance, low compliance was associated with male gender [relative risk ratio (rrr) = . ( . ; . )], younger age [rrr = . ( . ; . )], and lower public stigma [rrr = . ( . ; . )]. low compliers were also younger than public compliers [rrr = . ( . ; . )]. discussion: with % of the sample reporting full compliance, and % differing in terms of public and personal compliance, these findings challenge the sustainability of strict regulatory measures. moreover, young males were most likely to express low compliance, stressing the need for selective health promotion efforts. finally, the positive association between public stigma and compliance points to potential othering effects of stigma during a pandemic, but further longitudinal research is required to examine its impact on health and social processes throughout the pandemic. the current outbreak of the coronavirus sars-cov- and the associated disease, covid- , is transfixing the world with over million confirmed infections by april , . in addition to its physical threat, this outbreak also causes psychological distress, anxiety, and depression (wang et al., ) . moreover, research on the coronavirus-associated sars pandemic in / points to potentially long-lasting adverse consequences, such as depression, stigmatization, diminished quality of life, and post-traumatic stress (ko et al., ; lee et al., ; siu, ; gardner and moallef, ) . to contain infectious diseases like covid- , experts and government officials alike recommend a series of preventive behaviors, such as hand hygiene, and avoidance behaviors, such as social distancing or (voluntary) quarantine (e.g., glass et al., ; durham and casman, ; ding, ; karimi et al., ; weston et al., ; lewnard and lo, ) . previous simulations and current reports affirm that a combination of all strategies has the greatest success rates in containing the disease (kelso et al., ; kupferschmidt and cohen, ) . and yet, successful containment depends on adequate public compliance. while predictors of compliance can be explicated via a behavior theory (e.g., the theory of planned behavior; ajzen, ) , and they are well-documented for certain health behaviors (e.g., adherence in chronical illness; rich et al., ) , far less is known about compliance in pandemics. to date, several studies have identified perceived personal risk (i.e., susceptibility, anticipated severity, and anticipatory worry) and knowledge of adaptive behaviors as facilitators of compliance (c. wong, , ; cheng and ng, ; leppin and aro, ; kwok et al., ) , although an explicit theoretical framework is often missing (bish and michie, ) . moreover, barriers to adherence (i.e., non-compliance) have received less attention presumably due to preventive and avoidance behaviors being very easy to carry out. in a review of studies on preventive behaviors in pandemics (bish and michie, ) , however, compliance rates varied greatly, for example, between % for wearing a mask, . % for "one or more specific actions" (brug et al., ) , and up to % for quarantine (blendon et al., ) . despite the variety of illnesses, time frames, populations, and research methods in these studies, a general implication seems to be that a substantial proportion of the population does not adhere to the recommended behaviors. composite measures of preventive behaviors revealed even lower compliance: . % of a representative sample in singapore practiced six or more out of eight (quah and hin-peng, ) , . % in hong kong practiced five or more out of seven (leung et al., ) , and . % in england practiced one or more out of three measures (rubin et al., ) . in this respect, a qualitative study on (non)compliance with sars quarantine identified ethical (e.g., civic duty), legal (e.g., monetary sanctions), and social (e.g., peer pressure) reasons to publicly comply with quarantine, while acceptance of quarantine https://coronavirus.jhu.edu/ differed markedly within households and private environments (cava et al., ) . another study also identified practical issues (e.g., disposal of used tissues), selfishness, and responsibility shift (morrison and yardley, ) as core barriers to compliance. responsibility shift refers to the belief that infected persons are particularly responsible for (not) spreading the illness, thus protecting others, whereas healthy persons are responsible for protecting themselves from becoming infected, leading to a shift in personal priorities in protective behaviors depending on one's infection status. moreover, sociodemographic variables gender and age (i.e., male, younger age) consistently predicted non-compliance (leung et al., ; tang and wong, ) . this might be connected to a generally lower risk perception, particularly a lower perceived susceptibility, in young males . regarding educational attainment, higher levels of education have been discussed as barriers to as well as facilitators of behavioral compliance in different populations (leung et al., ; tang and wong, ; de zwart et al., ; bish and michie, ) . to capture the existing heterogeneity in (non)compliance, this study utilizes a latent class approach (collins and lanza, ) . latent classes are often used to analyze behavioral patterns in non-communicable diseases, such as substance use (e.g., tomczyk et al., tomczyk et al., , . however, to our knowledge, only one study applied latent class analysis to population behaviors following a novel virus outbreak [i.e., influenza a (h n )] in hong kong (liao et al., ) , despite the method's statistical advantages in modeling behavioral patterns (e.g., flexibility, integration of measurement error). liao et al. ( ) identified three latent classes of behavioral compliance, namely, moderate hygiene compliance (moderate personal hygiene, low avoidance behaviors), good hygiene compliance (high personal hygiene, low avoidance), and vigilance (high hygiene and avoidance). moderate hygiene compliance was the largest class (about % of the sample) and was significantly associated with male gender, lower age, poor education, and lower risk perception, thus stressing the need for selective prevention and health promotion. finally, the current study also focuses on stigmatizing attitudes in the context of compliance due to the impact of stigma on fear, psychosocial stress, and social rejection during infectious diseases, such as sars (sim and chua, ; lee et al., ; ko et al., ; siu, ) . stigmatization can occur at different levels (e.g., individual, social, structural) and is connected to social identity processes (tajfel and turner, ; bandura, bandura, , link and phelan, ) , where in-groups (i.e., individuals or groups that a person identifies with) and out-groups (i.e., individuals or groups a person does not identify with) are constructed based on certain characteristics (e.g., profession, illness symptoms). out-groups are subsequently devaluated, for instance, by being labeled irresponsible or dangerous. this devaluation can further lead to verbal discrimination or interpersonal violence (parker and aggleton, ; corrigan et al., ) . moreover, public stigma comprises support for a restriction of public opportunities (e.g., vote, utilize health care) for the devaluated out-group, in this instance, symptomatic and/or infected persons. in fact, survivors of the sars epidemic experienced blame and social rejection (lee et al., ; mak et al., ) , while persons of asian descent reported victimization, regardless of their personal infection status (zheng et al., ) . these experiences of being blamed and ostracized oftentimes outlasted the epidemic and were associated with continued psychosocial stress (brug et al., ; siu, ; jiang et al., ). in addition, an increase in influenza infections also corresponded to an increase in stigmatizing attitudes (e.g., a lack of trust, increased hostility) in previous research (williams and gonzalez-medina, ) . furthermore, qualitative studies argue that anticipated stigma might even prohibit personal preventive behaviors during infectious diseases, such as wearing masks, to avoid future stigmatization (siu, ; jiang et al., ) ; this hypothesis is supported by cross-sectional, quantitative research (leppin and aro, ) . similarly, perceived differences in responsibility for personal (healthy persons) and public protection (infected persons) during a pandemic (morrison and yardley, ) might reinforce stigma-associated social identity processes and increase the salience of group differences. in sum, stigmatization might differentially affect behavioral compliance. on the one hand, it might be beneficial from a prevention perspective by fostering social distancing toward and isolation of infected people, primarily by stigmatizing persons and defining them as a relevant out-group (so-called othering; see deacon, ) . on the other hand, it might reduce compliance with official recommendations among stigmatized and/or infected persons due to fear of social isolation, stress, or discrimination (williams and gonzalez-medina, ; smith and hughes, ) . therefore, to investigate compliance and the role of stigmatization during pandemics, this exploratory study aims to: . examine patterns of intentions to comply with behavioral recommendations to contain the covid- pandemic in the german population via latent class analysis. . inspect the role of stigma in non-compliance while considering sociodemographic differences, risk perception, and knowledge of adaptive behaviors. . explore intercultural similarities and differences of compliance by focusing on the german population, whereas previous research mostly focused on asian populations. via an online survey, a community sample of german adults [ % female; m (sd) age = . ( . )] provided information about their knowledge of preventive measures, risk perception, intentions to comply with official behavioral recommendations and guidelines as well as their stigmatizing attitudes toward people suffering from covid- . participants received gift vouchers (€ ) as incentives. the survey was conducted via convenience sampling between march and march by placing online advertisements on social media, for instance, on facebook. during this time, far-reaching social isolation measures were implemented in germany, for instance, restricting public meetings to two people (except for households) and establishing guidelines for a safety distance of . - . m in public spaces. in addition, behavioral recommendations on personal hygiene and avoidance behaviors were repeatedly and consistently issued by the government. the study procedure included informed consent in alignment with the declaration of helsinki and received ethical approval by a local ethics committee (bb / ). sociodemographic data comprised age, gender [ (female), (male)], country of origin [ (germany), (other)], level of education [ (lower secondary education), (higher secondary education, i.e., university entry level), (tertiary education, e.g., bachelor's degree)], region [ (rural, i.e., up to , inhabitants), (urban, i.e., more than , inhabitants)], and number of persons in one's household [continuous; recoded as ( ), ( ), ( or more)]. for analysis purposes, categorical variables were dummy-coded. measures of stigmatizing attitudes were adapted from previous research on mental health stigma, assessing support for discrimination (schomerus et al., (schomerus et al., , with three items ("persons with covid- should not be allowed to hold public office, " "persons with covid- should not be allowed to have a driver's license, " "if persons with covid- do not consent to medical treatment, they should receive compulsory treatment"), and blame (corrigan et al., ; schomerus et al., ) with four items (e.g., "persons with covid- are to blame for their problems") rated on a five-point scale each, from (don't agree at all) to (agree completely). support for discrimination (cronbach's α = . ) and blame (α = . ) showed satisfactory internal consistency. risk perception comprised two items representing cognitive and affective aspects of perceived risk, namely, perceived susceptibility ("how likely will you become infected?"; to %) and anticipated fear ["how afraid would you feel if you became infected?"; (not at all) to (very)]. intentions to comply with official recommendations were assessed by asking participants how likely [ (not at all) to (very)] they would follow the following nine recommendations: ( ) covering mouth and nose with flexed elbow or tissue when coughing or sneezing; ( ) avoid handshakes; ( ) avoid touching one's face (i.e., eyes, nose, and mouth) as much as possible; ( ) dispose of used tissue immediately and securely; ( ) frequent ventilation; ( ) increased hand hygiene; ( ) stay at home when sick/symptomatic; ( ) avoid personal contact to symptomatic persons; ( ) avoid mass events. since strictly following these recommendations is the safest way to contain further spreading of the infection, we recoded items to reflect likelihood of compliance [ (very high likelihood), (other)]. these nine indicators were then subjected to latent class analysis. in addition, a single item measuring subjective knowledge of adaptive behaviors was rated from (very low) to (very high). all measures are listed in supplementary table s . following an inspection of missing data and descriptive data analysis, latent class models were computed to examine patterns of (non)compliance in the population. subsequent multinomial logistic regression models inspected sociodemographic and psychosocial predictors of compliance patterns. descriptive data analysis was performed with stata . (statacorp, ), and latent class models and multinomial logistic regression models were computed with mplus . muthén, - ) . all analyses were based on α = . . we estimated latent class models of compliance via robust maximum likelihood estimation with , sets of random start values. the estimation process started with two latent classes (indicating full compliance and non-compliance), the number of latent classes was subsequently increased up to five, while comparing model fit between models. model selection considered overall model fit, parameter sparseness, classification quality, and theoretical tenability (nylund et al., ; tomczyk et al., tomczyk et al., , . as an overall fit measure, the bootstrapped likelihood ratio test (blrt) compared the estimated model to a model with one less class: a significant value indicated better fit of the current model. to achieve reliable estimates, we chose random starts with bootstrap draws for each comparison. the akaike information criterion (aic) and the sample sizeadjusted bayes information criterion (bic) indicated sparseness of the model; a lower value meant a sparser model. average latent class probabilities (al) and entropy demonstrated classification quality that is the differentiation between latent classes. values range between and ; the closer to , the better the fit; an entropy of at least . pointed to reliable estimates (asparouhov and muthén, ) . finally, latent classes needed to be interpreted based on the literature and theoretical background. therefore, the best latent class solution was selected on statistical criteria as well as content validity. using the three-step approach (asparouhov and muthén, ) , we calculated multinomial logistic regressions to predict compliance patterns by sociodemographic data and psychological variables (stigmatizing attitudes, risk perception, and subjective knowledge). for each regression model, relative risk ratios (rrrs) including % confidence intervals were reported as effect sizes. missing data were low ( missing values; . % overall) and equally distributed among variables, suggesting missing at random. therefore, complete cases were analyzed for descriptive statistics (schafer, ; dong and peng, ) , while full information maximum likelihood was used for latent class estimation. the sample was predominantly female, most persons did not have a migration background, and about a fifth lived in single households. due to the very high level of education, the variable "education" was dichotomized for further analysis [ (tertiary), (secondary)]. intentions to comply were mixed but particularly low for immediate disposal of used tissues, frequent ventilation, and reduced hand-to-face contact ( table ) . model fit criteria for latent class models are printed in table . while entropy and information criteria were in favor of a model with four classes, the difference to a three-class model was only marginal ( aic = . ; ssabic = . ), and according to the blrt, the latter was preferable. moreover, a fourth class would have been very small (n = ; . %) with similar conditional response probabilities to class of the three-class model. since it also showed good entropy and latent class separation (alcp > . ) compared to the remaining models, the three-class model was chosen. the following descriptions of latent class counts and proportions are based on most likely latent class membership. the first class was labeled "low compliance" (n = ; %), with low to moderate intentions to comply with most recommendations except for covering one's mouth and nose when sneezing or coughing. the second class was labeled "high compliance" (n = ; %), with high probabilities of following most recommendations and moderate compliance with reducing hand-to-face contact. finally, the third class, "public compliance" (n = ; %), had high intentions regarding compliance with public and avoidance behaviors (e.g., social distancing) but low intentions regarding personal behaviors (i.e., avoidance of face contact, tissue disposal, frequent ventilation). conditional response probabilities for each class can be seen in figure . multinomial logistic regression compared sociodemographic data, stigmatizing attitudes, knowledge, and risk perception between latent classes (table ) . to complement multinomial models, detailed descriptive comparisons of latent classes are provided in supplementary table s . compared to high compliance (class ), low compliance (class ) was associated with being male [rrr = . ( . ; . )], younger [rrr = . ( . ; . )], and expressing lower support for discrimination [rrr = . ( . ; . )], whereas public compliance (class ) and high compliance did not differ on sociodemographic data, stigmatizing attitudes or risk perception, although support for discrimination was considerably lower in public compliers than in high compliers [rrr = . ( . ; . ); p = . ]. furthermore, low compliers were significantly younger [rrr = . ( . ; . )] than public compliers and, by trend, were less fearful of a possible infection [rrr = . ( . ; . ); p = . ]. as one of the first studies examining patterns of (non)compliance with behavioral recommendations in the general population during the covid- pandemic, this study revealed that only a quarter of the surveyed german population expressed intentions to fully comply with recommendations, while a majority (about %) intended to follow some public actions but was less willing to enact personal hygiene behaviors (i.e., swift disposal of tissues, reduction of hand-to-face contact, ventilation). young males were significantly less likely to comply with recommendations, and aspects of public stigma were also linked to compliance intentions. in a virus outbreak, such as the covid- pandemic, personal hygiene and social distancing in the general population are paramount to containment of the illness (wu et al., ; karimi et al., ; weston et al., ) . and yet, only a minority was ready to comply with the main recommendations, with % reaching high compliance in this sample and similar, albeit slightly higher, proportions of . % (quah and hin-peng, ) , . % (williams and gonzalez-medina, ) , and . % (lee et al., ) in previous studies. since germany was not affected by previous pandemics (e.g., h n , sars) as strongly as hong kong, for instance, and measures like wearing face masks are not as common in europe (e.g., rubin et al., ) , we assume the lack of familiarity with such strict preventive measures to be responsible for this lower level of compliance. to further explore cultural differences of compliance during a pandemic and connect our findings to previous research, we compare our findings (germany) to liao et al. ( ) , who analyzed latent classes of behavior patterns in hong kong during a virus outbreak. they also identified three latent classes, with the class moderate hygiene being the largest group, followed by good hygiene and vigilance. moreover, younger males, persons with lower educational attainment, and lower risk perception were also more likely to belong to the moderate hygiene class (i.e., exhibit low compliance), similar to our findings. this trend of older persons and females reporting higher risk perception and willingness to perform preventive behaviors was consistently found in a variety of health risks (flynn et al., ) , among them also pandemics (bish and michie, ; kwok et al., ) , presumably due to a higher perceived susceptibility in these groups. since older people have a higher risk of manifesting covid- symptoms (davies et al., ) , which was promulgated via mass media reports, this might have led to lower susceptibility perceptions among younger people. across cultures and scenarios, young males tend to report lower risk perception and compliance intentions. by corroborating these associations in the context of covid- , our findings stress the need for selective prevention targeting young males to improve their compliance and thereby public health. despite these similarities, we observed differing intentions regarding personal hygiene behaviors but overall high intentions to comply with avoidance behaviors, in contrast to liao et al. ( ) . while studies in other western countries, that is, canada (toronto) and the united states (blendon et al., ) , also indicated high compliance with quarantine and social distancing strategies, it should be noted that avoidance measures are figure | conditional response probabilities and latent class proportions of three latent classes of (non)compliance with behavioral recommendations regarding infection prevention in a german community sample (n = ). the probabilities correspond to the dichotomized likelihood of complying with recommendations [ (not at all likely to quite likely); (very likely)], thus a higher probability indicates higher compliance. generally easier to implement than specific preventive behaviors that require personal action (bish and michie, ) . therefore, it is possible that in this early phase of the covid- outbreak in germany, personal responsibility was not as salient in the general population. this might be connected to the lack of familiarity with pandemics and appropriate preventive action in the german population. nevertheless, personal preventive actions may yet increase over time, coinciding with an increase in vigilance, knowledge, and positive attitudes, if supported by concerted action, as suggested by previous sars outbreak trajectories (leung et al., (leung et al., , . to concur, in their analysis of repeated cross-sectional surveys, liao et al. ( ) observed fairly stable behavioral patterns (i.e., robust latent classes) across time but an increase in public vigilance and perceived threat throughout the epidemic (i.e., an increase in latent class proportions in favor of vigilance). to foster vigilance, the media and governmental institutions are therefore urged to provide clear guidance, openly communicate and justify new measures to increase trust, and strengthen self-efficacy at early stages of a pandemic, as shown in previous health crises (e.g., seeger, ; bean et al., ; jha et al., ) . in addition to compliance patterns, this study also examined the impact of stigmatizing attitudes on intentions to comply with behavioral recommendations. while williams and gonzalez-medina ( ) connected an increase in influenza infections to an increase in stigmatizing attitudes, in this study, blame was low (mean = . on scale of - ) and did not predict compliance. instead, support for discrimination was significantly associated with higher compliance intentions. drawing on social psychiatric research, this type of discrimination might be described as intentional structural discrimination, where a worldview is actively supported that restricts patients' rights (by law), for example, regarding their opportunities to vote or to hold public office (corrigan et al., (corrigan et al., , schomerus et al., ) . in the context of covid- , a support for discrimination implies a desired restriction of access to sociopolitical resources for infected persons. as a result, while high compliance represents law-abiding and theoretically desirable behavior, its connection to discrimination, particularly in this highly educated sample, is noteworthy. in line with the reasoning behind selfishness and responsibility shift in confronting the sars pandemic (morrison and yardley, ), a support for discrimination might indicate a way to maximize differences between relevant in-groups (i.e., responsible, healthy) and out-groups (i.e., irresponsible, reckless) to affirm social identity status (tajfel and turner, ; link and phelan, ) and -at least symbolically -reduce the risk of infection. since blame did not differ between latent classes and was generally low, we assume that in this sample, stigma facilitated othering but not discriminatory action (deacon, ) . although this hypothesis requires further research in larger, longitudinal samples using more elaborate measures of stigmatizing attitudes, it is clearly in line with evidence-based demands of a more nuanced debate of the functional properties of stigmatization and its connection to discrimination in infectious diseases (deacon, ) . finally, this study is not without limitations, as the sample is a small convenience sample that is not representative of the german population. in fact, the sample was highly educated, predominantly female, and mostly without migration background. however, we still observed substantial heterogeneity in intentions, despite females and highly educated persons being generally more likely to report high compliance in previous studies. in addition, this study was cross-sectional and exploratory and used short but validated measures of core constructs, hence, effects of risk perception, for example, were not fully explored. components like anticipatory worry could also affect compliance intentions and should be studied in more detail (leppin and aro, ). furthermore, items measuring stigmatizing attitudes were adapted to covid- for this study, therefore, a thorough psychometric validation is necessary. moreover, we did not assess other important factors that might be connected to (non)compliance, such as ethnicity, interpersonal contact with infected persons, or trust in the government. finally, we captured behavioral intentions, but we did not assess actual behaviors, as the pandemic had just reached the german population, and official recommendations were first issued at the beginning of data collection. therefore, future studies should also focus on behavioral performance. when investigating the connection between compliance intentions and behavioral performance, health behaviors models like the theory of planned behavior should be applied to incorporate relevant intermediary variables, such as self-efficacy (ajzen, ; bish and michie, ) . overall, more comprehensive, longitudinal, and experimental studies are necessary to validate our findings in the context of covid- in diverse populations. nevertheless, we think this study provides an important look at patterns of compliance at early stages of the covid- outbreak and impactful sociodemographic and attitudinal factors, such as support for discrimination, that underline the need for selective preventive action. the raw data supporting the conclusions of this article will be made available by the authors, without undue reservation, to any qualified researcher. the studies involving human participants were reviewed and approved by the ethics committee of the university medicine greifswald, university medicine greifswald. the patients/participants provided their written informed consent to participate in this study. st, mr, and ss contributed to the conception and design of the study. st and mr were responsible for the data collection and statistical analysis. st wrote the first draft of the manuscript. all authors contributed to the article and approved the submitted version. we would like to thank simon barth, isabel buck, and hanna groth for their assistance in the collection and preparation of data. the supplementary material for this article can be found online at: https://www.frontiersin.org/articles/ . /fpsyg. . /full#supplementary-material the theory of planned behavior auxiliary variables in mixture modeling: three-step approaches using mplus health promotion from the perspective of social cognitive theory health promotion by social cognitive means the study of mobile public warning messages: a research review and 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general population in china infection prevention behaviour and infectious disease modelling: a review of the literature and recommendations for the future infectious diseases and social stigma reducing the impact of the next influenza pandemic using household-based public health interventions exploratory study on psychosocial impact of the severe acute respiratory syndrome (sars) outbreak on chinese students living in japan key: cord- - mbvmw u authors: fuentes-garcía, juan pedro; martínez patiño, maría josé; villafaina, santos; clemente-suárez, vicente javier title: the effect of covid- confinement in behavioral, psychological, and training patterns of chess players date: - - journal: front psychol doi: . /fpsyg. . sha: doc_id: cord_uid: mbvmw u the outbreak of covid- has triggered a pandemic, jeopardizing global health. the sports world is also suffering enormous consequences, such as the suspension of the olympic games in tokyo or, in chess, the cancelation of the world candidates tournament . chess is a sport characterized by high psychophysiological demands derived from long training durations, tournaments, and games, leading to mental, emotional, and physical stress. these characteristics could provide chess players a certain advantage in facing quarantine situations. this study aimed to analyze the effect of covid- confinement on behavioral, psychological, and training patterns of chess players based on their gender, level of education, and level of chess played. we analyzed chess players (n: ; age = . ± . years) in countries where confinement was mandatory: professional players (n: ; age = . ± ), high-performance players (n: ; age = . ± . ), competitive players (n: ; age = . ± . ), and amateur players (n: ; age = . ± . ). results showed that chess players significantly decreased physical activity per day while increased chess practise during the confinement period. however, anxiety levels remained moderate despite the anti-stress effects of physical activity. amateur players showed a significantly higher level of social alarm than professional and high-performance players. moreover, professional players showed higher values of extraversion than high-performance players and amateur players. in neuroticism, professional players showed higher values than high-performance players. in addition, the professional players showed higher scores in psychological inflexibility than competitive players. finally, chess players with the highest academic level showed higher levels of personal concern and anxiety due to covid- as well as lower psychological inflexibility compared to those with a lower academic level. in conclusion, chess players, especially those with a higher academic level, might have adapted their psychological profile to fit confinement situations and the worrying levels of physical inactivity. in december , a novel coronavirus emerged in china, which posed an international public health emergency. this virus was named as the severe acute respiratory syndrome coronavirus- (sars-cov- ) (rodriguez-morales et al., ) . on april , , there were , , confirmed cases and , deaths worldwide [world health organization (who) , a]. therefore, on march , the new coronavirus disease (covid- ) was described as a pandemic by the world health organization (who) ( a). with no vaccine available and no herd immunity, most of the world governments decreed a quarantine to stop the pandemic (clemente-suárez et al., ) . covid- confinement produces negative psychological effects, including post-traumatic stress, confusion, or anger (brooks et al., ) . in this context, the confinement is the highest rated preventive measure of the spanish population (de la vega et al., ) . during the confinement, most individuals are exposed to an unprecedented situation of unknown duration, being exposed to anxiety, fear, depression, or sleep disruption (altena et al., ) . considering the behavioral immune system theory (terrizzi et al., ) , in the pandemic, people would develop these somatizations due to a negative appraisal of the situation and self-protection . previous studies in long confinement ( days) produced direct modifications in stress hormone levels and immune functions (strewe et al., ) . moreover, studies carried out on involuntary confinement (prisoners), showed a different incidence of psychiatric morbidity (andersen et al., ) . the covid- pandemic is globally affecting physical activity behaviors, forcing many people around the world to self-isolate for a prolonged time (hammami et al., ) . this makes it challenging to comply with the global world health organization (who) ( b) physical activity recommendations ( ), and leads to an increase in sedentary behaviors, such as spending excessive time sat down, or using screens (playing games, watching television, using mobile devices) (chen p. j. et al., ) . nevertheless, practical recommendations for staying active at home, with aerobic exercise on ergometers, bodyweight training, dance, or active video games, can help to counteract the detrimental physical and mental side effects of the covid- confinement (hammami et al., ) . ahtlethes have also suffered the enormous consequences of this pandemic. for instance, the tokyo olympic games was postponed until (international olympic committee, ) and the international chess federation ( ) (fide) canceled the world candidates tournament (fide, ) . chess is considered a sport with high psychophysiological demands where players are exposed to higher levels of stress and cognitive load (fuentes-garcia et al., , fuentes-garcia et al., a ,b,c, villafaina et al., ) . previous neuropsychological studies have shown the benefits of chess practice in executive functions, facilitating the adaptation to complex or not routine situations (grau-perez and moreira, ; ramos et al., ) . therefore, chess players showed an excellent ability for planning, selfcontrolling, coping, or problem-solving (cuéllar and díaz, ; aciego et al., ) . since personality modulates stress and cognition relationships (radtke et al., ) , a chess player's personality could influence how they face covid- confinement. in this regard, chess players are characterized for unconventional thinking and orderliness (radtke et al., ) , being highly competitive players, and more suspicious (avni et al., ) , and introverted (vollstadt-klein et al., ) than nonplayers. interestingly, personality differences are evident even in young children who play chess. children, who scored high in intellect/openness and energy/extraversion, are more likely to play chess, while children who score higher on agreeableness are less likely to play chess (bilalic et al., ) . then, this study aimed to analyze the effect of covid- confinement in behavioral, psychological, and training patterns of chess players based on their gender, level of education, and level of chess game. a total of chess players ( . ± . ), residents in different countries of asia, america, africa, and europe were analyzed. all the participants competed in the world chess federation (fide) and were classified according to the ranking system developed by elo ( ) . they were divided into four groups: ( ) professional players: players holding the highest level qualification or the second-highest level awarded by the fide, grand master and international master (n: ; age = . ± ; elo = . ± ); ( ) high-performance players: players holding the third or fourth highest level of fide, fide master and master candidate (n: ; age = . ± . ; elo = . ± . ); ( ) competitive players: players with fide ranking (n: ; age = . ± . ; elo = . ± . ) and ( ) amateur players: people who practice chess regularly but do not compete in fide tournaments (n: ; age = . ± . ). the inclusion criteria were: (a) be a chess player of years or older, (b) live, at the time of data collection, in a country where covid- confinement was decreed, (c) have read and signed the written informed consent. before participation, experimental procedures were explained to all the participants who gave their voluntary written informed consent, following the declaration of helsinki. all the procedures were approved by the commission of bioethics and biosecurity of the university of extremadura (spain) (approval number: / ). chess players completed an online-based questionnaire between march , and april , . firstly, they had to sign the informed consent and then disclose the following information: • age, gender, and current country of residence. academic and sport-related information individual perceptions about covid- crisis in a liker - scale (adapted from de la vega et al., ) • because of the current confinement rules, i consider my options to get my best performance in the most important chess competitions when they are already allowed. • in this context of covid- , i am satisfied with the level of support that public institutions have had with chess players to try to maintain the highest level of preparation. • level of personal concern about covid- . • perception of social alarm by covid- . • control perception level to avoid getting infected by covid- . • level of personal care to avoid contagion by covid- . • i consider that the current situation generated by covid- has dramatically affected my chess training routines. • personality was assessed by the brief version of the big five personality inventory, where extraversion, agreeableness, conscientiousness, neuroticism, and openness to experience factors were analyzed (rammstedt and john, ) . • loneliness was evaluated by the short version of the ucla loneliness scale (hughes et al., ) . • psychological inflexibility was measured by the acceptance and action questionnaire-ii. it is a -item questionnaire where participants must respond in a - scale (ruiz et al., ) . • anxiety was assessed by the state-trait anxiety inventory (stai) short form (marteau and bekker, ) . based on the results of kolmogorov-smirnov and shapiro-wilk tests, non-parametric tests were used. the chi-square tests were performed (χ ) to analyze the ordinal categorical variables related to the number of chess and physical activity practises. mann-whitney u tests were conducted to investigate gender-based differences in elo and psychological variables. moreover, kruskal-wallis tests were performed to investigate betweengroup differences (according to the chess performance and level of study) in the psychological variables. the mann-whitney u-test with the bonferroni correction for multiple comparisons was conducted to explore pairwise differences. kendall's tau b (τb) was used to explore the correlation between the practice of physical activity and the practice of chess as well as the psychological profile of chess players. effect sizes (r), for each test, were calculated. it is classified as follows: . is a large effect, . is a medium effect and . is a small effect (fritz et al., ) . table showed the descriptive data such as the number of subjects ( the chi-square tests showed significant higher scores in physical activity practice before confinement (χ = . p < . τb = . ). significant effects were observed in the four groups (professional players, high-performance players, competitive players, and amateur chess players) (see table ). regarding chess practice (before and during confinement) results showed significantly higher scores in practice time during the covid- confinement (χ = . p < . τb = . ). only amateur chess players did not significantly change the chess practice during confinement ( table ) . mann whitney u showed a significantly higher elo level [z = - . , p < . , effect size (r) = . ] in men when compared to women. moreover, the elo fide score [z = - . , p < . , effect size (r) = . ] was higher in men. regarding the differences in the perception they have about covid- , only differences in the level of personal care to avoid infection appeared, with higher scores in the female group [z = - . , p < . , effect size (r) = . ]. finally, in the rest of the variables studied, anxiety and personality, only significant differences in kruskal-wallis tests showed significant differences in the perception of social alarm, extraversion, neuroticism, and cognitive inflexibility (p < . ). pairwise comparisons showed that differences were observed between professional players and amateur players, with higher values in the professional players [z ( , ) = . p < . , effect size (r) = . ]. differences were also observed between the high-performance players and the amateur players, with higher scores in the high performance group [z ( , ) = . p < . , effect size (r) = . ]. regarding personality variables, differences in extraversion were found between the amateur players and the high-performance players, with higher scores in the high performance group [z ( , ) = . p < . , effect size (r) = . ]. in neuroticism, statistically significant differences were obtained between the professional players and the highperformance players, with higher scores in the high performance group [z ( , ) = . p < . , effect size (r) = . ]. lastly, competitive players showed greater psychological inflexibility than professional players [z ( , ) = . p < . , effect size (r) = . ]. the kruskal-wallis analyses also showed differences when comparing chess players according to the level of study. thus, chess players with a high school education showed higher personal concern than those with university studies [z ( , ) = . p < . , effect size (r) = . ], as well as those with professional training showed higher scores than those with a high school level education [z ( , ) = . p < . , effect size (r) = . ]. regarding cognitive inflexibility, chess significant positive correlations between chess practice and physical activity both before (p < . τb = . ) and during confinement (p < . τb = . ) were found. in addition, significant correlations were found between different variables in the psychological profiles of chess players (see table for further details). this research aimed to analyze the effect of covid- confinement in behavioral, psychological, and training patterns of chess players, based on their gender, level of education, and level of chess game. the study showed that chess players significantly decreased physical activity per day while increased chess practise during the confinement period. however, anxiety levels remained moderate despite the anti-stress effects of physical activity. in the present confinement context, increased somatization of anxiety, resulting from the perception of lack of control in adapting to contextual demands (halabchi et al., ) and the imposition of a restriction of liberty or perception of non-voluntary self-isolation was described (halabchi et al., ) . its health impact may be related to the duration of the confinement (extended periods are associated with poorer mental health, avoidance behaviors, and anger), the fear of infection, frustration, and boredom, inadequate supplies (e.g., water, clothes, accommodation), or inadequate information (brooks et al., ) . however, the anxiety values evaluated could be considered as medium, despite the low values of physical activity during the pandemic, since it has an anxiolytic effect (petzold et al., ) . these results could be related to the higher cognitive resources and wide experience of these highperformance athletes when coping with anxiety contexts such as competitions (belinchon-demiguel et al., ) . interestingly, . % of chess players did not practise physical activity (sports, maintenance gymnastics) before the confinement ( . % less than min on average a day) and this percentage went to almost double, % ( . % less than min on average a day) during the confinement. the . % ( . % during confinement) of professional chess players did not carry out any type of physical training before covid- , and . % ( . % during confinement) did less than min per day. this is a controversial fact since a good physical condition is recommended to obtain the maximum chess performance (alifirov et al., ) . the physical activity analyzed did not accomplish the health requirements of world health organization (who) ( c), which is in line with the increased sedentarism of the general population around the world (middelbeek and breda, ) . focusing on gender-based differences, the results of the present study showed a significantly higher elo fide in men than in women. this finding is in line with a previous study (chess-rankings, ) , and could be explained by different factors such as participation rates, degree of involvement, starting age, and perseverance. our results also showed that women reported a higher level of care to avoid infection than men. this is consistent with a previous study (de la vega et al., ) in the spanish population where men and women significantly differed in compliance with safety measures, exercising proper care to wash hands, and in keeping at least . m distance from others in public spaces. however, this greater compliance with safety measures does not translate into a higher number of infections (wenham et al., ) . nevertheless, there seems to be higher mortality and vulnerability to the disease in men (epidemiology working group for ncip epidemic response and chinese center for disease control and prevention, ) which could be due to differences in the immunological response (chen n. s. et al., ) or the prevalence of smoking (liu et al., ) . regarding chess performance groups, professional and highperformance groups reported higher values of social alarm than amateur ones. this may be due to a high control perception to avoid infection and personal care to avoid infection, which is also shown in our results. in addition, positive correlations were found between the level of personal concern, the perception of social alarm, the control perception level to avoid getting infected, and the level of personal care to avoid infection by covid- . similar results were obtained in a previous study (de la vega et al., ) regarding attitudes toward covid- in spain. moreover, vollstadt-klein et al. ( ) showed that elite chess players showed a direct correlation between skill and extraversion, which is in line with an effect of extraversion on the psychological and physical strain. these results are in line with ours since our participants showed that the highest level of performance had the highest values of extraversion and neuroticism. in contrast, in the study of vollstadt-klein et al. ( ) , the authors did not find significant differences between the level of neuroticism between competitive players and non-players. differences in cognitive inflexibility were not found between the different performance groups. although previous studies as grau-perez and moreira ( ) or ramos et al. ( ) , showed that children who practice chess have higher scores on tasks that value cognitive flexibility than those who do not. this is probably because chess practice facilitates adaptation to complex or novel situations, which are not routine and demand control mechanisms to resolve effectively. however, when participants were divided by education levels, the professional education level group showed higher values than the university level group. these results are in line with a previous study showing a negative correlation between educational level and psychological inflexibility (wicksell et al., ) . on the other hand, the psychological inflexibility was related to an inadequate adaptive response in the confinement situation, since it correlated with a negative perception in their sports performance and more neuroticism trait, loneliness feeling, and anxiety. in this sense, psychological inflexibility has been shown to be detrimental to mental health (makriyianis et al., ) . the present study has some limitation that should be addressed. firstly, the use of non-validated questionnaires for assessing some of the outcomes. second, due to covid- confinement, only self-reported answers were possible to obtain. therefore, physical activity data should be taken with caution. thus, future studies should validate these questionnaires and use direct methods to assess physical activity, such as objective monitoring devices (accelerometers and pedometers). chess players perceived that covid- confinement negatively affected their physical activity profile, increasing chess practice, despite anxiety levels remained moderate. the perception of alarm is higher in the lower level of play, while the extraversion, neuroticism, and psychological inflexibility is higher in the higher level of play. a higher academic level seems to be related to higher levels of personal concern and anxiety due to covid- and lower psychological inflexibility levels. chess players, especially those with a higher chess level, might have an adapted psychological profile to confinement situations, as well as worrying levels of physical inactivity. the raw data supporting the conclusions of this article will be made available by the authors, without undue reservation, to any qualified researcher. the studies involving human participants were reviewed and approved by the commission of bioethics and biosecurity of the university of extremadura (approval no. / ). the patients/participants provided their written informed consent to participate in this study. jf-g and mm conceived the study and collected the data. jf-g and vc-s designed the questionnaire and analyzed the data. jf-g and sv designed the tables. jf-g wrote the manuscript. jf-g, mm, sv, and vc-s provided critical revisions on the successive drafts. all authors approved the manuscript in its final form. the benefits of chess for the intellectual and social-emotional enrichment in schoolchildren sport-specific diet contribution to mental hygiene of chess player dealing with sleep problems during home confinement due to the covid- outbreak: practical recommendations from a task force of the european cbt-i academy a longitudinal study of prisoners on remand: psychiatric prevalence, incidence and psychopathology in solitary vs. nonsolitary confinement personality and leisure activities -an illustration with chess players psychophysiological stress response of a paralympic athlete during an ultraendurance event. a case study personality profiles of young chess players the psychological impact of quarantine and how to reduce it: rapid review of the evidence epidemiological and clinical characteristics of cases of novel coronavirus pneumonia in wuhan, china: a descriptive study coronavirus disease (covid- ): the need to maintain regular physical activity while taking precautions world statistics dynamics of population immunity due to the herd effect in the covid- pandemic desempeño en pruebas de funciones ejecutivas que miden el componente de planificación en un grupo de ajedrecistas profesionales the rating of chessplayers, past and present the epidemiological characteristics of an outbreak of novel coronavirus diseases (covid- ) in china top players effect size estimates: current use, calculations, and interpretation heart and brain responses to real versus simulated chess games in trained chess players: a quantitative eeg and hrv study psychophysiological stress response of adolescent chess players during problem-solving tasks chess players increase the theta power spectrum when the difficulty of the opponent increases: an eeg study use of biotechnological devices in the quantification of psychophysiological workload of professional chess players differences between high vs. low performance chess players in heart rate variability during chess problems a study of the influence of chess on the executive functions in school-aged children covid- epidemic: exercise or not to exercise; that is the question! physical activity and coronavirus disease (covid- ): specific recommendations for homebased physical training a short scale for measuring loneliness in large surveys -results from two population-based studies fide stops the candidates tournament tokyo olympics postponed to due to coronavirus pandemic the impact of covid- epidemic declaration on psychological consequences: a study on active weibo users prevalence and patterns of tobacco smoking among chinese adult men and women: findings of the national smoking survey psychological inflexibility mediates the relationship between adverse childhood experiences and mental health outcomes the development of a -item short-form of the state ccale of the spielberger state trait anxiety inventory (stai). br obesity and sedentarism: reviewing the current situation within the who european region physical activity in the prevention and treatment of anxiety disorders personality, stress, and intuition: emotion regulation abilities moderate the effect of stressdependent cortisol increase on coherence judgments measuring personality in one minute or less: a -item short version of the big five inventory in english and german funciones ejecutivas y práctica de ajedrez: un estudio en niños escolarizados covid- , an emerging coronavirus infection: current scenario and recent developments -an overview measuring experiential avoidance and psychological inflexibility: the spanish version of the acceptance and action questionnaire -ii functional changes in neutrophils and psychoneuroendocrine responses during days of confinement the behavioral immune system and social conservatism: a meta-analysis electroencephalographic response of chess players in decision-making processes under time pressure personality of elite male and female chess players and its relation to chess skill covid- : the gendered impacts of the outbreak the psychological inflexibility in pain scale (pips) -statistical properties and model fit of an instrument to assess change processes in pain related disability coronavirus disease (covid- ) situation report - global recommendations on physical activity for health who director-general's opening remarks at the media briefing on covid- we acknowledged the crucial help, in the dissemination and collection of samples for the study, of the chess club "magic extremadura, " at mérida (badajoz), especially for their great involvement with the study, to its president, juan antonio montero aleu, and the international chess grandmaster, manuel pérez candelario. the authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. key: cord- -f q di t authors: pietrabissa, giada; simpson, susan g. title: psychological consequences of social isolation during covid- outbreak date: - - journal: front psychol doi: . /fpsyg. . sha: doc_id: cord_uid: f q di t perceived social isolation during the covid- pandemic significantly has had an extraordinary global impact, with significant psychological consequences. changes in our daily lives, feeling of loneliness, job losses, financial difficulty, and grief over the death of loved ones have the potential to affect the mental health of many. in an atmosphere of uncertainty, it is essential that clear and precise information is offered about the problem and how to manage it. in this contribution, a rationale is provided for an urgent call for a rapid response to the mental health impacts of covid- . moreover, suggestions for individuals to regulate their emotions effectively and appropriately are provided. the mental health consequences of covid- are already visible and even by conservative estimates they are yet to reach their peak and likely to considerably outlive the current pandemic. the most common psychological disorders emerging are anxiety and panic, obsessive-compulsive symptoms, insomnia, digestive problems, as well as depressive symptoms and post-traumatic stress (rogers et al., ) . these are not only a direct consequence of the pandemic but also largely driven by the effects of prolonged social isolation -that is the objective lack of interactions with others (leigh-hunt et al., ) . the medical journal the lancet recently published an article from which a clear and alarming picture emerges: periods of isolation, even less than days, can have long-term effects, with the presence -up to years later -of psychiatric symptoms (brooks et al., ) . although necessary to limit the spread of the epidemic, in fact, human beings are not "designed" to manage segregation for a long time. as the greek philosopher aristotle reminds us, man is a "social animal, " unable to live isolated from others, since the absence of relationships removes essential conditions for the development of personal identity and the exercise of reason. although our first instincts may be to react angrily at (and with) people who pour out onto the streets, there is a need for a more universal compassionate stance -and recognition that the very nature of the human being is in stark contrast with the situation we are experiencing. moreover, research shows that nourishment and movement -besides being important therapeutic expedients -are a fundamental vehicle for communicating with ourselves, others, and the world, and have an enormous influence on our biopsychological balance. prolonged isolation can adversely affect physical and emotional health, altering sleep and nutritional rhythms, as well as reducing opportunities for movement (cacioppo and hawkley, ) . as a result, the natural channels of human expression and pleasure become depressed, with attendant impacts on mood and subjective well-being (nardone and speciani, ) . furthermore, in accordance with current regulations, we have begun to behave "as if " other people are potentially dangerous for our health and for the health of our loved ones. this turn of events has cultivated a new universal belief based on vulnerability-to-harm, whereby proximity to fellow humanbeings poses a direct threat (nardone and portelli, ) . to date, more and more people are avoiding social relations, no longer by imposition, but as a choice. a decision initially moved by the fear of an invisible enemy and by the total uncertainty about what is right to do/not to do, to say/not to say, to think/not to think, derived from the informationambiguous and conflicting -that we have received. in turn, this determines behavior that will gradually replace our old worldview and interpersonal relationships. while the levels of environmental stress continue to rise, we are witnessing the deterioration of relationships. rather than connecting people, restrictive measures are creating rivalries and arousing discord between people. as conveyed by the latin phrase "divide et impera" (literally divide and conquer), an authority that exerts high levels of control and division in governing a population, tends to fragment them. the magnitude and impact of fragmentation can be influenced substantially by leadership style. grandiose leadership, for example, may create the seductive illusion of safety, with claims of invincibility and omnipotence, while providing an outlet for a range of grievances associated with inequalities and poverty through paranoia and blame of perceived "enemies. " these processes provide fuel for xenophobia and deeper divisions within society (case and maner, ; o'reilly and hall, ) . anger and nervousness, unspoken and lasting, come back to haunt us with psychological problems. likewise, spending an unusual amount of time together in confined spaces -often unsuitable for the purpose itselfincreases the risk of conflicts and domestic violence. china has experienced a significant rise in separations and divorces, particularly stressful events, which can act as a triggerespecially among the most sensitive -for the development of mental health problems, primarily depression. on the other hand, prolonged social isolation characterized by reduced social connections and contact, generates deep disconnection among those who live alone or cannot rely on an adequate social network, thus increasing the likelihood that depressive symptoms will emerge. social isolation has been linked to cognitive impairment, reduced immunity, increased risk of cardiovascular disease, and ultimately, mortality (cohen et al., ; bassuk et al., ; barth et al., ; heffner et al., ) . the association between physical frailty and social isolation has been linked to heightened inflammatory activity, as indicated by increased levels of c-reactive protein and fibrinogen (loucks et al., ) . social isolation and loneliness are related concepts and often coexist -loneliness can lead to isolation, and vice versa (shankar et al., ) . loneliness has been an emerging issue in society in recent years, and has been linked to depression, irritability, and preoccupation with negative self-related thoughts, alongside a % increase in risk of premature death. research suggests that this has been a growing problem in industrialized countries, with approximately one-third of the population affected, and one in people affected at a severe level. further, it appears that income and socioeconomic status are no barrier to loneliness -everyone is equally at risk holt-lunstad and smith, ) . loneliness is increasingly recognized as a public health issue, especially due to the detrimental effects on health and potential for premature mortality (grant et al., ; cole et al., ; murthy, ; yanguas et al., ; bzdok and dunbar, ) . loneliness is associated with feelings of emptiness, sadness, and shame, alongside the subjective perception that one is disconnected from others. it not only can occur in the context of social isolation but can also persist beyond this and can be experienced even when others are physically present. like social isolation, loneliness has been linked to depression (cacioppo et al., ; han and richardson, ) , increased cortisol levels (edwards et al., ; miller, ) , lowered immunity (cole et al., ) , and clinical disease, with attendant increases in length and frequency of hospital stays (thurston and kubzansky, ; hawker and romero-ortuno, ) . further, social isolation and loneliness may be stronger predictors of suicidality than other well-known risk factors, such as anxiety and hopelessness (hom et al., ) . in spite of the clear risks associated with loneliness, treatments to date based on cognitive-behavioral principles have shown poor outcomes (masi et al., ) . with the onset of covid- , enforced social isolation is likely to be exacerbating what is already a significant issue in our society (hughes et al., ) . added to this is the devastating and understandable impact of concerns related to economic problems and the loss of a loved one. during the coronavirus epidemic, we are forced to deal with death in ways unrelated to human civilization: from the thought of not being able to be with the deceased in his/her last moments of life, to the sense of guilt for the idea of having inadvertently infected the person, to the distress of not being able to properly honor him/her with a funeral ceremony, fundamental to the process of mourning -these are all factors that amplify the pain of death, increase the rates of depression, the consumption of alcohol, drugs and risky behaviors and, in the more extreme cases of suicide. unlike the common and ineliminable moments of crisis that characterize the existence of each of us -which, although destabilizing, represent a unique and fundamental opportunity to review personal strategies for problem management -in this period, people are experiencing impotence, vulnerability, and a feeling of loss of control over one's life as a response to something indeterminate in time and space. this generates anguish for an uncertain future and, once again, favors the appearance of depressive symptoms -especially in those most frontiers in psychology | www.frontiersin.org vulnerable, including those who already suffered from mental health problems and in health workers. those who have been placed in quarantine and those working on the front lines to deal with the epidemic are also at risk of being stigmatized: as possible "plague-spreaders, " they are viewed with fear and suspicion. certainly, some will prove to be more resilient than others and will be able to count on the presence of greater personal, social, and economic resources, but we all will be affectedto varying degrees -by the impact of this revolution on our way of living and relating to each other and on our physical and psychological health. the environmental stressors that characterize this particular historical moment clearly suggest the risk of a new epidemic, and this time there are signs it could be our mental health; but the national health system, once again, may not be ready to stem the effects of the epidemic. as the reality of social isolation persists throughout and beyond the pandemic, loneliness and interpersonal disconnection will emerge, particularly for those most socially vulnerable. psychophysical exhaustion, anxiety, fear and pain, anguish, trauma, and anger -these emotions alternate, mix, and grow in intensity to the point of overwhelm, leading to clinically significant psychological disorders, such as "reactive depression. " while the covid- crisis increases the risk of depression, depression affects the individual's ability to solve problems, set and achieve goals, and function effectively, at work and in relationships, making recovery from the crisis even more difficult. in fact, even if it manifests in different ways, at the basis of depression there is always an attitude of renouncement. people gradually lose any form of active reactivity in the face of life's difficulties: there is an increasing tendency to complain, let off steam, and rely completely on others in the management of themselves, all actions of delegation, therefore of renunciation. and, as described by emile cioran, the renunciation is nothing more than "a small daily suicide. " feeling safe and protected is a fundamental primary need of the human being to be able to move freely in the surrounding world, as well as the feeling of having control over the events of our own life. when all this fails, when the belief that whatever we do will not improve things begins to develop, a sense of "learned helplessness" takes hold, blocking any possibility of liberation or change. the anguish we experience is a normal human response to a serious crisis. recognizing and accepting these feelings prevents them from turning into disorder. giving up, delegating, and complaining are all attitudes that at the beginning of a crisis can help us, but after several months can become entrenched, self-perpetuating, and end up complicating the situation, evolving as a slow drift into a depressive mindset. recognizing these patterns immediately in one's thought processes and behavior is the best way to move in the opposite direction and to break the vicious circle that leads to global renunciation -and that characterizes the most severe depressive forms. this pandemic will inevitably lead to redefining our relationship styles, which will no longer be based on proximity but on distance. physical contact will be replaced by negotiated sharing, while the digitalization of lives, already started with the advent of social media, technology, and virtual reality, will be further emphasized, thanks to medical-scientific legitimacy. abandoning the idea that "things will go back to normal" and facing the changes taking place with flexibility mitigates the onset of psychopathology. the human being -by nature -is extremely flexible -facilitating adjustment to the reality that change will become the new normality (rossi et al., ) . in lao tzu's words, "water is fluid, soft, and yielding. but water will wear away rock, which is rigid and cannot yield. as a rule, whatever is fluid, soft, and yielding will overcome whatever is rigid and hard. this is another paradox: what is soft is strong. " but it takes time. specific treatment options are available for the most problematic situations, and more available than before the advent of the coronavirus, as mental health professionals -even the most resistant -are -flexibly -offering online support and advice. first, however, there is a need for higher level changes: state economic support measures are crucial responses to both the economic recession and the psychological depression. institutions must ensure that this experience is as tolerable as possible for people. alarmist messages, such as the emphasis on the negative aspects of the pandemic (number of seriously ill people or deaths) rather than on the positive ones (number of recovered), the abuse of alarmist expressions ("death even among young people"), and stories rich in personal details about the victims, are as counterproductive as excessive references to positivity and optimism, which, on the other hand, produce a paradoxical effect: the unrealistic nature of the messages may lead to greater mistrust and perhaps dismay ("they do not tell it as it is"). even vague or ambiguous messages ("if we are united, everything will be fine, " "be responsible, " "stay alert, control the virus") dilute the desired effects. human resilience is closely linked to the depth and strength of our interpersonal connections, including our involvement in groups and communities. in contrast, loneliness appears to be one of the greatest threats to our health, survival, and well-being. in an atmosphere of uncertainty and fear, it is essential that clear and precise information is provided on the problem and on the management of the emergency. greater cultural and economic investments will therefore have to emerge to support better and more timely prevention, treatment, and rehabilitation programs in the field of mental health, because "there is no health without mental health. " frontiers in psychology | www.frontiersin.org september | volume | article the original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author. lack of social support in the etiology and the prognosis of coronary heart disease: a systematic review and meta-analysis social disengagement and incident cognitive decline in community-dwelling elderly persons the psychological impact of quarantine and how to reduce it: rapid review of the evidence the neurobiology of social distance the neuroendocrinology of social isolation social isolation and health, with an emphasis on underlying mechanisms loneliness as a specific risk factor for depressive symptoms: cross-sectional and longitudinal analyses divide and conquer: when and why leaders undermine the cohesive fabric of their group social ties and susceptibility to the common cold myeloid differentiation architecture of leukocyte transcriptome dynamics in perceived social isolation transcript origin analysis identifies antigen-presenting cells as primary targets of socially regulated gene expression in leukocytes elevated macrophage migration inhibitory factor (mif) is associated with depressive symptoms, blunted cortisol reactivity to acute stress, and lowered morning cortisol social isolation and stress-related cardiovascular, lipid, and cortisol responses the relationship between depression and loneliness among homebound older persons: does spirituality moderate this relationship? social determinants of discharge outcomes in older people admitted to a geriatric medicine ward social isolation, c-reactive protein, and coronary heart disease mortality among community-dwelling adults loneliness and social isolation as risk factors for cvd: implications for evidence-based patient care and scientific inquiry a systematic review of help-seeking and mental health service utilization among military service members a short scale for measuring loneliness in large surveys: results from two population-based studies an overview of systematic reviews on the public health consequences of social isolation and loneliness relation of social integration to inflammatory marker concentrations in men and women to years a meta-analysis of interventions to reduce loneliness social neuroscience. why loneliness is hazardous to your health work and the loneliness epidemic knowing through changing: the evolution of brief strategic therapy mangia, muoviti, ama. firenze: ponte alle grazie grandiose narcissists and decision making: impulsive, overconfident, and skeptical of experts-but seldom in doubt psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: a systematic review and meta-analysis with comparison to the covid- pandemic the anxiety-buffer hypothesis in the time of covid- : when self-esteem protects from loneliness and fear for anxiety and depression loneliness, social isolation, and behavioral and biological health indicators in older adults women, loneliness, and incident coronary heart disease the complexity of loneliness gp drafted and edited the manuscript. ss critically revised the manuscript. all authors contributed to the article and approved the submitted version. key: cord- -znmpheia authors: simione, luca; gnagnarella, camilla title: differences between health workers and general population in risk perception, behaviors, and psychological distress related to covid- spread in italy date: - - journal: front psychol doi: . /fpsyg. . sha: doc_id: cord_uid: znmpheia in this study, we investigated the perception of risk and the worries about covid- infection in both healthcare workers and the general population in italy. we studied the difference in risk perception in these two groups and how this related to demographic variables and psychological factors such as stress, anxiety, and death anxiety. to this aim, we administered an online questionnaire about covid- together with other questionnaires assessing the psychological condition of participants. first, we found that the exposition to infection risk, due to living area or job, increased the perceived stress and anxiety (i.e., medical staff in north italy was more stressed and anxious with respect to both medical- and non-medical participants from center and south italy). then, we conducted hierarchical logistic regression models on our data to assess the response odds ratio relatively to each regressor on each dependent variable. we found that health workers reported higher risk perception, level of worry, and knowledge as related to covid- infection compared to the general population. psychological state, sex, and living area were less related to these factors. instead, judgments about behaviors and containment rules were more linked to demographics, such as sex. we discussed these results in the light of risk factors for psychological distress and possible interventions to meet the psychological needs of healthcare workers. on december , , some cases of pneumonia of unknown etiology have emerged in the hubei region of china. then, on january , , the causative agent has been identified by means of oropharyngeal swabs, i.e., a virus belonging to the coronaviridae family called sars-cov- (severe acute respiratory syndrome coronavirus ). this new coronavirus was responsible of the respiratory syndrome called , ). most patients with positive swab test developed only minor symptoms, such as fever, dry cough, and pharyngitis, with a benign evolution and spontaneous resolution of the clinical picture. however, some patients developed severe complications, such as interstitial pneumoniae with acute respiratory distress syndrome, pulmonary edema, multiorgan failure, septic shock, and even death (sohrabi et al., ) . patients at risk were especially males, aged older than years, suffering from cardiovascular comorbidities (e.g., arterial hypertension, diabetes, and chronic coronary artery disease), and affected by chronic pneumopathies or cancer (world health organization [who] , ; zhou et al., ) . in the following month, the disease spread to other countries outside china, including italy, where the first positive cases were found on february , (spina et al., ) . italy experienced a significant increase in new cases, mostly in the month of march, in particular in the north regions, and this caused in turn a growing alarm throughout the italian medical-hospital sector due to the imbalance between the resources of the national health system (indicated as ssn, i.e., "sistema sanitario nazionale") and the expected need for treatment required by forecasts on the virus spread. this concern was publicly expressed in the guidelines published by the italian society of anesthesia, analgesia, and intensive care (named siaarti, i.e., "società italiana anestesia, analgesia, rianimazione e terapia intensiva") on march , , which reported that in case of huge imbalance between the population clinical needs and the effective availability of intensive resources, medical doctors should have selected patients for intensive therapies based on their actual hopes of survival (siaarti, ) . in fact, in italy, there were about , beds in total for intensive care units, and on march , , , of these beds had already been destined to patients suffering from covid- . according to the predicted number of new cases, the peak of contagions would have been reached by mid of april, when at least , beds in the intensive care units would have been needed in order to treat patients with covid- (remuzzi and remuzzi, ) , with significant consequences also for patients not affected by covid- , who would have given less assistance in the aforementioned units. however, on the one hand, doctors and other health workers multiplied their alarms relatively to this critical situation and to the related recommendations regarding behaviors to be followed and the hygienic conduct to be implemented; on the other hand, there were daily episodes of violation of such medical recommendations by the population, apparently only scarcely aware of the problem. for this reason, i.e., the failure of the unanimous spontaneous compliance of the population to the proposed hygienic rules and health practices, since february the italian government implemented increasingly restrictive dispositions to limit the spread of the disease throughout the country with various prime minister decrees (named dpcm, i.e., decreto del presidente del consiglio dei ministri; see dpcm on february , march , march , march , march , and march , ) . in fact, a significant portion of population continued to engage in risky behaviors, prompting increasingly stricter rules emanated by the authorities. therefore, a gap appeared to emerge between the indications and requests from the national health system staff and the reception of these same indications by the population, as well as a general difference in the perception and evaluation of the risks associated with the covid- infection between the two groups. such a difference seemed more evident especially in the areas of central and southern italy, where the covid- spread was lower than those of northern italy, as reported by the daily data provided by the national civil protection (see cereda et al., ) . the spread of the sars-cov virus in has shown how this type of epidemic disease has important psychopathological consequences, in the short and long term, in particular on health workers (sim and chua, ; lung et al., ; maunder, ) . thus, in the actual spread of the new sars-cov- virus attention to psychological health of doctors and others healthcare workers had already been expressed regarding the chinese situation relating to covid- (see for example xiang et al., ) , with proposals for intervention and support from the hospital structures . in fact, chinese health workers in wuhan faced a situation characterized by poor safety and protection, with excessive workloads, high infectious risk, absence of adequate personal protective equipment, and shortage of staff. this risky situation for one's own and loved ones' health could have clinical consequences, but also psychic ones. in fact, these health workers showed a symptomatology characterized by tiredness, worry, fear, frustration, isolation, depression, anxiety, stress, insomnia, anger, and negation (kang et al., ) . in particular, in this group of workers, women, workers with more than years of service, and operators who had a history of psychological suffering showed higher risk of stress, anxiety, and depression (zhu et al., ) . a further risk factor for psychological distress has been also a reduced social network support, a protective factor in the stress resilience (ozbay et al., ) . in the emergency situation caused by sars-cov- , healthcare workers are indeed at high risk of acute stress, and this risk could be even higher if they feel such a disjunction from the social community formed by the other citizens, as the situation in italy seemed to lead. in addition to the personal consequences on the psychophysical health of the health professionals, this could easily lead to a progressive decline in their health services, with a worsening of the quality of care provided. the experience with the disease caused by h n in japan showed how policies that take care of healthcare and give physicians confidence positively affected the overall care they provide to the population (maunder, ; imai, ) . for all these reasons, it is very important to study the trait and state psychological variables of healthcare workers as risk or protective factors with respect to the actual stressful situation. in this manner, it would be possible to evaluate the analogies and the differences with the chinese model at both intracultural and intercultural levels (mccrae, ) , for considering which intervention strategies could be suited for italian healthcare workers and thus importing the most adequate recently developed for the chinese healthcare system in response to the spread of covid- . in such an emergency situation, characterized by contrasts between the opinions and the worries of medical doctors on one side and the behaviors and the attitudes of the general population on the other, we designed and conducted this study. according to the evidences reported above, our objectives were (i) to probe the opinions and the worries relative to covid- spread in both the general population and healthcare workers; (ii) to study which demographic, geographic, and psychological variables were related to a higher perception of the health risks; and lastly (iii) to assess any difference in risk perception relatively to covid- between the general population and healthcare workers. thus, our aim was to understand the influence of psychological and training/working experience in shaping opinions, worries, and risk perception relatively to covid- . to this aim, we administered an online battery including a questionnaire about the direct experience, the opinions and the worries relative to the covid- , and some questionnaires evaluating the psychological distress state. to evaluate the participants distress level, we administered questionnaires measuring perceived stress, anxiety, and death anxiety as they usually increased in the general population (brooks et al., ) and in healthcare workers (brady, ; kang et al., ) during emergency situation. as the social-health situation in italy was evolving continuously in the beginning of march, we limited the data collection in the days - march . based on the evidence reviewed so far, we hypothesized that healthcare workers would show higher levels of distress in terms of stress, anxiety, and death anxiety, particularly in north italy, where the contagion was higher. in fact, as reported by lai et al. ( ) , direct exposition to virus outbreak affected the psychological health of healthcare workers, with those living in the region of wuhan reporting higher distress than colleagues living elsewhere. then, we hypothesized that healthcare workers would perceive higher levels of risk for themselves and for their relatives and that this effect would be true even when controlling for such psychological distress. in fact, we expected that this higher risk perception was not linked only to a worse psychological state, but also to a greater knowledge of the covid- disease and of its possible consequences. thus, we also expected that healthcare workers would report higher levels of knowledge of the new coronavirus. about containment and prevention measures, we expected that healthcare workers would report a higher engagement in preventing measures with respect to other people and request for more stringent containment measures, in order to prevent ssn collapse due to an increased number of accesses in hospital. following all the previous hypotheses, we expected that participants not in the healthcare workers group would provide more optimistic forecast about the progress of the spread of covid- . three hundred fifty-three italian adults participated in this study (mean age = . years, sd = . years; females = , males = ). we divided our sample by means of their job or training: in the first group, we included medical doctors, nurses, paramedics, and students in medicine/nursing/other medical disciplines ("med" group; n = ; mean age = . years, sd = . years; female = , males = ), whereas in the second group, we included all the other participants (no-med or "nom" group; n = ; mean age = . years, sd = . years; females = , males = ). we recruited our participants with a convenience sample method via email and social media. participants received a brief description of the study together with an informed consent module. after providing the informed consent, they completed an online battery of questionnaires, as described afterward. data were collected in anonymous format, and participants were invited at the end of the battery to leave their email in order to be contacted for possible follow-up measures. in this study, we collected data not reported here, as fully specified in the "materials and methods" section. in this study, we administered questionnaires to evaluate the psychological condition and personality traits of each participant. where possible, we opted for short or brief version of each questionnaire, in order to contain the total number of items ( total items). we included in our battery the following questionnaires: • the four-item perceived stress scale (pss; cohen et al., ) , a questionnaire evaluating the stress perceived by the participant in the last month, that is, the participant's perceived feeling to be in control over external events, relationships, and emotional life. we used the short fouritem version. each item was evaluated on a five-point likert scale ranging from (never) to (very often). in our sample, the four-item pss showed a good reliability score, cronbach's α = . , similar to what was reported in the original version, α = . . • the six-item version of state-trait anxiety inventory (stai; marteau and bekker, ) , which assessed the anxiety of the participants on six items including emotions or feelings. each item was evaluated on a four-point likert scale ranging from (almost never) to (almost always). in our sample, the six-item stai showed a similar reliability score, cronbach's α = . , to that reported in the original version, α = . . • the death anxiety scale of the existential concerns questionnaire (ecq; van bruggen et al., ) , which evaluated the anxiety of the participant relatively to his/her sense of finitude, to the fear of diseases and death. the total score was computed overall five items. each item was evaluated on a five-point likert scale ranging from (never) to (always). in our sample, the ecq death anxiety scale showed a good reliability score, cronbach's α = . (in the original version, only the internal consistency for the global score was reported, α = . ). • the marlowe and crowne social desirability scale (m&c; manganelli rattazzi et al., ) , which assessed the tendency of answering in a socially desirable manner. this version of the scale implied nine items evaluated over a six-point likert scale ranging from (absolutely false) to (absolutely true). in our sample, the m&c scale showed an acceptable reliability score, cronbach's α = . , slightly lower than that reported in the cited italian validation, α = . . we also included in the battery other questionnaires, which results were not reported in the present work: the -item big five questionnaire (guido et al., ) , the acceptance and action questionnaire ii (pennato et al., ) , and the emotion regulation questionnaire (balzarotti et al., ) . we further developed a questionnaire about sars-cov- and covid- -related experience and personal opinion. both authors (l.s. and c.g.) compiled a first list of items, and then this list was revised by five experts (medical doctors and psychotherapists) in order to remove, change, or add relevant items. we obtained a final list including items. a complete list of the items was reported in appendix a. to keep the questionnaire simple and easy to understand, we preferred to include mostly yes/no questions. the questionnaire we administered included the following: data analysis was conducted with statistical software r, version . . (r core team, ). as first step, we assessed differences in our sample between the med and nom groups for the demographic variables in order to control for unbalanced factors in our sample. we conducted these comparisons by means of t-tests for numerical data and of χ tests for frequencies. then, we described the experiences about covid- infection in our sample and compared med and nom groups again and areas (north vs. center vs. south italy). we also compared the psychological state of our participants by group and area to assess difference in levels of anxiety, stress, and death anxiety. for these comparisons, we implied mixed-effects analyses of variance (anovas) with one between factor (group, two levels: med vs. nom) and one within factor (area, three levels: north, center, south). we further decomposed significant main or interaction effects by means of least significant difference-corrected post hoc pairwise comparisons. as main analysis, we computed hierarchical logistic regression on the dichotomic responses and reported overall our participants about preoccupations, opinions, and behaviors relatively to their experience with the new coronavirus. this analysis allowed us to estimate the odds to obtain a positive response to a particular question given a set of parameters. for non-dichotomous variables (e.g., contagious spread in the next days could either increase, decrease, or stay stable), we created n dichotomous dummy variables, where n was the number of possible alternative responses to "equal" response (e.g., for contagious spread in the next days, we created a dummy variable for increased forecast and a dummy variable for decreased forecast). we used as reference the middle-point response, i.e., "equal" response, and evaluated the propension to respond "more" or "less" with respect to this point. moreover, we did not analyze the questions for which we obtained identical or almost identical responses by all our participants, i.e., question with > % of equal responses. in fact, for such questions, it was easy to find one of the outcome categories so underrepresented that it could lead to rare event outcome or be linearly separated by only one of the independent variables (ivs). we introduced the regressors in the model at different steps of computation. at the first step, we introduced the demographic variables such as sex, age, and living area (with the north italy as reference). at the second step, we added to these variables the psychological state factors of perceived stress (pss score), anxiety (stai score), and death anxiety (ecq score), in order to investigate the contribution of these regressors. as last step, we investigated the difference between med and nom groups in responding to the questionnaire. for this aim, at the third step, we introduced the group variable as regressor. when conducting logistic regression analysis, we should check for assumption violations. first, we considered the sample size issue. in the full model, i.e., model at step , we had a total of eight ivs including all the regressors and the covariates. considering our sample size of participants, this resulted in an event per variable (epv) of approximately , computed as the ratio between number of participants and number of ivs. this epv could be considered as fairly sufficient to make the interpretation of our global model meaningful (harrell, ; ogundimu et al., ) , even if the more stringent bujang et al.'s rule of thumb bujang et al. ( ) would suggest to include at least participants for such a number of variables. moreover, for each tested model, we checked for influential outliers and for multicollinearity. to test for influential outliers, we computed cook's distance for each data point and check for values larger than sd from the mean, as a large value of cook's distance indicates an influential observation (martín and pardo, ; zhang, ) . to test multicollinearity, we computed the variance inflation factor (vif) for each regressor and check for any value greater than . , considered as more strict threshold with respect to the usual value of or (midi et al., ) . for all our logistic regression models, we found no influential outliers or any vifs greater than the threshold value. the results of these tests, together with the reported epv greater than , testified that our logistic regression analyses could be considered sufficiently reliable. to further support our logistic regression model results, we conducted semipartial correlation analysis by means of the ppcor package for r (kim, ) . we assessed the degree of relationship between group (coded as nom = and med = ) and each dependent variable of the covid- questionnaire while controlling for sex, age, living area, anxiety, death anxiety, and stress. semipartial correlations were reported as pearson r for each computed correlation, with values ranging from − , very strong negative relationship, to , very strong positive relationship. even if we conducted a great number of statistical analyses on the same sample, we decided not to apply a general correction to significance level for multiple tests. because of the exploratory nature of this study, we preferred not to strictly control over false-positive rate (type i error) while avoiding to inflate falsenegative rate (type ii error); i.e., we decided to collect all the significant results emerging from our analysis so to guide further, confirmatory experiments and studies (see fiedler et al., , for an overview of the problem on multiple testing correction). table reports the descriptive statistics for the two groups and the relative tests for samples' comparison. as shown, participants in the med group were younger (mean = . vs. . ), studied more years (mean = . vs. . ), had less children (mean = . vs. . ), reported to sleep in average less time per night (mean = . vs. . ), and were more frequently vaccinated for annual flu in ( % vs. %). in this first results section, we reported the analysis of the data relatively to the experience with the covid- . we thus referred to the data in the first part of the questionnaire, in which we asked if participants had personal experiences or contacts with covid- infection. we reported data overall participants and divided by groups in table . frequencies were compared by means of χ test. for the overall sample, we found an effect of the living area on question , about the presence of symptoms related to covid- , χ ( ) = . , p < . ; question , about thinking that the symptoms relate to a covid- infection, χ ( ) = . , p < . ; question , about the quarantine status, χ ( ) = . , p < . ; question , about contact with people at risk of infection, χ ( ) = . , p < . ; and question , about the presence of positive case in the living area or city, χ ( ) = . , p < . . in answering to all these questions, participants from north italy reported a greater direct experience with covid- than participants from center or south italy, whereas participants from center italy reported more personal experiences than participants from the south. then, we compared the frequencies between the two groups, med versus nom. we found significant differences in question , about contact with people at risk of infection, χ ( ) = . , p < . , and in question , about contact with people positive for covid- test, χ ( ) = . , p < . , with participants in the med group reporting more frequent contacts with people at high risk of infection or already positive. we measured various indexes of psychological distress state, i.e., anxiety, death anxiety, and stress. here, we tested if any difference existed between groups in the psychological state and if this difference was modulated by the living area. to this aim, we conducted mixed-effects (anovas) with a between-variable of group (med vs. nom) and a within-variable of living area (north vs. center vs. south italy). we controlled for the effect of age and sex as covariates. we probed significant effects by means of post hoc corrected tests. for the death anxiety score (ecq; see figure , left panel), we found no significant main effects or significant interaction, all p's > . . for the perceived stress score (pss; see figure , middle panel), we found a significant main effect of the living area, f( , ) = . , p < . , with participants from north italy reporting higher stress levels than participants from both center, p < . , and south italy, p < . . the analysis also revealed a significant group × living area interaction, f( , ) = . , p < . , with med participants from north reporting higher stress score than other med participants from both center, p < . , and south italy, p < . , as well as higher stress score than the nom group participants from all living areas, all p's < . . for the anxiety score (stai; figure , right panel), we found a significant main effect of living area, f( , ) = . , p < . , with participants from north italy reporting higher anxiety levels than participants from center, and a significant group × living area interaction, f( , ) = . , p < . . the interaction was due to a significant difference in anxiety between med participants from north with respect to the med participants from center and south italy, p's < . , and with respect to nom participants from center italy, p < . . this analysis thus revealed that the med group participants from north italy reported higher levels of anxiety and stress than the general population and the medical and paramedical staff from other living areas. before conducting the regression analysis on the questionnaire data, we reported some descriptive information and statistics about the response frequency of participants. response frequencies for each item overall sample as well as divided by group are reported in table , left group of columns. here we reported also a χ test comparing the frequency of "yes" responses for the two groups. of note, % of participants were thought to be at risk of contagion, but only % were thought to be at risk when the first cases appeared in italy. they also thought that their loved ones would be at risk ( %). the med group reported higher frequency of thinking to be at risk ( %). many participants in this group ( %) were scared about health consequences or death if infected, but almost all ( %) were more worried for family or loved ones' consequences of infection. similarly, the % of them reported worries about the global sociopolitical implication of virus spread, and the % about the possible collapsing of the national health system. moreover, % of them thought that people's behavior could be ever scaring of the infection and % were worried by the increased aggression risk for health workers in the near future. most of our sample ( %) reported to adhere to hygiene measures and to avoid public events or places ( %), and only a few participants reported to have risky behaviors for themselves ( %) or their family ( %). however, only % of nom and % of med believed that people's behavior was adequate to the situation. about violation of the public health dispositions, most of participants thought that violation should be punished more severely ( %) or that the national army should be implied ( %), as they reported to be preoccupied or angry toward such violations ( %). few reported to have bought more canned food ( %), and very few participants reported that they would try to escape if the infection would spread in their living area ( %), even if a great part of them ( %) believed that the infection fear could be considered a valid reason to break the containment rules. about the possible problem of accessing healthcare services, most of participants ( %) believed in the national health system, whereas few thought that it was right to give priority to people with greater hope of survival in case of shortage of hospital beds ( %) and even less ( %) that they would accept an exclusion for them or their loved ones at all kindly. about their opinions on the containment measures disposed, % of the participants thought that these measures were necessary, but only % thought that these same measures were adequate (the med group was more skeptical than the nom group), and % proposed to strengthen them. in line with this, most participants thought that it was right to limit people's freedom for controlling the virus ( %), as well as one's own freedom ( %), as they already limited their behaviors ( %). about the information, they reported to be properly informed about the virus ( %) and the social situation related to it ( %), but also requested more information from experts ( %). about perception of risk in public opinion, % of participants reported to think that it was lesser than it should be and % that it was greater. interestingly, % reported to think that there was some hidden information about the virus, and % of these that such hidden information was related to a greater danger related to the infection. the med group, instead, reported to be less convinced of the existence of hidden information ( % vs. % of the nom group). lastly, about the spread of the virus, the med group was more pessimistic than the nom group. in fact, they reported less likely that the spread would slow down in some days ( % vs. %) or in some weeks ( % vs. %). in this subsection, we present logistic regression results on the covid- questionnaire. we used each question as a dependent variable in a three-step hierarchical logistic regression. at step , we used as regressors the demographic variables (see "data analysis" section) and the living area, considering north italy as the reference (the coefficients reported should be interpreted as the odds that a participant from center or south italy would answer "yes" to a question compared to a participant from north italy). at step , we added as regressors the psychological factors of perceived stress, anxiety, and death anxiety. finally, at step , we included the group effect. along with step results, we also provided semipartial correlation score for the relationship between each dependent variable and the group (coded as = nom and = med). for the sake of brevity, we reported only the questions for which we obtained significant regressors. at step (see table , step block of columns), we included in the model only demographic variables. of these, the most influential were sex and age. with respect to male sex, female sex was linked to higher odds to be concerned by the following risks: being infected ( . ), loved ones being infected ( . ), developing serious complication or dying ( . ), global crisis ( . ), people's behavior in response of virus outbreak ( . ), infecting family members or love ones ( . ), and people's violating the containment provisions ( . ). in fact, females had higher odds to report that the public opinion had less riskrelated perception about covid- than it should be ( . ), that risky behavior should be punished more severely ( . ), that containment provisions should be improved ( . ), and that it would be right to limit people's freedom in this situation ( . ). in line with these results, they reported more likely to have not continued to attend public places and events ( . ). about age factor, older age was related to lower odds of reporting worries about the risk of infection for the loved ones ( . ), or about people's behavior as more dangerous that virus infection ( . ), or about the perception of risk in public opinion as lower that is should be ( . ). older age people also reported table | hierarchical logistic regression odds for demographics (step ), psychological (step ), and group (step ) factors for the covid- questionnaire. frequency of "yes" responses step step step questions in italics showed imbalanced responses (almost all "yes" or "no"). sex was coded as = male, = female. group was coded as = nom and = med. ecq = existential concerns questionnaire (death anxiety scale); pss = perceived stress scale; stai = state-trait anxiety inventory. rightmost column (sp. cor.) reports pearson r for semipartial correlations between group and questionnaire responses (coded as = "no" and = "yes") controlling for all the other variables, i.e., sex, age, living area, anxiety, death anxiety, and stress. significance level marked as follows: + p < . , *p < . , **p < . . frontiers in psychology | www.frontiersin.org lower odds to be concerned about their behavior as risky for themselves ( . ) or loved ones ( . ), but higher odds to be concerned about their health status in case of covid- infection ( . ) and by people reaction to virus spreading ( . ). lastly, they reported lower odds to request for more information by experts on media ( . ). also, the living area had a relative impact on the outcome variables at this step. with respect to participants from north italy, those from both center and south italy showed greater odds to judge the actual containment measures as adequate (center = . , south = . ) and to think that some information about covid- was hidden from them (center = . , south = . ), whereas they reported less likely to be at infectious risk (center = . , south = . not significant) or to consider themselves at risk when the first cases were discovered in italy (center = . , south = . ). of note, participants in south area reported lower odds with respect to participants in north area to consider fear of infection as a valid reason to violate the containment measures ( . ). at step (see table , step block of columns) of hierarchical model, we added psychological factors of perceived stress (pss), anxiety (stai), and death anxiety (ecq). we found that these factors were related to few, but interesting outcomes. in particular, the pss score was related to a higher worry to be currently at infection risk ( . ) and a major need of information by experts ( . ), while their opinion on the virus spread was that it would show equal speed in the weeks following the compilation ( . for both accelerated or slowed-down spread). instead, the stai score was related to higher concerns of accelerated spread of virus in the weeks following the compilation of the questionnaire ( . ). lastly, the ecq score was related to a higher level of worrying about the covid- situation, in particular about possible severe outcome of the disease for themselves ( . ) or loved ones ( . ) and marginally related to higher level of worrying about possible catastrophic social global outcomes ( . ) or violation of containment measures ( . ). at step , we added to the logistic regression model the group factor to check for the predictive effect of being in the med or nom group while controlling for both demographic and psychological variables. results are reported in table , step column (see the rightmost column). participants in the med group reported higher odds of thinking to be at actual risk of infection ( . ) and also to be at risk from the beginning of the covid- spread in italy ( . ). they also reported more likely to think that their family or loved ones were at risk of infection ( . ). the med group showed higher odds to report that the fear of contagion would be a valid reason to violate the containment measures ( . ) and that the ssn would adequately cure them in case of infection ( . ) and to report a sufficient level of information about the characteristics of the disease ( . ) and about the social situation relative to . they also reported less likely that some information about the virus was hidden ( . ), but the ones who answered affirmatively to this question had more than two times the odds with respect to the nom group thinking that such hidden information was related to a greater virus-related danger ( . ). about the spreading of the virus, participants in the med group were less probably convinced that the virus spread would slow down in the following days after the compilation of the questionnaire ( . ). lastly, the med group participants more likely reported that perception of risk in public opinion was lower than it should be ( . ). semipartial correlations mostly confirmed this pattern of results. however, differently from the logistic regression, this analysis revealed that the med group was related to the opinion that people's behavior was not adequate to the situation, r = − . , and to agree to give care priority to people with greater hope of survival, r = . . also, semipartial correlations did not confirm the regression results for the questions about the fear of contagion as a valid reason to violate the containment measures, r = − . , and the adequacy of the ssn to take care of people in case of infection, r = . . in this article, we investigated the worries and the perception of risk toward the health and social situation in italy related to the outbreak of covid- . to this aim, we conducted a crosssectional study by means of online questionnaires administered to a convenience sample of volunteer participants including both health workers and the general population. we asked participants to report their worries and opinions about covid- in about different questions combined with psychological variables measuring stress, anxiety, and death anxiety. we obtained and analyzed data from italian adult, divided in participants in the med group (medical doctors, paramedics, health workers, and students) and participants in the nom group. we mainly compared the answers given to the questionnaires by these two groups. we also investigated the effect of the living area in italy, as the northern regions were more involved than the central and southern ones (cereda et al., ) . first, we assessed risky situations in which people were involved relatively to covid- . as expected, people from north italy reported more direct experiences with covid- , including more symptoms related to the infection, more prolonged quarantine status, more contacts with people at risk, and higher numbers of positive cases in their zone. the med group, instead, reported a higher number of contacts with people currently infected or at risk. thus, both living area and group predicted a major or minor probability to be involved in risky situations or contacts. following this, we found that participants from north italy reported higher levels of stress and anxiety and in particular that health workers in north area showed a higher level of both health workers from other areas and the general population from the same area. thus, both living area and job combined with the higher exposition to infection risk in order to increase the level of stress and anxiety in health workers from north italy. we would caution about the relatively small number of participants in each area divided by group: our results about living area should be considered strictly as preliminary. further studies are welcome in order to confirm or refute the results that we presented on this topic. however, we should note that our result was in line with the psychological response of health workers in china, where lai et al. ( ) found that psychological distress increased for workers closer to the outbreak of epidemic (i.e., who lived and worked in wuhan region) or assigned to patients affected by covid- . thus, the same rule applies here: the closer to the risk of infection, the higher the risk of acute psychological distress. similar results were found in previous researches on new disease outbreaks. for example, wong et al. ( ) reported higher levels of anxiety in university students during the sars epidemic, in particular among medicine students and students living in the area in which the infection spread more. also wheaton et al. ( ) reported higher levels of anxiety in students in response to pandemic spread of h n . more generally, anxiety emerged in response to various viral diseases, from the annual influenza virus to the h n pandemic (coughlin, ) . in the period of viruses spread, anxiety seems to increase in population along with mood disorders, and this increase was related to exposition and infection risk. in line with these results, participants of our study reported higher levels of perceived stress and of anxiety proportional to their risk of infection, i.e., health workers from north were more stressed and anxious than both their colleagues in center and south italy and the general population. while our result supports an acute increase of stress and anxiety, we should carefully monitor the psychological state evolution in order to assess also the effect of covid- over time. in fact, we expected that the virus spread and the quarantine state endurance in italy could have also mid-and long-term consequences. survivors from sars reported posttraumatic stress, anxiety, and depression symptoms month after discharge, suggesting that lifethreating condition could have important psychic sequelae (wu et al., ) . such sequelae could be even more significant in health workers, showing higher levels of psychological distress both during and after a quarantine period (brooks et al., ) . for this reason, supporting psychological intervention for healthcare workers could be crucial in the first phase of an outbreak (xiang et al., ) , in particular considering that a timely and effective intervention could greatly reduce the later onset of posttraumatic stress disorder symptoms following a catastrophic event (watson et al., ) . we analyzed the answers to our questionnaire on covid- by means of logistic regression. for each item, we computed the response odds related to each regressor in three successive steps, by adding sequentially demographic factors, psychological factors, and the group factor. here we discussed the implication of all these computational steps by dividing the questionnaire items by content. in this section, we discuss the variable that we found for the items relatively to risk perception and worries related to the covid- outbreak in italy. group was strongly related to risk perception: healthcare workers showed about . times the odds of other participants to perceive themselves at risk of infection, as well as about two times the odds to think they were at risk even at the very start of virus outbreak in italy. moreover, they worried about their family situation and about virus spread as they reported that it would not slow down. this supported the idea that medical doctors, nurses, and paramedics had greater risk perception about the covid- infection, probably due to also a greater exposition to danger and to suspect positive cases. also, living area predicted the perception of risk, as both participants from center and south italy reported . times less preoccupation about risk of infection with respect to participants from north italy. again, combination of work, i.e., health workers, and area, i.e., north italy, combined for the greater perception risk. about the demographics, the stronger regressor of such worries was female sex, which was related to higher perception of risk, both at personal and family levels, and of a number of worries about social situation and people's behaviors. in particular, female healthcare workers were reported to be at higher risks of stress, anxiety, and depression during the covid- outbreak in china (lai et al., ; zhu et al., ) . this increased distress level in female health workers could be related to an increased perception of risk for themselves and for their relatives as we found in our study, as also reported usually in researches about risk perception in female participants (gustafsod, ) . our results suggested carefully supporting female healthcare workers implied in covid- treatments, as they could be more exposed to risk-related stress compared to their male colleagues. another important demographic variable was age, as we found that aged people were more worried than younger people about severe consequences of covid- , as they already knew that the disease was more dangerous for older people, in particular when older than years (novel coronavirus pneumonia emergency response epidemiology team, ). lastly, also psychological factors influenced the odds of perceived risk of infection. in fact, stress was related to increase in perceived risk, while death anxiety was related to the concern about fatal or severe consequences of covid- . while the effect of both stress (traczyk et al., ; sobkow et al., ) and death anxiety (langford, ) on risk perception and risk taking was already reported in literature, it should be noted that higher levels of stress could also be due to actual exposure to contagion risk in the case of covid- , as shown by our results about comparisons on levels of perceived stress between healthcare workers from north, center, and south italy. taken together, all these results suggested a higher risk perception relative to covid- in healthcare workers living in outbreak areas, especially if females and with high levels of stress. for covid- , knowledge on medicine and on virus could thus increase risk perception, whereas in other fields such as nuclear radiation usually knowledge was associated to lower risk perception (e.g., sjöberg and drottz-sjöberg, ) . it should be noted that, in case of nuclear radiation, knowledge could be associated to an increase capacity of avoiding risky behavior or situations, whereas in case of covid- spread knowing, the health risks related to disease, but feeling powerless against its containment could exacerbate the danger perception. a reducing stress intervention by means of psychological support to medical workers could reduce the worries due to the perceived risk, so that they could avoid both risky behaviors and overwhelming, stressful concerns. we proceed here by discussing the variables related to risky behaviors, judgments about behaviors, and confinement actions. in this respect, female participants reported higher levels of worries about their own behavior, as well as other people's behaviors as risky. related to this, they also were four times more likely than men to report the thought that it would be right to limit people's freedom in order to block the virus spread and three times more likely than men to request more severe punishment for risky behaviors. capraro and sippel ( ) showed that females adopted stricter moral judgments than men in personal dilemmas, such as behaving appropriately in the actual covid- outbreak scenario. females seemed more prone to strict adherence to rules and even to imply stricter rules, probably also in relationship to their increased perception of risk (see section "risk perception and worries about covid- "). also, the living area showed a strong relationship with these dependent variables. participants from center and south italy were more likely to judge the containment measures as adequate compared to participants from north italy. on note, participants from south also reported less likely than north ones that concerns about covid- were a valid reason to violate the containment measures. this result could be related to the recent great "escape" of people from the north italy (when virus spread initially) toward the south, increasing worries in south population, politicians, and medical staff. again, please consider results on living area no more than preliminary because of the limited number of participants per area in our sample. lastly, we should mention that both the group variable and the psychological factors had none or little impact on these variables thus, our data suggest that opinions and judgments about behaviors and containment actions rely more on demographic variables than on psychological or work-related ones. conflict of interests or searching media visibility. the same criticisms, however, are often not applied, for the antiscientific community, to the studies supporting their theories (kata, ) . all these factors could have an effect also on the underestimation of medical advices and warning on covid- infection by the general population, resulting in the unappropriated behaviors expressed. thus, providing more information to population could be ineffective, if not supported by psychological evaluation of social dynamics underlying the antiscientific phenomenon, for example, the questioning of the legitimacy of traditional authorities (see kata, ) . understanding how to contrast such a phenomenon could be even more important in case a vaccine for covid- is provided, as already happened for the h n flu in , when many people refused to vaccinate despite the availability of a vaccine (see offit, ). further studies are needed in order to investigate these contrasting hypotheses for planning effective interventions relative to public health problems. this study is not free from limitations. first, it implied a crosssectional design; thus, a relationship between variables could be interpreted only with cautions. second, we implied a convenience sample method to recruit our volunteer participants, with a possibility for introducing biases that could undermine the possibility to generalize our results to the entire population. we also collected a small sample with respect to the optimal one, i.e., about participants (as suggested by bujang et al., ) , thus calling for caution while interpreting our results. for all these reasons, we should underline that our results could not be considered as conclusive and they should be confirmed with further experiments or studies. however, we should note that we conducted this study with two major difficulties. the first was a time-related issue: we had a very short time to collect data as the containment rules and the virus spread vary at a day-by-day rate. thus, we should collect our data in a concise and brief timeframe. the second issue was a logistic one: most people in italy, including the authors of this article, were quarantined at the time we collected and analyzed the data, so we were forced to opt for an online methodology of data collection. while methodologically limited, our results could open a number of possible future studies. first, this study could be considered as a time-zero data collection for a longitudinal study. in this regard, we would contact our previous participants in order to ask if they will participate to further data collection. thus, we could follow the change in risk perception and psychological situation in the general population and healthcare workers during the evolution of covid- infection spread. more experimental and cross-sectional studies are requested in order to better understand the relationship between healthcare workers' and the general population's information gap and risk perception in a pandemic disease scenario. this could help scientific community to find new strategies for conveying lifesaving information to population. reducing such information gap could also help in reducing the sense of separation between the healthcare workers and the rest of population and thus the sense of isolation with its negative psychological consequences on both groups. our study supports that a difference in risk perception between health workers and the general population exists and suggests a number of explanations for its causes as well as possible solutions to reduce it, with benefits in the psychological conditions of both groups of participants. more efforts need to be done in this direction, also because reducing psychological distress could advantage physical health state (prince et al., ) , in particular for medical staff facing such a difficult time, improving the quality of care they could provide (maunder, ; imai, ) . the raw data supporting the conclusions of this article will be made available by the authors, without undue reservation, to any qualified researcher. ethical review and approval was not required for the study on human participants in accordance with the local legislation and institutional requirements. the patients/participants provided their written informed consent to participate in this study. ls and cg designed the study and administered the questionnaire. ls conducted the data analysis. ls and cg wrote and revised the manuscript. both authors contributed to the article and approved the submitted version. an italian adaptation of the emotion regulation questionnaire death anxiety among emergency care workers the psychological impact of quarantine and how to reduce it: rapid review of the evidence sample size guidelines for logistic regression from observational studies with large population: emphasis on the accuracy between statistics and parameters based on real life clinical 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health workers we would like to thank all participants to our study, who voluntarily donated their time. in particular, we thank healthcare workers, whose time is even more precious in this difficult situation for all the country, who participated and distributed the questionnaire to their peers and colleagues. finally, we would like to thank our colleagues and friends martina formisano, alessio montemagno, antonello catinari, francesco romano, elisabeth prevete, carola de berardinis, and salvatore chiarella for their valuable help and sustain. the supplementary material for this article can be found online at:https://www.frontiersin.org/articles/ . /fpsyg. . /full#supplementary-material in this section, we discuss how demographic, psychological, and group variables impacted on the perceived level of knowledge relative to covid- and to its related sociopolitical situation. in this regard, the group was the strongest factor. in fact, healthcare workers reported higher odds than nonmedical participants of being properly informed about both covid- and its related social situation. they also were less likely convinced that some information about coronavirus was hidden from public opinion, but those who credited such secret information more likely believed that this information was about a greater virus threat. also, they reported the opinion that perceived risk in the population was not adequate. this result pattern suggests a large gap between the two groups about the perception of being properly informed.this information gap could explain the risk perception difference, because a greater knowledge could actually influence the personal risk awareness. it should be noted that, in general public opinion, the risk related to the new coronavirus was mistakenly considered as similar to that related to the common cold or annual influenza viruses, an error that could have been induced by the similarity in the spreading strategy and of some of the symptoms. this underrepresentation of fatal or serious outcomes of covid- led to a poor adherence to health recommendations in the very first phase of the coronavirus outbreak in italy, with important consequences afterward. these considerations seem to suggest that the reduction of such an information gap could eventually mitigate the disproportion in risk perception between groups and consequently increase the adherence to public health rules. also, our results seem to support this possibility because of the lack of information from experts lamented by more stressed participants, who also perceived a higher level of personal risk. to this aim, an information campaign about the novel coronavirus characteristics, its related disease symptoms and consequences, and public health problems linked to that could greatly support population in this moment, reducing the stress and also the risky behaviors.however, increasing the communication and the information could not be the most appropriated solution to the problem. in the last decades, especially because almost everyone has a large access to internet resources, we have witnessed not only a significant spreading of online information, but also misinformation; this is causing the diffusion of baseless rumors, difficult to erase from common people system of beliefs (kata, ; del vicario et al., ) . misinformation spreading combines with people's distrust in experts' authority, a more and more rising phenomenon despite the increase in the general education level. as a result, as proposed by gawande (gawande, , p. ): "to defend those beliefs, few dismiss the authority of science. they dismiss the authority of the scientific community. people do not argue back by claiming divine authority anymore. they argue back by claiming to have the truer scientific authority." this kind of problem is well known in the field of the unfounded, yet persisting, vaccine fear. in anti-vaccination movement, this mistrust phenomenon has been also exasperated by conspiracy theorists and other actors moving criticisms toward physicians and other experts, accused of having conflict of interest: the authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.copyright © simione and gnagnarella. this is an open-access article distributed under the terms of the creative commons attribution license (cc by). the use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. no use, distribution or reproduction is permitted which does not comply with these terms. key: cord- -jekqhslx authors: schnepper, rebekka; reichenberger, julia; blechert, jens title: being my own companion in times of social isolation – a -day mobile self-compassion intervention improves stress levels and eating behavior date: - - journal: front psychol doi: . /fpsyg. . sha: doc_id: cord_uid: jekqhslx the worldwide spread of the coronavirus disease (covid- ) and the resulting lockdown has affected the whole world and the maintenance of healthy eating behavior might be an additional challenge. self-compassion (sc) interventions emphasize not only treating oneself in a caring way regarding personal weaknesses, e.g., diet lapses, but also the recognition of shared human suffering. thus, self-compassion might be particularly valuable during the current worldwide crisis due to covid- . in this study, n = participants that wanted to lose weight or develop a healthier eating behavior were randomized to either a -day self-compassion intervention arm or a waitlist control arm. the intervention consisted of daily journaling exercises and meditations via smartphone with a focus on improving eating behavior. before and after the intervention phase, questionnaires on self-compassion, eating, dieting, health behavior, stress, and emotion regulation were completed and body weight was determined. participants in the treatment arm (n = ) showed an increase in self-compassion, a decrease in perceived stress, eating in response to feeling anxious, and, on trend level, body mass index (bmi). changes in self-compassion fully mediated changes in stress. no such effects were found in the waitlist control group (n = ). thus, self-compassion might help to maintain well-being and healthy eating habits in times of increased stress and isolation. future studies should replicate these findings outside of the covid- crisis and test the effect of self-compassion in samples with eating disorders or weight problems. at the beginning of , governments all over the world passed laws to curb the spread of the coronavirus disease , caused by the severe acute respiratory syndrome coronavirus (sars-cov- ). this new virus is highly contagious and became a global pandemic within weeks. groups at risk for a severe course are older people or people with preexisting chronic diseases like diabetes or autoimmune disorders. however, also in healthy adults, fatal cases with respiratory or cardiac failure as a frequent cause of death occurred (beeching et al., ) . due to the restrictions that lasted at least months in most of the countries, public life halted -educational institutions, restaurants/bars/cafés, cultural and sports facilities, and non-essential shops were closed, events were canceled, and gatherings with people from different households were forbidden. during the peak of daily infections and deaths, more than half of the world population was on some sort of lockdown (sandford, ) . the pandemic confronted people with various fears: contracting covid- themselves (fitzpatrick et al., ) , job loss due to economic recession, and having to postpone long-term plans, like a change in occupation, place of residence, or getting a degree in time. further, social isolation during lockdown can result in loneliness, a worsening of pre-existing mental illnesses, and in increased anxiety and depression in populations that experience additional strain, e.g., health care workers and parents (holmes et al., ) . a review that investigated the psychological impact of being in quarantine identified a longer duration, fear of getting infected, frustration, boredom, inadequate basic and medical supplies, inadequate information on the current situation, financial loss, and stigma when being quarantined due to exposure to the virus as stressors (brooks et al., ) . in a swiss general population study, half of the participants reported an increase in stress, and % of the participants had an increase in depression scores and in anxiety levels (de quervain et al., ) . in a spanish sample, especially women, people with a history of mental illness, and people experiencing symptoms of covid- themselves or in close relatives reported a worsening of mental health (gonzález-sanguino et al., ) . thus, it is important to provide practical advice, support, and coping strategies for managing boredom, loneliness, and stress (brooks et al., ) . isolation and quarantine might also affect health behavior like physical activity or eating negatively. to illustrate, restrictions during the lockdown period made it more difficult to remain physically active (pinto et al., ) , which again can have a negative impact on mental health (lippi et al., ) . further, stress (adam and epel, ) , negative emotions (konttinen et al., ) , and boredom (havermans et al., ) can cause an increase in food cravings and a preference for high-calorie "comfort food. " besides, loneliness and social isolation have been related to the occurrence of binge eating (mason et al., ) and the risk of developing an eating disorder (levine, ) . indeed, there is initial evidence that the covid- lockdown had a negative impact on eating behavior. in an international survey, participants reported unhealthier eating habits, which might be partly due to a higher availability of unhealthy food as a consequence of stockpiling to avoid potential shortages of food (ammar et al., ) . in an italian sample, half of the participants reported eating more during lockdown, especially comfort food, and . % reported weight gain. participants attributed this to an increase in anxiety, boredom, and stress (scarmozzino and visioli, ) . thus, measures might be needed that promote healthy eating directly and also support coping with its predecessors like stress and isolation to prevent negative consequences of restrictions due to covid- (lippi et al., ) . in this context, self-compassion (sc) might play an important role, especially for vulnerable populations that were already concerned about their diet or weight prior to the lockdown. self-compassion is a concept that recently attracted a lot of interest. it can be defined by having a kind, non-judgmental attitude towards the own self, especially regarding perceived weaknesses (neff, b) . through sc, reflecting on these weaknesses is not avoided, but rather dealt with in a compassionate, gentle attitude and the aim to identify and fulfill own personal needs -similarly how one would treat a good friend in such a situation (neff, b) . according to neff ( b) , self-compassion entails three interrelated components: first, self-kindness, i.e., being gentle toward oneself in the face of failure and inadequacies (vs. self-judgment due to frustration with these shortcomings), second, common humanity, i.e., recognizing that everyone experiences suffering (vs. self-isolation, i.e., getting absorbed in an egocentric perspective on one's own problems). third, non-judgmental mindfulness/present moment awareness (vs. over-identification with negative feelings). studies show that higher sc is associated with less worrying (keng et al., ) , as well less anxiety and depression symptoms (van dam et al., ) . in addition, sc correlates with more adaptive coping in response to negative emotions and negative events . thus, sc might aid in protecting against the abovementioned negative consequences of social isolation due to the covid- lockdown. with regard to eating behavior and body weight, sc has shown potential to improve factors that are not addressed by traditional diets, including body image and disordered eating (rahimi-ardabili et al., ) . it also helps to reduce unhealthy eating styles, including restrictive eating and binge eating (pinto-gouveia et al., ) , which are risk factors for the later development of an eating disorder. further, it might facilitate mindful eating by making individuals more receptive for mindfulness interventions (mantzios and wilson, ) . self-kindness instead of self-isolation has been identified as possible pathways how self-compassion can prevent binge eating (webb and forman, ) . these abilities might be especially helpful in times of increased distress and isolation during the covid- pandemic. although a review showed beneficial effects of sc on eating behavior, body image, and weight loss (rahimi-ardabili et al., ) , previous studies suffered from several limitations like failing to include a control group (pinto-gouveia et al., ) , combining sc with other helpful components like mindfulness, yoga, and psychoeducation, or only assessing short-term effects. furthermore, no study has yet explored sc interventions in the context of a global crisis as the current one, despite their high applicability to fundamental and existential threats. in this study, participant who wanted to lose weight or change their eating behavior received a -week, smartphonebased self-compassion intervention. effects were compared to a waitlist control group. we hypothesized that first; selfcompassion would increase in the intervention group (ig) compared to baseline, while no change would be evident in the waitlist group (wg). second, we expected a positive effect of the intervention on stress experience related to covid- restrictions. third, we hypothesized that the intervention would help participants to improve their eating behavior and reduce their body mass index (bmi). for the second and third hypothesis, we explored whether changes in self-compassion mediate possible changes in stress, eating behavior, and bmi and if this relation was different between the two groups. we aimed for a sample size of participants ( participants per condition), based on a power ( -ß) of . , α = . , and a medium effect size of f = . in a repeated measures anova with within-between interaction, two groups, and two time points. this estimation took a possible dropout rate of % into account. however, since the duration of the lockdown phase was unclear and the intervention lasted days, we further took into consideration how many participants could be tested in a short period of time when calculating the sample size. data collection was stopped when signs pointed toward the lockdown measures being eased. the final sample consisted of n = participants who were recruited via newspaper articles, social media, and university newsletters between march and may when lockdown restrictions were stepwise increased in austria and germany. after expressing interest, they first filled out an online questionnaire to determine whether they met inclusion and did not meet exclusion criteria. inclusion criteria were being fluent in german, experiencing impairment in daily life due to the covid- lockdown (i.e., not going to work as usual), and the goal to lose weight or to develop a healthier eating behavior. exclusion criteria were a lifetime eating disorder and a current pregnancy or breastfeeding. all participants received an individual feedback based on their data; psychology students additionally had the possibility to receive five study credits ( . % of the final sample). in the final sample, . % of the participants were students, . % were employees, and . % had other occupations. the most frequent main reason for participating was the wish to lose weight ( %), followed by wanting to eat healthier ( %), wanting to have more regular meals ( %), and wanting to improve their emotional eating patterns ( %). see table for further sample characteristics. participants that met inclusion criteria received an informed consent form with the instruction to sign it and send it back via e-mail. further, they received a link to the baseline questionnaire, which included demographic information as well due to the unpredictability of the lockdown duration, we did not define a precise sample size, but aimed to include at least n = participants per condition. our final sample is slightly below this aim, but comparable to other studies that applied a self-compassion training pinto-gouveia et al., ) . as questionnaires on self-compassion, eating, dieting, health behavior, stress, emotion regulation, and a virtual food rating task. after completing the baseline questionnaire, participants were randomly allocated to the ig or wg, using a randomization scheme created with the website randomizer.org. then, they received login information for the app psydiary and installation instructions via a telephone call. the app was used during the -day intervention to provide the self-compassion exercises for the ig. further, both groups answered end-of-the-day questions on self-compassion, mindfulness, mood, eating behavior, and experienced consequences of the lockdown (results reported elsewhere). daily notifications reminded participants to do the self-compassion exercise and to answer the questionnaire. afterward, participants completed a post questionnaire similar to baseline. upon completion, the wg received the intervention. the ethics committee of the university of salzburg, austria approved of the study. see figure for a flowchart of the study. the -week sc intervention that aimed to increase sc was mostly inspired by material provided by dr. kristin neff ( ). it consisted of three different meditations and eight different journaling exercises in alternating order. both journaling exercises and meditations have been found to increase self-compassion and thereby assist in weight loss (mantzios and wilson, ) . exercises were adapted to the theme of improving one's eating behavior. in this context, participants learned to be mindful and less critical about negative emotions, but rather see them as a part of being human. when starting the intervention, participants were instructed to follow the structure of the -week plan that indicated which exercise should be done on each day. they were also encouraged to start a sc journal and to continue doing the exercises over the course of multiple weeks. the journaling exercises covered different, related topics: writing a letter about a perceived weakness regarding eating behavior to oneself from the perspective of a loving friend, reflecting on how participants would treat a friend in a similar situation, exploring the participants' self-criticism when trying to improve their eating behavior, and finding alternative and less critical ways to motivate themselves. further, they learned how to treat themselves kindly when experiencing food cravings, to recognize that unhealthy eating is not self-compassionate, and to find alternatives to reward themselves. the meditations contained compassionate breathing exercises, sc affirmations and soothing touch. each meditation repeated in the nd week, while each journaling exercise was only done once. the german -item version (hupfeld and ruffieux, ) of the original scale (neff, a) consists of six subscales that assess three positive components of sc as well as three negative counterparts: self-kindness (as opposed to self-judgment), common humanity (as opposed to isolation), and mindfulness (as opposed to over-identification). in previous studies, subscales were highly intercorrelated and best explained by an underlying construct of general self-compassion (neff, a; hupfeld and ruffieux, ) . participants indicate how they typically act toward themselves in difficult times from = "almost never" to = "almost always. " an example item for self-kindness is "i'm kind to myself when i'm experiencing suffering, " an example for common humanity is "when i feel inadequate in some way, i try to remind myself that feelings of inadequacy are shared by most people, " and an example for mindfulness is "when i'm feeling down i try to approach my feelings with curiosity and openness. " after reverse coding negative items, a sum score for sc can be calculated. internal consistencies in the present study were cronbach's α = . for self-kindness, α = . for common humanity, α = . for mindfulness, α = . for self-judgment, α = . for isolation, α = . for over-identification, and α = . for the overall scale at baseline and cronbach's α = . for self-kindness, α = . for common humanity, α = . for mindfulness, α = . for self-judgment, α = . for isolation, α = . for over-identification, and α = . for the overall scale after the intervention phase (hupfeld and ruffieux, ) . the german version (klein et al., ) of the perceived stress scale (pss; cohen et al., ) investigates the experience of psychological stress in the past month. it consists of items (e.g., "in the last month, how often have you been upset because of something that happened unexpectedly?") which are answered on a scale from = "never" to = "very often. " in this sample, stress levels were considerably higher than in previous general population samples (cohen et al., ; klein et al., ) . internal consistencies in the present study were cronbach's α = . at baseline and cronbach's α = . after the intervention phase (klein et al., ) . the salzburg emotional eating scale (sees; meule et al., ) assesses changes in eating behavior in response to four emotional figure | phases of the study design and number of participants who completed each phase. participants that met eligibility criteria were invited to fill out the baseline questionnaire. frontiers in psychology | www.frontiersin.org states (happiness eating, sadness eating, anger eating, and anxiety eating). it consists of items (e.g., "when i am worried, …"), which are rated from = "i eat much less than usual" to = "i eat much more than usual. " in this study, we included an overall scale of eating in response to negative emotions (i.e., sadness, anger, and anxiety), and each negative subscale separately. internal consistencies in the present study were cronbach's α = . for sadness eating, α = . for anger eating, α = . for anxiety eating, and α = . for overall emotional eating at baseline and cronbach's α = . for sadness eating, α = . for anger eating, α = . for anxiety eating, and α = . for overall emotional eating after the intervention phase (meule et al., ) . at baseline and post measurement, participants were asked to upload a photo of a scale showing the participants body weight. this information was then used to analyze changes in bmi. using spss (ibm, ), independent t-tests were conducted to test for baseline differences between wg and ig. further, × (group × time) mixed anovas were computed to test the pre-specified hypotheses on changes in outcome variables between pre and post measurement, and whether the intervention would interact with this change. eta squared was calculated as an estimate for effect sizes, with η > . indicative of a small effect, η > . of a medium effect, and η > . of a large effect. for further analyzing the intervention effect on the other outcome variables, an sc change score was computed and grand mean centered. the process . macro for spss (hayes, ) was used to build a mediation model with groups as a predictor for change scores of stress, bmi, and eating behavior, and the sc change score as a mediator. on average, participants in the ig reported that they completed an sc exercise on . of the days (sd = . ). the exercises were estimated to be moderately helpful (m = . on a continuous scale from to ), with no difference between meditations and journaling exercises, p = . . with specific regard to the current lockdown situation, the exercises were somewhat helpful (m = . on a continuous scale from to ). here, participants reported meditations to be more useful, p = . . the overall sc score showed a main effect of time, f( , ) = . , p = . , η = . , that was moderated by n = in the ig and n = in the wg did not own a scale and were not able to determine their weight due to the lockdown. figure for group differences in sc. a group × time interaction, f( , ) = . , p = . , η = . pointed to different time courses in the two groups. figure a indicates that perceived stress decreased in the ig while it increased in the wg. analyzing changes in bmi for the % of participants who were able to provide a photo of their body weight showed a trend group × time interaction, f( , ) = . , p = . , η = . . post hoc tests showed a significant group difference at post measurement, f( , ) = . , p = . , η = . . figure d shows that while bmi decreased in the ig, it increased in the wg. analyzing analyzing changes in bmi for the % of participants who were able to provide a photo of their body weight showed a trend group × time interaction, f( , ) = . , p = . , η = . . post hoc tests showed a significant group difference at post measurement, f( , ) = . , p = . , η = . . figure d shows that while bmi decreased in the ig, it increased in the wg. in this study, we applied a mobile -week sc intervention to individuals that wanted to reduce their weight or improve their eating behavior during the covid- lockdown. intervention effects were compared to a waitlist control group, which only answered daily questionnaires without completing an exercise. as expected, the ig showed increases in sc, which was especially visible in an increase in self-kindness and a decrease in self-isolation. in the context of the lockdown, experiencing less isolation might be particularly beneficial for mental well-being (liu et al., ) . further, perceived stress during lockdown decreased in the ig. this is in line with recent studies that showed the positive effect of a mindfulness intervention on anxiety and sleep quality during the covid- lockdown (zheng et al., ) . mediation analyses showed that a reduction in stress was due to increases in sc in the ig, showing that training sc can be a helpful tool to acquire stress coping skills. this is remarkable because reported stress in this sample was almost as high as in a sample of patients treated for work-related stress and mood disorders (glasscock et al., ) , which shows the detrimental effect that the lockdown policies had on mental health. the intervention also had a positive effect on emotional eating: the ig reported less eating in response to negative emotions, especially in response to anxiety. as the lockdown and uncertainties related to the spread of the virus has the potential to increase anxieties, which has been shown to negatively impact eating behavior (scarmozzino and visioli, ) , sc can pose a protective factor against the establishment of unhealthy eating habits. further, bmi trend effects are in line with the previously reported protective role of sc against binge eating disorder (pinto-gouveia et al., ) . however, a lack of significant results might also indicate a conflicting figure | group changes in overall self-compassion and for the subscales self-kindness and isolation before and after the -day intervention. frontiers in psychology | www.frontiersin.org effect of self-compassion: when feeling psychologically unwell, physiological long-term health might not be prioritized. consequently, self-kindness might lead to self-indulgence and an unhealthy but comforting snack might be permitted (mantzios and egan, ; egan and mantzios, ) . if future studies with a higher power show similar, more robust effects, this would be especially valuable as studies show the potential weight gain during the lockdown (e.g., di renzo et al., ) . unfortunately, not all participants were able to track weight changes since they did not own a scale, and due to the lockdown could not go elsewhere to weigh themselves. while other studies found a direct positive effect of sc components on eating behavior (webb and forman, ) , mediation analysis showed no direct effect of sc on emotional eating or weight. considering the increase in stress levels during the lockdown period (de quervain et al., ) , which were reported to be a cause for unhealthy eating behavior (scarmozzino and visioli, ) , the decrease in perceived stress might have helped to eat more balanced and less in response to negative emotions. again, a larger sample might help to clarify these effects that were significant on a trend level. besides the rather small group size, it has to be noted that although compliance to do an sc exercise each day was very high, the perceived helpfulness of the sc exercises can be improved. more guidance during the intervention phase, personalization of the training plan, and individualized diet or weight goals during the intervention period might help to increase the effect of the intervention. a long-term follow-up might help to determine the temporal stability of effects. in the waitlist group, participants filled out daily questionnaires on sc, eating behavior, mindfulness, and mood, which were needed for comparing ema data in the two groups. however, this could have drawn the participants' attention to these topics, thus creating an attenuated intervention effect. lastly, we did not preregister our hypotheses due to the limited amount of time in the lockdown situation. future studies are planned to overcome these shortcomings and replicate findings. despite these limitations, this study has various strengths. following recommendations of rahimi-ardabili et al. ( ), we tested the effect of an sc intervention and compared it to a waitlist control group, thus acquiring longitudinal and causal effects instead of mere correlational data. effect sizes were either medium or large, highlighting the potential of our intervention. further, we were able to apply the sc intervention in a highly stressful and potentially threatening time that affected everyone to some degree. previous studies showed the risk for weight gain especially in vulnerable populations like individuals with obesity (almandoz et al., ) . although the present study did not explicitly target overweight or obese individuals, we focused on individuals with an interest in weight loss who might face similar challenges during the lockdown. as face-to-face meetings were hardly possible during the covid- lockdown, the benefit that participants drew from the intervention is of high value. research calls for e-mental health technologies to provide necessary interventions during the covid- lockdown (wind et al., ) . the use of a mobile smartphone app and the intervention and installation instruction via phone further made the intervention feasible as well as cost and time saving during the lockdown situation. in the future, it might also be used as an add-on to existing therapies. in conclusion, the present study provides promising data on the positive effect of sc interventions, which should be transferred to regular daily life after the lockdown and to other vulnerable groups, e.g., individuals with obesity or an eating disorder. the raw data supporting the conclusions of this article will be made available by the authors, without undue reservation. the studies involving human participants were reviewed and approved by ethics committee of the university of salzburg, austria. the patients/participants provided their written informed consent to participate in this study. rs designed and conducted the study, did the statistical analyses, and drafted the manuscript. jr 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on sleep duration key: cord- -oa i ss authors: luo, li-sha; jin, ying-hui; cai, lin; pan, zhen-yu; zeng, xian-tao; wang, xing-huan title: covid- : presumed infection routes and psychological impact on staff in administrative and logistics departments in a designated hospital in wuhan, china date: - - journal: front psychol doi: . /fpsyg. . sha: doc_id: cord_uid: oa i ss objective: our aim was to explore the presumed infection routes and psychological impact of covid- on staff in administrative and logistics departments (alds). methods: we gathered data from all staff members with covid- in alds in zhongnan hospital of wuhan university, china. the baseline, job before diagnosis, presumed infection environment, use of protective equipment, and psychological status before and after diagnosis were collected and analyzed. a total of uninfected staff members working alongside them in the same environment and random matched infected doctors and nurses formed two control groups; the psychological impact of these three groups was then compared. results: of the members of staff, . % were infected due to the working environment (hospital), and nine had face-to-face conversations with doctors and nurses in their daily work. many staff members did not take any protective measures in their routine work. before they were diagnosed, staff members were aware of the seriousness of the epidemic, and most of the staff maintained a neutral attitude to the covid- outbreak. a total of . % of the staff experienced psychological stress or emotional changes after diagnosis, which were mainly caused by family health and disease related issues. most of them managed their emotions by self-control and video calls with their families. there was no significant difference in psychological impact among the three groups, but uninfected staff members were fully aware of the seriousness of the epidemic. conclusions: effective protective measures should be taken for staff members in alds. psychological interventions are very important to help infected staff members in alds cope with psychological distress. the novel coronavirus disease , caused by severe acute respiratory syndrome coronavirus (sars-cov- ), has been spreading rapidly worldwide, creating a tremendous public health burden . as of february , , there were a total of , infected healthcare staff members ( % in wuhan) (wu and mcgoogan, ) . staff in administrative and logistics departments (alds) are also front-line workers, alongside doctors and nurses, who provide strong support for the orderly conduct of medical work. compared with doctors and nurses, these staff members receive less attention from society. through their work in hospitals, this group is likely to be directly or indirectly exposed to the sars-cov- with a high risk of infection. additionally, they suffered high psychological pressures from an increased workload, fears of possible infection of their families and colleagues, and a lack of knowledge about protection from infectious diseases (lai et al., ) . public health emergencies can easily cause anxiety and panic among healthcare workers, and previous studies have shown that the severe acute respiratory syndrome (sars) outbreak has had adverse psychological effects on healthcare workers (bai et al., ) . the incidence of stress disorder among doctors and nurses has reached . % during the covid- epidemic . unlike doctors and nurses, staff in alds lack knowledge of protection, diagnosis, and treatment; the psychological effects of the epidemic may thus be more serious, especially for those contracting the disease. therefore, identifying their presumed routes of infection and psychological changes is also crucial to the success of fighting . several studies about psychological effects on healthcare workers during the covid- outbreak have been published, but none of them have focused on infected ald personnel kisely et al., ) . the current study thus aimed to explore the potential infection routes and psychological changes among hospital staff in alds and to provide scientific suggestions on preventing adverse effects among this population's during large-scale infectious diseases outbreaks. this retrospective study was conducted in the zhongnan hospital of wuhan university, one of the key hospitals at the epicenter of covid- outbreak. the participants were confirmed as covid- based on the diagnostic criteria of the national health committee of the people's republic of china (jin et al., b; ma et al., ) . this study is part of a larger cross-sectional study and was reviewed and approved by the committee for ethical affairs of zhongnan hospital (approval number: ). the study period was from february to , ; and data about doctors and nurses have been published elsewhere . data were collected using a validated electronic questionnaire, including informed consent, which was jointly developed by experts from multidisciplinary fields, such as epidemiology, evidence-based medicine, and front-line clinicians during the covid- epidemic. the readability and content validity of the questionnaire were tested by experts from several fields from different medical institutions, and the test-retest reliability was . (wang et al., a,b) . the questionnaire items included basic information, exposure history, protective measures, clinical symptoms, treatment measures, and psychological changes. in terms of psychological items, we collected staffs' awareness and feelings about the epidemic before diagnosis, as well as their psychological changes and coping mechanisms after diagnosis, to get a preliminary understanding of the impact of the epidemic on ald staffs. all infected staff members in the alds of this hospital were contacted through the division of medical affairs. to ensure the accuracy of results, we confirmed the exposure status through phone calls to all participates and their department directors. additionally, we compared the psychological impact between infected staff in alds with two control groups: one was infected doctors and nurses, randomly selected from the infected staff members , and the other group was uninfected alds staff members, nominated by their infected colleagues who worked in the same environment. they were also investigated used the validated electronic questionnaire (wang et al., b) . categorical variables were described as counts and percentages; wilcoxon signed rank sum tests and fisher exact tests were conducted to compare the psychological impact between staff in alds and the two control groups. the data analysis was performed by the sas software, version . ts m (sas institute inc., cary, nc) and visualized by microsoft powerpoint , where p < . was considered statistically significant. all staff members with covid- in alds were included in this study (table ) , and all have now recovered. five were males and were females, and their ages ranged from to years. a total of . % thought they were infected by the working environment in hospitals, and one case did not know the source of infection. nine staff members regularly had face-toface conversations with doctors and nurses in the course of their work. more than half of staff thought that the way they got the infection was droplets and contact transmission. table presents detailed information of these staff; four who worked as hospital environmental cleaners and often wore masks and gloves during work, while another one, responsible for operating the elevator, never wore masks or gloves. three staff members in the security department who distributed medical materials to each department sometimes wore gloves. two staff working in the sterilized supply center transporting patients and cleaning surgical instruments always wore masks and gloves. one person in convalescent department who was responsible for accompanying doctors to patients' homes never wore masks and gloves at work. one person working in the division of operation management to calculate the hospital's performance never took any protective measures. one person in the division of medical insurance never wore gloves when handling insurance problems for patients. one person in the division of personnel services occasionally wore gloves when receiving documents from staff. one person working in the scientific research center as laboratory manager occasionally wore masks. the psychological status before and after diagnosis of these infected staff were shown in figure . before they were diagnosed, staff said they were aware of the seriousness of the epidemic. most staff 's attitude remained neutral to covid- outbreak, and none of them were pessimistic. during the treatment, . % of staff experienced psychological stress or emotional changes, which were mainly caused by family health, disease related issues and negative news via the internet. they managed their emotions and stress by self-control, video calls with family members or colleagues, and communicating with others on wechat. most staff received comfort and care from leaders and colleagues, partners, and children. additionally, there was no significant difference for psychological impact between infected staff in alds and doctors and nurses before and after their diagnosis (tables , ) . in terms of the mental attitude toward the covid- outbreak, no significant difference was also observed between uninfected and infected staff before diagnosis in alds. however, uninfected staff was fully aware of the seriousness of the epidemic compared with infected staff ( table ) . it has been reported that the infection rates among healthcare workers during sars and middle east respiratory syndrome (mers) were and %, respectively (al-tawfiq and memish, ). unfortunately, the sars-cov- also infected a large number of healthcare workers. during previous infectious diseases outbreaks, studies on the healthcare staff 's infection have focused on the front-line doctors and nurses, while the staffs in figure | psychological status before and after diagnosis of the covid- staffs in administrative and logistics departments (a: awareness of the epidemic before diagnosis; b: mental attitude before diagnosis; c: psychological stress or emotional changes after diagnosis; d: the possible causes of emotional change after diagnosis; e: the methods used to control stress or mood changes after diagnosis; and f: the sources of comfort and care after diagnosis). alds were often ignored. these staff are crucial to the normal operation of the hospital, so protecting this population from infection is also crucial to success in fighting covid- . our study included all infected staffs in alds in zhongnan hospital of wuhan university: . % were in the logistics support department and therefore regularly come into contact with medical wastes when cleaning the hospital. there is no air circulation in the overcrowded elevator, and the infection of the elevator operator will thus expose all occupants to the virus. a recent study indicated that both air and surfaces may be contaminated by sars-cov- ; we therefore suggest that these staff must wear gloves and masks correctly in their routine work (ong et al., ) . for departments that have contact with doctors and nurses, such as personnel, finance and operation management departments, one infected staff member may transmit the virus to other staff and cause explosive infection both in the same department and also in clinical departments, and this potentially causes nosocomial infection. hence, special frontiers in psychology | www.frontiersin.org windows should be set up, and gloves and masks should be worn when documents are submitted and collected, especially in the autumn and winter when infectious diseases are prone to occur. additionally, hospitals can adopt the paperless offices in alds, thereby reducing direct and indirect contact with potentially contaminated materials. staff in the sterile supply department should wear more advanced protective equipment when cleaning surgical instruments and transporting patients (suen et al., ) . staff in convalescent department should take the same protective measures as healthcare workers when visiting patient's home, as they may constitute an infection source to spread the virus to other alds and clinical departments. at the same time, we should pay attention to the disinfection of offices, and careful use of central air conditioning in alds. the emerging virus outbreaks have had a significant psychological impact on healthcare workers. several viral outbreaks have occurred in the past years, such as sars, mers, and ebola disease (kisely et al., ) , and previous studies have reported that doctors and nurses at the frontline involving diagnosis and treatment commonly reported psychological problems during sars epidemic in (bai et al., ; lee et al., ) and the mers outbreak of (lee et al., ) . currently, several published studies highlighting psychological effects on healthcare workers during the covid- outbreak indicate that healthcare workers are at increased risk of psychological distress kisely et al., ) . most studies about the psychological impact focused on doctors and nurses who performed the tasks of diagnosis and treatment, while few studies have been conducted on the psychological effects of the covid- epidemic on staff in alds who were not infected (chen et al., ; huang et al., a,b; lai et al., ; xing et al., ) . however, no studies have focused on the psychological state of staff in hospitals who have been infected. thus, it can be argued that our study is of great significance for further understanding the psychological effects on staff in alds during virus epidemics. our study indicated most of staff in alds experienced psychological stress or emotional changes. a total of % of them were anxious about their conditions due to a lack of professional knowledge. almost everyone was concerned about health of his/her family members' health, and eight staff members were influenced by negative news via the internet. additionally, most logistics staffs are not regular employees of the hospital, and they may thus suffer from the risk of unemployment due to the impact of the epidemic, which further increases their psychological burden. consequently, psychological intervention treatment is very urgent to cope with the psychological stresses and emotional changes among this group of staff. in our study, we found no significant difference in psychological impact between infected doctors and nurses and staff in alds-neither in the awareness and mental attitude to the epidemic before diagnosis or the psychological changes after diagnosis. the results indicated that working in hospital and having clinical professional knowledge does not affect the psychological impact of covid- epidemic on hospital staff. in alds, the mental attitude to the epidemic was not different between infected and uninfected staff, while uninfected staff members' awareness of the epidemic was higher than that of infected staff, which may have reduced the risk of infection by influencing their behavior. the main limitation of this study is that it was a single-center study with a small sample size. although all infected staff in alds in this hospital were included, more studies are needed to verify the results. additionally, some memory bias maybe exist among participates. in conclusion, reasonable effective protective measures should be taken for staff in alds, such as setting up specialized windows for departments that have prolonged contact time with healthcare workers, adopting paperless offices to reduce contact with potentially contaminated materials, choosing appropriate protective equipment, disinfecting offices properly, and using central air conditioning carefully. most staff experienced psychological stress during their isolation period after diagnosis, and psychological interventions are thus very urgent when it comes to coping with psychological distress among this group of people. verification is needed using multi-center studies with a larger sample size in the future. all datasets presented in this study are included in the article/supplementary material. the studies involving human participants were reviewed and approved by committee for ethical affairs of zhongnan hospital of wuhan university. the patients/participants provided their written informed consent to participate in this study. x-tz, x-hw, and lc: the conception and design of the study. lc, l-sl, y-hj, z-yp, and x-tz: collection and assembly of data. l-sl, y-hj, and x-tz: analysis and interpretation of the data and drafting the article. y-hj, lc, z-yp, x-tz, and x-hw: revising it critically for important intellectual content. all authors contributed to the article and approved the submitted version. this work was supported by the fundamental research funds for the central universities ( kf ) and the special project for emergency of hubei province ( fca ). middle east respiratory syndrome coronavirus in the last two years: health care workers still at risk survey of stress reactions among health care workers involved with the sars outbreak mental health care for 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quarantined hemodialysis patients the legal class b infectious disease -the novel coronavirus ( -ncov) infected pneumonia in wuhan, china: a review developments, evolution, and implications of national diagnostic criteria for covid- in china air, surface environmental, and personal protective equipment contamination by severe acute respiratory syndrome coronavirus (sars-cov- ) from a symptomatic patient comparing mask fit and usability of traditional and nanofibre n filtering facepiece respirators before and after nursing procedures development and preliminary validation of questionnaire for novel coronavirus related nosocomial infection development and preliminary validation of questionnaire for infection process and prevention of novel coronavirus infection in medical staffs characteristics of and important lessons from the coronavirus disease (covid- ) outbreak in china: summary of a report of cases from the chinese center for disease control and prevention study of the mental health status of medical personnel dealing with new coronavirus pneumonia we express our gratitude to jean glover from tianjin golden framework consulting company for english editing. we also express our gratitude for the contribution of consultant experts and healthcare practitioners from all hospitals for their participation. the authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.copyright © luo, jin, cai, pan, zeng and wang. this is an open-access article distributed under the terms of the creative commons attribution license (cc by). the use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. no use, distribution or reproduction is permitted which does not comply with these terms. key: cord- -cuatqy u authors: wei, maryann title: social distancing and lockdown – an introvert’s paradise? an empirical investigation on the association between introversion and the psychological impact of covid -related circumstantial changes date: - - journal: front psychol doi: . /fpsyg. . sha: doc_id: cord_uid: cuatqy u the coronavirus disease (covid ) pandemic has effected the implementation of social distancing and lockdown measures across the globe, and the psychological impact of associated life changes is experienced more severely by some individuals than others. anecdotal evidence points to a common belief among the general public that introverts are faring better than their extraverted counterparts to this end. however, the claim lacks empirical research, and seems counterintuitive when the broader literature on the association between introversion and mental health is considered. the current study investigated whether the psychological impact of covid -related circumstantial changes was moderated by introversion, based on outcome measures across psychosocial, cognitive, and affective domains. the role of several demographic factors in determining covid -related mental health symptoms was also examined. one hundred and fourteen individuals ( usa residents) completed measures of introversion, and reported on the extent to which they experienced loneliness, anxiety, depression and cognitive impairments as a function of covid -related circumstantial changes. results showed that introversion predicted more severe loneliness, anxiety, and depression experienced as a function of covid -related circumstantial changes, but not cognitive impairments. among the range of demographic factors examined (age, gender, living condition, recent unemployment), living with others (vs. living alone) predicted more severe covid -related mental health symptoms. however, these effects were only observed on outcome measures pertaining to anxiety and cognitive impairments, but not loneliness and depression. current findings have implications for both consumers and disseminators of information on popular internet hubs. current findings also highlight the possibility that living with others (close human affiliation) may have protective and detrimental effects on different domains of mental health during the covid pandemic. the introversion-extraversion dimension is central to leading trait theories of human personality in psychology (e.g., myers, ; cattell, ; eysenck, ; hathaway, ; mccrae and costa, , although exact conceptualisations vary between theories), and the construct is ubiquitous in both academic and popular literature. commonly described in dichotomic terms, introverts and extraverts are often differentiated by the sources they draw energy from (internal vs. external, respectively). adjectives traditionally associated with introversion include "inhibited, " "reserved, " and "undemonstrative, " while those associated with extraversion include "outgoing, " "friendly, " and "enthusiastic" (eysenck, ) . the coronavirus disease (covid ) pandemic has effected the implementation of social distancing and lockdown measures across the globe, and the psychological impact of associated life changes is experienced more severely by some individuals than others (williams et al., ) . anecdotal evidence points to a common belief among the general public that introverts are faring better than their extraverted counterparts to this end. for example, a "how to survive social distancing as an extravert" guide on a popular psychology website begins with the following statements: "for introverts, being stuck at home without social interaction for long periods of time really isn't the worst thing at all. they are accustomed to this time spent alone and feel energized and recharged by it. when it comes to extroverts, the idea of social distancing can feel like somewhat of a death sentence" (personality growth, ) . in articles published on other widely-frequented non-psychology websites, introversion has been championed as an asset for thriving in covid -related social isolation (e.g., bloomberg, ; reuters, ; the conversation, ) . such beliefs are exemplified in the influx of user-generated pictorial content (more colloquially known as "memes") across the internet with similar sentiments (see supplementary material for exemplars (data sheet )). on that grounds that introverts prefer less stimulating environments (myers, ; cattell, ; eysenck, ; hathaway, ; mccrae and costa, ) , the assumption that introverts experience the psychological impact of covid related circumstantial changes less severely than extraverts seems plausible. however, the claim lacks empirical research, and there are several lines of work in light of which the claim appears counterintuitive. first, introversion has been linked to personality traits associated with the tendency to experience more intense emotions and more difficulties in regulating these emotions, namely the "feeling" dimension of the myer-briggs type indicator (janowsky, ) and neuroticism, respectively (janowsky, ; jylha et al., ; fadda and scalas, ) . additionally, and possibly resultantly, introversion has also been associated with more psychological problems in general (janowsky, ; jylha et al., ; fadda and scalas, ) , and adjustment problems in particular. specifically, studies have demonstrated that introverts struggle more than extraverts in adjusting to life events which entail changes in day-to-day life, including shifts between educational institutes (bauer and liang, ; davidson et al., ) , job relocation (pinder, ) , and retirement (löckenhoff et al., ; robinson et al., ) . although increased amounts of time alone should in theory be welcome by introverts, these findings raise questions on whether introverts necessarily have an advantage over their extraverted counterparts in adapting to covid related circumstantial changes. additionally, the psychological impact of covid -related circumstantial changes (and mental health in general) has psychosocial, cognitive, and affective aspects, which in turn represent functional domains which may be differentially moderated by personality traits (segel-karpas and lachman, ) . the primary aim of this study was to examine whether the psychological impact of covid -related circumstantial changes is moderated by introversion, based on outcome measures across psychosocial, cognitive, and affective domains. a second aim was to examine the unique role of several other demographic factors (which were also considered as control variables in fulfilling the primary aim) in determining covid related mental health symptoms. between late april and early may , a call for participants for a study on the psychological impact of covid was placed on the sub-reddit r/samplesize, an online platform designated to connect researchers and research volunteers. based on previous research (shatz, ; jamnik and lane, ) and the current author's own experience, recruitment using this platform reliably produces quality data from adult individuals dominantly residing in the united states of america (usa). the latter demographic profile seems appropriate for the current research, given the high incidence of covid in the usa and the strictness of lockdown/social distancing measures which ensued. one hundred and fourteen individuals responded to the call for participants (mean age = . , sd = . ; female). sixty two respondents were located in the usa. the other respondents were distributed across the following countries, including united kingdom (n = ), canada (n = ), australia (n = ), germany (n = ). usa and non-usa residents were compared on all outcome variables (described below) to identify cases where the current sample could not be considered as a whole. introversion-extraversion was measured as a continuous dimension using the introversion scale developed by richmond and mccroskey ( ) . this scale was developed based on the extraversion subscale in the eysenck personality questionnaire (eysenck et al., ) . to illustrate, items such as "can you usually let yourself go and enjoy yourself at a lively party?" and "do you tend to keep in the background on social occasions?" in the eysenck personality questionnaire have counterparts in richmond and mccroskey's introversion scale in "can you usually let yourself go and have a good time at a party?" and "are you inclined to keep in the background on social occasions?, " respectively . the introversion scale consists of such statements. respondents indicate whether each statement applied to them on a -point scale ranging from strongly disagree ( ) to strongly agree ( ). six statements serve as distractors and are not scored. alpha reliability estimates were above. in the initial validation study by richmond and mccroskey ( ) , and closely matched in the current study (cronbach's alpha = . ). scores range between and , with higher scores indicating higher introversion, and lower scores indicating lower introversion (i.e., higher extraversion). the following demographics were measured as predictor variables of interest: age, gender, living condition (alone/with others), recent unemployment due to covid (no/yes). the psychological impact of covid -related circumstantial changes was measured with a battery of established questionnaires, with instructions modified to elicit mental health ratings directly associated with the implementation of social distancing and lockdown measures. that is, instead of reporting on mental health symptoms based on a given retrospective timeframe, participants were asked to provide ratings as a function of covid -related circumstantial changes. the exact phrase of instructions participants received is detailed in context below. functional aspects in the psychosocial, cognitive, and affective domains were measured, with the affective domain further broken down into depressive and anxious sub-domains. participants completed the dejong gierveld loneliness scale (de jong gierveld and van tilburg, ) to provide an indicator of loneliness as a function of covid -related circumstantial changes. participants responded "no", "more or less, " or "yes" to six statements, headed by the question "how true are these statements for you, following the implementation of covid social distancing and lockdown measures?" on negativelyworded statements (e.g., "i miss having people around me"), "more or less" and "yes" responses are scored as while "no" responses are scored as . on positively-worded statements (e.g., "there are enough people i can trust completely"), "more or less" and "no" responses are scored as while "yes" responses are scored as . scores are summed across items (range - ), where higher scores indicate higher loneliness. reliability and validity of the scale has been demonstrated across the lifespan (de jong gierveld and van tilburg, ). cronbach's alpha for the de jong gierveld loneliness scale as presented in the current sample was slightly below the conventional acceptable benchmark of . at . ; however, cronbach's alphas bordering on . were observed in the initial validation study (de jong gierveld and van tilburg, ) , so that internal consistency estimates in a slightly lower tier are likely normative given the few number of items in the scale (tavakol and dennick, ) . cognitive impairments associated with covid -related circumstantial changes were assessed with the cognitive failures questionnaire (cfq; (broadbent et al., ) , a item inventory of self-reported day-to-day slips and errors in cognition. instructions were phrased as follows: "the following questions are about minor mistakes which everyone makes from time to time, but some of which happen more often than others. we would like to know how often these things have happened to you, following the implementation of covid social distancing and lockdown measures." respondents indicated on a scale ranging from (never) to (very often) how often they experience certain incidents (e.g., "do you find you forget what you came to the shops to buy?"). scores (range - ) are summed across all items, where higher scores indicate more extreme cognitive impairments. in the initial pilot study, internal consistency of . was demonstrated (broadbent et al., ) . cronbach's alpha for the cfq as presented in the current sample was . . depression. depressive symptoms associated with covid related circumstantial changes were assessed with the patient health questionnaire [phq- ; (kroenke and spitzer, ) ]. instructions were phrased as follows: "to what extent (frequency) have you experienced these symptoms, following the implementation of covid social distancing and lockdown measures?" participants report the frequency with which they experience nine depressive symptoms on a -point scale ranging from "not at all" ( ) to "nearly everyday" ( ) (e.g., little interest or pleasure in doing things). scores are summed across the nine items (range - ), where higher scores indicate higher depression severity. the phq- has been validated not only as a useful tool to recognize clinical depression but also subthreshold depressive symptoms in the general population (martin et al., ) . cronbach's alpha for the phq- as presented in the current sample was . . anxiety. anxious symptoms associated with covid related circumstantial changes were assessed with the generalized anxiety disorder screener (gad- ; (spitzer et al., ) . the response format for the gad- is identical to that of the phq- . instructions for the gad- were also identical to that which were presently used for the phq- . scores are summed across seven items (i.e., seven symptoms of anxiety; e.g., not being able to stop or control worrying), where higher scores indicate higher anxiety severity (range - ). similar to the phq- , the gad- has been demonstrated as a reliable and valid measure of anxiety in the general population (löwe et al., ) . cronbach's alpha for the gad- as presented in the current sample was . . all analyses described as follows (including the generation of descriptives) were processed with spss (version ). to evaluate whether introversion moderates the psychological impact of covid -related circumstantial changes, scores on the introversion scale were used to predict each outcome variable listed above. hierarchical regression analyses were used, with demographic factors entered in the first step as control variables. the predictive value of each demographic factor across the range of outcome variables was also of research interest (pertaining to the second aim). where significant differences were observed on outcome variables between usa and non-usa residents, regression analyses were performed separately for the two groups. for comprehensiveness, the two groups were also compared on all predictor variables. table gives means and correlations between all study variables for the full sample. usa and non-usa residents did not differ on any of the predictor variables (age, gender, living condition, recent unemployment, and introversion). however, pertaining to outcome variables, usa and non-usa residents differed on the psychosocial domain. specifically, usa residents reported experiencing higher loneliness as a function of covid related circumstantial changes compared to non-usa residents (m = . vs. m = . on the dejong gierveld loneliness scale, respectively), t( ) = . , p = . . thus, regression analyses predicting loneliness were performed separately for usa and non-usa residents. table gives standardized β coefficients for predictor variables and associated model statistics in hierarchical regression analyses predicting the psychological impact of covid related circumstantial changes, across psychosocial, cognitive, and affective domains. after controlling for age, gender, living condition and recent unemployment, higher introversion (higher introversion scale scores) uniquely predicted higher depression (phq- ) and anxiety (gad- ) experienced as a function of covid -related circumstantial changes, β = . , t = . , p = . and β = . , t = . , p = . , respectively. higher introversion also uniquely predicted loneliness (dejong gierveld loneliness scale) experienced as a function of covid -related circumstantial changes after controlling for demographic factors, although this effect was unique to usa residents (β = . , t = . , p = . ). introversion did not predict cognitive impairments (cfq) related to covid circumstantial changes after controlling for demographic variables (β = . , t = . , p = . ). in a model including introversion, recent unemployment predicted higher loneliness experienced as a function of covid -related circumstantial changes only for non-usa residents (β = . , t = . , p = . ). interestingly, after including introversion in the model, living with others (vs. alone) was associated with more severe cognitive impairments and anxiety experienced as a function of covid -related circumstantial changes (β = . , t = . , p = . and β = . , t = . , p = . , respectively). it is worth noting that the living condition did not have predictive value for loneliness and depressive symptoms experienced as a function of covid -related circumstantial changes (see table ). this study examined whether the psychological impact of covid -related circumstantial changes was moderated by introversion, based on outcome measures across psychosocial, cognitive, and affective domains. as a second aim of the current study, the role of several other demographic factors in determining covid -related mental health symptoms was also examined. overall, higher introversion (i.e., lower extraversion) was associated with higher loneliness, depression and anxiety experienced as a function of covid -related circumstantial changes. the finding that introverts experience the psychosocial and affective impact of social distancing and lockdown measures more severely than their extraverted counterparts converges and deviates from previous literature in several ways. first, the finding is in line with previous studies demonstrating that introversion is associated with more psychological problems in general (janowsky, ; jylha et al., ; fadda and scalas, ) , and adjustment problems specifically (pinder, ; bauer and liang, ; löckenhoff et al., ; robinson et al., ; davidson et al., ) , however, this finding appears to be in disagreement with the notion that introversion is associated with a preference for less stimulating environments (myers, ; cattell, ; eysenck, ; hathaway, ; mccrae and costa, ) such as that created in everyday life following the implementation of social distancing and lockdown measures. in turn, this assumption has fuelled the lay belief that introverts are coping better during the covid pandemic compared to extraverts (detailed in section "introduction"). current findings may be best understood without considering the two lines of thought as mutually exclusive. introversion has been linked to decreased help-seeking behavior (swickert et al., ; atik and yalçin, ; kakhnovets, ) , which may in part explain higher psychological problems among introverts at baseline (janowsky, ; jylha et al., ; fadda and scalas, ) . when experiencing negative emotions, introverts are similarly more likely turn inwardly to cope (shapiro and alexander, ) . while introspective behaviors can facilitate emotional self-regulation, such habits can also function as a double-edged sword in perpetuating internalization (bowker and rubin, ) , rumination (verhaeghen et al., ; cohen and ferrari, ) , and worry (philippi and koenigs, ) -key cognitive underpinnings of loneliness, depression, and anxiety, respectively (beck, ; newman et al., ; ypsilanti, ) . such an account of why individuals higher on introversion might experience the psychosocial and affective impact of covid -related circumstantial changes more severely is corroborated by other aspects of present findings. specifically, cognitive impairments experienced as a function of social distancing and lockdown measures were not moderated by introversion, suggesting that cognitive function and activity remains intact across the introversion-extraversion dimension through covid -related circumstantial changes. current findings are in keeping with previous research demonstrating that functional domains of mental health are differentially moderated by personality traits (segel-karpas and lachman, ) , and highlight the particular relevance of evaluating domain-specific effects in research on the association between introversion and mental health. crucially, these findings have implications for both consumers and disseminators of information on popular internet hubs -specifically, to keep in view that the notion of introverts thriving under lockdown and social distancing conditions may not necessarily be empirically supported. mental health professionals dealing with covid -related psychological issues should also be aware that introverts may risk being erroneously left out of the mental health system. one aspect of present observations is worth noting before proceeding to discuss findings pertaining to the second aim of the current study. namely, the psychosocial impact of covid related circumstantial changes (loneliness) was predicted by both introversion and demographic factors (specifically, recent unemployment), but these effects were unique to usa and non-usa residents, respectively. there are several possible explanations for this observation including: ( ) predictors of covid -related loneliness differ qualitatively at different levels of loneliness severity, given usa residents reported higher loneliness as a function of covid -related circumstantial changes in the current sample, and ( ) the psychosocial impact of covid -related circumstantial changes is predicted by qualitatively different factors in different cultures. while not within the scope of the present study's aims, these speculations represent testable hypotheses which may be of interest in future research. besides recent unemployment, other demographic predictors examined were age, gender, and living condition. only living condition made a unique contribution to covid -related mental health symptoms after accounting for introversion. specifically, living with others (vs. living alone) was associated with experiencing more cognitive impairments and anxiety as a function of covid -related circumstantial changes. adjacently, it was observed that covid -related loneliness and depressive symptoms were not predicted by living condition. interpreted together, it is possible that close human affiliation serves as a protective buffer against social disconnectedness and low mood during the covid pandemic, but works in the opposite direction for clarity of thought and keeping calm. further information on household dynamics would have helped in the development of this speculation, but was not obtained in the present study. other limitations of the current study include its crosssectional nature, so that pre-covid mental health issues may have been conflated with covid -related mental health symptoms as presently assessed. on a related note, the current study assumes that presently used outcome measures (worded with reference to covid social distancing and lockdown measures) captured psychological health as shaped specifically by social orders placed as preventative measures against covid . however, responses on these measures may also reflect psychological health as impacted by the globalscale pandemic more generally, so that responses may not be tied solely to increased amounts of solitary time. further, demographic variables were considered only in broad strokes in the present study. accounting for a wider range of demographic variables, including but not limited to income, would allow for a clearer picture of the association between introversion and the psychological impact of covid -related circumstantial changes to be drawn. next, the participant count in each non-usa country was small in the present sample, so that non-usa respondents had to be collapsed in a single "non-usa residents" group. although the covid outbreak is considered a global pandemic, there may still be subtle differences in the covid impact between countries. more targeted and selective recruitment according to location/residence should be considered in future research. finally, given present interests in multiple outcome variables, the current study would have benefited in terms of statistical power from a larger sample size. the datasets presented in this study can be found in online repositories. the names of the repository/repositories and accession number(s) can be found in the article/ supplementary material. ethical review and approval was not required for the study on human participants in accordance with the local 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conflict of interest.copyright © wei. this is an open-access article distributed under the terms of the creative commons attribution license (cc by). the use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. no use, distribution or reproduction is permitted which does not comply with these terms. key: cord- -e jy authors: giménez-dasí, marta; quintanilla, laura; lucas-molina, beatriz; sarmento-henrique, renata title: six weeks of confinement: psychological effects on a sample of children in early childhood and primary education date: - - journal: front psychol doi: . /fpsyg. . sha: doc_id: cord_uid: e jy spain has been one of the countries most affected by the health crisis derived from covid- . within this country, the city of madrid has registered the highest number of infections and deaths. this circumstance led to the adoption of strict confinement measures for a period of weeks. the objective of the present study was to investigate the psychological effects that this confinement has had on the psychological well-being of a sample of children from madrid. a total of families with children aged between and years participated in this study. the parents evaluated the children through the system of evaluation of children and adolescents (sena) scale in the month of february and refilled part of the same scale after the children had spent between and weeks confined. the comparison between the two measures showed no change among the -year-old children. however, change was observed among the – -year-old. children in primary education obtained lower scores in dimensions related to self-regulation (emotional, attentional, and behavioral) and in willingness to study. the results are discussed in light of the situation experienced between the months of march and may . spain has been one of the countries most affected in the world by the health crisis caused by the severe acute respiratory syndrome coronavirus (sars-cov- ). within this country, madrid has been the city where more confirmed cases of contagion and more deaths have occurred. this situation makes the city of madrid one of the places in the world most affected by this health crisis and where the restrictions have been the harshest. the entire population of this autonomous community and this city (around million inhabitants, ine, ) has suffered strict confinement measures for months, which have also affected children. on the th of march, all educational centers in madrid closed, from early childhood education to university levels. on the th of march, the state of alarm was declared and people were prohibited from leaving their homes except for essential supply services (real decreto / . for children, this confinement lasted until the th of april frontiers in psychology | www.frontiersin.org october | volume | article (real decreto / . after weeks and days at home, children were allowed to go outside for an hour a day. this outing regime was maintained until the th of may, date on which meetings with friends and family in private homes up to a maximum of people were authorized (real decreto / . thus, the most demanding isolation measures for the children of madrid extended over a period of weeks and the measures with a partial relief of h of outing per day for an additional weeks. in total, the children of madrid have lived confined or with only h a day of outing for a total of weeks. this novel situation in our world, due to the unexpectedness of the measure and its duration, may have had some effect on the psychological well-being of children. previous research shows that social isolation can cause some difficulties such as depression, anxiety, emotional problems, or sleep disorders (holt-lunstad et al., ; urbina, ) . some studies have found alterations related to an increase in anxiety in between and % of the population in the face of health crises already experienced, such as sars, ebola, or swine flu (rubin et al., ; shultz et al., ; satcher and kenned, ) . other very recent studies have shown that the duration of confinement and the associated emotions can generate significant psychological stress, as well as anxiety, delusional thinking, obsessions, or rumination in vulnerable people (brooks et al., ; mucci et al., ) . similarly, previous research on the effects of social isolation in children shows important effects on aspects, such as feelings of sadness, anger, frustration, and apathy (biordi and nicholson, ; brooks et al., ) . other indicative aspects of wellbeing and regulation during childhood have also been found to be altered, such as sleep patterns, potty training, or challenging behaviors (simon and walker, ) . changes have also been observed in the levels of anxiety (increased fear, worry, obsession, or rumination) and depression (depressed mood, lack of interest and motivation, or sadness; teo et al., ; urbina, ) . a study evaluating the psychological effects of pandemics in children and adults found that the risk of posttraumatic stress was four times higher for children who had suffered confinement measures compared to those who had not (sprang and silman, ) . there are very few published studies on the effects of confinement derived from the sars-cov- . jiao et al. ( ) report a study with families of chinese children aged between and years. the families evaluated the frequency of clinical symptoms through an online questionnaire. the results showed that the most frequent symptoms in the entire sample were inattention, irritability, and clinging. more specifically, the older children ( - ) showed greater inattention and persistent inquiry, while the younger ones ( - ) showed more clinging and fear that family members could contract the illness. in europe, a study prior to ours among italian children showed a significant impact on the psychological wellbeing of children (pisano et al., ) . italy and spain have been two comparable cases in confinement measures, number of infections, and deaths. pisano et al. ( ) designed a questionnaire for parents to assess the perceived changes in children aged between and years during the st month of confinement. the sample consisted of participants. between and % of parents said that their children showed more symptoms, such as irritability, excessive demands, sleep problems, mood changes, or fear. around % indicated that their children seemed more apathetic when performing their usual activities. some positive effects were also found. in fact, % stated that their children had been able to adapt to the restrictions imposed by the pandemic, % indicated that their children seemed more reflective, and % indicated that they were calmer. in spain, we also found a study, prior to ours, in which a group of sociologists designed a questionnaire for children to answer online (martínez muñoz et al., ) . this questionnaire was available between the st of march and the th of april for boys and girls aged between and years. it is important to note that the questionnaire was completed during the most difficult days of the crisis, when the number of daily deaths was close to a , people. a total of boys and girls answered the questionnaire, the majority aged between and years. the sample was made up of children residing in different communities in spain. most of the sample expressed a high level of satisfaction and well-being in their daily lives. this result suggests that the sample was made up of children belonging to normalized environments and without problems of social exclusion, poverty, etc. the results of this work are interesting and show, according to previous studies, some of the psychological effects that confinement and the health crisis had at that time on the children. thus, the most frequent feeling that the participants said they experienced every day or quite a lot was boredom ( % of the sample), followed by worry ( %), sadness ( %), and fear ( %). the main concern of the children was that a member of their family would fall ill or die ( %). a very relevant fact has to do with the relationship between subjective well-being and academic performance. there was a negative relationship between perceived well-being and the feeling of being overwhelmed by academic tasks. in this sense, % of children said they felt overwhelmed by the amount of academic work sent by their teachers and % said they felt tired from working so much. these two results show that, on the whole, % of children perceived the work demanded by their teachers as exaggerated or inadequate and this perception affected their sense of well-being. finally, children expressed joy during these weeks for being able to spend more time with the family ( %), having more time to play ( %), having free time ( %), and not having to get up early and not go to school ( %). these results clearly show that spanish children overwhelmingly demand more time for their family life, for themselves, and for resting. these previous results lead us to think that spanish children were able to experience negative changes and, perhaps, also positive changes derived from the absence of school, the greater availability of time, and family life. however, one of the main problems of the studies that began to evaluate once the crisis had started is the absence of a previous measure with which to compare the changes experienced. frontiers in psychology | www.frontiersin.org october | volume | article the objective of the present study is to evaluate the changes that the confinement situation experienced between the th of march and the th of april could have caused on a sample of children residing in the community of madrid. our study is the result of a particular circumstance that has allowed us to compare the changes between a previous measure of adaptation and psychological well-being, collected during the month of february, and a subsequent measure taken during the most restrictive period of confinement. in this sense, we believe that we can provide a reliable assessment of the effects that the health crisis and confinement has had on children in madrid after weeks of restrictive measures. a total of families with children aged between . and . years ( % girls, mean age of years and months, sd = . , and range = . - . ) participated in the study. the sample was divided into two age groups: preschool families (m = . , sd = . , range = . - . ) and primary families (m = . ; sd = . , range = - . ). from this sample, families completed a questionnaire before and during confinement ( from primary education). the rest of the participants ( ) only completed the questionnaire during confinement ( from primary education). the convenience sample was obtained thanks to the fact that the schools were participating in a research project related to the promotion of emotional skills when the pandemic struck. children went to two public schools of the northern area of madrid (spain) and resided in middle and upper middle class neighborhoods. the questionnaire used was the system of evaluation of children and adolescents (sena, fernández-pinto et al., ) , validated and scaled for the spanish population. this instrument offers a comprehensive assessment of emotional and behavioral problems for ages between and years. as it is a very broad questionnaire, with more than items, answering it fully during the confinement involved a too demanding task for parents with school-age children. for this reason, those dimensions of the questionnaire that evaluated aspects related to psychological adjustment were selected. the selected scales were attentional problems, depression, challenging behaviors, emotional regulation, hyperactivity, and willingness to study (the latter only for the primary education version). the score for each item ranged from (never or almost never) to (always or almost always). for all dimensions, except for willingness to study, the lowest scores indicate absence of problems and scores above indicate the presence of some type of difficulty. for the willingness to study scale, a score lower than indicates a problem. to the selected scales of the questionnaire, we added an open-ended question, so that the families could comment on any aspect that had not been included in the questionnaire. the instruction was "comment here on anything you have observed, any change you have noticed in your child since the confinement began that seems significant to you and has not been included in the previous questions (for example, eats too much, has nightmares, complains of headaches, is very afraid, etc.). " as a consequence of the confinement caused by covid- and the closure of the educational centers in madrid decreed on the th of march , the research project in which we had been working with the two educational centers in the northwestern area of madrid had to be discontinued. however, according to the schedule of our research project, before the closing of the educational centers we had carried out assessments on different aspects of the participating children. the families had completed the assessment tests related to the children during the month of february. based on these previous assessments, a month and a half later and after having spent between and weeks of confinement, we again asked the families to fill out a part of the questionnaire. all the questionnaires were answered by the parents between the th and the th of april , granting their consent to participate in the study. both the pretest and posttest questionnaires were answered online. this research was approved by the deonthological committee of the faculty of psychology of the complutense university of madrid. the principals and the families of the participating schools were informed of the purpose of the study by the research team. parents signed the appropriate consent forms. both the university and the schools followed the protocols for applying the ethical procedures that regulate research in spain. as we mentioned before, the families had answered the questionnaire during the month of february, a few weeks before confinement. this situation could sensitize parents when answering the questionnaire in the second round. on the other hand, some families did not answer the pretest (t ) but did answer the questionnaire during confinement (posttest/t ). to control the possible sensitivity to the test of the participants with pretest, the scores of both groups were compared -with and without prior assessment in the t measure. to do so, we used a manova in which the main factor was whether or not the assessment was carried out before confinement. with this analysis, we wanted to rule out that the t measure had interfered with the t measure in that group. to assess whether there were differences in the psychological adjustment between before and during confinement, we carried out a repeated-measures (rm) anova in which the psychological adjustment was contrasted in the two measures, observing the possible differences in age and sex. given that the sena questionnaire has different items for children in early childhood education ( - years) and primary education ( - years), we carried out the statistical analysis for each group separately. we used spss for these analyses. the open-ended question was coded into broad categories of change, that is, if the change reported by the family indicated a worsening of the child's condition, an improvement, or an absence of change. likewise, the symptoms described by the families were grouped into several categories. subsequently, the percentage of responses was calculated for both the early childhood and primary education groups. the objective of this open-ended question was to obtain a more accurate description of the families' perception of their children's changes during confinement. the preliminary analysis carried out to verify whether previously applying the questionnaire had sensitized the participants indicated that the difference between the groups with and without prior assessment was not significant, either for the primary education ]. this result allowed us to consider with greater guarantee that the possible differences between the pretest and the posttest assessment were not biased. comparison between the pretest and posttest scores for the early childhood education group indicated very little variation in the mean scores of the five dimensions (see table on the contrary, for the primary education group of children, some differences were observed between the mean scores obtained before and during confinement (see table ). in general terms, the scores suggest that there was normality regarding the dimensions evaluated. in the pretest evaluation, the scores were mostly rather low, while some mean scores increased during confinement and willingness to study decreased. the statistical analysis indicated that there were no significant differences due to gender [f( , ) = . , p = . , h p ] scales did not vary. the qualitative analysis of the responses was carried out on the voluntary comments of the parents. it should be noted that only % of the participants answered this open-ended question. the comments were classified into three categories: those that indicated an improvement in the child's general condition, those that indicated a worsening, and those that did not show any significant change. figure shows the percentage of responses for each category in each age group. families reported a higher percentage of children whose psychological state worsened, both in early childhood ( %) and in primary education ( %). however, this result was higher in primary education, where only % of families indicated that children did not change ( %) or had improved ( %) . when comparing early childhood and primary education, it is observed that in early childhood, the percentage of children who did not experience changes was higher ( %) and the percentage of children who improved their psychological state ( %) was similar. taken together, these results are consistent with those obtained through the questionnaire, showing, on the one hand, that although children were affected by the situation of confinement, those in primary education suffered this situation more than those in early childhood education, and on the other, that a significant percentage of children in both cycles improved their psychological state. in addition to these percentages, the behavior or type of symptomatology described by families in the open-ended question was also classified. table lists the percentages of the types of behaviors that parents perceived in their children. in the early childhood group, families reported overall greater difficulties in emotional regulation (he/she is more irritable, has more mood swings, etc.), in sleeping and eating patterns (he/she does not want to sleep alone, has trouble falling asleep, has nightmares, eats more, etc.) and in potty training (he/she wets the bed again at night, has had a potty accident during the day, etc.). in the primary education group, families also mentioned these three types of behaviors or symptoms, but they also mentioned attentional difficulties and, above all, school difficulties. finally, some families indicated positive changes, referring to improvements in mood (he/she is happy, is calmer, etc.) and to the positive effect of the greater availability of free time (he/she has more time to play, has more time for him/herself, etc.) and family time (he/she is delighted to be with us, enjoys playing with his/her sibling very much, has strengthened the bond with his/her siblings, etc.). the objective of the present study was to verify whether the situation of weeks of strict confinement experienced in madrid as a consequence of the sars-cov- health crisis had caused a change in the psychological well-being of children. the results show significant changes in most of the indicators evaluated in the older children of the sample ( - year-old). these changes, however, were not observed in the younger children of the sample ( -year-old). more specifically, children aged between and scored higher in emotional regulation difficulties, attentional difficulties, hyperactivity, and impulsivity. willingness to study was the scale on which the worst result was obtained. in this dimension, the greatest difference was observed between the pretest and posttest scores. on the contrary, no changes were found in the depression or challenging behaviors scales. in general, the results obtained are congruent with those found in previous studies on the effects of social isolation on children and also with the few studies that have been carried out on the particular situation of confinement during sars-cov- health crisis (jiao et al., ; pisano et al., ) . despite this coincidence, it is necessary to highlight that the two previous studies mentioned found a significant increase in symptoms in children aged from to years, respectively; in our case, this difference was delayed until the age of years. it is possible that the sample size may have influenced these differences. one of the most striking results of the present study is the greater difficulties that primary school children seem to experience when carrying out school tasks. this result coincides with the school difficulties expressed by the children in study of martínez muñoz et al. ( ) . despite the fact that the mean age of the sample in this study was years, it should be highlighted that % of children expressed difficulties in adequately performing school tasks as well as excessive demand on behalf of teachers. our results also show that the dimension in which primary children obtained worst results was related to academic performance. in this sense, it is necessary to take into account the difficulties that online teaching may pose for primary children. as rogero-garcía ( ) points out, distance learning can become a fiction in which no one can fulfill their role, but in which frustration and stress of teachers, students, and families will grow. the difference observed in the present study between early childhood and primary education children shows that, in some way, young children are more protected from reality than older children. this protection comes, on the one hand, from the family and, on the other, from the cognitive system of young children. in this sense, the care that young children receive from their families should facilitate the continuity of their lives, turning confinement into a time similar to that of holiday time spent at home or periods of illness that are so frequent in young children. furthermore, the toddler's cognitive system operates largely within the framework of fiction (harris, ) . fiction is a fundamental element for development and learning that in this age group has a very relevant role. it is possible that the time and cognitive effort that children dedicate to fiction constitutes a protective element of psychological well-being in this circumstance. it is also possible that these two protective factors have been less present in the lives of children aged , , and years during confinement and that part of their psychological deterioration may be due to the progressive decrease in pretend play that is experienced from the age of , the more conscious perception of reality, and the lesser need for constant attention from the adults. despite the fact that early childhood children did not show a significant worsening, when the families described the observed changes, they mentioned similar symptomatology to that manifested by primary education children. these changes have to do mainly with regulatory skills and are manifested in behaviors related to executive functions (i.e., emotional regulation, attentional control, hyperactivity, and impulsivity). likewise, despite the fact that families pointed out regulation problems, around % of families observed that children were not affected or had even improved during the situation of confinement. this improvement situation, in which around % of the children are, together with the comments of the families that noted that children were happy to be able to have more time and enjoy family life constitutes a call of attention on the impact that school days and daily activities can have on the well-being of children. although the children who were not affected by or even appreciated the situation of confinement were not a majority, they constitute a significant percentage and it would be desirable to make the appropriate adjustments to optimize their development. finally, keeping in mind the reality we will probably have to face this following academic year, with the difficulties that online teaching can pose for children of these ages, the decrease in the willingness to study that has been observed in these weeks of confinement, and the stress that the academic burden can pose for children, it would be necessary for the responsible authorities in education to design an academic course focused on the essential contents, adapting the demands to the real working and learning abilities of the children, in which the workload is reduced, the stress is decreased, and the psychological well-being is promoted. the impact that this health crisis may have on the psychological well-being of future generations is still unknown, but the first studies carried out in spain coincidentally indicate an increase in academic difficulties. the design of the next course can be a very relevant variable. education managers, school directors, and teachers have an important role to play in the coming months (jansen et al., ) . this study has some limitations that need to be considered. firstly, the sample size is small and it is a convenience sample. in the future, it will be necessary to design studies with representative populations and larger samples in order to generalize the results. likewise, it would be necessary to carry out studies with vulnerable populations. secondly, the instrument applied is relatively small. it would have been desirable to be able to obtain broader assessments that consider other dimensions. thirdly, it would also be necessary to carry out medium-and long-term follow-up studies to understand the scope and maintenance of the changes observed in these st week of confinement. moreover, the long-term impact on mental health together with the need to monitor children and adolescents' well-being are important issues to consider for future research (lee, ) . the raw data supporting the conclusions of this article will be made available by the authors, without undue reservation. the studies involving human participants were reviewed and approved by comisión deontológica, facultad de psicología, ucm. written informed consent to participate in this study was provided by the participants' legal guardian/next of kin. mg-d designed the study. mg-d and lq have collected the data. lq has analyzed data. mg-d and lq have written the first draft. bl-m and rs-h have reviewed and completed the manuscript. mg-d did the submission. all authors contributed to the article and approved the submitted version. this work has been funded by the spanish ministry of science and innovation (rti - -b-i ). social isolation the psychological impact of quarantine and how to reduce it: rapid review of the evidence the work 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impact of social isolation during the covid- lockdown and effective strategies we are grateful to the principals, the teachers, the children, and the families that have participated. key: cord- -jwlc fxj authors: vagni, monia; maiorano, tiziana; giostra, valeria; pajardi, daniela title: coping with covid- : emergency stress, secondary trauma and self-efficacy in healthcare and emergency workers in italy date: - - journal: front psychol doi: . /fpsyg. . sha: doc_id: cord_uid: jwlc fxj coping with the coronavirus disease (covid- ) is a significant risk factor for the psychological distress of health workers. hence, this study explores the relationship between coping strategies used by healthcare and emergency workers in italy to manage the stress factors related to the covid- emergency, which may result in the risk of developing secondary trauma. we study differences between healthcare (n = ) and emergency workers (n = ) in terms of their coping strategies, emergency stress, and secondary trauma, as well as the relationships of these differences to demographic variables and other stress factors (instructions and equipment). for this purpose, we collected data from participants through the following questionnaires online: secondary traumatic stress scale – italian version, the coping self-efficacy scale – short form, an original questionnaire on stressors, and the emergency stress questionnaire (to assess organizational–relational, physical, decisional inefficacy, emotional, cognitive, and covid- stress). we performed a t-test, correlational analysis, and hierarchical regression. the analyses reveal that compared with the emergency worker group, the health worker group has greater levels of emergency stress and arousal and is more willing to use problem-focused coping. healthcare workers involved in the treatment of covid- are exposed to a large degree of stress and could experience secondary trauma; hence, it is essential to plan prevention strategies for future pandemic situations. moreover, individual efficacy in stopping negative emotions and thoughts could be a protective strategy against stress and secondary trauma. the coronavirus disease , or the acute respiratory disease caused by severe acute respiratory syndrome coronavirus (sars-cov- ), began spreading in china at the end of and, to date, represents an international health emergency without precedents in terms of its health, economic, and organizational effects on people's lives (world health organization, ) . after china, italy was the first country to be affected by this epidemic, with the first deaths on february , , and a rapid increase in the spread of infection and mortality. covid- was first detected in northern italy, and it then spread, although at different rates of incidence, to the other regions. it was immediately evident that healthcare and emergency workers were at great risk of contagion and that protection and intervention protocols needed to be introduced in the absence of adequate points of reference because of the exceptional nature of the epidemic, the rate of spread of the infection, the seriousness of patients' health condition, and the mortality index. the extreme conditions in which health workers have had to work, especially in the most affected regions in northern italy, are indicated by the following data from the italian national institute of health ( ): over doctors died and , other health workers were infected within the general context of the population of , deaths and , infections in a span of weeks. it was also clear that the medical staff would experience serious psychological repercussions because of the working conditions as well as the difficulty of having scientific points of reference on care and intervention procedures. to this must be added the increase in workload, the extension of working hours and, for health workers, the frequent exposure to the suffering and death of their patients. therefore, healthcare and emergency workers were subjected to serious psychological as well as physical stress. hence, the aim of this study, which was also the aim of a previous study (vagni et al., ) , is to focus on the similarities and the differences in the stress management of two professional groups-healthcare and emergency workersduring the acute phase of the pandemic. both groups have had to deal with covid patients as frontline responders and have been exposed to the related risks of infection and psychological consequences, which, to date, have not been examined in detail through a comparative analysis. as regards the stress that they experience, the literature clearly explains that healthcare and emergency workers who intervene in emergency situations are exposed to the risk of developing dysfunctional reactions that can be identified at different levelsphysical and/or physiological (e.g., psychosomatic disorders, sleep/wake cycle alterations, and sense of tiredness); emotional (e.g., irritability, nervousness, agitation, anger, low self-esteem, and guilt); cognitive (e.g., distractibility, sense of ineffectiveness, and negative anticipation of events); and relational (e.g., increase in conflicts within emergency teams and/or with their organization/institution, and social withdrawal)-and may also develop reactions from secondary trauma (del missier et al., ; sbattella, ; argentero and setti, ; fraccaroli and balducci, ; bellelli and di schiena, ; walton et al., ) . faced with stressful events regarding which they lack previous experience and specific, necessary knowledge, and which cause tension owing to the need for rapid decision timings and a sense of responsibility, emergency workers may experience a sense of decision ineffectiveness. in fact, emergency situations are characterized by high levels of decisional and operational uncertainty with associated regret and guilt (del missier et al., ) . several studies have highlighted that insufficient instructions and a lack of personal protective equipment (ppe) are important predictors of stress for healthcare and emergency workers in large-scale emergencies (oh et al., ; du et al., ; el-hage et al., ; walton et al., ) . oh et al. ( ) highlighted that nurses involved in managing the middle east respiratory syndrome (mers) experienced lower levels of stress when the levels of goods supply and hospital training were higher. some studies have highlighted that frontline healthcare workers had lower secondary traumatization scores than non-frontline health workers and the general public in contrast to the findings of previous research on the sars outbreak in the same area in singapore (chan and huak, ) . according to barleycorn ( ) and tan et al. ( ) , these results may be due to the dedicated training and psychological support given to healthcare workers after the sars outbreak and demonstrate the validity of policy strategies for prevention of stress in the psychological health field. an analysis of studies published from january to march aimed at investigating the stress experience of healthcare workers in facing covid- shows that health workers experienced symptoms of depression and anxiety related to this stressful experience. moreover, the severity of their symptoms was influenced by their age, gender, role, specialization, type of activity performed, and exposure to patients with covid- ; however, prevention, resilience, and social support interventions mediated their response to stress (bohlken et al., ) . in a review of the literature, spoorthy ( ) underlined that sociodemographic variables, such as age, gender, profession, and workplace, and psychological variables, such as poor social support and self-efficacy, affect the stress level experienced by health workers. in addition, covid- emerged as an independent stress risk factor. xiao et al. ( ) found that social support plays a role in reducing the anxiety levels in medical staff and increases their sense of self-efficacy. according to walton et al. ( ) , the specific stressors that health workers face in the covid- emergency are related to the organizational context. the challenges for medical staff include not only an increased workload but also a fear of infection, the need to work with new protocols that change frequently, and the use of ppe. in uncontrollable situations such as a pandemic, when specific action protocols are absent and limited resources are available, health workers must make individual decisions with a heavy burden of responsibility that may be contrary to their moral principles. for example, in the case of covid- , they may have to choose which patients to save because only a few places are available in intensive care. in this regard, cai et al. ( ) showed that for a sample of healthcare professionals who worked closely with covid- patients in hubei, the most stressful factors were the lack of protocols for the treatment of covid- , the scarcity of ppe, the exhausting work shifts, their concern about the risk of infection, and their exposure to the death and suffering of their patients. they also found that the support of superiors proved to be one of the most important motivational factors for medical staff, and the presence of clear guidelines and effective safety protocols were protective factors against the development of stress, in particular, for females. further, walton et al. ( ) identified the organizational stressors as the changes in work shifts, the prevalence of night shifts, an excessive workload, staff roles, autonomy, the lack of support from superiors, and the absence of adequate information and clear instructions. on the basis of these stressors, they estimated that % of the medical staff working on the front line of this pandemic are at risk of developing posttraumatic stress disorder (ptsd). in addition, limited resources, longer shifts, decreased hours of rest, and the occupational risks associated with covid- exposure have increased the physical and mental fatigue, stress, anxiety, and burnout of these staff members (sasangohar et al., ) . the loss of a social support network, which can be an important resilience factor, is another risk factor (ozbay et al., ) . in the covid- emergency, healthcare and emergency workers have often experienced a separation from their affective links, either because of the restrictions on social contacts imposed by the lockdown or the fear of spreading the infection to their family members. to this must be added that although, at first, health workers received unanimous encouragement from the population, later, they also experienced demonstrations of stigma and isolation. some studies have shown that being able to resort to their own social support network is a significant protective factor for health workers dealing with this emergency . as favretto ( ) stated, when individuals experience situations that go beyond their coping strategies, their vulnerability to, and risk of developing, psychopathological reactions increases. studies conducted during previous epidemics, such as the sars, mers, and ebola epidemics, converge in detecting how healthcare and emergency workers may experience extremely high levels of stress and even develop secondary traumatic stress or vicarious trauma. this trauma is defined as an experience of symptoms similar to those found in people with ptsd, such as in emergency nurses working with traumatized patients (beck, ) . figley ( ) defined it as a form of stress that derives from the feelings of empathy experienced when helping traumatized people. the symptoms may include intrusive recurring thoughts, disturbed sleep, fatigue, physical symptoms, hyperarousal, increased stress response, anxiety, depression, and feeling emotional (adriaenssens et al., ) . wolf et al. ( ) described how nurses may feel "overwhelmed, " and this condition becomes a source of moral distress that triggers feelings of powerlessness, guilt, fear, anger, and frustration. the sense of frustration and impotence felt by nurses when they are unable to treat and save a patient has been highlighted as a risk factor for secondary traumatic stress in several studies (missouridou, ) . avoidance and emotional numbing can become tools for self-protection from intrusive symptoms that exceed the personal tolerance level (coetzee and klopper, ; mealer and jones, ) . their frustration obviously intensifies on a patient's death. the onset of ptsd in the health workers involved in treating mers was also detected after the acute phase of the emergency was over, highlighting a risk not only in the immediate period but also in the medium-term period (lee et al., ) . in reference to covid- , updated studies conducted on chinese health workers have already highlighted the strong impact of the epidemic on the psychological health of doctors and nurses. some studies have found that healthcare workers have high levels of anxiety, depression, insomnia, and distress (lai et al., ; li et al., ; zhu et al., ) . in particular, female professionals with more than years of experience and previous psychiatric pathology present more risk factors of developing the symptoms of stress, anxiety, and depression (lai et al., ; zhu et al., ) . huang j. z. et al. ( ) studied stress levels during the covid- emergency in a sample of medical staff. they found that females showed higher levels of anxiety and ptsd than males did and that the levels were higher for nurses than for doctors. moreover, li et al. ( ) found that nurses had developed higher levels of vicarious trauma than those of the general population and that nurses who did not work closely with covid- patients showed a more severe symptomatology, both physical and psychological, compared with their colleagues working on the frontline emergency services. in italy, a study conducted on healthcare workers found that doctors and nurses developed high levels of stress and anxiety, greater than those developed by the general population, and that healthcare workers operating in the north, the area of italy most affected by the virus, showed a more severe symptomatology (simione and gnagnarella, ) . this study also confirmed that females tend to have a greater perception of the risk of infection, which increases their risk of developing the symptoms of anxiety and distress. because of their long, intense exposure to various stressors, it is important to note the nature of the coping strategies used by these healthcare and emergency workers in these situations and their effectiveness in terms of reducing and effectively coping with stress. indeed, the effective management of stress levels in the acute/emergency phase could reduce the risk of developing long-term ptsd or other pathologies, such as anxiety and depression (fullerton et al., ; slottje et al., ; argentero and setti, ; sakuma et al., ; birinci and erden, ; li et al., ) . coping may be defined as a series of cognitive and behavioral efforts to manage specific internal or external issues that test or exceed individual resources (lazarus and folkman, ) . a distinction can be made between problem-focused and emotion-focused coping strategies. the former is aimed at modifying and solving the stressful situation through active interventions. by contrast, emotion-focused coping is aimed at managing the emotions connected to the stressful event and regulating affective reactions, such as anxiety and the tension of response to stress, for example, by trying to avoid the threat (denial) or re-evaluating it (reappraisal). the choice of coping strategies is influenced by the individual's cognitive evaluation of the event, termed secondary evaluation, which involves estimating the resources available and the most effective strategies to deal with the situation (lazarus and folkman, ) . a key element of this assessment is the extent to which the individual can maintain control over the outcome of the situation. the literature indicates that individuals apply dysfunctional coping when they face an uncontrollable event by responding primarily with a coping strategy focused on the problem, and conversely, when they face a controllable situation, they respond with coping strategies focused on emotions (strentz and auerbach, ; vitaliano et al., ) . a coping strategy may be defined as adaptive when the controllability of the stressful event corresponds with the choice of coping strategy: in this case, the subject will experience fewer symptoms related to stress (park et al., ) . the strategies used to cope with trauma may differ among individuals, but they can also vary according to the profession and the features of the traumatic event (nydegger et al., ) . individuals differ in their choice of coping strategies (connor-smith and flachsbart, ) , and factors related to the situation can also have a decisive influence on such choice (brown et al., ) . a few studies have considered the ways in which gender influences the perception of stress in emergency situations and the choice of coping strategy. these studies highlight that females tend to perceive events as more negative and uncontrollable and to resort more to coping strategies focused on emotions and avoidance, whereas males tend to resort more to applying problem-focused coping and to inhibiting emotions (matud, ; matud et al., ; matud and garcia, ) . the literature on the relationship between coping strategies and the stress levels of emergency workers has shown that the use of coping strategies focused on the problem usually tends to correlate with lower stress levels, both in healthcare workers (watson et al., ; howlett et al., ) and in other emergency workers, such as firefighters (brown et al., ) . however, a coping strategy frequently used by emergency workers is that of avoidance and minimization, and this strategy is associated with higher levels of stress (brown et al., ; chang et al., ; kerai et al., ; witt et al., ; theleritis et al., ) . loo et al. ( ) found that in a group of emergency workers, avoidance as well as coping strategies focused on emotions were associated with the development of post-traumatic symptomatology. rodríguez-rey et al. ( ) revealed that among health workers working in a pediatric emergency department, approximately % of the variance in ptsd was explained by the frequent use of coping strategies focused on emotions and the infrequent use of those focused on the problem. in addition, kucmin et al. ( ) , who considered a sample of paramedics, highlighted that the risk of developing ptsd symptoms was predicted by the use of coping strategies focused on emotions. however, the literature does not offer unanimous results. chamberlin and green ( ) found that in a group of firefighters, all coping strategies actually correlated with high levels of stress: the authors explained this finding by suggesting that it is not the individual coping strategies that are maladaptive in themselves, but that greater effort is needed to adjust in stressful situations. by contrast, young et al. ( ) indicated that firefighters use problem-focused coping strategies more often at the beginning of the operation and emotion-focused coping strategies more commonly in the phase of breakdown and fatigue. however, after the incident, they use both strategies (young et al., ) . a meta-analysis by shin et al. ( ) highlighted that different coping strategies have different effects on work burnout: in particular, emotional stress and depersonalization are associated with the use of emotion-focused coping strategies, whereas professional ineffectiveness is associated with the use of problem-focused strategies. further, a few studies have investigated the coping strategies that emergency workers can use during health emergencies similar to covid- . maunder et al. ( ) revealed that healthcare professionals who tended to apply dysfunctional coping strategies, based on avoidance, hostile comparison, or self-blame, tended to develop higher stress levels. wong et al. ( ) highlighted that during the sars epidemic, doctors and nurses tended to use different coping strategies. the doctors tended to turn more to action planning, but this strategy did not affect their stress level. instead, their stress level was positively correlated with their use of coping strategies based on emotional outlets. by contrast, the nursing staff tended to resort more to behavioral disengagement and distraction strategies, which, however, correlated with higher levels of stress among them. in this regard, during the mers epidemic, hospital staff tended to adopt coping strategies related to the use of ppe and the adoption of all prevention measures, as well as social support, whereas the coping strategy that they adopted the least was that based on an emotional outlet (khalid et al., ) . a recent study on healthcare workers in hubei, china, during the covid- epidemic , yielded similar results: to reduce stress, the medical staff tended to rely on active coping strategies, such as using security protocols, practicing social isolation measures, and seeking support from family and friends, but they did not find it necessary to discuss their emotions with a professional. huang l. et al. ( ) found that a sample of nurses working during the covid- emergency presented greater emotional reactions and turned more to problem-focused coping compared with university nursing students. emergency workers must have sufficient self-efficacy in terms of their coping skills to be able to manage and cope with stress levels. self-efficacy in coping appears to be an effective protective factor in relation to stress levels and maladaptive responses (chesney et al., ) . self-efficacy to cope with traumatic events has been effective in reducing the risk of developing ptsd (bosmans et al., ) . the main objective of this study is to identify the coping strategies activated by healthcare and emergency workers to deal with stress factors related to the covid- emergency that may be associated with the risk of developing vicarious or secondary trauma. few studies have considered both groups simultaneously when analyzing the strategies they have adopted to manage stress during the covid- emergency. hence, in this study, we are interested in detecting the similarities and differences in the approaches they adopted to manage their stress during the acute phase of the current pandemic according to walton et al. ( ) , the main acute stress reactions of emergency workers to emergency medical situations are emotional, cognitive, physical, and social reactions. therefore, these factors were included in the questionnaire used in the present study. moreover, reactions linked to stress factors for difficulties due to ineffective decision-making and dealing with stress were also considered (chesney et al., ) . in addition, fears regarding contracting the virus and infecting their own families because of covid- were specifically considered (du et al., ; huang j. z. et al., ; ornell et al., ; walton et al., ) . based on results found in the literature, the specific objectives of this study are as follows: ( ) to examine the relationships between coping strategies, emergency stress, and secondary trauma in healthcare and emergency workers. ( ) to identify significant differences in stress factors, coping strategies, and secondary trauma between two groupshealth workers and emergency workers. participants were selected on a voluntary basis through a trasversal sampling in order to take a picture of the situation caused by the pandemic emergency. we used an internet platform to conduct the study and approached the participants using social media, dedicated mailing lists, and forums. participants from all italian regions completed the questionnaire online. the sample consists of participants- males ( . %) and females ( . %)-whose average age was . years (sd = . ; min -max ). further, . % of the sample were married, . % were separated, and the remaining . % were single. we selected various professional figures who had directly worked in various sectors during the covid- emergency and who could be divided into two main groups. the first, the "health group, " consists of participants ( . %) who were healthcare workers: doctors ( %), nurses ( . %), psychologists ( . %), and seven healthcare assistants ( . %). their average age was . years (sd = . ), and their average years of active professional service was . (sd = . ). the second, the "emergency group, " consists of participants ( . %): emergency workers ( . %), firefighters ( . %), and civil protection staff ( . %), whose average age was . years (sd = . ) and average years of service was . (sd = . ). there was an age difference between the two groups (t = − . ; p < . ), and the distribution of the gender variable differed between the two groups, with males and females in the health group and males and females in the emergency group (χ . ; p < . ). the study involved participants from the entire national territory, and their workplace could be divided as follows: , , and % were from north, central, and south italy, respectively. further, % of the sample worked directly with covid- patients and . % worked in specific covid- departments. among the healthcare workers, % had worked in direct contact with covid- patients, whereas among the emergency workers, only % had assisted these patients (χ . ; p < . ). in the present study, we included two variables, lack of necessary instructions and lack of ppe, in accordance with the findings in the literature on their impact on the stress reactions of healthcare and emergency workers during the covid- pandemic. among the participants, and % of healthcare and emergency workers, respectively, did not have sufficient instructions to intervene (χ . ; p n.s.), and and % of healthcare and emergency workers, respectively, lacked adequate ppe when working (χ . ; p n.s.). this study used an online questionnaire and was conducted during the lockdown period owing to the covid- pandemic. the questionnaire had three parts: one each to collect online informed consent and baseline sociodemographic information, and one with an online series of questionnaires, as described in the next section. participants' anonymity was maintained in collecting the data. the institutional ethics committee approved all the procedures. we administered a series of questionnaires to evaluate the psychological stress and coping style of each participant. we included the following questionnaires. in detail, the arousal items describe situations characterized by anxiety, confusion, physical and psychological complaints, and agitation. intrusion refers to the re-experiencing of the traumatic event-even if not directly suffered-through internal images and memories. instructions for the stss-i indicated that respondents should specify how frequently an item was true for them in the previous weeks. the statements are evaluated on a -point scale ( = never; = very often) that provides scores for intrusion (example items: "i thought about my work with victims when i didn't intend to"; "reminders of my work with clients upset me") and arousal (example items: "i had trouble concentrating"; "i was easily annoyed"; "i expected something bad to happen"; "i felt jumpy"). the reliability coefficients of the instrument are . and . for arousal and intrusion, respectively. the coping self-efficacy scale -short form (cses-sf; chesney et al., ) this is a -item measure of perceived self-efficacy for coping with challenges and threats. this measure focuses on the changes in individuals' confidence in their ability to cope effectively, based on the self-efficacy theory (bandura, ; chesney et al., ) . participants were asked, "when things aren't going well for you, or when you're having problems, how confident or certain are you that you can do the following." then, they were asked to rate on an -point scale the extent to which they believed they could perform important behaviors for adaptive coping. the instrument yields three subscale scores: "problem-focused coping" (α = . ), "stop unpleasant emotions and thoughts" (α = . ), and "support" (α = . ). anchor points on the scale are ("cannot do at all"), ("moderately certain can do"), and ("certain can do"). we constructed an ad hoc -item questionnaire that included yes/no questions to detect stress factors identified by the literature, such as the availability of suitable equipment and the receipt of clear instructions during the covid- coping experience. in this study, we present the results related to two of these items: "instructions, " which refers to having received the necessary instructions to intervene, and "equipment, " which refers to having ppe. predictions of these factors have also been made in other studies (du et al., ; walton et al., ) . in light of the relevance and specificity of the lack of clear information or instructions and adequate ppe in the management of covid- in the italian context, as well as the findings in other studies, we decided to focus attention on these two risk factors. our analysis of the literature revealed that in situations in which they have to cope with a pandemic, several factors may affect the stress of medical staff and emergency healthcare workers and that covid- represents an independent specific stressor (spoorthy, ) . these stress factors have been identified as frequently affecting healthcare and emergency workers in emergency situations and leading to physical, emotional, cognitive, decision-making, relational, and organizational stress (del missier et al., ; sbattella, ; argentero and setti, ; fraccaroli and balducci, ; bellelli and di schiena, ; du et al., ; walton et al., ) . focusing on the specificity of the covid- epidemic, items have been constructed regarding the fears of contracting the infection and of infecting colleagues or family members (walton et al., ) , since covid- represents a factor of independent stress (spoorthy, ) that has great impact (huang j. z. et al., ) . consequently, we constructed the esq consisting of items assessed on a point likert scale, with scores ranging from (not at all) to (very much), grouped into six scales. the participants were asked to indicate how often they experienced certain emotions and thoughts while performing intervention and emergency activities during the covid- pandemic. the scales correspond to the factors identified and confirmed by factorial analysis through an analysis of the main components with orthogonal rotation of factors (varimax). the number of factors to be extracted was initially verified through the unit's largest eigenvalue criterion and, subsequently, by the scree test. the esq is based on six scales: ( ) organizational-relational stress: measures the stress levels related to the organizational context, relationships with colleagues, and social support (consisting of eight items: , , , , , , , and ); ( ) physical stress: composed of five items describing symptoms of physical fatigue ( , , , , and ); ( ) inefficacy decisional stress: consists of five items that analyze decision-making aspects and the possibility to act, which are related to the level of self-efficacy ( , , , , and ); ( ) emotional stress: comprises six items that indicate the participant's emotional reactions ( , , , , , and ); ( ) cognitive stress: consists of four items on the cognitive aspects of stress ( , , , and ); ( ) covid- stress: comprises five items regarding worries related to the covid- emergency ( , , , , and ) . first, we performed pearson's correlation analyses to identify the associations between the variables for the two groups that we considered in this study. subsequently, we checked for significant differences between the two groups as their stress levels, coping strategies, and secondary trauma. we used hierarchical linear regression models to verify the predictive effect of the risk factors (lack of adequate information and ppe) on the different stress levels (in step ). then, we verified the protective effect of the coping strategies (in step ). the models were controlled for age, gender, and group. lastly, we used hierarchical regression models to verify the predictive effect of stress factors on the components of secondary trauma. the models were controlled for age, gender, and group. first, we conducted correlational analyses and comparisons of averages on the reference sample. table shows the correlations between the scales of the esq and the other instruments. preliminary comparisons were made through the student's t-test between the health group and the emergency group in relation to the esq, cses-sf, and stss-i scores. table shows the comparison between the two groups. as shown in table , significant differences emerged between the two groups in relation to their stress and arousal levels. the results indicate higher levels of both for the health group, and that emergency workers turn more to the stop unpleasant emotions and thoughts strategy. further, we performed comparisons with reference to the gender variable to detect differences in the levels of stress factors, coping strategies, and secondary trauma. the emergency group, there were no differences in levels of stress and secondary trauma or coping strategies. moreover, we found similar correlations between the two groups for the stop unpleasant emotions and thoughts strategy and the stress factors, whereas for the other two coping strategies, we found a different association, particularly for the emergency group. however, the t-test comparisons highlight differences only at the level of the stop unpleasant emotions and thoughts strategy. given the findings of the preliminary analyses, we considered it necessary to include the age, gender, and group variables to test the predictiveness of the coping strategies on the participants' stress levels. to test the predictive effect of the coping strategies on various levels of stress, hierarchical regression was conducted. considering the age and gender differences within the groups, we included these variables in all models together with the group variable (health vs. emergency) and the "instructions" and "equipment" variables. the models generated by assuming the esq scales as dependent variables are shown in table . regarding the coping strategies, we observed an important effect of the stop unpleasant emotions and thoughts coping strategy on all the stress scales, except for physical stress where the effect of the focused problem coping strategy is recorded. as shown in table , significant negative associations between stressors and secondary trauma were found for both groups. the hierarchical regression models of stress scales were analyzed for the arousal and intrusion levels of secondary trauma. the models included the age, gender, health/emergency group variables, and the esq scales. the results are shown in table . . *** f = . *** f = . *** f = . *** f = . *** f = . *** *p < . , **p < . , ***p < . ; gender ( = male; = female); instructions ( = yes; = no); equipment ( = yes; = no); cses-sf scales, focused problem; stop emotion_thought; support. the same regression models were generated by including coping strategies as predictors and were analyzed by age, gender, and health/emergency group. compared with arousal, the results of this study show that healthcare and emergency workers both experienced high stressors during the covid- epidemic, exposing them to the risk of developing secondary trauma (dominguez-gomez and rutledge, ; argentero and setti, ; adriaenssens et al., ; duffy et al., ; aisling et al., ; morrison and joy, ; wolf et al., ; roden-foreman et al., ; lai et al., ; li et al., ; zhu et al., ) . we found significant differences between the two groups regarding their reactions and their levels of organizational, physical, and relational stress, their sense of decision-making, and their emotional and cognitive ineffectiveness. compared with emergency workers, healthcare workers had higher stress levels, leading them to perceive more serious tensions and difficulties in teamwork, physical fatigue, somatic illnesses, irritability, and difficulty in maintaining control over the situation, in taking decisions, and in predicting the consequences of their actions. higher levels of stress have been reported related to the fears of contracting covid- and of infecting family members. in line with other studies, we found that the covid- emergency led health workers, in particular, to perceive specific stress factors that affected the organizational area, with consequences in terms of tension in teamwork and a sense of ineffectiveness since they had to intervene without sufficient tools and resources. they also experienced deep emotional reactions of anger, powerlessness, and frustration with inevitable cognitive stress, in terms of increased arousal levels. many of the healthcare workers also developed physical stress, due not only to the lack of sleep but also to the possible forms of somatization of the psychoemotional tension they perceived (sasangohar et al., ; walton et al., ) . the differences recorded between the two groups in stress levels may be explained by taking into account, for example, the fact that the emergency group perceived their intervention with a greater sense of continuity in their usual procedures compared with the health group. the former performed their usual activities on the organizational, cognitive, and procedural levels, although with greater levels of safety and self-protection and a greater frequency of interventions. conversely, the health group had to reorganize aspects such as departments, teams, and shifts to cope with the emergency, which thus involved making radical changes. in addition, the health group helplessly witnessed a large number of deaths of their patients and had to make decisions in conflict with their moral sense and in situations of insecurity and unpredictability regarding the consequences of their actions walton et al., ) . however, in terms of physical stress, there was no predictive effect of the group, which indicates that the health and emergency groups were both exposed to very similar physical stressors. it is important to consider the significant impact of the gender variable. according to other studies, females developed a greater reaction of physical and emotional stress and the sense of decision-making ineffectiveness than did males (lai et al., ; zhu et al., ) . in fact, females apparently tend to perceive events as more negative and uncontrollable, and thus suffer higher levels of stress. further, females tend to resort to coping strategies focused on emotions, which tend to be less effective in emergency situations (matud, ; matud et al., ; matud and garcia, ) . however, in the present study, these gender differences did not have an impact in terms of psychopathological or specific maladaptive consequences, and coping strategies. in fact, females and males perceived a similar sense of efficacy/ineffectiveness in dealing with stressful situations and had similar scores on the secondary trauma scale. the results shown in table also indicate that predictive impact is also assumed by the lack of adequate instructions and knowledge about the emergency and the lack of necessary ppe. in particular, for the health group, the lack of necessary instructions on how to conduct quick interventions affected almost all stressors, leading to tensions or conflicts within the team, difficulty in making decisions, irritability, anger, and frustration. above all, the lack of ppe affected the sense of making the right decisions, the emotional sphere and, most importantly, the fear of contracting the virus or of transmitting it to their families. these results converge with those of other studies that have highlighted that the lack of adequate and specific information and of equipment for healthcare staff in dealing with covid- affected their self-efficacy and the factors protecting them from stress, thus increasing their fear of contracting an infectious disease and causing them greater emotional, decisional, and physical stress. conversely, the professionals who were provided with the necessary knowledge and equipment were more resilient during the emergency response (du et al., ; huang j. z. et al., ; ornell et al., ; walton et al., ) . the lack of specific equipment and instruments in emergency situations along with the risk of infection increases the feeling of poor control, leading to cognitive and emotional stress and a sense of ineffectiveness (placentino and scarcella, ; walton et al., ) . higher levels of stress were found in the health group than in the emergency group because of the absence of ppe, the risk of infection from the virus, and the lack of necessary instructions or prompt information . the incidence of these variables is contained and limited by the use of coping strategies. the coping strategy that assumes a predictive effect, reducing stress levels, is to block those negative or unpleasant emotions and thoughts associated with the risk of developing secondary trauma. in fact, the use of the stop unpleasant emotions and thoughts strategy reduces the arousal and intrusion levels of the secondary trauma. the effectiveness of this strategy in reducing the arousal levels appeared to be greater in the health group. as fraccaroli and balducci ( ) suggested, in situations of high emergency stress, healthcare workers and emergency workers may have a deficit in the cognitive process of emotions, thus failing to identify their emotional reactions, which tends to be associated with maladaptive behaviors. the lack of a complete recognition of one's unpleasant emotions, which tends to be denied and dismissed as a coping strategy, would explain the greater predictive impact of cognitive stress and physical stress on post-traumatic arousal compared with emotional stress. further, the results of this study highlight that the stop unpleasant emotions and thoughts strategy has an inhibitory and therefore effective and highly significant impact on the stress levels and the components of secondary trauma, unlike the problem-focused and social support strategies. the literature points out that the avoidant matrix coping strategies tend to present themselves when healthcare and emergency workers experience a condition of fatigue and exhaustion, and this would explain the presence of the greater acute stress responses in healthcare workers (maunder et al., ; young et al., ) . the results of this study show that the problem-focused coping strategy (the strategy most frequently used in the health group in line with the finding of huang l. et al., ) in this emergency situation did not appear to demonstrate protective efficacy. this is likely to be because the workers were dealing with an emergency that was not yet fully understood and the therapeutic and treatment procedures were not fully known. moreover, the supply of ppe was scarce, especially in the first few weeks of the covid- emergency in italy, in all hospitals (e.g., a lack of respirators and insufficient number of resuscitation beds), which meant that the level of protective efficacy of this strategy may have been lower than the stress levels. in other words, emergency workers, although task-oriented, were faced with a problem that was not fully understood, and in the absence of ppe, perceived poor self-efficacy in terms of trust and belief in their ability to organize and make effective decisions. the strategy that ensured optimal levels of self-efficacy was the one that allowed negative thoughts and emotions associated with the epidemic to be removed from consciousness, which was also found to have a protective function against the risk of developing traumatic symptoms. the government lockdown and the consequent restriction of visits outside the working environment limited the use of coping strategies involving social support, family, and friends, implying a greater use of emotional and cognitive avoidance methods to deal with anguished thoughts, intrusive memories, and the constant vision of corpses or the seriously ill. in this regard, the health group appears to have developed a greater secondary trauma arousal than the emergency group. by contrast, the latter appears to have developed more aspects of intrusiveness related to secondary or vicarious trauma than the health group (see table ). since they were interviewed during the covid- emergency, the healthcare and emergency workers who participated in the present study do not appear to have developed a complete secondary trauma. this may explain the prediction of the stress factors on arousal and not on intrusion. in other words, these individuals were interviewed while the emergency was still in the acute phase and before a structuring of answers in a psychopathological sense could be performed. therefore, performing a follow-up study would be interesting. ptsd can take several months to fully emerge, and its stabilization can depend on the individual's internal as well as external factors. because they blocked negative emotions and unpleasant memories, the healthcare and emergency workers' arousal appears to be mainly due to, at least in the full phase during the epidemiological emergency, the factors of a cognitive matrix, linked with the difficulty of focusing on and identifying the most appropriate intervention strategies, leading them to experience regret, disappointment, and both physical and relational tension. the health workers apparently blocked the emotional aspects related to pain, impotence, and guilt, which allowed them to continue their work. in an emergency phase that is still active, and a few weeks after the start of the pandemic, it is possible to detect high arousal and a lower level of intrusiveness of stressful or traumatic events. this condition may be more likely if the blocking of negative emotions and intrusive thoughts linked to one's personal experience intervenes as a coping strategy. low perceptions of self-efficacy regarding coping has been found to be a predictor of ptsd in other studies (benight and harper, ; bosmans et al., ) . in emergency situations, high stress can cause emergency workers to experience impotence, breathlessness, cognitive difficulties, and difficulties in decision-making and managing emotional reactions along with a prevalence of feelings of anger, as recorded in this study. if the lack of adequate knowledge and of ppe are added to these factors, even professional experts may perceive a loss of self-efficacy in coping and, simultaneously, experience an inability to orient their skills more effectively, thus developing maladaptive responses. this study has several limitations. the first is the limited sample size. the second is that our study involved participants in the very midst of the covid- emergency, which means that the level of stress in healthcare workers may have been more severe and acute. moreover, the long-term psychological implications for the healthcare and emergency population should be investigated for the presence of a full secondary trauma. therefore, a large-sized longitudinal study is called for to further explore the pathogenesis of vicarious traumatization. the third is that participants were not selected based on whether they had existing psychological problems. in proposing the hypothesis of this study, we anticipated that we would be able to discover the relationships between coping strategies, emergency-related stress, and secondary trauma in healthcare and emergency workers and commenced our investigation by assuming that the impact of stress can provoke psychological consequences in emergency situations. in future work, this assumption could be tested to verify whether an emergency situation has a different impact on workers who have already experienced psychological problems. the raw data supporting the conclusions of this article will be made available by the authors, without undue reservation, to any qualified researcher. the studies involving human participants were reviewed and approved by comitato etico per la sperimentazione umana -cesu of the university of urbino. the patients/participants provided their written informed consent to participate in this study. mv, tm, vg, and dp: conceptualization, writing -original draft preparation, and writing -review and editing. mv, tm, and vg: methodology and investigation. mv and tm: 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impact of severe acute respiratory syndrome outbreak on healthcare workers in emergency departments and how they cope the effects of social support on sleep quality of medical staff treating patients with coronavirus disease (covid- ) in january and february in china stressors and coping strategies of u.k. firefighters during on-duty incidents covid- in wuhan: immediate psychological impact on health workers key: cord- -bvnky yr authors: alemany-arrebola, inmaculada; rojas-ruiz, gloria; granda-vera, juan; mingorance-estrada, Ángel custodio title: influence of covid- on the perception of academic self-efficacy, state anxiety, and trait anxiety in college students date: - - journal: front psychol doi: . /fpsyg. . sha: doc_id: cord_uid: bvnky yr the worldwide pandemic situation caused by coronavirus disease (covid- ) has led to a state of confinement of the population, which has caused, following consulted research, an increase in stress. faced with this situation, the spanish university not only had to adapt to the changes derived from the causes of the pandemic but also had to face a new methodological model—e-learning teaching—for which not all teachers and students were prepared. this could cause an increase in stress due to the uncertainty caused by this time of change. this research analyzes the relationship between perceived self-efficacy in the confinement period and the level of trait anxiety (ta) and state anxiety (sa) during covid- . four hundred twenty-seven students from the university of granada (spain) participated in this study. the adaptation of two scales that measure perceived academic self-efficacy and anxiety (ta and sa) has been applied. the results indicated that there was an inversely proportional relationship between anxiety and self-efficacy; men showed the highest perception of self-efficacy, while women had higher scores in ta and sa; the latter was accentuated in cases when a relative died. to conclude, students who show a higher level of anxiety (ta and sa) express more negative emotions and also perceive themselves with less academic self-efficacy. therefore, a stressful situation (pandemic and confinement) together with a critical event (illness and death of a relative/friend due to covid- ) increases anxiety levels and influences the perception of academic self-efficacy. march in spain, the first period of the state of alarm caused by coronavirus disease was declared. this led to the confinement of the population. among the containment measures adopted in the university field was the suspension of face-toface educational activity. as a result, a more online-focused delivery of education was considered. this change affected more than . % of higher education institutions in european countries, argentina, and russia (marinoni et al., ) . garcía-peñalvo ( ) indicated that, although the digitization of the spanish university began a decade ago, we have focused on face-to-face teaching. however, in this time of isolation, it is necessary to integrate technology into classrooms (mingorance et al., ) . but any change generated many uncertainties in the university context. thus, not attending faceto-face lessons made the american students worried, nervous, and anxious; therefore, % of them would like to go back to face-to-face interactions (kelly, ) . confinement, fear of the unknown, and all these changes caused by the health situation of covid- have increased negative emotions in the peruvian population, which might harm mental health (huarcaya-victoria, ) . according to ozamiz et al. ( ) , in their research within the spanish population, at the moment, it is difficult to know the psychological and emotional consequences of this situation, but it is evident that they can lead to anxiety disorders, depression, stress, and increased consumption of harmful substances (asmundson and taylor, ; ozamiz et al., ; shigemura et al., ; torales et al., ; valiente et al., ; wang c. et al., ) . other investigations delved into the effects of infectious diseases, such as the research carried out by digiovanni et al. ( ) about the severe acute respiratory syndrome (sars) virus in toronto, li et al. ( ) about the h n virus or influenza a in chinese university students, taylor et al. ( ) about equine influenza in the australian population, and tucci et al. ( ) about the ebola virus in occidental africa and the zika virus in brazil and puerto rico. they concluded that, during this pandemic situation, the risk of psychological problems increased in the population. due to the nature of the virus and the fact that is very contagious, among other reasons, the general chinese population experienced these situations with an increase in anxiety, depression, and other stress reactions , incrementing psychological anguish if there was a loss of a relative (mohammed et al., ; ho et al., ) , results obtained in chinese and nigerian populations. the university environment is not exempt from all these factors. focusing on the science, technology, engineering and mathematics (stem) student body in the united states, these new circumstances originating from covid- was joined to the many demanding aspects of this educational stage, such as academic success (hall and sverdlik, ) . azad et al. ( ) and the american college health association ( ) reported that, faced with the pandemic situation, turkish and american university students, respectively, had a high risk of suffering anxiety, depression, and panic attacks; these were the most common disorders. in addition, having someone close diagnosed with covid- increased the risk of higher anxiety levels in chinese population . furthermore, the university context is potentially stressful, and the situation generated by covid- could have a negative impact on students. although there is little research that analyzes the impact of the pandemic on chinese students and its influence on academic expectations, some studies concluded that . % of medicine students showed mild anxiety, . % moderate anxiety, and . % severe levels of anxiety. having relatives or acquaintances infected with covid- was a risk factor . in the survey to college students conducted by the american college health association ( ), data indicated that % of college students reported feeling very depressed compared to % who indicated that they were overwhelmed by anxiety. but in addition, the situation of isolation increased psychological pressure (xiao, ) ; the symptoms persisted even after the confinement (pfefferbaum and north, ) . regarding the psychological impact, li et al. ( ) reported that . % of the chinese respondents suffered anxiety symptoms from moderate to severe and . % responded that they had stress levels (from moderate to severe); chinese and canadian women suffered from higher levels of stress, anxiety, and depression taylor et al., ) . in the same line, vera-villaroel ( ) indicated that the stress generated by the global pandemic was related to anxiety, and women presented higher levels than men (gutiérrez-garcía and landeros-velázquez, ). during the covid- crisis, % of the general chinese population suffered symptoms of depression (kang et al., ) , increasing anxiety, depression, and outrage (dubey et al., ) . furthermore, anxiety is indirectly related to academic performance and directly related to the perception of academic self-efficacy (gutiérrez-garcía and landeros-velázquez, ). therefore, % of the spanish university students with a high level of stress had low levels of self-efficacy (navarro-mateu et al., ) . in this line, anxiety was negatively related to academic selfefficacy (gutiérrez-garcía and landeros-velázquez, ) and positively to state anxiety (sa) in nigerian university students (onyeizugbo, ) . on the other hand, the perceived academic self-efficacy in the academic environment and the performance of university students are factors that are positively related. this is stated by colom ( ) and ahmadi ( ) who found that iranian students' self-perceptions about their own ability and competence to perform a certain task is significantly associated with academic performance. a subsequent study confirmed the influence that academic self-efficacy and emotions have on the academic success of university students. thus, higher levels of positive emotionality were related to higher levels of success (de la fuente et al., ) . at the academic level, academic self-efficacy was related to performance and indirectly influenced academic aspirations (ahmadi, ) . in addition, the stress generated by the academic context (overload of tasks, pressure due to work, frequent evaluations, and the pandemic situation, among others) could lower expectations of self-efficacy. thus, % of students with high levels of stress showed low levels of self-efficacy, concluding that there is an inversely proportional relationship (navarro-mateu et al., ) . these findings highlight the importance of these variables for academic performance since those who had great academic self-efficacy also presented more study and cognitive tools that helped organize themselves better (delgado et al., ) . some research indicated that there were no differences between women and men in academic self-efficacy (rivera-heredia et al., ; hernández-jácquer, ) ; however, narváez-olmedo et al. ( ) concluded that it is men who showed the highest perception of academic self-efficacy. academic self-efficacy is a variable to be considered in the university context, as it indicates students' future goals according to their abilities, such as achievement motivation, access to scholarships, academic performance, or permanence in higher education (borzone, ) . but, in this time of confinement, when we have quickly moved from face-to-face teaching to remote emergency teaching (abreu, ) , it was important to analyze whether this improvised change could affect the expectations of perceived self-efficacy of university students to achieve academic success, since students were not prepared. there is little research on the impact of the pandemic and its influence on levels of anxiety in university students, and even less related to expectations of academic self-efficacy. for this reason, the objective of this research is to analyze the relationship between perceived self-efficacy and trait anxiety (ta) and sa, during the first moments of covid- , since it was an exceptional situation to learn how university students responded to critical situations (related to sa). in addition, the situation of uncertainty and ignorance about the disease was high, generating a great concern in the spanish population and, more specifically, in university students, given the challenges they faced with the closure of the university. there were two hypotheses: ( ) there is an inversely proportional relationship between academic self-perception and ta and sa; and ( ) the students are more sensitive to this situation if they manifest higher ta and also if they or their relatives and friends have suffered from covid- . the design used in this research was a retrospective or ex post facto study (sharma, ) with a cross-sectional design to collect data. the research was carried out in the melilla campus at the university of granada (ugr) (spain). for the selection of the participating sample, a non-probability sampling was used, using the virtual snowball technique (baltar and gorjup, ) . the selected sample consisted of university students with an average age of . years (sd = . ), ranging years, minimum age is and maximum age is . eighty-four of the participants were men ( . %), and were women ( . %). this percentage is a reflection of the feminization of the degrees in nursing and education sciences. a total of . % (n = ) of participants were enrolled in the faculty of education and sport sciences, . % (n = ) were enrolled in the faculty of nursing, . % (n = ) belonged to the faculty of social sciences, and . % (n = ) studied master's degrees. in addition, . % (n = ) of the students had suffered/were suffering from covid- compared to . % (n = ) who answered no. in addition, . % (n = ) students affirmed that a friend or a relative had suffered from covid- , and of these, . % (n = ) died of it. the questionnaires were administered online in march. this was the time of greatest uncertainty and when the state of alarm was declared due to covid- . for this purpose, the delegates of the courses from the faculties of the university of granada at the melilla campus (spain) were contacted via e-mail. the questionnaires were uploaded to the google form application (free access) with instructions on how to complete it. furthermore, students were asked to explicitly consent to participate in this experience willingly and anonymously, following the indications given by the committee on publication ethics (cope). the questionnaire, https://forms.gle/yp vgwmas e b we , consisted of three sections: . the sociodemographic data section collected information on age, ongoing studies, if he/she suffered/had suffered from covid- , and if any relative or friend suffered/had suffered from covid- and if they had died of this cause. . the "adaptation of the specific perceived self-efficacy scale in confinement situations by covid- (asps-covid- )" scale was based on the "academic situations specific perceived self-efficacy scale" by garcía-fernández et al. ( ) , consisting of items, with a -point likerttype response format that ranged from (never) to (always). the minimum score was and the maximum was , with a reliability of . . the objective was to measure the expectations of self-efficacy in specific situations in the educational context in university students at the time of isolation due to the pandemic. therefore, the text clarification "during the confinement due to covid- " was added to the items of the original scale, keeping the original answer format, so the higher the score, the greater the perceived academic self-efficacy. . the "adaptation of the trait anxiety/state anxiety scale in confinement situations by covid- (ata/sa-covid- )" scale was based on the spanish adaptation of the "state-trait anxiety inventory (stai)" by spielberger et al. ( ) . the scale was composed of items for the trait anxiety subscale (ta) and for the state anxiety subscale (sa). the response formats ranged from (hardly ever) to (almost always). the internal consistency indices were . and . , respectively. the ata/sa-covid- was made up of items, for ta and for sa. the answer had a -point likert-scale format that ranged from (not at all) to (very often). the minimum score was for ta and for sa. items were added and repeated in both scales to measure the influence of the pandemic on the emotional and motivational factors that might affect academic goals, such as anger, outrage, boredom, distraction, discouragement, and despondency. positive items scored inversely (ta: , , , , and ; sa: , , , , , , , , , and ) , so that the higher the score, the higher the anxiety level. statistical software spss . was used for conducting descriptive analysis of the data, anova test, reliability statistics, and multivariate analysis. statistical significance was set at p < . . effect size was reported with cohen's. table showed the reliability and descriptive analyses of the total score of the different scales used. as it can be observed, the reliability was very high in the three instruments used. in relation to the ta subscale and in the sa subscale of the ata/sa-covid- , items , , , , and and items , , , and were removed, respectively, as the corrected item-total correlation was under . . the two subscales were composed of items, with a very high inner consistency index, which was measured with the cronbach's alpha. in relation to the first hypothesis, the relationship between asps-covid and the ata/sa-covid- subscales was analyzed. the pearson's correlation coefficients indicated moderate and significant (p < . ) relationships between the scales ( table ) , thus increasing anxiety-reduced perceived academic self-efficacy. furthermore, in relation to the asps-covid- scale, students were classified into three groups: low perception of academic self-efficacy (means below the th percentile, x ≤ ), moderate level of self-efficacy (means between the st percentile to the th percentile,x ≥ . tox ≤ . ), and high level of academic self-efficacy (x ≥ . ). the data showed that the students with the lowest levels of self-efficacy were ( . %), of which ( . %) presented very high levels of both ta and sa; women and three men presented the highest level of sa. in addition, one student had suffered from the disease, had a relative who had suffered from it, of whom five had died from covid- . the inferential analysis based on the sex variable showed significant differences. women showed lower levels of selfefficacy than men (x men = . ;x women = . ; t = , ; p < . ; dcohen = . ; r sizeeffect = . ). the size effect was large. regarding whether any relative had died, data indicated that the students who had lost a relative scored lower in the perception of academic self-efficacy (x yes deceased = . ; x nodeceased = . ; t = − . ; p < . ; d cohen = − . ; r sizeeffect = . ). the size effect was large. multivariate inferential analyses, using sa and ta as covariates and their influence on perceived self-efficacy, showed significant differences (f , = . , p < . ; ηp parcial = . ), which indicated that the higher the levels of ta and sa, the worse the perception of self-efficacy in academic performance. regarding the second hypothesis, firstly, in the ta and sa subscales, students were classified into three groups in such a way that the first group, with a low level of anxiety, was the one that obtained average scores below the th percentile. the group with moderate anxiety level ranged from the st to the th percentile. last, the third group, with high anxiety levels, obtained means over the th percentile. these were the criteria for the three scales. in table , students are presented according to their level of ta and sa. in addition, the students who presented high scores on the ta scale were selected (pc x ≥ ). they were a total of ( . % of the total sample). in this group, nine were men ( . %) and were women ( . %), only two university students (one man and one woman) had covid ( . %). furthermore, students had a relative or a friend who had suffered from the disease ( . %), of whom died ( . %). of the university students, ( . %) also showed high levels of sa (pc x ≥ ) and ( . %) moderate levels. sixty-seven were women ( . %) and nine were men ( . %); two of them had suffered from the disease. in relation to whether a relative/friend suffered/had suffered from covid- , answered yes and reported they died of the virus. in the analyses of the students (n = ), ta and sa showed that the sa was high in this pandemic time during the confinement, the analyzed data showed significant differences, increasing the sa in this pandemic time (ta = . ; sa = . ; t = − . ; p < . ; d cohen = − . ; r sizeeffect = − . ); the size effect was medium. although there were no significant differences, the sa was higher in the students who had a sick frontiers in psychology | www.frontiersin.org relative who died of covid- (ta = . ; sa = . ; t = − . ; p > . ). the results of the students with high levels of sa (n = ) indicated that a % felt worried and nervous, . % felt distressed, and % felt helpless in the situation. among the characteristics presented by the students with high levels of ta (n = ) and in relation to their teachinglearning process, the data indicated that they were unfocused ( . %), unmotivated ( . %), and discouraged ( %) in the situation they were experiencing ( %). in relation to how they experienced the confinement, % felt angry, % outraged, and % felt unhappy about the pandemic. the objective of this research is to analyze the relationship between perceived self-efficacy and ta and sa during the first moments of covid- . with this objective, the "academic situations specific perceived self-efficacy scale" and "state-trait anxiety inventory (stai)" questionnaires were adapted. the reliability found in the asps-covid- was similar to that obtained by garcía-fernández et al. ( ) . in the same way, the ata/sa-covid- subscales obtained high internal consistency indices similar to fonseca-pedrero et al. ( ) . regarding the first hypothesis, the data showed that there was an inversely proportional relationship between the perception of academic self-efficacy and anxiety, both ta and sa, results in line with the research of gutiérrez-garcía and landeros-velázquez ( ), navarro-mateu et al. ( ), and colom ( ) . one explanation might be that anxiety is related to both cognitive and motivational and emotional processes. in this way, negative emotions such as tension about how students experienced the pandemic and a high level of concern could decrease the levels of achievement and self-efficacy (de la fuente et al., ) . but also, university students with high levels of anxiety showed high scores in demotivation, discouragement, and boredom, results in line with the research of vancouver ( ) . these motivational characteristics could negatively affect the expectations of self-efficacy that, together with the demands of the university context, could interfere with their academic aspirations (ahmadi, ) . in addition, the psychological pressure of the confinement (xiao, ) was joined to the academic demands, workload, and online evaluations that could negatively affect the perception of academic self-efficacy (navarro-mateu et al., ) , generating higher levels of anxiety in university students (huarcaya-victoria, ). in addition, not attending classes due to the closure of universities was a factor of concern and anxiety (kelly, ), since the work methodology changed (abreu, ) when the students were not prepared. as for the second hypothesis, there was a directly proportional relationship between ta and sa. the students with the highest ta also increased their level of sa during covid- . this might be due to the fact that the pandemic generated a stressful situation causing highly negative emotions, mainly in students who had someone close diagnosed with covid- and those who reported the death of a relative or a friend (mohammed et al., ; ho et al., ) . thus, the data showed that students with high levels of sa indicated feeling distressed and helpless in this situation, as reported by the american college health association ( ). regarding the analyses of the sex variable, men showed a better perception of self-efficacy, data consistent with those found by narváez-olmedo et al. ( ) . on the other hand, women presented higher levels of anxiety, as reflected by gutiérrez-garcía and landeros-velázquez ( ), cao et al. ( ) , and taylor et al. ( ) . their sa increased in stressful situations, such as the death of a relative (ho et al., ) , which directly affected the perception of self-efficacy; this result coincided with gutiérrez-garcía and landeros-velázquez ( ) and de la fuente et al. ( ) who came to the conclusion of the relationship between self-efficacy and emotionality. gender differences in academic self-efficacy could be associated with socialization processes and the perpetuation of gender stereotypes in young university students, learned within a sociocultural context. some limitations must be acknowledged: first, the type of sampling, but given the situation of confinement, it was the only possibility to obtain data. these data were collected at the beginning of the pandemic. the cross-sectional methodology of this study was necessary and mandatory, but it has been compared with other investigations. for future studies, stratified non-probability sampling will be used and the number of participants will be increased. secondly, sa and ta and their relationship with the perception of academic self-efficacy have been analyzed, but it is still necessary to include other complementary instruments, such as effects of changes in learning through academic performance (grades), resilience, selfconcept, and cognitive-motivational factors that might affect the variables studied. it will be necessary to continue working on the adaptation of the instrument used as well. third, we did not analyze the effect of the methodological change and how it affects ta and sa and the perception of academic selfefficacy in the e-learning model, so it should be studied in subsequent investigations. to conclude, students who show a higher level of anxiety (ta and sa) express more negative emotions and also perceive themselves with less academic self-efficacy. therefore, a stressful situation (pandemic and confinement) together with a critical event (illness and death of a relative/friend due to covid- ) increases anxiety levels and influences the perception of academic self-efficacy. thus, students in exceptional situations increase their levels of anxiety and reduce their perception of academic self-efficacy that can put their permanence in higher education at risk. therefore, it is necessary to follow up on university students after confinement in order to explore the causes of anxiety and the influence that covid- had on their academic performance and on their permanence in university. the raw data supporting the conclusions of this article will be made available by the authors, without undue reservation. ethical review and approval was not required for the study on human participants in accordance with the local legislation and institutional requirements. written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements. ia-a contributed to the research conception and design, data analysis and interpretation, statistical analysis, and critical revision of the manuscript for important intellectual content. gr-r contributed to obtaining information, reading the manuscript, and critical revision of the manuscript for important intellectual content. jg-v contributed to obtaining information, reading the manuscript, and critical revision of the manuscript for important intellectual content. 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wang, wangshuai; xie, peihong; chao, yifan; zhu, jingru title: perceived severity of covid- and post-pandemic consumption willingness: the roles of boredom and sensation-seeking date: - - journal: front psychol doi: . /fpsyg. . sha: doc_id: cord_uid: iqa pxda the covid- pandemic restricts people’s activities and makes consumer businesses suffered. this study explored the relationship between the perceived severity of covid- and the post-pandemic consumption willingness. study surveyed chinese people in march , found the perceived severity of covid- during the pandemic significantly increased the willingness to consume post-pandemic, and boredom stemming from limited activities and sensation-seeking expressions mediated this effect. study conducted an experiment with participants in august , found a high level of perceived severity of covid- and the experience of life tedium during the pandemic significantly increased individuals’ impulsive buying tendencies after the pandemic. the results suggested the level of perceived severity of covid- may influence people’s post-pandemic consumption patterns. no one could have predicted the second decade of the st century would begin with a global super pandemic. in just a few months, the novel coronavirus (covid- ) swallowed more than , lives and infected more than , people in china. the chinese government established unprecedented measures and suspended almost all social activities throughout the country to combat the virus. although these measures have effectively slowed down the spread of the virus, society has paid a considerable price, especially consumer enterprises. the iresearch consulting group ( ) report stated that businesses such as catering, tourism, and transportation were struck during the pandemic due to the order to enforce social distancing, with the net consumer population falling by more than %. a column analysis of beijing business daily ( ) also reported the sharp drop in customers from the pandemic led to small and medium-sized retailing and catering enterprises to lose nearly % of their income, leaving many businesses in decay. the pandemic hit china's consumer economy hard in the first quarter of , creating a secondary disaster from with the pandemic gradually controlled in china, many chinese businesses have their hopes on a consumption rebound after the pandemic. the ministry of commerce of china reported a rebound in consumption in april (people's news, ) . many business analysts also agree that a spending spree may occur after the pandemic (beijing business daily, ; iresearch consulting group, ) . however, what is the psychological reasons for the rise in consumer willingness after the pandemic? existing research lacks an explanation. this study explores the psychological mechanisms between the perceived severity of covid- and the post-pandemic consumption willingness. we found that during the pandemic, the perceived severity of covid- leads to an increase in boredom state and sensation-seeking expression, which makes the purchasing activity after the pandemic becomes more attractive. we hope this study could provide a reference for similar follow-up researches and consumer enterprises' postpandemic business planning. the covid- pandemic quickly made headlines in global media after dr. zhong nanshan indicated on the china central television (cctv) news channel that "it can affirm that this novel coronavirus has human-to-human transmission" on january , , and the public soon began to realize the seriousness of the coronavirus. wuhan city quickly locked down on january after dr. zhong's interview. a week later, all provinces and regions across china launched a first-level public health emergency response (xinhua news agency, ). local governments quickly initiated a series of rigorous control methods, such as comprehensive screening and quarantining suspected cases, close monitoring and tracking their contacts, and actively promoting scientific knowledge and expert consensus on coronavirus prevention. however, at the same time, many rumors about the pandemic spread rapidly through online social media, generating a great deal of panic . 's survey of , chinese people in february showed the perceived severity of covid- was as high as . out of (sd = . ), which demonstrated that these pandemic-related incidents put people on high alert and led to a dramatic increase in the perceived severity of covid- . the health belief model proposes that perceived severity refers to an individual's subjective perception of a disease's serious state, which is influenced by a range of factors related to the current existing reality and anticipation of future events (green and murphy, ) . weinstein ( ) demonstrated that a high perceived severity of disease causes proactive health-protection behaviors. "washing hands frequently, wearing masks, not gathering and going out" are the covid- control requirements strongly advocated by the chinese government (xinhua news agency, ). chinese people actively followed the above pandemic-control instructions when the perceived severity of covid- increased, obeying social distancing rules and locking themselves at home. the survey of showed that chinese people's social participation levels during the pandemic were as low as . out of (sd = . ) since february . although people's proactive health-protection behaviors do effectively slowed the spread of coronavirus, the limited activities have also caused a sudden increase in psychological pressure, resulting in different degrees of mental stress xiang et al., ; zhang et al., ) . this study paid particular attention to a psychological consequence of limited activities for a long time: boredom. boredom is an aversive experience of wanting but not being able to engage in satisfying activities, which occurs when people are unable to focus on desired tasks (eastwood et al., ) . boredom can be seen as a situational state that lacks novel stimuli over a period of time, and low arousal is the most dominant feature of boredom (van hooft and van hooff, ) . the arousal theory states that individuals need a certain amount of external stimulation to maintain the desired activities required by the body; otherwise, they may feel uncomfortable (reisenzein, ). individuals prefer a moderate level of stimulus; being in a high or low degree of arousal for a long time causes discomfort. a higher level of arousal makes people feel excited, but it also makes them feel nervous, anxious, and irritable. a lower level of arousal makes people feel relaxed; however, it may also cause weariness, depression, and most importantly, boredom (picard et al., ) . a high level of perceived severity of covid- makes most chinese people exhibit active health-protection behaviors and stay at home, which significantly limits the social activities people can enjoy. simple and repetitive external stimuli reduce individuals' arousal levels and create boredom (van tilburg and igou, ) . long-term activity limitations made people experienced repetitive and monotonous external stimuli; consequently, people's arousal levels during the pandemic were far below the average (chao et al., ) . although the optimal amount of external stimulation preferred by each individual varies, the long social distancing period has generally caused high levels of boredom in most of the population . there were always those who ventured onto the streets and even gathered to play mahjong during the pandemic, despite government calls to reduce going out and gathering (npr, ). the above cases demonstrate that the pandemic restrictions significantly increased people's boredom. long-term boredom states can cause individuals to actively seek out more and stronger complex external stimuli (reisenzein, ) . we suggest that the boredom stemming from limited activities during the pandemic leads to an increase in sensationseeking expression. sensation-seeking refers to people's desire for a novel, exciting, and complicated feeling or experience (zuckerman, ) . most researchers conceptualize sensationseeking as a stable trait (zuckerman and aluja, ) . however, the degree of expression of this trait may be affected by a long period of boredom due to limited activities. trait activation theory highlights that situational cues may affect how an individual expresses his or her traits (tett and burnett, ) . lynne-landsman et al. ( ) found that the social environment influences an individual's sensation-seeking expression. lydon-staley et al. ( ) also showed that individuals express higher than usual sensation-seeking behaviors during the days they consume alcohol, demonstrating that sensation-seeking expression has a within-person variability. therefore, although the trait of sensation-seeking is relatively stable, one's expression of sensation-seeking may change depending on the situation. as stated above, elevated perceived severity of covid- led to active health-protective behaviors that made people afraid to leave their homes. consequently, the monotony of repetitive life from activity limitations reduced people's arousal levels and increased people's feelings of boredom (chao et al., ) , which resulted in increased sensation-seeking expressions (dahlen et al., ; jiang et al., ; jee et al., ) . those processes let people need more and stronger external stimuli to achieve the desired state of arousal; otherwise, people may feel unpleasant (zhang et al., ) . the above mental changes provide a psychological basis for the increased post-pandemic consumption willingness. people's increased boredom from limited activities and sensationseeking expressions during the pandemic gave us good reason to speculate that people's willingness to consume and impulsive buying tendencies may climb significantly after the pandemic is effectively controlled. by satisfying an individual's needs through payment, consumption is an effective means to elevate arousal levels (batra and ghoshal, ; koles et al., ) . yan et al. ( ) demonstrated that individuals' willingness to consume would greatly increase if they try to seek external stimuli to enhance their arousal. sundström et al. ( ) found that boredom is one of the primary motivators driving people's buying behavior. consumers are easily attracted by stimuli, such as advertisements and discounts, when they are bored. deng and gao ( ) also showed that sensation-seeking makes individuals actively pursue complex stimuli, so a high level of sensationseeking expression may result in a significant willingness to consume. as stated above, during the pandemic, a high level of perceived severity of covid- made people reluctant to engage with the outside world . the long period of physical and psychological limitations severely deprived people of external stimuli, resulting in increased boredom and sensationseeking expressions (chao et al., ; droit-volet et al., ; kim, ) . we suggest that after the covid- pandemic is effectively controlled, people are highly likely to engage in a variety of consumption activities precisely because shopping is a complex stimulus that can relieve consumers' boredom state (sundström et al., ) and satisfy their sensation-seeking needs (punj, ; deng and gao, ) . we hypothesize the following based on the above reasoning: h : the perceived severity of covid- during the pandemic will increase the post-pandemic consumption willingness. h : the above effect is mediated by boredom from limited activities and sensation-seeking expressions. boredom states and sensation-seeking expressions are usually associated with impulse buying because it is a strong psychological stimulus that brings great satisfaction (dahlen et al., ; iyer et al., ) . we speculate that since the perceived severity of covid- made an increase in boredom and sensation-seeking expression, it is very likely that the perceived severity of covid- will lead to an elevated impulsivity buying tendency after the pandemic is effectively controlled. the experience of life tedium during the pandemic will play a moderating role in this impact. during the quarantine, many people were restless because of the tedium of life, but many people also found new pleasures, such as cooking or learning a new musical instrument (droit-volet et al., ) . due to the experience of life tedium greatly improves one's boredom states and sensation-seeking expressions, we suggest that the impulse buying tendency after the pandemic may decrease if an individual's prolonged homestay was filled with new things. conversely, an individual's tendency to impulsively buying after the pandemic may significantly increase if he or she felt life was tedious during a long period of quarantine. we hypothesized the following based on the above reasoning: h : high levels of perceived severity of covid- and experience of life tedium during the pandemic significantly increased individuals' impulse buying tendency after the pandemic. we tested the three above hypotheses through two studies. a questionnaire modeling tested h and h , which provided an aggregate survey of the relationship between perceived severity of covid- and post-pandemic consumption willingness, as well as the mediators between them. a behavioral experiment tested h , which provided evidence of how the perceived severity of covid- and the experience of life tedium during the pandemic affected one's impulse buying tendency after the pandemic. study aims to use the questionnaire modeling method to test h and h (i.e., whether perceived severity of covid- increased ones' post-pandemic consumption willingness through the mediating roles of boredom from limited activities and sensation-seeking expressions). we conducted this study in march . at this time, the number of new covid- cases in china has been gradually decreasing, but the overall situation of the pandemic is still serious. we posted a set of questionnaires on a chinese web-based survey platform on march , . within days, people responded in full for a small cash reward. the participants ( females, mage = . , sd = . ) came from all regions in china. among them, were students ( . %), had formal jobs ( . %), had part-time jobs ( . %), were freelance ( . %), and were unemployed ( . %). we asked participants to respond to the questionnaires in the following order (see supplementary material for full items). referring to the "covid- pandemic perception questionnaire ( nd round), " published by the sun yat-sen university team ( ), items suitable for the topic of this study were selected after authors' discussion (e.g., "i often suspect that people around me may be infected by the coronavirus.") participants responded on a -point likert scale from (very much disagree) to (very much agree), with higher scores indicating a higher level of perceived severity of covid- . in this study, the items have a good unidimensional structural validity (goodness-of-fit of cfa: χ = . , df = , rmsea = . , srmr = . , cfi = . , tli = . ), with factor loading between . and . and the cronbach's α is . . we adopted the low arousal subscale of the chinese multidimensional state boredom scale (cmsbs), which was developed by liu et al. ( ) . the cmsbs contains five subscales: inattentiveness, perceived slowing of time, low arousal, high arousal, and a desire to engage in more exciting activities. of these, the low arousal state best suits this study because compared with the other four subscales, it best described a low mental arousal state. this subscale consists of items. the phrase "during the period of home staying" was added to each item, for example, "during the period of home staying, everything is repetitive and boring for me because of the restrictions on my activities." participants responded on a -point likert scale from (very much disagree) to (very much agree), with higher scores indicating a higher boredom state during the pandemic. in this study, the cronbach's α of this subscale is . . several instruments have been developed for different research purposes for assessing sensation-seeking. the -item sensation-seeking scale form v (sss-v) is the most widely used among these instruments (zuckerman and aluja, ) . however, large-scale surveys require a shorter measurement tool, and sensation-seeking expression closely relates to an individual's culture (wang et al., ; agrusa et al., ) . therefore, we adopted the chinese brief sensation-seeking scale in this study, which hoyle et al. ( ) derived from the sss-v and chen et al. ( ) culturally adapted. this scale consists of items and mainly measures the behavioral tendencies of sensationseeking individuals. the phrase "during the pandemic" was added before each item to evaluate participants' sensationseeking expressions during that period, for example, "during the pandemic, i always liked to do things that i had not done before." participants responded on a -point likert scale from (very much disagree) to (very much agree), with higher scores indicating a higher sensation-seeking tendency during the pandemic. the cronbach's α of this scale was . in this study. six items were developed to measure this variable based on the general psychometric procedure, i.e., when the pandemic is over, ". . .i want to go out and eat some delicious food", ". . .i want to have more shopping and buying", ". . .i will compensate for my pent-up spend desire and satisfy myself by buying more things", ". . .my consumption desire will increase significantly than before the pandemic", ". . .i want to buy something that i haven't bought before", and". . .i will spend more and have fun in time." participants responded on a -point likert scale from (very much disagree) to (very much agree), with higher scores indicating a higher post-pandemic consumption willingness. the items have a good unidimensional structural validity (goodnessof-fit of confirmatory factor analysis: χ = . , df = , rmsea = . , srmr = . , cfi = . , tli = . ) in this study, with factor loading between . and . and the cronbach's α is . . considering the pandemic affected many people's financial income, which is a significant consumption-related factor, this study also asks the question "has the pandemic affected your economic income?" participants answered on a -point likert scale from (no impact at all) to (the impact is huge). furthermore, considering that life satisfaction during the pandemic may also affect the post-pandemic consumption willingness, this study adopted a single-item scale developed by cheung and lucas ( ) (i.e., "in general, are you satisfied with your life situation during the pandemic?") participants responded on a -point likert scale from (very much disagree) to (very much agree). first, we examined the differences of post-pandemic consumption willingness between demographic variables. an independent t-test found the score of females on post-pandemic consumption willingness (m females = . , sd = . ) was slightly higher than that of males (m males = . , sd = . ), but the difference was not significant [t( ) = . , p = . , cohen's d = . ]. the correlation between age and post-pandemic consumption willingness also failed to reach a significant level (r = − . , p = . ). those results demonstrated that the post-pandemic consumption willingness is a general trend, with little change in demographics. next, table shows the pearson correlations between variables. a significant positive correlation can be found between the perceived severity of covid- and post-pandemic consumption willingness (r = . , p < . ). furthermore, there were also significant positive correlations between boredom from limited activities (r = . , p < . ) and sensation-seeking expressions (r = . , p < . ) regarding the post-pandemic consumption willingness. in addition, the impact of the pandemic on income significantly and positively correlated with the post-pandemic consumption willingness, but the effect size was at a low level (r = . , p < . ). life satisfaction during the pandemic did not significantly correlate with the post-pandemic consumption willingness (r = . , p = . ). the results suggested little relationship exists between the two control variables and the dependent variable. we used a structural equation model to further test h and h based on hayes' ( ) model . our model contained both observed and latent variables and was computed with bootstrapping through maximum-likelihood estimation. the model's goodness-of-fit was acceptable (χ = . , df = , rmsea = . , srmr = . , cfi = . , tli = . ). the results indicated the perceived severity of covid- had led to a significant increase in boredom from limited activities (β = . , p < . ), which then result in a significant rise in sensationseeking expressions (β = . , p < . ), and eventually made a significantly elevation in post-pandemic consumption willingness (β = . , p < . ). figure also shown that the effect of boredom from limited activities on post-pandemic consumption willingness was not significant (β = . , p = . ), as well as the indirect effect through boredom only (β = . , p = . ). therefore, the indirect effects of the perceived severity of covid- on post-pandemic consumption willingness were realized through sensation-seeking expressions only (β = . , p < . ), and boredom and sensation-seeking expressions in succession (β = . , p < . ). the total indirect effects (β = . , p < . ) account for almost half of the total effects (β = . , p < . ). study supports h and h . it shows a general trend that the perceived severity of covid- could lead to increased boredom from limited activities, then result in heightened sensation-seeking expressions. as a consequence, these changes led to a raised post-pandemic consumption willingness. the results of study indicate that in march , in which the pandemic in china was still severe, the perceived severity of covid- was closely related with a climbed post-pandemic consumption willingness. boredom and sensation-seeking expressions are often associated with impulsive consumption (dahlen et al., ; sundström et al., ) , so does the perceived severity of covid- makes people more likely to consume impulsively after the pandemic? we examined this speculation in study . study aims to replicate and extend the findings of study . we examined whether the perceived severity of covid- and the experience of life tedium during the pandemic elevated people's impulsive buying tendencies after the pandemic was effectively controlled by manipulating these two variables (i.e., test h ). we conducted a behavioral experiment in august . at this time, the pandemic has been brought under control in most parts of china, with only a few sporadic new cases. participants ( people, females, mage = . , sd = . ) from a chinese web-based survey platform were randomly assigned to a (perceived severity of covid- : severe vs. not severe) × (experience of life tedium: tedious vs. not tedious) between-subjects design from august - , . in the manipulation of the perceived severity of covid- , the severe group watched a -s news video that emphasizing the virus was still serious in china. the not-severe group watched a similar length video; however, that video stating the covid- pandemic was effectively controlled in china. both news videos were clipped from authoritative chinese media outlets (see supplementary material). in the manipulation of the experience of life tedium during the pandemic, the tedious group was asked to describe in detail "how your life was repetitive and tedious during the long period of home staying." the not-tedious group was asked "how your life was full of new things during the long period of home staying." next, all participants were required to respond to the following items from (very much disagree) to (very much agree). three items from xin ( ) were adopted to measure participants' perceived severity of covid- (e.g., "i feel that if i am not careful, my family or i am very likely to infected by the coronavirus, " "i feel that the current pandemic situation is very serious, " and "i feel that it is tough to control the pandemic effectively.") the cronbach's α of those three items is . . two items from study were used to measure participants' experience of life tedium during the pandemic (one from the boredom scale: "during the period of home staying, everything is repetitive and boring for me because of the restrictions on my activities" and one from the sensation-seeking scale: "during the period of home staying, i would do anything as long as it exciting and stimulating.") the cronbach's α of those two items is . . participants were first asked to read the following text: "now, except for a few regions, the pandemic in china has been effectively controlled. in your community, several large shopping malls are planning a large-scale shopping festival, and they will cater to all aspects of the consumer needs such as household figure | perceived severity of covid- results in an increased post-pandemic consumption willingness through the mediating roles of boredom from limited activities and sensation-seeking expressions (study ). numbers are the standardized path coefficient, ***p < . . goods, entertainment, leisure, sports, and many more." then, participants were required to respond to the following five items revised from sharma et al. ( ) : in this shopping festival, i ". . .will not think too much before buying what i like"; ". . .will buy things if i like it"; ". . .will tempted to choose what i like"; ". . .will not think too much about the consequences of choosing what i like"; and ". . .will chose what i like as quickly as possible, before i change my mind." the cronbach's α of those items is . . independent t-tests showed the manipulation of the perceived severity of covid- [m severe (not severe) = . ( . ), sd severe (not severe) = . ( . ), t( ) = . , p < . , cohen's d = . ] and the experience of life tedium during the pandemic [m tedious (not tedious) = . ( . ), sd tedious (not tedious) = . ( . ), t( ) = . , p < . , cohen's d = . ] were both effective. a × anova on impulsive buying tendencies after the pandemic revealed two significant main effects [perceived severity of covid- : f( , ) = . , p < . , η p = . ; experience of life tedium during the pandemic: f( , ) = . , p < . , η p = . ] and a significant interaction [f( , ) = . , p = . , η p = . ]. post hoc tests found that participants' post-pandemic impulsive buying tendencies was the highest in the condition of high perceived severity of covid- and high experience of life tedium during the pandemic (m severe and tedious = . , sd = . ), which was significantly higher than the condition of high perceived severity and low experience of life tedium the results of study support h . the perceived severity of covid- and the experience of life tedium during the pandemic jointly influenced people's impulsive buying tendencies after the pandemic. it indicates that in august , in which the pandemic in china was basically controlled, people are more likely to satisfy their stimulus-seeking needs through impulse consumption if they are at high levels of both variables. studies have shown that whether in china , the united kingdom (chronopoulos et al., ) , scandinavia countries (andersen et al., ) , or the united states (cox et al., ) , the covid- pandemic limited consumers' activity and led to a significant decline in spending. our findings suggest this phenomenon may change after the pandemic is adequately controlled. based on the survey results of people (study ) in march , we see that individuals' post-pandemic consumption willingness is relatively high ( . out of , sd = . ), which implies people's spending may bounce back after the pandemic. we suggest the psychological basis for this potential postpandemic consumption rebound is that individuals are motivated to seek external stimuli to relieve the boredom stemmed from limited activities and to satisfy their sensation-seeking needs. the arousal theory demonstrates that simple and repetitive stimuli reduce individuals' arousal levels. in the long run, people may actively seek out more significant and complicated external stimuli to restore their desired arousal level. during the pandemic, a high perceived level of severity of covid- led people to be afraid of contact with the outside world, resulting in minimal activities that individuals could participate in. low-level stimulation for months made people more likely to feel bored, anxious, and irritable (chao et al., ; xiang et al., ; zhang et al., ) . consumption is an activity that can quickly lead to novel stimuli. di muro and murray ( ) found that consumers experiencing negative emotions prefer to choose goods that are inconsistent with their current arousal level. those consumers attempt to escape their emotional discomfort and find their preferred optimal arousal level through consumption. the results of study demonstrate the high levels of boredom from limited activities and sensationseeking expressions have a strong positive effect on people's postpandemic consumption willingness. during the international workers' day holiday (may ) in , china saw a significant rebound in tourism numbers (financial times, ) , which suggests people are very likely to meet their demand for external stimulus through consumption. our findings echoed other independent studies. based on samples from the united states, kim ( ) found the perceived threat of covid- has a close relationship with variety-seeking because the pandemic limited individuals' activity, therefore people display a high motivation to increase freedom and restore control. it suggests that the impact of the perceived severity of covid- is cross-cultural. study confirms the perceived severity of covid- is strongly associated with increased boredom and sensationseeking expressions during the pandemic, which is often closely related to impulsive buying behaviors (dahlen et al., ; deng and gao, ; sundström et al., ) . study found significant main and interaction effects of both the perceived severity of covid- and the experience of life tedium during the pandemic on impulse buying tendencies. individuals are highly likely to exhibit an impulsive buying tendency in cases when both of the above variables are at a high level. study echoes the findings of , which states impulsive consumption is a typical behavior people often present during public health emergencies. moreover, found the pandemic's severity positively affects people's impulsive consumption, and individuals' perceived control and materialism mediate this effect. our study complements another path of this effect, that is, perceived severity of covid- and experience of life tedium during the pandemic can also lead to an increased impulsive buying tendency. it demonstrated that the perceived severity of covid- might affect not only the willingness to consume after the pandemic, but also people's consumption patterns in the future. extending the findings of study , we speculate that in addition to impulsive buying tendencies, the perceived severity of covid- and experience of life tedium during the pandemic may also increase a variety of impulsive behaviors. van rooij et al. ( ) found that in the united states, impulsivity during the pandemic led to a violation in coronavirus control measures. mesa vieira et al. ( ) also found that a sharp rise in the divorce rate in china during the pandemic may be associated with increased impulsive decisions. the results of study suggest that lowering the perceived severity of covid- and experience of life tedium during the pandemic could alleviate people's impulsivity, thereby reducing the likelihood of making poor decisions. for consumer businesses, it is important to not only prepare for the rapid rebound in consumption after the pandemic, but also to prepare a plan for the normalization of consumption after the rebound weakens. in other words, consumer enterprises must understand that the rebound in consumption will not stem from a sudden increase in society's spending power, but from the urgent need for consumers to relieve their boredom from limited activities and satisfy sensation-seeking needs. therefore, consumer enterprises should conduct more forward-looking marketing research and understand consumers' psychological changes to make the right decisions. we also advocate that consumers be rational in their purchasing after the pandemic and beware of impulsive buying decisions and overconsumption. on the one hand, after longterm low levels of arousal, moderate consumption could help people restore their perceptual stimulation to their ideal arousal levels. on the other hand, excessive consumption may lead to negative results, such as excessive debt and resource waste (deng and gao, ; lee and ahn, ) . future research should pay attention to the differences in consumption willingness between regions. in china, the covid- outbreak was centered in wuhan city, hubei province. people in the epicenter of the pandemic experienced stricter control measures and had a much higher perceived severity of covid- (dai et al., ) . the yerkes-dodson law states that either too high or too low levels of psychological stimulation are not conducive to achieving the best mental state. wuhan city lifted its lockdown on april , . after scary days and nights, will the spending spree of those in the epicenter be more vigorous, or will it be business as usual? it is subject to follow-up observation. future studies should also focus on the pandemic's longterm impact on consumer behavior. the covid- pandemic caused long-term, continuous, high-intensity, and traumatic group psychological stress to the people of china and to the world. it could change many people's views of consumption, making some consumer industries decline while others rise. what new consumption drivers will form by this profound collective memory of a generation? this question is beyond the scope of this study and is left for subsequent studies to explore. there are three limitations to this study. first, this study lacks distinctions between different consumption types. the pandemic impacted human connection, leaving a significant portion of the population apprehensive about socializing. therefore, the consumption scenario is better further subdivided into socially based consumption (e.g., bar parties) and non-socially based consumption (e.g., traveling alone), because of the psychological basis of these consumption activities is different. second, selecting a subscale may not be a good choice for evaluating low arousal states of boredom. these measurements constitute various dimensions, in addition to being highly variable depending on the time of day the individual responds (adan and guàrdia, ) . therefore, a multidimensional measure approach should be incorporated to measure low arousal states of boredom to assess the fine effect of the perceived severity of covid- on this variable. third, both the arousal state and sensation-seeking closely relate to the individual difference in circadian typology, which associates with various psychological symptoms (prat and adan, ) . therefore, circadian typology may determine mediation. this study only used questionnaires at a rough level to investigate people's overall levels of boredom. follow-up 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for the novel coronavirus outbreak is urgently needed public perception of epidemic risk and economic confidence survey (in chinese) fighting covid- : china in action an arousal-based explanation of affect dynamics analysis and suggestions on the dynamic changes of residents' consumption under the covid- pandemic situation (in chinese) recommended psychological crisis intervention response to the novel coronavirus pneumonia outbreak in china: a model of west china hospital sensation-seeking and domainspecific risk-taking behavior among adolescents: risk perceptions and expected benefits as mediators sensation seeking measures of sensation seeking the following grants funded this research: the foundation of humanities and social science of the ministry of education of the people's republic of china ( yjc ), shanghai foundation of philosophy and social science ( egl ), national natural science foundation of china ( ), and shanghai "early bright" project ( cg and cg ). we thank the editor and two reviewers for their suggestions on the revision for the earlier version of the manuscript. the supplementary material for this article can be found online at: https://www.frontiersin.org/articles/ . /fpsyg. . /full#supplementary-material key: cord- -fgvc qw authors: tao, yun; bi, xiao-yan; deng, min title: the impact of parent–child attachment on self-injury behavior: negative emotion and emotional coping style as serial mediators date: - - journal: front psychol doi: . /fpsyg. . sha: doc_id: cord_uid: fgvc qw in order to explore the relationship between parent–child attachment, negative emotion, emotional coping style, and self-injury behavior, junior high school students in four junior middle schools in china’s yunnan province were investigated using a parent–child attachment questionnaire, adolescent negative emotion questionnaire, emotional coping style scale, and adolescent self-injury behavior scale. as a result, two mediate models were created to explain how parent–child attachment affects self-injury behavior. negative emotion and emotional coping style play serial mediating roles in mother–child and father–child attachment models, respectively. the results show that negative emotion mediates between self-injury behavior and both father–child and mother–child attachment, while emotional coping style only functions between father–child attachment and self-injury behavior. by means of bootstrap analysis, negative emotion and emotional coping style have serial mediating roles concerning the impact of parent–child attachment on self-injury behavior. by comparison, the father–child and mother–child attachment have different mediating models: the former relies on emotional coping style, while the latter is associated with emotional experiences. this implies that parent–child attachment has different mechanisms in triggering self-injury behavior, which is in line with the hypothesis of attachment specificity. non-suicidal self-injury (hereafter referred to as nssi or self-injury) is the direct, deliberate destruction of one's own body tissue in the absence of suicidal intent, which is intended by the individual, rather than accidental (klonsky and olino, ; nock and favazza, ) . the incidence of self-injury among the general population is ≤ % (sleuwaegen et al., ) ; however, adolescents with a history of self-injury are up by - % (yulong et al., ; cerutti et al., ) . domestic studies show that the proportion of self-injury behavior among teenagers is over % (feng, ; ying et al., ; yinqgian et al., ) . thus, there is clearly a high occurrence of self-injury behavior, especially among adolescents. self-injury behavior is a negative way for individuals to deal with current problems (sornberger et al., ) , and causes great harm to adolescents' mental health (guvendeger et al., ; baetens et al., ) . at the same time, selfinjury behavior is also a risk factor leading to suicide. in the absence of intervention, it may lead to a high possibility of suicide among people (guan et al., ; ge et al., ) . the biosocial model also holds that an ineffective family environment is an important cause of self-injury behavior, and parents' neglect of children's emotion and abuse can most directly cause self-injury behavior (thomassin et al., ) . the parent-child relationship is unavoidably related to the formation and sustainable development of self-injury behavior in junior high school students. in the face of increasingly severe self-injury behavior, previous research has mainly investigated the effects of adverse family environments on adolescents' self-injury behavior, such as early traumatic experiences, emotional susceptibility, personality characteristics, stressful life events, family conflicts, etc. (fuxia et al., ; buser et al., ) . a strong parent-child attachment with an emotional link in their relationship may to some extent prevent junior high school students from self-injury behavior. however, the mechanism of how parent-child attachment affects adolescents' self-injury behavior still remains unclear. therefore, this paper mainly discusses the impact of parent-child attachment on one's self-injury behavior as well as the mechanism behind it, in an attempt to offer targeted suggestions for the prevention and intervention of self-injury behavior in junior high school students. parent-child attachment is a relatively stable relationship model formed in the communication between children and their parents, which can significantly influence children's social communication and mental health during their growth (yulong, ) . a study demonstrates that there are various and unique associations between family based risk factors and self-injury behavior, as well as addictive features (martin et al., ) . it is worth noting that the experience of adverse family life is correlated with self-injury behavior. in addition, another study shows that high-quality family relationships, such as parent-child trust and parent-child communication, were linked to fewer discipline violations, less antisocial behavior (burk and laursen, ) , and lower levels of anxiety, depression (nadorff et al., ) , and loneliness, which may further contribute to middle school students' higher emotional levels (al-yagon, ), their seeking help, and more positive ways to adapt to society, thus reducing the probability of selfinjury. on the contrary, the higher the degree of parentchild alienation, the higher the risk of self-injury (weihua, ) . in the period of adolescence, junior high school students are going through drastic changes both psychologically and physiologically, being faced with a series of adaptation problems, including physiological maturity, cognitive development, and social role transformation (guoliang and yu, ) . thus, when they fail to cope with family relationships, they may alleviate their pain by means of self-injury behavior (victor et al., ) . fuxia et al., has pointed out that parent-child attachment is an important factor in adolescents' self-injury behavior (fuxia et al., ) . in addition, recent studies have demonstrated that poor-quality parent-child attachment can increase the incidence of self-injury behavior (honglei et al., ) . interpersonal or systematic models have also pointed out that self-injury is the result of family dysfunction, and that the family environment of certain individuals will unconsciously support or strengthen their self-injury behavior (crouch and wright, ) . moreover, studies find that fathers and mothers play different roles in parent-child communication; the father spends relatively less time interacting with their children, and tends to engage in more physical and outdoor activities, while mothers invest time and are involved in more caring and household interactions (oliveri et al., ) . consequently, it is possible that father-child and motherchild relationships represent different variables that affect the self-injury behavior of junior high school students. previous research says that children have fewer problematic behaviors with a healthy father-child relationship (hardcastle et al., ) . meanwhile, the attachment specific hypothesis further indicates that when children undergo attachment experience with different caregivers, the multiple layers of attachment formed boast a non-differentiated degree of influence on children's social and psychological development (zborowski and mcnamara, ) ; i.e., the influence of father-child and mother-child attachment on children's development is not superimposed or comprehensive, but independent from one another. do father-child and mother-child attachments have the same impact on self-injury behavior? we will explore their respective mechanisms. at present, the mechanism of how parent-child attachment influences self-injury behavior stills remains unclear and requires further exploration. two main theories used to explain selfinjury behavior are the interpersonal or systematic models, as well as the emotion regulation model (yulong et al., ) . interpersonal or systematic models emphasize the impact of the family environment on self-injury behavior, demonstrating the influence of the family system on adolescent problematic behavior, especially from the perspective of parent-child relationships (crouch and wright, ) . by contrast, the emotion regulation model shows that individual self-injury behavior is a behavioral strategy to deal with negative emotions or reduce pain from the angle of emotional management (messer and fremouw, ) . however, these two models do not explore the negative emotions caused by parentchild relationship in the family system, so they fail to fully reveal the effects of parent-child attachment on negative emotions, emotional coping style, and self-injury behavior. in other words, the question is, as negative emotions are generated by poor parent-child relationship, why are children unable to manage their emotions effectively, and why is parent-child attachment not protective to self-injury behavior? a possible explanation is that, due to negative emotions, individuals choose self-injury behavior as a coping method, which is influenced by the parent-child relationship. a poor attachment relationship may strengthen the connection between negative emotions and self-injury behavior; good attachment weakens it. adolescents, lacking in emotional regulation and control, can possibly resort to self-punishment when facing environment changes and negative emotions. this kind of emotional coping style gives junior high school students the tendency to adopt self-injury behavior instead of other approaches when faced with poor family relationships (glassman et al., ) . therefore, in order to examine how and when father-child and mother-child attachment were linked to adolescents' self-injury behavior, negative emotion and emotional coping style are listed as possible mediating factors. negative emotion is a general term for subjective stress and unpleasant experiences (watson et al., ) , which reflects individual differences in emotional stability (watson, ) . previous studies have found that high-quality parent-child attachments can reduce the influence of negative emotions on individuals, and vice versa (yinqgian et al., ) . yan et al. ( ) have also discovered that good parent-child relationships can meet individual's emotional needs, while low-quality relationships may contribute to negative emotions as the result of parent-child alienation (yan et al., ) . furthermore, some studies have suggested that mother-child attachment can be directly employed to predict negative emotions, while some other studies have showed that the father-child attachment has no such obvious effect, which means the impact of the former outweighs that of the latter (yinqgian et al., ) . thus, all these studies have demonstrated that unhealthy father-child and mother-child attachment can directly trigger junior high school students' negative emotions, and that the influencing mechanisms are actually different. on the other hand, negative emotions may bring about self-injury behavior. a study has found that individuals with high negative emotions can probably relieve their emotional burdens through self-injury behavior, and may weaken the psycho-social function of junior high school students, leading to a series of problems inducing depression and anxiety (yulong et al., ) . the experiential avoidance model and emotional management model on selfinjury behavior also proposes that individuals will eliminate their unhealthy emotions through self-injury behavior when lacking an effective emotional management ability or to avoid unpleasant emotions (paivio and mcculloch, ; chapman et al., ) ; i.e., individuals manage their negative emotions by means of self-injury behavior (quanquan et al., ) . further, more studies have also confirmed that there is a significant positive correlation between negative emotion and self-injury behavior (yulong et al., ) . generally speaking, negative emotion, as a mediate variable, has a wide range of impacts on individual's cognition, motivation, and social behavior. therefore, based on the model above, it is assumed that negative emotion is to some extent related to the self-injury behavior of junior high school students. thus, we expected negative emotion may play a mediating role between father-child and mother-child attachment and selfinjury behavior. coping style refers to the strategies adopted by individuals to relieve stress under pressure (runxin and jianmei, ) , i.e., problem and emotional coping styles (folkman and lazarus, ) . some researchers have pointed out that people are more likely to adopt emotional coping methods such as enduring, escaping, venting, fantasy, and denial, when people believe there is no way out (folkman and lazarus, ) . probing into literature, guerreiro et al. have found that self-injury behavior is linked to emotional-directed coping strategies (guerreiro et al., ) . people with self-injury behaviors tend to take emotional responses, and individuals constantly resorting to emotional responses are more likely to injure themselves when dealing with adverse emotions (cramer et al., ) .with an observation of adolescents, castro and kirchner ( ) have made it clear that adolescents with multiple self-injury behaviors would employ more coping strategies like venting, which has therefore proven a risk factor for self-injury. the evidence above shows that emotional coping style is closely associated with self-injury behavior. in a family, an adverse parent-child relationship is the direct cause of emotional coping styles (qiangqin, ) . as junior high school students lack social experience, when they suffer an adverse parent-child relationship, they most probably have a sense of inability, not knowing how to change their situation and being apt to resort to emotional coping methods. attachment theory has also proposed that the secure attachment formed earlier between children and their caregivers can affect the coping styles of junior middle school students (davila and levy, ) . meanwhile, qiangqin, has also found that father-child attachment and motherchild attachment could both significantly negatively predict emotional coping style (qiangqin, ) . considering this, we expected emotional coping style may play a mediating role between father-child and mother-child attachment and selfinjury behavior. moreover, there is also a close positive correlation between negative emotion and emotional coping style. domestic researchers have discovered that emotional problems are positively related to their coping styles; foreign studies suggest that negative emotion can lead to individuals reacting with such coping styles as avoiding, denying, and enduring, where emotional coping style is considered as a "response to emotion" (folkman and lazarus, ) . to sum up, it is believed that negative emotion may affect emotional coping style; therefore, it is essential to examine the serial mediating roles of these two factors in the correlations between father or mother-child attachment and self-injury behavior. the present study's main objective is to analyze the different roles of father-child and mother-child attachment in the development of self-injury behavior of adolescents. thus, we aim to observe the associations between parentchild attachment, negative emotion, emotional coping style, and self-injury behavior. lastly, we will analyze the pathways through which father-child and mother-child attachment is linked to self-injury behavior. therefore, this research has been guided by four objectives. first, we expected parentchild attachment to be associated with self-injury behavior, and there to be a difference between the effects of fatherchild attachment and mother-child attachment on self-injury behavior. second, we anticipated that negative emotion may play a mediating role between father-child and mother-child attachment and self-injury behavior. third, we expected emotional coping style may play a mediating role between fatherchild and mother-child attachment and self-injury behavior. finally, we expected there to be a serial mediating role played by negative emotion and emotional coping style in the correlations between father or mother-child attachment and self-injury behavior. participants for this study were recruited from the junior high schools in china's yunnan province. six hundred and seventy students were approached to take part in this study. the final sample consisted of ( . %) boys and ( . %) girls. in reference to the participants' schooling, were in the first year of junior high school, in the second year, and in the third. the age range was between and (m = . , sd = . ). the data were collected by means of cluster random sampling in the four junior high schools. ethical approval for this project was given by the executive council of yunnan normal university. the adolescents signed their informed consent. data collection occurred in a classroom context, in the presence of the supervising researcher who, in a succinct manner, administered the standard instructions, including the general objectives of the study as well as guaranteeing free will, privacy, anonymity, and confidentiality of all the information provided. parent-child attachment questionnaire (inventory of parent and peer attachment, ippa) the parent-child attachment questionnaire, compiled by armsden and greenberg ( ) , was translated by wendao et al. ( ) for use in china. this questionnaire in its revised form is composed of questions that are distributed in three subquestionnaires, from which we adopt two sub-questionnaires in this study: the father-child attachment questionnaire-"i think my father is a competent father"; the mother-child attachment questionnaire-"my mother respects my feelings". each fatherchild and mother-child attachment questionnaire included items, which were divided into three dimensions: trust, communication, and alienation. for each item, there are five answer options given for the father and the mother separately, in which the responses are presented on a likert style scale that varies between (totally disagree) and (totally agree). in this study, the cronbach's alpha coefficients of each dimension on the father scale were . , . , and . , respectively, and those on the mother scale were . , . , and . separately. the negative emotion questionnaire translated into chinese by wenfeng and jianxin ( ) from the original version by bradburne and tyrrell ( ) was used with the objective of evaluating the negative emotional experience from the last months. we used the sub-questionnaire of the negative affect scale. it includes six items-"i feel like i'm upset for some reason." for each item, there are four answer options, presented on a likert style scale, which varies between (never) and (always). the higher the score, the more intense the negative emotion. the psychometric studies performed in the present sample revealed a cronbach's alpha coefficient of . . the coping style scale by shulin et al. ( ) was used to evaluate adolescents' emotional response to problems or troubles. this questionnaire in its revised form consists of questions that are distributed in two sub-questionnaires. we used the subquestionnaire of the emotional coping style scale ( items), which presents itself in four dimensions: endurance ( item)-"i buried the unpleasant things in my heart, " escape ( item)-"refuse to believe that bad things have happened, " venting emotion ( item)-"you will be very upset and vent to your family and friends when you can't solve the problem, " and fantasy denial ( item)-"love to do something unrealistic to eliminate trouble." for each item, there are four answer options, presented on a likert style scale, which vary between (not adopt) and (always adopt). the psychometric studies performed in the present sample revealed a cronbach's alpha coefficient of . . the adolescent self-injury behavior scale, translated into chinese by fang et al. ( ) from the original version of the ottawa self-injury scale, was used with the objective of evaluating the adolescents' self-injury behavior from the past year. it includes items-"deliberately burying your head in the water." the frequency of self-injury behavior in each way was set to times, time, - times, or times or more, and the total score of the items was calculated as a continuous variable. the psychometric studies performed in the present sample revealed a cronbach's alpha coefficient of . . the present study is of a cross-sectional nature given that the set of measurements were all carried out at the same moment in time. data treatment was carried out using the statistical program spss-statistical package for social sciences, version . for windows, and the mediate model was tested with amos . . in order to test the mediating effect, the percentile bootstrap method for deviation correction was used, which is recommended by jie and minqiang ( ) . in order to control the common method deviation, we told all participants that the questionnaires were filled out anonymously, and all the data were strictly confidential and only used for scientific research. the harman single factor method was adopted to test common method deviation, and thus the exploratory factor analysis for all variables referred to in the research was carried out. the results show that the eigenvalues of factors are greater than , and the variation explained by the first factor is . %, less than %, which means that there is no common method deviation in this study (hao and lirong, ) . a total of participants were recruited for the study, with the response rate being . %. among the respondents, . % of males and . % of females never committed self-injury behavior; . and . % of those who never self-injured were from rural and urban areas respectively; . , . , and . % of the never-selfinjured students were in their first, second, and third year, respectively ( table ) . the results of the inter-scale correlations and the respective averages and standard deviations, reported in table , allow us to state that there are correlations between the variables being studied. the correlation analysis showed that there was positive correlation between mother-child and father-child attachment, but negative correlation with negative emotion, emotional coping style, and self-injury behavior. meanwhile, negative emotion, emotional coping style, and self-injury behavior were positively correlated with each other. the mediating effects of the quality of negative emotion and the emotional coping style variable were calculated using the structural equations model, through the realization of the steps of the percentile bootstrap method. the analysis of the mediating roles of the negative emotion and emotional coping style were carried out, taking into account all of the following dimensions: the negative emotion, the emotional coping style (endurance, escape, venting emotion, fantasy, and denial) as serial mediators of both the parent-child attachment (trust, communication, and alienation), and self-injury behavior. in regard to the model test that verified the parent-child attachment and self-injury behavior, the model test verified that initially. the results are listed as below. the father-child attachment model fits well (χ /df = . , rmsea = . , nfi = . , ifi = . , cfi = . , srmr = . ), and the attachment can significantly negatively affect self-injury behavior (β = − . , p < . ). the mother-child attachment model is also well fitted (χ /df = . , rmsea = . , nfi = . , ifi = . , cfi = . , srmr = . ), and this attachment can significantly negatively affect self-injury behavior (β = − . , p < . ). in summary, the father-child attachment and mother-child attachment can both significantly negatively affect self-injury behavior. the fitting degrees of the structural model and the data of fatherchild attachment were tested, and the results show that the fitting indexes of the model are sound: χ /df = . , rmsea = . , nfi = . , ifi = . , cfi = . , srmr = . , as displayed in figure . the normalized load of all the observed variables on corresponding latent variables is between . and . , and the composite reliability values are all larger than the standard value of . , indicating that the measurement model has reached the ideal standard, and the observed variables can well reflect the corresponding latent variables. thus, the structural model can be further tested. with negative emotion and emotion coping style taken into consideration, the significant paths are as follows: father-child attachment has a direct negative effect on negative emotion (β = − . , p < . ) and selfinjury behavior (β = − . , p < . ); negative emotion positively affects emotional coping style (β = . , p < . ) and self-injury behavior (β = . , p < . ); and emotional coping style positively affects self-injury behavior (β = . , p < . ). furthermore, the percentile bootstrap method of deviation correction was employed to test mediating effects (jie and minqiang, ) . bootstrap samples were extracted from the original data (n ≤ ) by repeated random sampling, and the bootstrap % confidence interval of the mediating effect was calculated. the results, as are demonstrated in table , show that the bootstrap % confidence interval of the mediating paths above do not include , which means that father-child attachment can affect self-injury behavior through the mediating role of negative emotion and emotional coping style, and that negative emotion and emotional coping style play a serial mediating role between father-child attachment and self-injury behavior. the fitting degrees of the structural model and data of motherchild attachment were tested, and the results indicate that the fitting indexes are sound: χ /df = . , rmsea = . , nfi = . , ifi = . , cfi = . , srmr = . , as represented in figure . the observed variables can well reflect the corresponding latent variables (the calculation method is the same as above); therefore, the structural model can be further tested. with negative emotion and emotion coping style *p < . , **p < . , ***p < . , the same as below. figure | father-child attachment mediate model. father-child attachment→negative emotion→self-injury behavior − . *** − . − . father-child attachment→emotional coping style→self-injury behavior − . ** − . − . father-child attachment→negative emotion→emotional coping style→self-injury behavior − . *** − . − . the lower limit and upper limit of boot ci respectively refer to the lower and upper limits of the % confidence interval of the indirect effect estimated with percentile bootstrap method to correct deviation; all values retain two decimal places, the same as below. *p < . , **p < . , ***p < . . taken into account, the significant paths are as follows: motherchild attachment can directly negatively affect negative emotion (β = − . , p < . ) and self-injury behavior (β = − . , p < . ); negative emotion can positively affect emotional coping style (β = . , p < . ) and self-injury behavior (β = . , p < . ); and emotional coping style can positively affect self-injury behavior (β = . , p < . ). in addition, the percentile bootstrap method of deviation correction is adopted to test mediating effects. the results, as are listed in table , demonstrate that the % confidence interval of the mediating paths above do not include , indicating that the mediating effect is significant. in other words, motherchild attachment could affect self-injury behavior through the mediating effect of negative emotion, with negative emotion and mother-child attachment→negative emotion→self-injury behavior − . *** − . − . mother-child attachment→negative emotion→emotional coping style→self-injury behavior − . *** − . − . *p < . , **p < . , ***p < . . emotional coping style playing serial mediating role between mother-child attachment and self-injury behavior. the direct effect of parent-child attachment on self-injury behavior this study finds that father-child and mother-child attachment of junior high school students can both directly negatively influence self-injury behavior, which conforms to the basic view of interpersonal or systematic models (crouch and wright, ) . this also supports the conclusion of previous studies; i.e., adverse parent-child attachment will lead to the students' selfinjury behavior (martin et al., ; gromatsky et al., ) . family relationships are critical to adolescents, and they tend to adopt self-injury instead of other means to ease the tension and stress once the relationships fall ill. some studies have discovered that a high-quality parent-child relationship is a protective factor. when there is a poor quality parent-child relationship, children are more likely to resort to self-injury (glenn and klonsky, ) , which means that a healthy parent-child relationship is an essential factor to prevent junior high school students from self-injury behavior. in addition, the higher the score of parentchild attachment, the lower the score of individual self-injury behavior, i.e., the better the quality of attachment, the more trust and cooperation between parents and children, and the lower the possibility of individual self-injury behavior. this research finds that negative emotion can mediate between father-child and mother-child attachment and self-injury behavior, i.e., parent-child attachment can not only directly, but also indirectly, effect self-injury behavior through negative emotion. it also testifies the main principles of theexperience avoidance model and emotion management model (paivio and mcculloch, ; chapman et al., ) . it demonstrates that parent-child relationships can induce negative emotion, which will further trigger the occurrence of self-injury, both being consistent with the previous studies (klonsky et al., ; feng, ) . when the individuals lack the ability to manage their negative emotion effectively, they try to relieve the emotion through self-injury. thus, it is certain that negative emotion increases the risk of self-injury behavior. additionally, father-child attachment can be negatively associated with emotional coping style, and the latter further effects self-injury behavior, which is in line with the results of previous studies (qiangqin, ; castro and kirchner, ) . owing to the lack of experience to cope with social problems, junior high school students do not know how to deal with challenging problems and tend to adopt emotional coping styles after suffering from father-child conflict. however, the emotional coping style puts more emphasis on emotion itself, which is not conducive to solving the problems, but reinforces the negative emotion and even leads to self-injury. studies have shown that the students being accustomed to the emotional coping style are slow at communication, with a significantly higher level of anxiety and depression compared with the general population, and previous studies have also proven that the continuous negative emotional coping style can result in self-injury (konick and gutierrez, ) . it shows that a poor quality father-child relationship will increase the chance of emotional coping style by junior high school students, thus increasing their self-injury behavior. in terms of mother-child attachment, however, a poor relationship cannot directly affect emotional coping style, which is inconsistent with former studies (qiangqin, ) . this is because mothers, as the main supporter of the children's lives, have established a close relationship with their children from an early age. such a bond tends to be more emotionally connected. therefore, the unhealthy mother-child attachment does not easily lead to an emotional response. at the same time, negative emotion and emotional coping style play serial mediating roles between father-child and mother-child attachment and self-injury behavior. it is believed that junior high school students can have negative emotions due to poor quality parent-child attachment (yulong et al., ) , under the influence of which individuals resort to a series of solutions to adapt to their negative emotions. with a sense of inability in emotional processing, they naturally surrender to the emotional coping style, which further contributes to self-injury behavior (folkman and lazarus, ; castro and kirchner, ) . as children grow up, fathers will use games and set challenges to encourage children to face dangers, overcome difficulties, and promote children's social adaptability (paquette, ) , which may serve as an effective indicator of adolescents' psychological elasticity (xiaoyan et al., ) ; mothers, however, tend to be more emotionally connected with their children. recent research has also suggested that father-child attachment and mother-child attachment have different roles in the parent-child relationship. father-child attachment has a more significant role in promoting children to cope with challenges and emotions, while mother-child attachment is mainly reflected in emotional experience. therefore, the intermediate model in this study is in line with the attachment specific hypothesis. the mother-child attachment model tends to affect emotional experience, while the father-child attachment model would affect behavioral coping style. this shows that a child's emotional connection with his mother is the basis and starting point for exploring the outside world and will affect his whole life. this is because in the early attachment relationship, infants and children internalize the interaction experience with their attachment objects into their internal working mode. when they contact others later, the internal working model will guide his behavior performance, which also supports the attachment theory. fathers are often a role model who encourages their children to face and solve problems, which is line with previous explanations (gottman, ) . the reason for this difference may come from traditional family rearing pattern of "strict father and gentle mother," and adolescents generally hold the stereotype that mothers are more sensitive, gentle, and modest, while fathers are decisive, independent, and vigorous, so the latter is usually imitated by children (chuanhua et al., ) . this study proves that father-child attachment is highly predictive of individuals' stress response, which means that father-child attachment, via words and deeds, may change the way junior high school students cope with their emotions. maybe fathers with bad behaviors such as alcoholism, smoking, etc., are more likely to pass their emotional coping styles to their children; however, mother-child attachment does not have this effect, i.e., mothers emotional coping style has less of an effect on children. in other words, mother-child attachment more depends on emotional communication and expression, so an unhealthy mother-child relationship brings more negative emotional feelings. in a word, the quality of mother-child attachment and fatherchild attachment embodies the trust and cooperation between parents and children, but they have different connotations (yan, ) . for example, parent-child attachment mainly promotes the emotional communication between parents and children through caring and nurturing behaviors, while parent-child attachment mainly reflects the quality of parent-child attachment by setting an example and giving confidence. the connotation of this attachment is also reflected in the process of emotional adaptation and emotional management. mothers show more emotional warmth and understanding, but fathers demonstrate more problem-solving, so mother-child attachment establishes relationship quality through positive emotions, while fatherchild attachment reflects relationship quality through problemsolving and positive response. parent-child attachment plays an important positive role in the healthy development of individuals; however, unhealthy attachment can destroy the ability for emotional adaptation and regulation. it not only directly affects the self-injury behavior of individuals, but also influences the self-injury behavior through negative emotions and negative emotional coping styles. this study provides a new angle for the intervention and education of self-injury behavior, i.e., from the perspective of attachment theory, paying attention to the impacts of fatherchild attachment and mother-child attachment work models on individual self-injury behavior. attachment mode not only has gender differences, but also differences between safe attachment and non-safe attachment. future research should further explore the relationship between non-safe attachment individuals and the relationship among negative emotion, emotional coping style, and self-injury behavior. in addition, there are some shortcomings in the study as well. first, as a cross-sectional study, the relationship between different attachment types and junior high school students' self-injury behavior could not be examined in more detail. future research may use tracking design to deepen this issue. second, this study has only examined the impact of parent-child and mother-child attachment on self-injury behavior, without referring to peer attachment. in fact, junior high school students' attachment targets are not limited to parents; peer attachment is also of huge importance. studies have suggested that the role of peer attachment has even surpassed that of parent-child attachment in their development (bogaerts et al., ) , but there are other different perspectives, so future research may further explore the impact of peer attachment on junior high school students' self-injury behavior. third, the measurement of each variable is entirely based on the self-report of junior high school students; the method of measuring self-injury behavior specifically is relatively single, and there may be social approval effects. thus, future research may consider combining multiple methods to obtain more comprehensive data. fourth, the measured groups are all students, and the sample size is relatively small. in later research, more group samples could be considered for investigation. first, mother-child and father-child attachment directly negatively influences self-injury behavior of junior high school students. second, father-child attachment affects self-injury behavior through separate mediation of negative emotion, through separate mediating effects of emotional coping style, and r through serial mediating effects of negative emotion and emotional coping style. third, mother-child attachment affects self-injury behavior through separate mediation of negative emotion, and through serial mediating effects of negative emotion and emotional coping style. the datasets generated for this study are available on request to the corresponding author. ethical review and approval was not required for the study on human participants in accordance with the local legislation and institutional requirements. written informed consent to participate in this study was provided by the participants' legal guardian/next of kin. written informed consent was obtained from the individual(s), and minor(s)' legal guardian/next of kin, for the publication of any potentially identifiable images or data included in this article. yt conceived the study, participated in its design, carried out the study, performed the statistical analysis, and drafted the manuscript. md and x-yb supervised the study, participated in the design of the study, helped to draft the manuscript, and revised the manuscript critically. all authors read and approved the final manuscript. this study was supported by the natural science foundation's "cognitive control of ethnic bilinguals" fund of yunnan normal university ( ) and project from yunnan province ministry of education fund ( j ). adolescents with learning disabilities: 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and adolescents' negative emotion: a mediating model with regulation the effect of invalid family environment on self-injury behavior of different family types of adolescents the self-punishment function of teenagers' self-harm behavior: does it stem from guilt or shame? the relationship between parental conflict and adolescent self-injury: a regulated intermediary model attachment hypothesis of rem sleep toward an integration of psychoanalysis, neuroscience, and evolutionary psychology and the implications for psychopathology research key: cord- -ka abe c authors: idoiaga, nahia; berasategi, naiara; eiguren, amaia; picaza, maitane title: exploring children’s social and emotional representations of the covid- pandemic date: - - journal: front psychol doi: . /fpsyg. . sha: doc_id: cord_uid: ka abe c covid- , a new emerging infectious disease (eid), has spread throughout the world, including europe. spain, in particular, has witnessed a significant outbreak of the pandemic. all classes have been canceled, and the government has declared a state of emergency, ordering the lockdown and confinement of the entire population. all children in the country have been confined to their homes since march and are not allowed to leave at any time. this population is thus facing the harshest restrictions. given the vulnerable situation of children, the aim of this research is to understand how they represent and emotionally cope with the covid- crisis. a free association exercise elicited by the word “coronavirus” was completed by children (age range: – years) from the north of spain. to analyze the content, we employed the reinert method with iramuteq software for lexical analysis. the results revealed that children represent the covid- as an enemy that is being fought by the doctors. children are afraid and worried about catching the virus, but mainly because they think they can infect their grandparents, and this makes them feel guilty. moreover, the lockdown situation has produced conflicting emotions in the children. on the one hand, they are scared, nervous, lonely, sad, bored, and angry, but they also feel safe, calm, and happy with their families. these results indicate the need for governments to also consider children in their management of the current situation by placing greater emphasis on social and inclusive policies to help alleviate the possible effects that they may suffer as a consequence of the pandemic and the lockdown. in short, there is a need to address the psychological, educational, social, health, and well-being needs of children. children represent only a small percentage of covid- cases (hamzelou, ; pavone et al., ) , and the majority of infected children might appear asymptomatic (cai et al., ) or present mild clinical manifestations (jiao et al., ) . it might therefore be tempting to assume that, in comparison with adults, children are less vulnerable to this pandemic (pavone et al., ) . however, from the beginning of the pandemic, health authorities and politicians have repeatedly pointed out that because of this mild symptomatology, children may play a significant role in spreading the infection. consequently, in most countries of the world, schools have been closed (united nations educational, scientific and cultural organization, ) with children confined to their homes. nevertheless, each country has imposed its own specific rules for children in the frontiers in psychology | www.frontiersin.org august | volume | article lockdown; while in some countries they are allowed to leave their homes to exercise, play sports, or take walks with their parents, in other countries these activities are prohibited (garcia, ) . spain is currently one of the european countries most affected by . cases began to multiply exponentially and uncontrollably in early march. in view of this situation, all the schools in the country were closed (sánchez, a) , with the spanish prime minister declaring a state of emergency on th march , ordering a mandatory lockdown for all citizens (royal decree / . in the same speech, the prime minister stated that the rules of this lockdown were very drastic, possibly the most stringent in europe and even the world (merino, ; sánchez, b) . in that speech, there was not a single mention of children, even though the rules of the lockdown are particularly harsh for them. children were forbidden to leave their homes, with spain along with italy, being the only european countries where children were not allowed to go out at all (granda, ; grechyna, ) . on the th of march, however, the government clarified a detail of this law, which permitted single parents (specifically those unable to leave their children in the care of another adult) to leave their homes accompanied by children to purchase groceries and essential items. further, children were not allowed to use the communal spaces within their buildings, such as a shared terrace or garden (royal decree / . in spain, this absolute lockdown for the children lasted weeks, and then, from april , they were allowed to go outside, but only for h a day. pediatricians, psychologists, and educators have warned of the serious threats that this confinement may pose to children from both a physical and emotional perspective (grechyna, ; jiloha, ; léon, ; the spanish children's rights coalition, ) , stressing that it is essential that children understand what is happening in order to mitigate the damage that this situation may cause them (dalton et al., ; wang et al., ) . however, no research has yet been conducted to explore the ways in which children integrate this coronavirus outbreak into their everyday thinking and how they are coping with the psychosocial impact of the crisis. during the s and s, a considerable body of research focused on children's understanding of illness (myant and williams, ) . most of this research was based on piaget's theory of development, essentially demonstrating that children have different perceptions of the disease depending on their age and stage of development (bibace and walsh, ; banks, ; gillis, ; hergenrather and rabinowitz, ; carson et al., ; simeonsson et al., ; kury and rodrique, ; moss-morris and paterson, ) . however, these cognitive studies, even in their most modern versions (vacik et al., ; koopman et al., ; myant and williams, ; piko and bak, ) , have failed to address how children understand specific diseases from a common sense standpoint or the ways in which they deal with illnesses on an emotional level. in contrast, the present study is theoretically framed within the social representations theory (srt; moscovici, moscovici, , because this theory provides a framework for embracing the symbolic meaning that is assigned to diseases in everyday thinking (joffe, ) . although relatively little work has been conducted with children from the perspective of social representations (galli and nigro, ; galli and fasanelli, ; cagnin et al., ; goodwin et al., ) , srt offers an innovative point of view since the function of social representations is to make familiar the things that are unknown or unfamiliar to us (such as the new covid- pandemic; galli and nigro, ) . thus, a key concern of this theory relates to how knowledge about a new risky phenomenon is transformed from scientific discourse into the common understanding of lay people (joffe, ) . consequently, extensive research has been carried out with regard to specific emerging infectious diseases (eids) within this framework (joffe and haarhoff, ; joffe and bettega, ; joffe and lee, ; washer, ; idoiaga et al., a,b) . however, this work has always been conducted from the perspective of adults. in recent years, social representation research on several eids (wagner-egger et al., ; idoiaga et al., a) , including the covid- pandemic (eiguren et al., ; idoiaga et al., a,b , ) , has revealed that recurring emotional patterns can be observed when it comes to dealing with pandemics. first, eids are usually represented in terms of heroes, victims, and villains (wagner-egger et al., ) . the heroes are typically the scientific and medical experts who work to beat the disease, while villains are the media and governments (washer, ) . the victims are represented as the infected people, particularly those who are defenseless to face the epidemic (idoiaga et al., b) . however, the representation of risk is not homogeneous throughout society. the srt also states that in these moments of crisis specific shared ideas emerge among different groups, and also, of course, among children (wagner and hayes, ; washer, ) . social representations are important in these contexts because they are constructed based on the particular experiences that each group is living through during the pandemic and the information they receive both from the media and through social interactions (moscovici and duveen, ) . moreover, research in the field of social representations (smith and joffe, ) and eids highlights the role played by the emotional context in symbolic thought and its relevance for making a topic recognizable and understandable (höijer, ) . in fact, the work carried out so far has revealed that in modern societies there are recurring emotional patterns that emerge in response to the threat of eids, with fear being very prominent, along with anger and emotional fatigue (joffe, ; sherlaw and raude, ; idoiaga et al., a,b) . in the case of children, it has been warned that the lockdown imposed in response to covid- could generate feelings of fear, worry, sadness, or stress (jiao et al., ; jiloha, ; wang et al., ) and that understanding children's reactions and emotions is essential to properly address their emotional needs (jiao et al., ; jiloha, ) . frontiers in psychology | www.frontiersin.org given these considerations, it is of critical importance to identify how children understand this health crisis in order to develop strategies and tools that, by taking into account their concerns, will ultimately help them to overcome these unprecedented circumstances. thus, the main goal of this article is to study how children understand or represent the covid- , while observing their emotional response to the coronavirus pandemic in spain. a total of children participated in this study between th march and th april . the sample was recruited in the basque country region located in northern spain. of the sample, . % were girls and . % were boys. the mean age of the participants was . years (sd = . ) with an age range of - years. as additional information on participating families and with regard to the economic status of the families, most of them ( . %) have a medium economic status, the rest . % have a low economic status, and the remaining . % have a high economic status. moreover, most of the parents have a university education . % or a bachelor's degree . %. and, only . % have a secondary education and the . % have a primary education. besides, with regard to children care, most of the parents, % said that they shared the childcare tasks, . % said that it is the mother who takes care of the children, . % said that it is the father, and . % said that other people take care of their children. finally, . % of the families had no outside space (such as a balcony, terrace, or garden) in their homes. due to the confinement situation, we decided to access the children through their parents. questionnaires were sent to all schools in the basque country region and the schools were asked to forward these questionnaires to the families. in that email, a document was sent explaining how the study should be carried out and a link to do so. in the explanatory document, it was specified to the parents that this was a free association exercise for their children and that they, the parents, would take the role of interviewers. to carry out the exercise, they had to ask to their children two specific questions: ( ) these days we are talking a lot about the coronavirus. when you hear the word coronavirus, what comes to mind, or what do you think? ( ) how are you feeling these days because of the coronavirus? the parents were then encouraged to transcribe the exact responses given by their children. the document gave two practical examples of how the exercise should be done and how it should not be done (specifying that no suggestions should be made or that the children's words should not be paraphrased). all children participated on a voluntary basis, received information about the procedure of the investigation, and their parents gave their consent before participating in the study. this research has obtained the approval of the ethics committee of the upv/ehu [m / / ]. the reinert method using iramuteq software for lexical analysis (reinert, (reinert, , ) was employed to analyze the corpus of text. this method has frequently been used for the study of social representations (lahlou, ; klein and licata, ; kalampalikis, ) , confirming that the results obtained agree with those of other methods used in this field of research (lahlou, ) . iramuteq software eliminates problems of reliability and validity in text analysis (reinert, ; klein and licata, ) . using this method, which follows a descending hierarchical analysis format, the analyst obtains a series of classes and statistical cues in the form of typical words and typical text segments (see idoiaga et al., a) . specifically, the software identifies the words and text segments with the highest chi-square values, that is, those words and text segments that best identify each class or idea that the participants have repeatedly mentioned. once these "classes" have been identified, they are associated with "passive" variables (independent variables). in the present case, the passive variable was the age range, that is, young children ( - years), middle-aged children ( - years), or old children ( - years). in accord with previous research using the reinert method (camargo and bousfield, ) , the raw data were entered into the iramuteq software, and the most significant items of vocabulary in each class were selected on the basis of three criteria: ( ) an expected value of the word greater than ; ( ) proof of association of the chi-square, tested against the class [χ ≥ . (p = . ); df = ]; and ( ) the word appears mainly in that class, with a frequency of % or more. reinert method operations are statistical, transparent, and reproducible until the final stage of interpretation, where the analyst assigns a label to each specific vocabulary set that the software had identified as a lexical world on the basis of co-occurrences and distribution patterns (schonhardt-bailey, ) . finally, as a complementary analysis, iramuteq also conducts a lexical similarity analysis. this analysis presents in a graphical format the structure of a corpus, distinguishing between the shared parts and the specificities of coded variables. this allows the link between the different forms in the text segments to emerge. that is, this analysis allows to identifying the words' co-occurrences, providing information on the words connectivity, and thus helping to identify the structure of a text corpus content. it also allows to identify the shared parts and specificities according to the descriptive variables identified in the analysis (marchand and ratinaud, ) . the full corpus contained , words, of which , were unique words. specifically, the descending hierarchical analysis divided the corpus into segments and five classes. the results of this analysis can be observed in figure . the analysis identified the main ideas held by children regarding covid- , elicited through the free association procedure. each issue or idea is represented by a set of typical words and text segments, which is referred to as a class. first, the results revealed two main branches or themes (composed of different classes), which are referred to as main clusters frontiers in psychology | www.frontiersin.org and labeled as "coronavirus" and "lockdown". the first main cluster is composed of classes (our enemy the virus) and (fear of coronavirus). the second main cluster is composed of classes (safe at home), (emotions regarding lockdown), and (when is this going to end?). following the hierarchical clustering dendrogram, within the first main cluster describing the coronavirus, the first class to emerge was class , with a weight of . %, which has been labeled as "our enemy the virus". within this class, it can be observed how children describe the covid- with words such as bug, bad, or enemy but they also mention words such as doctors, win, brave, balcony, or clap, praising the work of the doctors to tackle the virus and stressing that what they must do is to stay at home, as can be seen in the characteristic text segments: "it's a virus but we don't really know what it is. we have to stay home and beat it because it's bad and it's a bug or something that gets into our tummy. in the street the doctors, who are heroes and brave, are going to beat it and that's why we go out every afternoon to the balcony to clap for them" (x = . , boy, years); "it's a bad bug, but we're going to beat it and the doctors are going to kill it! and get it out of here now!" (x = . , boy, years); and "it travels by plane and has come here and will not leave. that's why we have to beat it and to beat it we have to help the doctors and stay home and that's it, and then everything will be fine" (x = . , girl, years). this class was mainly elicited by young children ( - years; p < . ). within the same "coronavirus" main cluster, the second class emerges, labeled as "fear of coronavirus" with a weight of . %. this class describes the emotions of fear, concern, sadness, nervousness, or fright created by this health crisis. however, children are more afraid of infecting their grandparents than themselves, even mentioning that they would feel guilty if that happened. the most significant text discourses are: "it's a virus but since it's new we're all a little scared and they talk about it on the radio, on television and everywhere else. it doesn't hurt children but we can infect our grandparents and that scares me and that's why we can't go to their house" (x = . , girl, years); "older people say they are afraid but then they go out and buy bread four times a day! i don't care about those people! i am worried and afraid that something will happen to my grandmother! that's why i don't go to her house because if she gets sick i will feel guilty" (x = . , girl, years); and "the coronavirus is a virus that makes you feel a little afraid but not for yourself, for older people (x = . , boy, years). this class was mainly elicited by middle-aged children ( - years; p < . ) and old children ( - years; p < . ). in the second main cluster, classes related to the lockdown situation emerged, including the fourth class ( . %), which has been labeled as "safe at home. " with words such as safe, protected, calm, home, parents, or mother, children describe how they feel safe and protected at home and are happy with their family, as revealed in the most characteristic segments: "the virus can't figure | the hierarchical clustering dendrogram of the free association exercise, showing the most frequent words and the words with the greatest association χ ( ), p < . . frontiers in psychology | www.frontiersin.org get into my house so i am safe here and i don't want to go out. besides, i am happy to play with my family a lot" (x = . , boy, years) and "i am happy and calm because i like to be with my father and mother and we do many things that i like, and at home we are safe" (x = . , girl, years). within the same main cluster, the first class emerges, labeled as "emotions regarding lockdown" ( . %). in this class, it is emphasized that children have conflicting emotions during these times. on the one hand, they say they are bored, angry, overwhelmed, tired, and even lonely because they have to stay at home without being able to go out. on the other hand, they also say that they are happy and cheerful being with their family, as can be seen in the characteristic text segments: "bored because i have to do a lot of homework, sad, and a little lonely because i don't see my friends or my dog. but also happy because at home we spend more time with my father, mother, and sister and because we clap our hands at the window" (x = . , boy, years); "i am happy and cheerful but sometimes i get angry because i want to go out and see my friends. it's a virus that makes me feel angry because it's a pain in the ass and i can't decide about anything" (x = . , girl, years); and "i feel happy when i play with my family. sometimes i get angry and sometimes i get bored too. if i get angry, i yell and then my mother gets angry" (x = . , girl, years). finally, the fifth class emerges, labeled as "when is it going to end?" ( . %). children are very explicit about wanting to know when they will be able to return to school and to their normal life. in addition, many of them are also worried about whether they will still be in confinement on significant dates, for example, on their birthdays. the following are some of the most significant text segments of this class: "i have doubts because i don't know when this boring confinement is going to end. i want to go back to school and play with my friends" (x = . , boy, years); and "i want to know when i will go back to school. april th is my birthday, i will be and i will have to be at home, and i don't like it. " (x = . , girl, years). this class was mainly elicited by the oldest children ( - years; p < . ). given the wide range of emotions that emerged in the different classes, and in order to analyze these in more depth, we decided to create a tgen with all the words reflecting emotions and a sub-corpus with these and the associated text segments. this sub-corpus was subjected to a lexical similarity analysis (see figure ). the similarity analysis is interesting to observe the words interconnection as well as the level of relation between them, which rate of co-occurrences between them may be stronger or weaker (chi-squared test). based on this analysis, it can be seen more clearly that the coronavirus evokes feelings of fright -and even terror and fear -in the children. this fear is mainly associated with the possibility of infecting their grandparents, along with feelings of guilt. infants are also concerned about whether the doctors will manage to kill the bad bug (the covid- ). moreover, the children are also nervous, sad, and afraid of having to leave their house and are worried about falling ill outside. therefore, they feel happy, cheerful, calm, and safe at home with their family. however, at the same time, being at home also bores and tires them, particularly when it comes to schoolwork. finally, this lockdown situation also makes them feel angry. the findings of this research offer important clues for identifying how children integrate covid- into their everyday thinking. from the voices of the children, the issues that have arisen can be classified into two categories: the coronavirus itself, and the lockdown that has been implemented to control the spread of the virus. first, coronavirus is represented not only as an enemy, but also as something that could be contagious. specially from the youngest children's standpoint, the virus is viewed as something that is very bad and they represent it as a serious bug that is clearly their enemy. in the research carried out so far on covid- , and in other work on previous eids, other populations (adults and young people) also showed representations of enemies, but interestingly, this enemy or villain was never the disease itself, but the media, the government, or even the citizens who were perceived as behaving in an uncivilized way (idoiaga et al., b ). however, there is agreement regarding the heroeswhich are the doctors and healthcare professionals -and also the victims, who are the people most vulnerable to infection (wagner-egger et al., ; idoiaga et al., b ) . moreover, older children (the ones from to years) are quite concerned because they know that covid- is highly contagious. in fact, these children expressed their fear, concern, sadness, nervousness, and fright when they were asked about coronavirus. however, they understand the situation well, and most of them are more worried about infecting their grandparents than being infected themselves. however, some of them have expressed that they would feel guilty if someone close to them became infected. this emotion of guilt should be particularly taken into account since in china these feelings have been found to be intrinsically linked to post-traumatic stress (vidal, ) . therefore, it is of vital importance to make it clear to children that they will in no way be blamed if someone close to them becomes infected. second, and in relation to the lockdown, we observed the emergence of a sense of security on account of being made to stay at home. they express the idea that for them their house is a safe place and they feel protected at home. however, it should be borne in mind that along with this sense of security, children also express fear of going outside. it is true that at the time at which this research was conducted, children were not allowed to leave their homes under any circumstances. even so, the street should not be represented as something dangerous or scary because this could have undesirable consequences when the children are eventually permitted to go outside, turning those initial exits into the outside world into traumatic events (pakpour and griffiths, ) . returning to the confinement situation, the counter-emotions expressed by the children are remarkable. on the one hand, they are bored, angry, overwhelmed, tired, and even lonely because they have to stay at home without being able to go out. previous research conducted in china also found that similar negative emotions arise in children regarding the coronavirus lockdown (jiao et al., ; wang et al., ) . however, loneliness is a new and striking feeling to emerge in our study. in research with other age groups on covid- , loneliness was only aroused in the case of older people (aged over ; eiguren et al., ) . loneliness is an exceedingly painful experience that is the sum of an unfulfilled need for intimacy and social relationships that are felt to be insufficient or not entirely satisfactory (berger and poirie, ) . therefore, the emergence of this feeling indicates that peer interaction is extremely important to children (howes, ) . that is, they need contact with others such as friends and classmates, and the fact that they feel lonely indicates that they are not receiving the opportunity for such interaction, or at least, not to the extent that is required. given the importance of relationships in this growth stage, different strategies must be developed for children to cope with these feelings of loneliness until they have the opportunity to become re-acquainted with friends and classmates. for example, it would be useful to promote socialization strategies from within schools. in other words, in "real life" educational institutions are much more than places, where academic skills are developed; indeed, in terms of socialization in children, the school environment is the space par excellence (wentzel and looney, ) . therefore, in this situation, emphasis should also continue to be placed on promoting active relationships, with schools playing a primary role in the development and well-being of children. further, the children also report feeling happy and cheerful being at home with their family, because now they have more options to spend time and play with their parents, brothers, and sisters. this indicates the great work that families are doing to create safe and pleasant spaces, even in adverse situations like this, particularly in nurturing resilience in children exposed to epidemics (jiao et al., ) . resilience is an attribute that helps children to manage everything from minor disappointments to major life traumas (goldstein and brooks, ) . amid the current covid- crisis, research from china suggests that resilience should be nurtured by public health programs implemented by healthcare professionals, schools, and families in order to help children to overcome conditions of distress, and prospectively provide them with emotional and psychological support (pettoello-mantovani et al., ; dalton et al., ; jiao et al., ) frontiers in psychology | www.frontiersin.org further, given the results of our lexical similarity analysis, it is worth noting that we again observed the appearance of the emotions of fear, nervousness, sadness, happiness, calmness, boredom, and anger. some of these emotions, particularly those linked to fear, sadness, worry, or nervousness, have already been identified in other studies (jiloha, ) , but new emotions have also emerged here. in particular, emotions of anger and boredom need to be considered as they have been noted as risk factors for mental health during lockdown (brooks et al., ) and have already appeared in previous lockdown experiences during the sars epidemic (cava et al., ) . in addition, the fact that these emotions are represented in relation to schoolwork should be analyzed more carefully, since it might need to be considered whether this work is an additional source of conflict for families, as certain pedagogues point out (tonucci, ) . finally, there appears to be one particular question that repeatedly comes to the minds of the children, especially to the oldest ones, that is, when is this situation going to finish? it is clear that this question cannot be answered by anyone at this time, but this call for answers also makes it obvious that children need to be considered in communications regarding covid- . in fact, several academics have argued that communication about the epidemic in both family and institutional networks is essential for mitigating its effects and is also one of the best tools for fostering resilience (dalton et al., ; jiloha, ; weaver and wiener, ) . it is worth noting that this research also has some limits that should be mentioned. first of all, the main limitation refers to the way in which data were collected, that is through parents. although this choice was due to lockdown circumstances, the presence of parents may have altered some responses, especially those of younger children. secondly, the sample of this research includes a range of children of very varied ages, from to years. and although the results have pointed to some differences among the responses of children from different ages, their understandings for an epidemic disease and for their own cognitions and feelings probably will vary quite differently. in short, we are experiencing an unprecedented and rapidly changing situation. understanding the emotional patterns linked to the current pandemic from the voice of those that are most vulnerable i.e., children, and identifying how they cognitively represent and emotionally face this new situation could help to lay bare the strategies that could be developed in order to help them deal with the crisis from a psychological, emotional, and social sphere. to begin with, this research has shown that, contrary to popular belief, children are not impervious to covid- . they are experiencing this health crisis and its consequences first-hand, and they are feeling the considerable effects of these unprecedented circumstances at different levelsnot only emotionally, but also in physical and social terms. special attention must also be paid to the emotions of fear, worry, guilt, loneliness, boredom, and anger, with an emphasis on strengthening resilience and offering psychological support to parents and children, a point that has already been emphasized by a number of scholars during this crisis (coyne et al., ) . in this regard, it will be essential for governments and local authorities to develop social and inclusive policies that address the psychological, social, health, and well-being needs of children, which could help to mitigate the possible effects that they could suffer as a consequence of this crisis. the data that support the findings of this study are available on request from the corresponding author. the data are not publicly available due to their containing information that could 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håkansson, anders title: impact of covid- on online gambling – a general population survey during the pandemic date: - - journal: front psychol doi: . /fpsyg. . sha: doc_id: cord_uid: ri kw k the covid- pandemic may have severe impact on mental health, and concerns have been raised about potentially increased online behavior and possibly increased gambling problems, such as in sports bettors at risk of transfer to even riskier forms of gambling during sports lock-down. given the need for objective data about gambling behavior during the pandemic, the present analysis, from a project assessing online gambling in sweden, aimed to study past- -day gambling patterns in online gamblers in sweden. the study, carried out in may, , during the pandemic and its restrictions on society, included past-year online gamblers (n = ). past- -day gambling for several gambling types was lower compared to a previous study in online gamblers in the same setting, while online non-sports gambling remained at high levels. those reporting sports betting even during a period with decreased sports betting occasions proved to have markedly higher gambling problems. covid- may alter gambling behaviors, and online gamblers who maintain or initiate gambling types theoretically reduced by the crisis may represent a group at particular risk. the covid- pandemic has raised a number of issues related to health, beyond the most urgent and life-threatening consequences. the risk of mental health consequences has been highlighted (holmes et al., ) , and this also includes a risk of increased online behavior, such as increased video gaming (king et al., ) or addictive internet use (sun et al., ) . likewise, concerns have been raised about covid- -related consequences on gambling behavior. problem gambling and the gambling disorder represent conditions which are globally widespread; past-year problem gambling has been reported to occur in between . and . % of the general population across different countries and continents (calado and griffiths, ) . the gambling disorder is associated with severe financial, social and psychological consequences, including psychiatric comorbidity, but can be treated, primarily with cognitive-behavioral therapy and motivational interventions (potenza et al., ) . it has been documented in previous national financial crises that these may affect gambling behavior (economou et al., ) , although experiences from such crises are somewhat inconclusive (olason et al., ) . the covid- crisis, and the confinement and other restrictions associated with it, represent a previously unseen situation with both financial consequences for the population, other changes to the labor market, schooling and leisure activities. these changes include an increase in the time spent at home, possibly more time spent online, a risk of increased worry about the future, and may potentially affect gambling behavior . one specific circumstance is the substantial change in the gambling market itself, as virtually all sports typically subject to sports betting disappeared during a significant period of time . given the possible effects on other types of online behavior from covid- -related confinement (king et al., ; sun et al., ) , it may be hypothesized that some gambling types would be more favored than others, whereas others may decrease . sports betting is one of types of gambling known to increase the risk of problem gambling, and represents the second most common gambling type reported by treatment-seeking gambling disorder patients in the present setting (håkansson et al., ) . one concern is that given the large impact on sports during the pandemic, due to lockdown regulations and canceled events (radio sweden, ) , people with otherwise predominating sports betting habits would turn to gambling types with potentially even higher addictive potential, such as online casino games or other online-based gambling, due to the lack of sports events and land-based gambling opportunities . early in the pandemic, fear of such a transition within the gambling market led politicians to take legal action, such as through a limit to gambling advertising (sbc news, ) , or other proposed limits to the extent of online gambling (reuters, ) . sweden, the setting studied here, is one of the countries where the online gambling market is strong and online gambling is common among treatment-seeking patients (håkansson et al., ; håkansson and widinghoff, ) , which contributes to the perceived risk of further online gambling predominance during covid- . the fear of a transition to online gambling is supported by the general impression of online gambling being more addictive (chóliz, ) . however, so far, population data are very limited with respect to actual gambling habits during the covid- crisis. a previous general population study (including both gamblers and nongamblers) in sweden found a modest percentage reporting an increased gambling behavior during the crisis. as a response to decreased sports events, a minority reported either turning to other remaining sports events, online casino, or horse betting. in total, those reporting an increase in their gambling behavior were more likely to be problem gamblers (håkansson, ) . from a population survey in ontario, canada, it was reported that during the first weeks of lockdown of physical facilities such as landbased casinos, a substantial migration appeared to have occurred from land-based-only gambling to online gambling (price, ) . given the theoretically increased role of online behaviors (king et al., ; sun et al., ) , and the cancelation of sports activities, the present study focused on people reporting to be online gamblers. for the present study, data were derived from a population study on gambling behaviors, designed prior to the covid- crisis as a web survey which was carried out during the month of may, , i.e., during the ongoing crisis. this substudy used the past- -day data in order to describe gambling patterns during covid- . the aim of the present study was to describe past- -day use of different gambling types during the covid- pandemic in individuals defined as online gamblers, in order to enable a comparison with past- -day data reported from a previous survey in online gamblers carried out in . in particular, given the considerable changes in sports world-wide, the study also aimed to assess whether online sports bettors still reporting past- -day sports betting differed from those who did not. here, it was hypothesized that past- -day gambling in swedish online gamblers would be more common (in relation to a measure of past-year gambling behavior) for some gambling types, such as online casino or other online-based gambling types likely to be unaffected by the covid- constraints, compared to gambling types more clearly affected by the pandemic. also, it was hypothesized that people who maintained gambling during the crisis, particularly for gambling types such as sports betting believed to be reduced during covid- -related restrictions, would present other characteristics than other online gamblers. the present analysis is a partial analysis from a larger study on online gambling in sweden. this sub-analysis focuses on past- day and past-year gambling patterns in swedish online gamblers, in order to highlight the online gambling situation during the ongoing covid- crisis. the overall study was designed prior to the covid- crisis, and aimed for a larger number of analyses of the online gambling behavior in the setting. as a past- -day measure for different gambling types is available, this subset of data was used for the present analysis. the survey was carried out from may to , such that the -day period for each participant refers to a period well within the period of time when constraints due to covid- were actively ongoing, and during that whole -day period, sports betting related to major sports events, such as major soccer leagues, were completely canceled. the study data was collected using the same inclusion criteria and the same methodology as in a previous study carried out in , and which previously has reported associations between specific types of online gambling patterns and problem gambling and indebtedness (håkansson and widinghoff, ) . the study was reviewed by the swedish ethical review authority (file number - ), which expressed that the study did not formally require ethical permission according to swedish law, as it does not deal with data that can be directly or indirectly linked to a specific individual, and also expressed no ethical concerns with respect to the study. the study was opened only after a participant provided informed consent. participation in the study was paid following the credit system used by ipsos for other studies, and where a survey of the present extent and duration is rewarded with credit points corresponding to a value of around . euros within the credit system of the company. the present study took place in sweden, where gambling, since january st, , is regulated in a license-based system, with a large number of licensed operators. land-based casinos and land-based electronic gambling machines are run by a statebased monopoly, whereas betting on sports and horse racing, online casino and bingo games, as well as land-based and online lotteries, are subject to competition between a number of operators. a large percentage of the gambling advertisements seen in television promote online gambling, with online casino representing the largest share of these commercial messages (håkansson and widinghoff, ) . likewise, a majority of treatment-seeking gambling disorder patients report online casino as their predominating gambling type, with sports betting being the second most common type (håkansson et al., ) . slightly below . % of the general population are believed to be problem gamblers, with an increase reported to have occurred particularly in women, according to official general population survey data (bbc, ). during the period analyzed in the present study, sports events on competitive level in sweden were canceled, whereas land-based horse track racing continued, although without present audience but available through wagering online. likewise, the four major land-based casinos, all owned by the state monopoly, were closed. the present study aimed to include past-year online gamblers. the sample addressed were web panel members of a swedish market survey company, ipsos, i.e., individuals already enrolled with that company's web panel, and typically receiving market surveys and political opinion polls. the same methods and the same recruitment strategy were used in a previous study assessing online gamblers in sweden, recruited through the same web survey company and with the same screen-out question (håkansson and widinghoff, ) . participants of the web panel are regularly addressed with offers to participate in different surveys. in this case, they were included with the question "if you think about the past months, how often have you gambled on sports betting or online casino games?" with the options to respond "don't gamble on sports betting or online casino, " " - times, " " - times, " " times or more, " or "unsure/don't know." only individuals responding " times or more" were further considered in the study. the study had the intention to include , individuals. when closing the study, , individuals had answered the survey. for of them, at least one of the nine items of the gambling severity instrument (pgsi, see below) were missing, and therefore could not be categorized in a gambling severity category. three of them, however, had a total value already reaching above the cut-off for the highest problem level in that instrument (eight points or more) from the available items, and were accordingly categorized into that highest problem gambling category and included in the study. the remaining individuals were excluded from further analyses (based on the uncertainty of their problem gambling status), such that a final sample of individuals were included in the study. patterns of recent gambling was measured for each of the gambling types included, asking for whether that gambling types had been used ( ) during the past days, and if not ( ) at any time during the past-year (gambling types assessed were online casino, land-based casino, online horse betting, landbased horse betting, sports live betting, sports non-live betting, online poker, land-based poker, land-based electronic gambling machines, online bingo, and gambling within video games). thus, respondents endorsing the past- -day item were not asked about the period of time prior to the past days. individuals reporting any past-year gambling for a gambling type, but not past- -day gambling for that type, were compared to those reporting past- -day gambling (non-recent vs. recent gamblers). as no comparable -day period was available for comparison, the proportions of past-year gamblers who reported past- -day gambling, for each gambling type, were used as a measure of the extent to which different gambling types were affected by the covid- period. problem gambling severity was measured using the problem gambling severity index (pgsi), a nineitem scale (wynne and ferris, ) frequently used for the measure of a hazardous or problematic gambling behavior, with questions asked with a time frame of the past months. the same instrument was used, among other studies, in the preceding study on online gamblers in the present setting (håkansson and widinghoff, ) . as in previous research, respondents were categorized as having no risk gambling ( points), low risk gambling ( - points), moderate-risk gambling ( - points), or problem gambling ( points and above). gender and age (the latter in age groups) were reported, as well as living conditions (categories collapsed into living alone without children vs. not living alone) and occupation (categories collapsed into working/studying vs. unemployed/retired/sick-leave). also, it was reported whether the individual had ever self-excluded from gambling through the national self-exclusion system spelpaus , a governmental authority-based system introduced in swedish gambling legislation since january st, , and which allows a person to self-exclude for a duration of up to months (with the possibility of prolongation) from all legal (licensed) gambling operators in the country. sample characteristics and gambling patterns were reported as descriptive data. also, for each gambling type, descriptive data report the percentage of past-year gamblers for that gambling type who report having used it during the past days. past- -day gamblers-for each gambling type-were compared to non- -day past-year-gamblers for that gambling type, using chi-square analyses. seventy-five percent of respondents were men, and a majority were either working or retired. in total, % had a history of self-exclusion from the spelpaus system. fifty-two percent had no risk gambling according to the pgsi measure, % had lowrisk gambling, % were moderate-risk gamblers, and % were ( ) - ( ) and above ( ) living conditions alone with children ( ) alone without children ( ) with partner and children ( ) with partner without children ( ) with my parents ( ) occupation working ( ) studying ( ) unemployed ( ) retired ( ) other ( ) history of national self-exclusion yes ( ) no ( ) wish not to answer ( ) no risk ( ) low risk ( ) moderate risk ( ) problem gambling ( ) problem gamblers. a full description of the characteristics of the study sample is found in table . in women (n = ), % were moderate-risk gamblers and % were problem gamblers (a total of %), and in men (n = ), the corresponding percentages were and % (total %, p < . for gender difference, chi-square linear-by-linear). expressed as the percentage of past-year gamblers who gambled during the past days, for each gambling type, this ratio of past- -day gambling was the highest for online horse betting ( %), online casino ( %), online poker ( %) and online bingo ( %), as well as for the less frequent gambling within video games ( %), but lower for sports live betting ( %), non-live sports betting ( %), electronic gambling machines ( %), landbased horse gambling ( %), and land-based casino games ( %, table ). for those reporting past- -day gambling, compared to those denying that but reporting past-year gambling for the same gambling type, being a moderate-risk or problem gamblers was significantly more likely among the recent gamblers for landbased casino gambling, land-based electronic machine gambling, and for any sports betting, but less likely for online horse betting. the past- -day gamblers for online casino and land-based poker were significantly more likely to be female, whereas the recent online horse bettors were significantly more likely to be men ( table ) . the percentage of respondents in active work or studying were lower in recent gamblers for online casino ( vs. %, p < . ) and for online horse betting ( vs. %, p = . ), whereas no significant differences were seen in other gambling types (data not shown). among respondents reporting any sports betting during the pastyear (n = ), those who reported past- -day sports betting (n = ) were more likely to report past- -day online casino gambling ( vs. %, p < . ), land-based casino gambling ( vs. %, p = . ), online poker gambling ( vs. %, p < . ), land-based poker gambling ( vs. %, p = . ), land-based electronic gambling machines ( vs. %, p < . ), online bingo ( vs. %, p < . ), and gambling within video games ( vs. %, p < . ), while there were no significant differences regarding other types of gambling. those who reported past- -day sports betting were more likely to have a history of indebtedness ( vs. %, p = . ), and had higher levels of gambling problems (p < . , linear-by-linear, with the proportions of moderate-risk and problem gamblers being and % vs. and % vs., respectively). instead, they did not differ with respect to gender, age, history of self-exclusion, living alone without children, or currently in work/studies (data not shown). the present study is among the first studies reporting recent online gambling data from the covid- crisis. the present study included online gamblers, and focused on the characteristics of those reporting or not reporting recent gambling, in a situation with a changing gambling market where all major sports events had been canceled world-wide. thereby, the study attempts to shed light onto the discussion about whether the dramatic changes in the society during covid- could affect gambling among online gamblers. in summary, it can be concluded that online gambling types were more common compared to their past-year rates than were the landbased gambling types. importantly, sports bettors who did report sports betting even during this period, where such betting in the society was assumingly rare, had a very high degree of gambling problems and indebtedness, and gambled more. there was no indication that past-year sports bettors who denied betting in the recent covid- -affected period would have an increased gambling on other types of gambling. however, online horse bettors appeared to have a lower degree of gambling problems if they were recent gamblers, such that the characteristics of this group of gamblers may have been different during the pandemic than in the months prior to that. in the current study carried out during the covid- pandemic, the rates of -day gambling in the present study can be compared to the findings of a previous study with the same methods for recruitment, carried out in (håkansson and widinghoff, ) . in that study, the gender distribution was virtually the same as here ( % men in the previous study), whereas in the present study, participants tended to be older; in the previous study, % were in the youngest age group ( % here), and and % were in the two oldest age groups ( and % here). in the present study, past- -day gambling was comparable to the previous study for online casino ( vs. % in the previous study) and online bingo ( % in both studies), whereas gambling types which were lower in the present study include land-based casino gambling ( vs. % in the previous study), land-based horse betting ( vs. %), live sports betting ( vs. % in the previous study) and non-live sports betting ( vs. % in the previous study), land-based electronic gambling machine gambling ( vs. % in the previous study), and online poker ( vs. % in the previous study). instead, past- -day gambling in the present study was higher for online horse betting ( vs. % in the previous study). while respondents in the present study tended to be older, the data still describe clearly that land-based gambling types were markedly lower this time, whereas the percentages for online casino and online bingo appeared to be unchanged during the covid- situation. thus, although movements between gambling types cannot be analyzed here, the present data confirm the hypothesis that during the pandemic, some gambling types are more likely maintained than others, in line with the reported changes to the gambling market during the pandemic, whereas other types are more likely affected. for example, a low reporting of land-based casino gambling was far from surprising, as the major official casinos were closed during the study period, although smaller restaurantbased casinos may still be operating in many places in the country. this is consistent with the description of a relatively substantial migration of gamblers from land-based gambling opportunities to online gambling during casino lockdown in ontario, canada (price, ) . the higher degree of gambling problems and indebtedness in past-month gamblers were consistent with the hypothesis that in times where gambling of some types is scarce, those who still engage in that gambling type differ from those who do not. in this context; in times when sports betting is scarce, those who still bet on the reduced amount of sports are likely to have more severe gambling problems. in a recent general population study, a minority of respondents reported that the reduced sports betting opportunities made them gamble on other sports events than they usually do (håkansson, ) . in the present study, land-based gambling options, such as casino and gaming machine gambling in the land-based modality, also displayed the same pattern. thus, even though this was a sample recruited for their online gambling patterns; those who did report recent gambling on the markedly reduced land-based gambling types, had more severe gambling problems. in covid- and potential future similar crises, preventive efforts and interventions should address individuals who maintain gambling behaviors which are abandoned by a majority due to physical and legal restrictions. sports betting was far from inexistent even during the weeks when the global restrictions from covid- were the largest, such as during confinement in many countries. here, it should be borne in mind that individuals were recruited based on their past-year gambling online on occasions or more, i.e., they are likely to be a high-risk sample with respect to online involvement and intense gambling patterns, as supported by a previous study using the same recruitment strategy (håkansson and widinghoff, ) . thus, the present study may capture a group with particularly pronounced involvement in gambling and low tendencies to give up gambling completely. also, it is clear that despite the nearly total lock-down of wellestablished sports world-wide, some sports events still did occur. for example, there have been reports of low-tier soccer games receiving disproportional attention on betting sites, which has been highlighted mainly in the context of fears of fraud (match-fixing). however, besides this type of amateurlevel sports events still happening (sbc news, ), some nations' soccer leagues, otherwise unseen in the global media, continued; the belarus soccer league, for example, received some attention as it remained available for legal sports betting (the guardian,, ). therefore, again, despite a very large decrease in sports-related gambling opportunities world-wide, individuals who stick to the few gambling options left on the market may be a group presenting particularly high risk of gambling problems. it has been discussed whether specific other gambling types would attract new users because of the covid- , with the fear that some gambling types would put ex-bettors into more addictive gambling because of turning to other than the preferred gambling type. in the present study, for most gambling types, the past- -day gamblers either did not differ from past-year gamblers, or had a higher degree of gambling problems, such as for sports betting (as discussed above), landbased electronic gambling machines, or land-based casino. it is difficult to know whether the enhanced gambling problems in these recent gamblers are due to a recent increase because of the pandemic, or simply because frequent gamblers are more likely to report recent gambling compared to a person who gambles only occasionally, and therefore likely with a lower degree of problems. interestingly, however, one specific gambling type demonstrates the opposite trend; online horse bettors had significantly less gambling problems if they reported past- -day use, compared to past-year users with no recent use of that type. although this was measured in a limited sample and can be subject to confounding factors unknown here, it can be hypothesized that this specific gambling type has attracted individuals during the pandemic who have less gambling problems and who typically do not engage in horse race betting, such as if a move had happened from other more pandemic-influenced gambling types to this one. the relatively high reporting of online horse betting (and higher than in our previous study from the same setting) is in line with media reports of a sharp increase in horse wagering during the crisis (financial times, ) , and with the previous reporting from the general population in sweden that the ratio of individuals increasing/decreasing their horse wagering was unsurprisingly higher than for sports betting which was largely canceled (håkansson, ) . in contrast to the association with gambling problems (and indebtedness), it is interesting to note that employment status, or living alone, were factors unrelated to the reporting of recent sports betting; thus, this study gives no support to the idea that living conditions or a labor situation affected by the crisis may change gambling patterns. however, this issue would require more research, including more detailed and in-depth analyses including longitudinal study designs, and likely would merit from a longer time frame to study than only the weeks of crisis preceding this study. the present sub-analysis, describing sports betting and other gambling behaviors in online gamblers during a unique change to the society and to the gambling market, may have implications in immediate association with the covid- crisis. for the remainder of the acute and sub-acute phases of the pandemic, those who bet even on a scarce betting market may be more likely to have gambling problems and should be particularly approached by responsible gambling strategies. likewise, both in the short and long run, the present findings call for more research following gamblers over time during and after the pandemic, and particularly interventions research testing methods to prevent excessive gambling in the context of this crisis. such interventions may involve legal constraints on gambling types perceived to be particularly hazardous, in particular rapid online games, such as the limitation of advertisements or deposit limits suggested by policy makers in some settings (reuters, ; sbc news, ) . the actual effect of such interventions remains to be studied. interventions may also involve an increased awareness in mental health care or social support settings, where hazardous gambling patterns can be screened for in times of a financial crisis. although the world has never seen a crisis similar to the present one, study implications may also be relevant to other crises of a magnitude affecting many parts of society, including the world of sports and gambling. also, again, it puts attention to the importance to address the role of gambling in sports; for example, previous research has shown that elite athletes (grall-bronnec et al., ) may have a higher risk of being problem gamblers. in the present study, problem gambling was more common in women. while this may be a surprising finding in relation to most previous research, where a majority of problem gamblers are male (tavares et al., ; díez et al., ; calado and griffiths, ; edgren et al., ) . however, in the present setting, female problem gambling may have increased in recent years (svensson and romild, ; bbc, ) , and the gender distribution of the whole sample and the sub-sample with moderate-risk or problem gambling is consistent with the previous study using the same methodology (håkansson and widinghoff, ) . the present study has limitations; it relies on self-report data collected through a market survey company, which may limit the preciseness of reported data. the present study had the intention to include online gamblers, i.e., individuals with a certain degree of online gambling behavior (ten or more occasions during the past-year), given the high prevalence of online gambling and in order to provide a new measure to compare to a previous online gambling study carried out in the present setting (håkansson and widinghoff, ) . therefore, the present findings cannot be readily generalizable to samples of typical land-based gamblers (but also was not intended to do so), and were studied in only one country (where online gambling is common in problem gamblers, håkansson et al., ) , and may not be generalizable to settings where online gamblers represent a smaller proportion of the overall population gamblers. while some key figures were comparable to the previous study in online gamblers in sweden, the study can only claim to be representative of web panel-recruited online gamblers, and not to represent the whole population of land-based gamblers as well. while lock-down decisions due to the covid- pandemic clearly affected other types of land-based gambling that gambling related to sports, the sample assessed here was included because of their pastyear online gambling, making conclusions more difficult to draw conclusions about populations who may have had only a landbased casino gambling, for example. likewise, data rely on self-report rather than on objective measures of actual gambling, which, however, would have been difficult given the large number of gambling operators available in the area. it is also not possible to establish, from the present data, whether an individual's recent gambling represents an initiation or an increase in gambling, or even an individual's typical pattern of irregular or rare gambling which happened to occur during the past days prior to taking the survey. related to this, another limitation is the cross-sectional study design, i.e., the lack of a possibility to follow each individual's changing gambling pattern over time. however, the present analyses aimed to assess the gambling patterns in online gambling during the most acute phases of the pandemic in the present setting, but future followup studies are planned using the same type of recruitment, and can provide new measures of how gambling behaviors may alter in post-acute phases of the pandemic. overall, the results of the present study call for new data collections in this and other geographical settings, and in different pandemic phases. despite these limitations, the present sub-study from a structured web survey dataset of online gamblers, is one of the first and one of the few studies reporting gambling involvement actually happening during the covid- crisis. in conclusion, the present study has implications of relevance to stakeholders in the gambling policy area and in preventive and treatment work in problem gambling. people reporting sports betting in times when the world of sports is dramatically altered due to the pandemic may be at higher risk of problem gambling than other sports bettors, and should be a group to address for prevention and intervention. online casino and bingo gambling appear to less affected by the covid- crisis, while land-based gambling in these online gamblers appeared to be more scarce, and online horse betting was the only gambling type more commonly reported than in a corresponding previous dataset. the present findings add to the knowledge about online gambling, and to the need to address online gambling as one of the potential health hazards in the aftermath of the covid- pandemic. the raw data supporting the conclusions of this article will be made available by the authors, without undue reservation, to any qualified researcher. the studies involving human participants were reviewed and approved by the swedish ethical review authority. the patients/participants provided their written informed consent to participate in this study. ah was the sole author of the present manuscript, and the responsible of the research idea, the planning and ethics application of the study, as well as statistical analyses and writing of the manuscript. the present study does not have any specific funding. however, the study could be carried out thanks to the researcher's overall funding from the swedish state-owed gambling operator svenska spel, from the swedish alcohol monopoly, 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during the covid- pandemic in china problem gambling features and gendered gambling domains amongst regular gamblers in a swedish population-based study gender differences in gambling progression last league standing: belarusian football basks in new-found popularity the canadian problem gambling index: final report. ottawa: canadian centre on substance abuse (ccsa) conflict of interest: ah holds a position as researcher at lund university which was sponsored by the swedish state-owned gambling operator svenska spel as part of that body's responsible gambling policies, and also had funding from the research council of svenska spel as well as the research council of the swedish alcohol monopoly and from the swedish sports federation. none of these organization have been involved in or had any influence on any part of the present work.copyright © håkansson. this is an open-access article distributed under the terms of the creative commons attribution license (cc by). the use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. no use, distribution or reproduction is permitted which does not comply with these terms. key: cord- - vyik e authors: probst, thomas; humer, elke; stippl, peter; pieh, christoph title: being a psychotherapist in times of the novel coronavirus disease: stress-level, job anxiety, and fear of coronavirus disease infection in more than , psychotherapists in austria date: - - journal: front psychol doi: . /fpsyg. . sha: doc_id: cord_uid: vyik e this study investigated stress-level, degree of job-related anxiety, and fear of coronavirus disease (covid- ) infection in psychotherapists in the early weeks of the covid- lockdown in austria. one thousand five hundred and forty-seven psychotherapists participated in an online survey, assessing stress [perceived stress scale- (pss- )], work-related worries and fears of existence [job anxiety scale (jas)], fear of covid- infection during face-to-face psychotherapy, and adherence to five protective measures against covid- infection during face-to-face psychotherapy. stress-levels were higher than in a representative sample (p < . ). when psychotherapy was the sole income, stress-level (p = . ) and job anxiety (p < . ) were higher. experiences with teletherapy, the psychotherapy format used during covid- , as well as reductions in number of patients treated during covid- , had no effect on stress-level or job anxiety. psychotherapists still conducting face-to-face psychotherapy during covid- reported less fear of infection compared to those conducting no face-to-face psychotherapy (p < . ), whereby the fear of infection was further reduced when they were more able to adhere to protective measures against covid- (p < . ). mental hygiene is important for psychotherapists to manage stress and job-related anxiety during covid- , especially in those whose income relies on psychotherapy. previous research suggested that emotional stressors and existential stressors due to financial concerns range among the major stressors' psychotherapists are exposed to (petrowski et al., ; puig et al., ) . the novel coronavirus disease and the measures necessary to fight it (i.e., quarantine, isolation, and social distancing; see nussbaumer-streit et al., ) are new stressors, which can increase and even cause public mental health problems (brooks et al., ; hossain et al., ; sharma et al., ) . mental health care is, therefore, essential during and after covid- (fiorillo and gorwood, ; pfefferbaum and north, ; xiang et al., ) . psychotherapists are specifically qualified to provide mental health care. yet, they might face problems in dealing with the impact of covid- on their life and professional activity (pfefferbaum and north, ) . for example, sessions are usually provided in personal contact (faceto-face), which has to be reduced now and most likely in the near future as well. although providing psychotherapy via telephone or internet (teletherapy) is possible (whaibeh et al., ; wright and caudill, ) , many state that face-to-face contact is an essential part of the therapy (connolly et al., ) . thus, the required reduction of face-to-face contacts might lead to a reduced number of patients (humer et al., ; probst et al., ) as some reservations against teletherapy have been shown in psychotherapists (schuster et al., ) and the general population (apolinário-hagen et al., ) . this situation might reinforce distress and job anxiety in psychotherapists, especially in those not used to provide teletherapy. moreover, psychotherapists still providing psychotherapy face-to-face during covid- might be especially stressed because of fear of becoming infected with covid- . consequences of these examples might be increased mental burden of psychotherapists, and this distress may negatively impact process and outcome of psychotherapy (salyers et al., ; la verdière et al., ) . the issue of preventing psychotherapists' burnout is a central concern in this context. research suggests that helpers who experience increased psychological distress are unable to respond optimally or to use their core skills (west and shanafelt, ; kitchingman et al., ) . thus, exploring stress-level, job anxiety, and fear of covid- infection in psychotherapists is essential to know if psychotherapists need to increase their mental hygiene during covid- . to the best of our knowledge whether and to what degree psychotherapists experience stress, job-related anxiety, and fear of infection in situations of exposing public health emergency, such as during the covid- outbreak, have not been studied previously. therefore, the current study aimed to investigate the stress-level, degree of job-related worries and fears of existence, as well as fear of covid- infection in psychotherapists in the early weeks of the covid- outbreak in austria. throughout the present study, job anxiety refers to generalized job-related worrying, as well as worrying about job security and the future. in austria, the first covid- infections were reported on th of february . to combat the rapid spread of the virus, a lockdown became obligatory on th of march (bundesgesetzblatt für die republik Österreich, a,b,c). in general, entering public places was strictly prohibited. people were only permitted to leave their homes if they had a good reason for doing so, such as to meet necessary basic needs of daily life or to fulfill work responsibilities. in these exceptions, a minimum safe distance of m ( feet) had to be maintained between people. certain areas in austria were under quarantine at the time of the study and had even stronger restrictions. in the present study, the following research questions (rqs) were addressed. • rq : how are stress-level, job-related worries and fears of existence, and fear of covid- infection in psychotherapists in the early weeks of the covid- outbreak? we hypothesized higher stress-level, as well as job-related worries and fears of existence than pre-pandemic scores from representative samples. in the current study, eligible participants included all licensed austrian psychotherapists. in austria, psychotherapy is an independent profession regulated by the austrian law since (psychotherapy act, st federal act of june , on the exercise of psychotherapy). in brief, candidates have to complete a professional training comprising two stages (a general training followed by a specialist training) to qualify frontiers in psychology | www.frontiersin.org as a psychotherapist. all licensed psychotherapists in austria are registered in the list of psychotherapists of the austrian federal ministry of social affairs, health, care and consumer protection. in the current study, all psychotherapists who provided a valid e-mail address in this list (~ , psychotherapists of more than , licensed psychotherapists) were contacted by the first author in cooperation with the austrian federal association for psychotherapy (Öbvp). psychotherapists received a link to an online survey, which was open from th of march until st of april . to start the survey, participants had to agree to the data protection declaration (electronic informed consent). no incentives were provided, and participation was voluntary. the survey followed the principles outlined in the declaration of helsinki, and the ethics committee of the danube university krems (austria) approved the study. the perceived stress scale with items (pss- ; cohen et al., ) was used to measure the psychotherapists' stresslevel on a five-point response scale ( = "never" and = "very often"). the questions in this scale ask about feelings and thoughts during the last month, such as "how often have you been upset because of something that happened unexpectedly, " or "how often have you felt nervous and stressed. " the positively worded items of the pss- ( , , , and ) were reverse scored. the total score of the pss- was obtained by summing up the items, so that higher scores indicate higher stress-level. in previous studies, cronbach's alpha of the pss- was evaluated at > . , and test-retest reliability was > . (see review by lee, ) . in our sample, cronbach's alpha was . . job anxiety was measured with the items of the "worrying and fear of existence" dimension of the job anxiety scale (jas; linden et al., ) . this dimension consists of the subscales "worrying" and "fears of existence" and has shown good internal consistency (cronbach's alpha: . ). the instruction was adapted, so that participants were asked to rate the statements in relation to the psychotherapeutic work in the current situation around covid- . psychotherapists rated statements that described situations, thoughts, and feelings which one can have experienced in connection with the workplace on a five-point response scale ( = "strongly disagree" and = "totally agree"). the "worrying" scale describes generalized worrying about minor matters concerning the workplace and the work itself, comprising of five items such as "colleagues or family have already told me that i should not always worry that much about work. " the "fears of existence" scale focuses on worries about job security and the future, consisting of five questions like "a loss of my workplace is/would be existentially threatening. " the score for the worrying and fears of existence dimension was obtained by averaging the items, with higher scores indicating more job-related worries and fears of existence. values above the cut-off point of two points indicate high job-related worries and fears of existence (muschalla et al., ) . cronbach's alpha was . in our sample. psychotherapists were asked about their number of patients treated on average per week in the covid- lockdown as well as (retrospectively) in the months before. these numbers were given for face-to-face psychotherapies, for psychotherapy via telephone, and for psychotherapy via internet. for psychotherapists not treating during/before covid- , these numbers were set to . using these numbers, reductions of total (face-to-face, telephone, and internet) number of patients treated on average per week during covid- vs. in the months before were calculated (number in the months before covid- was subtracted from the number during covid- , i.e., during covid- -before covid- , so that more negative values indicate more reductions). as reported in another paper (probst et al., ) , the reductions of patients treated on average per week was statistically significant [m = . (sd = . ), p < . ]. psychotherapists were asked whether psychotherapy is their sole source of income or whether they have additional sources of income. psychotherapists were asked to rate their fear to become infected with covid- during psychotherapy in which they are face-to-face with patients on a sliding scale ranging from ("not at all") to ("extreme"). psychotherapists treating patients face-to-face during the covid- lockdown rated for each of the five protective measures against covid- how well they can adhere to the protective measure during face-to-face psychotherapy on a four-point response scale ( = "cannot adhere to the measure at all" and = "can completely adhere to the measure"). the following five protective measures were suggested by the government (austrian federal ministry of social affairs, health, care and consumer protection, ): ( ) wash your hands frequently! regularly and thoroughly wash your hands with soap or clean them with a disinfectant. ( ) maintain social distancing! maintain at least m ( feet) distance between yourself and all other persons who are coughing or sneezing. ( ) do not touch eyes, nose, and mouth! hands can pick up viruses and transfer the virus to your face! ( ) practice respiratory hygiene! cover your mouth and nose with your bent elbow or tissue when you cough or sneeze and dispose of the used tissue immediately. ( ) if signs and symptoms occur, do not leave your home and contact health care professionals or emergency services by phone. statistical analyses were performed with spss (ibm analytics). descriptive statistics were calculated to characterize participants and address rq . the comparison of the pss- with a norm sample was conducted using a t-test. for the job-related worries and fears of existence dimension of the jas, we compared the average score against the cut-off of two points indicating high job-related worries and fears of existence. to address rq a,b and rq a, independent t-tests were used to compare two groups of psychotherapists in each rq. for rq c, univariate anovas were performed to investigate four groups of psychotherapists. frontiers in psychology | www.frontiersin.org september | volume | article to address rq d and rq b, pearson's correlation analysis was performed. we report effect sizes using hedge's g with % cis. all statistical tests for significance were conducted two-tailed with an alpha level of . . in total, , psychotherapists participated. their mean age was . (sd = . ) years, and . % of them were female. a comparison of the distribution of their psychotherapeutic orientations with the distribution of therapeutic orientations in the official austrian list of psychotherapists (march ) showed that the humanistic orientation was overrepresented in the survey (% in the study sample vs. % in the austrian list of psychotherapists): psychodynamic . vs. . %, humanistic . vs. . %, systemic . vs. . %, and behavioral . vs. . % (not specified for % of the survey sample). the average year in profession (indicated as the time since psychotherapists were registered in the austrian list of psychotherapists in march ) was . (sd = . ) years. of the participating psychotherapist, ( . %) were treating only adults, ( . %) only children and adolescents, and ( . %) adults as well as children and adolescents. in total, , psychotherapists ( . %) were self-employed practitioners, ( . %) were regularly employed, and ( . %) worked self-employed as well as regularly employed. the average stress-level of the participating psychotherapists on the pss- was m = . (sd = . ). compared to the stress-level of employed persons in a representative german sample (m = . , sd = . ; klein et al., ) , the stress-level of the psychotherapists was higher, p < . , but the effect size was very small, hedge's g = . , % ci = . , . . on average, psychotherapists scored m = . (sd = . ) on the "worrying and fears of existence" dimension of the jas, thus scoring below . , the threshold differentiating between low and high job-related anxiety in a nonclinical employees sample (muschalla et al., ) . the average fear to become infected with covid- during face-to-face psychotherapy was m = . (sd = . ). compared to psychotherapists with additional sources of income (n = ), psychotherapists whose income relied solely on psychotherapy (n = ) reported significantly higher stress-levels, t( , . ) = . , p = . , hedge's g = . , % ci = . , . , and higher job-related worrying and fears of existence, t( , . ) = . , p < . , hedge's g = . , % ci = . , . . means and sds are shown in table . compared to psychotherapists who already used telephone or internet for psychotherapy in the months before covid- (n = ), psychotherapists who did not use telephone or internet for psychotherapy in the months before covid- (n = , ) reported no differences regarding perceived stress, t( , ) = . , p = . , hedge's g = . , % ci = − . , . , and job-related worrying and fears of existence, t( , ) = . , p = . , hedge's g = . , % ci = − . , . . table shows the means and sds. between psychotherapists treating only face-to-face (n = ), face-to-face as well as via teletherapy (telephone or internet, n = ), only via teletherapy (telephone or internet, n = ), or not at all (n = ) in the early weeks of the covid- lockdown, stress-levels, f( , , ) = . , p = . , and job-related worries and fears of existence, f( , , ) = . , p = . , did not differ. of the psychotherapists treating not at all reported that they treated patients in the months before covid- , whereas reported that they did not. means and sds are shown in table . psychotherapists with more reductions in the total (face-toface + telephone + internet) number of patients treated on average per week in covid- as compared to the months before experienced comparable stress-level, r = − . , p = . , as well as comparable job-related worries and fears of existence, r = − . , p = . , as psychotherapists with less reductions in the total number of patients treated on average per week. psychotherapists who conducted no face-to-face psychotherapy in the early weeks of the covid- lockdown (n = ) reported higher fear of infection (m = . , sd = . ) compared to the psychotherapists who still conducted face-to-face psychotherapy during the covid- lockdown (m = . , sd = . ), t( , . ) = . , p < . , hedge's g = . , % ci = . , . . table shows the means and sds regarding how well psychotherapists could adhere to the five protective measures against covid- during face-to-face psychotherapy in the early weeks of the covid- lockdown. in addition, the correlation coefficients for associations between the psychotherapists' ability to adhere to the protective measures and fear of covid- infection during face-to-face psychotherapy are given in table . the correlation coefficients between ability to adhere to the protective measures and fear of covid- infection were all negative and statistically significant (all values of p < . ). this means that psychotherapists treating face-to-face during the covid- lockdown had significantly less fear of covid- infection when they were more able to adhere to the protective measures against covid- . this survey explored stress-level, job-related worries and fears of existence, and fear of covid- infection during face-toface psychotherapy in psychotherapists in austria. stress-level was higher than scores of a german-speaking norm sample. job-related worries and fears of existence were below the cut-off that defines high job-related anxiety. these results confirm the hypothesis that stress-level was elevated, but reject the one that job-related worries and fears of existence were high. stress-level and job-related worries and fears of existence were significantly higher in psychotherapists who had no other sources of income besides psychotherapy. this confirms our hypothesis. since mental well-being of psychotherapists represents a key determinant of their ability to deliver high-quality psychological health care (salyers et al., ; la verdière et al., ) , this illustrates the need to reduce existential stressors due to economic uncertainty, especially for psychotherapists whose income relies solely on psychotherapy. besides professional policy, stressmanagement interventions for health care professionals might cohen et al., ) . job-related worrying and fears of existence were measured with the items "worrying and fears of existence" dimension of the job anxiety scale (jas; linden et al., ) . mean parameter values for each of the analyses are shown for the psychotherapists with psychotherapy as sole income (n = ) and the psychotherapists with additional sources of income (n = ), as well as the results of the two-tailed t-tests (assuming unequal variance) comparing the parameter estimates between the two groups of psychotherapists. (cohen et al., ) . job-related worrying and fears of existence were measured with the items "worrying and fears of existence" dimension of the jas (linden et al., ) . (cohen et al., ) . job-related worrying and fears of existence were measured with the items "worrying and fears of existence" dimension of the jas (linden et al., ) . frontiers in psychology | www.frontiersin.org be further options for psychotherapists who derive all their income from psychotherapy (ruotsalainen et al., ) . stress-level and job-related worries and fears of existence were not lower for psychotherapists who practiced psychotherapy via telephone or internet already before covid- . this result contrasts with our hypothesis assuming that those psychotherapists already used to teletherapy experience less stress-level, as well as job-related worries and fears of existence during covid- . maybe switching to telephone or internet to provide psychotherapy was easy for those psychotherapists who did not use these formats for psychotherapy before covid- . it has also been reported that in the context of the forced transition toward teletherapy because of the covid- pandemic, the majority of surveyed psychotherapists from north america and europe developed a positive attitude toward teletherapy (békés and aafjes-van doorn, ) . therefore, it is possible that psychotherapists without previous teletherapy experience felt more at ease using teletherapy after they gained first experiences. also previous studies showed that therapists reported that they were pleasantly surprised by the functionality and ease of use of videoconferencing upon using teletherapy (connolly et al., ) . the context of this forced transition to teletherapy because of the covid- pandemic might have further increased the psychotherapists' motivation to use remote psychotherapy in order to be able to continue the sessions with all or most of their patients. stress-levels as well as job-related worries and fears of existence did not differ between psychotherapists treating only face-to-face, face-to-face as well as via teletherapy, only via teletherapy, or not at all. one explanation why psychotherapists treating not at all during covid- did not differ from the other groups regarding stress and job anxiety might be that they did not depend financially on psychotherapy. indeed, about one-third ( out of ) of the psychotherapists providing no psychotherapy at all during covid- did not treat patients in the months before covid- , either. thus, they could afford to quit practicing during the lockdown without additional stress and job-related worries. however, one has also to consider that both groups of psychotherapists were rather small (n = psychotherapists practicing only face-to-face and n = psychotherapists practicing not at all), which limits the overall significance of the current findings. details on the number of patients treated with respect to treatment format have been published recently (probst et al., ) . in brief, the total number of patients treated on average per week decreased from m = . (sd = . ) in the months before the covid- lockdown to m = . (sd = . ) in the early weeks of the covid- lockdown (p < . ). reductions in total number of patients treated on average per week in covid- as compared to the months before affected neither stress-level nor job-related worries and fears of existence. this result is in contrast to our hypothesis that more reductions in patients treated are associated with more stress-levels as well as more job-related worries. one explanation for this could be that, in the early weeks of the covid- lockdown, psychotherapists were hoping that the lockdown will soon be over and that they will be able to treat their usual number of patients by face-to-face psychotherapy soon again. the longer the lockdown, the higher the correlations (between reduced number of patients on the one side and stress-level or job-related worries or fears of existence on the other side) might be. psychotherapists still practicing face-to-face during the covid- lockdown had lower fear of covid- infection during face-to-face psychotherapy than psychotherapists not practicing face-to-face during covid- . this result rejects our hypothesis that fear of covid- infection during face-to-face psychotherapy is higher in psychotherapists still treating patients face-to-face during covid- . an explanation for this result might be that fear of covid- infection might be a reason for some psychotherapists to stop treating face-to-face. furthermore, it might be that those psychotherapists who have limited practice space, stopped treating face-to-face as they would not have been able to keep an appropriate safety distance. this is further supported by the negative correlation between the adherence to the protective measure of social distancing and the fear of covid- infection in psychotherapists treating face-to-face during the lockdown. similarly, also the ability to adhere to the other four protective measures against covid- of the austrian government was associated with lower fear of covid- infection for psychotherapists treating face-to-face. it should be kept in mind that most effect sizes for the significant results were small. the results refer to the early weeks of the covid- situation in austria (first covid- infections were reported on th of february , measures of the government became obligatory on th of march , and the survey was open from th of march to st of april ). stress-levels and job-related anxiety might change dynamically either positively or negatively depending on the durations and intensity of the restrictions. there are a number of limitations in this study. the major limitation is the cross-sectional design, so that we cannot say whether the psychotherapists' stress-level or job-related worries and fears of existence changed during covid- as compared to the time before. a further limitation is that the fear to become infected was operationalized by a single item measure. meanwhile, a validated scale to assess the fear of covid- became available (ahorsu et al., ) , which should be considered in future studies. in addition, only psychotherapists' self-ratings on number of patients treated on average per week could be analyzed and not health insurance data. due to the cross-sectional design, there might be a recall bias regarding the number of patients treated on average per week in the months before covid- . moreover, stress-level was operationalized only with self-reports and not complemented by more objectively quantifiable physiological measurements, such as cortisol analyses (dickerson and kemeny, ) . such analyses are not easily possible in online surveys, and lab studies would be necessary. another shortcoming is the online conduction of the survey, which might have caused some respondent bias, such as higher psychotherapists' participation with higher preference for new technologies, which might have contributed to the finding that experience with teletherapy did not affect stress-level and job-related anxiety. carrying out the survey online may also have introduced some selection bias toward fewer elder psychotherapists' participation (bethlehem, ) . although the sample largely reassembled the psychodynamic, behavioral, and systemic population of austrian therapists (deviation range from − . to − . % units), therapists with a humanistic orientation were overrepresented (deviation range of . % units), which further limits the generalizability of the findings to the population of austria's psychotherapists. since the study was conducted in austria, results may only be applicable to countries with similar mental health care systems (for example, psychotherapy -but not counseling -via internet is rejected by the official internet guideline for psychotherapists in austria at the time of the study; however, health insurances started to cover the costs for psychotherapy via telephone or internet during and comparisons with countries, which already implemented e-health solutions in routine psychotherapy would be interesting. overall, psychotherapists need to meet the challenges inherent in balancing stressors, especially in situations of increased mental, emotional, and economic challenges, such as during covid- , to ensure optimal psychotherapeutic services. this study suggests that mental hygiene is important for psychotherapists to manage stress and job-related anxiety during covid- . the finding that mainly being financially dependent on psychotherapy was associated with higher stress-level and job anxiety is important in regard to professional policy. this might also have an effect on therapeutic process, as increased mental burden of psychotherapists and distress may negatively affect process and outcome of psychotherapy. therefore, results suggest that especially psychotherapists whose income relies on psychotherapy need to increase their mental hygiene during covid- . the raw data supporting the conclusions of this article will be made available by the authors, without undue reservation. ethical review and approval was not required for the study on human participants in accordance with the local legislation and institutional requirements. the patients/participants provided their written informed consent to participate in this study. tp, ps, and cp: conceptualization. tp: methodology, formal analysis, investigation, and data curation. tp and eh: writingoriginal draft preparation. cp and ps: writing -review and editing. all authors have read and agreed to the published version of the manuscript. frontiers in psychology | www.frontiersin.org the fear of covid- scale: development and initial validation public attitudes toward guided internet-based therapies: web-based survey study austrian federal ministry of social affairs, health, care and consumer protection ( ) psychotherapists' attitudes toward online therapy during the covid- pandemic selection bias in web surveys the psychological impact of quarantine and how to reduce it: rapid review of the evidence . verordnung: verordnung gemäß § z des covid- -maßnahmengesetzes . verordnung: Änderung der verordnung gemäß § z des covid- -maßnahmengesetzes . verordnung: Änderung der verordnung gemäß § z des covid- -maßnahmengesetzes a global measure of perceived stress a systemic review of providers' attitudes toward telemental health via videoconferencing acute stressors and cortisol responses: a theoretical integration and synthesis of laboratory research the consequences of the covid- pandemic on mental health and implications for clinical practice mental health outcomes of quarantine and isolation for infection prevention: a systematic umbrella review of the global evidence provision of psychotherapy during the covid- pandemic among czech, german and slovak psychotherapists telephone crisis support workers' psychological distress and impairment the german version of the perceived stress scale-sychometric characteristics in a representative german community sample psychological health profiles of canadian psychotherapists: a wake up call on psychotherapists' mental health review of the psychometric evidence of the perceived stress scale die job-angst-skala (jas): entwicklung eines neuen fragebogens zur erfassung arbeitsplatzbezogener Ängste the significance of jobanxiety in a working population quarantine alone or in combination with other public health measures to control covid- : a rapid review occupational stressors in practicing psychological psychotherapists mental health and the covid- pandemic changes in the provision of psychotherapy in the early weeks of the covid- lockdown in austria burnout syndrome in psychotherapists: a comparative analysis of five nations preventing occupational stress in healthcare workers the relationship between professional burnout and quality and safety in healthcare: a meta-analysis the advantages and disadvantages of online and blended therapy: survey study amongst licensed psychotherapists in austria impact of isolation precautions on quality of life: a meta-analysis physician well-being and professionalism telemental health in the context of a pandemic: the covid- experience remote treatment delivery in response to the covid- pandemic timely mental health care for the novel coronavirus outbreak is urgently needed key: cord- - j p e authors: suomi, aino; schofield, timothy p.; butterworth, peter title: unemployment, employability and covid : how the global socioeconomic shock challenged negative perceptions toward the less fortunate in the australian context date: - - journal: front psychol doi: . /fpsyg. . sha: doc_id: cord_uid: j p e unemployed benefit recipients are stigmatized and generally perceived negatively in terms of their personality characteristics and employability. the covid economic shock led to rapid public policy responses across the globe to lessen the impact of mass unemployment, potentially shifting community perceptions of individuals who are out of work and rely on government income support. we used a repeated cross-sections design to study change in stigma tied to unemployment and benefit receipt in a pre-existing pre-covid sample (n = ) and a sample collected during covid pandemic (n = ) by using a vignette-based experiment. participants rated attributes of characters who were described as being employed, working poor, unemployed or receiving unemployment benefits. the results show that compared to employed characters, unemployed characters were rated substantially less favorably at both time points on their employability and personality traits. the difference in perceptions of the employed and unemployed was, however, attenuated during covid with benefit recipients perceived as more employable and more conscientious than pre-pandemic. these results add to knowledge about the determinants of welfare stigma highlighting the impact of the global economic and health crisis on perception of others. the onset of covid pandemic saw unemployment climb to the highest rate since the great depression in many regions globally . over just one month, from march to april unemployment rate in the united states increased from . % to over . % and in australia the effective rate of unemployment increased from . to . % (australian bureau of statistics, ) . in australia, a number of economic responses were rapidly introduced including a wage subsidy scheme (jobkeeper) to enable employees to keep their employees connected to the workforce, one-off payments to many welfare recipients, and a doubling of the usual rate of the unemployment benefits (jobseeker payment) through a new coronavirus supplement payment. at the time of writing in july , many countries, including australia remain in the depths of a health and economic crisis. a rich research literature from a range of disciplines has documented the pervasive negative community views toward those who are unemployed and receiving unemployment benefits, with the extent of this "welfare stigma" being particularly pronounced in countries with highly targeted benefit systems such as the united states and australia (fiske et al., ; baumberg, ; contini and richiardi, ; schofield and butterworth, ) . the stigma and potential discrimination associated with unemployment and benefit receipt are known to have negative impacts on health, employability and equality (for meta-analyses, see shahidi et al., ) . in addition, the receipt of unemployment benefits co-occurs with other stigmatized characteristics such as poverty and unemployment (schofield and butterworth, a) . the changing context related to the covid crisis provides a novel opportunity to better understand the determinants of stigmatizing perceptions of unemployment and benefit receipt. negative community attitudes and perceptions of benefit recipients are commonly explained by the concept of "deservingness" (van oorschot and roosma, ) . the unemployed are typically seen as less deserving of government support than other groups because they are more likely to be seen as responsible for their own plight, ungrateful for support, not in genuine need (petersen et al., ; van oorschot and roosma, ) , and lacking reciprocity (i.e., seen as taking more than they have given -or will give -back to society; van oorschot, ; larsen, ; petersen et al., ; aarøe and petersen, ) . given the economic shock associated with covid , unemployment and reliance on income support are less likely to seen as an outcome within the individuals control and may therefore amplify perceptions of deservingness. prior work has shown that experimentally manipulating perceived control over circumstances does indeed change negative stereotypes (aarøe and petersen, ) . a number of experimental paradigms have been used to investigate perceptions of "welfare recipients" and the "unemployed." the stereotype content model (scm; fiske et al., ) , for example, represents the stereotypes of social groups on two dimensions: warmth, relating to being friendly and well-intentioned (rather than ill-intentioned); and competence, relating to one's capacity to pursue intentions (fiske et al., ) . using this model, the "unemployed" have been evaluated as low in warmth and competence across a variety of welfare regime types (fiske et al., ; bye et al., ) . the structure of stereotypes has also been studied using the big five personality dimensions (schofield and butterworth, b; schofield et al., ) : openness, conscientiousness, extraversion, agreeableness, and emotional stability (for background on the big five see: goldberg, ; hogan et al., ; saucier and goldberg, ; mccrae and terracciano, ; srivastava, ; chan et al., ; löckenhoff et al., ) . there are parallels between the big five and the scm: warmth relating to the dimension of agreeableness, and competence relating to conscientiousness (digman, ; ward et al., ; cuddy et al., ; abele et al., ) and these constructs have been found to predict employability and career success (barrick et al., ; cuesta and budría, ) . warmth and agreeableness have also been linked to the welfare-specific characteristics of deservingness (aarøe and petersen, ) . the term "employability" has been previously defined as a set of achievements, skills and personal attributes that make a person more likely to gain employment and leading to success in their chosen career pathway (pegg et al., ; o'leary, o'leary, , . while there are few studies examining perceptions of others, perceptions of one's own employability have been recently studied in university students, jobseekers (atitsogbe et al., ) and currently employed workers (plomp et al., ; yeves et al., ) , consistently showing higher levels of perceived employability being linked to personal and job-related wellbeing as well as career success. examining other's perceptions of employability may be more relevant to understand factors impacting on actual employment outcomes. a majority of studies examining other's perceptions of employability have focused on job specific skills study (lowden et al., ; dhiman, ; saad and majid, ) . building on this previous work, our own research has focused on the effects of unemployment by drawing on frameworks of big five, scm and employability in pre-covid samples (schofield and butterworth, b; schofield et al., ) . our studies consistently show that unemployed individuals receiving government payments are perceived as less employable (poorer "quality" workers and less desirable for employment) and less conscientious. we found similar but weaker pattern related to agreeableness, emotional stability, and the extent that a person is perceived as "uniquely human" (schofield et al., ) . further, we found that vignette characters described as currently employed but with a history of welfare receipt were indistinguishable from those described as employed and with no reference to benefit receipt (schofield et al., ) . findings such as this provide experimental evidence that welfare stigma is malleable and can be challenged by information inconsistent with negative stereotype (schofield and butterworth, b; schofield et al., ; see also petersen et al., ) . the broad aim of the current study was to extend this previous work by examining the impact of covid on person perceptions tied to employment and benefit recipient status. it repeats a pre-covid study of an australian general population sample in the covid context, drawing on the same sampling frame, materials and study design to maximize comparability. the study design recognizes that the negative perceptions of benefit recipients may reflect a combination of difference sources of stigma: poverty, lack of work, and benefit receipt. therefore, the original study used four different conditions to seek to differentiate these different sources: ( ) employed; ( ) working poor; ( ) unemployed; and ( ) unemployed benefit recipient. finally, for the covid sample we added a novel fifth condition: ( ) unemployment benefit recipient also receiving the "coronavirus" supplement. we except that the reference to a payment specifically applicable to the covid context may lead to more favorable perceptions (more deserving) than the other unemployed and benefit receipt characters. the study capitalizes on a major exogenous event, the covid crisis, which we hypothesize will alter perceptions of deservingness by fundamentally challenging social identities and perceptions of one's own vulnerability to unemployment. the study tests three hypotheses, and in doing so makes an important empirical and theoretical contribution to understanding how deservingness influences person perception, and understanding of the potential "real world" barriers experienced by people seeking employment in the covid context. the pre-covid assessment uses a subset of data from a pre-registered study, but this reuse of the data was not preregistered . we hypothesize that, at time (pre-covid assessment) we will find that employed characters will be rated more favorably than characters described as unemployed and receiving unemployment benefits, particularly on dimensions of conscientiousness, worker and boss suitability. moreover, we expect a gradient in perceptions across the four experimental conditions, from employed to working poor, to unemployed to unemployed receiving benefits and to show a similar trend for the other outcome measures included in the study. we hypothesize that the character in the unemployed condition(s) would be rated less negatively relative to the employed condition(s) at time , compared to time . we predict a two-way interaction between time and condition for the key measures (conscientiousness, worker and boss suitability) and a similar trend on other outcomes. we expect that explicit reference to the unemployed benefit character receiving the "coronavirus supplement" payment will increase the salience of the covid context and lead to more positive ratings of this character relative to the standard unemployed benefit condition in the pre-covid and covid occasions. two general population samples (pre-covid and covid ) were recruited from the same source: the australian online research unit (oru) panel. the oru is an online survey platform that provides access to a cohort of members of the general public who are interested in contributing to research. the oru randomly selects potential participants who meet study eligibility criteria, and provides the participant with an incentive for their participation. the sample for the time (pre-covid ) occasion was part of a larger study ( participants) collected in november . from this initial dataset, we were able to use data from ( . % female, m age = . [ . ] years, range: - ) participants who were presented with the one vignette scenario that we could replicate at the time of the social restrictions applicable in the covid context (i.e., the vignette character was not described as going out and visiting friends, as these behaviors were illegal at time ). the sample for time (covid ) was collected in may-june , at the height of the lock down measures in australia and included participants ( . % female, m age = . [ . ] years, range: - ). the two samples were broadly similar (see below), though the proportion of male participants at time was greater than at time . the pre-covid assessment at time was restricted to those participants who completed the social-distancing consistent vignette in the first place to avoid potential order/context effects. this provided, on average, respondents in each of the four experimental conditions. using the results from our previous published studies as indicators of effect size (schofield and butterworth, b; schofield et al., ) . monte carlo simulation was used to identify the time sample size that would provide % power to detect an interaction effect that represented a % decline in the difference between the two employment and two unemployment conditions on the three-key measures at the covid occasion relative to the pre-covid difference. this sample size of per condition also provided between and % power to detect a difference of a similar magnitude between the employed and unemployment benefit conditions across the two measurement occasions. given previous evidence that the differences between employed and unemployed/welfare conditions is robust and large for conscientiousness and worker suitability (schofield and butterworth, b) , the current study is also adequately powered to detect the most replicable effects of unemployment and welfare on perceptions of a person's character (even in the absence of the hypothesized interaction effect). the procedures were identical on both study occasions. participants read a brief vignette that described a fictional character, and then rated the character on measures reflecting personality dimensions, their suitability as a worker or boss, morality, warmth, and competence, and the participant's beliefs the character should feel guilt and shame, or feel angry and disgusted. at time (pre-covid context) participants then repeated this process with a second vignette, but we do not consider data from the second vignette. the key experimental conditions were operationalized by a single sentence embedded within the vignette that was randomly allocated to different participants (employed: "s/he is currently working as a sales assistant in a large department store"; working poor: "s/he is currently working as a sales assistant, on a minimum-wage, in a large department store"; unemployed: "s/he is currently unemployed"; and receipt of unemployment benefits: "s/he is currently unemployed, and is receiving government benefits due to his/her unemployment"). the four experimental conditions were identical at both time points. at time , an additional covid -specific condition was included (to maximize the salience of the covid context): "s/he is currently unemployed and is receiving government benefits, including the coronavirus supplement, due to his/her unemployment." all three study conditions will imply poverty/low income. in australia, few minimum-wage jobs are supplemented by tips, and so a minimum-wage job indicates a level of relative poverty. a full-time worker in a minimum wage job is in the bottom quartile of income earners (australian bureau of statistics, ). prior to the covid crisis and the increase in payment level, a single person with no dependents receiving unemployment benefits received approximately % of the minimum-wage in cash assistance. during covid and at the time of the data collection, the rate of pay exceeds the minimum-wage. several characteristics of the vignette character, including age and relationship status, were balanced across study participants. age was specified as either or years, relationship status was either "single" or "lives with his/her partner." the character's gender was also varied and names were stereotypically white. for time , manipulated characteristics yielded unique vignettes, comprised of four key experimental conditions (employed, working poor, unemployed, and unemployment benefits) × ages × genders × relationship statuses. for time , manipulated characteristics yielded unique vignettes, comprised of five key experimental conditions (employed, working poor, unemployed, unemployment benefits, and unemployed + coronavirus supplement) × ages × genders × relationship statuses. the vignette template construction is presented in figure including each component of the vignette that was randomly varied. in both studies, participants were required to affirm consent after debriefing or had their data deleted. participant comprehension of the vignettes was checked via three freeresponse comprehension questions about the character's age and weekend activities. participants who did not answer any questions correctly were not able to continue the study. personality, employability (suitability as a worker or boss), communion and agency, cognitive and emotional moral judgments, and dehumanization were included as the study outcomes. while not all personality or character dimension measures can be considered as negative or positive, higher scores were used in the study to indicate more "favorable" perceptions by the participants of the characters. the ten item personality inventory was used to measure the big five (gosling et al., ) and adapted to other-oriented wording (i.e., "i felt like the person in the story was. . .") (schofield et al., ) . two items measured each trait via two figure | outline of vignette construction in parts. bullet pointed options replace the underlined text, with gendered pronouns in each option selected to match character name. paired attributes. one item contained positive attributes and one contained negative attributes. participants indicated the extent to which "i think [name] is [attributes]" from (strongly disagree) to (strongly agree). the order of these items was randomized. agreeableness (α = . ) was assessed from "sympathetic, warm" and "critical, quarrelsome" (reversed); extraversion (α = . ) was assessed from "extraverted, enthusiastic" and "reserved, quiet" (reversed); conscientiousness (α = . ) was assessed from "dependable, self-disciplined" and "disorganized, careless" (reversed); openness to experience (α = . ) was assessed from "open to new experiences, complex" and "conventional, uncreative" (reversed); emotional stability (α = . ) was assessed from "calm, emotionally stable." and "anxious, easily upset" (reversed). the order of these items was randomized. single item measures: "i think [name] would be a good worker" (worker suitability) and "i think [name] would be a good boss" (boss suitability) were rated on the same scale as the personality measure. the order of these two items was randomized. higher scores indicated better employability. communion and agency was assessed using bocian et al. ( ) adaptation of abele et al. ( ) scale that measures the fundamental dimensions of communion and agency using twosubscales for each dimension. the morality and warmth subscales are seen as measures of communion (referred to as warmth in scm; fiske, ) ; while the competence and assertiveness subscales measure agency (what fiske refers to as competence in scm; fiske, ) . this subscale structure has been identified in multiple samples. participants indicated the extent to which "i think [name] [attributes]" from (not at all) to (very much so). morality (α = . ) was measured with six items, e.g., "is just, " "is fair"; warmth (α = . ) with six items, e.g., "is caring, " "is empathetic"; competence (α = . ) with five items, e.g., "is efficient, " "is capable"; and assertiveness (α = . ) with six items, e.g., "is self-confident, " "stands up well under pressure." these items were presented in a random order. dehumanization was measured with a composite scale of twoitems drawn from bastian et al. ( ) . based on prior research, we measured dehumanization with two items: "i think [name] is mechanical and cold, like a robot" and "i think [name] lacked self-restraint, like an animal" order of these two items was randomized. we reverse coded the two items for the analyses for consistency for the other variables, so that higher scores were indicative of more favorable perceptions. moral emotions were measured by four items that asked about emotional responses to the character that were framed as selfcondemning or other-condemning (haidt, ; giner-sorolla and espinosa, ) . two other-condemning items asked the participant about their own emotional response to the character in the vignette (anger: "[name]'s behavior makes me angry"; disgust: "i think [name] is someone who makes me feel disgusted, " α = . ). the two self-condemning items asked about the character's emotional response (guilt: " [name] should feel guilty about [his/her] behavior"; shame: "i think [name] should feel ashamed of [him/her]self "; α = . ). we reverse coded the two scales to ensure consistency with other variables, with higher scores indicative of more favorable perceptions. with the exception of the moral emotion (and communion and agency) scales that are new to this study and the previously tested openness to experience, our previous research has demonstrated differences between the ratings of employed and unemployed characters on the included outcome measures (schofield and butterworth, b; schofield et al., ) . we undertake the analysis using a four-step process. we use mixed-effects multi-level models, with the outcome measures nested within participants, and predicted by fixed (betweenperson) terms representing the experimental "condition, " "time" (pre-/covid ) and their interaction, and controlling for measure differences and allowing for random effects at the participant level: i) we initially assessed the effect of condition in the pre-covid occasion to establish the baseline pattern of results; ii) we then evaluated the interaction term and, specifically, the extent to which the baseline difference observed between employment and unemployment conditions is attenuated at time (covid occasion); iii) we tested the three-way interaction between condition, occasion and measure to assess whether this two-way interaction varies across the outcome measures; and if significant iv) repeated the modeling approach using separate linear regression models for each outcome measure. our initial model contrasts the two employed (employed and working poor) and unemployed (unemployed and benefit receipt) conditions. the second model examines the four separate vignette conditions separately, differentiating between unemployed and unemployed benefit conditions. finally, we contrast the three unemployment benefit conditions: ( ) unemployment benefit recipients at time ; ( ) unemployment benefit recipients at time ; and ( ) unemployment benefit recipients receiving the coronavirus payment at time . for all models, we consider unadjusted and adjusted results (controlling for participant demographics). to address a potential bias from gender differences between samples, post-stratification weights were calculated for the covid sample to reflecting the gender by age distribution of the pre-covid sample. all models were weighted. the two samples from time (pre-covid ) and time (covid ) were comparable on all demographic variables, except for gender (χ [ , ] = . , p < . ) and employment (χ [ , ] = . , p < . ): the gender distribution was more balanced at time with . % of males, compared to . % of males at time . there was also a significant increase in unemployment with . % of time participants out of work compared to . % of the time participants. this was likely reflective of the employment rate nearly doubling in australia during covid crisis. bivariate correlations showed significant positive correlations between all outcomes (p's < . ), except for extraversion that was only positively correlated with emotional stability, boss suitability, warmth, assertiveness, and competence (p's < . ). the results, both adjusted and unadjusted, from the initial overall multilevel model using a binary indicator of whether vignette characters were employed (those in the employed or working poor conditions) or unemployed (unemployed or welfare) and testing the interaction between vignette condition and time (pre-covid vs covid ) are presented in the supplementary table s . the adjusted results (holding participant age, gender, employment, and education constant) indicated that the unemployed characters were rated lower than the employed characters at time (b = − . ). this difference in the ratings of employed and unemployed characters was reduced in the covid assessment at time , declining from . to . , across all the outcome measures. the addition of the threeway interaction between condition, time and outcome measure significantly improved overall model fit, χ ( ) = . , p < . , indicating the interaction between condition and time varied over measures. a series of separate regression models considering each outcome separately (see supplementary table s ) showed a significant effect of condition (employment rated higher than unemployment) at time (pre-covid) for all outcomes except openness and extraversion. the lower ratings for unemployed relative to employed characters were significantly moderated at time on the competence, worker and boss suitability, and guilt/shame outcomes (p's < . ). the next set of analyses consider the four separate vignette conditions, differentiating between the unemployed and unemployed benefit recipient conditions. the overall mixedeffects multilevel model incorporating the four distinct vignette conditions provided evidence of significant effects for condition and condition by time in both adjusted and unadjusted models. the result for the adjusted model (table ) , averaged across the various outcomes, replicated the previous finding of a difference in ratings of employed and unemployed characters at time (pre-covid ): relative to the employed condition, there was no difference in ratings of the working poor, but the unemployed and the unemployed benefit recipient characters were rated less favorably. there was some evidence of a gradient across the unemployed characters: the average rating of the unemployed condition was higher than the unemployed benefit condition, though this difference was not statistically significant. in the presence of the interaction effect, the non-significant effect of time shows that, averaged across all the outcome measures, there was no difference in the rating of the characters in the employed condition on the pre-covid and covid occasions. we tested for the effect of sociodemographic characteristics as covariates in the adjusted models (employment and benefit receipt status, education, age, and gender) but found no main effects of any of the covariates except for gender: females tended to rate characters higher (b = . , % ci [ . , . ]) compared to males. testing the heterogeneity of these patterns across outcomes via the inclusion of a three-way interaction between vignette condition, occasion and measure significantly improved overall model fit, χ ( ) = . , p < . , prompting analysis of each outcome separately. the separate linear regressions for each outcome measure (supplementary table s ) show that ratings of unemployed benefit recipients at the time (pre-covid ) were significantly lower than the employed characters for all outcomes except openness and extraversion. statistically significant condition by time terms indicated that the unemployed benefit effect was moderated at time (covid ) for the three key outcome measures identified in previous research (conscientiousness, worker and boss suitability) and for the measure of guilt and shame. figure depicts this interaction for these four outcomes. these occurred in two profiles. for conscientiousness, worker and boss suitability, covid attenuated the negative perceptions of unemployed relative to employed characters, providing support for hypothesis . by contrast, covid has induced a new difference, such that participants thought employed characters should feel higher levels guilt and shame at time , compared to time . while the "working poor" condition was not central to the covid hypotheses, we note that we found no evidence that ratings of these characters on any outcome differed from the standard employed character, or that this difference was changed in assessment at time (covid occasion). the inclusion of the fifth covid -specific unemployment benefit condition did not generate more positive (or different) ratings than the standard unemployment benefit condition. overall mixed-effects multilevel models, both adjusted and unadjusted, indicated that participants in the coronavirus supplement condition (adjusted model: b = . , % ci [ . , . ]) and the general unemployed benefit recipient condition at time (adjusted model: b = . , % ci [ . , . ]) were both rated more favorably in comparison to unemployed benefit recipients at time . there was no difference between these two time benefit recipient groups (b = . , % ci [− . , . ]). these results did not support hypothesis . previous research has demonstrated that people who are unemployed, and particularly those receiving unemployment benefits, are perceived more negatively and less employable than those who are employed. however, the economic shock associated with the covid crisis is likely to have challenged people's sense of their own vulnerability and risk of unemployment, and altered their perceptions of those who are unemployed and receiving government support. the broad aim of the current study was to examine the potential effect of this crisis on person perceptions tied to employment and benefit recipient status. we did this by presenting brief vignettes describing fictional characters, manipulating key experimental conditions related to employment status, and asking study participants to rate the characters' personality and capability. we contrasted results from two cross-sectional general population samples collected before and during the covid crisis. the pre-covid assessment replicated our previous findings (e.g., schofield and butterworth, b) showing that employed characters are perceived more favorably than those who were unemployed and receiving government benefits on measures of conscientiousness and suitability as a worker. these findings supported hypothesis . in comparison, the assessment conducted during the covid crisis showed that unemployed and employed characters were viewed more similarly on these same key measures, with a significant interaction effect providing support for hypothesis . our third hypothesis, suggesting that n reference to the coronavirus supplement (an additional form of income support introduced during the pandemic) would enhance ratings of unemployed benefit recipients at the second assessment occasion, was not supported. we found that benefit recipients at time were rated more favorably than the benefit group at time , irrespective of whether this covid -specific payment was referenced. this suggests the broader context in which the study was conducted was responsible for the change in perceptions. we sampled participants from the same population, used identical experimental procedures, and found no difference over time in the ratings of employed characters on the key outcome measures of employability (worker and boss suitability) and conscientiousness. the more favorable ratings of unemployed and benefit receiving characters at time is likely to reflect how the exogenous economic shock brought about by the covid crisis challenged social identities and the stereotypes held of others . the widespread impact and uncontrollable nature of this event are inconsistent with pre-covid views that attribute ill-intent to those receiving to unemployment benefits (fiske et al., ; baumberg, ; contini and richiardi, ; bye et al., ) . we suggest the changing context altered perceptions of the "deservingness" of people who are unemployed as unemployment in the context of covid is less indicative personal failings or a result of one's "own doing" (petersen et al., ; van oorschot and roosma, ) . it is important to recognize, however, that the negative perceptions of unemployed benefit recipients were attenuated in the covid assessment, but they continued to be rated less favorably than those who were employed on the key outcome measures. in contrast to our findings on the key measures of employability and conscientiousness, the previous and current research is less conclusive for the other outcome measures. the current study showed a broadly consistent gradient in the perception of employed and unemployed characters for all outcome measures apart from openness and extraversion. findings on these other measures have been weaker and inconsistent across previous studies (schofield and butterworth, b; schofield et al., ) , and the current experiment was not designed with sufficient power to demonstrate interaction effects for these measures. there was, however, one measure that showed significant divergence from the expected profile of results. a significant interaction term suggested that study participants at the time (covid ) assessment reported that the employed characters should feel greater levels of guilt and shame than those who participated in the pre-covid assessment. in contrast, there was consistency in the ratings of unemployed characters on this measure across the two assessment occasions. while not predicted, these results are also interpretable in the context of the pervasive job loss that accompanied the covid crisis. haller et al. ( ) , for example, argue that the highly distressing, morally difficult, and cumulative nature of covid related stressors presents a perfect storm to result in a guilt and shame responses. the context of mass job losses may leave "surviving" workers feeling increasingly guilty. the main findings of the current study are consistent with previous experimental studies that show that the stereotypes of unemployed benefit recipients are malleable (aarøe, ; schofield et al., ) . these previous studies, however, have demonstrated malleability by providing additional information about unemployed individuals that was inconsistent with the unemployed benefit recipient stereotype (e.g., the external causes https://pursuit.unimelb.edu.au/articles/our-changing-identities-under-covid- of their unemployment). in contrast, the current study did not change how the vignette characters were presented or the experimental procedures. rather, we assessed how the changing context in which study participants were living had altered their perceptions: suggesting the experience of covid altered stereotypical views held by study participants rather than presenting information about the character that would challenge the applicability of the benefit recipient stereotype in this instance. perceptions and stereotypes of benefit recipients can be reinforced (and potentially generated) by government actions and policies. structural stigma can be used as a policy tool to stigmatize benefit receipt as a strategy to reduce dependence on income support and encourage workforce participation (moffitt, ; stuber and schlesinger, ; baumberg, ; contini and richiardi, ; garthwaite, ) . in the current instance, however, the australian government acted quickly to provide greater support to australians who lost their jobs (e.g., doubling the rate of payment, removing mandatory reporting to the welfare services) and this may have reduced the stigmatizing structural features of the income support system and contributed to the changed perceptions of benefit recipients identified in this study. the current study took advantage of a natural experimental design and replicated a pre-covid study during the covid crisis. the study is limited by the relatively small sample size at time , which was not designed for current purposes but part of another study. we were not able to include most of the participants from the original time study as most of the experimental conditions described activities that were illegal/inconsistent with recommend activity at the time of the covid lockdown and social restriction measures. finally, the data collection for the current study occurred very quickly after the initial and sudden covid lockdowns and economic shock, which is both a strength and a limitation for the generalizability of the results. the pattern of results using the same sampling frame offers compelling support for our hypothesis that the shared economic shock and increase in unemployment attenuates stigmatizing community attitudes toward those who need to receive benefits. our current conclusions would be further strengthened by a subsequent replication when the public health and economic crises stabilize, to test whether pre-covid perceptions return. the current study provides novel information about impact of the covid health and economic crisis, and the impact of the corresponding policy responses on community perceptions. this novel study shows how community perceptions of employment and benefit recipient status have been altered by the covid pandemic. these results add to knowledge about the determinants of welfare stigma, particularly relating to employability, highlighting societal level contextual factors. the raw data supporting the conclusions of this article will be made available by the authors, without undue reservation. the studies involving human participants were reviewed and approved by melbourne university human research ethics committee. the patients/participants provided their written informed consent to participate in this study. as led the review conceptualized by ts and pb. as and pb conducted the analyses and wrote up the review. ts led the data collection, reviewed and edited the manuscript, and provided data management support. this manuscript is based on previous extensive work by ts and pb on stereotypes toward the unemployed and welfare benefit recipients. all authors contributed to the article and approved the submitted version. this study was funded by the australian research council (arc) grant # dp . investigating frame strength: the case of episodic and thematic frames crowding out culture: scandinavians and americans agree on social welfare in the face of deservingness cues facets of the fundamental content dimensions: agency with competence and assertiveness-communion with warmth and morality perceived employability and entrepreneurial intentions across university students and job seekers in togo: the 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warmth respectively follow from perceived status and competition fear of the brown envelope: exploring welfare reform with long-term sickness benefits recipients social cuing of guilt by anger and of shame by disgust the structure of phenotypic personality traits a very brief measure of the big-five personality domains the moral emotions a model for treating covid- -related guilt, shame, and moral injury personality measurement and employment decisions: questions and answers knowledge network hubs and measures of research impact, science structure, and publication output in nanostructured solar cell research gender stereotypes of personality: universal and accurate? employers' perceptions of the employability skills of new graduates. london: edge foundation universal features of personality traits from the observer's perspective: data from cultures an economic model of welfare stigma graduates' experiences of, and attitudes towards, the inclusion of employability-related support in undergraduate degree programmes; trends and variations by subject discipline and gender gender and management implications from clearer signposting of employability attributes developed across graduate disciplines pedagogy for employability deservingness versus values in public opinion on welfare: the automaticity of the deservingness heuristic psychological safety, job crafting, and employability: a comparison between permanent and temporary workers employers' perceptions of important employability skills required from malaysian engineering and information and communication technology (ict) graduates the language of personality: lexical perspectives patterns of welfare attitudes in the australian population are negative community attitudes toward welfare recipients associated with unemployment? evidence from an australian cross-sectional sample and longitudinal cohort community attitudes toward people receiving unemployment benefits: does volunteering change perceptions? the persistence of welfare stigma: does the passing of time and subsequent employment moderate the negative perceptions associated with unemployment benefit receipt? does social policy moderate the impact of unemployment on health? a multilevel analysis of welfare states the five-factor model describes the structure of social perceptions sources of stigma for means-tested government programs who should get what, and why? on deservingness criteria and the conditionality of solidarity among the public the social legitimacy of targeted welfare measurement of agency, communion, and emotional vulnerability with the personal attributes questionnaire age and perceived employability as moderators of job insecurity and job satisfaction: a moderated moderation model the supplementary material for this article can be found online at: https://www.frontiersin.org/articles/ . /fpsyg. . /full#supplementary-material key: cord- -jeu fye authors: slimani, maamer; paravlic, armin; mbarek, faten; bragazzi, nicola l.; tod, david title: the relationship between physical activity and quality of life during the confinement induced by covid- outbreak: a pilot study in tunisia date: - - journal: front psychol doi: . /fpsyg. . sha: doc_id: cord_uid: jeu fye the present study aimed to determine the relationship between physical activity (pa) and quality of life (qol) during the confinement caused by the covid- outbreak. a total of participants (men: n = , women: n = ) were included in the present study. they were divided into three groups [i.e., inactive group (ig): less than metabolic equivalent of tasks (mets), n = ; minimally active group (mag): from to , mets, n = ; and health-enhancing pa group (hepag): , + mets, n = ] based on their habitual pa level in the period of confinement. who quality of life instrument-short form (whoqol-bref) and international physical activity questionnaire-bref (ipaq-bref) questionnaires were used to assess qol and pa intensities. the main findings of the present study showed that mag and hepag have better total pa, physical, psychological, social, and environmental qol domains scores than ig (all, p < . ). small to large correlations (r ranging from . to . ) were also observed between total pa, total walking activity, total moderate-intensity pa, total vigorous-intensity pa, and qol domains (all, p < . ). pa with light-, moderate-, and vigorous-intensities can be well recommended to decrease the negative psychosocial effect of confinement. however, longitudinal studies are needed to draw causal inferences and underpin more robust and evidence-based and informed recommendations. "severe acute respiratory syndrome coronavirus type (sars-cov- ), " responsible for an infection termed the coronavirus disease , is a newly discovered pathogen in humans. it was first discovered on november , in the city of wuhan, mainland china, and then spread throughout the world. on march , , covid- was declared a pandemic by the world health organization (who). as of march , the number of confirmed cases was , cases and , deaths, which increased to , , cases and , deaths as of april (who situation reports; zhu et al., ) . in this context, the who recommended the adoption of various protective, behavioral, and non-pharmacological measures (such as avoiding physical contact, handshakes, hugs and kisses; banning social gatherings and major events; closing universities and schools; and implementing selfisolation, social/physical distancing, confinement, and quarantine) to curb the spread of the virus as well as preventive approaches [including practicing physical activity (pa), sleeping well, etc.] to keep oneself healthy during the ongoing outbreak. governments of all countries ordered their people to self-isolate (stay at home). however, long-term isolation or home-confinement may have negative effects on psychosocial and mental health, especially causing stress, negative emotions, and impaired cognition (hawkley and capitanio, ) . if prolonged, they may suppress immune system and physiological functions (kiecolt-glaser et al., ) , which may increase the risk of exposure to sars-cov- and the likelihood of contracting the infection. for instance, the who suggested that people stay physically active at home in order to optimize their health status, decrease the negative psychosocial consequences of confinement, and maintain their immune system function. many studies have reported positive effects of pa on psychosocial status, such as quality of life (qol), outside of confinement (anokye et al., ; vagetti et al., ; krzepota et al., ; ho et al., ) . however, no study has so far investigated the relationship between pa and qol during a period of confinement, such as the quarantine caused by covid- . therefore, we aimed to explore the relationship between pa and qol in the general population of tunisia during the first weeks of the confinement implemented by the government to curtail the covid- pandemic. this may help the community members to improve their qol in the face of a future pandemic, such as the covid- outbreak or potential secondary waves/relapses, should the virus not be completely eradicated and suppressed by means of pharmacological interventions (drugs and vaccines). a non-probabilistic sampling approach was utilized. subjects were considered eligible to take part into the study if meeting the following inclusion criteria: (i) age in the range - years; (ii) not using alcohol, drugs, or other substances; and (iii) no co-morbidities and/or orthopedic limitations that could interfere with the perceived qol or level of pa. a link to the online questionnaires was sent via mail to potential participants, of which returned valid questionnaires (participation rate of . %). thus, participants were included in the analysis. the link contained a brief explanation of the questionnaires and instructions on how to complete them. it was sent weeks after the implementation of the quarantine by the tunisian government. all measures were collected on the same day, to avoid any bias in the study, considering the constantly evolving situation of the pandemic. most participants in the current survey were men (n = , . %), and the mean age at the time of the study was . years (sd = . ). participants were divided into three groups [i.e., inactive group (ig): less than metabolic equivalent of tasks (mets), n = ; minimally active group (mag): from to , mets, n = ; and health-enhancing pa group (hepag): , + mets, n = ] based on their habitual pa level in the period of quarantine, as recommended by previous research (lee et al., ) . we excluded participants who were not compliant to government guidelines at home during the covid- epidemic. participants completed the online pa and qol questionnaires. they were thoroughly advised of the aims of the study. all participants signed a free and informed consent form. local institutional ethical approval was provided for this study, which was conducted in accordance with the declaration of helsinki and its subsequent amendments. physical activity pa was assessed using the international physical activity questionnaire-bref (ipaq-bref; lee et al., ) . this questionnaire comprised of seven questions which assessed the frequency and duration of vigorous intensity, moderate intensity, and walking pa for at least min during the past week. participants were asked to respond to one of the frequency options: from to days. duration options included the number of minutes exercised, never do, or do not know. participants who had not undertaken any pa in the previous days responded only to the question "during the last days, how much time did you spend sitting on a week day?" the ipaq assessed total pa and total sedentary time, whereas the intensity of activity was converted to met units (met -h ·week − ), as recommended by previous study (ainsworth et al., ) . qol was measured using the self-administered who quality of life instrument-short form (whoqol-bref; skevington et al., ) . it comprised items including domains and facets (or sub-domains). the first two items assessed the "overall rating of qol (oqol)" and subjective satisfaction with health. the other items measured four domains, namely, physical health (seven items), psychological health (six items), social relations (three items), and environment (eight items). the participants marked a response using a -point likert scale [ranging from (very dissatisfied/very poor) to (very satisfied/ very good)]. the domain scores of the whoqol-bref were computed according to the guideline of the who (who, ). statistical analyses were performed by means of the commercial software "statistical package for the social sciences" (spss for windows, version . , spss inc., chicago, illinois, usa). descriptive statistics were calculated for all experimental data. kolmogorov-smirnov test was used to assess if data were normally distributed. differences in pa level and qol domains were determined by using mann-whitney u tests. to assess a difference between different categories of participants based on their pa level, kruskal-wallis tests were used. in the case of significant differences, post hoc comparisons with bonferroni corrections were applied using the mann-whitney u test. furthermore, bivariate correlations were computed by using spearman's rho to examine the relationship between pa level and qol domains. an overview of the participants' mets and qol domain scores is shown in table . most of the time was spent with participants being sedentary, followed by light-, moderate-, and high-intensity activities, regardless of the group. in general, all dependent variables differed among the groups (kruskal-wallis test, p < . ; table ), except being sedentary. post hoc analyses revealed that the differences between groups were significant in all comparisons and by the pattern, where the ig accumulated less light-, moderate-, and high-intensity activities when compared to hepag (table ) . when compared to the mag, the ig did not differ in total time spent at light activities only. regarding qol, the ig reported lower scores compared to the mag and hepag for all four domains, while the mag and hepag did not differ (p = . ). the same pattern was observed for qol total score, where the ig reported lower scores compared to the mag and hepag, while the mag and hepag did not differ (p = . ; table ). correlation analysis showed that total pa (met) had a small to moderate relationship with qol domains ( table ) . more in-detail, small to moderate correlations (r ranging from . to . ) between all pa intensities and qol domains were observed ( table ) . the present study aimed to determine the relationship between pa and qol during the confinement caused by the covid- outbreak. the main findings of the present study showed that mag and hepag groups have better total pa, physical, psychological, social, and environmental domains scores than the ig. small to large correlations were also observed between total pa, total walking activity, total moderate-intensity pa, total vigorous-intensity pa, and the qol domains. the relationship between active living and qol is well studied in patients with different diseases and also in healthy participants (ellingson and conn, ; brown et al., ; anokye et al., ; ha et al., ; krzepota et al., ; ho et al., ) . however, the current study showed that total pa (met) was correlated with all qol domains during a period of government directed confinement and a limiting of personal freedom. specifically, large correlations were observed between total pa and psychological and social qol domains. accordingly, some studies have also reported a positive correlation between pa and qol domains (mourady et al., ) . for instance, some authors have reported positive correlations between total pa and physical and mental domains (stewart et al., ; wendel-vos et al., ; fox et al., ; shibata et al., ) , while others have shown positive correlations between pa and some qol domains, namely general qol; functional capacity; mental health; autonomy, past, present, and future activities; death and dying; intimacy; vitality; and psychological domain (vagetti et al., ) . mourady et al. ( ) reported that total pa was significantly correlated with physical and psychological health, general qol, social relationships, and the environmental domains in healthy participants. on the contrary, in one study, sedentary pa was significantly associated with the social relationship domains (mourady et al., ) . the last finding is not in agreement with our study result regarding the correlation between sedentary and qol domains (e.g., in our study total sedentary mostly had non-significant relationships with qol domains). this contradiction may be explained by the differences in the study contexts. participants in the present study practiced social distancing to avoid the spread of covid- . in addition, by staying at home, without practicing pa, they may feel insecure. regarding the dose-response relationship between pa and qol domains, the current study reported small to moderate correlations between all pa intensities and qol domains. more in-detail, moderate correlations were observed between low-and moderate-intensities and psychological and social domains. previous studies have reported positive relationships between moderate to vigorous pa and several sf- domains in participants attending a behavior change service within primary care, with these domains including: (a) general health and vitality, (b) physical functioning, and (c) the role of physical activity (blom et al., ) . light pa was also associated with the aforementioned domains and the emotional sphere (blom et al., ) . this is not surprising, since a lot of studies showed the beneficial effect of light, moderate, and vigorous physical activities on all qol domains (gillison et al., ; gill et al., ) . regarding the correlation between pa and qol domains, in our study, total pa, total walking activity, total moderateintensity pa, and total vigorous-intensity pa were positively correlated with all qol domains in both males and females. these findings are in agreement in part with nakamura et al. ( ) , who reported that leisure-time pa, moderate-intensity pa, and vigorous-intensity pa were associated with physical health domains. moderate intensity and total activity leisuretime pa were also correlated with mental health in men (nakamura et al., ) . van den berg et al. ( ) reported that only vigorous-intensity pa was associated with the physical and mental health domains in workers. however, our study showed large correlations between psychological and social domains and all intensities of pa. in addition, a previous study reported that light-intensity of pa was positively correlated with psychological health and social relationship domains in healthy participants (mourady et al., ) . these studies and the current investigation support the latest guidelines issued by the who suggesting that people attain min of moderateintensity, min of vigorous-intensity pa per week, or a combination of both to improve health, well-being, and qol during the confinement. despite its novelty and methodological rigor, the present study is not without any limitations that should be properly acknowledged. the major limitation is given by the sampling approach, which calls up for caution when interpreting and generalizing the results. a further drawback is represented by the study design that being cross-sectional does not allow causal inferences to be drawn from the data. given the preliminary nature of the present report, further research is needed to confirm our conclusions among different populations, using representative samples. in particular, longitudinal studies are needed to better understand the relationship between pa levels and perceived qol during the confinement measures and after their lifting. from the present findings, we can conclude that there is an association between pa levels and perceived qol during the confinement period and the covid- outbreak. if longitudinal studies replicate our data, pa with light-, moderate-, and vigorous intensities can be well recommended as an important method to improve qol and to decrease/counteract the negative psychosocial effects of confinement. however, based on the above-mentioned limitations, along with the impact that disease-caused confinement has on people physically and psychologically, further research in the field is urgently warranted. the datasets presented in this article are readily available from the corresponding author (maamer @hotmail.fr). the studies involving human participants were reviewed and approved by local institutional ethical approval provided for this study, which was conducted in accordance with the declaration of helsinki. written informed consent to participate in this study was provided by the participants' legal guardian/ next of kin. all authors: conceptualization and methodology. ms and ap: software. all authors: validation and formal analysis. ms: investigation and resources. ms and ap: data curation. all authors: writing, original draft preparation, review and editing, and visualization. dt: supervision. nb: funding acquisition. all authors contributed to the article and approved the submitted version. authors thank the participants to the study. compendium of physical activities: an update of activity codes and met intensities physical activity and health related quality of life health-related quality of life and intensity-specific physical activity in high-risk adults attending a behavior change service within primary care associations between recommended levels of physical activity and health-related quality of life. findings from the behavioral risk factor surveillance system (brfss) survey exercise and quality of life in elderly individuals physical activity and mental well-being in older people participating in the better ageing project physical activity and quality of life the effects of exercise interventions on quality of life in clinical and well populations: a meta-analysis quality of life among people living with hypertension in a rural vietnam community perceived social isolation, evolutionary fitness and health outcomes: a lifespan approach relationships among fatigue, physical activity, depressive symptoms, and quality of life in chinese children and adolescents surviving cancer emotions, morbidity, and mortality: new perspectives from psychoneuroimmunology relationships between physical activity and quality of life in pregnant women in the second and third trimester validity of the international physical activity questionnaire short form (ipaq-sf): a systematic review associations between quality of life, physical activity, worry, depression and insomnia: a cross-sectional designed study in healthy pregnant women health related quality of life is differently associated with leisure-time physical activity intensities according to gender: a cross-sectional approach recommended level of physical activity and health-related quality of life among japanese adults the world health organization's whoqol-bref quality of life assessment: psychometric properties and results of the international field trial. a report from the whoqol group are fitness, activity, and fatness associated with health-related quality of life and mood in older persons? association between physical activity and quality of life in the elderly: a systematic review the influence of psychosocial factors at work and life style on health and work ability among professional workers leisure time physical activity and health-related quality of life: cross-sectional and longitudinal associations program on mental health: whoqol user manual a novel coronavirus from patients with pneumonia in china the authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. no use, distribution or reproduction is permitted which does not comply with these terms. key: cord- -ntu wdzg authors: teng, yi-man; wu, kun-shan; lin, kuan-ling title: life or livelihood? mental health concerns for quarantine hotel workers during the covid- pandemic date: - - journal: front psychol doi: . /fpsyg. . sha: doc_id: cord_uid: ntu wdzg nan a novel coronavirus pneumonia, known as covid- (coronavirus disease ), spread rapidly around the globe. the worldwide outbreak of pandemic had apprehended more than half of the population of the world that has caused immense damage to human health and economic and social life (fareed et al., ; shehzad et al., ) . it paused the majority of global economic activities, causing major impacts on most industries, particularly the hospitality and leisure industry. as a result, hotels, viewed as a declining industry, have suffered a staggering drop in average occupancy (atomize, ) . it is not only hotels in western countries affected (djeebet, ) , the chinese hotel industry has also been negatively impacted by the covid- outbreak . a major dilemma is the financial burden of keeping the hotel open vs. many people losing their jobs if it closes. with such severe impacts, the hospitality industry must learn to function in a new way. with positive cases of covid- escalating, hospitals face problems with overcrowding and insufficient isolation space (feng and cheng, ) . in addition, there is increasing worry from frontline health care workers about contracting the virus and contaminating loved ones (rosemberg, ) . a quarantine hotel is one possible solution to address both these issues. in addition, as the covid- pandemic continues, more countries require both citizens and foreign visitors arriving from abroad to enter a mandatory -day quarantine period within centralized observation centers or at home. because of the shortage of quarantine infrastructure, some hotels have been commandeered by governments to be quarantine hotels. providing quarantine space is a smart business move for the hospitality industry. quarantine packages will not only assist individuals (e.g., health care workers) but will also provide some economic relief for the hospitality industry (rosemberg, ) . many hotels are now considering offering quarantine packages, and some have already been put in place in austria, china, malaysia, new zealand, taiwan, and the united states. during the covid- pandemic, the hospitality industry and those who make a living within it will face unprecedented changes. the resulting economic stress, isolation, and uncertainty can quickly take a toll on their physical and mental health. when a hotel transforms into the quarantine hotel, employees must decide whether to continue to earn a living while risking their lives or to walk away. it is a very difficult choice for quarantine hotel employees. there have been numerous articles written in recent months regarding mental health care from a medical perspective (e.g., health care workers) during the covid- pandemic (e.g., kang et al., ; walton et al., ) . however, to date, it is difficult to find relevant literature or empirical studies exploring quarantine hotel employees' mental health and coping strategies. this article is more concerned about the new working situation, conditions, and mental health considerations for quarantine hotel staff during the covid- pandemic. the aims of this research are -fold: first, to demonstrate the specific changes to roles and workload for the quarantine hotel employees; and second, to protect the quarantine hotel employees' mental health and provide recommendations for hoteliers in order to support their staff. the quarantine hotel must provide the basic amenities for centralized observation during the period of mandatory quarantine, good living conditions, and independent rooms. as a quarantine hotel in china, the workload now includes following an operation guide, complying with antiepidemic and disinfection standards, and implementing quarantine services, as follows: ( ) receptionists are required to wear personal protective equipment (ppe), including surgical masks, latex gloves, disposable gowns, caps, and eye protection. ( ) check-in and check-out counters should be in different areas of the hotel to minimize the risk of infection. ( ) temperatures of new guests must be taken before they enter the lobby. ( ) a receptionist distributes masks, gloves, and thermometers at a different counter. they also need to provide and explain an information sheet about covid- . ( ) cleaners must wear ppe. ( ) all potentially contaminated surfaces, including elevators, rooms, passages, lobbies, reception desks, public toilets, hotel entrances and exits, door handles, and any other public facilities, should be disinfected using household bleach at least three times a day and recorded. ( ) wet disinfecting foot pads should be installed at lobby and elevator entrances. ( ) emphasis should be on strict cleaning and disinfection of air conditioning or fresh air systems, water supply, and drainage equipment. ( ) check and record the quarantine guests' body temperatures daily. ( ) three meals a day are provided using disposable lunch boxes on a trolley outside guest rooms to avoid contact with quarantine guests. ( ) guest rooms must be fully cleaned and disinfected prior to quarantine guests' check-in or after check-out. ( ) guest rooms and public areas should have classified bins for collection of wet and dry garbage. the cleaners disinfect, collect, sort, and record the garbage outside the rooms every day. although quarantine hotels provide quarantine space for exposed individuals, providing beneficial assistance to the public during this crisis is also likely to yield some financial relief (rosemberg, ) . however, the challenge for quarantine hotel staff is not only the increasing workload created by the quarantine hotel operation but also high psychological stress associated with job insecurity, risk of exposure, and contagion for themselves, their friends, and families. the quarantine hotel employee hosts those who need quarantine infrastructure, medical staff, first responders, and/or hospital patients not suffering from covid- with new and frequently changing protocols and ppe. communication with quarantine guests during check-in and check-out is made more complicated by ppe, which covers most of the face, while quarantine hotel cleaners' duties have increased by the necessary disinfection of rooms and hotel areas, also with ppe. as the main route of transmission is from respiratory droplets and direct contact with quarantine guests, quarantine hotel staff face a higher risk of infection. thus, it is important to keep the health and safety of quarantine hotel employees, particularly the cleaners, at the center of operations. these changes may cause quarantine hotel staff to be distressed and/or feel vulnerable. consequently, this can cause negative impacts to their mental health, which quarantine hoteliers need to aim to mitigate. employers have a duty to protect the health and safety of their workers. although temporary quarantine hotels slightly relieve financial pressures caused by the covid- outbreak and contribute to corporate social responsibility (csr) worldwide, it is possible that quarantine hotel employees are at a greater risk of adverse mental health outcomes owing to physical fatigue, risk of infection, and shortages of ppe. because of the increased risk of adverse mental health of staff, the quarantine hoteliers need to support the employees' mental health needs during the quarantine hotel period of operation. in this setting, it is suggested that quarantine hoteliers should develop short-and long-term mental health assistance programs for employees based on the following recommendations. proper training is essential during and after the covid- pandemic and is viewed as a protective factor against mental health issues (brooks et al., ) . training helps educate employees about necessary behaviors and their importance in preventing the spread of the virus (hamouche, ) , for example, training staff in various covid- protective measures including causes, transmission types, symptoms, cleaning, and disinfection safety procedures. it is therefore recommended that hoteliers implement co-development programs to train their employees in preparation for the impact of covid- in the workplace. during the covid- pandemic, communication is crucial in order to reduce the quarantine hotel employees' uncertainty and stress levels (hamouche, ) . in this context, it is recommended that hoteliers develop a communication plan to provide employees with clear information about what will happen during the covid- pandemic, for example, daily updates of pandemic information and the quarantine guests' status, what major actions will be taken to operate the hotel, and the potential impact of these actions on the employees' workloads. furthermore, they should build a two-way communication platform that encourages staff to express their needs and concerns, as this is one of the most useful resources to promote resilience in quarantine hotel employees. strategies to improve their mental health will inspire staff to believe they are part of a working family, and together they can overcome the challenges presented by the covid- pandemic now and in the future. in the stressful working atmosphere of covid- , arousing a positive working environment is compulsory. quarantine hoteliers can build a resilience model by encouraging supportive interactions between workers via bulletin boards and online and highlight their sense of honor and pride for continuing to work in a high-risk situation. these are significant environmental protective factors of resilience, as they are strongly related to mental health and considered essential components of successful psychosocial adjustment (shastri, ) . the more employees who engage with and benefit from the resilience model, the more the working atmosphere will be improved. some studies have suggested that inadequate psychological support from employers is a risk factor for their mental health (brooks et al., ; hamouche, ) . employees who have high perceptions of organizational support are less likely to experience long-term physical and psychological health problems, such as depression and anxiety (e.g., liu et al., ; lei and chen, ) . in order to mitigate the potential negative impact of quarantine, fear of infection, and uncertainty on employees, hoteliers need to create a supportive environment in the workplace, for example, using online surveys to assess the scope of mental health problems and to observe the staffs' psychological status. once mental health symptoms are identified, rapid access to psychological assistance and contingency for time off work should be provided. in addition, employee assistance programs, such as developing online materials for mental health education and counseling, etc., can provide psychosocial support (liu et al., ) . the quarantine hotelier can also implement additional benefits and practical support strategies, such as reducing workloads or hours, as well as increasing remuneration. during the covid- pandemic, the hotel industry faces unprecedented changes. this article is concerned with the risks to quarantine hotel employees' mental health and aims to suggest that quarantine hoteliers develop coping strategies to minimize the negative impact of covid- on their employees' mental health. to echo the prior study of qiu et al. ( ) , we suggest quarantine hoteliers provide counseling services for psychological first aid through telemedicine for their staff. it also encourages offering the communication pathways for hotel employees of clear communication with a regular update about covid- . further, parallel to the views of hamouche ( ) , to develop the urgent timely mental health care team to offer regular screening psychological anxiety and depression should be performed for patients, as well as quarantine hotel workers. having the effective preventive mental health measures in the workplace will help to reduce staffs' level of stress. the quarantine hoteliers have the responsibility to protect their staff and to ensure a workplace free from hazards that may harm employees or cause their death. faced with this epidemiological catastrophe, the world is still fighting to control the pandemic. it is necessary to understand the influence of the antecedents from the perspective of the quarantine hotel workers' mental health, especially the need to be empirically explored further in future studies, for instance, whether the hotel employees' knowledge of the pandemic is adequate and what kind of effective strategies, such as providing a communication pathway and counseling service, can relieve their fear and perception of the severity of covid- . through understanding the protective and risk factors of working in the quarantine hotel, policy makers and hoteliers will be able to build a holistic practical and theoretical model to support the hotel employees' mental health and behaviors during the global emergent public health crisis. the basic of hotel service quality depends on the performance of the staff that provides enthusiasm and courtesy service to customers. the staff is a significant asset and treasure of the hotel industry. in fact, the hospitality industry is accepted to be highly stressful environments because of long working hours and night shifts and weekend shifts parameter. during the covid- pandemic, the mental health concern of the quarantine staff who has faced unprecedented changes is undoubtedly necessary. as a significant role of the lodging industry, protecting the staff 's mental health has become an urgent task for the hoteliers. to take care of the mental health of these quarantine staff is a critical part of the public health response and also a positive csr way. while this study drives the quarantine hoteliers' concern about the staffs' mental health in the short term, researchers need to explore and discover effective care strategies of staff mental health, which will bring beneficial csr to their employees for long. the state of the global hospitality industry following covid- and what hoteliers can do now a systematic, thematic review of social and occupational factors associated with psychological outcomes in healthcare employees during an infectious disease outbreak what is the impact of covid- on the global hospitality industry? co-variance nexus between covid- mortality, humidity, and air quality index in wuhan. china: new insights from partial and multiple wavelet coherence hospital beds for coronavirus patients are scarce. national public radio covid- and employees' mental health: stressors, moderators and agenda for organizational actions the mental health of medical workers in wuhan, china dealing with the novel coronavirus effective resources for improving mental health among chinese underground coal miners: perceived organizational support and psychological capital online mental health services in china during the covid- outbreak a nationwide survey of psychological distress among chinese people in the covid- epidemic: implications and policy recommendations health and safety considerations for hotel cleaners during covid- resilience: building immunity in psychiatry the impact of covid- as a necessary evil on air pollution in india during the lockdown mental health care for medical staff and affiliated healthcare workers during the covid- pandemic covid- and the chinese hotel sector all authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication. the authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.copyright © teng, wu and lin. this is an open-access article distributed under the terms of the creative commons attribution license (cc by). the use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. no use, distribution or reproduction is permitted which does not comply with these terms. key: cord- -jrsg pdk authors: hu, na; li, ying; he, su-shuang; wang, lei-lei; wei, yan-yan; yin, lu; chen, jing-xu title: impact of the family environment on the emotional state of medical staff during the covid- outbreak: the mediating effect of self-efficacy date: - - journal: front psychol doi: . /fpsyg. . sha: doc_id: cord_uid: jrsg pdk during the outbreak of the coronavirus disease (covid- ), the medical staff was facing severe work pressure, which led to a negative emotional state. the purpose of this study was to explore the relationship between the family environment and the emotional state of the medical staff members during the covid- outbreak. due to the importance of self-efficacy in regulating mental health, the mediating role of self-efficacy in the association between family environment and emotional state was also explored. a cross-sectional survey was performed, using an online questionnaire, on medical staff who participated in the epidemic prevention and control tasks during the covid- outbreak in beijing. family environment, self-efficacy, anxiety, and depressive symptoms were measured by the family environment scale-chinese version (fes-cv), the general self-efficacy scale (gses), the generalized anxiety disorder scale- (gad- ), and the patient health questionnaire- (phq- ), respectively. correlation analysis and mediating effect analysis were used to explore the relationships between them. first, a higher prevalence of anxiety ( %) and depressive ( %) symptoms were confirmed among the medical staff. second, the symptoms of anxiety and depression were negatively correlated with the dimensions of cohesion and expressiveness and positively correlated with the dimensions of conflict in the fes-cv scale. third, self-efficacy significantly mediated the association between the family environment and anxiety symptoms (p < . ) as well as the family environment and depressive symptoms (p < . ). these findings show that a negative family environment was the main predictor of symptoms of anxiety and depression in the medical staff during the covid- outbreak. furthermore, we found that self-efficacy played a critical mediating role between the family environment and the symptoms of anxiety and depression. our study also indicates that improvements in the family environment benefit the mental health care of the medical staff, and high self-efficacy enhances this effect. the outbreak of coronavirus disease continues to attract worldwide attention . to date, covid- cases have been confirmed in more than countries around the world, and it has become a public health emergency of international concern. many people who have directly faced this large-scale public crisis, especially the medical staff involved in the prevention and control of this epidemic, showed anxiety symptoms (huang et al., ) . they faced a high risk of getting infected at their workplace and the possibility of their family members at home getting infected through them (xiang et al., ) . medical staff working in a high-pressure environment suffer from psychological problems, especially anxiety and depression (kang et al., ; wang et al., ) . although guidelines on the care of the mental health issues in medical staff have been issued in china (kang et al., ) , some of the staff refused to receive mental health care . it has been reported that the incidence of anxiety and depression was high among the medical staff during the outbreak of covid- , with prevalence rates of anxiety and depressive symptoms being . % and . %, respectively (lai et al., ) . due to the stigma around mental health problems in china (bai et al., ) , many members of the medical staff community were reluctant to accept professional psychological help . however, they preferred to seek help from their family members. some medical staff was far away from their families because of the fear of infection, and they were reluctant to have close contact with them. others were isolated and cannot return home for a long time (raven et al., ) . it has shown that family support is very important for medical staff involved in epidemic prevention (mohindra et al., ) . however, there has been no research on how family members can help medical professionals suffering from mental health issues and what kind of family environment can be useful in relieving negative emotions in these individuals during an epidemic. the family, which is the basic social unit, may affect the mental health of family members (cheng et al., ) . in chinese culture, family relations are highly valued, and family is a very important support system (poulin et al., ) . it means that the importance of family is the core feature for most chinese people. previous studies have shown that the family environment can directly affect the emotions in family members, especially the dimension of cohesion (harris and zakowski, ; burnett et al., ) , expressiveness (luebbe and bell, ) , and conflict (yap et al., ; yap and jorm, ; fosco et al., ) . however, whether the family environment has an effect on the mental health of medical staff during the epidemic is still not clear. self-efficacy refers to an individual's judgment about his or her ability to complete a certain task successfully, and it reflects the self-confidence of an individual to cope with various difficulties and setbacks in life (tang et al., ) . previous research has shown a positive correlation between the family environment and self-efficacy (mahmoudi, ) . individuals with a better family environment were shown to be more likely to have higher levels of self-efficacy (hemati et al., ) . for example, individuals can freely communicate with family members, express more about themselves, and have a frequent high contact of intimacy with other family members, which will lead to a high level of selfefficacy (hemati et al., ) . studies show that increasing selfefficacy is an essential aspect of the psychological intervention to protect the mental health of individuals (caldwell et al., ) . it seems that the higher the self-efficacy in an individual, the better the mental health (sebastian, ; jiang et al., ) . high self-efficacy can improve an individual's mental health (bandura, ). however, a low level of self-efficacy harms a person's psychological well-being (cieslak et al., ; sachs-ericsson et al., ) . importantly, studies have shown that self-efficacy is one of the critical factors that modulate an individual's emotions, especially feelings of anxiety and depression (bandura et al., ; kanfer and zeiss, ; cybulski et al., ; schönfeld et al., ) . these studies suggested that higher levels of selfefficacy are associated with lower levels of feelings of anxiety and depression. during the outbreak of sars, medical staff with low self-efficacy often had a higher fear of the epidemic, which was positively correlated with their poor mental health status (ho et al., ) . self-efficacy can predict the significant difference in mental health during the epidemic. the lower the self-efficacy, the worse the mental health status (yıldırım and güler, ) . it has been found that lower psychological stress among dentists during the covid- epidemic is associated with being in a stable relationship and having a higher sense of self-efficacy (shacham et al., ) . it suggests that family relationships and self-efficacy during the epidemic may both affect the mental health of medical staff. the partial mediating role of self-efficacy in some psychological trait relationships has been supported by relevant research (haj-yahia et al., ) . indeed, it has been found that self-efficacy was a mediator for the association of daily stress and mental health (schönfeld et al., ) . however, there has been no study focusing on the relationship between family environment, self-efficacy, and the emotional state of medical professionals during an epidemic. the relationship between family environment, self-efficacy, and depression and anxiety, and whether the influence of family environment on anxiety and depression is regulated by selfefficacy needs to be further studied. therefore, the purpose of this study was to further explore the direct and indirect impact of the family environment on symptoms of anxiety and depression among the medical staff involved in controlling the epidemic. when examining the indirect effects, we took self-efficacy as an intermediary variable. mediating effect analysis was performed to explore the role of self-efficacy in the relationship between family environment and symptoms of anxiety and depression. based on our findings, we provide viable strategies for the family based psychological intervention of the medical staff during an epidemic that will help to improve our psychological crisis intervention system. this research was a cross-sectional study using the convenience sampling method to collect survey results through an online questionnaire. the online survey was conducted in beijing from february , to march , . inclusion criteria for the study were as follows: ( ) chinese, working in beijing; ( ) - years old; ( ) medical staff including doctor or nurse involved in covid- epidemic prevention and control; and ( ) has read and agreed to the online informed consent. the protocol of this study was approved by the ethics committee of the beijing huilongguan hospital. the family environment scale-chinese version (fes-cv) this scale was based on the family environment scale (fes) developed by moss (moos and moos, ) , which was translated into chinese by wang et al. (wang et al., ) . the scale has entries in total, including dimensions (cohesion, expressiveness, conflict, independence, achievement orientation, intellectual-cultural orientation, active-recreational orientation, moral-religious emphasis, organization, and control), with nine entries for each dimension. each entry has a true and false option. the higher the score of a particular dimension, the more prominent the characteristics of the family in that aspect. the scores of conflict and control were negatively correlated with the family environment, whereas others positively correlated with the family environment. this scale has been shown to have good structural, content, and external validity when applied to the chinese population (phillips et al., ) . in this study, we selected three dimensions of this scale that were closely related to emotions investigated in previous studies: cohesion, expressiveness, and conflict (harris and zakowski, ; burnett et al., ) . this scale was developed by german psychologist schwarzer (schwarzer, ) , which was translated and revised for the chinese version by wang et al. (wang et al., ) . the scale comprises of items with four answer options, and the answer options range from (not at all true) to (completely true). higher scores mean higher levels of self-efficacy; a score of . - . means low level, . - . means medium level, and . - . means a high level of self-efficacy. the revised scale has been shown to have excellent reliability and validity in the chinese population (wang et al., ) . the cronbach's alpha of this scale is . , the retest reliability is . , and the correlation coefficient between the items and the total scale score is . - . . this scale was developed by spitzer et al. (spitzer et al., ) . previous research demonstrated that the chinese version of gad- has good reliability and validity, and the sensitivity and specificity of this version were . and . , respectively (huang et al., ) . this scale is composed of seven items, and each item has a - points scale. the total score range is - points; - for no anxiety, - for mild anxiety, - for moderate anxiety, and more than for severe anxiety. the patient health questionnaire- (phq- ) the scale was developed based on the fourth edition of the diagnostic and statistical manual of mental disorders (kroenke et al., ) . we used the chinese version of this scale. this scale is composed of nine items, and each item has a - points scale. the symptom severity is determined by the total score, with - being mild, - being moderate, - being moderately severe, and - being severe. cronbach's alpha of the phq- in the chinese population is . , and the retest reliability is . , which indicates that this test has excellent reliability and validity (wang et al., ) . all of the analyses were performed using spss for windows . . we reported means and standard deviations for continuous variables showing normal distribution and frequencies and proportions for categorical variables. the original scores of the dimensions of conflict in fes-cv were not normally distributed and were presented as medians and quartiles. a chisquared test was used to test the relationship between the demographic data of the participants and their anxiety and depressive symptoms. the study participants were grouped based on whether they showed/did not show anxiety or depressive symptoms. the inter-group comparison of the scores of fes-cv and gses was carried out using the independent sample t-test and the independent sample kruskal-wallis test. spearman correlations were calculated to determine the relationships between the scores of the various scales. we categorized the family environment (cohesion, expressiveness, and conflict) as an independent variable, anxiety and depression symptoms as dependent variables, and self-efficacy as an intermediary variable. after controlling for demographic variables, the direct, indirect, and total effects of the family environment on the symptoms of anxiety and depression were examined. the mediation analysis was run on the process macro for spss (preacher and hayes, ), using , bootstrap samples for bias correction and to establish % confidence intervals. all of the tests were twotailed, and the significance level was set at p < . . the medical staff involved in this study mainly includes two groups. one is the staff of the hospital involved in treating patients infected with covid- ; the other is the staff at the isolation point, whose main task is nucleic acid testing and medical services for the quarantined personnel. a total of medical staff members completed the online questionnaire, out of which six individuals did not complete the basic information, and two took more than min to answer the questionnaire. thus, medical staff members participated in the study, of which ( %) were women, and ( %) were men, aged - , with an average age of . ± . . most of the participants were under ( %), had a bachelor's degree ( %), were married ( %), and were living with their families ( %). among these participants, ( %) had anxiety symptoms, and ( %) had depressive symptoms. the symptoms of anxiety and depression were closely related to the gender of the medical staff and whether they lived with their family members or not. the prevalence rate of anxiety and depression symptoms was higher in women (x = . , p = . ; x = . , p = . ) and in those who did not live with their families (x = . , p = . ; x = . , p = . ) ( table ) . we divided the participants into two groups: one group with anxiety symptoms (gad- score > ) and the other group without anxiety symptoms (gad- score ≤ ). we then investigated the significance of the differences in the scores of the two groups for the fes-cv and gses scales. next, the participants were divided into two groups according to whether they had depressive symptoms or not (depressive symptoms: phq- score > ; no depressive symptoms: phq- score ≤ ). like the anxiety symptoms, we investigated the significance of the difference between the scores of fes-cv and gses scales in the two groups. the results, which show the significant differences among groups, are shown in table . next, we used correlation analysis to determine the correlation between the scores of each scale. the results showed that there were statistically significant relationships between the anxiety and depressive symptoms of medical staff, their family environment, and their sense of self-efficacy. anxiety and depressive symptoms showed a significant positive correlation with the dimension of conflict in fes-cv scale (r = . , p < . ; r = . , p < . ), and a significant negative correlation with the dimension of cohesion (r = − . , p < . ; r = − . , p < . ), expressiveness (r = − . , p < . ; r = − . , p < . ), and self-efficacy (r = − . , p < . ). more specifically, individuals with bad family environments and low self-efficacy were more likely to show symptoms of anxiety and depression. besides, selfefficacy positively correlated with the dimension of cohesion and expressiveness and negatively associated with the dimension of conflict (table ) . after controlling for demographic variables, we examined the mediating effects of self-efficacy (figure ) . self-efficacy was significantly associated with the symptoms of anxiety and depression. it significantly mediated the association between the family environment and anxiety symptoms (β = − . ; % ci, − . to − . ; β = − . ; % ci, − . to − . ; and β = . ; % ci, . to . ). similarly, it mediated the association between family environment and the depressive symptoms (β = − . ; % ci, − . to − . ; β = − . ; % ci, − . to − . ; and β = . ; % ci, . to . ). when controlling for self-efficacy, the association between the family environment and anxiety symptoms were still significant (β = − . , p < . ; β = − . , p < . ; and β = . , p < . ) and similarly for family environment and depressive symptoms (β = − . , p < . ; β = − . , p < . ; β = . , p < . ). thus, self-efficacy partly mediated the relationship between the family environment and the symptoms of anxiety and depression. in the current study, we conducted an online questionnaire survey of some medical staff involved in covid- prevention and control in hospitals and isolation sites in beijing. we found that a considerable proportion of medical professionals had anxiety ( %) and depressive symptoms ( %), as noted in previous studies (huang et al., ; lai et al., ) . moreover, our results showed that the family environment of medical staff and their symptoms of anxiety and depression during the epidemic were closely related to self-efficacy, and self-efficacy partly mediated the relationship between the family environment and the symptoms of anxiety and depression. in this present study, we found that the self-efficacy of male medical staff was significantly higher than that of female medical staff (t = . , p = . ). however, the symptoms of anxiety (p < . ) and depression (p = . ) during covid- were significantly lower than that of female medical staff, which was consistent with previous research results. for example, it showed that female medical workers experience higher levels of anxiety, depression, and distress during covid- (lai et al., ) . it also reported that the self-efficacy of male medical staff is significantly higher than that of female medical staff (tang et al., ) . it should also be noted that medical staff who did not live with their families were more likely to have symptoms of anxiety and depression during the epidemic. thus, our study suggests that we should pay more attention to such medical staff and provide them psychological intervention. this observation also indicates that the family plays a certain role in regulating negative emotions. furthermore, our study showed a close relationship between the family environment of the medical staff and their symptoms of anxiety and depression. the medical staff members with low cohesion and expressiveness, as well as high conflict in the family environment, were more likely to show anxiety and depressive symptoms during the epidemic. notably, in this present study, the relationship between the family environment and the symptoms of anxiety and depression reveals that the family environment can, directly and indirectly, affect the emotions of medical staff during an epidemic. the family environment can significantly predict the emergence of anxiety and depressive symptoms directly, which is consistent with previous results. for example, some studies found that there was a correlation between cohesion in the family environment and depression in family members (burnett et al., ) ; families with high cohesion, which have high levels of family support and ties, likely reduce depression (park et al., ; cano et al., ) . in contrast, low family cohesion and conflict between parents increased the risk of depression and anxiety in family members (park et al., ; cano et al., ) . in families with a high degree of cohesion, individuals can get more psychological help and emotional support within the family (birgisdóttir et al., ) , so that the psychological pressure can be appropriately relieved. positive emotional expression within the family can prevent suppression of inner feelings and buffer internal conflicts, especially in the face of stressful events. in contrast, negative emotional expression and low emotional expression within the family are associated with higher anxiety and depression (luebbe and bell, ; park et al., ) . in a high-conflict family, family members are prone to conflict between each other, leading to anxiety. therefore, the results in this study support the hypothesis that the family environment can influence the emotional state of the family members and that a negative family environment is a psychological risk factor for the rising emotional distress of the medical staff during an epidemic. additionally, the influence of the medical staff 's family environment on their symptoms of anxiety and depression during the covid- epidemic is partly through the role of self-efficacy, which means self-efficacy plays a critical role in mediating the effect of family environment on symptoms of anxiety and depression. indeed, previous studies supported that self-efficacy had a protective effect on mental health (bandura, ) and played a vital role in the regulation of stress (bandura et al., ) . high self-efficacy was related to better psychological adjustment (bandura, ) and lower emotional distress (benight and harper, ) . individuals with high selfefficacy had positive expectations and beliefs, had successful experiences, generated positive emotions, and were more likely to seek psychological support to modulate their emotions when facing stressful situations (tsang et al., ) . a bad family environment can reduce an individual's self-confidence and ability (hemati et al., ) . self-efficacy is the embodiment of such confidence and ability (tang et al., ) . that is to say, the family environment affects self-efficacy by affecting people's self-confidence and ability, thus affecting individuals' behavioral patterns and emotional responses to stress (tsang et al., ) . for example, a medical worker with a good family environment has confidence in the success of the fight against the epidemic and also believes that he is capable of doing his job, which will ease his fear of the epidemic and anxiety about the high-risk work of infection. self-efficacy played a partial mediating role between the family environment and symptoms of anxiety and depression, indicating the existence of other variables between them. future studies should, therefore, include other relevant variables that are likely involved in the relationship between the family environment and negative emotions. this study indicates that adjusting self-efficacy is a meaningful way to regulate the anxiety and depressive symptoms of medical staff during an epidemic. because of the close correlation between the family environment and the symptoms of anxiety and depression of medical staff during an epidemic, we need to pay more attention to psychological assistance for medical staff from the perspective of their family situation. when providing psychological assistance to medical staff during the epidemic, we should not only focus on the medical staff but also care about their family members and family relations. by improving the family environment and increasing the active support of the family, their emotional problems can be effectively alleviated (mohindra et al., ) . the focus of the medical staff 's treatment of family relations should be to enhance the intimacy between family members, increase their interaction, encourage them to talk to each other, resolve the family conflicts in time, and create a good family atmosphere. based on the results of this study, we propose the following suggestions for medical staff. first, we suggest that medical staff should have time to communicate with their families and that they should be encouraged to share their feelings with family members and get their support and encouragement. for example, they should be encouraged to record their routines in the hospital and share them with their families . the hospital or isolation point shall provide relevant communication conditions and equipment for this purpose. second, during the epidemic period, the staff of the relevant departments of the hospital should be aware of the difficulties existing in the family of medical staff, and they should guide these staff members and help them solve those problems to avoid family conflicts. third, the family members of medical staff should be aware of the mental health issues of the staff member. family safety plays the most important role in reducing the pressure of medical staff during the epidemic . therefore, the staff members should stay connected with their families through wechat, sms, and other apps to understand their health status, which will help lessen the negative mental state of the medical staff during the covid- pandemic outbreak. these suggestions can bring medical staff closer to their families, have more emotional communication, and reduce family conflicts. with the implementation of these measures, the medical staff 's sense of self-efficacy will also be improved. besides, our results suggest that improving self-efficacy will help to alleviate the anxiety and depressive symptoms of medical staff during the covid- outbreak. manipulating self-efficacy is an important way to prevent mental health problems when dealing with stress (schönfeld et al., ) . previous studies have focused on the effects of self-efficacy on the mental health and work quality of medical staff (amiri et al., ; tang et al., ) , and it suggested that necessary interventions should be implemented to improve the self-efficacy of medical staff. in the prevention and control of covid- , medical staff is faced with two main difficulties. on the one hand, medical staff has heavy work tasks, great pressure, high risk of infection, and lack of support (spoorthy et al., ) . on the other hand, most of the medical staff are required to be isolated in hospitals or isolation points. their families will face more prominent problems (mohindra et al., ) . some positive motivation factors can boost morale and improve the self-efficacy of medical staff, such as family and social support, positive example, recognition, and appreciation from others, successful experience, self-identity (spoorthy et al., ) . positive feedback and encouragement from others could also effectively improve self-efficacy (bandura, ; zinken et al., ; brown et al., ) . the pre-job training, encouragement from colleagues and family, affirmation from patients and society, and sufficient material support were all helpful ways to improve the self-efficacy of medical staff during the covid- outbreak. medical staff in a good family environment can get better family support. the support reduces the sense of uneasiness caused by isolation, and improve self-efficacy, increase work confidence, improve work efficiency and quality, and reduce the negative emotions caused by epidemic infection. it has been reported that the mental health status of chinese medical staff is poor (zhou et al., ) , and they are exposed to immense workplace pressure and face complex doctor-patient relationships. the reason lies in the contradictions in the current medical system reform in china, such as the uneven distribution of medical resources (lu et al., ) , the disequilibrium between health care needs and medical development (zhou et al., ) , and the imperfection of the medical system (ta et al., ) . during an epidemic period, protecting the mental health of the medical staff would benefit their health as well as the control of the epidemic worldwide (kang et al., ) . the national health commission of china has published a national guideline of psychological crisis intervention for covid- , which is guided for the protection of the mental health of the medical staff (kang et al., ) . however, the family environment is particularly important to the mental health of the medical staff, and self-efficacy plays an important role in regulating the relationship between them. appropriate guidelines should be issued nationally to improve the family environment of the medical staff and for the improvement of their selfefficacy. there are some limitations to the current study that need to be addressed. first, there are limitations to the method of sampling. sampling bias may have occurred by using a convenient sampling method. second, we have a small sample size, and all participants are from beijing, so the research participants in this study may not be sufficiently representative of the population we are interested in studying, which may limit the conclusion of research results. third, online questionnaire surveys cannot observe the participants' answering process, there is the possibility of random answer and perfunctory answer, cannot guarantee the complete authenticity of data. fourth, we did not measure other potential confounding variables that may exist between the family environment and the emotional state of medical staff during the covid- outbreak. finally, the researchers are all medical staff, and the design of the survey may be more based on clinical observation. in the future, the research design can be combined with clinical observation and the existing theoretical framework. in the current study, we found that the anxiety and depressive symptoms of medical staff during the covid- outbreak was closely related to their family environment, and their self-efficacy regulated the relationship between them. this study provides a new direction for the psychological intervention in medical staff during the epidemic that mainly focuses on improving their family environment and their self-efficacy. the raw data supporting the conclusions of this article will be made available by the authors, without undue reservation, to any qualified researcher. nh contributed to the manuscript writing. j-xc, yl, and s-sh contributed to the conception and designed the work. yl, l-lw, y-yw, and ly contributed to the critical revision of the article. all authors contributed to the article and approved the submitted version. study of the relationship between self-efficacy, general health and burnout among iranian health workers survey of stress reactions among health care workers involved with the sars outbreak self-efficacy in changing societies on the functional properties of perceived self-efficacy revisited 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a systematic review and metaanalysis parental factors associated with depression and anxiety in young people: a systematic review and meta-analysis covid- severity, self-efficacy, knowledge, preventive behaviors, and mental health in turkey determinate factors of mental health status in chinese medical staff: a cross-sectional study analysis system for selfefficacy training (asset). assessing treatment fidelity of self-management interventions key: cord- -mnlzj ly authors: barattucci, massimiliano; chirico, alice; kuvačić, goran; de giorgio, andrea title: rethinking the role of affect in risk judgment: what we have learned from covid- during the first week of quarantine in italy date: - - journal: front psychol doi: . /fpsyg. . sha: doc_id: cord_uid: mnlzj ly due to covid- spreading in italy, on march the prime minister of italy declared a lockdown and imposed severe restrictive measures impacting citizens’ freedom at several levels. people were required to stay at home and go out only to satisfy basic needs. several risk models have postulated a link among online searching behavior, affect, anxiety, and complaints by individuals toward government restrictions (gr), which emerged as also related to an increased perception of knowledge toward risk. however, to date, no study has addressed how these key risk-related aspects (i.e., affect, anxiety, perceived knowledge on risk, and risk dimensions) can act jointly to orient online health information-seeking behavior, and people’s complaints toward gr imposed during the lockdown. this study investigated the mechanisms underlying online health information-seeking behavior and people’s complaints toward the government’s restrictions during a covid- emergency in the italian population. drawing from the health belief model (hbm), which postulates a link between sociodemographic variables, risk, and affect dimensions in emergency, we assumed risk factors as predictors of affect and anxiety, which, in turn, were posited as mediators between risk dimensions, online health information-seeking behavior, and complaints toward gr. participants ( , ) were involved during the first week of the quarantine (march – ) and completed an online survey composed of (i) an adapted version of the italian risk perception questionnaire; (ii) the italian positive (pa) and negative affect (na) schedule (panas- ); (iii) the state anxiety scale (stai-y ); (iv) ad hoc personal knowledge measure about novel coronavirus; (v) ad hoc item measuring information search behavior regarding the novel coronavirus; (vi) ad hoc measure of the complains regarding gr; and (vii) sociodemographic questions. general linear models and structural equation modeling (sem) were carried out to test the model. sociodemographic and cognitive factors predicted the participants’ affect and anxiety, which, in turn, motivated and fully mediated both information search behavior and complaint toward gr. this research can offer useful suggestions for policy-makers during the covid- emergency, and it advanced the knowledge on the risk–emotion link in emergency situations. in december , a cluster of pneumonia cases of unknown etiology was detected in the city of wuhan, hubei province, central-eastern china. this initial phenomenon turned into a novel coronavirus (zhu et al., ) , which is named sars-cov- (i.e., severe acute respiratory syndrome), and which caused a disease named covid- (qu et al., ) . even though symptomatology has been defined clearly, it is still hard to define how long it will last and if a cure is possible (porcheddu et al., ; wangping et al., ) . recently, the infection has caused enough deaths to be considered as a pandemic by the world health organization (who) (onder et al., ; sohrabi et al., ) . in italy, the outbreak spread on february , and after an ad hoc decree of the president of the council of ministers (dpcm), a lockdown was imposed on italians (i.e., days after the first recognized patient). all italians were required to stay home if they were not involved in jobs or tasks involved in other people's survival. since march in italy, restrictive and severe measures have been gradually implemented (from march to ) (de giorgio, a,b) . according to the health belief model (hbm) (janz and becker, ; carpenter, )-well-established theoretical frameworks in health-related behavior research-often, the psychological counterpart of disease-related emergencies can entail an increased risk perception (bults et al., ) modulated also by sociodemographic variables (e.g., vaughan, ; clifton et al., ) . this cognitive perception of risk can have significant implications on individuals' emotional states on the short and on the long-term (cafagna and barattucci, ) . moreover, it would be closely related to the intention to adopt protective behaviors (leppin and aro, ; goodwin et al., ) as well as to personal susceptibility (lin et al., ) . however, hbm has never been used to investigate the mechanisms underlying all these variables in a pandemic situation. moreover, no data on the italian population's risk perception have been reported yet. crucially, no studies have investigated the impact of risk cognition and emotional response on research behavior and compliance with government actions. this last aspect can be far more relevant if considering that cognitive perception of risk is sensitive to peculiar emergencyrelated environmental factors. for instance, italians were forced to stay home, thus changing their normal habits related to work and leisure activities. confined at home, italians tended to rely more on the internet to remain up-to-date on pandemic progress in a safe way. crucially, online information searching regarding health issues is not a neutral task since it can influence people's affective states, especially anxiety (jutel, ) . to investigate the joint impact of cognitive risk dimensions, affect, and anxiety on online searching behavior and compliance toward government restrictions (gr), in the peculiar context of the italian pandemic emergency, we drew from the hbm to formulate and test a novel explicative model. first, we posed the first day of lockdown (march , ) as the trigger event and the online health information on covid- searching behaviors as the main outcome. then, we built and tested a novel model including sociodemographical factors, risk cognitions, behaviors, and affect as mediators between the trigger event and the main outcome of the online health information searching behaviors (figure ) . elucidating this mechanism can be crucial also because information-seeking behaviors can influence the population' general compliance with government decisions (clifton et al., ) . therefore, these data can provide the government with useful indications regarding which online communication strategies would be the most effective in an emergency situation (liao et al., ) . the term "risk" represents the possibility of suffering damage connected to foreseeable circumstances. in essence, it is consequently a variable connected to the frequency (or probability) of the occurrence of the damage and the magnitude that the latter can cause in the individual (slovic, ) . this universally recognized definition may look as reducible to a mere mathematical formula. however, its subjective dimension suggests a deeper complexity. indeed, a plethora of approaches have been developed to capture all the key aspects related to risk perceptions, as well as its main consequences on people' behavior. among the main subjective dimensions of risk, cognitive factors emerged as playing a key role (slovic, ; leppin and aro, ) . risk perception would be determined by a complex series of cognitive factors: (i) the perceived possibility of having damage to health; (ii) the subjective importance that the damage is more or less possible; (iii) by personal uncertainty associated with the exposure to a specific risk factor (slovic et al., ) . in the case of general risk or infection or disease, personal knowledge negatively affects the perception of risk danger (shook et al., ) . in turn, risk perception impacts behaviors (sjöberg, ) , specifically between different risk dimensions regarding infection, perceived fatality, severity, vulnerability, and uncontrollability, and are proven to have effects on protective conduct . in regard to pandemic-related risk perceptions, two main factors emerged as relevant, that is, vulnerability (a person's subjective perception of the risk of acquiring an illness or disease) and severity (a person's feelings on the seriousness of contracting an illness or disease) of harm (carpenter, ) . however, despite that it has been repeatedly shown that risk perception can affect behavior (brewer et al., ; vaughan, ; shook et al., ) , the underlying mechanism still needs to be elucidated. specifically, antecedents of cognitive dimensions of risk should be still clarified. with this regard, demographic factors/variables emerged as playing a key role in shaping pandemic risk perception and subsequent behaviors (see e.g., vaughan, ) . for instance, women resulted as more avoidant, fearful, and vulnerable in terms of pandemic risk perception, with lower risk acceptance scores when compared to men (see e.g., de zwart et al., ) . conversely, age often leads to an increased perception of control on infection risk, lower susceptibility, avoidance, and higher acceptance of risk (see e.g., clifton et al., figure | the first week of lockdown in italy: epidemiological and variable trends. all variables have been standardized. due to the numerical difference of epidemiological data between northern and southern italy, we divided the real values by , and have thus reported them in the y-axis. ). conversely, the level of education was negatively related to the risk of infection and contagion (i.e., vulnerability) (gidengil et al., ) . lower income and urbanization positively affected vulnerability and perceived infection risk (brewer et al., ; de zwart et al., ; gidengil et al., ) . another factor, which would act as a mediator, should be included between risk perception and behavior, that is, affect. affect, such as fear, is related to a general amplification of the perception of the danger of risky events, while anger would be significantly associated with underestimation of dangers (slovic, ; brown, ) . moreover, the degree of emotional involvement in the perceived consequences of different risks, or specific personality dimensions that determine emotional attitudes, is associated with different aspects of risk perception (among all, vulnerability, and severity) (slovic, ; brown, ) . crucially, among the stimuli triggering emotional states, also online searching information should be included, which could also lead to a phenomenon of large-scale emotional contagion (hatfield et al., ) . emotions expressed via the internet, and mainly through social media, can lead to a longterm psychological impact (arapakis et al., ; fowler and christakis, ; coviello et al., ; kramer et al., ; ferrara and yang, ; mui et al., ) including also a simple health information search (gadahad et al., ) . specifically, both general and specific discrete emotional states can orient people's online search for information on health issues (wissow, ; myrick and willoughby, ) . emotions and affect act as motivators of specific survival behaviors (frijda et al., ) , and this definition could hardly be more appropriate than in this worldwide emergency. in this case, one key survival behavior motivated by affect could consist of online health information seeking or avoidance (savolainen, ) . while positive affect (pa) resulted in determining people's attitudes toward information avoidance, negative affect (na) predicted individuals' attitudes toward information seeking (yang and kahlor, ) . on the other hand, searching for information about symptoms or specific illnesses can increase people's distress and anxiety about their health (graffigna et al., ) . crucially, na and anxiety have often resulted in closely positively intertwined affective states (crawford and henry, ) , even though they can be considered as clear, distinguishable constructs (watson and kendall, ; clark and watson, ) . according to the tripartite model of anxiety and depression, high levels of na underlie both anxiety and depression, while na would act as a central risk factor of anxiety (clark and watson, ) . na has also often been considered an early predictor of anxiety in several domains (crawford and henry, ; cisler et al., ) . during the lockdown, the internet became one of the most important sources of health-related information; thus, it would be crucial to analyze antecedents of this behavior as well as its potential impact on compliance with gr. to date, the literature regarding risk perception and behavior on worldwide pandemics has focused mainly on general population's or on healthcare workers' punctual psychological responses immediately after the end of isolation (wilder-smith and freedman, ). acute stress/posttraumatic disorders, as well as higher propensity to live state anxiety, emerged as serious issues (leppin and aro, ) . crucially, no data on the italian population's risk perception have been reported yet. moreover, no studies have investigated the role of risk cognition and emotional response to research behavior and compliance with government actions. in this study, we aimed to advance previous studies on covid- at two levels. first, we elucidated the link between cognitive and emotional risk dimensions in a pandemic, then, we built and tested a novel model linking cognitive, emotional, and sociodemographic factors to a peculiar behavior enacted in this emergency, which would be probably increasingly adopted in the future, that is, online searching behavior of health-related information. moreover, we also used the hbm, for the first time, as a general explicative framework in a pandemic situation. health belief model posits a cognitive appraisal framework, in which perception of the risk for individual health affects emotions and protective behavior (roseman, ) . more specifically, when referring to the hbm framework (janz and becker, ) and adapting recent theoretical models (watson and spence, ; keller et al., ; lemée et al., ) , the present research model considers sociodemographics as antecedents of risk cognition and emotion as a buffering factor between risk perception and behavior (figure ). this novel model proposes that two different risk cognition aspects have independent effects on pa and na. perceptions regarding specific pandemic and perceived knowledge of risk (champion and skinner, ; carpenter, ) can act differently on contingent affect, which can have an impact on both information search behavior and complaints regarding government action. in a situation of physical and social constraint, i.e., quarantine, the sudden perceptions of the risk would depend mainly on mass media, social media, and word of mouth information (jung et al., ) . this growing information impacting the emotional state can, in turn, act as both a search trigger for further infection information and a facilitator of compliance with the government's restrictions (goodwin et al., ; rolison and hanoch, ) . in line with hbm and literature, major evidence linking cognitive risk dimensions and affect keller et al., ) , this study aimed to explore the following hypotheses: sociodemographic factors have an impact on risk perception and perceived risk knowledge (hp ); more precisely, the research expects that age (hp a) and education (hp b) will negatively affect risk perception and positively risk knowledge; thus, it is hypothesized that women will have a worse perception of pandemics and less perceived knowledge compared to men (hp c). the research assumed that risk perception would positively impact on na (hp a) and negatively on pa (hp b); on the contrary, it expected that risk knowledge would negatively impact on na (hp a) and positively on pa (hp b). moreover, the research intends to elucidate whether the differential effect of na (hp a) and pa (hp b) on search behavior and a complaint is mediated by state anxiety (hp ). in order to test all the mentioned hypotheses thoroughly, we tested this novel model by means of structural equation modeling (sem) (figure ). one thousand thirty-one participants from italy voluntarily took part to this study (mean age = . ; sd = . , range = - ). after removing the data of the participants who did not answer all the survey questions, we analyzed participants, of which were females (mean age = . ; sd = . ) and were males (mean age = . ; sd = ). their marital status was as follows: . % were engaged in a relationship, . % were married, . % were single, . % were divorced, . % were widowed; . % reported living in central big city areas, . % were living in the suburb of a big city, . % reported living in a small town (i.e., less than , inhabitants), and . % reported living in the countryside; . % resided in northern italy, . % resided in central italy, . % resided in south italy, and . % resided in the islands; . % were students, . % were retired, . % were freelance, . % were temporary workers, and . % were full-time employees with a permanent position; and . % reported having no children, . % reported having two children, . % reported having one child, and . % reported having more than three children. regarding schooling, . % reported having a middle school diploma, . % declared having a high school degree, . % reported having a bachelor's degree, . % reported having a master's degree, and . % reported having a ph.d. this study was conducted in accordance with apa ethical standards and with the declaration of helsinki. participants: (i) were fully informed in regard to institutional affiliations of the researchers and research scope; (ii) continued the survey only if they were adult (> years old); (iii) gave information that could not allow their identification; (iv) had the right to refuse to participate in the study and withdraw at any time; (v) filled an anonymous questionnaire and confirmed the understanding of instructions and voluntary participation. participants completed an online survey between march , the first day of quarantine and national lockdown, and march . the research design relied on snowball sampling (chain referral process). participants were recruited through flyers, social networks, and by word of mouth. the questionnaire answering began in the evening (march ) when the dpcm decree was issued. first, participants completed the part of the questionnaire created to gather sociodemographic information. second, the following questionnaires were then completed: . italian risk perception questionnaire (cafagna and barattucci, ) : originally developed by savadori et al. ( ) . based on literature indications (keller et al., ) , the study deduced that the pandemic risk could generally be identified as terrifying, uncontrollable, fatal, and dangerous for future generations, and widespread in terms of exposure. hereupon, the researchers built a tool that measures five single-item dimensions of risk infection, on a seven-point scale ranging from to : severity, vulnerability, uncontrollability, terror, and danger for future generation (item examples: "considering the scale below ( 'not fatal' to 'fatal'): in your opinion, when the virus infects a subject, how likely are the consequences of being fatal?" "considering the scale below ( 'not exposed' to 'totally exposed'), in your opinion, to what extent do you think you are exposed to the coronavirus risk?" . italian short version of the positive and negative affect schedule (terraciano et al., (agresti and kateri, ) . moreover, regarding the residence area, we operationalized the "residence area" into two different variables. the former "residence area" refers to how far from the city center a person lives: (i) city center; (ii) suburb of a city; (iii) town; (vi) countryside, and (v) the latter, "residence area in italy" refers to a zone of residence from the north to the south of italy and islands, which also coincides with the distance from the first epidemic center of diffusion (i.e., codogno) in northern italy. a comprehensive structural equation model with amos was used to test the proposed theoretical model and the main hypotheses. commonly reported fit statistics were: comparative fit index (cfi), tucker-lewis index (tli), normed fit index (nfi), goodness of fit index (gfi), incremental fit index (ifi), root mean square error of approximation (rmsea), plus standardized root mean square residual (srm) for measurement model fit. research has sought to reduce response bias and common-method variance problems utilizing suggested methods (podsakoff et al., ) : scales were visually divided, and different formats and endpoints were used for each different measure. psychological impact on anxiety, negative affect, risk dimensions, and search behavior all factors are reported in table with significant regression coefficients and wald statistics. all omnibus models were residency: countryside note. "male" as category of "gender"; "single" as a category of "status"; "ph.d,/ms" as a level of "education"; "three or more children" as "number of children"; "city center" as a level of "residency"; "islands" as a level of "residency in italy" were not reported since they are a redundant levels. marital status was transformed into a dummy variable (engaged vs. single). a the predictor was significant, but the omnibus model was not. ci , conventional % confidence interval; pa, positive affect; na, negative affect; sb, search behavior; knw, knowledge; vul, vulnerability; con, control; sev, severity; ter, terrifying; dfg, damage for future generations; com, compliance. significant except for the model with "knowledge, " i.e., a risk dimension, as the predicted variable. we reported results for each of the dependant variables (anxiety, pa, na, sb, knw, vul, con, sev, ter, dfg, com) in relation to all predictors taken together (gender, marital status, education, number of children, residency, residency in italy). only b values useful for explaining results were reported in order to avoid redundancies. younger , not engaged, significantly positively predicted the perception of being vulnerable against risk. a lower education (beta decreased positively from high school to elementary school) and being older (b = . ) significantly positively predicted the perception of control over the risk associated with the pandemic. being female, with a lower level of education, and with no to one child and older led to a significantly higher perception of risk severity. being less educated and younger led to a significantly higher perception of risk as terrifying. being female, with lower education, and an increasing number of children (from no to two children) led to a significantly higher perception of risk damage associated with new generations. females with lower education and younger tended to report more compliance toward the government's measures. descriptive statistics for all the measures and zero-order correlations between them are described in table . with the aim of exploring a measurement model and construct validity, a confirmatory factor analysis (cfa) was conducted comparing four nested models from one factor to a final model composed of the four principal latent factors (risk perception, na, pa, and anxiety). table represents chi-square and goodness of fit indices for the four measurement models developed. considering that risk perceptions were all measured with single items, and despite the final cfa indexes not being optimal, there was an evident amelioration of all indices from the first to the final model. therefore, the measurement model can be profitably used in further testing of the proposed structural model. thus, we tested through sem the proposed structural model (figure ) : the five risk perception dimensions (fatality, vulnerability, uncontrollability, terrifying) and risk knowledge as (correlated) antecedents, with direct relationships with both na and pa as intermediate variables, which themselves have direct links with state anxiety that fully mediates information search behavior. the proposed model exhibited optimal goodness of fit: chi-square = . (df = ; p < . ), rmsea = . , cfi = . , ifi = . , nfi = . , gfi = . , tli = . . consequently, we tested the same model deleting nonsignificant relationships (severity, vulnerability, and terrifying with pa; risk knowledge with na) and some correlations between antecedents (vulnerability and danger for future generations, with terrifying risk, risk dimensions, and risk knowledge). consistent with our hypothesized relationships, the model showed excellent goodness of fit: chi-square = , (df = ; p < . ), rmsea = . , cfi = . , ifi = . , nfi = . , gfi = . , tli = . , with all significant relationships (p < . ). regression weights are presented in table , while the path diagram of the final model is shown in figure . as hypothesized (hp a), each dimension of risk perception is positively related to na. in contrast, only two dimensions (uncontrollability and danger for future generations) are significantly linked to pa, not confirming what was expected (hp b); conversely, confirming hypotheses hp a but not hp b, risk knowledge is only positively related to pa. results confirmed that the expected differential effect of na (hp a) and pa (hp b) on search behavior and on a complaint is fully mediated by state anxiety (pa indirect effect on search behavior: β = − . , p < . ; na indirect effect on search behavior: β = . , p < . ). overall, the relationships expressed in the model explained % of the variance for na, % for pa, % for state anxiety, % for search behavior, and % for complaint in government actions. the present research carried forward the literature regarding the fact that cognitive factors predict population affect that, in turn, motivate and fully mediate information search behavior and complaints about government actions, overturning contributions that proposed that risk behavior is driven by affects (kahan, ; leppin and aro, ; wu et al., ) . considering our sample of participants, results showed that being female and younger with a lower level of education led to more anxiety, na, a higher risk perception as terrifying, and higher complaint regarding gr. moreover, pa increased significantly in older males and those with a decreasing number of children (less than two). younger people or those who were not engaged or married tended to look for information online about the covid- more frequently. older females with a lower education level (from middle to elementary school) were more prone to perceive themselves as competent regarding their acquired knowledge on covid- . being engaged or married acted as a protective factor regarding the perceived vulnerability against covid- . older people with lower levels of education (from high school to elementary school degree) tended to feel more able to control the gravity of risks associated with this pandemic. older females having from one to no children, and with high-school to elementary school degree, tended to perceive the covid- -associated risk as more severe. females who have a higher number of children (from no child to two children) and with a lower level of education (this effect increased from bachelor to elementary school) tented to perceive an increased risk associated with covid- for future generations. younger females with lower education tended to report more compliance toward the government's measures. in this study, we elucidated two crucial phenomena in emergency: general na and its link with anxiety. na and anxiety have often resulted in closely positively intertwined affective states (crawford and henry, ) even though they can be considered as clear, distinguishable constructs (watson and kendall, ; clark and watson, ) . the tripartite model of anxiety and depression confirmed that high levels of na underlie both anxiety and depression, while na acts as a predictor of anxiety (clark and watson, ) . specifically, na has been often considered as an early predictor of anxiety in several domains (crawford and henry, ; cisler et al., ) . the model tested in this study confirmed the direction of this link. emotions and affect also act as motivators of specific survival behaviors (frijda et al., ) , and this definition could hardly be more appropriate than in this worldwide emergency. in this case, affect can trigger behaviors such as online health information seeking or avoidance (savolainen, ) . while pa resulted in playing a pivotal role in determining people's attitudes toward information avoidance, the negative one predicted individuals' attitudes toward information seeking (yang and kahlor, ) . on the other hand, searching for information about symptoms or specific illnesses can increase people distress and anxiety about their health following a reinforcing spiral to the extent that a new term has been coined to refer to this condition, i.e., "cyberchondria" (te poel et al., ) . indeed, people with high health anxiety (i.e., fears stemming when individuals exaggerate in interpreting their bodily symptoms as an indicating severe illnesses) (mcmullan et al., ) trend to increase their negative responses related to the likelihood of suffering from a given disease now and in the future (baumgartner and hartmann, ) . the present result showed that anxiety triggered by na acted as a strong predictor of people's searching behavior regarding health. in other words, italians were motivated by anxiety stemming from na and triggered by their risk perception on the controllability and vulnerability regarding sars-cov- spread and health searching behavior. overall, results provided support for the cognitive appraisal framework in risk perception keller et al., ) and the main hypotheses. risk perception and knowledge acted with different mechanisms on emotions: risk perception mainly contributed to having an effect on negative affect, while knowledge influenced only positive affect. furthermore, in line with our hypotheses, emotions fully mediated the relation among risk cognition, complaint, and information search behavior (champion and skinner, ; carpenter, ; jung et al., ) . risk perception and affective response to pandemics can be crucial factors for managing population behaviors, thus ensuring the best adherence to prescription and safety norms (poletti et al., ; merino, ; shook et al., ) . moreover, the efficiency of prevention behaviors in pandemics by the government is related to population cooperation, which is highly related to risk perception (leppin and aro, ; goodwin et al., ) . exploring risk perception during pandemics is fundamental because misperceptions can often cause inadequate responses (poletti et al., ; merino, ) . in particular, perceptions regarding infection can lead people to take safer actions, to reduce exposure, and to increase protective conducts (e.g., vaccination, social distancing, hygiene, search for information; shook et al., ) . these individual behaviors can significantly influence the disease progression at a system level (de zwart et al., ; jiang et al., ) . since emotion and behavior are closely related (loewenstein et al., ; slovic and peters, ; brown, ) , beliefs and perceptions regarding risk represent core predisposing factors to predict people reactions. therefore, it would be crucial to promote public order and right risk communication and to prevent counterproductive behaviors linked to bad information and fake news (brug et al., ; voeten et al., ; shook et al., ) . the risk controllability is one of the most important factors that need to be considered since pa can reduce anxiety and, consequently, affect complaint and informational search behavior. in italy, especially during the first days of the epidemic (from the end of february), there was too much conflicting information (e.g., "this virus is very similar to normal flu."/"please, pay attention, it is a very dangerous virus; it is not like normal flu."). it is crucial to evidence that too much information, especially if conflicting (or worse, fake news), can cause confusion in the population, and this, in turn, can affect emotional states (bawden and robinson, ). politicians should act on proper information dispersion procedures regarding specific risk, as perceived knowledge may act on search behavior and complaint. our results can suggest more tailored strategies of communication for prevention to be implemented by the government, not just in pandemic emergency (smith, ) . research regarding the way the population appraised hazards acquired significant scientific attention, and different approaches and paradigms to the perception of risk have been discussed (leppin and aro, ; keller et al., ) . recent contributions have conformed on the emotional appraisal of risk perception (loewenstein et al., ; wu et al., ) . thus, results from our study could offer evidence in favor of the hypothesis that the analytic system (i.e., risk judgment) would precede the emotional one, at least in a pandemic emergency. covid- is having, and is predicted, to have a substantial impact on the world economy, both due to the effect on national health systems, and on the slowdown of business activities through lockdowns and measures of social distancing. the economic impact would be even more substantial in developing countries, due to both difficulties related to social distancing in the slums and in the suburbs, as well as for the absence of stable health systems, welfare measures, and smart-working policies, and for the access to the various forms of institutional communication and to the mass media. the literature concerning the other pandemics has clearly shown that the perception of risk has a strong cultural component; thus, communication strategies should be tailored according to the peculiarities of each country . in this regard, the proposed model can indicate a priority of all the variables capable of influencing preventive behavior or adherence to restrictions directly, which must be taken into account when planning communication to the general public. for instance, accurate and clear communication should clarify the danger for future generations, the terror aroused, and the degree of exposure to the pandemic (van bortel et al., ) . furthermore, the proposed model evidenced also perceived knowledge of risk as another key variable to be considered in mass communication. finally, communication in developing countries should consider that people living in precarious economic conditions could give less weight to the health consequences of covid- , in a cost-benefit assessment process that could overestimate economic costs to the detriment of those for health and economics (leppin and aro, ). given the novelty and relevance of this study, some limitations should be discussed. first of all, the cross-sectional design of the research limits the generalizability of its findings. although results should be interpreted, especially concerning the specificity of both the contagion risk and the quarantine situation, useful indications on the mechanism that operates between cognitions, emotions, and behaviors in situations of high stress and forced captivity can be provided. moreover, due to the recruitment type (i.e., online), and despite a large number of participants, this sample cannot be considered as fully representative of the italian population ( % males, % in northern italy). almost % of the participants filled out the survey in the first days (maybe caused by people's reactions to the lockdown). therefore, this distribution does not allow for longitudinal analysis. the raw data supporting the conclusions of this article will be made available by the authors, without undue reservation. ethical review and approval was not required for the study on human participants in accordance with the local legislation and institutional requirements. the patients/ participants provided their written informed consent to participate in this study. categorical data analysis affective feedback: an investigation into the role of 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alessandro; tessitore, francesca; troisi, gina; mannarini, stefania title: mental health through the covid- quarantine: a growth curve analysis on italian young adults date: - - journal: front psychol doi: . /fpsyg. . sha: doc_id: cord_uid: bboc z introduction: health emergencies, such as epidemics, have detrimental and long-lasting consequences on people’s mental health, which are higher during the implementation of strict lockdown measures. despite several recent psychological researches on the coronavirus disease (covid- ) pandemic highlighting that young adults represent a high risk category, no studies specifically focused on young adults’ mental health status have been carried out yet. this study aimed to assess and monitor italian young adults’ mental health status during the first weeks of lockdown through the use of a longitudinal panel design. methods: participants (n = ) provided self-reports in four time intervals ( -week intervals) in month. the syndromic scales of adult self-report - were used to assess the internalizing problems (anxiety/depression, withdrawn, and somatic complaints), externalizing problems (aggressive, rule-breaking, and intrusive behavior), and personal strengths. to determine the time-varying effects of prolonged quarantine, a growth curve modeling will be performed. results: the results showed an increase in anxiety/depression, withdrawal, somatic complaints, aggressive behavior, rule-breaking behavior, and internalizing and externalizing problems and a decrease in intrusive behavior and personal strengths from t to t . conclusions: the results contributed to the ongoing debate concerning the psychological impact of the covid- emergency, helping to plan and develop efficient intervention projects able to take care of young adults’ mental health in the long term. the novel coronavirus disease (covid- ) is a highly infectious disease that began as a viral pneumonia in late december . in march , the world health organization (who) declared the state of pandemic. as rapidly pointed out (fiorillo and gorwood, ; jakovljevi et al., ) , the covid- global pandemic has affected-and is still affecting-not only physical health but also individual, family, and collective mental health. in line with recent studies (horesh and brown, ; masiero et al., ) , the covid- pandemic should be classified as a critical event with a potential traumatic nature, which may be overwhelming and could lead to complex emotional responses that can negatively affect individuals and collective psychological systems. starting with china and followed by other states, extraordinary measures and containment efforts (e.g., lockdown) aimed to prevent the high risk of contagion and limit the covid- outbreak have been adopted. in europe, italy was the first country that had to face the pandemic. here, on march , , strict lockdown measures were imposed by the government. a series of decrees imposed restrictions on the movements of individuals in the entire national territory from march until may . during the lockdown, people were allowed to leave their homes only for limited and documented purposes. schools, universities, theaters, and cinemas, as well as any shops selling non-essential goods were, therefore, temporarily closed. as previous studies demonstrated (tucci et al., ) , health emergencies, such as epidemics, have detrimental and longlasting consequences on people's mental health. concerning the covid- pandemic, initial studies carried out in china reported high levels of anxiety, depression, and trauma-related symptoms (qiu et al., ) , both during the epidemic peak and month later . moreover, the detrimental effect of epidemics on mental health seems to be higher during the implementation of strict lockdown measures. specifically, previous studies have associated quarantine with higher levels of trauma-related disorders (wu et al., ) , depression (hawryluck et al., ) , irritability and insomnia (lee et al., ) , acute stress (bai et al., ) , and avoidance behaviors and anger (marjanovic et al., ) . in a recent review, brooks et al. ( ) individuated major stress factors as being the long duration of quarantine, the fear of infection, the inadequate supplies and information, boredom, and frustration. in a recent italian study carried out during the third week of lockdown, cellini et al. ( ) have highlighted that italians reported high levels of depression, anxiety, and sleep disturbances. similarly, have found that high rates of negative mental health outcomes were seen in the general population weeks into the covid- lockdown. within the stream of research investigating the impact of quarantine during epidemics on individual's mental health, there have been very few longitudinal investigations aimed at understanding and monitoring the changes in the mental health status during quarantine (brooks et al., ) . where longitudinal research designs were carried out, they were limited to investigating people's mental health during and after quarantine (jeong et al., ; wang et al., ) . recent psychological research on covid- has also highlighted that specific target groups are more at risk than others to develop a wide variety of psychological problems, such as medical workers, marginalized people (i.e., homeless and migrants), and young adults. regarding young adults ( - years old), recent researches have highlighted that they present higher levels of anxiety, distress, and depression than do other adult groups (cao et al., ; huang and zhao, ; qiu et al., ) . these findings have also been confirmed in italy (rossi r. et al., ) . according to cheng et al. ( ) , one of the possible reasons can be found in young adults' tendency to obtain information from social media, which can represent a high stress factor for mental health. these initial findings strongly suggest the need to assess and monitor young adults' psychological situation during the epidemic and the weight of their mental health outcomes. to the best of the authors' knowledge, there are no previous studies specifically aimed at evaluating the impact of lockdown measures on italian young adults' mental health and monitor the changes in their mental health status. to fill this gap, the current study presents a longitudinal panel design aimed to assess the italian young adults' mental health status and monitor their mental health trends during the firsts weeks of lockdown imposed from the italian government during the covid- outbreak. on the basis of recent literature on the general population, an increase in mental health problems among young adults during quarantine was hypothesized. participants were enrolled online and provided self-reports over month ( -week intervals, t -t -t -t ). participants were considered eligible for participation if they met the following inclusion criteria: (a) were between and years and (b) were in a lockdown condition. exclusion criteria were as follows: (a) diagnosis of psychiatric disorder and/or psychopharmacological treatment (assessed with filter questions in the survey) and (b) not "absolute" lockdown condition (workers who were allowed to work outside their home during the lockdown measures). from the initial sample size of t (n = ), nine participants did not participate at t (n = ); four other participants did not participate at t (n = ); and other participants did not participate at t . these participants were, therefore, excluded from the data analysis. the final simple-size was composed of participants. approval from the university research ethics committee was obtained for collecting data. data collection took place during the italian lockdown from mid-march to mid-april . the administration took place in four time intervals ( -week intervals) in month. the first survey (t ) was made at the end of the first week of lockdown. the second survey (t ) coincided with the end of the second week of the lockdown. the third survey (t ) coincided with the end of the third week of the lockdown. the fourth survey (t ) coincided with the end of the fourth week of the lockdown. participants were informed about a complete guarantee of confidentiality and the voluntary nature of participation and their right to discontinue at any point. the enrollment procedure was carried out through an online advertising on social platforms. participants voluntarily accessed the online platform used for data collection once a week for the weeks of administration. to ensure anonymity, a request was made to create a personal identification code to be used for the four administrations. adult self-report (asr/ - ) the syndromic scales of adult self-report - (achenbach and rescorla, ) were used to assess the internalizing and externalizing problems. the asr is especially valuable when used routinely, as in this study design. the asr norms provide a standardized benchmark with which to compare what is reported by each individual. standardized reassessments over a regular interval enable to identify reported stabilities and changes in a group who have particular kinds of problems. in this case, the asr instrument was administered at regular intervals of week for weeks in the period of the italian lockdown. the asr was developed both to document specific problems and to identify syndromes of co-occurring problems. in this study, six specific syndromic scales, anxious/depressed, withdrawn, somatic complaints, aggressive behavior, rule-breaking behavior, and intrusive were used. anxious/depressed ( items) refers to anxiety and depressive symptoms (e.g., "i feel lonely" and "i am too fearful or anxious"). withdrawn ( items) mainly refers to attitudes of isolation and lack of contact with others (e.g., "i don't get along with other people" and "i keep from getting involved with others"). somatic complaints ( items) include physical illness, without a known medical cause (e.g., "i feel dizzy or lightheaded" and "physical problems without a known medical cause: stomachaches"). aggressive behavior ( items) includes behaviors and attitudes characterized by poor control of one's aggression (e.g., "i blame others for my problems" and "i scream or yell a lot"). rule-breaking behavior ( items) refers to transgressive behavior and violation of social norms (e.g., "i am impulsive or act without thinking" and "i lie or cheat"). intrusive ( items) refers to the difficulty faced in the interpersonal relationships and to the prevalence of intrusive behavior (e.g., "i damage or destroy my things" and "i drink too much alcohol or get drunk"). in addition, the broadband scales, internalizing and externalizing, were computed. internalizing problems reflect internal distress, while externalizing problems reflect conflicts with other people. the internalizing scale consists of the syndrome scales anxious/depressed, withdrawn, and somatic complaints, whereas the externalizing scale consists of aggressive behavior and rule-breaking behavior. moreover, the scale of personal strengths ( items) was used to assess the adaptive functioning of the individuals (e.g., "i try to get a lot of attention" and "i am louder than others"). the items are scored on a three-point rating scale: (not true), (somewhat or sometimes true), and (very true or often true); and a total score may be calculated. higher raw scores indicate more problematic behaviors on each scale. then, a normalized t score-weighted for sex and age-was assigned for the syndromic scales and to each internalizing and externalizing problem scales. raw scores of the both types of scales have been quantitatively converted in terms of gender-and agespecific t scores. clinical significant threshold is indicated by t-scores ≥ . borderline range is from to . the asr is a reliable and valid measure for the - general population (achenbach and rescorla, ) . cronbach's alpha (α) and mcdonald's omega (ω) are reported in table . statistical analyses were performed with r software (v. . . ; r core team, , and the following packages: psych (v. . . ; revelle, ), irr (v. . . ; gamer et al., ), lme (v. . - ; bates et al., ) , lmertest (v. . - ; kuznetsova et al., ), esvis (v. . . ; anderson, ) , aiccmodavg (v . - ; mazerolle, ), and ggplot (v. . . ; wickham, ) . no data were missing for any of the participants on any of the asr scales at any of the measurement points. reliability was evaluated by internal consistency analysis, using cronbach's alpha (α) and mcdonald's omega for categorical data (ω). first, the mean differences between the four time intervals (t , t , t , and t ) were performed. the unbiased sample estimate of standardized mean difference effect sizes (hedges' g; hedges, ) was performed, evaluating the magnitude of these differences. the following established ranges guide interpreting standardized mean difference magnitude: from . to . = small; from . to . = medium; and . = large (cohen, ) . growth curve analysis (gca) models were used to estimate the growth trajectories (i.e., slopes) of the syndromic scales of the asr-both internalizing and externalizing scales-and the personal strength scale. models also estimated subject variability in change across time, as represented in random-intercepts coefficients. parameters in each gca model were computed with maximum likelihood (ml) estimation. several models were estimated for each of the outcome variables, separately. specifically, it was hypothesized that the time (the week of quarantine) could have had an effect on the asr syndromic scales. in addition, it was also hypothesized that covariates, such as sex and the experience of covid- (exp-cvd ), intended as the experience of direct proximity with relatives and/or friends affected by covid- , could have had an effect on the shape of the growth curve across time. models were sequentially specified according to the guidelines (long, ; grimm et al., ) . first, a null model was estimated to provide a baseline comparison and to calculate the intraclass correlation coefficient (model -intercept only). second, a null model with covariates was specified (model -intercept model with covariates). third, a linear model with time as predictor and covariate interactions was estimated (model -linear model with covariates). fourth, a quadratic model was specified with linear interaction effects of the covariates (model -quadratic the best model fit was assessed with several indices. first of all, the likelihood ratio test (lrt) was performed between one model and the following one in a step-up approach analysis: model vs. model ; model vs. model ; model vs. model ; and model vs. model -the most parsimonious model will be preferred (long, ) . in addition, also "information criteria" indices were computed by comparing the abovementioned models. first, the schwarz bayesian information criterion (bic; schwarz, ; burnham and anderson, ) was calculated: the model with the lower bic indicated the best model-and it is recommended when model parsimony is overriding (kadane and lazar, ; long, ) . moreover, considering that the bic tends to favor simpler model (long, ) , the corrected akaike information criterion (aicc; akaike, ; azari et al., ) was also computed: even in this case, the model with the lower aicc indicated the best model. in addition, considering that-on a theoretical level-the bic is less desirable for model evaluation than the aicc (long, ) , several effect sizes based on the aicc were carried out: (i) the difference of aicc ( aicc); (ii) the weight of evidence (w h ): given a set of competing models and the unknowable true model, the w h indicates the probability that a model h is the best approximate model (the model with the large w h is the best-fitting model) (the more probable the model is, the best approximating the model will be to the true model); (iii) the evidence ratio (e h ) that expresses the difference-in oddsbetween the best-fitting model and the first worst-fitting model: the higher the e h , the more plausible is the best-fitting model. of participants, were male ( . %) and were female ( . %). the mean age of the sample was . (sd = . ; range = - ). a total of participants ( . %) had experienced proximity with a covid- -infected relative or friend. most of the participants lived with their parents during the quarantine ( . %). all participants came from the campania region, in southern italy, and attended the university. means and standard deviations between the four time intervals (t , t , t , and t ) and the effect size of means difference (hedges' g) are displayed in table . the preliminary analysis showed that the increments tended to be small from t to t for each syndromic scale and breadboard scale ( . was the highest value). from t to t , the results highlighted a medium increase for the anxious/depressed, withdrawn, and internalizing scales. from t to t , the increase was null. for somatic complaints, aggressive behaviors, rule-breaking behavior, and externalizing scales, the magnitude of the effect size was medium only considering the increments from t to t . across the weeks of quarantine, the somatic complaints scale increased with an almost null effect. finally, the personal strengths showed a small increase only from t to t and from t to t . scatterplot (figure ) showing the change of the syndromic scales and broadband scales score over time. quadratic model with linear covariates interactions quadratic model with all covariates interactions scales, as well as the related broadband scales, across the weeks of quarantine. specifically, figure was split by sex (males vs. females), and figure was split by the experience of covid- (yes vs. no). finally, figure shows the interaction between sex and experience of covid- . the broken lines demarcate a borderline clinical range from the rd to th percentiles for the syndromic scales and from the th to th percentiles for the internalizing and externalizing broadband scales. scores above the top broken line, i.e., above the th percentile for the syndromic scales and above the th for the internalizing and externalizing broadband, indicate that the individual reported enough problems to be of clinical concern. scores below the bottom broken line is in the normal range. as show in figure , the anxious/depressed scale is above the clinical threshold in t , and the withdrawn scale is above the normal threshold in t with an increase in t . preliminary analyses (m. ) revealed that the variance related to the random intercept of the participants was equal to . . the null model with covariates (m. ) revealed a nonstatistically significant effect of the interaction between sex and exp-cvd (b = − . , se = . , t = . , p = . ) or their main effects (sex: the linear model with covariates (m. ) revealed a nonstatistically significant effect of the interaction between time and exp-cvd (b = . , se = . , t = . , p = . ) or the two simple main effects (sex: b = . , se = . , t = . , p = . ; exp-cvd : b = − . , se = . , t = − . , p = . ). however, the model revealed a statistically significant interaction effect between time and sex (b = − . , se = . , t = − . , p = . ) as well as the principal effect of time (b = . , se = . , t = . , p < . ). figure shows a greater increase in males from t to t and from t to t than in females. the preliminary analyses (m. ) revealed that the variance related to the random intercept of the participants was equal to . . the suggested that this model had % probability of being the best approximate model (w h of m. was %), and the eh suggested that m. had a weight of evidence almost two times ( . ) greater than m. of being the best approximate model ( table ) . preliminary analyses (m. ) revealed that the variance related to the random intercept of the participants was equal to . . the null model with covariates (m. ) revealed a nonstatistically significant effect of the interaction between sex and the comparison of the different multilevel growth curve models suggested that the linear model with covariates (m. ) showed the lower bic and the lower aicc. the lrt showed that m. was statistically significantly different from m. (intercept model with covariates). however, although m. was not statistically significantly different from m. , it was the most parsimonious-and thus, it was chosen as the best model. however, the effect size indices suggested a negligible preference (table ) . the comparison of the different multilevel growth curve models suggested that the linear model with covariates (m. ) showed the lower bic and the lower aicc. the lrt showed that m. was statistically significantly different from m. (intercept model with covariates). however, despite that m. was not statistically significantly different from m. , it was the most parsimonious-and thus, it was chosen as the best model. however, the effect size indices suggested a small preference for m. . indeed, the aicc suggested a small difference m. and m. ( . ), the w h of m. indicates that this model had % probability of being the best approximate model, and the e h recommend that m. had a weight of evidence more than two times ( . ) greater than m. of being the best approximate model ( table ) . preliminary analyses (m. ) revealed that the variance related to the random intercept of the participants was equal to . . the ( . ) , the w h of m. suggested that this model had % probability of being the best approximate model (w h of m. was %), and the e h suggested that m. had a weight of evidence two times ( . ) greater than m. of being the best approximate model ( table ) . the comparison of the different multilevel growth curve models suggested that the quadratic model with linear covariates interaction (m. ) showed the lower bic and the lower aicc. the lrt showed that m. was statistically significantly different from m. (linear model with covariates). however, the lrt suggested that m. was not statistically significantly different from m. , but it was more parsimonious-and thus, m. was chosen as the best model. however, the effect size indices suggested a small preference for m. . indeed, the aicc suggested a small difference m. and m. ( . ), the w h of m. suggested that this model had % probability of being the best approximate model, and the e h suggested that m. had a weight of evidence more than three times ( . ) greater than m. of being the best approximate model ( table ) . as stated above, in addition to being a public physical health emergency, the covid- pandemic also implies a global mental health emergency that may have a potential traumatic nature and provoke complex emotional responses that could negatively affect individual and collective mental health (jakovljevi et al., ; masiero et al., ) . therefore, this global pandemic constantly requires researchers and professionals to monitor and assess the current mental health situation, in order to plan and develop efficiency-driven strategies aimed to reduce its negative psychological impacts. this study assessed and monitored italian young adults' mental health status during the firsts weeks of lockdown imposed by the government during the covid- outbreak, from march to april . to the authors' knowledge, this is the first study specifically focused on young adults' mental health status during covid- quarantine, both in italy and worldwide. a longitudinal panel design was carried out in order to assess internalizing and externalizing problems on italian young adults living in the campania region, southern italy. a gca (jackson et al., ) was performed to monitor the changes during the first weeks of quarantine. first of all, in line with the global trend reported by previous studies carried out on the general population (cao et al., ; huang and zhao, ; qiu et al., ; rossi r. et al., ) , this study confirmed the negative behavioral and emotional responses provoked by covid- quarantine and also highlighted the high vulnerability of young adults in developing psychological distress. comparing the internalizing and externalizing domains, the results showed an analogous increase for both areas from t to t , even though higher rates of internalizing manifestations were registered. specifically, the growth curve modeling highlighted that, within the internalizing problems area, the levels of anxiety/depression, withdrawal, and somatic complaints overall increased from t to t , showing an increase while the lockdown measures were in place. in this context, in line with results obtained on medical health workers (zhang et al., ) , having experienced a closeness with a covid- -infected relative or friend resulted in an increase of somatic complaints. similarly, within the externalizing problems area, the levels of aggressive behavior and rule breaking behavior increased from t to t . among the internalizing domains, youth reported clinical-level symptoms of anxiety and depression. according to the recent review on the psychological impact of quarantine (rajkumar, ), anxiety as well as depressive symptomatology was the most common. furthermore, the results showed that withdrawal level was above the normal threshold. this finding could be related to the specific situation of quarantine and the impossibility to engage in social behaviors due to the lockdown. indeed, the physical distance can intensify feelings of loneliness that in turn trigger intense anxiety (boffo et al., ; banerjee and rai, ; . if, broadly, the results obtained confirmed the general detrimental effects of social isolation due to epidemics on young adults' mental health (hawryluck et al., ; tucci et al., ; qiu et al., ; wang et al., ) , some brief reflections need to be outlined about the specificities of young adults' condition. indeed, young adults live a specific transition period in which their identity development process is based and founded on continuous affective investments on social and extra-familiar relationships (sica et al., ) . in this context, the lockdown measures may be interpreted as a forced regression that triggers negative mental health outcomes even more. within the range from t to t , higher levels of internalizing and externalizing problems were registered at t , whereas a sort of stabilization from t to t emerged. the peak reported at t probably indicated a sort of gradual cognitive and emotional recognition experienced from young adults about the seriousness of the pandemic, which increased feelings of anxiety, depression and worry, and irritability and anger. regarding the stabilization of both internalizing and externalizing problems between t and t , these findings might need to be interpreted in relation to the specific historical context of the covid- pandemic in italy. specifically, t corresponded to the week from april to in which a double attitude was observed in italy. on the one hand, despite the lockdown, the italian "civil protection" continued to alert the general population about the very high levels of contagions; on the other hand, in that period, italians also started to receive the first information about the so-called "phase , " which followed the forced lockdown. it might be hypothesized that the high levels of viral load continued to worry participants, even though the closeness to phase assumed a sort of protective function regarding an eventual mental health worsening. in correspondence to the increase of mental health distress, the results also showed a gradual decrease of participants' perception of their personal strengths, suggesting the need for researchers to strengthen individual's psychological resources in order to mediate the individual reaction to the covid- pandemic (di giuseppe et al., ) . in conclusion, regarding gender differences, a significant increase of the levels of anxiety/depression from t to t and, to a lesser extent, from t to t in males than the females emerged. these findings were in line with previous studies that pointed out higher symptoms of anxiety and depression in condition of social isolations in boys than girls (troop-gordon and ladd, ; derdikman-eiron et al., ) . the results reported no other statistically significant differences between sex. these findings seemed to be in opposition with the recent studies that have investigated the impact of covid- on mental health and highlighted a higher vulnerability for women to develop negative mental health outcomes, as compared with men (qiu et al., ; rossi r. et al., ) . in the context of gender studies, a wide range of recent literature tended to connect these results to the reinforced gender inequalities promoted by the lockdown measures. according to these studies (adams-prassl et al., ; béland et al., ; etheridge and spantig, ) , in fact, during the lockdown measures, the increase of unemployment rates as well as the commitment into the domestic work and in the management of children has represented a high risk factor for women, compared with men. within the same interpretation field, the lack of significant gender differences as emerged by the results might be correlated to the same nature of the sample, which mostly involved university students who probably were involved in the same challenges and tasks and did not experienced greater or smaller efforts connected to specific gender roles, such as to outline differences. the present study is not free from limitations. first of all, the number of participants should be increased in future studies, and the results need to be replicated in other geographical areas to determine their generalizability. furthermore, the sample was only composed of university students who came from the campania region in southern italy where the covid- outbreak has been taken more under control. to assess the mental health of young people during the quarantine, only a self-report measure was used. consequently, the data may be influenced by a reporting bias (e.g., social desirability). moreover, despite the longitudinal panel, the study is an observational study. in this sense, experimental manipulations and a control group are lacking. future researches need to extend the young adults' mental health assessment to other italian regions, taking into consideration that in the south of italy, where the study was carried out, the covid- outbreak has been taken moderately and was under control, compared with the north. higher levels of distress might be hypothesized in places where very high numbers of losses and deaths have been registered. moreover, the present study investigated the internalizing and externalizing problems as individual responses to covid- pandemic; further investigations to measure the traumatic symptomatology and the characteristics of post-traumatic effects caused by such stressful events are needed (troisi, ; margherita and tessitore, ) . follow-up investigations are also needed. considering the high levels of withdrawal that emerged from the results, future investigations should explore the function and the role played by virtual environments and e-communities during pandemic in-depth, taking into account the roles played by the online environments and by the use of social media in terms of both risks and protective functions (faccio et al., ; gargiulo and margherita, ; procentese et al., ; boursier et al., ) . in this sense, future investigations might be also directed to investigate the changes in the dynamics of social and love relationships (mannarini et al., (mannarini et al., , a balottin et al., ; as well as the role of social support (ratti et al., ) postlockdown and post-pandemic. in conclusion, recognizing the fundamental value of qualitative investigations to shed light on the inner aspects and subjective meanings of personal experiences is also vital (margherita et al., ; felaco and parola, ; parola, ; parola and felaco, ; tessitore and margherita, ) . these are much needed actions in order to develop an indepth understanding of the emotional and affective dimensions connected to the experience of the covid- pandemic, as well as possible risk and protective factors for mental health. in conclusion, the present study could contribute to the ongoing debate concerning the psychological impact of the covid- emergency, helping to develop efficient and personcentered intervention projects able to take care of young adults' mental health in the medium and long terms, understanding their specific needs and susceptibilities (benedetto et al., ; parola and donsì, ; fusco et al., ) . this is even more urgent considering that despite the distressing and prolonged situation, a significant number of people avoid seeking psychological help . on the one hand, some of these people may be reluctant to seek professional help due to the associated stigma (mannarini et al., b (mannarini et al., , faccio et al., ; mannarini and rossi, ) . on the other hand, some individuals may deny the problem, leading them to think that it will probably resolve itself naturally (sareen et al., ; rossi ferrario et al., ; rossi ferrario and panzeri, ) , thus choosing to manage the psychological issue on their own (wilson and deane, ) . the datasets generated in this article are not readily available because to ensure the privacy of the participants. requests to access the datasets should be directed to ap, anna.parola@un ina.it. the studies involving human participants were reviewed and approved by the ethical committee of psychological research of university of naples federico ii and was carried out in accordance with the american psychological association rules. the patients/participants provided their written informed consent to participate in this study. ap developed the theoretical framework of the present study, designed the study, and developed the methodological approach. ar performed all the analyses and designed tables and figures. ft and gt led the literature search and interpretation of data. sm critically revised the manuscript. all authors read and approved the final version of the work. manual for the aseba adult forms & profiles inequality in the impact of the coronavirus shock: 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dark side of organizational identification: a multi-study investigation of negative outcomes date: - - journal: front psychol doi: . /fpsyg. . sha: doc_id: cord_uid: ujwztpd after more than two decades of research on the positive side of organizational identification, researchers have begun to realize that it also has a dark side that needs immediate consideration. with support from social identity theory, the current study sheds light on the understudied role of the dark side of organizational identification by investigating its indirect effects on (a) psychological entitlement, (b) unethical pro-organizational behavior, and (c) pro-social rule-breaking through externally motivated organizational citizenship behavior, taking leader–member exchange as a boundary condition. two surveys were conducted to test the proposed moderated mediation model. data for the study was collected from employees (n = ) working in the service sector (i.e., universities, banks and telecommunication organizations), whereas responses for study were taken from employees (n = ) working in the hospitality industry. a time-lagged research design was selected for both surveys to avoid common method bias. the results demonstrate that organizational identification leads to adverse outcomes in the form of psychological entitlement, pro-social rule-breaking and unethical pro-organizational behavior through externally motivated organizational citizenship behavior. furthermore, a high-quality leader–member exchange relationship enhances these indirect effects of organizational identification. several theoretical and practical implications, along with limitations and future research directions, are also discussed. since its inception, organizational identification (oi) has been considered a source of positive employee outcomes (tarakci et al., ) . most definitions also suggest that it represents something positive. for example, mael and ashforth ( ) define it as "perceived oneness with the organization." however, researchers have begun to realize that oi might not be as beneficial for organizations as it seems, mainly because it might cultivate negative emotions and behaviors among employees (naseer et al., ) . this calls for further investigation of the dark side of organizational identification, as repeatedly called for by different organizational behavior researchers (for references, see galvin et al., ; ashforth, ; conroy et al., ) . the literature on the dark side of oi is still in its infancy stage some studies have highlighted its adverse outcomes such as upob (umphress et al., ; effelsberg and solga, ) , reduced cooperation (polzer, ) , work-family conflict (li et al., ) , resistance to change (van dijk and van dick, ) , and psychological entitlement (naseer et al., ) . all these studies are either organization directed or self-directed adverse outcomes. our study has focused on the dark side of oi from multiple perspectives, i.e., self-oriented (pe), organizationoriented (upob), and organizational stakeholder-oriented (psrb). the existing literature on the dark side of oi suggests that the negative outcomes of oi are subject to underlying mechanisms and boundary conditions, which still need to be tested to fully understand the factors that cause employees to exhibit negative attitudes and behaviors as a result of oi (ashforth, ; chen et al., ; naseer et al., ) . in light of these limitations and inconsistencies, the current study aims to test an underlying mechanism and boundary condition through which oi leads to adverse outcomes like self-serving, deviant, and unethical employee behaviors (mackey et al., ) . for decades, oi has been acknowledged to enhance organizational citizenship behavior among employees, but what if employees display citizenship behavior due to external or controlled motivation to constantly benefit the organization? externally motivated organizational citizenship behavior (emocb) has recently emerged as a negative side of ocb. it is based on the notion that employees do not engage in ocb out of free will; instead, they are expected by citizenship norms to display extra-role behaviors, leaving them with no other option than to do much more than their formal job description (yam et al., ) . since employees with higher levels of oi feel obligated to fulfill organizational norms due to a feeling of togetherness and shared goals, they are more likely to display a certain amount of emocb over and above internally motivated ocb (imocb). the limited research on emocb suggests that it does more harm than good to the organization. emocb involves all extra-role behaviors that are not part of an employee's job description (yam et al., ) . researchers have highlighted several negative outcomes associated with it, such as workplace deviance (yam et al., ) . engagement in externally motivated extra-role behavior can lead employees to a state of psychological entitlement (pe), in which they think they are worthy of praise and have earned the right to special treatment by performing extra tasks beyond their formal job duties (harvey and harris, ; cooper et al., ) . nonetheless, employees with high oi do not stop here, they further extend emocb by engaging in pro-organizational and pro-social behavior even when unethical and against organizational rules (ryan and deci, ; chen et al., ; yam et al., ; naseer et al., ) . this is mainly because of their loyalty and attachment to the organization, which motivates them to engage in pro-organizational behaviors even at others' expense (ashforth et al., ) . two pro-organizational behaviors currently receiving attention are unethical pro-organizational behavior (upob), which refers to behaviors that are in the better interest of the organization but are unethical (umphress and bingham, ) , and pro-social rule-breaking (psrb), which is defined as the violation of organizational rules in the better interest of organizational stakeholders (brief and motowidlo, ) . when employees high in oi engage in ocb not because they want to but because they believe they have to, they might end up displaying upob and psrb as a way of showing the organization that they are willing to go out of their way to ensure the organization's success. oi researchers have also considered boundary conditions in the relationship between oi and its negative consequences, as various personality dispositions, interpersonal factors, and situational variables might shape the relationship between oi and employee outcomes (collins et al., ; naseer et al., ) . one such potential boundary condition that has received little attention is leader-member exchange (lmx). leader-member exchange has mostly been examined as a predictor of oi (katrinli et al., ; loi et al., ) . however, recent studies have identified it as an essential moderator between oi and employee outcomes and have called for further research on its role as a boundary condition (liu et al., ; zhao et al., ; teng et al., ) . matta and van dyne ( ) have called for exploring the adverse outcomes of lmx in certain conditions. they suggest that contrary to popular belief, in-group members do not simply enjoy the benefits of having a high-quality relationship with their leader; they also have to do something extra to meet their leader's expectations. such expectations lead to extra-role performance and emocb, which is not necessarily based on employees' autonomous motivation. hence, we suggest that ingroup members high in oi engage in both emocb and imocb to meet the double criteria of oi and lmx. in light of this, the current study also tests a boundary condition of the oi-outcomes relationship, namely lmx, which is a relatively understudied situational factor for adverse outcomes. to summarize, the current study investigates the indirect effect of oi on (a) psychological entitlement, (b) upob, and (c) psrb through externally motivated ocb. the current study further examines lmx as a boundary condition between oi and emocb. the selection and placement of variables in the proposed model is based on social identity theory (tajfel and turner, ) . this theory states that people choose to join those groups that have higher status and similar values. congruence in values develops identification, which motivates people to associate themselves with powerful people in the group. in every group, members not only enjoy the benefits of association, they also have to follow certain group norms (jones and volpe, ) . when people fulfill their expected role, it enhances their selfesteem and encourages them to stand up for the group by engaging in activities that are beneficial to the group as a way of enhancing their status (scott, ) . employees who strongly identify with their organization thus feel bound to fulfill their organization's expectations by engaging in emocb. employees high in oi who are additionally part of the leader's in-group could feel more burdens of expectations to engage in emocb. engagement in emocb enhances employees' self-esteem and motivates them to engage in upob and psrb. in a causal study, it is important to ensure that all variables are different from each other and the relationships are in the right direction. we believe that all study variables are different from each other, with the exception of minor overlaps. for instance, organizational identification and leader-member exchange share some characteristics like strong bonding and affiliation, but these feelings are directed toward different sources. oi is directed toward the organization and reflects an employee's closeness with his/her organization (tarakci et al., ) , whereas lmx refers to the exchange relationship between the leader and his/her followers (loi et al., ) . furthermore, all three dependent variables, i.e., pe, upob, and psrb exhibit visible differences in terms of their characteristics. pe is self-serving behavior in which employees think they deserve better treatment (cooper et al., ) , upob is unethical behavior that benefits the organization (umphress and bingham, ) and psrb is a social variable encompasses rule-breaking for social purposes, such as for the benefit of colleagues, customers or other stakeholders, but at the cost of organizational rules (ghosh and shum, ) . hence, the current study focuses on investigating the antecedents of selfserving behavior (pe), pro-organizational behavior (upob), and pro-social behavior (psrb). this study explains how and when oi leads to destructive outcomes by relying on social identity theory (tajfel and turner, ) . considering the tenants of social identity theory, we believe that organizations act as a group, and employees are the members of this group. employees are obligated to do what is expected of them in order to maintain their jobs. since organizations these days expect their employees to engage in ocb (yam et al., ) , employees high in oi engage in emocb in order to maintain their status. according to social identity theory, identity with any group enhances self-esteem and gives members the courage to go to extra mile to benefit the group (tajfel and turner, ) . the self-esteem of employees high in oi increases after engaging in emocb due to their inner belief that they have done what is expected of them, which is why employees high in oi should tend to feel psychologically entitled. similarly, employees high in oi do not hesitate to engage in psrb and upob to benefit their organization. it is their way of showing the organization that they value their membership and are willing to do anything to maintain the organization's superiority. the more strongly an individual identifies with the group, the more pro-organizational activities he/she engages in. since employees who are part of the leader's in-group strongly identify with the organization due to their bonding with both the organization and the leader, they engage in emocb to satisfy the leader as well as the group. figure shows the proposed theoretical framework for study and study . oi refers to perceived oneness and high congruence between employees' values with those of their organization (tarakci et al., ) . oi facilitates individual in developing connections in the power circles within the organization, and thus, one becomes a part of close organizational community/environment in which important information are openly shared, significant decisions are discussed and organizational strategies are debated (avanzi et al., ) . the existing studies also suggest that highly identified employees receive organizational support due to their closeness with the organization (avanzi et al., ) . highly identified employees share a special bond with their employing organization which is based on common goals, norms and values. this bond distinguishes them from others by enabling them to enjoy privileges based on their closeness with the organization (liu et al., ; avanzi et al., ) . this privilege, which is contingent upon the display of oi augments psychological entitlement in the individual (tufan and wendt, ) . psychologically entitled employees expect preferential treatment from the organization irrespective of their efforts (Żemojtel-piotrowska et al., ) . this expectation of special treatment is the result of access to resources, strong affiliation with the power figures and high bonding with the organization (galvin et al., ; naseer et al., ) . highly identified employees view themselves as important members of the organization to the extent that they start to believe that the organization cannot work properly in their absence (galvin et al., ) . greater control over the organizational matters which is the result of oi gives employees the feeling that they are important for organizational success which develops feeling of entitlement (chatterjee and hambrick, ; naseer et al., ) . social identity theory (tajfel and turner, ) also supports the association between organizational identification and psychological entitlement. according to this theory, employees become members of those groups whose values are aligned with their own, and this membership and assimilation in turn enhance self-esteem, pride, and feelings of entitlement (naseer et al., ) . hence, we propose the following hypothesis in both study and : h : oi is positively associated with employees' pe. organizational members high in oi share personal stakes with their organization and consider the organization's success as their own (mael and ashforth, ) . these employees' sole objective is to promote their organization, even if it requires them to engage in unethical behaviors (blader et al., ) . one form of unethical behavior gaining attention these days is upob due to organizations' direct or indirect involvement in promoting these behaviors (chen et al., ) . employees high in oi frequently engage in unethical pro-organizational behavior in order to promote their organization at the cost of all other stakeholders (umphress and bingham, ) . highly identified employees disregard moral standards and do not hesitate to engage in upob to maintain their positive self-image, which is directly associated with the organizational image (martin et al., ) . zuber ( ) is of the view that highly identified employees considered threats directed toward the organization as a direct threat to their identity, which motivates them to do everything they can to protect their shared self-image. highly identified employees are willing to bypass ethical standards for the sake of the organization (ashforth and anand, ) , which is why they are flexible to display unethical pro-organizational behaviors. highly identified employees rationalize unethical behaviors by considering them crucial for protecting the shared self-image, as their ultimate objective is to benefit the organization (campbell and göritz, ) . some researchers believe that highly identified employees engage in unethical pro-organizational behavior to show their higher level of belongingness with the organization (leavitt and sluss, ) . ploeger and bisel ( ) suggest that oi promotes in-group biases as a result of which employees engage in unethical behaviors that benefit their organization. social identity theory also supports this association by stating that members of a particular group engage in activities that promote their group's chances of success over others, because their group's success also enhances their self-worth due to shared identity (tajfel and turner, ) . therefore, we hypothesize following in study : h : oi is positively associated with employees' upob. highly identified employees want what is best for their organization even if requires them to do more than their formal responsibilities as their self-identity is linked with the organization (brown, ) . the loyalty with the organizations motivates them to look for different means for profiting their organization and its key stakeholders. psrb is also intended to benefit the organization and other organizational stakeholders. unlike other employees, highly identified employees receive social support from their employing organization, which encourages them to engage in psrb as they know that their organization is at their back (avanzi et al., (avanzi et al., , . oi promote organizational commitment, which encourages employees to break the rules if it benefits the organization (dávila, ) . the ultimate objective of highly identified employees is to do what is best for the organization and its stakeholders. the existing research also suggests that highly identified employees raise their voice for the betterment of the organization (qi and ming-xia, ; wang et al., ) . identified individuals consider organizational harm as personal harm, and they are willing to deviate from rules to protect their organization (zuber, ) . they often engage in those behaviors which benefit the organization, such as psrb, as the organizational benefit is linked to their benefit. identified employees experience in-group biases, which encourage them to engage in unacceptable behaviors such as rule breaking as long as those actions benefit the organization (ploeger and bisel, ) . to summarize, oi enhances loyalty and organizational commitment among employees, which motivates them to engage in all those behaviors which offer benefit to the organization even at the cost of compromising the rules. social identity theory supports this notion by suggesting that members of a specific group will do anything they can to benefit their group. hence, we propose the following hypothesis in study : h : oi is positively associated with employees' psrb. due to shared values, employees high in oi consider it their responsibility to follow the organization's norms and engage in all behaviors that are beneficial for the organization frontiers in psychology | www.frontiersin.org (tajfel and turner, ; ye, ) . one well-known form of behavior that benefits the organization is ocb . contrary to the popular notion that ocb is voluntary behavior, researchers have started to observe that ocb has become a "must-do" activity in contemporary organizations (ocampo et al., ) . several studies have found that modern organizations encourage their employees to engage in ocb in order to lubricate the organizational machinery for effective functioning (bolino et al., . in other words, employees are expected to participate in ocb to maintain their jobs (yam et al., ) . as this type of ocb is displayed due to external/controlled motivation rather autonomous motivation, it is termed as emocb (yam et al., ) . individuals higher in oi are more prone to engage in emocb, as they are willing to do anything in line with the organization's expectations (newman et al., ) . existing research further indicates that emocb not only benefits the organization, it also enhances employees' expectations of their organizations (newman et al., ; yam et al., ; langerud and jordan, ) . yam et al. ( ) conducted an interesting study directing attention to this very association by proving that emocb acts as a perfect soil for cultivating a feeling of pe among employees. the external motivation to display ocb gives rise to a feeling of entitlement among employees, in which they start to think that they deserve special treatment from their organization as a result of the extra time and energy they were advised to invest in extra-role behaviors (alkahtani, ) . seeking preferential treatment is a notable characteristic of psychologically entitled employees (Żemojtel-piotrowska et al., ) . yam et al. ( ) also state that a state of psychological entitlement arises when employees are motivated to go above and beyond their formal work requirements by their employing organization due to their association. hence, we propose the following hypothesis in both study and : h : emocb mediates the relationship between oi and pe. organizational citizenship behavior between organizational identification and unethical pro-organizational behavior chen et al. ( ) found that oi is a strong predictor of upob. however, this relation is subject to some underlying mechanisms (blader et al., ) . oi integrates employees' inner self with organizational membership, which obligates them to work for the organization's better interest. nowadays, citizenship behaviors are expected of employees (bolino et al., ) . as members of the group, the primary focus of employees high in oi is to meet and exceed these expectations regarding citizenship behavior (chen et al., ) . organizational citizenship norms encourage employees high in oi to work for the betterment of the organization as a result of their group membership (cornwell et al., ) , which leads them to engage in emocb. when employees feel that organizational norms demand ocb, they seek to exhibit all those behaviors that are beneficial for the organization without taking into account moral and ethical values (bolino and klotz, ) . researchers believe that the expectation to display ocb leads to deviant and unethical behavior at the workplace (bolino and klotz, ) . umphress et al. ( ) are of the view that unethical behaviors can be pro-organizational in nature. the existing literature suggests that when organizational norms encourage employees to perform extra-role behaviors, employees expand these citizenship behaviors to include upob in order to promote organizational functioning . hence, we propose following hypothesis in study : h : emocb mediates the relationship between employees' oi and upob. mediating role of externally motivated organizational citizenship behavior between organizational identification and pro-social rule breaking bolino et al. ( ) term emocb as the dark side of ocb. when ocb is ingrained as an important activity in the organizational culture, employees extend their citizenship behavior to include rule-breaking in order to perform one's job activities efficiently and extend one's support of customers and coworkers (bolino et al., ; koopman et al., ) . as previously stated, oi increases motivation among employees to engage in emocb, and employees expand their emocb to include deviant behavior in the form of psrb. borry ( ) highlighted that organizational norms are the gateway to rule-bending and rule-breaking behaviors. rules compliance is dependent on endorsement by management (fleming, ) . when emocb becomes an organizational requirement, it leads to breaking organizational rules for pro-organizational purposes . thus, it is proposed that external motivation to display citizenship behavior leads to psrb, because employees deem such behavior an extension of ocb that contributes to the organization's success. social identity theory also supports this notion that employees unconditionally extend their work to support the group to which they belong and would do anything that is beneficial for the group. since employees with higher levels of oi are obligated to fulfill organizational norms due to their ingroup assimilation, they are more likely to display emocb due to group expectations (tajfel and turner, ) . hence, we propose following hypothesis in study : h : emocb mediates the relationship between employees' oi and psrb. high-quality lmx promotes extra-role behavior among employees due to the fostering of a good relationship with the supervisor (bowler et al., ) . high-quality lmx creates implicit pressure for employees to engage in citizenship behavior (farmer et al., ) . huang et al. ( ) state that lmx quality and oi are potential predictors of citizenship behavior. in light of the existing literature, the current suggests that employees who have a high-quality relationship with their leader are more likely to display emocb as a result of oi. this is mainly because individuals high in oi who are also part of the leader's in-group have two reasons to exhibit positive behavior: their shared identity with the organization and their close relationship with the leader (tajfel and turner, ) . both of these external sources of motivation promote emocb. hence, we propose following hypotheses in both study and : h : lmx moderates the relationship between oi and emocb, such that this relationship will be stronger when the quality of lmx is high and weaker when the quality of lmx is low. the current study further proposes that leader-member exchange conditionally affects the indirect impact of oi on pe, upob and psrb through emocb. we believe that employees who have a high-quality lmx relationship with their leader are more likely to engage in emocb, which gives them a sense of pride and pe, upob and psrb compared to employees with a low-quality relationship. hence, we hypothesize the following in both study and : h : lmx moderates the positive indirect effects of oi on employee pe, such that the indirect effect through emocb is stronger when lmx quality is high and weaker when lmx quality is low. h : lmx moderates the positive indirect effects of oi on employee upob, such that the indirect effect through emocb is stronger when lmx quality is high and weaker when lmx quality is low. h : lmx moderates the positive indirect effects of oi on employee psrb, such that the indirect effect through emocb is stronger when lmx quality is high and weaker when lmx is low. the current study consists of two field surveys in which data was collected from employees working in pakistan in three timelags through a self-administered questionnaire. the first study tested the mediating role of emocb between oi and pe and the moderating role of lmx between oi and emocb. data for the first study was collected from employees working in the service sector, particularly universities, banks, and telecommunication organizations. the service sector consists of businesses that provide a wide range of services to the customers ranging from physical services to transfer of knowledge. we used a constructive replication approach (lykken, ) by using diverse datasets to enhance the external and internal validity of our findings. the second study was more extensive as it (a) validated the results of study in the hospitality industry which also comes under service industry but involves generous reception of customers and is fast growing in pakistan. also it is less studied particularly in the context of oi, (b) tested an additional dependent variable that is pro-organizational namely upob (c) investigated a form of deviant pro-social behavior as an outcome variable namely psrb (d) tested the mediating role of emocb between oi and self-serving behavior namely pe, organizational serving behavior namely upob and social serving behavior namely psrb and (e) tested the moderating role of lmx in a different industry. researchers believe that multiple surveys conducted in different sectors validate the results and increase the generalizability of the findings. social sciences researchers are advised to conduct multiple studies to test the same models as it boosts confidence in the results and offers practical implications to a wider population (harold and holtz, ) . before data collection, the authors personally visited the human resource department of different organizations and officially took permission for data collection from the human resource manager. the human resource managers were requested to let the research team approach the respondents at the workplace to ensure the confidentiality of the respondents. after receiving permission, the researchers approached the employees and told them about the purpose of the study. questionnaires were distributed to those employees who volunteered to participate in the study. to get maximum responses at all three-time lags, the respondents were told that those respondents who will submit responses at all threetime lags will be given the chance to participate in the lucky draw. the researchers personally visited the organizations at all three time lags for data collection. at the end of the data collection process, two winners were announced (one for study and other for study ). the winners received , pkr. since the total population of employees working in the service and hospitality sector is unknown, we used a non-probability purposive sampling technique. data for both studies were collected by using a -point likert scale ranging from = strongly disagree and = strongly agree. the current study adopted well-established scales for all variables in both surveys. questionnaires were distributed in english language as it is the official language of pakistan and is commonly used in pakistan work settings. other researchers also collected data from pakistani samples in the english language and did not face any language-related issues sarwar et al., ) . g * power (version . . . ) was employed to check the adequacy of sample sizes. the medium effect size ( . ), an alpha level ( . ) with high power ( . ) was set in the input parameters that is well above the minimum requirement ( . ) recommend by cohen's ( ) , the number of predictors were set to due to maximum number of arrows to the mediating variable emocb (i.e., oi, lmx, and oi * lmx; memon et al., ) . the minimum sample size required for our study with high power of . is . thus, our sample size for study and for study is adequate to test the hypothesized model. hayes' process macro developed for spss was used to test the hypotheses in both studies. our model formally included mediation, moderation, and moderated mediation relationships. model of the process macro was used to test for mediation, model for the moderation analysis, and model for the overall moderated mediation model. the same strategies have been used by past researchers to analyze similar models (yoo and lee, ; lan et al., ) . for study , printed questionnaires were distributed. employees were asked about their level of oi and their exchange relationship with their supervisor along with their demographic information. responses were received back. at time , the respondents from time were traced through their assigned key and asked to fill out a survey containing questions regarding their emocb. responses were obtained at time . at time , employees who provided data in the first two waves were contacted and asked to answer questions regarding their pe. out of employees responded to the third wave of the study. after matching the keys for all three time waves and eliminating incorrectly filled-out questionnaires, completed questionnaires were considered in the final analysis. the sample consisted of % males and % females. . % of respondents were less than years of age, % fell within the age bracket of - years of age, . % were between and years of age, and % were years of age or older. . % of respondents had below a bachelor's degree, % had a bachelor's degree, and . % had master's degree or above. . % of respondents had one to years of job experience, . % of respondents had - years of experience, and . % of respondents had more than years of job experience. employees' gender, age, education, and experience were added as control variables in the present study. details of study variables is given below: a six-item scale developed by mael and ashforth ( ) was adopted to measure employees' oi. a sample item is: "when someone criticizes my organization, it feels like a personal insult." the alpha reliability of this scale was . in the current study. employees' emocb was measured with a five-item scale by yam et al. ( ) . sample items are: "i have the skills that are needed to make this change work" and "i engage in organizational citizenship behavior because others will reward me." the alpha reliability value for this scale was . . the seven-item scale developed by graen and uhl-bien ( ) was adopted in this study. a sample item reads: "regardless of how much formal authority he has built into his position, what are the chances that your leader would use his power to help you solve problems in your work?" this scale's reliability in the current study is . . the nine-item measure developed by campbell et al. ( ) was adopted to measure sense of psychological entitlement. a sample item read: "i feel entitled to more of everything." cronbach alpha for this scale was . . one item of this scale was context related. its statement was: "if i were on the titanic, i would deserve to be on the first lifeboat." the researchers personally administered the data collection process and explained the context behind this statement to the respondents. none of the respondents faced any issue in this statement or any other statement. other researchers have also used the same scale for collecting data on psychological entitlement in a similar context and did not face any languagerelated or context related issues (naseer et al., ) . according to the anova results, gender was not associated with significant variance in the dependent variable. age, education and job experience were associated with significant variance in psychological entitlement (f = . , p < . ), (f = . , p < . ), and (f = . , p < . ), respectively. before testing the hypothesized relationships, confirmatory factor analysis was conducted to test the model's fit to the collected data. cfa results of study for the four-factor model of oi, lmx, emocb and pe provides best fit indices (χ = , df = , χ /df = . , cfi = . , ifi = . , tli = . , rmesa = . ) than combining all into a single factor (χ = , df = , χ /df = . , cfi = . , ifi = . , tli = . , rmesa = . ). these results prove that the collected data is more fitted to four factors than one factor. table shows the means, standard deviations, reliability coefficients, and correlation analysis for the variables under study. the results show that all variables are significantly correlated with each other. the correlation between oi and lmx was found positive and significant (r = . , p < . ), which might cause the problem of multi-collinearity. to address the issue of multi-collinearity, a two-factor confirmatory analysis model fitness results were compared with one factor. two factor model for oi and lmx yielded better fit indices (χ = . , df = , χ /df = . , cfi = . , ifi = . , tli = . , rmesa = . ), than one factor model (χ = . , df = , χ /df = . , p < . ; cfi = . , ifi = . , tli = . , rmesa = . ). it proves that respondents have provide the data for oi and lmx separately rather than considering them one factor. furthermore, collinearity diagnostic test was employed and variance inflation factor (vif) value was . and tolerance value . which fall within the threshold value limit for high multi-collinearity, i.e., vif > . and tolerance < . (hair et al., ) . therefore multi-collinearity is not a problem in our study. study bootstrapped results for the direct and indirect effects are presented in table . the results show that oi leads to an increase in pe (β = . , p < . ). hence a result of study provides support to acceptance of h . table illustrates that oi has a significant indirect effect on pe via emocb (indirect effect = . ), as the lower and upper limits ( . , . ) of the % confidence intervals do not include zero. hence, the results of study also support h . in table , the bootstrap results at a % confidence interval indicate that interaction effect of oi and high-quality lmx on emocb is significant (β = . , p < . ). the change in r squared due to the interaction effect is ( r = . , p < . ). the simple slopes test also indicated that the relationship between oi and emocb is stronger and significant at + standard deviation above the mean value (β = . , ci [ . , . ]) than at − standard deviation below the mean value of the moderator lmx quality (β = . , ci [− . , . ]). furthermore, the moderation graph for study showed that high-quality lmx strengthens the relationship between oi and emocb compared to low-quality lmx. hence, h is supported. figure shows the moderation graph for study . the moderated mediation results for study are presented in table , which indicates that the conditional indirect effect of oi on pe through emocb becomes stronger and significant at + standard deviation above the mean of lmx quality (β = . , ci [ . , . ]) than at − standard deviation below the mean of lmx quality (β = . , ci [− . , . ]). hence, h is fully supported by the results of study . for the replication and generalizability of results, we conducted another time-lagged study in a different sector (i.e., hospitality). two additional outcome variables (i.e., upob and psrb) of organizational identification through emocb were also added to extend the model of study . four hundred questionnaires were distributed among employees in the pakistani hospitality sector. similar to study , employees were asked to report their demographics, level of oi, and quality of lmx relationship at t . at t , the same employees were asked to report their emocb. at t , employees were asked to report their pe, upob, and psrb. the same procedure as in study was followed to track employees across the different waves. we distributed questionnaires at t and received surveys back. these respondents were approached at t weeks later. of these respondents, returned the questionnaires at t . these respondents were then invited to participate at t , and we received questionnaires back. after removing incomplete and mismatched responses, complete questionnaires were obtained at the end of t and considered in the analysis. the total response rate was . %. among these complete responses, were male and were female. . % were between and years of age, . % from to years of age, and the remaining % have above years of age. in terms of education, % of respondents had a th grade completion certificate ('matric' in pakistan), . % had a high school diploma ('fsc'), . % have a bachelor's degree, and % had a master's degree or higher. . % of respondents had less than years of experience, . % had between and years of experience, and % had more than years of experience. we measured oi, emocb, pe, and lmx quality using the same scales as in study . alpha reliabilities for the scales in study were . for oi, . for emocb, . for pe and . for lmx quality, respectively. the six-item scale used to measure upob was adopted from umphress et al. ( ) . a sample item is: "if needed, i would conceal information from the public that could be damaging to my organization." the alpha reliability of the sixitem scale was . . the -item scale developed by dahling et al. ( ) comprised questions regarding rule-breaking for efficiency, helping customers and coworkers. a sample item is: "i break organizational rules or policies to do my job more efficiently." the alpha reliability for the thirteen-item scale was . . an analysis of variance (anova) was performed to check the control variables impact on dependent variables. significant variance in pe was found due to education (f = . , p < . ), and experience (f = . , p < . ). for study , cfa results of the six-factor model of oi, lmx, emocb, pe, upob, and psrb provides best fit indices (χ = , df = , χ /df = . , cfi = . , ifi = . , tli = . , rmesa = . ) than combining all into a single factor (χ = , df = , χ /df = . , cfi = . , ifi = . , tli = . , rmesa = . ). these results prove that the collected data for study is best fitted to six factors than one factor. means, standard deviations, reliabilities score and intercorrelations among variables in study are presented in table . the results show that all variables are significantly correlated with each other. regression results for the direct and indirect effects examined in study are presented at the table . the results of study are in line with those of study , thus replicating the first study's overall contribution and demonstrating its generalizability. oi was found to be significantly associated with pe (β = . , p < . ), as well as with the additional outcome variables upob (β = . , p < . ) and psrb (β = . , p < . ). thus, the results of study support h , h and h . the indirect effects for study are presented at the bottom of table . oi has a significant indirect effect (indirect effect = . ) on pe via emocb, as the confidence interval did not include zero ( . , . ). thus, h is also verified by the results of study . oi also had a significant indirect effect (indirect effect = . ) on upob, as the confidence interval did not include zero ( . , . ). additionally, oi had a significant indirect effect (indirect effect = . ) on psrb, as the confidence interval did not include zero ( . , . ). hence, study results provide support for h , h , and h . the results of study , in table indicate that high-quality lmx strengthened the positive relationship between oi and emocb, as the interaction effect was significant (β = . , p < . ). the change in r squared due to the moderating effect was ( r = . , p < . ). the slope test for highquality lmx is positive and significant (β = . , ci [ . , . ]), while the slope test results for low-quality lmx is not significant (β = . , ci [− . , . ]). the moderation graph for study also demonstrates that high-quality lmx enhances the relationship between oi and emocb. hence study also justifies result of h . figure shows the moderation graph for study . table since its initial conceptualization by ashforth and mael ( ) , oi has been perceived as a positive phenomenon offering a wide range of benefits for employees as well as organizations. however, this "optimistic view" has started to dim after repeated criticism from organizational behavior scholars (naseer et al., ) . however, existing studies have not fully revealed the underlying mechanisms and boundary conditions contributing to the impact of oi on adverse outcomes (brown, ; naseer et al., ) . another significant gap in oi research is the lack of studies on its dark side. the current study contributes to this relatively understudied field by examining pe, upob, and psrb as the negative outcomes of oi through the intervening mechanism of emocb. moreover, by studying the conditional effect of lmx on the association between organizational identification and emocb, the current study illustrated the significance of situational factors in understanding the oi-outcome relationship. the results supported the hypothesized moderated mediation model of a strong indirect relationship between oi and employee outcomes -specifically pe, upob, and psrb through emocb in the case of a high-quality lmx relationship. these results not only respond to calls to study the negatives outcomes of organizational identification but also open new research avenues for future studies to explore. these results have endorsed the repeated claims that organizational identification can prove to be detrimental for the organizations. this study is timely as it has identified three important negative outcomes of organizational identification and the underlying mechanism that cause these outcomes. further, it has highlighted the role of lmx in strengthening the relationship between oi and negative employee outcomes. the results of the current study validate the assumptions of social identity theory in the service industry (i.e., universities, banks, and telecommunication organizations) and hospitality industry both. this theory talks about social identification with the group and its consequences. according to this theory, membership of a certain group gives employees a feeling of pride, and these members of a particular group also expect to experience beneficial outcomes from acting in accordance with group norms (tajfel and turner, ) . the results also supported this association by providing support to the oi-pe relationship. this theory further states that members of a group are willing to engage in behaviors that benefit the group and its stakeholders. the current study validated this assumption by providing support for the impact of oi on upob and porb. the core assumption of social identity theory is that employees high in oi feel obligated to engage in behaviors that are ingrained in the organizational culture and expected from organizational members. one such behavior frequently expected by contemporary organizations is emocb. since employees with higher levels of oi are obligated to fulfill organizational norms due to their in-group assimilation, they are more likely to display emocb due to group expectations (tajfel and turner, ) . the results support this assumption by supporting the mediating hypotheses. additionally, this theory posits that those individuals who feel identified with the group and are close to the people who are in power in the group are more likely to accept group norms. the significant results of moderation hypothesis supported this assumption. the current study has several strengths. first, it adds to the existing body of knowledge on the negative side of oi by proposing pe, upob, and psrb as outcomes. second, it untangles the dark side of emocb by studying it as an underlying mechanism in the relationship between oi and negative outcomes. third, it studies the conditional effect of a situational factor, lmx, on the oi-outcome relationship. fourth, it validates research on organizational identification by studying underexplored outcomes as well as a unique underlying mechanism and boundary condition in the pakistani context, which is characterized by high power distance and collectivism. in addition to these important theoretical contributions, the study has various methodological strengths. first, the current study tested the outcomes of oi on two different samples by conducting multi-wave surveys. study tested a single adverse outcome of oi (i.e., pe), whereas study not only replicated and generalized the results of study but also studied two additional consequences (i.e., upob and psrb). other strengths of this study include its time-lagged research design and use of the bootstrapping method. despite offering substantial theoretical and methodological contributions, the current study also has a few limitations. first, this study used time-lagged data. second, the sample consisted only of employees working in the service and hospitality sectors, which decreases the generalizability of the findings. given these limitations, future researchers may replicate our study by utilizing a longitudinal research design in a relatively different context. it is also recommended to study this model in the manufacturing sector. moreover, in light of the significance of research on oi and its adverse outcomes, researchers are suggested to identify other mediating and moderating mechanisms to further enhance our understanding of the processes and boundary conditions that cause adverse outcomes of oi. it would also be fruitful to study the antecedents of oi. for instance, researchers could identify leadership styles which can increase organizational identification among employees to optimal level. additionally, the conditional effect of individual differences, such as the big five personality traits and the 'dark triad' , could be studied in the future. our study offers valuable insights for managers. first, the positive association between oi and pe indicates that a high level of oi is detrimental for organizations. hence, managers should be proactive in identifying and addressing employees who exhibit a high level of oi to stop them from becoming entitled. one way of doing so is to institute a transparent reward system based on performance so that employees are clear that they will only be rewarded if they show good performance. organizations must also discourage employees from demanding preferential treatment by creating a strict policy that clearly shows that no extra favors will be given to any employee. second, the positive association between oi and upob should encourage managers to develop a strict organizational ethical code of conduct to discourage employees from engaging in unethical behaviors, even when they are pro-organizational. managers should act as role models. they must refrain from engaging in unethical behaviors even if they are beneficial for the organization. those employees who are engaged in these behaviors should be given oral or written warning to discourage them from engaging in these behaviors in the future. third, managers should be rigid when it comes to organizational rules. strict policies should be in place to discourage employees from breaking the rules even if it is beneficial for the organization and its stakeholders. those employees who break the rules must be given warning to stop employees from developing the culture of rule breaking. one way of doing so is linking rule following with job performance and rewards. those employees should be given monetary or nonmonetary rewards who refrain from engaging in unethical proorganizational behaviors and rule breaking. forth, the adverse outcomes of emocb indicate that employees don't like to be forced to engage in ocb; hence, managers should not obligate employees to show ocb. fifth, employees who are part of the leader's in-group should not be given any indirect signals to do more than what is required from their job, as external pressure to engage in extra-role behavior can prove to be dangerous for the organization, as it can promote negative behaviors. there has been a paradigm shift from positive side of oi to its dark side. the current study has contributed toward this underexplored side of oi 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of prevention health programs date: - - journal: front psychol doi: . /fpsyg. . sha: doc_id: cord_uid: uf nb w this work explores the use of fnirs neuroimaging technique using young female college students with different levels of consumption of pornography, and the activation of the prefrontal cortex (cue reactivity) when viewing a pornographic clip (cue exposure) versus a control clip. the results indicate that the viewing of the pornographic clip (vs. control clip) causes an activation of brodmann’s area of the right hemisphere (ba , pars triangularis) (p < . ). an effect also appears between the level of self-reported consumption and the activation of right ba : the higher the level of self-reported consumption, the greater the activation (p < . ). on the other hand, those participants who have never consumed pornographic material do not show activity of the right ba compared to the control clip (p < . ) indicating a qualitative difference between non-consumers and consumers. these results are consistent with other research made in the field of addictions. it is hypothesized that the mirror neuron system may be involved, through the mechanism of empathy, which could provoke vicarious eroticism. finally, we suggest the applications that these results may have for primary and secondary prevention programs in the field of problematic consumption of pornography. in recent years, the technological advances experienced in the field of neuroscience allow us to study the structure of the brain and its functioning from a previously unknown approach. this has been a very important advance in various applied areas of the human sciences. one of the most developed fields thanks to this has been that of public health and prevention since essential research has been generated for the development and optimization of public health interventions (cuesta-cambra et al., ; horn et al., ) . that is defined by adequate knowledge of the motivating concepts that provoke the reaction of the brain receptors (gallagher and updegraff, ) . for this reason, some authors speak of the important emergence of a new study area: the neuroscience of persuasion (cacioppo et al., ) . as these authors say: "a growing literature on the neural correlates of persuasion has emerged within the past decade. . .with the majority of studies in this literature focused on the neural correlates of behavior change following exposure to a persuasive appeal. . . but there are important remaining questions to address and major opportunities to be pursued that should attract and ignite research attention" (cacioppo et al., , p. ) . the importance of integrating the neuroscientific approach with theories of cognitive and emotional information processing underlying persuasive communication and prevention is evident. these investigations will not only increase our knowledge of brain and behavior interaction, but will also allow us to better understand the mechanisms of persuasion and social influence. addiction is one of the biggest public health problems in the contemporary world. the different existing addictions cause a large number of deaths and physical and psychological diseases, also causing disorders of behavior, personality, affectivity and social integration (san juan, ) . in order to comprehend the basic principles of addiction, the most recent studies focus their interest in understanding how the prefrontal lobe works and what are the associated cognitive functions, in order to assess what role dopaminergic reinforcement systems play in the process, inhibitory control, decision making, the search for experiences or social relationships and other factors. goldstein and volkow ( ) explain how addiction occurs when the motivational system and the prefrontal inhibitory control system are decompensated and the former gives an exaggerated value to the substance consumed repeatedly while the individual is unable to inhibit a behavior that generates an immediate reward and disregard the risks of this addiction. the increased interest in addictions, more recent research has emerged regarding behavioral addictions. in , the fifth edition of the diagnostic and statistical manual of mental disorders was modified to include a subdivision of non-substancerelated disorders in the substance-related and addictive disorders category (goldstein and volkow, ) . this subdivision is specifically focused on addictive disorders that do not involve the use of substances and is often called behavioral addictions. in addition, in recent years the who has introduced behavioral addictions into its classification. in this new list, internet addiction is one of the most widespread and could be the cause of important emotional and psychological disorders in the individual (demetrovics et al., ; vondrácková and gabrhelík, ) . within the internet, the use of the net with the aim of achieving sexual gratification is an increasingly common practice (cooper and griffin-shelley, ) . there is solid evidence that indicates that problematic consumption of pornography as well as addiction to pornography is increasing, especially in young men (castro et al., ; de alarcón et al., ) , causing serious difficulties in this population. thanks to neuroscience, it has been possible to investigate the reasons why adolescents are more likely to develop substance use disorders than adults. the results explain how during adolescence the reward/motivation mechanisms and the limbicemotional circuits exhibit a state of hyperactivity that fosters greater emotional reactivity and drives the search for behaviors that generate immediate reward. furthermore, the prefrontal cortex cannot fully self-regulate, leading to increased impulsivity and risk taking (jordan and andersen, ) . through studies based on neuroimaging methodologies, it has been possible to observe the neural circuits that are activated during addictive behaviors, the gratifying responses, as well as all those processes that activate conditioning to the substance, mood, anxiety or reactivity during withdrawal symptom period (volkow et al., ; zilverstand et al., ) . there are multiple studies based on knowledge of substancerelated addictions (addicott, ; votaw et al., ) , however, research related to behavioral addiction is much more scarce, highlighting those focused on understanding the relationship between addictive behavior and activation of the dorsolateral prefrontal cortex and its effects on working memory and inhibition of the control of impulsive responses (alizadehgoradel et al., ; maheux-caron et al., ) . one of the behavioral addictions that has attracted the most attention in recent years is pornography addiction. the increased use of the internet may have led to increased consumption and acceptance of pornography (d'orlando, ) . internet pornography is unique as it offers anonymity, free and easy access. these three drivers of internet pornography usage referred to as the "triple-a engine" are what causes the popularity of internet pornography (cooper and griffin-shelley, ) . as a consequence of the increased pornography use worldwide, there has been much focus on compulsive internet pornography as a subdomain of hypersexuality (carroll et al., ; döring, ; griffiths, ) . on the other hand, individuals who consume cybersex increasingly show younger profiles, and the consumption of online pornography causes a decrease in self-esteem and an increase in stress levels in young people (ainsworth-masiello and evans, ). according to the report of the association for media research (aimc), "internet audience march , " . % of users in spain are young people between and years old, highlighting the progressive growth of included in the section from to years. in addition, the internet consumption habit by adolescents is characterized by impulsive and uncontrolled behavior in which the need to repeat addictive behaviors prevails, generating a high degree of irritation if browsing is interrupted (xanidis and brignell, ; rojas et al., ) . if we consider that one of the main personality traits of adolescents trained in the digital age is the urgent need to obtain immediate pleasure, we will better understand the activities risk that the consumption of online porn content can pose for individuals still in maturation process of gratification. empirical evidence seems to support the notion that abusive online pornography use leads to adverse behavioral (couple-related behavioral changes, reduced social interaction, modified goal standards), physiological (modification of sexual psychophysiological patterns such as erection) and emotional effects (guilt, negative chains of thought, reduction of selfesteem) (de alarcón et al., ) . there is also strong evidence that indicates the effects that porn consumption causes on the brain (muller, ) . in this way, through reverse induction, it is possible to better understand the mechanisms that underlie the problematic consumption of pornography and even analyze the existence of possible differences or "typologies" profiles of consumers. in this sense, one of the most important differences to investigate in this field is gender differences. inhóf et al. ( ) have recently presented strong evidence on gender differences in activation of the prefrontal cortex in internet addiction. sometimes, this behavior ends up becoming a behavioral addiction, which may in turn increase its adverse effects. behavioral addictions are becoming more prevalent, especially among young adults (e.g., online gambling, excessive smartphone use, and online porn addiction). there exists evidence indicating that women are joining the use of these websites and devices (shaughnessy et al., (shaughnessy et al., , french and hamilton, ) . on the other hand, health organizations are generating research projects that allow to develop primary and secondary (treatment) prevention programs based on already-existing intervention programs on this field (vondrácková and gabrhelík, ; sniewski et al., ) . nevertheless, there is no robust empirical evidence on women's online porn use habits nor on the neurocognitive mechanisms involved in this behavior, which in turn is hurting the creation of these prevention programs. this research is carried out within the emerging area of "neuroscience of addiction and prevention" (volkow and boyle, ) . in this frame of reference, it has been proposed that the addiction cycle is articulated in three stages and involves three fundamental brain regions: ( ) the anticipatory response, mainly caused by stimuli (internal or external) involving the prefrontal cortex and which is responsible of craving, the irrepressible impulse that starts the behavior, ( ) the execution of the behavior (with or without substance intake) that involves the base ganglia and the reward circuit, and ( ) the extended circuit of the amygdala responsible for withdrawal and restoring balance to the stress response (united states department of health and human service, ). the goal of primary prevention is to persuade the target population to prevent the problem behavior from occuring. therefore, according to this model, the anticipatory response cycle, as responsible for the initiation of the behavior, is the one that plays the most important role. furthermore, as the model points out, the behavior is activated due to the appearance of a stimulus. since addictive behavior consists of very powerful learning due to the intensity of the reward, the triggering stimulus acts as a discriminating stimulus. the discriminative stimulus is defined by the psychology of learning as that stimulus that signals to the subject the availability of reinforcement in operant conditioning. when reinforcement involves the dopaminergic brain systems as intensely as it does in addictions, discriminative stimulation and craving play an essential role. this research focuses on studying the importance of the discriminative stimulus consisting of sexually explicit images (cue exposure) and the craving response (cue reactivity) in young women who watch a clip with pornographic content versus a clip with neutral content. this paradigm has been used in the study of substance addictions, such as smoking (kroczek et al., ) , but it has not been developed in the field of behavioral addictions such as the consumption of pornography. recently, strahler et al. ( ) have studied the neural correlates of gender differences in distractibility by sexual stimuli. these authors researched neural activity specific to sexual images in brain regions implicated in motivation and reward processing. they found that men as compared to women showed stronger responses in the nucleus caudatus, the anterior cingulate cortex, and the nucleus accumbens. sexually-motived traits were selectively correlated with nucleus caudatus activity. the goal of our research is to analyze the role of the dorsolateral prefrontal cortex during pornography cue exposure in young women. by achieving this goal, we intend to provide with knowledge on the neurocognitive fundamentals of this behavior, which will set the foundations of future developments of useful prevention programs. this research may also help to consolidate already-initiated communication programs within health organizations in the field. this study tested whether the prefrontal cortex of participants high (vs. low) in porn consumption showed more activation when exposed to pornographic content relative to a no-treatment condition. in line with previous research (kühn and gallinat, ; zangemeister et al., ) we expected participants high (vs. low) in porn consumption to increase their activity (cue reactivity) in the prefrontal cortex area when being exposed to footage with pornographic content (cue exposure). we analyzed the activity of the prefrontal cortex using the fnirs (functional near infrared spectroscopy) technique, which has been shown to be effective in this type of study (karthikeyan et al., ) . there is also similar evidence in neuroimaging studies using fnirs in the field of addictions (leong et al., ) . as noted, previous research has shown that higher levels of right pars triangularis reactivity as measured by fnirs in the prefrontal cortex area are associated with self-regulatory endeavors. of course, it is possible that other stimuli in the lab context might be responsible for such potential difference in activation (e.g., cover story, brain-measuring apparatus, lab environment). thus, an important goal of the current study was to compare the extent to which the prefrontal cortex activation differs as a function of the type of video (control vs. porn) participants were exposed to. the hypothesis to be investigated proposes that certain areas of the prefrontal cortex will be activated to a greater extent during the viewing of pornography (vs. control). finally, an interaction effect is also hypothesized: that is, the effect of cue reactivity in the presence of the discriminating stimulus (porn clip) will be greater the higher the rate of pornography consumption and, therefore, the more intense the operant learning has been (ferrari and quaresima, ) . as a research question, the specific prefrontal area where the greatest activation will appear in each circumstance will be considered. the experimental procedure of the study was approved by the research and ethical protocol commission of the department of communication theories and analysis of the complutense university of madrid. the research was conducted with subjects: right-handed women, spanish university students (mean age = . ; sd = . ) who voluntarily participated without knowing the objectives of the research. women of homosexual or bisexual orientation were excluded. in order to control socio-cultural influence, subjects from other countries were also excluded. the activation of the prefrontal cortex was evaluated during the viewing of the clips using the fnirs system: the s pornographic clip was broadcasted followed by a s blank screen (porn baseline) and another s of a control clip (television interview), followed by a s blank screen (baseline control). the order of presentation of the conditions "porn clip + porn baseline" and "control + control baseline" was randomized. the stimuli were designed with the program psychopy , an open source package written in the python programming language that allows the creation of visual and auditory stimuli, presentation protocols and the registration and analysis of data in a simple way and used for neuroscience and experimental psychology experiments (peirce, (peirce, , peirce and macaskill, ; hansen, ) . the independent variables were as follows: vi = video type (porn video vs. control video) and vi = self-reporting porn consumption as a continuous variable (range to ). the frontal cortex activation measured with fnirs was the dependent variable. first, participants were told that they were going to be involved in a study exploring personality variables and reactions to certain stimuli. participants then responded to some ancillary questions that served to support the cover story, and then responded to the item (e.g., "with what frequency do you usually watch porn per week?") on which responses ranged from " " to " " with higher numbers reflecting more porn consumption indicating if they had viewed pornography. this measure of pornography consumption has been previously used (with a slightly different scale) and has demonstrated its validity and reliability for this type of study (grubbs et al., ) . during fnirs recording, subjects were instructed to sit and focus on a blank screen. then a -second clip was then presented, preceded by a -second fixation point and followed by a second blank screen as baseline, in an uninterrupted sequence. once these -second of white screen are finished, another second begin with a neutral clip followed by another -second of blank screen as a baseline. to generate a sexual arousal clip, we selected a roman orgy scene from the film caligula, by tinto brass, explicitly depicting sex. for the neutral clip, we chose a standard tv interview with a similar stimulus complexity with the same blank screen as baseline. the choice for a pornographic scene was able to provoke sexual arousal as it was confirmed in a previous pilot study with similar subjects. in order to avoid cumulative error, the stimuli were presented in random order. data collection using fnirs was carried out in the neurocommunication laboratory of the school of communication of the complutense university of madrid . participants were then connected individually to the fnirs devices to record the prefrontal activity while watching the stimuli. the prefrontal activity data was recorded using a nirsport fnirs system by nirx (nirx medical technologies llc) which assesses cognitive activation by recording brain oxygenation. light-emitting diodes (leds) in optodes held to the scalp by a tight cap emit light from to nm. this light passes through the skull and the first layer of the cortex before being picked up by corresponding detectors. some of this light is absorbed by chromophores, but human tissue is relatively "transparent" in this spectral range (ferrari and quaresima, ) . hemoglobin, the transport protein that allows red blood cells to carry oxygen, is one such chromophore. a higher concentration of oxygenated hemoglobin results in more light being absorbed. the fnirs system displays the degree of oxygenation in real-time to researchers based on this principal. the presence of increased oxygenated hemoglobin is interpreted to be the result of more neural resources being used in that area. this is typically referred to as "activation." researchers infer cognitive activity based on activation and draw conclusions from there. other technologies and techniques are also routinely used to assess neural activity. as a neuroimaging technique, fnirs is a much less expensive alternative to traditional functional magnetic resonance imaging (fmri). despite its lower signal-to-noise (snr) ratio, fnirs correlates highly with fmri measures (cui et al., ) , making it a reliable alternative for use in psychophysiological studies. fnirs is both mobile and less sensitive to movement artifacts than fmri (cui et al., ) , which allows for neuroimaging experiments that would otherwise be impossible, such as fullbody motion studies. the ability of fnirs to be used in a mobile modality is vital to naturalistic studies, since the goal of a naturalistic study is to be as close to real-world activity as possible. for investigations of cue reactivity there are several benefits in using fnirs, e.g., subjects are sitting www.neurolabcenter.com in a realistic upright position and can handle real objects to elicit cr by triggering several senses (visual, tactile, olfactory and interoception during movement). although fnirs cannot measure hemodynamic activity in subcortical structures, it can assess both the dlpfc involved in inhibitory processes and the ofc involved in the processing of emotional valence (ehlis et al., ) . the fnirs shows the relative changes in hemoglobin levels, calculated using the modified beer-lambert law (figure ) : oxygenated hemoglobin change: delta o hb (µmol/l), deoxygenated hemoglobin change: delta hhb (µmol/l) and total hemoglobin change: delta chb (µmol/l). in order to measure changes in cerebral oxygenation this study utilized the nirsport system. (nirsport - , nirx medical technologies llc, united states) which is a portable, wearable, multichannel fnirs system consisting of led illumination sources and active detection sensors. emitters were placed on positions f , af , fc , f , f , af , fc , and f while detectors were placed on positions f , af , fc , f , f , af , fc , and f (figure ) . eighteen channels were set up covering the prefrontal cortex. the source-detector distance was cm. optodes were placed on the participant's head using an easycap relative to the international / system (jasper, ) . the data was acquired with the aurora . . acquisition software (v nirx medical technologies llc) at two near infra-red light wavelengths of and nm, with a sampling rate of . hz. participants were then sat in front of a screen, and were told that video footage was going to be shown. they were instructed to watch it while the apparatus measured their brain activity, and to wait for about s after the video was over so a return to baseline could also be collected. after data collection was completed, participants were debriefed, thanked and dismissed. the nirsport comes together with aurora fnirs: a software platform designed to record the signal. the automated signal optimization algorithm ensures optimal signal quality before a measurement is started. once data is being recorded, hbo and hb concentration changes can be visualized in real-time in several display modes. in addition, high-end whole-head visualizations are immediately available. also, the nirslab package is available: is a matlab-based software analysis environment developed to support the study of time-varying near infrared measurements of tissue using the nirsport system. it is composed of modules for: importing nirs measurement data. creating files that contain the optodeposition. preprocessing of measurement data using software programs that exclude data channels having excessive noise, deleting experimentally irrelevant time intervals, removing artifacts from data and filtering to exclude experimentally irrelevant frequency bands. computing hemodynamic states using wavelength and path length dependent parameter settings. the data analysis uses functions found in the spm (statistical parametric mapping) package to extend the capabilities of nirslab to include statistical analysis of hemodynamic-state time series. the functions include: level- general linear model (glm) analysis of fnirs hemodynamic-state time series, to evaluate the positiondependent relationships between computed data-channel responses and user-specified temporal models. level- and level- assessment of the statistical significance of the glm model-fitting coefficients (t-test, anova), or of user-defined contrasts of two or more models. figure shows the spm contrast manager beta image display at a . p-value. the colors denote the magnitude of oxygenated hemoglobin response to pornographic clip vs. non-pornographic clip and the specific area of the prefrontal cortex that was activated (p-value = . ). the only area that was activated significantly more when viewing the pornographic clip compared to the non-pornographic clip was that corresponding to channel fc (optode d ) and f (optode s ) corresponding to channel n (figure ) . this channel records right brodmann area (ba ), more specifically the pars triangularis. in the video that appears as figure , the activation of the prefrontal cortex in a consuming person can be seen dynamically during the viewing of the porn clip. the heatmap in the video shows the highest intensity in the activation of the right ba . when https://youtu.be/yb vnsxicgq the subjects were grouped into two clusters (non-consumers vs. consumers) based on the self-report of consumption of pornographic material, the spm analysis produced the same result regarding the activated area (right pars triangularis) verifying the interaction effect (p < . ): high consumption subjects show more right ba activity when viewing the pornographic clip than non-consumer subjects (figure ). this figure shows how the right activity is lower than the left activity in non-consumers. figures a-c show the relative changes in hemoglobin levels for channel that can be seen during the viewing of the pornographic clip ( figure a ) in a subject with high consumption scores of pornographic material (consumer) and (figure b ) a subject with low consumption scores (non-consumer). in figure c we can see the levels of oxygenated and deoxygenated hemoglobin referred to right ba in consumer during the porn clip. once the nirslab indicated that the only significant effects appeared in channel , we conducted a linear regression analysis using the process . macro model for spss (spss, rrid:scr_ ) with porn consumption (centered), porn footage as a multicategorical predictor (control video, return to baseline control, porn video, return to baseline porn), and the interaction of the two variables on participantś blood flow in the channel of prefrontal cortex (right pars triangularis). we contrast coded the porn footage as follows: − = control, − = control baseline, = porn video, = porn baseline. in order to properly probe an interaction that has one multi-categorical predictor, we followed the tutorial by montoya and hayes ( ) . this required transforming the independent variable into three different dichotomous variables (d , d , and d ). we report all possible comparisons between conditions (control vs. control baseline, control vs. porn, control vs. porn baseline, control baseline vs. porn, control baseline vs. porn baseline, and porn vs. porn baseline). the regression revealed a significant two-way interaction between porn consumption and video footage, r = . , f( , ) = . , p < . , meaning that the relationship between reported porn consumption and right pars triangularis reactivity varied as a function of the different videos and baselines (see figure for the entire two-way interaction). specifically, when comparing control video and the control baseline, a significant two-way interaction emerged, b = − . , t( ) = − . , p < . , % ci: − . , − . . as can be seen in table , there was no relationship between self-reported porn consumption and right pars triangularis reactivity in the control video, b = − . , t( ) = − . , p = . , % ci: − . , . . however, porn consumption was negatively associated with right pars triangularis reactivity in the control baseline, b = − . , t( ) = − . , p < . , % ci: − . , − . , indicating that participants who reported high (+ sd) porn consumption showed lower right pars triangularis reactivity than those who reported low (− sd) porn consumption. a two-way interaction in the opposite direction emerged when comparing the control video with the porn video, b = . , t( ) = . , p < . , % ci: . , . . there was no relationship between self-reported porn consumption and right pars triangularis reactivity in the control video, b = − . , t( ) = − . , p = . , % ci: − . , . . however, porn consumption was positively associated with right pars triangularis reactivity in the porn video, b = . , t( ) = . , p < . , % ci: . , . , indicating that participants who reported high (+ sd) porn consumption showed higher right pars triangularis reactivity than those who reported low (− sd) porn consumption. a similar marginally significant two-way interaction emerged when comparing the control video with the porn baseline, b = . , t( ) = . , p = . , % ci: − . , . . specifically, there was no relationship between self-reported porn consumption and right pars triangularis reactivity in the control video, b = − . , t( ) = − . , p = . , % ci: − . , . . however, porn consumption was marginally associated with right pars triangularis reactivity in the porn baseline, b = . , t( ) = . , p = . , % ci: − . , . , indicating that participants who reported high (+ sd) porn consumption showed marginally higher right pars triangularis reactivity than those who reported low (− sd) porn consumption. when comparing the control baseline with the porn video, a significant two-way interaction also emerged, b = . , t( ) = . , p < . , % ci: . , . ( table ) . t( ) = . , p < . , % ci: . , . . however, porn consumption was marginally associated with right pars triangularis reactivity in the porn baseline, b = . , t( ) = . , p = . , % ci: − . , . . lastly, a significant two-way interaction also emerged between the control baseline and the porn baseline, b = . , t( ) = . , p < . , % ci: . , . . as can be seen in table , reported porn consumption was negatively associated with right pars triangularis reactivity in the control baseline, b = − . , t( ) = − . , p < . , % ci: − . , − . . however, porn consumption was marginally associated with right pars triangularis reactivity in the porn video, b = . , t( ) = . , p = . , % ci: − . , . (see figure for the entire two-way interaction). as can be seen in table , the results of the analysis of variance show statistically significant values at all levels of analysis (p < . ) for both main effects and interaction, confirming the data previously obtained by the multiple regression. in the following figure (figure ) the independent variable "consumption level" has been transformed into a dichotomous variable: subjects who have never consumed pornographic material and subjects who have consumed it. the new dichotomous variable generated two practically identical groups regarding the number of subjects. the analysis of variance performed (table ) indicated that there are main effects (p < . ) of the factor "type of clip viewed" (control vs. porn) but there are no main effects (p < . ) of the factor "level consumption" (consumer vs. non-consumer) as well as interaction effect (p < . ). that is, the interaction effect is strong enough to override the main effect of the type of viewing: subjects who have never seen porn decrease their cortical activation in n (ba , right pars triangularis) while those who have seen it some increase cortical activation significantly in right ba . the objective was to find evidence that allows us to contribute knowledge not only to the foundations of neuroscience, but also to the foundations of persuasion neuroscience and communication and health. thus, the final objective of this research is to find certainties that allow the design of health prevention programs. more specifically, in the area of prevention of problematic consumption of pornographic material by young women, who have recently joined the problematic consumption of pornography (shaughnessy et al., (shaughnessy et al., , serrano, ; french and hamilton, ) . the increased use of the internet may have led to increased consumption and acceptance of pornography (d'orlando, ) . internet pornography is unique as it offers anonymity, free and easy access. these three drivers of internet pornography usage referred to as the "triple-a engine" are what causes the popularity of internet pornography (cooper, ) . as a consequence of the increased pornography use worldwide, there has been much focus on compulsive internet pornography as a subdomain of hypersexuality (carroll et al., ; döring, ; griffiths, ) . prevention programs manage to reach a large part of the population avoiding risks and diseases. however, there is an evident lack of neurocognitive research that makes it possible to develop better communication programs in health. only a knowledge of the mechanisms underlying the behavior to be modified will allow the design of adequate preventive programs. this research focuses on studying the importance of the discriminative stimulus consisting of sexually explicit images (cue exposure) and the craving response (cue reactivity) in young women consumers and non-consumers of porn videos. this paradigm has been frequently used in the study of substance addictions (kroczek et al., ) , but it has been much less developed in the field of behavioral addictions such as the consumption of pornography. the underlying idea is the following: in order to develop effective prevention programs on porn consumption, it is necessary to know how the discriminative stimuli that trigger the onset of behavior. it is important to consider that the environment in which the behavior of young people develops constantly presents stimuli of high erotic charge that can act as discriminating stimuli. not only advertising stimuli, but many others, such as those that appear on social networks such as instagram or tiktok, present a large amount of erotic content that can act as discriminatory stimuli causing behavior and strengthening the learning of problematic behavior. there is also strong evidence that indicates the effects that porn consumption causes on the brain (muller, ) . this study tested whether the prefrontal cortex of participants high (vs. low) in porn consumption showed more activation when exposed to pornographic content relative to a no-treatment condition. in line with previous research (kühn and gallinat, ; zangemeister et al., ) we expected participants high (vs. low) in porn consumption to increase their activity (cue reactivity) in the prefrontal cortex area when being exposed to footage with pornographic content (cue exposure). we analyzed the activity of the prefrontal cortex using the fnirs (functional near infrared spectroscopy) technique, which has been shown to be effective in this type of study (leong et al., ; karthikeyan et al., ) . in the current research, young college women selfreported their porn consumption habits and viewed two second video clips (porn vs. control) while the activity of their prefrontal cortex was recorded using fnirs. the results obtained indicated that the discriminative stimulus caused greater cortical activity in brodmann's area (right ba , pars triangularis) of the right hemisphere in women consumer, but not in non-consuming women (p < . ). they also indicated that this effect occurs in the experimental group compared to the control group and that the porn stimulus causes a greater effect depending on the degree of consumption. consistent with our expectations, women who have never consumed pornographic material do not increase the degree of activation of right ba compared to the control group. this result is consistent with the interpretation of the porn stimulus as a discriminative stimulus of operant learning "pornography consumption": if the person has never consumed pornography, the learning has not started, so the stimulus is not discriminatory, but neutral (it could even be aversive). future research should analyze the difference between "nonconsumers" and consumers to test this interpretative hypothesis. in addition, it should be analyzed using different types of addictions such as gambling, social networks, etc. given that one of the priority interests of this research is to provide evidence for the foundation of prevention programs in health and consumption of pornography in women, it is important to deepen the interpretation of the result: the activation of pars triangularis (area of brodmann) prefrontal of the right hemisphere. although this line of research is very recent, there is already some bibliography where more activity of the right pars triangularis has been found in addictions. for example, irizar et al. ( ) has found that the right lower frontal gyrus volume (i.e., pars triangularis) was significantly larger in both the pathological gambling and cocaine dependency versus control groups. there is an abundant bibliography that links this area with mirror neurons and empathy (uribe et al., ; krautheim et al., ; rymarczyk et al., ) . recently it has been empirically confirmed that the right hemisphere plays an important role in the interpretation of gestures and nonverbal language, especially brodmann's area (inhóf et al., ; krautheim et al., ) . these data could imply that brodmann's area , traditionally associated with verbal language in the left hemisphere, is complemented by the functions developed in the right hemisphere. in this way, the left hemisphere would have a role more linked to semantic memory and the understanding of linguistic meanings, while the right hemisphere would deal with the understanding of non-linguistic meanings. both would work together with working memory but linked to different functions. on the other hand, neocortical correlates have also been found for the cognitive empathy dimension, while affective empathy would be related to subcortical structures. functionally, affective empathy appears to be linked to the connectivity between the orbital and cingulate cortices and deeper structures of the limbic system (uribe et al., ; xiong et al., ) . a very plausible hypothesis could be that the ba 's neo-cortical structure acts as an interface between the cognitive and emotional aspects of empathy and the interpretation of the non-verbal behavior of others. furthermore, this hypothesis is consistent with the fact that a significant number of mirror neurons are found in this area, which would be highly involved in empathy (gallese, ; decety, ; preston and de waal, ; decety and jackson, ; keysers and gazzola, ) . in reality, this brain area, and others very close, such as the anterior insula, the anterior cingulate cortex, the inferior frontal cortex, are closely linked to the experience of emotions such as disgust, happiness or pain, especially when viewing another person experiencing these emotions (botvinick et al., ; lamm et al., ) . freedberg and gallese ( ) have shown the importance of the mirror neuron system for aesthetic experiences. aesthetic experiences are considered as experiences of perception, creation and evaluation of stimuli that evoke very intense feelings (chatterjee, ; pearce et al., ) . christian keysers at the social brain lab and colleagues have shown that people who are more empathic according to self-report questionnaires have stronger activations for emotions, providing more direct support for the idea that the mirror system is linked to empathy. it is possible that the mirror system does not passively respond to the observation of actions but is influenced by the mindset of the observer (molenberghs et al., ) . these investigations allow us to propose the following interpretation of the results of our research: the subjects who consume pornography, according to their self-report questionnaires, may show greater empathy for pornographic images. in other words, the "cue exposure" would provoke a greater reaction due to the activation of a kind of "vicarious eroticism" linked to empathy rather than to the pure dopaminergic pleasure provided by brain pleasure systems. although there is not yet enough empirical evidence, it could be thought that mirror neurons are involved in sexual behavior, especially in its empathic component. white ( ) speaks of "erotic empathy" when referring to this concept. as we have pointed out, this interpretive hypothesis would also be supported by the fact that it is the right cerebral hemisphere that shows ba activity. as indicated, the right hemisphere seems to be in charge of processing cognitive interpretations of non-semantic aspects of communication. on the other hand, very clear gender differences have been found in this brain area. for example, kurth et al. ( ) found significantly larger gray matter volumes in females than males for right ba and ba bilaterally but no significant sex differences with respect to ba / asymmetry. this could explain the difference between men and women in terms of semantic and empathic capacity in many aspects of psychosocial relationships. despite the novelty of this proposal, other authors have found data that supports the idea that right brodmann's area of the right hemisphere could be linked to behavioral addictions closely linked to empathy and social relationships. for example, schmitgen et al. ( ) found that subjects with smartphone addiction showed greater activation in the right prefrontal cortex, specifically in the pars triangularis (right ba ). in a very similar sense, inhóf et al. ( ) has shown that women who self-reported problematic use or addiction to social networks on the internet showed greater activation in the same area: the pars triangularis (right ba ) of the right hemisphere and also in the right pars opercularis. considering that the objective of this work is to contribute knowledge to the area of communication and health neuroscience and, more specifically, of prevention, it is necessary to propose an interpretive hypothesis of these results in terms of the theory of communication and prevention. in this sense, two future research routes can be established. the first is to delve into the difference between "non-consumers" and "consumers": the data seems to indicate that the reactions to discriminating stimuli (erotic stimuli), responsible for cue exposure, act very differently in non-consumers compared to the rest. in non-consumer participants, right ba (pars triangularis) from the right hemisphere does not appear to be activated, compared to the erotic stimulus, which is very consistent with the idea that it is a discriminative stimulus. the first conclusion, therefore, is important: it is convenient to distinguish very clearly between primary prevention (the subject has not started the problem behavior) and secondary prevention (when the behavior has already started and sought to manage the risks or make it disappear). in the first case, prevention must focus on health education and health promotion programs. here, the axis of communication should be such that it explains to the subject and their guardians, in the case of minors, the importance of not initiating the behavior. it's initiation would quickly provoke a sensitization of this cortical prefrontal area, with the consequences of possible craving before discriminative erotic stimuli. in the case of secondary "prevention, " persuasion programs should focus on modifying the attitudes of the subject to eliminate or modify the consumer behavior. in the case of young women, the result of this research seems to indicate that an important motivation in the behavior of consumption of pornography may be the vicarious search for empathic links of an erotic nature that is highly driven by the mirror neuron system. in other words, we would find two variables: the limbic pleasure system characteristic of erotic behavior and the mirror neuron system characteristic of empathic behavior involved. if these hypotheses are correct, prevention programs in young women should focus on modifying attitudes linked to the search for "erotic empathy" or "vicarious eroticism." said in terms of communication theory: the target's insight indicates that the axis of communication and the strategy of preventive programs should focus on these aspects of human behavior. therefore (in terms of persuasive social communication theory) the usp (unique selling proposition) should refer to the benefits in terms of "erotic empathy" that the subject would obtain if they modify their attitudes (and, therefore, their behavior) in this area. in the same sense, the rw (reason why) should provide the subject with new reinforcement incentives to replace the cognitive and emotional pleasure provided by "vicarious/empathic eroticism." therefore, in this sense, future lines of research should be developed: analyzing, using neuroimaging techniques (fnirs, fmri), how the brain mechanisms of the subjects behave against different preventive communication messages in this area of pornography consumption. the procedure may consist of manipulating, as an independent variable, the type of message, the usp and the rw, using the neuroimaging results as the dependent variable. in this sense, another important line of future research may consist of analyzing gender differences. if the hypothesis is correct, it is reasonable to hypothesize that different areas of the prefrontal cortex are activated in men compared to women, in the face of pornographic stimuli. the limitations of this research refer to the size of the sample: although the number of subjects is considerable for this type of neuroimaging research, especially considering that the sample is very homogeneous (young spanish female college students). however, an expansion of the sample size could make it possible to better differentiate between the different degrees of addiction and between "non-consumers" and consumers. our paradigm is interesting in several ways. first, it shows that, in young women, ba (pars triangularis) from the right prefrontal cortex plays an important role in the behavior of pornography consumption. this finding could explain the cue reactivity caused by the cue exposure that would be responsible for the craving which, in turn, would trigger consumption behavior. secondly, these data could be considered a foundation for secondary prevention programs where the communication strategy, the reason why and the unique selling proposition were "vicarious/empathic eroticism." in contrast, for primary prevention programs, the communication strategy should focus on explaining the modifications in the circuits of the right prefrontal cortex that cause the onset of this behavior and its cognitive and emotional consequences. finally, this research can be useful, if research continues in this direction, to find biological markers in this problematic or addictive behavior, in line with other similar research (man et al., ) . the raw data supporting the conclusion of this article will be made available by the authors, without undue reservation. the experimental procedure of the study was reviewed and approved by the commission of investigation and ethical protocol of the department of theories and analysis of communication of the complutense university of madrid. the patients or participants provided their written informed consent to participate in this study. uc aided in the conceptualization and execution of the study, primarily responsible for data analysis and partial drafting of the manuscript and critically reviewed the manuscript and approved its final form. jn aided in the conceptualization of the study, partial drafting of the manuscript, and critically revised the manuscript and approved its final form. lm assisted in data recollection and interpretation, drafting of the manuscript and critical revisions, and approved the final manuscript. bp assisted in data analysis and interpretation and critical review of the manuscript. all authors contributed to the article and approved the submitted version. our gratitude to carolina bengochea, research support staff at the ucm neurolabcenter laboratory (www.neurolabcenter.com) for their collaboration in data collection and analysis. also to marion roberts, a laboratory trainee for their help in coordinating the research. tobacco addiction: cognition, reinforcement, and mood expectations vs reality: in which ways might watching porn online, as male and female adolescents, contribute to poor emotional health? 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psychol doi: . /fpsyg. . sha: doc_id: cord_uid: krv ekb wearing masks against coronavirus (covid- ) is beneficial in suppressing pandemic spread, not through preventing the wearer from being infected but by preventing the wearer from infecting others. despite not providing much protection, the custom of wearing masks has prevailed in east asia from the early stages of the pandemic, especially in japan, to such an extent that it caused a shortfall in supply. why do many japanese people wear masks during the covid- pandemic, even though masks are unlikely to prevent them from getting infected? we examined six possible psychological reasons for wearing masks: three involved expectations about the risk of infection and three involved other driving psychological forces. the results of our nationwide survey revealed that people conformed to societal norms in wearing masks and felt relief from anxiety when wearing masks. however, risk reduction expectations did not affect mask usage. the social psychological motivations successfully explained much about mask usage. our findings suggest that policymakers responsible for public health should consider social motivations when implementing public strategies to combat the covid- pandemic. why do many japanese people wear masks during the coronavirus (covid- ) pandemic, even though masks are unlikely to prevent them from getting infected? wearing masks against covid- is beneficial in suppressing pandemic spread, not through preventing the wearer from being infected but by preventing the wearer from infecting others, according to suggestions from the world health organization (who, a,b,c) and lessons from previous pandemics, such as the severe acute respiratory syndrome (sars) pandemic and the influenza a virus subtype h n pandemic (mniszewski et al., ; leung et al., ) . the director-general of the chinese center for disease control and prevention also stated that, "not wearing masks to protect against coronavirus is a "big mistake"" in terms of preventing the spread of infection, but not in terms of personal infection prevention (cohen, ) . despite not providing much protection, the custom of wearing masks has prevailed in east asia from the early stages of the pandemic, especially in japan (yamagata et al., ) ; to such an extent that it caused a shortfall in supply (bbc, ) . what are the psychological reasons prompting an individual to take a measure from which they cannot directly benefit? individuals' cumulative actions are beneficial to society, but not directly beneficial to themselves. in our survey, we examined six possible psychological reasons for wearing masks: three involved individuals' perception of the severity of the disease and the efficacy of masks in reducing the infection risks both for themselves and for others; the remaining three involved other psychological driving forces. the altruistic intention could be the primary reason for wearing masks, to avoid spreading the disease to others. although perfect altruism seems impossible, people often behave to benefit others at a certain cost to themselves (batson et al., ; schwartz and howard, ) . altruistic risk reduction to others is favorable for the whole of society; however, does such an altruistic motivation work well during a dreadful pandemic? another motivation to reduce risk is self-interest that is, protecting oneself against the virus, even if this is a misperception. if people are confident that masks will protect them against infection, they are likely to wear them. perceived seriousness of the disease could be another reason to wear a mask. the more an individual sees the disease as serious, the higher is the person's motivation to take action. theories of protection behavior such as the protection motivation theory (rogers, (rogers, , and the protective action decision model perry, , ) posit that people cope well with risks when they perceive a threat as serious, and take action when they perceive the action as effective in mitigating associated damage. those three reasons are predicated on reducing the risk of infection to others or to oneself. however, people's actions are not necessarily connected to the original motivating purpose of the action. three factors could result in collective maskwearing even in the absence of an intention to avoid risk. people may simply conform to others' behavior, through perceiving a type of social norm in observing others wearing masks (i.e., a descriptive norm; cialdini et al., ; lapinski and rimal, ) . during the h n epidemic, wearing masks became a norm in hong kong (lau et al., ) . ambiguous situations or states of anxiety -which are central characteristics of the present emergency -can also boost conformity (taylor, ; crutchfield, ) . wearing masks might relieve people's anxiety regardless of masks' realistic capacity to prevent infection. another factor that may explain the decision to wear a mask is the affect heuristic, which predicts that our intuitive feelings toward activities or technologies define our perceptions of benefit as well as risk (finucane et al., ; slovic et al., slovic et al., , . many people might wear masks simply because doing so promotes positive feelings, irrespective of masks' objective effectiveness in reducing risks. finally, a single-action bias in which people tend to adopt a single action against a risk may also be at play (weber, (weber, , . the pandemic compels people to cope as well as they can, and wearing masks may be an accessible and convenient means to deal with the hardship. our research examined how these six broad psychological reasons may explain the japanese use of masks against covid- . identifying influential psychological predictors can help us to improve our collective solutions. we recruited participants through cross marketing, a leading market research company in japan. participants were recruited through electronic mail and accessed the designated website to participate in the survey. they earned small amounts of points for participating, with cash or a gift card awarded based on the number of accumulated points. we included only those who consented to participate in the study. there were female participants and male participants; . % of female participants were in their s, . % were in their s, . % were in their s, . % were in their s, . % were in their s, . % were in their s, and . % were years of age or older; . % of male participants were in their s, . % were in their s, . % were in their s, . % were in their s, . % were in their s, . % were in their s, and . % were years of age or older. the mean age of participants was . (sd = . ). the sample closely reflected the general population in japan for sex, age, and residential area (the whole of japan is divided into seven regions). this survey was conducted between march and , . during this period, the total number of people infected with the novel coronavirus in japan increased from , to , , and the government announced that japanese people should only go out if the trip was necessary or urgent. participants were asked about covid- and the efficacy of masks, responding to six items using a five-point likert scale ( = not at all to = very much). the items were the following: • perceived severity (severity): do you think that your disease condition would be serious if you had covid- ? • perceived self-efficacy of wearing a mask for protection (protection): do you think that wearing a mask will keep you from being infected? • perceived efficacy of wearing a mask for preventing spread (prevention): do you think that people who have covid- can avoid infecting others by wearing masks? • perceived norm to wear masks (norm): when you see other people wearing masks, do you think that you should wear a mask? • feeling relief when wearing masks (relief): do you think that you can ease your anxiety by wearing a mask? • impulse to take whatever actions are necessary (impulsion): do you think that you should "do whatever you can" to avoid covid- ? participants were also asked about their frequency of wearing masks during this outbreak, using a three-point scale ( = i have not worn one at all, = i have sometimes worn one, and = i have usually worn one). figure shows the results of participants' mask usage, indicating that more than half usually wore masks from the beginning of the pandemic (yamagata et al., ) . table shows the descriptive statistics and correlations among variables regarding mask usage. we computed the product of severity and efficacy as an indicator of the effectiveness of wearing a mask (effectiveness). reversed efficacy implies the inefficacy of wearing masks; thus, the product of severity and inefficacy is the perceived risk of infection under the mask-wearing condition (ineffectiveness). all psychological motivations were positively correlated to mask usage. mask usage was regressed by the six psychological reasons to wear masks, removing the products above to avoid multicollinearity, and in order to compare the explanatory power of the psychological reasons. as indicated in table , a powerful correlation was found between perception of norms and mask usage; conformity to the mask norm was the most influential determinant, given the standardized coefficient. feeling relief from anxiety by wearing masks also promoted mask use. by contrast, frequency of mask usage depended much less on the participants' perceived severity of the disease and the efficacy of masks in reducing infection risk both for themselves and for others. this implies that the perceived threat and risk reduction intentions were not the primary reason for wearing masks. our analysis did not find a significant effect of willingness to take any action necessary. these six psychological factors explained one-third of the total variance in the frequency of wearing masks. even though the expectation of risk reduction (personal or collective) explained only small portion of mask usage, motivations superficially irrelevant to disease mitigation strongly promoted mask-wearing behavior; conformity to the social norm was the most prominent driving force for wearing masks. this tendency to conform was reported narratively during the h n epidemic (lau et al., ) , but our research empirically confirmed the association. as mentioned in the context of the sars pandemic, wearing masks can be a symbol of collective confrontation against a pandemic, even though its effectiveness in reducing personal risk remains uncertain (syed et al., ) . to establish effective strategies against covid- , social motivations such as conformity should be used to good advantage and embedded in nudge approaches. nudges utilizing social norms are widely accepted and recommended by social scientists (nyborg et al., ) ; therefore, we encourage policymakers to apply the effects of the social norm on the wearing of masks to promote collective efforts to combat covid- . from the perspective of canonical models of risk-coping behavior, mitigation should be driven by intentions of risk reduction. however, our findings of the modest association between risk reduction expectations and behavior illustrate the complexities of risk-coping. policymakers should also consider these complexities when conducting public relations. the positive correlation between behavior and relieving anxiety by wearing masks suggests that laypeople consider subjective feelings rather than objective risks. we did not examine whether this was derived from lack of knowledge, risk calculation ability, or human predisposition toward risks. however, this tendency should also be considered when delivering risk information. this study has limitations, prompting recommendations for future research. single items were used for measuring the constructs in the survey. therefore, the measures may be associated with larger error variance compared with multiple scales. furthermore, factors other than conformity, affect heuristic and single action bias were not included in the predictors of mask usage in the regression model. despite these limitations, this study has empirically revealed that the expectation of risk reduction does not greatly promote mask-wearing countermeasures against covid- , suggesting that the nudge approach (i.e., taking advantage of people's conformity) may be more promising. in future research, it will be necessary to construct more extensive models and design and conduct more elaborate surveys to comprehensively understand the public's behaviors in relation to infection risks. all datasets presented in this study are included in the article/supplementary material. the studies involving human participants were reviewed and approved by the ethical commission of the faculty of psychology at doshisha university. written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements. kn designed and performed the research. ry analyzed the data. to and ys wrote and edited the paper. all authors contributed to the article and approved the submitted version. this research was supported by internal funds from doshisha university to kn. is empathic emotion a source of altruistic motivation? coronavirus: sharp to use tv factory to make surgical masks a focus theory of normative conduct: recycling the concept of norms to reduce littering in public places not wearing masks to protect against coronavirus is a "big mistake conformity and character the affect heuristic in judgments of risks and benefits prevalence of preventive behaviors and associated factors during early phase of the h n influenza epidemic respiratory virus shedding in exhaled breath and efficacy of face masks behavioral foundations of community emergency planning the protective action decision model: theoretical modifications and additional evidence understanding the impact of face mask usage through epidemic simulation of large social networks" in theories and simulations of complex social systems, intelligent systems reference library social norms as solutions a protection motivation theory of fear appeals and attitude change cognitive and physiological processes in fear appeals and attitude change: a revised theory of protection motivation" in social psychophysiology: a sourcebook a normative decision-making model of altruism" in altruism and helping behavior: social, personality, and developmental perspectives the affect heuristic" in heuristics and biases: the psychology of intuitive judgment risk as analysis and risk as feelings: some thoughts about affect, reason, risk, and rationality journey through an epidemic: some observations of contrasting public health responses to sars a personality scale of manifest anxiety perception and expectation of climate change: precondition for economic and technological adaptation" in environment, ethics, and behavior: the psychology of environmental valuation and degradation (the new lexington press management series experience-based and description-based perceptions of long-term risk: why global warming does not scare us (yet) coronavirus disease (covid- ) advice for the public: when and how to use masks world health organization (who) ( b) who emergencies press conference on coronavirus disease outbreak - the relationship between infection-avoidance tendency and exclusionary attitudes towards foreigners: a case study of the covid- outbreak in japan we are grateful to makiko oku for assistance with data collection. the dataset generated for this study can be found online at: https://www.frontiersin.org/articles/ . /fpsyg. . / full#supplementary-material. the authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. the original publication in this journal is cited, in accordance with accepted academic practice. no use, distribution or reproduction is permitted which does not comply with these terms. key: cord- - gau vmc authors: giorgi, gabriele; montani, francesco; fiz-perez, javier; arcangeli, giulio; mucci, nicola title: expatriates’ multiple fears, from terrorism to working conditions: development of a model date: - - journal: front psychol doi: . /fpsyg. . sha: doc_id: cord_uid: gau vmc companies’ internationalization appears to be fundamental in the current globalized and competitive environment and seems important not only for organizational success, but also for societal development and sustainability. on one hand, global business increases the demand for managers for international assignment. on the other hand, emergent fears, such as terrorism, seem to be developing around the world, enhancing the risk of expatriates’ potential health problems. the purpose of this paper is to examine the relationships between the emergent concept of fear of expatriation with further workplace fears (economic crisis and dangerous working conditions) and with mental health problems. the study uses a quantitative design. self-reported data were collected from italian expatriate workers assigned to both italian and worldwide projects. structural equation model analyses showed that fear of expatriation mediates the relationship of mental health with fear of economic crisis and with perceived dangerous working conditions. as expected, in addition to fear, worries of expatriation are also related to further fears. although, the study is based on self-reports and the cross-sectional study design limits the possibility of making causal inferences, the new constructs introduced add to previous research. the globalization of markets that has taken place in recent decades was a great opportunity for companies to become known and to operate in a wider context (biemann and andresen, ; andresen et al., ) . this phenomenon led to the possibility that many of the managers who served in a national territory could be transferred to foreign countries, characterized by different cultures and work processes (sims and schraeder, ) . however, working globally involves changes in occupational dynamics and in the levels of job complexity, and it also requires great skills of adaptation and adjustment (black et al., ; black and gregersen, ) . most of the researches conducted on adjustment in a foreign country concerned so-called expatriate workers or expatriates (sims and schraeder, ) , who are those workers sent from their own organization to follow projects or to lead company sectors abroad. an expatriate can be properly defined as one who works in a foreign country for a period of at least months (birdseye and hill, ; jones, ; chan et al., ) . however, shorter forms of expatriation also exist, as shown in the present study. supporting expatriates in performing their tasks in a new environment is nowadays essential for companies. accordingly, researchers have studied expatriated performance and adaptation and evaluated the influence of specific practices of human resource management on their behavior. relevant dimensions have been identified (mol et al., ; cheng and lin, ) , such as training, to support expatriates in dealing with different cultural values, unexpected behavioral rules, and language barriers. on the other hand, the dark sides of the expatriation experience have also been studied, such as the possible failure of the assignment, leaving without having finished the task, or psychologically withdrawing and performing worse than they usually would. failure may be particularly expensive in human and monetary terms (baruch, ) . however, adaptation/adjustment may be defined as the comfort degree (or the stress absence) associated with the role of the expatriate (bhaskar-shrinivas et al., ) ; expatriates who fail to face the demands of a job and do not properly adapt to a new environment may experience high levels of stress (perone et al., ) . the scenario of stressors among expatriates seems complex, from the micro-environment and the macro-environment to the mega-environment (lei et al., ) . in particular, according to bhaskar-shrinivas et al. ( ) , work assignments to be carried out abroad lead to greater stress when the following situations occur: (a) when the leader perceives his role as unclear, or rather he does not understand which tasks are actually his and what the company expects from him; (b) when the leader feels he has a low decision latitude; if he does not feel free to make decisions without first having to ask and obtain the green light from his company; (c) if the position is considered too demanding, difficult or new; or in a situation that the leader does not feel up to the task of handling because of lack of experience or lack of capacity; (d) when the manager recognizes that there is a conflict, such as in a case where certain tasks cannot be completed because that would hamper the achievement of other business objectives he is trying to achieve. black et al. ( ) observed that expatriates tend to suffer a greater number of relapses after periods of stress. jones ( ) , in a review, identified some risk factors that could not only adversely affect health, but could also lead to developing fear and anxiety of expatriation: risk of being involved in accidents; quality of living conditions; working conditions; risk of disease contagion; fear of being involved in violence; kidnappings and terrorist acts. these risk factors are analyzed below: -risk of being involved in accidents. this fear is typically supported by the objective evidence that in some countries there are very low driving standards and poor road safety. moreover, in some countries the roads are of low quality. -quality of living conditions. the quality of food and hygiene is one of the most important factors to ensure the adaptation of an expatriate to the new job environment. for example, good water quality cannot be ensured in all countries. drinking poor quality water could cause the development of oral infections or gastrointestinal problems. the same effects can also be produced by eating non-controlled food. as far as lifestyle is concerned, a lack of leisure activities and difficulties in communication (for example, poor internet and telephone functionality) may be a concern. -working conditions. there are higher psychological and physical strains in developing countries, which can inhibit the expatriate's ability to cope with perceived stress and can eventually increase unsafe practices. heavy traffic and low control of industrial gas emissions could also affect the health of expatriates. also, the presence of pristine nature in some working locations might interact negatively with a lower standard of safety and health. -chances of disease contagion. expatriates should be informed on the prevalence of diseases in the host country before their trip or during their stay. the possibility of having specific vaccines would be an important protective factor against possible contagion. however, the fear of contagion from some illness might be always present in some countries. psychological susceptibility to become stressed by the potential contagion also appears important. -fear of being involved in violence, kidnappings, and terrorist acts. this issue, once confined to few world regions, seems now to be more widespread (bader and schuster, ) . given that anxiety could significantly decrease people's psychological well-being and mental health, there is increasing empirical research on the effect of fear in the workplace (mueller and tschan, ) . fear, especially if chronic, may damage, in particular, the immune, the nervous and the cardiovascular systems (shiba et al., ) . the human body may be weakened by states of fear, especially if chronic. in particular, the immune, the nervous and the cardiovascular systems are damaged, but equally, the gastrointestinal tract and the reproductive system are not spared. in particular, the fear may compromise the decoding of emotions and decision making processes, making the subject susceptible to intense emotions and impulsive reactions and, consequently, to making inappropriate actions. fatigue, depression, accelerated aging, and even premature death may be the further consequences of long-term fear (shiba et al., ) . furthermore, the literature shows that expatriate workers have an increased risk of consuming psychotropic and narcotic substances as well as of abusing of psychotropic drugs (aubry et al., ; bianchi et al., ; kaeding and borchers, ) . our study enhanced the literature by being the first to look at a set of important fears among expatriates. in particular, we aimed to find out how the emergence of fear of expatriation, induced by mental health problems, might impact on the expatriate's further fears in the workplace, using data from a survey of italian expatriate workers. building on the stress perspective (lazarus and folkman, ; lazarus, ) , we have, in particular, examined the following issues: how mental health is associated with fear; the relationship between fear of expatriation and fear of economic crisis as well as perceived dangerous working conditions; the mediation of fear with mental health and the development of further fears. we intend to conceptualize fear of expatriation due to the risk factors discussed above. indeed, this study contributes to the literature on expatriates' health by testing an emergent model for the prevention of mental health issues. this paper proceeds as follows. first of all, we present the conceptual model and the derived hypotheses. then, we explain the methodology used. finally, the results and discussion (including limitations and research perspectives) are considered. expatriate workers often experience difficulties in their adjustment to new work and living situations and, consequently, they are at risk of developing mental health problems (costa et al., ; zhu et al., ) . this situation may enhance the fear of violence and of poor living and working conditions during the experience abroad (lazarus and folkman, ) . this fundamental concept is the basis of our conceptual model (figure ) . with this in mind, workers can be severely traumatized not only by actual violence but also from any potential violence . for instance, terrorism is quickly spreading (leistedt, ) . data from the global terrorism database (gtd) of the national consortium for the study of terrorism and responses to terrorism (start) ( ) regarding global terrorism shows that in such attacks relate to countries. in , the worldwide attacks numbered , ( % more than in ), which led to more than , deaths and more than , injured people. the geographical distribution is highly concentrated. sixty percent of these attacks took place in five countries (iraq, india, afghanistan, pakistan, and nigeria), while % of the fatalities caused by terrorism took place in five countries (iraq, nigeria, afghanistan, pakistan, and syria). the strategy of the most developed terroristic groups -e.g., islamic state of iraqi and the levant (isil) and boko haram -not only provides for violent attacks on military or civilian points, but also for kidnapping, torture, and rape. these practices increase the fear of the people -particularly those who are located in the directly involved geographical areas -and of international public opinion. workers with mental health problems might be particularly vulnerable to developing fears of these practices. the use of social media by isil has allowed for the extreme visibility of this organization with a widespread dissemination of its terroristic contents (united states department of state publication bureau of counterterrorism, ) and might increase anxiety in workers with pre-existent mental health problems or stress (solberg et al., ; glad et al., ; paz garcía-vera et al., ) . the context of living and working conditions in the host country is another factor associated with expatriates' psychological well-being. frazee ( ) pointed out that healthcare is one of the main issues for expatriates: more than one-third of international assignments are dissatisfied with the health assistance they receive. the standard of healthcare around the world varies in a very important way. however, discrepancies may exist even among different regions of the same country. in addition, expatriates might be afraid of not receiving an adequate and timely treatment for all types of injury and, moreover, the sanitary conditions might not be good, increasing the risks of contagions or illness. these concerns affect virtually all expatriate workers, but may result in real states of fear in subjects with mental health problems and may generate the acute and chronic worsening of any already existing clinical situation (pierre et al., ; cleary et al., ; wilde and gollogly, ) . hypothesis : mental health problems generate fear of expatriation. the second part of the model is focused on the development of further fears in the workplace. despite the numerous relevant stressors in global assignments, in our conceptual framework we mainly focused on two areas of fear of expatriation. the first is related to violence, intended both as physical and psychological. the second is related to the perceived impeded living and working conditions (including workplace safety, illness contagion, and lifestyle). as already explained, the presence of a pre-existing state of fear or anxiety may enhance the likelihood of negative stimulus to elicit fear. indeed, emotions are specific to the context and imply a person-environment relationship. more specifically, emotions embody a particular theme, reflecting the way the individual sees his/her relationship with the environment in a given situation (lazarus, ) . the fear of expatriation might negatively influence the perception of the safety environment and the anxiety caused by economic crisis. moreover, expatriates are often exported to societies with weaker and less expensive h&s policies (heymann, ) , raising a perception of unsafe working conditions (curcuruto et al., ) . in our model we expect a mediation process of fear of expatriation among mental health and further fears in the workplace. first, mental health problems generate anxiety and fear. fear can impair the formation of long-term memories and can cause damage to certain parts of the brain, such as the hippocampus (besnard and sahay, ) . this can make it even more difficult to regulate fear and can leave a person anxious most of the time. the threats to our security impact our mental wellbeing, whether they are real or perceived, generating multiple fears. hypothesis : mental health problems, through the mediation of fear of expatriation, influence further fears in the workplace: dangerous working conditions and economic stress. this study was conducted in a large international company dealing with technology and services in heavy industry. the expatriate managers employed in this company were all invited to participate in the study. expatriation services in this company are usually in short form. expatriates spend cyclically days outside the workplace (often in platforms or yards located worldwide). the final respondents were employees (response rate = %) working in multiple locations (italy, europe, middle east, asia, africa, australia, etc.). the survey was administered through the corporate intranet, ensuring anonymity, and privacy rules. a video, in which an industrial psychologist and an occupational physician explained the procedure of questionnaire compilation and the survey aims, was also made available through the corporate intranet. the sample consisted of only men in managerial positions. workers were, on average, relatively young: . % years old or younger, . % from to years old, . % from to years old, and only . % were over . regarding job tenure, . % of the participants had worked from to years, . % of participants had worked from to years, . % of the participants had worked from to years, and . % of participants more than years. finally, the majority of employees had long working hours ( . % h per week, . % - h per week, % more than h per week). after collecting some socio-demographic variables, participants completed the scales on fear of expatriation, economic stress, dangerous working conditions and psychological distress. the scales used in this study are described below. fear of expatriation was measured by a new questionnaire, developed by our research group and called fear of expatriation scale (supplementary material). the measure is composed of two dimensions: (a) fear of violence/terrorism -(two items) employees are scared of being subjected to violence/terrorism (e.g., "i am scared of being the object of physical violence -kidnapping, terrorism, etc."); (b) fear of the working and living conditions -(three items) employees are worried about the working and living conditions and about healthcare (e.g., "i am scared of contracting a disease"). the scores were collected, for each dimension, through a fivepoint likert scale (from : "strongly disagree" to : "strongly agree"). as this instrument was developed for this research, we evaluated the construct validity and reliability of the fear of expatriation scale in order to investigate its psychometric properties. we assessed the construct validity (convergent validity and discriminant validity) of the scale by conducting a confirmatory factor analysis (cfa) in order to compare the hypothesized factorial model involving two distinct factorsfear of violence/terrorism and fear of the working and living conditions -with a one-factor model. results showed that the hypothesized two-factor model yielded a good fit to the data (χ [ ] = . , ns; cfi = . ; rmsea = . ; srmr = . ) and outperformed that of the one-factor solution (χ [ ] = . , p < . ; cfi = . ; rmsea = . ; srmr = . ; χ ( ) = . , p < . ), thus supporting the distinctiveness between the two sub-dimensions of fear of violence/terrorism and fear of the working and living conditions. furthermore, standardized regression coefficients of items on each factor were all higher than . (hair et al., ) , thus supporting the convergent validity of the factors (range = . - . ). however, cfa results also indicated that the correlation among latent constructs was higher than . . this therefore suggests that the two dimensions might be best combined on an overall scale of fear of expatriation (kline, ) . accordingly, in our subsequent analyses to test hypotheses and , we considered only the overarching fear of expatriation scale, and not its separate dimensions. finally, internal consistency, which was assessed by the calculation of reliability coefficients (cronbach's alpha), was . , . , and . for the overall fear of expatriation scale, the fear of violence/terrorism dimension and the fear of the working and living conditions dimension, respectively. thus, this indicated good internal consistency of the measure (nunnally, ) . economic stress was measured with the scale about subjective economic stress included in the recent stress questionnaire (sq), developed and validated in italy (giorgi et al., ; mucci et al., ) . the economic stress measure is composed of two dimensions: (a) fear of the economic crisis (five items) -employees perceive that the organization is suffering from the economic crisis (e.g., "i am scared that my organization is affected by the economic crisis; i am scared that my organization, due to the economic crisis, will be subjected to downsizing"); (b) non-employability (five items) -employees perceive that their working competencies would not permit them to acquire another job in the market (caricati et al., ) [e.g., "my professionalism is not spendable (recognized) in the labor market; my staying in the organization is linked to the difficulty of outplacement in the labor market"]. each dimension includes five items in a five-point likert scale (from : "strongly disagree" to : "strongly agree"). we used a scale, included in the above mentioned stress questionnaire (giorgi et al., ; mucci et al., ) , that covers two factors in a five-point likert scale (from : "strongly disagree" to : "strongly agree"): this was measured with the general health questionnaire (ghq- ; goldberg and hillier, ; fraccaroli et al., ) . the scale asks whether the respondent has experienced a particular symptom or behavior related to general psychological health recently. each item is rated on a four-point likert-type scale ( - - - ). a higher score indicates a greater degree of psychological distress. in this study we particularly focus on the sub-dimension "anxiety and insomnia" (seven items, e.g., "considering the last few weeks, have you recently [. . .] felt constantly under strain?"). following anderson and gerbing's ( ) two-step structural equation modeling (sem) procedure, we tested a measurement model (cfa) by determining whether each measure's estimated loading on its expected underlying factor was significant. this allowed us to establish discriminant validity among the study constructs. then, a structural model was performed to estimate the fit to the data of the hypothesized model in which fear of expatriation mediates the relationship of mental health problems with economic stress and perceived dangerous working conditions (hypotheses and ) . a cfa was, therefore, performed with mplus, version . (muthén and muthén, - ) , with the four variables measuring mental health problems, fear of expatriation, economic stress, and perceived dangerous working conditions. moreover, the variables' dimensions were used as indicators of their corresponding latent constructs in the measurement and structural models. these dimensions were formed by averaging the items of each sub-scale for the four latent variables. we therefore obtained three indicators for mental health problems, two indicators for fear of expatriation, two indicators for economic stress, and two indicators for perceived dangerous working conditions. to evaluate the model fit, we considered chi-square (the higher the values are, the worse is the model's correspondence to the data), and used both absolute and incremental fit indexes. absolute fit indexes evaluate how well an a priori model reproduces the sample data. in our study, we focused on three absolute fit indexes: the standardized root mean square residual (srmr), for which values of less than . are favorable, and the root-mean-square error of approximation (rmsea), which should not exceed . (browne and cudeck, ; kline, ) . incremental fit indexes measure the proportionate amount of improvement in fit when a target model is compared with a more restricted, nested baseline model (schreiber et al., ) . we considered the comparative fit index (cfi), for which values of . or greater are recommended (schreiber et al., ) . as expected, the hypothesized four-factor model yielded a good fit to the data: χ ( ) = . , cfi = . , rmsea = . , srmr = . (table ) . additionally, as shown in table , this model had a significantly better fit than alternative, more parsimonious models (p < . ), supporting the distinctiveness of the study variables. table displays the descriptive statistics, correlations, and reliability coefficients of the variables. in order to examine the hypothesized model, we performed sem with mplus. sem offers the following advantages: (a) controlling for measurement errors when the relationships among variables are analyzed (hoyle and smith, ) ; (b) comparing the goodness-of-fit of the hypothesized model with other alternative models (cheung and lau, ). thus, we tested our proposed structural model and compared it with alternative models. additionally, when conducting sem analyses, we controlled for the effects of age and organizational tenure on both the mediator and the dependent variables. fit indexes for each tested model are presented in table . the hypothesized model (model ), which is a full mediation model, displayed a good fit to the data: χ ( ) = . , cfi = . ; rmsea = . ; srmr = . . specific inspection of direct relationships further revealed that mental health problems were positively associated with fear of expatriation (β = . , p < . ), thus supporting hypothesis . additionally, fear of expatriation, in turn, was positively related to economic stress (β = . , p < . ) and perceived dangerous working conditions (β = . , p < . ), thus providing preliminary support for hypothesis . completely standardized path coefficients for model are depicted in figure . to assess whether the hypothesized model was the best representation of the data, we then compared its fit to that of different alternative models. first, we assessed a partial mediation model, which included two additional direct paths from mental health problems to economic stress and perceived dangerous working conditions. this model yielded an adequate fit to the data (χ [ ] = . , cfi = . ; rmsea = . ; srmr = . ), but it was not significantly better than model , as revealed by the chi-square difference ( χ [ ] = . , ns). moreover, the additional direct relationships of workplace mental problems with economic stress (β = . , ns) and dangerous working conditions were not significant (β = . , ns). next, we compared the hypothesized model with a nonmediation model (model ), which only included direct paths from mental health problems and fear of expatriation to economic stress and perceived dangerous working conditions. results revealed that the non-mediation model was a slightly worse fit to the data than the hypothesized fully-mediated model however, because this model had the same degrees of freedom as the hypothesized model, the statistical significance of the chisquare difference could not be calculated. accordingly, we used the akaike information criterion (aic), instead of the chisquare, to compare the two models. the hypothesized model is considered to be superior to the non-mediation model if the former has an aic value lower than the latter by four or more units (burnham and anderson, ) . results revealed that model had an aic of . compared to an aic of . for model , suggesting that the hypothesized full mediation model represents a superior fit to the data than the non-mediation model ( aic = . ). furthermore, because mental health problems, fear of expatriation, economic stress, and perceived dangerous working conditions were all measured at the same time, reverse relationships could also be expected between the four variables. in order to rule out this possibility, we therefore compared the hypothesized model against a set of alternative models that specified all the possible reverse indirect relationships among the study variables, namely: the indirect relationship of economic stress and perceived dangerous working conditions with fear of expatriation via mental health problems (model ); the indirect relationship of economic stress and perceived dangerous working conditions with mental health problems n = . cfi, comparative fit index; rmsea, root-mean-square error of approximation; srmr, standardized root mean square residual; akaike information criterion χ = chi-square difference tests between the best-fitting model (model ) and alternative models; aic, akaike difference test between the best-fitting model (model ) and alternative models. fex, fear of expatriation; fec, fear of economic crisis; dwc, dangerous working conditions; mhp, mental health problems. * p < . . via fear of expatriation (model ); the indirect relationship between mental health problems and fear of expatriation via economic stress and perceived dangerous working conditions (model ); the indirect relationship of fear of expatriation with economic stress and perceived dangerous working conditions via mental health problems (model ); the relationship between fear of expatriation and mental health problems via economic stress and perceived dangerous working conditions (model ). again, because models - had the same degrees of freedom as the hypothesized model, we compared the model fit by using the aic difference test. as can be seen from table , models - all yielded a worse fit to the data than the hypothesized model. overall, results from model comparison suggested that model was the best fitting model. we therefore retained the hypothesized fully-mediated model. finally, in order to assess whether the indirect relationship of mental health problems with economic stress and perceived dangerous working conditions through fear of expatriation was significant (hypothesis ), we calculated % bootstrapping confidence intervals (preacher and hayes, ; preacher and kelley, ) . based on , bootstrap replications, results indicated that mental health problems had an indirect positive effect on economic stress (indirect effect = . ; % ci = . , . ) and perceived dangerous working conditions (indirect effect = . ; % ci = . , . ) via fear of expatriation. hypothesis was therefore fully supported. in a globalized working environment with turbulence in the economy and in the security expatriate workers are confronted with several stressors, making international assignments potentially stressful. accordingly, expatriate managers might report lower psychological well-being and anxiety (wang and kanungo, ; shaffer et al., ; wang and nayir, ) . at the same time, fears are now increasing in the workplace, marked by emotional discomfort, apprehension, or concerns about the internal and external environment, and expatriates seem particularly at risk. these symptoms can progress to more severe psychosomatic symptoms, including further anxiety and additional fears (blum et al., ; besnard and sahay, ) . in our model, fear of expatriation is particularly associated with mental health problems. this result is in line with the field literature (i.e., perone et al., ; andresen et al., ; aracı, ) . in addition, an expatriate might go through several personal and professional problems. in fact, expatriation is associated with a lot of unhealthy issues such as stress, anxiety, loneliness and homesickness, generating a sort of potential and prolonged cultural shock (barón et al., ) . finally, it must be emphasized that expatriates cannot count on the support of family and/or other trusted people if they need it (bhaskar-shrinivas et al., ) . fear of expatriation might generate a spiraling effect in which people, feeling more anxious, might become less engaged in the workplace, developing beliefs that money and extrinsic reward are the most important aspects of employment (gerhart and fang, ) . at the same time, they may be more worried about their financial situation and their ability to hold on to their jobs and their benefits, developing their fear of economic crisis. on one hand, from a subjective point of view, h&s measuresunder certain circumstances (for instance, the emergence of fear in the workplace) -do not necessarily express feelings of safety, but rather can be interpreted as latent danger (bader and berg, ) generating a widespread anxiety. on the other hand, from an objective point of view, expatriates are often exported to societies with weaker and less expensive h&s policies and less organized labor forces, bringing potentially stressful and unsafe working conditions (heymann, ) to expatriates. this might raise a perception of dangerous working conditions. moreover, h&s procedures are usually highly specific to each country and with very important differences -related to the various national legislations and traditions -and working conditions abroad are generally perceived as less familiar and presenting higher risk (taylor et al., ) . expatriates are a group of people with a high cumulative risk of exposure to illness and injury (including the increased risk of certain vaccine-preventable illnesses) due to changes in travel patterns and activities, lifestyle alterations, and increased interaction with local populations. pre-travel immunization management provides one safe and reliable method of preventing infectious illness in this group; however, this might not be enough to cope with anxiety (vaid et al., ; shepherd and shoff, ) . in addition, there are diseases that are not preventable with vaccines. these diseases, in particular of a viral nature, seem to spread faster nowadays -such as, for example, the recent ebola or middle east respiratory syndrome (mers) outbreaks -and might be frightening for expatriates (cohen et al., ; regan et al., ) . in summary, the non-optimal h&s perception (beeley et al., ) , the risk of contracting infectious diseases (jones, ; hamlyn et al., ) and the unsuitability of medical care (pierre et al., ) were also evaluated under the construct of the fear of expatriation. in our study, expatriates reported being frightened by the risk of becoming involved in accidents during their frequent moves from one country to another. in particular, this fear seemed to be greater for traffic accidents (wilks et al., ) , but a fear of flying was also described (hack-polay, ) . a further and significant stress factor for expatriate workers is the managers' fear of terrorist attacks or other fatal events involving the governments of countries where there are companies' headquarters (leistedt, ; bader and schuster, ) . finally, in our model we consider the concerns about the working and living conditions (costa et al., ; zhu et al., ) . in addition, our model has shown that the presence of fear of expatriation may, in turn, generate further fears in the workplace. in particular, fears of both the economic crisis and of the foreign working conditions are mediated by fear of expatriation. in fact, fear could adversely disturb human thinking and decision-making processes, leaving the individual more susceptible to generating further fears, as in a vicious circle (barón et al., ; besnard and sahay, ) . our findings are in line with the basic propositions of lazarus and the "affective events theory" (aet; weiss and cropanzano, ) . the latter pointed out that an emotion experienced by a worker (e.g., fear) may impact on later within-person emotions (e.g., fear again), influencing different organizational outcomes. as far as economic crisis is concerned, economic stress might be more frightening for those who have more invested in the company, such as expatriates. in fact, these workers, being away from home for extended periods of time, are completely absorbed by their job and, therefore, they may be an easier target for contagious negative emotional cycles (quantin et al., ) . moreover, they could be most affected by the psychological impacts of the economic crisis and its consequences as they have lower levels of social support (fernandez et al., ) . similarly, fear of expatriation may significantly lead to perceiving a priori all foreign working conditions as being more dangerous. these findings support our assumption and the literature (perone et al., ; andresen et al., ) . the impact of working and living conditions -resulting, for instance, in perceived risks of harms -might be higher if expatriates are scared by the impeded living conditions or by the threat of violence. this might have several negative implications as often expatriates have the tendency to "get the job done" as smoothly as possible, so they can return home again (aracı, ) . however, this specific issue should be investigated in future studies. our findings provide interesting contributions both to the literature and to the managerial practices in the field of foreign work. first, we believe that the subjects in the process of leaving their own country should be mentally healthy and not feeling frightened by either the place of destination or the assigned tasks. according to lazarus and folkman ( ) , if an expatriate is worried and anxious, it is less likely that he/she will ever adjust. therefore, it is essential to help expatriates to prevent the development of any type of fear. strategies of prevention and rationalization, particularly useful in this sense, can be implemented through several instruments: specific training for foreign services, company's reference facilities in countries where employees come to work, remote counseling (on-line/phone) provided by occupational physicians and psychologists affiliated with the company, company procedures for immediate repatriation in the case of adverse events (e.g., terrorism, infective outbreaks, and health problems), etc. in the second place, stress management training is also recommended. from this perspective, issue-focused coping strategies seem crucial to counteract fearful feelings as well as to minimize the states of anxiety and distress (folkman et al., ) . thirdly, companies should conduct preventive screening to identify the human resources to be sent to foreign countries, favoring those who have demonstrated both a highly qualified professionalism in their field and robust mental health (stone, ; di fabio, , . consequently, a process for the successful management of expatriation needs to be adopted using both individual and organizational strategies to reduce the possibilities of stress among expatriates. at the organizational level, selection, training, healthcare activities, and counseling need to be implemented and monitored in order to prevent the diffusions of workplace fears. at the individual level, expatriates should be psychologically supported, e.g., with mentoring and coaching, analyzing competencies, health perceptions, and mood over time (de paul and bikos, ) . our study has many and innovative strengths but is not without limitations. although the expatriates worked worldwide, the sample was limited to a single company, limiting the generalizability of the results. in addition, the sample was composed only of men. however, by virtue of family demands, men expatriate much more frequently than women. our scale fear of the expatriation is new in the literature and, consequently, a replication of this study is needed. in addition, we look forward to more large studies whose starting points are the results of the first application of our scale. in particular, comparative research evaluating stress responses between italian and other ethnic populations around the world would be particularly helpful. this study used a cross-sectional design, resulting in the impossibility of determining causal relationships. longitudinal research is needed in order to provide further evidence that mental health problems cause fear of expatriation, which, in turn, may generate additional workplace fears. in summary, following this new research path, we have developed a new model, formulated a new theory that found an association between mental health and fears in the workplace, and explored different fears in the workplace and their links. our results confirmed our innovative hypothesis and we suggest that companies' key people take into account the construct of fear of expatriation for business health purposes. with this in mind, companies need proper advice from qualified consultants such as occupational physicians and industrial psychologists. an investment dedicated to the prevention and protection of the h&s of expatriate workers is not only an instrument of risk assessment -in the context of the obligations under the laws of eu countries in the field (e.g., the italian legislative decree n. and subsequent amendments) -but also, and moreover, a significant tool to improve the company's business. some studies have estimated that the cost associated with the failure of expatriation would be about one million usd (insch and daniels, ; wentland, ) . overall, considering the aggregate data about the american situation, punnett ( ) has calculated that us companies spend a total of up to two billion usd annually to address the failures of their expatriate managers. in such a context, it is legitimate to expect that intervention strategies -such as a careful selection of personnel to be devoted to foreign missions and the development of actions aimed at improving the real and perceived well-being in destination countries -will lead to significant returns on investment (roi) for the companies. gg, fm, jf-p, ga, and nm equally contributed to all the following issues of the research: conception and design of the work; acquisition, analysis, or interpretation of data for the work; drafting the work and critically revising it; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. the supplementary material for this article can be found online at: http://journal.frontiersin.org/article/ . /fpsyg. . structural equations modeling in practice: a review and recommended two-step approach addressing international mobility 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is an open-access article distributed under the terms of the creative commons attribution license (cc by). the use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. no use, distribution or reproduction is permitted which does not comply with these terms. key: cord- -hydccq m authors: wang, chongying; zhao, hong title: the impact of covid- on anxiety in chinese university students date: - - journal: front psychol doi: . /fpsyg. . sha: doc_id: cord_uid: hydccq m covid- had become a pandemic raising concerns of widespread panic and increasing anxiety and stress in individuals all over the world (world health organization, a). lots of countries had closed their schools. as the first country to do so, chinese colleges and universities were making use of different modes of learning, including online-learning based on different platforms to achieve the goal suggested by ministry of education in china, “suspending classes without suspending learning,” since middle february. this paper is the first one which aims to investigate the anxiety of chinese university students after the outbreak of covid- right before the start of new spring term. university students (female: male = . : ) aged between to from all over china were enrolled to this study from a top university in china. the self-rating anxiety scale – sas (zung, ) was used to assess anxiety days before the start of new spring term in middle february. all four-year undergraduate students were included in the study. the mean sas score was . (sd = . ), significantly higher than the national norm (mean = . , sd = . , and p ≤ . ), and there were still ( . %, mean = . , and sd = . ) students met the cutoff of and were screened positive. comparisons among sexes, grades and majors were also conducted. significant differences were found between all males and all female (p ≤ . ), and between all students majoring arts and sciences in the anxiety sample (n = , p = . ). the results also showed that the mean sas scores were not correlated with the regions they came from/lived in. this study concluded that the chinese university students showed higher anxiety for covid- . covid- , the infection caused by a novel coronavirus detected in december in wuhan (hubei province), is now a pandemic announced by world health organization, raising concerns of widespread panic and increasing anxiety in individuals (world health organization, a,b) . this outbreak has also seen entire cities in china effectively placed under mass quarantine since late january . brooks et al. ( ) reviewed and reported quarantine could bring "posttraumatic stress symptoms, confusion, and anger. stressors included longer quarantine duration, infection fears, frustration, boredom, inadequate supplies, inadequate information, financial loss, and stigma." some researchers also suggested long-lasting effects (brooks et al., ) . besides, previous researches showed that infectious diseases of uncertainty in recent years such as sars, ebola, the and h n influenza pandemic, middle east respiratory syndrome and equine influenza all caused negative psychological effects (bai et al., ; taylor et al., ; wu et al., ; liu et al., ; sprang and silman, ; rith-najarian et al., ) . in situations that are uncertain and evolving such as covid- , it is common to feel stressed, anxious, or upset, among other emotional reactions. medical staff, children, patients with suspected infection, and quarantined family members have been reported under physical and psychological pressure (chen et al., ; duan and zhu, ; wang y. et al., ; xiang et al., ) . depression and anxiety are both common mental disorders with a prevalence of - % in developing countries and depression is the fourth leading cause of morbidity (azad et al., ) . university students are at high risk for depression and anxiety symptoms (zivin et al., ; american college health association, ) and are exposed to multiple stressors unique to this developmental period (beiter et al., ; drake et al., ) . some studies conducted during sars and h ni in china have indicated obvious anxiety and stress of university students and suggested coping strategies (jia et al., ; chen et al., ; li et al., ) . in response to the covid- outbreak, the chinese government has ordered a nationwide school closure as an emergency measure to prevent spreading of the infection. ministry of education of china and ministry of industry and information technology of china ( ) suggested "suspending classes without suspending learning, " hence there were over million students in china making use of different modes of learning, including online-learning based on different platforms to achieve the goal starting from middle february . schools can actively promote a health-conscious schedule, good personal hygiene, encourage physical activities, appropriate diet, and good sleep habits, and integrate such health promotion materials into the school curriculum (brazendale et al., ) . university campus life and learning have a critical role in the psychological development of students and the home confinement-related issues were hypothesized having psychological impact on university students. however, how would the closure of schools and online-learning affect university students? will covid- and quarantine increase or decrease their anxiety? are there any relations between the high numbers of confirmed cases and their increased anxiety? though previous studies have indicated increased stress and anxiety during epidemic (jia et al., ; chen et al., ; li et al., ) , these study samples were all comparatively small (from to participants). as covid- is now pandemic and there are rapidly increasing cases and mortalities in some countries, such as italy, iran, south korea, japan, etc., many countries have announced to close schools and start online-learning immediately. however, no research had been found on the impact of covid- on the anxiety of university students. our current study conducted in february in china may be of some reference for people related and the implementation of the coping strategies and prevention programs in future. it would also help us to establish a baseline data, and better mental health is likely to improve the academic performance of the students. this paper aims to investigate the anxiety of chinese university students after the outbreak of covid- right before the start of new spring term. for all the undergraduate students, this is the first time in their lives to start a new term in this way, no face-to-face classroom learning but totally via internet and online platform. our hypotheses are university students would have higher anxiety than usual for the start of new term and their most concern is new term and covid- . a total of questionnaires were distributed to undergraduate students aged between to in a top multidisciplinary and research-oriented university directly under the jurisdiction of the ministry of education in north china during am february to am february , . (female: male = . : ) valid questionnaires were received, and the response rate is . % (see table ). all four-year undergraduate students from all the colleges and schools were included in the study. the participants were also classified into two groups according to their majors and degrees: arts and sciences, in which arts include economics, literature, history, philosophy, foreign languages, law, management, marxism, chinese languages and culture, business, tourism and finance, and sciences include mathematics, physics, chemistry, life science, environmental science and engineering, medicine, pharmacology, electronic information and optical engineering, material science and engineering, computer science, cyber science, artificial intelligence, software, and statistics and data science. the participants for this study also represented the distribution of the enrolled students from different regions of china in this university, where there was a high ratio of undergraduate students from tianjin, hebei, shandong, henan, shanxi and sichuan province, and there were several from hong kong, macau, and taiwan regions. there were also students from hubei province and from wuhan city, where the majority of cases affected by covid- were identified. following the granting of ethical approval from the university to conduct this study, undergraduate students in all grades from one to four were enrolled through online study platforms and groups recently established for the remote learning in new semester to participate in the study during am february to am february , right before the new semester started. students who agreed in writing to participate were each given an online questionnaire package to complete and return to the researchers. the questionnaire package used in this cross-sectional study consisted of three components: a sociodemographic questionnaire that required each student to provide their sexes, year of study, city or province they were living, major and colleges, or schools; a measure of student anxiety (the self-rating anxiety scale); an open question about their most concern. the self-rating anxiety scale the self-rating anxiety scale -sas (zung, ) was used to assess anxiety days before the start of new spring term, within month of covid- outbreak in china. the sas is a -item self-report assessment device built to measure anxiety levels, based on scoring in groups of manifestations: cognitive, autonomic, motor, and central nervous system symptoms. a person should indicate how much each statement applies to him or her within a period of one or two weeks prior to taking the test. each question is scored on a likert-type scale of - (based on these replies: "a little of the time, " "some of the time, " "good part of the time, " "most of the time"). some questions are negatively worded to avoid the problem of set response. overall assessment is done by total score. among the items, were reverse scored. the total raw scores range from - and then needs to be converted to an "anxiety index" score which can then be used on this scale below to determine the clinical interpretation of one's level of anxiety. the validity and reliability of the instrument has been found to be adequate among chinese participants. according to chines norm based on the research on participants, the levels of anxiety were classified as, - is normal range; - is mild anxiety levels; - is moderate anxiety levels; and above is severe anxiety levels. the data were organized and analyzed using spss . software. the surveyed population was divided into different groups according to the sas scoring criteria. measurement data were expressed as mean and standard deviation (sd). counting data are expressed by the number of people (%). the analysis of the relationship between sex, major, grade, region, and anxiety initially used the two sample t-test. the correlation betwwen sas scores and confirmed affected cases in different regions were anaylyzed by pearson's product-moment correlation analysis, and p < . on double sides was statistically significant. the mean sas score was . (sd = . ; see table ), below the cutoff of and significantly lower than that (mean = . , sd = . ) during sars outbreak in in china . one sample t-test was conducted and p ≤ . . however, the mean sas score was significantly higher than that of the national norm (mean = . , sd = . , and p ≤ . ), and there were still ( . %) students identified as anxious of different levels with the maximum score of , whom were from different provinces and at different grades with different majors. two-sample t-test was conducted and it was found that there were significant differences on sas scores between males and females (p ≤ . ) but not between students of arts and sciences (p = . ). sas mean scores of grade one were found significantly different from those of grade two and three (p ≤ . ) but not grade four (p = . ). there was also significant difference between sas mean scores of grade two and three (p ≤ . ). the sas mean scores of grade four were found not significantly different from any other grades which may be due to comparatively small sample of grade four. there were around . % of the participants who replied "good part of the time" or "most of the time" for "i feel more nervous and anxious than usual, " about . % of the undergraduate students who chose "good part of the time" or "most of the time" for "i feel afraid for no reason at all" and . % found themselves upset easily or feel panicky for "good part of the time" or "most of the time." furthermore, ( . %) participants answered "a little of time" or "some of the time" for "i feel that everything is all right and nothing bad will happen." ( . %) participants chose "a little of time" or "some of the time" for "i feel calm and can sit still easily." in addition, there were ( . %) students felt weak and got tired easily for "good part of the time" or "most of the time." table showed the sas score ranges of participants. there were participants who were severely anxious among whom males and females. only one male came from xiangyang city in hubei province and the rest participants were from other provinces. in table , we exmained the students whose sas scores was above the cutoff and therefore identified as anxious. according to chen et al. ( ) , the mean scores of students identified as anxious during sars was . (sd = . ). one sample t-test showed that significant difference (p ≤ . ) was found between the mean sas scores during sars and covid- in this study (mean = . , sd = . ). we also conducted two sample t-test among students of different grades, and no significant difference was found (see table ). significant differences were found between all males and all female (p ≤ . ) and between all students majoring arts and sciences (p = . ) in the anxiety sample. we also conducted two sample t-test for the students were living in hubei. their mean sas score was . (sd = . ), but no significant difference (p = . ) was found with comparison to that of all participants (mean = . , we also conducted the correlation analysis of the sas scores and the confirmed cases in each region. city except wuhan or each province except hubei province. as the confirmed affected cases in wuhan is far higher than all other cities or provinces, we first deleted the participants from wuhan and participants whom we did not know which city they were from (for whom we only knew their provinces), then we got participants from cities. pearson's product-moment correlation analysis was conducted and it was found that t = − . , df = , and p = . . the alternative hypothesis is that true correlation is not equal to and percent confidence interval is − . to . . we also conducted the correlation analysis between sas scores and the confirmed cased in each province except hubei province and got the same result which confirmed that students' sas scores has no significant correlation with the confirmed affected cases of covid- in their cities or provinces. city except hubei provinces. we then had a close look of all the cities except hubei province where covid- first outbroke and spread widely. we conducted the pearson's product-moment correlation and found that t = - . , df = , and p = . . the alternative hypothesis is true correlation is not equal to and percent confidence interval is − . to . . the results indicated that sas scores has no significant correlation with the confirmed affected cases of covid- in each city outside hubei province all over china. city in hubei provinces. a pearson's product-moment correlation analysis was also conducted between the sas scores of students from different cities in hubei province and the confirmed affected cases in these places. the results showed that t = . , df = , and p = . and the alternative hypothesis is that true correlation is not equal to . the percent confidence interval is − . to . . therefore, no significant was found either. in the current study, we also designed an open question to ask our participants to write down one sentence of their most concern. the majority of the answers are, such as, when the new term will properly start, if their summer holidays will be shortened then, etc. the cronbach.α is . . the word cloud of answers to this open question showed that the most obvious words were: start of new term, come on, covid- and school. some other words they also concerned were: class, online learning, china, anxiety, wuhan, and teacher, etc. any major epidemic outbreak will have negative effects on individuals and society. a study on the public psychological states of people during covid- outbreak showed that their sas score was . (sd = . ) and . % had anxiety (wang c. et al., ) . our results indicated that university students had higher anxiety than the general population after the outbreak of covid- , which showed that the covid- had negative psychological impact on university students on anxiety at least. this confirmed the previous findings and was in accordance with recent articles urging mental health care for people affected by the epidemic. studies have suggested that public health emergencies can have many psychological effects on college students, which can be expressed as anxiety, fear, and worry, among others (mei et al., ) . there was no such national norm of anxiety level (such as sas score) for chinese college students but we compared our results with the sas scores of university students during sars and h ni, and concluded that university students have higher anxiety during covid- than sars (only in anxious group) and h n . besides, cao et al. ( ) indicated that . % of medical students were afflicted with experienced anxiety because of the covid- outbreak. compared to our study, higher percentage of medical students had anxiety than the general university students amid covid- . in addition, the results showed that the majority ( . %) of participants were facing different levels of challenges and found difficult to sit still for a longer time, and there were quite a few of them ( . %) were identified as anxious of different levels. and there were . % of students felt weak and got tired easily. it had been almost a month that the majority of chinese people were recommended to stay at home to prevent the spread of covid- , and our students have kept a slack hand and also lacked proper exercises and social lives. the results showed that quite a few students were suffering stress, fear or uneasy and being affected by the uncertainty of covid- and all these should be taken into account when teachers were delivering online classes. compared to sars in when university students then experienced same quarantines as now, internet was playing a major role nowadays in speedy information spread, open online discussion, feeling expressions, etc. news report and social media also caused complex emotions, such as depression, anxiety, stress, upset, fear, frustration, anger, etc. about the health staff infected and died, daily life difficulties, social unfair and corruption, helplessness of the ordinary people living in wuhan, etc. according to the feedback from various psychological counseling telephone hotlines set up for covid- around china, anxiety was one of the main characteristics of callers. studies have confirmed that individuals who have experienced public health emergencies still have varying degrees of stress disorders, even after the event is over, or they have been cured and discharged from hospital (cheng et al., ; national health commission of china, ) . university students were at an important developmental age for their values and judges, and could be easily affected by the opinions and views from social media, therefore, their emotions were also vulnerable. significant sex differences were found and female students showed more anxiety than male students. this confirmed with previous researches that females were more likely to suffer from anxiety (azad et al., ) , such as the prevalence of depression and anxiety in pakistan is % (range - % in women and - % in men (mirza and jenkins, ) . but there was no significant difference between students majoring in arts and sciences. however, students in grade one had lower anxiety level than grade two and three while grade two had higher anxiety than grade three. this could be explained that grade two and three students had more academic burdens. the postpone of new term and onlinelearning, etc. caused by covid- would have more effect on their lives and plan, such as the cancelation of gre, toefl, ielts in february and march will affect their applications for abroad studies in near future, etc. especially for students in grade two, they just started the professional curriculum in the second year and the scores for each course are more important than in grade one as the scores would be evaluated if they could be recommended for postgraduate students without examinations in the following year. however, compared to students in grade two, grade three was a more stable year and students became more mature and would have better ability or experience to handle fluctuant emotions. this is why students in grade three had lower anxiety than grade two. in the current study we also investigated if confirmed affected cases of covid- in their cities or provinces had any correlation with students' increase anxiety, however, no significant correlation was found, even in wuhan city and hubei province where had % of the confirmed affected cases of whole china (national health commission of china, ). this showed that university students were not much affected by things happening just around them because the convenience of internet brought a national and international vision for them. young people nowadays obtain information largely via internet on which information travels. social media are especially popular among young people, which in turn affect their lives. young people have a high level of trust in information online and it tends to be the place they look first. therefore, the confirmed affected cases in each city or province would not affect their anxiety, but rather the direction of public opinion. people had been quarantined for weeks when we conducted this study, and the spread of covid- had been well controlled by chinese government, therefore, our undergraduate students would no longer worry too much about the confirmed cases in each city considering the whole situation in china was getting better which in contrast to the sharp increase of cases abroad. in line with our hypotheses, their main concerns were "the start of new term, " "come on, " "covid- , " and "school". even covid- changed their lives and habits in the past month, they were facing the start of new term which would take place online rather than face-to-face. they were anxious but also curious about the new challenges, so "come on" was another hot word to encourage themselves, wuhan and china. "come on" was also one of the hottest words during the covid- in china, given government media, social media and donated stuffs used the words very frequently. some other words they also concerned such as class, online learning, china, anxiety, wuhan, and teacher, etc. were all hot topics in china too on various social media and closely related to the undergraduate students. this study had some limitations. firstly, our sample was still small, though already much bigger compared to the previous similar studies. furthermore, our sample was from one top university in north china, hardly representative of all china. future studies could improve the study design by recruiting more students from different regions of china and also from various universities, such as top ten, top , top , universities under the jurisdiction of ministry of education and those of local government, multidisciplinary universities and academies, etc. secondly, in this current study we only investigated the anxiety of students, not depression, post-traumatic stress disorder, and other possible mental problems. thirdly, we did not include the coping strategies and prevention programs in this study which could be explored further in future studies. additionally, we did not collect the information about if participants were infected or not infected, or with infected family members, and the major source used by students to obtain information about covid , which could be improved in future studies. it was concluded that chinese undergraduate students during covid- outbreak showed higher anxiety. however, in general the psychological status of university students was fairly good, which laid a good foundation for the new term's online-learning. a further study after a few weeks of new term comparing their anxiety was also suggested. furthermore, as this is the first study on the impact of covid- on the anxiety of undergraduate students, this data could also be used as baseline to further explore the causes of the higher anxiety and to take measure to reduce the anxiety in our students. all datasets generated for this study are included in the article/supplementary material. the studies involving human participants were reviewed and approved by the nankai university ethics committee and were in accordance with the helsinki declaration and its later amendments or comparable ethical standards. the participants provided their written informed consent to participate in this study. cw and hz co-designed the study while hz conducted the study and analyzed the data. cw interpreted the data, wrote, and revised the manuscript. american college health association-national college health assessment ii: reference group executive summary fall anxiety and depression in medical students of a private medical college survey of stress reactions among health care workers involved with the sars outbreak the prevalence and correlates of depression, anxiety, and stress in a sample of college students 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world health organization coronavirus disease (covid- ) situation report - the psychological impact of the sars epidemic on hospital employees in china: exposure, risk perception, and altruistic acceptance of risk timely mental health care for the novel coronavirus outbreak is urgently needed persistence of mental health problems and needs in a college student population a rating instrument for anxiety disorders this research was supported by grants from the tianjin social sciences planning project (tjqywt - ) to cw and teaching reform projects of nankai university in and (nkjg , nkjg , and nkjg ) to hz. the authors are grateful to all the undergraduate students for their participation in this study. the authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.copyright © wang and zhao. this is an open-access article distributed under the terms of the creative commons attribution license (cc by). the use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. no use, distribution or reproduction is permitted which does not comply with these terms. key: cord- -jvhgrsbm authors: phan, huy p.; ngu, bing h.; chen, si chi; wu, lijuing; lin, wei-wen; hsu, chao-sheng title: introducing the study of life and death education to support the importance of positive psychology: an integrated model of philosophical beliefs, religious faith, and spirituality date: - - journal: front psychol doi: . /fpsyg. . sha: doc_id: cord_uid: jvhgrsbm life education, also known as life and death education, is an important subject in taiwan with institutions (e.g., high school) offering degree programs and courses that focus on quality learning and implementation of life education. what is interesting from the perspective of taiwanese education is that the teaching of life education also incorporates a number of eastern-derived and conceptualized tenets, for example, buddhist teaching and the importance of spiritual wisdom. this premise contends then that life education in taiwan, in general, is concerned with the promotion, fulfillment, and cherishing of quality life experiences (e.g., personal contentment, happiness). one example of life education, which resonates with other spiritual beliefs and religious faiths (e.g., hinduism), is related to spiritual cultivation and the enlightenment of life wisdom. our own teaching of the subject, likewise, places emphasis on the goal of teaching students to seek meaningful understanding of and appreciation for three major, interrelated components of life education: life wisdom, life practice, and life care. it has been acknowledged, to a certain degree, that life education has made meaningful contributions, such as the creation and facilitation of a civil, vibrant society, and that many taiwanese individuals show dignity, respect for elders, and reverence for spiritual and religious faiths. for example, aside from high-quality hospice care, many taiwanese engage in different types of benevolent acts (e.g., providing spiritual advice to someone who is dying), where possible. life education is a beneficial subject for teaching and learning as its theoretical understanding may help individuals cope with pathologies and negative conditions and life experiences. one negative life experience, in this case, is the ultimate fate of humankind: death. approaching death and/or the onset of grief is something that we all have to experience. how does one approach death? it is not easy feat, and of course, grief for a loved one is personal, and some of us struggle with this. we contend that spiritual cultivation and enlightenment, arising from life education, may assist us with the topic of death (e.g., the possibility of transcendence beyond the realm of life). more importantly however, from our own teaching experiences and research development, we strongly believe and rationalize that the subject of life education could, indeed, coincide with and support the paradigm of positive psychology (seligman, , ; seligman and csíkszentmihályi, ). forming the premise of the present conceptual analysis article, we propose that a person’s “spiritual and enlightened self,” reflecting the convergence of three major aspects of life education (i.e., philosophical reflection, enrichment of personal well-being, and spiritual cultivation), would result in the initiation and creation of a number of virtues and positive characteristics, for example, having a positive outlook in life, having a perceived sense of spirituality, showing compassion, forgiveness, etc. these virtues and quality characteristics, from our philosophical reasoning, are equivalent to those qualities that the paradigm of positive psychology advocates for. in summary, we conceptualize that the subject of life education, from the perspective of taiwanese education, may intertwine with the paradigm of positive psychology. a person’s spiritual and enlightened self, or his/her “holistic self,” from our rationalization, is the ultimate optimal life experience that he/she may have, enabling him/her to address the gamut of life conditions and experiences. the distinctive nature of life education in this case, as a point of summary, is that it incorporates spiritual beliefs and religious faiths (e.g., buddhist faith), encouraging a person to seek nature and divine–human relationships, as well as to contemplate and to explore the complex nature of his/her inner self. the notion of buddhist samsâra, for example, as “evidence” of spirituality, entailing the endless cycle of birth, rebirth, and redeath, may provide a person with hope into the afterlife. such esoteric discourse, we contend, is positive and optimistic, allowing individuals to discard the dividing line between life and death. life education, also known as life and death education, has gained vast interests both in terms of teaching and research development. specifically, with reference to the case of taiwan and its education systems, life education is taught in schools and universities, as well as applied in society in the form of educational and social programs. what is significant, however, with reference to taiwanese education, is that the teaching and learning of life education also incorporate eastern-derived theoretical tenets of buddhism (yeshe and rinpoche, ; sheng yen, ) , confucianism (yao, ; havens, ) , and spirituality (carmody et al., ; lazaridou and pentaris, ) . the teaching of buddhist meditation (e.g., a focus on enlightenment), for example, has been incorporated to emphasize the salient nature of the study of life education-that life education is concerned with exploration of death, which is inevitable, and the fulfillment of a cherished life. how can a person overcome grief and accept that a close relative has moved on from this physical world? how does life wisdom assist a person in his daily functioning? are immortality and the notion of transcendence beyond death a possibility? these questions, we contend, are significant, which the study of life education makes attempts to address. death, grief, negative outlook, and maladaptive life experience are inevitable. overcoming these life deficiencies, obstacles, and difficulties is an important quest, which we believe the study of life education (shi, ; huang, ; chen, ) could assist. indeed, aside from life education, we acknowledge that the paradigm of positive psychology (gilham and seligman, ; seligman, ; seligman and csíkszentmihályi, ) could also play a prominent role in helping to alleviate suffering, helplessness, grief, negative life conditions, etc. our existing research inquiries into the effect of positive psychology have resulted in the development of a psychological concept that we termed as "personal resolve" (e.g., phan et al., phan et al., , phan et al., , c . despite our emphasis on educational processes, we contend that personal resolve, briefly defined as "person's mental resolute and "unwavering focus" to stay on task without any uncertainty or reservation to achieve optimal best" (phan et al., c, p. ) , could feature and assist individuals to overcome barriers, negative life experiences, etc. an interesting question, though, is whether we could integrate the study of life education and the paradigm of positive psychology into a holistic framework for research development and/or implementation. to date, to our knowledge, no researchers have yet made this attempt to unify the two theoretical orientations into one coherent model. this inquiry, we contend, is significant for the purpose of cross-cultural contribution, especially when we consider the uniqueness of eastern epistemologies and philosophical reasoning. recently, we published an article in frontiers in psychology (phan et al., a) , where we focused, in particular, on the unification of positive psychology (gilham and seligman, ; seligman, ; seligman and csíkszentmihályi, ) and mindfulness from the perspective of buddhism (hanh, ; loden, ; sheng yen, ) . from this account, a focus on life and death education from the perspective of taiwanese education is insightful in terms of elucidation of theoretical understanding of the relationship between the two orientations. it is interesting to note that taiwan places strong emphasis on the study of life education. it is a subject that is taught in school and university. indeed, many scholars, government officials, and teachers would attest that the study of life education has played a central role in transforming taiwanese society into what it is today-civil, democratic, robust, and stable. one clear example, in this case, is the recent covid- coronavirus pandemic where taiwan had only seven cases of death (note: dated as of june , ) (source: https: //www.worldometers.info/coronavirus/#countries). in a similar vein, high-quality service of hospice care for senior citizens in taiwan is commendable. some taiwanese, for example, serve as hospice care volunteers to provide religious and spiritual advice. given its importance, we have devoted a complete chapter in our forthcoming book on the subject of life and death education. the history of life education in taiwan, which we covered in detailed in this chapter, is quite interestingfor example, in part, it arose from the study of thanatology (fonseca and testoni, ; doka, ; meagher and balk, ; chapple et al., ) , or death education, from the united states and other western countries. to understand and appreciate the nature of life education, it is important for us to identify the chinese characters of " , " which translate to mean "life education." the term life education has been in use since , when taiwan started to promote various life education programs for secondary school teaching and learning (ministry of education taiwan, , . likewise, and interestingly, the ministry of education, taiwan, dedicated as the year of life education in acknowledgment and recognition of its significance and relevance to individuals, families, and the community. the national taipei university of education, where four of the authors work, has also established the life education and health promotion institute, which serves to promote life and death education. other institutions have similar programs and courses that promote the cultivation of life and death education. despite our brief mentioning so far, it is noteworthy to ask the question of what life education is about. we contend that this question does not have a definitive, consistent answer as the study of life education is relatively broad in scope. our attempt to provide a balanced definition and description of life education, from historical accounts (e.g., evolution of life education with the introduction of a seminal paper by professor song-yuan huang (huang, ) , titled: "death education: a controversial subject in school health education"), has resulted in the following: that life education is concerned with "spiritual and personal cultivation, " via different means (e.g., formal learning of a subject titled "spiritual cultivation" in university) in order to elicit appreciation and meaningful understanding of life and death (chen, (chen, , . in this analysis, life education is a formal process of delivery of knowledge that could, in effect, assist in the promotion, fulfillment, and cherishing of quality life experiences. from this account, it is noted that life education in taiwan is a valuable subject matter that could educate taiwanese citizens to appreciate and live productive life. it is important to note, however, that life education is not simply concerned with the nature of life. death is also a topic of discussion within the teaching of life education (huang, ) , hence why life education is also known as life and death education. for many taiwanese and asians, in general, death is a taboo topic that is often not talked about. this point is interesting as life and death are on the opposite ends of a spectrum. life is perceived as being positive (e.g., celebration, joy), whereas, in contrast, death is negative (e.g., sorrow, grief). any person for that matter would choose life, and not death, for studying in school and/or university. death, of course, is inevitable and is the ultimate fate that we all have to face. grief, sorrow, and despair, upon death of a loved one, are personal experiences that require assistance, counseling, and resolution. in this sense, life education, complementing with the teaching of buddhism (hanh, ; loden, ; sheng yen, ) , may assist and counsel taiwanese to confront and face death with sense of dignity, serenity, and respect (fu, ) . for example, the notion of buddhist samsâra may provide understanding into the possibility of "personal transcendence" beyond death itself. an interesting question that is often asked within the context of life education is the following: what is life? this question, similar to that of life education, does not have a straightforward answer. death, in contrast, is perhaps more easily definedfor example, we can define death as simply the permanent ceasing of a person or a biological organism. life, however, is more complex and may entail different interpretations and theoretical approaches-philosophical, scientific, theological, and metaphysical speculation. from a general point of view, though, we could say that the nature of life is concerned with a person's fulfillment of his/her purposes and goals in life, which are structured and timed for different periods in life (e.g., as part of life, the fulfillment of a goal to attend university). one taiwanese scholar, tsai ( ) , proposes that life in itself is not a passive "pathway"; rather, there are dynamic and proactive operations and contextual influences that ultimately portray unique, differing pathways for each person. one person's pathway, unique in its depiction, is likely to differ from other individuals' pathways. in this discussion of tsai's ( ) in summary, from the two aforementioned points of view, it is noted that life is made up of different life course trajectories. in a person's lifetime, he/she may possess and manifest different life course trajectories-for example, a life trajectory as a spouse vs. a life trajectory as an employee at a local bank. we anticipate that different life course trajectories are complementary with each other, despite their uniqueness (e.g., a spouse vs. an employee). in a similar vein, of course, there are underlying operational mechanisms or principles (tsai, ) that may contribute to assist and facilitate in the achievement of different life course trajectories. in the course of a person's life as a university student, say, he/she may rely on the process of optimization (phan et al., (phan et al., , a (phan et al., , b as an operational mechanism to assist with his/her schooling experiences. in a similar vein, another person's life trajectory as a senior citizen may consist of his/her social relatedness to others. the preceding sections have highlighted the nature of life and briefly, likewise, the importance of death and its aftermath. life education, as detailed, has a number of purposes that are related to both life and education. the goals of life education in this sense are unambiguous, focusing on meaningful appreciation for quality life experiences and in-depth understanding of deathrelated matters (e.g., the coping of grief). in our recent writing, surmising other scholars' discussions (huang, ; chen, chen, , , we purport that the main goal of life education is to educate, cultivate, and enrich a person's knowledge and ability so that he/she is able to (i) continuously refine the daily practice and wisdom of life, (ii) initiate the importance of care (e.g., looking out for others), and (iii) live a meaningful life through different stages. we surmise that the goal of life education, likewise, is to empower individuals with personal belief and resolute to accept death and/or to overcome death-related matters (e.g., sorrow). for example, the teaching of buddhism (yeshe and rinpoche, ; sheng yen, ) , situated within the framework of life education places consistent emphasis on spiritual cultivation (chen, (chen, , , which in this case encourages a person to seek meaningful understanding into the transcendence of oneself toward an ultimate, better self, and the transformation of the complexity of life experiences (i.e., positive and negative) into some form of unity. this emphasis of spiritual cultivation, likewise, considers the incorporation of mystical and esoteric sentiments such as a person's quest to strive for "awakening" or enlightenment experiences, and to offer hope into the possibility of the afterlife. the significance of life education is reflected by the objectives and subject contents that different courses and educational programs offer. in the course of a person's life, there are three aspects for consideration in development: i. the wisdom of life: it is important for a person, from birth to death, to continuously reflect on his/her acquired knowledge and experiences, which could help refine understanding into the meaning of life wisdom (e.g., "why is it important for us, as a nation, to offer free health care?"). ii. the caring of life: life wisdom, as we briefly described, may cultivate an appropriate mindset, which could emphasize the importance of empathy, compassion, mercy, and love toward oneself and toward others. these attributes, in turn, may motivate and compel a person to show love and care for others. iii. the practice of life: it is a noteworthy feat for a person to live a meaningful life with the main purpose of contemplation, refinement, and improvement. meaningful practice of life, in this case, may consist of voluntary community service (e.g., helping out at church on saturday). from this understanding, it can be seen that with reference to life, there are three distinctive elements that are of significant value: wisdom, care, and practice. as we explore next, wisdom, care, and practice are inseparable and may, in fact, unite the two contrasting topics: life and death. thus, as a point of summation, we could say that the main goal of life education is to explore the true meaning and nature of the wisdom, caring, and practice of life. in a course of study at university, for example, an educator may choose to include subject contents that focus on and/or reflect the importance of wisdom, care, and practice of life. at the same time, of course, subject contents via whole-class teaching, individual learning, and/or collaborative may also entail the study and understanding of death-related matters-for example, the coping of sorrow using faith in buddhism as a possible means (phan et al., b (phan et al., , a . research into the positive effect of life education in taiwan, over the years, has focused on different aspects of developmentfor example: empirical establishment, application, theorization, and conceptualization (e.g., tsai, ; huang, ; chen, ; tsai et al., tsai et al., , tsai et al., , . for example, recently, we conducted an empirical study that consisted of taiwanese undergraduate students from public and private universities, where our focus of inquiry delved into the empirical validation of a concept that we developed, termed as "appreciation and the valuing of life." for us, appreciation and the valuing of life, as a psychosocial concept, is defined as a person's gratitude, respect, and cherishing of life and/or toward others in society (e.g., "i appreciate bau-yi for who she is, regardless of her poor upbringing"). importantly, however, we conceptualized and reasoned that acquired knowledge of the subject of life education could assist in the development of the concept of appreciation and the valuing of life. moreover, as shown in figure , we postulate that personal experience of appreciation and the valuing of life could act as a potent antecedent of future outcomes. using likert-scale measures and the statistical technique of structural equation modeling (loehlin, ; kline, ) , we found evidence to substantiate our hypothesized a priori modelfor example, appreciation and the valuing of life positively predicted the concepts of daily functioning (β = . , p < . ), personal experience (β = . , p < . ), willingness to help others in society (β = . , p < . ), and happiness (i.e., positive emotions) (β = . , p < . ). this study overall, we contend, is significant as it underlines the potency of the study of life education-that meaningful understanding life education, in this case, could yield in the development of perception and personal experience of appreciation and the valuing of life. aside from empirical research, we have noted that many scholars, educators, government officials, etc. have also made concerted efforts to advance the study of life education. one interesting line of inquiry has involved advancement into the nexus between research and application. this emphasis, in this case, focuses on the successful transformation of theoretical tenets of life education into practice. for example, in , a buddhist master, master xiao yun, used "enlightenment education" as a philosophical foundation to establish huafan university, currently located in new taipei city, taiwan. master yun advocated the use of humanistic education (e.g., the study of self-actualization) to enrich a person's mindset. master xiao yun, in particular, believed in the integration of both humanities and technological advances and that, likewise, there was a need to acknowledge and recognize the importance of compassion and wisdom. to promote this thinking, huafan university offered a unit, titled "enlightenment wisdom and life, " which was compulsory for enrolment. this enlightenment education is based on the theoretical premise of enlightenment, taking into consideration both chinese culture and buddhist teaching. specifically, reflecting our previous mentioning, this unit incorporates contemporary pedagogical practices and places emphasis on the integration of both humanities and technological frontiers in psychology | www.frontiersin.org advances, as well as the promotion of compassion and wisdom (shi, ) . it was hoped at the time that enlightenment education, focusing on the cultivation of compassion and life wisdom (e.g., caring for another person), would bring peace and happiness to taiwanese society. other institutions in taiwan, similar to huafan university, have also made attempts to highlight and promote the importance of life education. for example, from our observations and professional experiences, we note that there are pastoral care programs, courses and degree programs, extracurricular and social activities, and campus events that place emphasis on religious and spiritual cultivation, the enrichment of personal well-being, and the proactive caring for others (chen, ) . one notable goal from these positive initiatives is to educate and to encourage students to practice care, love, compassion, and life wisdom (e.g., looking out for friend in time of needs). at huafan university, even to this day, there are weekly classes on buddhist meditation practice and mindfulness that are intended to cultivate spirituality and beliefs in religious sentiments (e.g., the seeking of understanding of transcendence). the main premise of the present conceptual article is to consider the possibility that life education, in general, could coincide with and/or support and substantiate the paradigm of positive psychology (gilham and seligman, ; seligman, ; seligman and csíkszentmihályi, ) . as we briefly mentioned in the preceding sections, we recently published a conceptualanalysis article, titled "advancing the study of positive psychology: the use of a multifaceted structure of mindfulness for development, " which explored the interrelationship between buddhist mindfulness (hanh, ; loden, ; sheng yen, ) and positive psychology. this conceptual analysis is poignant as it acknowledges the possibility that both western and eastern epistemologies and philosophical rationales (e.g., psychological thoughts vs. spirituality) could combine into a holistic framework, which would then provide detailed information about the proactivity of human agency (bandura, (bandura, , . the advent of technologies and globalization has encouraged social dialogues and, importantly, the sharing of knowledge, ideas, opinions, and viewpoints across cultures. our cross-institutional research collaborations over the past years, for example, have resulted in our propagation of meaningful and interesting cross-cultural discussions of topical themes, such as subjective well-being, optimal best, and personal fulfillment. how does life education, from the perspective of taiwanese education, fit in with the teaching of positive psychology? an alternative question that we could inquire, likewise, is whether and/or to what extent positive psychology would fit in and support the teaching of life education. this attempt to integrate the two theoretical frameworks is innovative as it would add credence to the prominence of positive psychology as a driver of life's proactivity and, by the same token, the promotion of the teaching of life education in school, college, and society. positive psychology, in brief, explores life conditions and experiences both in terms of negativities (e.g., the remedy of pathologies and maladaptive functioning) and positivities (e.g., the encouragement and promotion of enriched life conditions) (gable and haidt, ) . this theorization of positive psychology (gable and haidt, ) largely arises from the work of seligman, csikszentmihalyi, and peterson, who seek to understand the psychological well-being and optimal functioning of people (quick, ) . from the literature, seligman and csikszentmihalyi (seligman and csíkszentmihályi, ) have been credited with coining the term "positive psychology." according to sheldon et al. ( ) , positive psychology is defined as: "the scientific study of optimal human functioning. it aims to discover and promote the factors that allow individuals and communities to thrive. the positive psychology movement represents a new commitment on the part of research psychologists to focus attention upon the resources of psychological health, thereby going beyond prior emphases upon disease and disorder". this definition, as reflected in pawelski's ( ) comprehensive review of this topic, suggests that positive psychology incorporates and emphasizes personal characteristics, such as internal drive, character building, human strength, and family and civic virtue. from this emphasis, the study of positive psychology may entail the "building of the most positive qualities of an individual" (seligman, , p. ) and "on building of what makes life most worth living" (seligman, , p. ) . seligman and csíkszentmihályi's ( ) published work, likewise, emphasizes the science of positive psychology may exist on three levels-subjective, individually, and institutional: "the field of positive psychology at the subjective level is about valued subjective experiences: well-being, contentment, and satisfaction (in the past); hope and optimism (for the future); and flow and happiness (in the present). at the individual level, it is about positive individual traits: the capacity for love and vocation, courage, interpersonal skill, aesthetic sensibility, perseverance, forgiveness, originality, future mindedness, spirituality, high talent, and wisdom. at the group level, it is about the civic virtues and the institutions that move individuals toward better citizenship: responsibility, nurturance, altruism, civility, moderation, tolerance, and work ethic" (p. ). interestingly, ancient greek philosophers refer to the concept of "eudaimonia, " which is translated to connote good spirit, happiness, and a state of flourishing. psychologists in early as the s, likewise, recognized the need to examine the virtue of strength-based approaches to prevent and treat a person's mental illness. in the area of human motivation (franken, ) , likewise, maslow's ( a maslow's ( , humanistic theory describes the importance of self-fulfillment of inner psychological needs. maslow ( b) argued that the science of psychology has been far more successful on addressing the negatives than improving the positives. it has revealed man's and woman's shortcomings, his/her illness, and his/her sins, but little about his/her potentialities, his/her virtues, his/her achievable aspirations, or his/her full psychological height (maslow, b, p. ) . indeed, positive psychology has been and is difficult to define because of its nature and broad scope of psychological domains (donaldson et al., ) . over the years, of course, there have been different theories proposed to explain and/or to reflect the tenets of positive psychology-for example, phan et al.'s ( ) framework of achievement bests, seligman's ( ) perma model (i.e., positive emotions, engagement, relationship, meaning and accomplishment), keyes's ( ) continuum of psychological well-being, and peterson and seligman's ( ) character strengths and virtues framework. in their seminal writing, seligman and csíkszentmihályi ( ) defined positive psychology as "the combination of valued subjective experiences, which could contribute to the optimal experience of well-being." this testament, based on our analysis, may incorporate reflection of a person's past (e.g., achievement), as well as his/her hope and optimism for the future (e.g., positive emotions), and flow and happiness in the present moment (e.g., engagement and meaning) (phan et al., a) . this personal experience, indeed, attests to a continuation of time: past, present, and future. at an individual level, it is operationalized through positive individual traits such as the capacity for love, vocation, courage, interpersonal skill, aesthetic sensibility, perseverance, forgiveness, originality, future mindedness, spirituality, high talent, and wisdom. at the community or the organization level, in contrast, positive psychology is concerned with civic virtues and the goal of institutions to move individuals toward better citizenship, responsibility, nurturance, altruism, civility, moderation, tolerance, and work ethic (seligman and csíkszentmihályi, ) . as noted from the preceding section, positive psychology may act to negate pathologies and maladaptive states of functioning (e.g., continuing failures in mathematics learning) and, in contrast, to also promote positive life conditions and experiences (e.g., enjoyment in seeking mastery in music composition). the theory of optimization (e.g., fraillon, ; phan et al., phan et al., , a , b , recently developed to coincide with the paradigm of positive psychology, interestingly places more emphasis on positive life experiences and adaptive outcomes-for example, the achievement of optimal best (liem et al., ; phan et al., ) . this focus of development (i.e., a focus on the achievement of optimal functioning) is beneficial and insightful as it seeks to promote the importance of positive life conditions and different types of adaptive outcomes. it is a central feat of human agency that individuals in society strive to achieve their optimal bests and flourish in life. in terms of schooling, for example, what is it that could encourage a student to strife for optimal best in gymnastic? in a similar vein, in a non-academic sense, what could we do to cultivate optimal health? optimal best, also known as optimal functioning, is an important hallmark of positive psychology (seligman and csíkszentmihályi, ; fraillon, ; phan et al., a) and, by the same token, is an antithesis of pessimism, procrastination, a state of demotivation, and suboptimal functioning. optimal best, as the term connotes, is concerned with successful accomplishment and/or fulfillment of a state of functioning (e.g., cognitive functioning) that, in this case, reflects the maximization of a person's capability (fraillon, ; phan et al., a) . in terms of diversity, for example, achievement of optimal best may involve the following: • academic learning, for example, a student's optimal cognitive functioning in essay composition, where he is able to write a , -word essay and subsequently receiving an a + grade. • personal well-being in a workplace environment, for example, a bank employee's optimal state of resilience, personal resolve, and motivation to overcome difficulties and achieving exceptional kpis. • health functioning on a daily basis, for example, a senior citizen's optimal state of health despite her recent temporary illness from the covid- pandemic. • professional sports performance (e.g., european football), for example, a football player's optimal physical and creative ability to score goals in the / season. the above examples emphasize the general nature of optimal best for different life contexts. optimal best, which fraillon ( ) also terms as "notional best, " is a point of reference by which a person strives to achieve. "what is my optimal best?" indeed is a phrase that one may commonly use as a source of aspiration and motivation to succeed. in their recent article, phan et al. ( a) provided a comprehensive overview and conceptual analysis of this concept of optimal best. according to the authors, determination of optimal best in a subject matter (e.g., a football player's optimal physical and creative ability), denoted as "l , " requires some form of "benchmarking" or referencing from a current level of best practice, denoted as "l ." interestingly, from their conceptualization, phan et al. ( a) argued that the difference between l and l , denoted as (l -l ) , would represent and define a person's state of flourishing. from this account, we contend that a person's experience of flourishing, (l -l ) , entails some positive, enriched quantitative and/or qualitative change. importantly, however, phan and his colleagues' research work of optimal best is seminal and innovative for their emphasis on the process of optimization-that is, what is it that governs and causes a person to achieve optimal best? positive psychology does not simply focus on optimal functioning, nor does it entail the masking of negative life conditions and experiences (pawelski, ) . indeed, helplessness, sorrow, depression, continuing failures, and despair are some notable pathologies and negative life conditions, which we contend are noteworthy for consideration and addressing. in brief, the taboo subject of death itself is something that we all have to confront. it is the ultimate fate of humankind: the ceasing of life itself. in life, there are many personal situations, circumstances, events, experiences, etc. that are ongoing and/or repetitive, allowing us to recall and inform others-for example, ". . .it was like this for me when the covid- coronavirus pandemic happened. . ., " and ". . .i really enjoyed the music concert the other day. . .." death, however, is not an experience, situation, events, etc. that we can recall and repeat to someone (e.g., ". . .. for me, death was like . . ."). interestingly, there is an article by jennie dear (september , ) published in the atlantic (titled "what it feels like to die") that seeks to clarify the question of what it feels like to die. by all accounts, dr. james hallenbeck, a palliative care specialist at stanford university, compares dying to blackholes-"we can see the effect of black holes, but it is extremely difficult, if not impossible, to look inside them. they exert an increasingly strong gravitational pull the closer one gets to them. as one passes the 'event horizon, ' apparently the laws of physics begin to change" (source: https://www.theatlantic.com/health/archive/ / /what-it-feels-like-to-die/ /). dear's (september , ) article and personal account of death is interesting as it makes attempts to understand death. of course, the article does not completely elucidate the complex nature of death in terms of the emergence of onset experience (e.g., one's onset experience as he/she approaches death), grief, suffering, etc. despite this caveat, the article does, in part, support the use of positive psychology, as a form of remedy, to address death and other related negative aspects of life (e.g., a person's experience of trauma). moreover, as an interesting premise from dear's (september , ) article, we contend that the subject of life education in itself could coincide with the paradigm of positive psychology (seligman, (seligman, , seligman and csíkszentmihályi, ) and serve as an important remedy. that life education, in this sense, could play a prominent role in helping to alleviate negative emotions, feelings, and experiences and, by contrast, improve and enhance positive life characteristics (e.g., a state of personal resolve). from this account, we posit that life education (chen, (chen, , huang, ) , as a subject, could act as an informational source, which then would help to facilitate in the achievement of optimal best, academically and non-academically. let us now consider this possibility in detail in terms of the focus of theoretical orientation. by all accounts, we acknowledge that life education is not the only subject and/or theory that could coincide with the paradigm of positive psychology (seligman, (seligman, , seligman and csíkszentmihályi, ) and/or that it is the only framework, which could facilitate a person's achievement of optimal best. our examination of the literature, for example, has indicated that there are a number of notable theories that may successfully explain the achievement of optimal best: academic buoyancy (e.g., martin et al., ; collie et al., ) , personal thriving (e.g., su et al., ; wiese et al., ) , and academic striving (e.g., phan and ngu, ; phan et al., c) . what is unique, though, from our proposition, is that the study of life education may delve into the premise of philosophical psychology, spiritual psychology, and religious psychology. its scope, as we indicated earlier on, is more broader than just the teaching of theories pertaining to the different stages of human development (e.g., stage of cognitive development) (inhelder and piaget, / ; erikson, ) . life education from the perspective of taiwanese education is quite unique in terms of its theoretical premise, which we contend may coincide with other religious faiths, cultural practices and values, and philosophical beliefs, for example, christianity (davis, ; knitter, ; van der merwe, ) , hinduism (warrier, ; srivastava and barmola, ; goswami, ) , and islam (nasr, (nasr, / bonab et al., ; marzband et al., ) . in this analysis, as a point of prominence, life education's focus is more philosophical, spiritual, and personal, delving into a person's inner self and his/her relationship with nature, others in society, and some form of "divine being" (e.g., buddha). at its core, perhaps, is the fact that the teaching of life education makes a concerted attempt to promote and facilitate the enrichment of personal well-being via means of what we term as "divine-human relationships" (bonab et al., ) . enrichment of subjective well-being (e.g., a person's experience of optimal health well-being) is positive and, in this case, reflects one of the theoretical tenets of positive psychology (seligman, (seligman, , seligman and csíkszentmihályi, ) , namely, to encourage and promote positive life experiences and conditions (i.e., in this case, to encourage and promote optimal health wellbeing). of particular interest, from our point of view, is that life education shares a point of commonality with other religious faiths and philosophical beliefs (e.g., saksena, ; jones, ; kourie and ruthenberg, ; marzband et al., ) in terms of emphasis in acknowledgment of the importance of nature and its intimate association with life, inclination and human attachment to some form of divine being (e.g., the importance of god), and the seeking of spiritual cultivation and connectedness between personal and transpersonal realms (nasr, (nasr, / bonab et al., ) . this theoretical contention, interestingly, suggests that life education espouses the importance in unity of the spirit, the mind, and the body in both worldly and nonworldly esoteric contexts. it is evident that there is consensus among researchers' conceptualizations and established findings (e.g., saksena, ; jones, ; koenig, ; marzband et al., ; wagani and colucci, ; villani et al., ) , which showcase the positive impact of religious faith, spiritual cultivation, and personal enlightenment toward the optimization of one's personal wellbeing. bonab et al.'s ( ) theoretical overview of islamic spirituality, for example, is interesting as it highlights the relationship between personal religious commitment and mental health and coping ability (miller and thoresen, ) . in this analysis, a person's perceived positive relation with god is likely to enhance his/her coping and mental health condition (galanter et al., ; pargament, ; belavich and pargament, ) . testament of appreciation of spirituality, likewise, has also been found to make a profound impact on a person's wellbeing. in a recent study in north india, interestingly, wagani and colucci ( ) explored an important "negative" aspect of positive psychology with reference to hindu faith-in this case, the remedy and prevention of pathologies and maladaptive experiences. the authors found that spirituality (e.g., defined as "the improvement and knowledge of oneself. spirituality. . . defined as a way to know oneself, the inner self, or the soul": wagani and colucci, , p. ) positively impacted on a student's well-being and, more importantly, served as a protective measure against suicidal tendency. as we have acknowledged earlier, the subject of life education is not new to taiwan and has, in fact, been credited elsewhere in terms of theoretical development. what is novel, though, is that taiwan has placed strong emphasis on the application of life education theories into practice. how can life education assist individuals to appreciate their sense of self-worth? how can life education negate a person's perception of life dissatisfaction? how does life education complement a person's emphasis on a need to have financial wealth? these questions are authentic and have life-related relevance, emphasizing the importance of theoretical understanding into the multiple purposes of life, personal reflection, and philosophical reasoning, all of which account for the goals of life education. that life education, specific to the case of taiwan, is concerned with a focus on enrichment of personal well-being, appreciation for life and the fulfillment of life qualities, and the development of coping mechanisms to deal with life matters. our quest is to consider a coinciding support for positive psychology from the study of life education. how does the subject of life education, from the perspective of taiwanese education, support and/or coincide with the theoretical tenets of positive psychology? this consideration acknowledges, from our viewpoint, the perspective and understanding that life education, in general, is positive and/or that it entails positive life characteristics for development (e.g., emphasizes the importance of positive emotional well-being). on this point, we concur and strongly believe that life education, in terms of its proposed theoretical tenets (e.g., a focus on the development of life wisdom, which may consist understanding of spiritual cultivation), is a positive subject that may soundly support the paradigm of positive psychology. this testament, indeed, is the hallmark of this conceptual analysis article. let us now explore three major components of life education, which we consider as being prevalent to supporting our seminal postulation-that the subject of life education is closely aligned with and in support of the paradigm of positive psychology (seligman, (seligman, , seligman and csíkszentmihályi, ) . our proposition, drawn from professional teaching practices and existing theoretical and research development, posits that life wisdom (i.e., acquired knowledge pertaining to the importance of spirituality), personal daily engagement of life practices (e.g., engagement in meditation), and one's willingness to show care for others in society, in general, produce a number of positive life qualities, for example, a person's positive outlook in life. in a similar vein too, from our point of view, taiwanese life education studies (chen, (chen, , huang, ) also facilitate and enhance the following: philosophical reflection: personal reflection, we contend, encourages a person to internalize and to reflect on daily happenings in a philosophical manner in order to attain meaningful understanding. the main premise, in this case, is for a person to philosophically reflect and reason why things in life happen and why they are the way they are. buddhist meditation, resulting in calmness and serenity of the mind (loden, ; phan et al., a) may, in this sense, enable the person to reflect from "within the mind" and to provide sound philosophical reasoning. as an example, consider the case of social stigma and its subsequent effect (major and o'brien, ; frost, ) that an adolescent is experiencing. philosophical reflection, in this analysis, would encourage a person to seek understanding from all sides, not necessarily for the purpose of resolution for this social mishap. this act, in turn, formulates evidence of life wisdom, which a person may refer to and use for other contexts. spiritual cultivation: spiritual cultivation, also known as the cultivation of spiritual mind, seeks to enlighten a person in a religious and/or spiritual sense. specifically, with reference to the incorporation of buddhist teaching (yeshe and rinpoche, ; sheng yen, ) , taiwanese scholars and students alike believe that spiritual cultivation, via means of acquired knowledge (e.g., buddhist scripture) and meditation practice, would enable a person to attain meaningful understanding and appreciation of esoteric matters, such as the possibility of transcendence beyond the realm of death itself, unexplained phenomena of this physical world, and the true meaning of satori (phan and ngu, ; phan et al., a) , that is, the achievement of perfection and/or tranquility. spiritual cultivation, indeed, is a form of teaching, both formal and informal, which may serve to enlighten a person's view and mindset of the world in a positive manner. for example, compassion, love, and willingness to forgive are all evidence of the success of spiritual cultivation. enrichment of personal well-being: enrichment of personal well-being reflects the nature of life care in which a person may show love, care, and compassion for oneself and for others in the community. enrichment of personal well-being may reflect a person's mindset, as well as his/her physical being. importantly, however, enriched personal well-being may espouse the development and acquired experience of a "spiritual self "-in this case, the perception in experience of calmness, serenity, peace, and harmony with reference to the surrounding. moreover, research development and the study of life education (e.g., chen, chen, , chen, ) in taiwan posit that spiritual cultivation (e.g., the teaching of satori) could assist and encourage individuals to show willingness in care, love, and wisdom for others' well-being. taiwan is relatively advanced in terms of quality services of hospice care to senior citizens. one of the authors of this article, for example, works as a volunteer on weekends and afterhours to look after senior citizens. his personal account, as he describes, entails spiritual advice, which may consist of buddhist chanting and reading of buddhist scriptures. from our rationale, we contend that philosophical reflection, spiritual cultivation and enlightenment, and a person's enriched well-being are positive experiences and characteristics that may arise from the study of life education. by all accounts, we acknowledge that this viewpoint and rationalization may resonate elsewhere with other religious faiths, teaching subjects, cultural practices, etc. indeed, as attested from the extensive literature, religious faiths such as christianity (davis, ; knitter, ; van der merwe, ) , hinduism (warrier, ; srivastava and barmola, ; goswami, ) , and islam (nasr, (nasr, / bonab et al., ; marzband et al., ) also explore the importance of spiritual cultivation and life enlightenment. for example, as we briefly referenced, hindu faith places emphasis on a need for a person to "know and live in the highest self, the divine, the all-embracing unity, and to raise life in all its parts to the divinest possible values" (goswami, , p. ) . what is poignant, however, is that taiwanese society and education systems place self-awareness and prominence on these elements, all of which are quality characteristics that coincide with positive psychology (seligman, (seligman, , seligman and csíkszentmihályi, ) . drawing from the preceding section, our proposition considers the extent to which life education would yield quality life characteristics that, in turn, support the paradigm of positive psychology (seligman, (seligman, , seligman and csíkszentmihályi, ) . positive psychology, in a general sense, entails the promotion of optimal best, academically [e.g., optimal cognitive achievement (e.g., mastery) in algebra] and non-academically (e.g., optimal emotional well-being despite one's obstacle). we rationalize that, in this instance, spiritual cultivation and enlightenment, philosophical reflection, and enriched well-being, all of which are positive qualities, would naturally converge, resulting in the development of life-relevant characteristics, which are shown in figure and summarized in table . our rationalization for the support of positive psychology (seligman, (seligman, , seligman and csíkszentmihályi, ) from the study of life education (e.g., chen, chen, , chen, ) is shown in figure . foremost from figure is our conceptualization, shown as a venn diagram, which depicts a point of convergence (i.e., denoted as 'x") between three described components-spiritual cultivation and enlightenment, philosophical reflection, and enriched well-being. in particular, we propose that life education would create a specific form of knowledge, understanding, and personal experience that we term as "spiritual and enlightened self." a person's spiritual and enlightened self is religious and spiritual and, from our proposition, may emphasize his/her intimate connectedness with some form of divine being and/or divinity. this point about spirituality and enlightenment, in a general sense, is not novel and has been noted to resonate with other religious faiths. for example, aside from islam faith, hindu faith, etc., christian spirituality also recognizes the importance of a "dynamic divine-human dialogue-between the divine and the spiritual person" (van der merwe, , p. ). what is of consistency, perhaps, is that a perceived sense of spirituality could give rise to a person's "eureka moment" of awakening, or enlightenment (schneiders, ; knitter, ) , resulting in his/her experience of connectedness with nature, people, and divinity (van der merwe, ). what do the characteristics, or "virtues, " in table , as we conceptualize, actually represent? our rationale, in this analysis, posits the following: that the study of life education, focusing . perceived sense of spirituality acquired knowledge and manifestation of spiritual belief-for example, a person's striving to appreciate and/or to engage in the practice of tranquility. a person's willingness to show love, empathy, and care for others in society, regardless of their ethnicity, race, social standing, political affiliation, etc. a person's willingness to be non-judgmental and to forgive others for their deeds, regardless of subsequent effects. forgiveness, in this sense, reflects a person's magnanimous state . social relatedness social relatedness is more than just evidence of proactive social interactions between individuals. it is also about empathetic thoughts and acts, such as offering friendship to a person who is in need . enlightened the word "enlightened" arises from personal understanding and/or, perhaps, experience of enlightenment, or nirvana. this emphasis identifies the beatitude of life, both in the physical sense and the esoteric sense . open-mindedness a person's understanding, acknowledgment, and acceptance that anything in this physical world is possible. this description, in particular, reflects a person's state of inquisitiveness to understand about the world . benevolence a person's disposition to engage in charitable acts and to show kindness and good will to others in the community. benevolence, in this case, may also reflect sacrifice and willingness to go beyond of what is expected . resolute personal resolute, a concept recently developed, emphasizes a person's unwaivered focus, concentration, and mental fortitude, which may then account for his/her state of decisiveness in a particular context. on the teaching of philosophical reflection, the cultivation of spirituality, and the enrichment of personal well-being would give rise to the "creation" of a holistic entity-a person's spiritual and enlightened self. when a person experiences spirituality and feels enlightened or awakened) (i.e., his/her holistic self), he/she is likely to exhibit different types of life characteristics and virtues such as having a positive outlook about life, being compassionate and showing forgiveness, etc. by all accounts, these positive life characteristics (e.g., a positive outlook) are comparable with those established elsewhere, especially in relation to other theoretical perspectives, cultural viewpoints, religious faiths, and customary practices. for example, our description of the positive characteristic of "positive outlook in life" (i.e., a person's inclination to be positive about life, regardless of his/her current situations, etc.) has been referenced in existing research development pertaining to the subject of future time orientation (e.g., wallace, ; nuttin, ; mehta et al., ) in the field of psychology. a positive future time orientation at school, according to research evidence, would result in an improvement in academic performance. in a similar vein, a person's experience and manifestation of compassion is welldocumented with other religious faiths, for example, islam (i.e., the concept of rahmah) (engineer, ; taib, ; nasir, ) and christianity (cornelius, ; godlaski, ; zylla, ) . holistic self, from our proposition, is a virtuous and magnanimous entity that arises from the study of life education. this consideration of a person's holistic self is personal for us, drawing from our own teaching experiences, existing theoretical understanding, and ongoing research development. a person's holistic self, we contend, reflects his/her state of liveliness, awakening, and spirituality, yielding a number of virtues and life qualities (e.g., indication of compassion) that largely support the paradigm of positive psychology (seligman, (seligman, , seligman and csíkszentmihályi, ) in helping to address different types of pathologies and/or the achievement of optimal best. let us consider a negative condition of death and how a person would overcome this fate. death as a topic is dark, negative, and something that not many of us would like to discuss and/or talk about. death is the ultimate destruction of life. for a person who is approaching death, it is a daunting and suffering experience. by the same token, for a close relative of someone who is dying, this "confrontation" of death is also a daunting experience, for example, the self-cognizance of grief, denial, and pain. how would positive psychology and, more importantly, a person's holistic self-address this fundamental topic? likewise, how would life education assist someone who is approaching death, and/or the close relative who is experiencing the onset of grief, etc.? referring to our previous discussion, an acquired spiritual and enlightened self (i.e., a person's holistic self) in this case may provide relevant information (e.g., meaningful understanding of life wisdom) and experiences (e.g., realization that everything in life is aesthetic) (loden, ; phan et al., a) , which could assist a person to confront and cope with death. buddhist faith, in particular, could encourage and instill the following comparable beliefs and/or perceptions: i. the spiritual belief of samsāra, that is, the endless cycle of birth, rebirth, and redeath. that is, in this case, every rebirth is temporary and impermanent. upon death, a person is reborn elsewhere in accordance with his/her own karma. hence, from this spiritual belief, those who are approaching death may view death with a sense of encouragement, hope, and optimism, knowing that this is simply a cycle of life and death. ii. the spiritual belief that the nature of life and death is aesthetic and that negativity, pain, suffering, etc. are part of the norm and subjective, depending on a person's resolve, outlook, open-mindedness, etc. this emphasis connotes, in particular, the importance of enlightenment, which would potentially allow a person in this case to achieve the everlasting the beatitude of life. ii. the spiritual belief into the esoteric nature of life and death, which may involve the possibility of transcendence beyond the realm of the physical world. in other words, spiritual cultivation may allow a person to view death as not being the ultimate end, but rather as a dividing line that separates one physical world life cycle from that of another cycle. in contrast to death, pathologies, and other forms of maladaptive functioning, likewise, a person's acquired holistic self is also able to facilitate the achievement of optimal best (fraillon, ; liem et al., ; phan et al., b) and the experience of flourishing (diener et al., ; seligman, ; phan et al., a) . our consideration in this matter connotes that virtues (e.g., compassion) and quality characteristics (e.g., having a positive outlook), in this case, may reflect a person's optimal "individual experience." in other words, a person's achievement and/or experience of spirituality and enlightenment is more than just perceived evidence of positivity; rather, we rationalize that development of the holistic self is the ultimate optimal achievement or fulfillment that a person may experience. this optimal personal experience of spirituality and enlightenment, enabling a person to feel connected with god or some divine being (nasr, (nasr, / bonab et al., ; goswami, ; van der merwe, ), is of an exceptional level, which many of us may not achieve. the study of death education in taiwan is extremely prominent. over the past four decades, institutions have offered degree programs and courses that emphasize the importance of life education. one unique aspect of life education in taiwan has been the incorporation of specific eastern-derived epistemologies, philosophical and religious beliefs, and cultural practices. this uniqueness has led to the conceptualization and meaningful understanding that life education, in general, is concerned with enrichment of life qualities, cultivation of spiritual wisdom, and the pursuing of personal contentment and happiness. the main premise in this case is that aside from social stability and financial wealth, the notion of having a spiritual, fulfilling life is a noteworthy feat for development. hence, on a daily basis, many taiwanese engage in buddhist meditation and other forms of meditation, as well as partaking in charitable acts and short courses, which would facilitate in the achievement and fulfillment of life qualities. our premise, as explored in the preceding sections, is to consider the extent to which life education, from the perspective of taiwanese education, could coincide with and/or support the study of positive psychology (seligman, (seligman, , seligman and csíkszentmihályi, ) . this consideration is innovative as it emphasizes the potential nexus in terms of epistemologies, philosophical reasoning, and theoretical psychology between western and eastern contexts. the study of life education in taiwan, for example, is interesting, delving into the complex nature of three interrelated elements that, in this sense, incorporate eastern-derived epistemologies (e.g., buddhist spirituality): life wisdom, life practice, and life care. our concerted effort, in this analysis, led to the proposition of a theoretical-conceptual model for continuing research development. the proposed point of convergence, labeled as "x" in figure , is significant, highlighting a person's spiritual and enlightened self. this point of convergence, which we termed as spiritual wisdom and life enlightenment, is positive and, more importantly, would form part of a person's holistic development (forbes, ; hare, ) . overall, then, what is the main premise of our conceptual analysis article and, more importantly, our proposition? for us, as scholars, we have a collective interest to seek understanding into the proactivity of human agency-for example, does having a positive mindset assist a person to flourish, and/or to cope with an impending health problem? from the "western" literature, we note that the paradigm of positive psychology (seligman, (seligman, , seligman and csíkszentmihályi, ) has been effective in assisting individuals with their wellbeing experiences (e.g., facilitating positive emotional wellbeing, via means of resilience). our viewpoint, largely derived from teaching and research development, likewise, considers the use of life education theories (huang, ; chen, ; huang, ) to gauge into and facilitate the proactivity of human agency. in this case, we hope that researchers, educators, organizations, etc. will consider the use of life education and, in particular, our proposition (e.g., a person's holistic self) to encourage and promote quality life experiences. quality life experiences for a person, in this case, may entail the following: (i) to appreciate and value life, regardless of personal hardship, socioeconomic standing, obstacles, etc.; (ii) to seek meaningful daily understanding, insights, and experiences about life and to live a meaningful life; and (iii) to plan and to have positive future outlooks about life, including death and other liferelated negativities. our intent, as scholars of education and psychology, is to seek innovative and new frontiers in theory and research development, which may then assist students and educators alike in their learning and teaching experiences. a focus on the seeking of life wisdom, spiritual cultivation (e.g., endeavor and/or perceived connectedness with some divine being), and experience of enlightenment (e.g., personal feeling of contentment and inner peace) is a noteworthy feat for consideration, especially in terms of applicability, practicality, and continuing research development. foremost, from the present article, we encourage readers to capitalize on our research proposition of life education and to consider other inquiries for development. our future goal, interestingly, is to use theoretical psychology and philosophical reasoning to unify comparable theories (e.g., life education, mindfulness, positive psychology) and cross-cultural viewpoints into an overarching framework for understanding-namely, to date, we have inquired into the process of optimization, the nature of holistic psychology, the multifaceted nature of mindfulness and the potential interrelationship between mindfulness and positive psychology, and of course life education and positive psychology. of particular interest for us, in this case, is to develop and propose a unified theoretical model that could explain a person's holistic development in terms of his/her subjective well-being (e.g., emotional well-being), cognition, morality, and social relationship. is this feat of developing a unified model possible, and/or can we develop a theoretical model of human agency (e.g., a person's achievement of optimal best in a particular domain of functioning) that could successfully take into account different philosophical beliefs, religious faiths, theoretical perspectives, etc.? theoretical psychology, philosophical reasoning, epistemologies, etc. are interesting "academic strategies" and/or approaches that we could use to develop new innovative theories and conceptualizations. like any proposed theory or theoretical model for that matter, however, it is important that we are able to scientifically validate a particular line of inquiry, theoretical model, conceptual framework, etc. for example, in terms of quantitative research, it is perceived as being straightforward to investigate, say, a one-factor (e.g., brown and ryan, ; chadwick et al., ) , a two-factor (e.g., cardaciotto et al., ; davis et al., ) , and/or a more complex factorial structure of mindfulness (e.g., a four-factor model: baer et al., ; feldman et al., ) using likert-scale inventories with confirmatory factor analysis techniques (kline, ; byrne, ) . in a similar vein, despite modest empirical development at present, it is possible to explore and empirically validate the nature of subjective well-being (diener et al., (diener et al., , wiese et al., ) . we acknowledge that our discussion in this article is theoretical and that, at present, there is only limited empirical evidence (e.g., figure ) to support its premise. in this sense, it is not always feasible and/or achievable to validate an inquiry, especially when it is esoteric and non-scientific in nature. for example, in accordance with our previous discussion, we contend that it is somewhat unachievable to design an appropriate methodological design for usage, which could measure, assess, and validate different types of esoteric experiences (e.g., "tranquility, " "enlightenment, " "samsāra"). in this analysis, we are extremely constrained in our quest to validate the experience of and the concept of transcendence-that is, the possibility of life transcending beyond death. how would we scientifically determine whether this notion of postdeath experience is plausible? one interesting topic and/or line of inquiry in the social sciences is related to methodological design (bordens and abbott, ; gravetter and forzano, ; babbie, ) , which a researcher could use to investigate and validate a particular concept, relationship, etc. for example, as a question for consideration, would a two-group experimental design (e.g., control group vs. experimental group) be the course for usage in terms of validating the negative impact of cognitive load imposition (sweller et al., ; sweller, ) ? in our research development (phan et al., a) and, in particular, our recent conceptual-analysis article (phan et al., a) , we introduced a term, coined as "methodological appropriateness." methodological appropriateness, in brief, is concerned with a researcher's consideration of the appropriateness (or inappropriateness) and adequacy (or inadequacy) of a methodological design that he/she would use to validate a concept, association, etc. methodological appropriateness, from our point of view, may explain limitations, as well as the ineffectiveness, inconsistency, and inaccuracy of established findings of empirical research. poignant to this discussion, though, is the fact that the topic of methodological appropriateness (phan et al., a (phan et al., , a is also associated with conceptualizations and theorizations drawn from philosophical reasoning, theoretical psychology, and non-scientific intuitions. in other words, it is still plausible for researchers to consider the relevance and applicability of methodological appropriateness for esoteric and non-scientific matters. from the above, we contend there are a number of caveats that are worthy for continuing research development. foremost, in this analysis, is the "scientific" validation of our proposed conceptualization, as shown in figure . with reference to figure , there are two notable issues for researchers to consider: i. develop likert-scale measures [e.g., ( ) not true at all, ( ) neutral, ( ) complete true], other forms, which could assist in the measurement and assessment of positive life characteristics, such as a perceived sense of spirituality (e.g., likert-scale rating of item: "i often experience a sense of spirituality for the unknown"), forgiveness (e.g., likert-scale rating of item: "i am a forgiving person"), benevolence (e.g., likert-scale rating of item: "i find it fulfilling to help others in the community"), etc. ii. develop a comparable framework, which we could perhaps use to cross-validate the described theoretical model as depicted in figure . researchers often use this methodological approach to cross-validate and establish psychometric properties of a likert-scale measure. in a similar vein, as one of our reviewers recently pointed out, our conceptualization of the spiritual and enlightened self may have relevance and applicability to the western context. in other words, in addition to buddhist teaching (yeshe and rinpoche, ; sheng yen, ) , it is plausible for us to consider the impact of other cultural and religious faiths, which could also initiate, instill, and facilitate a person's spiritual belief regarding life [e.g., christianity (davis, ; knitter, ; van der merwe, ) , hinduism (warrier, ; srivastava and barmola, ; goswami, ) , islam (nasr, (nasr, / bonab et al., ; marzband et al., ), etc.] . in a similar vein, resonating with the focus of our conceptual analysis, we contend that support for the study of positive psychology (gilham and seligman, ; seligman, ; seligman and csíkszentmihályi, ) could involve other cultural practices, religious faiths, and theoretical understanding. an important question then for consideration is whether and/or to what extent there is a central point of commonality between different cultural practices, religious faiths, and theoretical understanding, which in turn could support the paradigm of positive psychology and/or the teaching of life education. in this sense, is it plausible for us to establish some form of "convergence" in terms of commonalities of theoretical understanding between, say, christianity, buddhism, and islam? how does this convergence point, in particular, assist a person to appreciate, value, and/or understand the true meaning of life? by all accounts, we contend the possibility that there are contrasting and diverse viewpoints, resulting in dissimilarity and inconsistency with reference to the study of life education. for example, in terms of life wisdom, we note that hinduism also places emphasis on the notion of moksha, or the freeing of the samsāric cycle altogether (warrier, ) . spiritual enlightenment, the personal striving for inner discipline, and one's detachment from the external world at large may all assist a person to free himself/herself from the endless cycle of birth, death, and rebirth. social sciences research, as we mentioned, places emphasis on the topic of methodological appropriateness and the use of different methodological data collection techniques to gather evidence. some subject matters are relatively straightforward, relying on quantitative methodological approaches and robust statistical analyses. it is sound and possible, from our point of view, for researchers to consider their own teaching practices, professional and personal experiences, personal reflections and interpretations of life, and social interactions as "anecdotal evidence, " which could provide insights and theoretical understanding into the study of life education. for example, documenting our own experiences of meditation and teaching of mindfulness (hanh, ; chen, ; phan et al., a) has helped us to appreciate the importance of spirituality and the meaning of life wisdom as opposed to cognitive intelligence in a subject matter. continuing practice of buddhist meditation, in this sense, has encouraged and motivated us to engage in benevolent acts. by the same token, our anecdotal experiences, in tandem with our existing research and personal intuitions, have enabled us to develop different conceptualizations and theorizations of positive psychology (e.g., the theory of optimization) (phan et al., (phan et al., , a . researchers may adopt our lead and take a similar pathway, sharing with the academic community personal practices, experiences (e.g., esoteric experience), intuitions, etc. that could, likewise, assist in theoretical understanding of life education. having said this, however, we acknowledge that personal anecdotal evidence is non-scientific and contentious in nature, raising the question of validity, acceptance, and generalization. to a certain degree, the same point of acknowledgment also lends itself to the study of positive psychology, which has received relatively modest scientific evidence to date. on this basis, we encourage researchers to consider pathways, conceptualizations, methodological designs, etc. that could, similarly, help validate the paradigm of positive psychology. in this analysis, taking our cue, it is plausible to consider the 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comprehensive inventory of thriving (cit) and the brief inventory of thriving (bit) an introduction to confucianism wisdom energy: basic buddhist teachings inhabiting compassion: a pastoral theological paradigm we would like to extend our appreciation and gratitude to the editor and the two reviewers for their insightful comments. hp would also like to express his appreciation to the university of new england, armidale, australia for allowing him to undertake his sabbatical, which led to the preparation and writeup of this article. a special thank you to the national taipei university of education and, in particular, the department of education (especially, sc, lw, and wl) for hosting the first author's sabbatical. the authors declare that the research was conducted in the key: cord- - ndp ru authors: xu, pengbo; wu, di; chen, yuqin; wang, ziwei; xiao, wei title: the effect of response inhibition training on risky decision-making task performance date: - - journal: front psychol doi: . /fpsyg. . sha: doc_id: cord_uid: ndp ru response inhibition is an important component of executive function and plays an indispensable role in decision-making and other advanced cognitive processes. at the same time, we need an effective way to improve decision-making in the face of complex and limited information. this study mainly explored the influence of response inhibition training on college students’ risky decision-making. the recruited students were randomly divided into the training group (n = ) and the control group (n = ). the training group engaged in go/nogo and stop-signal tasks for weeks, while the control group was given the task of reading and summarizing popular science articles related to self-control. the stroop task and balloon analog risk task were used to evaluate the pretest and posttest performance in inhibitory control and risky decision-making tasks, respectively, for all subjects. the results showed that response inhibition training can be effectively transferred to interference control task performance. the results showed that both the reward acquired and adjusted balloon analog risk task score (adj bart) significantly improved compared to the pretest in the training group, while the control group showed no significant differences in the reward acquired and the adj bart between the pretest and the posttest. although response inhibition training increased risky behaviors in the balloon analog risk task, it substantially reduced overly conservative behaviors and participants gained more money. there are all kinds of risky decisions that we make in life. from daily shopping to financial investments, people always need to make choices with limited time and information resources. many studies have shown that people's decision-making is influenced by gender, individual characteristics, emotional states, cognitive abilities, irrelevant information, and so on (sun et al., ; stanovich, ; talukdar et al., ; weller et al., ) . however, little is known about whether a simple and an operational training method can effectively affect decision-making. in the dual-process theories of decision-making, system processes are often automatic, fast, and easily affected by emotion, while system processes are relatively slow and rational process, in which the most important function of system is the successful override of system (stanovich and west, ; evans and stanovich, ; stanovich, ) . moreover, the selection of alternative responses in the decision-making process also depends frontiers in psychology | www.frontiersin.org on the continuous effectiveness of regulatory control processes (moeller et al., ) . that is, to achieve better decision-making, it is necessary to continuously control their own dominant responses and irrelevant interference information, which is undoubtedly closely related to the ability of inhibitory control. the purpose of this paper is to determine whether primary cognitive training can effectively change high-level decisionmaking behavior. if the method of improving risky decisionmaking ability through primary cognitive training (such as inhibitory control) is proven and widely accepted, it will greatly advance the research process in the field of decision-making and will certainly provide a direction for future development. inhibitory control, one of the important components of executive function, is the ability to suppress irrelevant, interfering, incorrect or inappropriate goal-directed dominant responses, impulses, behavioral choices, and automatic behavioral habits (barkley, ; miyake et al., ; munakata et al., ; enge et al., ) . inhibitory control can be roughly divided into reaction inhibition and interference control; the former mainly focuses on the suppression of the dominant response, while the latter focuses on the suppression of irrelevant information. many studies have shown that inhibitory control plays an important role in verbal communication (bishop and norbury, ) , reading comprehension (wang and gathercole, ; potocki et al., ) , memory retrieval (depue et al., ; penolazzi et al., ) , and mathematical ability (gilmore et al., ) and is involved in other higher cognitive processes, such as problem-solving and decision-making (sakagami et al., ; shenoy and yu, ) . in addition, inhibitory control training can affect working memory and fluid intelligence (liu et al., ) , and there have already been some practical applications in controlling addictive behavior, losing weight, reducing diet consumption, and improving mental illness (houben, ; bartholdy et al., ) . therefore, inhibitory control can be considered a basic ability that people must have. the traditional view is that inhibitory control is an internal top-down execution process (aron et al., ). an increasing amount of research results shows that top-down implementation of frontal regions is not always necessary to inhibit control behaviors and the participation of these inhibitory regions can be automatically driven by specific stimuli (lenartowicz et al., ) . manuel et al. compared event-related potentials (erps) before and after auditory go/nogo task training and found decreased activity in the left parietal cortex (manuel et al., ) , suggesting that the repeated and stable association between the stimulus and inhibition response in the go/nogo task resulted in the gradual separation of top-down connectivity in the frontal lobe, thus facilitating rapid automatic inhibition. this is also the purpose of inhibitory control training, that is, training the slow thought suppression process into an automated, faster process. there are many disputes about whether there is a close relationship between performance in the inhibitory control task and the risky decision-making task. kertzman et al. ( ) used the performance on the go/nogo task, the matching familiar figures test (mfft), and the stroop task as indicator of inhibition ability and used the iowa task performance as an indicator of risk and found no direct correlation between the two (kertzman et al., ) . they suggested that although there is some overlap between inhibitory control and the cognitive processing of risky decision-making, they may represent two relatively independent abilities. this may have something to do with the limitations of the iowa gambling task itself. previous studies have demonstrated that short-term stop-signal task (sst) training can reduce risk-taking behavior in gambling tasks (verbruggen et al., ; stevens et al., ) . they designed a special training study and systematically studied the generalization model of promoting automatic inhibition and developing a top-down control inhibition training program. simply training people to control their exercise behavior induced them to make cautious and risk-averse decisions for at least h and the effect was comparable to that found in previous studies that used transcranial direct current stimulation (tdcs) to control risk (fecteau et al., ) . the previous studies examined only immediate changes after training and the decision task selection typically included a single task. on the basis of previous studies, we chose the balloon analog risk task that has strong operability with initial results that are relatively stable and we appropriately increased the time interval between cognitive training and posttest decision-making task assessment. after excluding the immediate effects of training, we wanted to demonstrate that classic response inhibition training can also effectively change performance in this task. it can make the response suppression training more stable, more generalizable, and more convincing for improvements in risky decision-making. this paper proposes a hypothesis: classic response inhibition training can reduce risk behavior in the balloon simulation risk task, thereby resulting in more rewards. a total of university students were randomly divided into a training group ( men and women; mean age = . years, sd = . ) and a control group ( men and women; mean age = . years, sd = . ). there was no significant difference in age between the two groups [t ( ) = . , p = . ]. subjects were included based on the following inclusion criteria: they were - years old, physically and mentally healthy, right-handed, with normal vision or correctedto-normal vision, and had not participated in other relevant psychological experiments. the exclusion criteria were as follows: neurological disorders, alcohol or other substance abuse or overdependence, mental illness, and treatment with any psychotropic substance. the training process in our experiment is all person-by-person training. under the condition of limited manpower and financial resources, the workload of these subjects is close to the maximum. however, post hoc power calculation is calculated by gpower . . . with a sample size of participants, a significance level of % and an effect size of . . the calculated power value is . , proving that the sample size is sufficient. this research was approved and strictly implemented the recommendations of the local ethics committee. all subjects were given detailed experimental instructions and agreed to participate in the experiment. then, they signed the informed consent in accordance with the declaration of helsinki and were entitled to a certain payment after the experiment was completed. the training group adopted the go/nogo task and sst as training tasks that were presented using e-prime . . all experiment started with a short practice phase to make sure that the subjects understood the rules of the task completely. all training tasks were completed in the laboratory over a total of weeks. the two groups were assessed with the stroop task and the balloon analog risk task to evaluate the pretest and posttest performance on inhibitory control and risky decision-making tasks at weeks and . in the intervening weeks in the training group, two classic paradigms were simultaneously used and cross trained. the whole training schedule consisted of -min sessions, three times per week. during each training session, the two tasks alternated twice. in this study, two kinds of response inhibition training tasks were adopted. on the one hand, to increase the generalization effect of training, the inhibitory control ability was improved by automatic inhibition and top-down control inhibition (spierer et al., ) . on the other hand, with this kind of pure training, the more obvious the training boost will be and the more likely that the change in gambling task performance was due to improved inhibitory control. the control group read popular science articles related to self-control and were required to complete a task of summarizing the articles. the time and frequency for this task were consistent with the cognitive training of the training group. there were double triangles ("go") and single triangles ("nogo") used as stimuli in the task. the participants had to make a button-press response to the double triangle and inhibit their response to the single triangle. go and nogo stimuli were randomly presented in a : ratio. all stimuli were presented for ms in the center of the screen with a , ms interstimulus interval. the experimental phase consisted of go stimuli of trials and nogo stimuli of trials. there was a pause at the halfway point of this task and the participants could take a break or press any key to continue the experiment. the optimal performance of the task is to minimize the response time and the number of errors (the sum of the number of omission errors and commission errors). the task is the classic response inhibition task paradigm that has been widely used and is also recognized as a method that reflects inhibitory control abilities in a relatively simple and pure way (congdon et al., ; wostmann et al., ; enge et al., ) . the participants were required to press the "f " or "j" key when the "f " or "j" letter (go signal), respectively, appeared, and during a relatively low proportion of trials ( %) with obvious red dots (stop signal) appearing after the go signal, to immediately suppress the impulse to press the button. the task consisted of trials, including no-stop stimuli and stop stimuli. the center of the screen shows a fixation point (+) of ms before all the stimuli appear, and there is a , ms interval after the button response. in the no-stop stimulus, the most presentation time of the go signal was , ms. if the subject does not press the button in time, the screen will show "too slow". in the stop stimulus, the stop signal will appear later than the go signal and the stimulus presentation time is still , ms at most. if the subject does not immediately suppress the key, there will also be an interval of , ms. the difference between this task and the go/nogo task is that each stop signal is preceded by a reaction impulse and the clever experimental design allows a measure of behavioral inhibition time (verbruggen and logan, ; verbruggen et al., ; i.e., stop-signal reaction time, ssrt). the tracking method was used to automatically adjust the time when the stop signal appeared (i.e., stop-signal delay, ssd) and the initial value was set at ms. when the inhibition was successful, the ssd increased by ms, while the inhibition failed, and the ssd decreased by ms to ensure that the successful inhibition rate of the subjects was approximately equal to %. then, the ssrt value can be calculated (ssrt was equal to the average go reaction time minus the average ssd). the stroop task, which is commonly used for inhibitory control and relatively complicated in processing, was used to evaluate the ability of stimulus interference to inhibit or selectively focus on target-related stimuli (turner et al., ) . the participants were asked to select the corresponding key according to the four colors of red, blue, green, and yellow fonts. all stimuli were presented for ms followed by fixation point (+) for ms and there was a , ms interval after the subject responded. the task consisted of trials. four colors and four fonts were randomly matched and presented (every font was matched with four different colors, so that the ratio of consistent trials to inconsistent trials was : ) and consistent and inconsistent response times (rt) were recorded. the conflict effect (incongruent trials rt -congruent trials rt) and conflict score (conflict effect/congruent trials rt) were calculated to evaluate the two groups before and after the inhibitory control ability training (maraver et al., ) . the balloon analog risk task was used to evaluate risky behaviors and is a decision-making task that can effectively simulate realistic risky behaviors that are relatively stable under laboratory conditions (lejuez et al., ) . the experimental programming of this task was based on computer programming (c++) prepared and rendered on the computer screen. the participants can make money by inflating the balloon with a click of the mouse (earning yuan per inflation, which was included in the temporary account), but if the balloon bursts, they lose the money they made during the round (the temporary account). at the same time, the participants can choose to stop the pump at any time and the temporary account is transferred into the permanent account. each balloon is blown between and times and there is a predetermined explosion point (randomly set by the computer). the participants were asked to conduct balloon trials to make money and were given the sum from their permanent accounts for the balloon trials. the only way to make money is to stop the balloon before it explodes. the subjects were also told that the goal was to inflate the balloon as large as possible without exploding to maximize the benefit. the final benefit of each subject was recorded and average adjusted pumps (i.e., adj bart; adj bart = total number of unexploded balloon pumps/number of unexploded balloons) was calculated to measure the performance and impulsivity in the task. first, a curve was drawn between the performance in the two tasks in the training group and the training time. then, two independent sample t-tests were conducted on the pretest values of the stroop task and balloon analog risk task for the two groups and no significant difference was found between the two groups at pretest. because the experiment adopted a mixed design with between-and within-subjects factors, mixed-model anovas of (control group and training group) × (pretest and posttest) factors were used to evaluate the transfer effect of response inhibition training to stroop performance and its impact on balloon analog risk task performance. finally, we further analyzed the correlation between the initial threshold and the change amount of the training group. since both tasks were completed twice in one training session, we took the average of the two as the performance for that training session. repeated-measures anovas were conducted to compare the performance in the first session with that of the sixth session. as shown in figure , both go rt and ssrt were gradually reduced from the first to the last training session in their respective tasks and the differences reached statistical significance [go rt: f ( , ) = . , p < . , η = . ; ssrt: f ( , ) = . , p < . , η = . ]. in the two tasks, the error rate did not significantly change from the first to the sixth training session [go/nogo task: f ( , ) = . , p = . , η = . ; sst: f ( , ) = . , p = . , η = . ; figure ]. however, there was a downward trend in the go/nogo task, especially across the first four training sessions. the pretest conflict effect [t ( ) figure , we also found a significant time × group interaction effect [conflict effect: f ( , ) = . , p = . , η = . ; conflict score: f ( , ) = . , p = . , η = . ]. through simple effect analysis, two groups of effects were obtained. the conflict effect and conflict score in the training group after training were significantly lower (p < . ), while no significant difference between pretest and posttest performance was found in the control group [conflict effect: f ( , ) = . , p = . , η = . ; conflict score: f ( , ) = . , p = . , η = . ; table ]. the inhibitory control ability in the training group was improved compared with that of the control group because of the training. frontiers in psychology | www.frontiersin.org july | volume | article as shown in figure , there was no significant difference between the two groups in the pretest adj bart [t ( ) we further analyzed the correlation between the initial threshold and the change in the training group and found a significant negative correlation (reward: r = − . , p < . ; adj bart: r = − . , p < . ; figure ). the results indicated that adj bart and reward acquired by the training group after training significantly increased compared with that before training. moreover, the subjects with lower pretest indexes had a greater range of changes through training. from the results of the whole experiment, we not only improved the performance of the training task through weeks of response inhibition training (go/nogo and stop-signal tasks), but also more importantly, we found the migration effect of training in the untrained stroop task and balloon analog risk task. the fact that inhibition control plays an important role in people's complex decision-making process has been verified. there was a gradual improvement in the performance of the training group in two classic response inhibition tasks. the error rate in the go/nogo task (the ratio of the sum of omission errors and commission errors) showed a downward trend over the first four training sessions and increased in the later sessions. moreover, it can be seen from the results of the last two training sessions that the task response decreased while the error rate increased. this may have been because the participants were too reactive, which sometimes led to a rebound in error rates. in the later sessions, there was a gradual balance between the reaction time and the error number, and finally, it tended to be stable. therefore, although the error rate during the last four training sessions showed a slight upward trend, the overall response time showed a downward trend and an obvious training effect could still be seen. the error rate in the sst refers to the proportion of errors in the go response, not the proportion of suppression failures. the low error rate during the first exposure may have been due to the relatively small allocation of cognitive resources in the process of inhibition. with the increase in the allocation of cognitive resources in the inhibition process, the accuracy of keystrokes is ignored and the error rate changes little or slightly increases. however, we can still see the improvement in task performance from the trend in the ssrt scores. there was a significant difference in the effect of the two kinds of training, and it was also found that the pursuit of reaction speed might lead to a decrease in accuracy in the later periods of training, and eventually, the two tended to stabilize. in addition, enge et al. also found that in the latter stage of training in the sst, ssd and mean go reaction time were simultaneously reduced, which would eventually lead to the reverse increase in ssrt (enge et al., ) . in this experiment, this phenomenon occurred in some subjects, but the overall trend was not found. lower conflict scores in the stroop task in the training group after training suggested that response inhibition training could be transferred to interference control. this also showed that the two classic response inhibition task training methods are effective. friedman and miyake used latent variable analysis to demonstrate that almost all inhibition tasks have a common inhibitory control mechanism (friedman and miyake, ) . although brydges et al. ( ) later used erp technology to show that the two tasks engaged two different cognitive components (brydges et al., ) , they were still closely related, and performance could be transferred (maraver et al., ) . from the adj bart in the balloon analog risk task, it can be concluded that the training of response inhibition led to an increase in the subjects' risky behaviors, which seems to contradict our hypothesis. however, at the same time, the reward acquired in the task increased after the training. according to the value gained by pumping up the balloon and the probability of explosion, the value of the first rounds of pumping is greater than the value of the nonpumping rounds. it is not until the seventeenth turn that pumping up the balloon becomes irrational (lejuez et al., ) . therefore, from the perspective of profits obtained, the subjects were too conservative to avoid balloon explosion, thereby losing the chance to win more money before training. this also explained our increased risk-taking behavior and benefits after training. we therefore suggest that the key decision for balloon analog risk task is not to inflate (this is a continuous process) but to decide when to stop inflating and put the contents of the temporary account into the permanent account. only by making a rational decision to stop inflating (properly suppressing decisions that are too early or too late) can the maximal amount of reward be obtained. each inflation is actually equivalent to a go reaction, and it is the ability of response inhibition that is needed as the basis for the critical and appropriate stopping of inflation. the results of increasing risk-taking behaviors in this paper were inconsistent with those of the previous study (verbruggen et al., ) . although many gambling tasks are task paradigms for evaluating risky decision-making, different tasks represent different risky decision-making processes (buelow and blaine, ) . the stopping of inflation in the balloon analog risk task may be more related to the ability to response inhibition, which may also have contributed to the inconsistent results across different tasks. we further analyzed the significant negative correlation between the initial threshold and the change amount in the training group and found that the lower the initial value was, the more significant the improvement. this suggested, to some extent, that people with lower initial values were more likely to improve (schmaal et al., ) . therefore, we should probably focus more on the lower level of the population, where the limited training intensity could achieve a higher training effect. there are many other factors that affect inhibitory control training. it is widely recognized that emotion and motivation affect cognitive inhibition processes, higher decision-making processes, and other neural or psychological functions (padmala and pessoa, ; turner et al., ) . in the traditional sense, it is considered that subcortical structures, such as the amygdala, ventral striatum, and hypothalamus, are mainly responsible for processing emotions and behaviors, while cortical structures, such as the dorsolateral prefrontal cortex and anterior cingulate cortex, are responsible for activating cognitive control and higher executive functions (pessoa, ) . therefore, appropriate incentives and positive feedback will effectively improve the training effect of the subjects. in addition, some studies failed to achieve transfer effects of training (enge et al., ; zhao et al., ; kable et al., ) , which may be because the differences were not significant due to the insufficient number of subjects or the training time and intensity did not reach the threshold needed to transfer tasks (kable et al., ) . as shown in figure , there were also some subjects with opposite results, but this pattern of results were mainly concentrated in those with higher starting values. if the primary group chosen were primarily high-level people, then grouplevel indifference would be inevitable. therefore, the initial level of grouping will also affect the training effect. the basis for improving decision-making through training in response inhibition is brain plasticity (i.e., a change in behavior and its underlying brain anatomy based on experience; spierer et al., ) . these changes can facilitate the acquisition of new skills, the improvement of acquired abilities, and the recovery of defective or impaired functions (kelly and garavan, ) . changes in behavior and brain plasticity induced by training have been demonstrated at different levels of executive function. research has shown that people's inhibitory control ability is closely related to the inferior frontal gyrus and dorsolateral prefrontal cortex (aron et al., ) . at the same time, these brain regions also play an important role in risky decision-making tasks (chiu et al., ) . during the training of the inhibitory control tasks, the corresponding brain regions will be repeatedly activated and the connections between the corresponding brain regions will be increased, which will inevitably affect the neural connections in the decisionmaking process. although there is no neuroscientific evidence, it is likely that this is one of the important reasons that response inhibition training changes subsequent performance in decision-making tasks. the results of the control group also showed that reading about self-control skills alone was not enough to improve the participants' inhibitory control skills, which also reflected the need for cognitive training of response inhibition. first, the selection range of the subjects was relatively limited, leading to limited generalization. second, the training time was short, and there was no long-term tracking due to the effect of novel coronavirus, so the duration of the transfer effect cannot be determined at present. third, the degree of improvement in the balloon analog risk task performance in the training group was relatively limited, which may also be related to shorter training time and lower intensity. fourth, as the training group needs to spend a lot of time in the whole training process, our subjects may be potentially inadequate. the problem of subject size is also a shortcoming of most cognitive training studies. because of this, slight differences in some experimental conditions may lead to different migration outcomes or no migration effects between many similar training studies. in addition, for the measurement of inhibitory control and risky decision-making, a variety of evaluation indicators should be used, such as questionnaires, behavioral observation, and imaging techniques such as erps and magnetic resonance imaging (mri), rather than cognitive task paradigms on computers. a single score from the inhibition task or risky decision-making task cannot represent the complex control processes that may be correlated with each other, so it is necessary to use multiple tasks to evaluate the inhibitory control ability and risky decision-making (dougherty et al., ) . this study confirms that classic response inhibition training can increase risk-taking behavior in the balloon analog risk task, improve their overly conservative behaviors, properly inhibit them to obtain more benefits, and substantially increase economic rationality. during the whole experiment, various experimental conditions were strictly controlled and the training and transfer effects were statistically significant. it is particularly important that compared with inhibiting the near transfer between control tasks, the risky decision-making task can be considered a far transfer (crespi et al., ) and this experiment is a good attempt at selecting a cognitive training far transfer task. research on the transfer effect of inhibitory control training to higher cognitive function and the tracking of training will also become the focus of future research in this field. however, at the same time, we 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differences reliability and plasticity of response inhibition and interference control wesley says": a children's response inhibition playground training game yields preliminary evidence of transfer effects key: cord- -kdjgu q authors: spinelli, maria; lionetti, francesca; pastore, massimiliano; fasolo, mirco title: parents' stress and children's psychological problems in families facing the covid- outbreak in italy date: - - journal: front psychol doi: . /fpsyg. . sha: doc_id: cord_uid: kdjgu q objectives: the present study aimed to explore the effect of risk factors associated with the covid- outbreak experience on parents' and children's well-being. methods: parents of children aged between - and -years-old completed an online survey reporting their home environment conditions, any relation they had to the pandemic consequences, their difficulties experienced due to the quarantine, their perception of individual and parent-child dyadic stress, and their children's emotional and behavioral problems. results: results showed that the perception of the difficulty of quarantine is a crucial factor that undermines both parents' and children's well-being. quarantine's impact on children's behavioral and emotional problems is mediated by parent's individual and dyadic stress, with a stronger effect from the latter. parents who reported more difficulties in dealing with quarantine show more stress. this, in turn, increases the children's problems. living in a more at-risk area, the quality of the home environment, or the relation they have with the pandemic consequences, do not have an effect on families' well-being. conclusions: dealing with quarantine is a particularly stressful experience for parents who must balance personal life, work, and raising children, being left alone without other resources. this situation puts parents at a higher risk of experiencing distress, potentially impairing their ability to be supportive caregivers. the lack of support these children receive in such a difficult moment may be the reason for their more pronounced psychological symptoms. policies should take into consideration the implications of the lockdown for families' mental health, and supportive interventions for the immediate and for the future should be promoted. on th of january , who declared a public health emergency of international concern after the first clusters of people infected by covid- were diagnosed in china (who, ) . the day after, the italian government started to define the first containment measures, such as checking people entering the country from china, in order to prevent the expansion of the contagion in the country (government, ) . however, from the second half of february the number of italian cases increased, especially in northern italy. this led the government to announce on february st the first restrictive measures in what was defined as the first red zone, including defined territories in the regions of lombardia and veneto, the areas most affected by the infection. since the pandemic kept spreading around the country, the prime minister issued on march th a decree which extended to the entire national territory the restrictions already in force locally. the rules were supposed to last until april rd, but were extended by two more decrees firstly until april th and, later, until may rd (government, ) . at the time of writing (april th, ), there were in italy , confirmed cases and , deaths, more than half of which occurred only in lombardia and veneto. when the data of the present study were collected (between the nd and the th of april), those numbers were still increasing, showing that the end of the pandemic is still a long way off. the measures, known as #iamstayingathome (#iorestoacasa), include the closure of shops, except those selling crucial necessities, the cancellation of all sports events, and the shutdown of schools and universities across the country (government, ) . with schools, all the educative supporting services directed to children of all ages were closed, with teachers from primary grade onwards providing online lectures. quarantine began for the entire population; everyone was banned from leaving home except for non-deferrable and proven work or health reasons, or other urgent matters. smart working has been incentivized, but since most activities are closed many people lost their job or went through a severe reduction of their income. the life condition of families suddenly and deeply changed. in the home environment, the educational role of parents for children has become even much crucial than before. children have only their parents around them, to provide support with homework when necessary and promote a positive development and new learning experiences for toddlers and preschoolers . parents have been left alone not only in taking care of home-schooling their children, but also in general in the management of their children and of the home environment. all other educational services are closed, babysitters and grandparents are not available, and contact with peers is not allowed. many parents also must do smart-working, and handling time and spaces to work with children around may be very problematic. though quarantine means that time that can be shared with loved ones has increased, it also poses a major burden on parents' shoulders, as they are called to take an educational role while also trying to live their own lives and get on with their everyday job commitments. this situation has significantly increased the risk of experiencing stress and negative emotions in parents, with a potentially cascading effect on children's wellbeing (sprang and silman, ) . hence, despite its positive effect in reducing the number of new infected cases, the mobility restriction and social isolation abbreviations: sdq, strengths and difficulties questionnaire; psi, parenting stress index short form. associated with quarantine are major concerns for families' psychological wellbeing. related to this, the health care situation of the country is fragile, calling for attention. hospitals are overcrowded, and the number of deaths is still increasing, as well as the number of infected people and those recovering in hospitals (government, ) . it is becoming very common to know at least one person who tested positive to covid- or was hospitalized, and, most regretfully, to have experienced the loss of a person due to covid- . this might generate fear and preoccupation in parents and children, even for families who do not have to face health problems . literature concerning previous experiences all over the world that may have some aspects in common with the covid- situation reported a high presence of psychological distress such as depression, stress, irritability, and post-traumatic stress symptoms associated with quarantine (hawryluck et al., ; brooks et al., ) with long-lasting effects continuing for years after the event (liu et al., ) . the majority of studies conducted during previous pandemics and from the beginning of the covid- outbreak examined psychological consequences on the general population, leaving the study of effects on parents and children mainly unexplored, with few exceptions (brooks et al., ) . one study found that levels of post-traumatic stress were four times higher in children who had been quarantined than in those who were not (sprang and silman, ) . a preliminary study conducted in china reported the presence of psychological difficulties in children during the covid- pandemic, with fear, clinging, inattention, and irritability as the most severe symptoms for younger children (jiao et al., ) . still, mechanisms that might explain what specific covid- related risk factors put children more at risk of negative outcomes, and what is the interplay between covid- lockdown and parents' wellbeing on children's adjustment, have not been investigated yet. a deeper understanding of family processes, protective factors, and risk factors in the home environment might be important if the wellbeing of children is to be promoted in these difficult times . the present study wants to shed light on families' well-being during the covid- outbreak in italy, by exploring parents' and children's individual and dyadic adjustment after one month of quarantine. understanding parents' and children's reactions and emotions, and identifying risk and protective factors, is essential to properly address their needs to tailor present and future intervention programs (sprang and silman, ) . in general, little is known about which factors may be associated with protection against child behavioral and emotional problems during a health emergency. in order to fill this gap, the main aim of the present study was to explore how pandemicrelated variables, structural aspects of the home and family environment, and parental subjective experience of stress and adjustment to the quarantine, affect the wellbeing of parents and children, and how in turn the well-being of parents and children are associated. specifically, we explored both individual parent stress and dyadic perception of stress since it is well-know that both levels of stress may impair children's well-being (belsky, ; abidin, ; madigan et al., ; martin et al., ) . we expected that implications of the covid- outbreak might increase parents' psychological difficulties, particularly stress both at the individual and the dyadic level, with a consequent negative impact on children's emotional and behavioral wellbeing (dalton et al., ) . parents filled out an anonymous online survey, after reading the written consent form and explicitly agreeing to take part in the study. the survey was shared via social media for a limited time (from april nd to th, ), targeting parents of children aged -to -years-old. in the case of multiple children, the parent was asked to report on one child only. all the questionnaires, both parent-and child-related, were completed by the parent. there was no monetary compensation for participating. the final sample providing information on all study variables consisted of parents living in italy, of which were mothers (mage = . ( . ) ( % of whom had a high school degree or less, % a bachelor's or master degree, and % a higher education degree) and were fathers (mage = . ( . ) ( % of whom had a high school degree or less, % a bachelor's or master degree, and % a higher education degree). children's mean age was . ( . ); were boys. a total of parents were resident in the north of italy where most covid- cases, were registered i.e., lombardia and veneto (from now on defined as the red area). data reported in this study are part of a wider longitudinal research project designed with multiple purposes related to the investigation of the psychological impact of the covid- outbreak in italian parents and children. the study was approved by the ethical commitment of the department and was conducted according to the american psychological association guidelines in accordance with the helsinki declaration. an ad-hoc index was computed to evaluate the amount of contact the parent had with people directly affected by the virus, following the assumption that the greater the number of contacts, and the closer the people affected by covid- that the parent knows are to the parent, the greater the impact on psychological wellbeing would be. one point was given for each of the following if present: the parents tested positive for the virus, a familiar or close friend tested positive, a familiar/close friend was hospitalized, a familiar/close friend died. a half=point each was given if the parent knew a person (not familiar or close friend) who tested positive, was hospitalized, or died. an ad-hoc risk index was computed to evaluate the house and family situation, including factors supposed to be related to the quality of life condition. one point was given for each of the following: loss of job due to the pandemic, absence of external spaces (balcony or garden), total family income less than e per month, only one adult in the house in charge of the child, no wi-fi, no pets. to compute the index, this score was summed with the number of rooms/number of people ratio in the house. difficulties experienced by parents during the quarantine were investigated with a newly developed pool of items. parents were asked to indicate, using a -point likert scale, how difficult they were perceiving, during the last week, dealing with several aspects related to the quarantine such as finding a relaxing space alone to unplug, time for the partner and for kids, and to do activities such as sport, reading, cooking, etc. (see appendix for the full list of items). cronbach's alpha was . , with % cis [ . - . ]. perception of parent's stress in the parent-child interaction was investigated using the items parent/child dysfunctional interaction domain of the parenting-stress index short form (psi) (abidin, ) . the scale investigates with a -point rating scale the extent of parents' agreement or disagreement with statements describing the parent-child relationship as difficult to manage. cronbach's alpha in the current study was . , % cis [ . - . ]. parent's individual perception of stress was investigated using the items from the stress subscale of the depression anxiety stress scale-short form (dass) (lovibond and lovibond, ) . the scale provides on a -point rating scale a measure of individual symptoms indicating stress i.e., irritation and agitation. to obtain the total score, items are summed. cronbach's alpha in the current study was . , % cis [ . - . ]. behavioral and psychological problems in children were investigated using the parent-report form of the strengths and difficulties questionnaire (sdq) (goodman, ) . the current study focuses specifically on the following subscales: emotional symptoms, hyperactivity-inattention, and conduct problems. each subscale is measured by items, rated on a -point scale. to obtain the total scores, items are summed. cronbach's alpha in the current study were as follow: . first, descriptive statistics and bivariate correlations among study variables were presented. afterwards, two multivariate mediation models were tested, including as a predictor relevant quarantinerelated risk factors (derived from the correlational analysis), as a mediator parents' stress (in one model dyadic parenting stress was explored as the candidate mediator, in the other model it was individual stress) and as outcomes children's psychological problems at the sdq. mediation models were compared with a with a null model and a main effect model, including only quarantine-related risk factors as the predictor. akaike weights, providing the probability of a model to support new data conditional on the set of models considered, were used for model comparison (wagenmakers and farrell, ) . parameters were investigated for the best fitting model. finally, as a followup analysis, we explored whether results were comparable distinguishing between parents' living in the red area (including lombardia and veneto regions) with the rest of the sample. to this aim, we performed a multi-group analysis. analyses were run using the statistical software r (team, ) , lavaan package (rosseel, ) . plots were depicted using package ggplot . means, sds, and correlation values among variables of interest are reported in table . due to the large sample size, correlation values above . (i.e., trivial in effect size) were significant at p < . ; thus, for interpreting effects, we considered the strength of the association (namely pearson's r) as an effect size. results showed that overall there were no relevant associations of covid-contact risk index and home environment risk index with dyadic parenting stress (psi), parent's individual stress (dass), and children's psychological problems (sdq). because the only risk factor associated with parent's individual and dyadic stress and children's psychological problems was the quarantine parent risk index, we did not include in the model the home and covid risk indices. thus, models tested had as a predictor the quarantine parent risk index, as the candidate mediator parent stress (dyadic and individual), and as outcomes children's emotional and behavioral problems. for both the model including dyadic parenting stress as a mediator and individual stress as a mediator, the mediation model outperformed the null and main-effect regression model. specifically, for the model including dyadic parenting stress as a mediator, akaike weights were lower than . for both the null and the main effect model, and very close to . for the mediation model. the same weights were obtained for the comparison with the mediation model including individual stress. standardized estimates of the two mediation models are reported in figures , . parameters for indirect effects and proportion of variance explained for each outcome variable for the investigated models are reported in table . because of the significant association between study variables and age, we ran the analyses again, including the effect of the child's age on the mediator and outcome variables. results remained stable overall. with a multi-group analysis, we finally explored whether results were comparable for residents in the red area (lombardia and veneto) vs. other regions. no relevant differences were identified. results are available upon request to the corresponding author. the covid- outbreak is a completely new and unexpected situation currently affecting many countries. italy was, after china, the second most highly affected country at the time, with the pandemic spreading very fast. in just a few weeks, the population found itself from thinking that the pandemic was happening far away, to being directly involved (government, ) . the closure of schools and the decision to keep children locked at home was obvious, but the consequences of all this for families' well-being were barely considered. our study is the first to examine the impact of the covid- outbreak on parents' and children's wellbeing. we explored bivariate associations among the environment, family, and covid- outbreak-related factors on parents' stress and children's psychological problems, and the interplay among these variables. results showed that factors such as living in a more at-risk contagion zone or being in closer contact with the virus' effects do not relevantly affect parents' and children's well-being. this confirms findings from a preliminary study in china, where the difference in children's symptoms between areas identified by different levels of epidemic risk was not statistically significant (jiao et al., ) . similarly, the quality of the environment, such as the physical characteristics of the living space, is not associated with parents' and children's psychological symptoms. yet, it is the parents' individual perception of the situation, and more specifically how difficult they find it dealing with the many stresses the quarantine imposes, that is significantly associated with parent's stress and children's psychological problems, and that indirectly impacts on children's behavioral and emotional problems through the mediating role of parent's stress. parents who report finding taking care of their children's learning, finding space and time for themselves, the partner, the children, and for the activities they used to do before the lockdown more difficult, are more stressed. this confirms studies that found an effect of the limitations associated with quarantine on the well-being of adults (brooks et al., ) . we further add to the literature that this stress is experienced both at the individual (e.g., being over-reactive, feeling nervous and irritated) and at the dyadic level (e.g., finding it difficult to enjoy interactions with the child, and child behavioral and emotional expressions). in addition, we pointed out that it is this stress that significantly impacts on children's well-being. hence, it is mainly when the strains of quarantine affect the ability of the parent to enjoy and appreciate the parent-child relational experience that the consequential negative impact on the child's well-being is stronger, a result with important implications for informing intervention programs that target the family and the child. moreover, this impact is present at every age, even though our age range is quite wide. this underlines that the impact of the lockdown on parents and children is present with similar mechanisms for families with children younger than years. the effect we identified in our study may be explained in many ways. more stressed parents find it more difficult to understand their child's needs and to respond in a sensitive way (abidin, ; scaramella et al., ) . stress is often associated with rude behaviors and difficulties in explaining limits and discipline. thus, children in these families may feel less understood by their parents and may react in more negative and aggressive ways (pinquart, ) . moreover, we know that children have lower personal resources to deal with the many changes the pandemic is imposing on their life and guidelines suggest parents should discuss and explain the situation with them, since correct information about what is happening and the reasons for the restrictions children have to face is crucial to prevent negative psychological consequences (dalton et al., ) . however, how and when to do that is completely left up to the parents' choice. we can speculate that more stressed parents may be too overwhelmed by the situation to find appropriate ways to be a supportive figure for their children and to find the best ways to address children's questions and fears (digiovanni et al., ) . when children do not find responsive answers to their preoccupations from adults, they may show more distress, evidenced by more emotional and behavioral problems as well as inattention and difficulties in concentrating. these results suggest many interesting implications that should be addressed in the present and in the future in italy, and in all countries involved in the pandemic, if we want to promote children's wellbeing, and prevent the onset of more severe behavioral and emotional problems. the pandemic and the quarantine associated with it require using personal resources to deal with everyday life and fears and worries. correct information and guidelines have to be given to adults about how this stressful situation may affect their personal and children's wellbeing. public health should provide parents with knowledge about, for instance, how children at different ages express distress and the importance of sharing and talking about fears and negative emotions (dalton et al., ) . in this way even less resilient and more stressed parents may be helped in finding ways to understand and support their children (belsky, ) . the closure of schools may have also contributed to this phenomenon. firstly, because parents are left alone dealing with their children's education and learning, this may be a very challenging duty. moreover, teachers have a role not only in delivering educational materials but also in offering an opportunity for children to interact, and to receive from them support and explanations. organizing online courses in a way to also improve the possibility for children to interact with their teacher about things outside of the learning context should be a priority especially if school closures are to be prolonged. moreover, the government should take into consideration the impact of school closures on parents by finding ways to help them deal with the learning experience of children and with having children at home / , while parents also have to manage homeworking and childcare. this is going to be even more relevant if, during the second phase of the emergency, job activities will re-open, and parents will be asked to go back to work, but schools will be kept closed. how are parents supposed to deal with this? some limitations of the present study should be addressed. firstly, this is a correlational study; a longitudinal exploration of the effects of quarantine on parents and the cascading effects on children over time would help in better understanding the phenomenon. moreover, we have collected children's psychological symptoms from parent reports; although this data collection method is widely used it may be less informant than child reports or direct evaluation of children's well-being made by experts. lastly, we may expect that quarantine risk is higher for more at-risk families i.e., families of separated parents, families with children with disabilities, very poor families, etc. the exploration of the phenomenon with those in at-risk situations would help in developing more tailored interventions. if properly supported by healthcare professionals and other social connections, including the school environment, parents and children can appropriately overcome this critical period of distress and avoid severe long-term consequences. quarantine and social distancing are efficient ways to deal with the pandemic, but these experiences may have consequences on people's wellbeing. however, the media and public institutions concentrate primarily on physical health to recommend steps for the prevention and containment of the disease, leaving the impact on mental health undiscussed. indeed, stable mental health is one of the keys to fight this ongoing pandemic and to restore a post-pandemic society; the well-being of parents and children must be under surveillance since problems on this side may have long-lasting implications. as bowlby suggested years ago, "man and woman power devoted to the production of material goods counts a plus in all our economic indices. man and woman power devoted to the production of happy, healthy, and self-reliant children in their own homes does not count at all. we have created a topsy-turvy world" (bowlby, ) . the raw data supporting the conclusions of this article will be made available by the authors, without undue reservation. the studies involving human participants were reviewed and approved by department of neuroscience, imaging and clinical sciences. the patients/participants provided their written informed consent to participate in this study. ms, fl, and mf conceptualized the study and organized the data collection. ms and fl wrote the first draft of the manuscript. fl and mp run the analyses and wrote the results section. all authors contributed to revision of the final version of the manuscript. the determinants of parenting behavior the parenting stress index professional manual the determinants of parenting: a process model a secure base: parent-child attachment and healty human development the psychological impact of quarantine and how to reduce it: rapid review of the evidence protecting the psychological health of children through effective communication about covid- factors influencing compliance with quarantine in toronto during the sars outbreak psychometric properties of the strengths and difficulties questionnaire italian government: measures to face the coronavirus covid- sars control and psychological effects of quarantine behavioral and emotional disorders in children during the covid- epidemic mental health considerations for children quarantined because of covid- depression after exposure to stressful events: lessons learned from the severe acute respiratory syndrome epidemic manual for the depression anxiety stress scales ( nd a meta-analysis of maternal prenatal depression and anxiety on child socioemotional development associations between child sleep problems and maternal mental health in children with adhd associations of parenting dimensions and styles with externalizing problems of children and adolescents: an updated meta-analysis lavaan: an r package for structural equation modeling and more. version . - (beta) a test of the family stress model on toddler-aged children's adjustment among hurricane katrina impacted and nonimpacted low-income families posttraumatic stress disorder in parents and youth after health-related disasters package: splines, r: a language and environment for statistical computing. r foundation for statistical computing the strengths and difficulties questionnaire-parents for italian school-aged children: psychometric properties and norms aic model selection using akaike weights mitigate the effects of home confinement on children during the covid- outbreak key: cord- -z rupgfo authors: di crosta, adolfo; palumbo, rocco; marchetti, daniela; ceccato, irene; la malva, pasquale; maiella, roberta; cipi, mario; roma, paolo; mammarella, nicola; verrocchio, maria cristina; di domenico, alberto title: individual differences, economic stability, and fear of contagion as risk factors for ptsd symptoms in the covid- emergency date: - - journal: front psychol doi: . /fpsyg. . sha: doc_id: cord_uid: z rupgfo on january th , the world health organization (who) declared the covid- pandemic a public health emergency of international concern (pheic). italy has been one of the most affected countries in the world. to contain further spread of the virus, the italian government has imposed an unprecedented long-period lockdown for the entire country. this dramatic scenario may have caused a strong psychological distress, with potential negative long-term mental health consequences. the aim of the present study is to report the prevalence of high psychological distress due to the covid- pandemic on the general population, especially considering that this aspect is consistently associated with ptsd symptoms. furthermore, the present study aims to identify the risk factors for high ptsd symptoms, including individual differences and subjective perception of both economic and psychological aspects. we administered an online survey to participants during the peak period of the contagion in italy. a logistic regression on the impact of event scale – revised (ies-r) scores was used to test the risk factors that predict the possibility to develop ptsd symptoms due to the covid- pandemic. gender (female), lower perceived economic stability, higher neuroticism, and fear and consequences of contagion were predictors of high ptsd symptomatology. the results, highlighted in the present study, extend our understanding of the covid- pandemic’s impact on the population’s mental health, by identifying individuals at high-risk of developing ptsd. this may help with the implementation of specific protocols to prevent the possibility of developing symptoms of ptsd in target populations. coronavirus disease arises from sars-cov- , which is an infection that affects the lower respiratory tracts (ashour et al., ; wölfel et al., ) . specifically, covid- symptoms range from asymptomatic infections to mild-severe respiratory symptoms, often accompanied by fever and dry cough, and in some cases, a severe lethal form of pneumonia, acute respiratory distress, and fatality (rothan and byrareddy, ) . it has been estimated that around % of covid- patient symptoms will show a severe form of the disease (zhong et al., ) . at this time, there is no specific vaccine or treatment for this disease and the elective clinical procedures consist in isolating patients to manage their clinical symptoms. in early december , several cases of this new acute respiratory infection were reported in wuhan, hubei province, china. on january th , the world health organization (who) declared the covid- outbreak as a public health emergency of international concern (pheic) (mahase, ) . although china has been relatively successful in containing its outbreak by reducing new cases of infection by more than %, the number of infections spread in other countries, especially italy, iran, and united states (callaway, ) . currently, to contain further spread of the virus, governments are implementing unprecedented strict restrictive measures to reduce person-toperson transmission of covid- . consequently, entire nations in different parts of the world have been lockdown, with a full or partial lockdown. the implementation of restrictive measures, such as "social distancing" or "social isolation, " have caused an inevitable readjustment in the daily life of modern societies causing limitations in traveling, social interactions, and work life. although the psychological impact of covid- pandemic has not yet been well-documented, based on previous experience with coronavirus infections (e.g., mers-cov and sars-cov), it has been hypothesized that the pandemic is leading to several health problems such as stress, anxiety, depressive symptoms, insomnia, denial, anger, and fear (torales et al., ) . in support of this, a study on the psychological impact of the covid- , found that more than half of the respondents reported a moderateto-severe psychological impact, and approximately one-third reported moderate-to-severe anxiety during the initial phase of the outbreak in china (wang et al., a) . specifically, anxiety levels seem to be related to the fear for contagion of covid- , as assessed on an iranian sample using a new validated selfreport questionnaire (ahorsu et al., ) . furthermore, a study on the psychological impact of the lockdown in italy showed a high increase of distress levels associated to several factors including gender, personality traits, depression and anxiety levels (mazza et al., ) . beyond the direct effects on mental health, the spread of the pandemic and the consequent restrictive measures are significantly impacting the world economy, resulting in a sharp decline in major financial indices and prompting fear of a global recession (uddin et al., ) . crucially, the ilo monitor (ilo, ), published on april th , reports that full or partial lockdown measures, adopted to contain the spread of the virus, are affecting almost . billion workers globally, which represents around % of the entire world's workforce. many families are experiencing higher financial distress because of the uncertainty of their incomes. as a result, consumers are reducing spending and are avoiding making new investments (fernandes, ) . although the psychological and economical long-term effects of the covid- are not yet predictable at this time, it is possible to hypothesize that the covid- emergency is causing drastic changes in the daily life of individuals, causing levels of distress similar to those found in response to traumatic events. post-traumatic stress disorder (ptsd) refers to the development of specific negative symptoms after exposure to one or more traumatic events. this symptomatologic presentation may include fear-based re-experiencing, emotional and behavioral changes, dysphoric moods, and negative effects on cognition (american psychiatric association, ). a self-report questionnaire often used to measure the subjective response to a specific traumatic event, related to the consequent development of ptsd symptoms, is the impact of event scale -revised (ies-r) (horowitz et al., ) . in previous studies, ies-r has been used to evaluate the traumatic impact of past epidemics (sars, h n ) during previous cases of lockdown (hawryluck et al., ; wu et al., wu et al., , wang et al., ; liu et al., ) . furthermore, two recent studies used ies-r to measure the psychological distress caused by the covid- pandemic (wang et al., a,b) . these studies highlighted a significant impact of the covid- pandemic in determining high levels of psychological distress, showing, also, differences related to gender with females reporting higher ies-r scores. several studies have highlighted a similar link between ptsd and gender (carmassi et al., ; gilmoor et al., ) . furthermore, symptoms of ptsd have also been associated to additional variables such as personality traits, socio-economic level, and educational level. regarding personality traits, the role of neuroticism (alias emotional stability at the opposite end of the continuum) has been widely studied in ptsd. neuroticism is characterized by aspects of affective negativity (watson and tellegen, ; mccrae and costa, ) and is constituted by a negative emotional response to frustration, or loss, that often overlaps with specific aspects of arousal symptoms (yin et al., ) . authors have investigated the relationship between neuroticism and stressful events, highlighting the significant correlation between neuroticism, risk of developing ptsd symptoms, and worsening in mental health conditions following a stressful/traumatic event (holeva and tarrier, ; engelhard et al., ; frazier et al., ) . furthermore, a longitudinal study using ies-r to measure ptsd symptoms, due to the tsunami, highlighted that neuroticism was negatively related to ptsd symptoms improvement ( - months post-disaster) (hussain et al., ) . people who reported high levels of neuroticism tend to react with strong emotions to stressful events. the literature has also highlighted that lower education may be a risk factor in developing ptsd (carmassi et al., ; kvestad et al., ) . for instance, education level was associated with the ies-r avoidance score (wu et al., ) . furthermore, a recent meta-analysis highlighted that lower socioeconomic status, lower education level, and gender (female) were predictors of ptsd (tang et al., ) . finally, research highlighted that fear is one of the main factors involved in ptsd (blechert et al., ; beckers et al., ) . notably, during a health crisis the degree of fear can be influenced by the probability of contracting the disease and the consequences derived by it (yuen et al., ) . in the present study we specifically focus on the role of individual differences, perception of economic stability, and psychological factors (including neuroticism and fear for the covid- pandemic) in predicting symptoms of ptsd. we conducted a nationwide survey on a large sample of the italian population in the period starting from april st, to april th, (the peak of the contagion in italy, see supplementary material). as of may , official data showed that italy represents one of the most affected countries in the world with approximately , confirmed cases and more than , deaths. furthermore, since march th, , the entire country has been experiencing an unprecedented long-term period of lockdown with strict measures including the impossibility for people to leave their home for non-essential reasons, the closure of shops and public spaces, and the ban on gatherings and traveling. this is a crucial aspect considering that a recent review study, on the psychological effects of the lockdown during previous outbreaks, pointed out that individuals experiencing the lockdown showed higher levels of psychological distress compared to their counterparts (brooks et al., ) . we recruited participants using a web-based survey. economic stability was one of the variables considered for this study. for this reason, we identified individuals who receive a stable income and those who do not receive an income by selecting only unemployed and full-time workers. other categories such as students, stay-at-home individuals, and retirees were excluded. a total of ( female) italian adults between -and -years-old (m = . , sd = . ) were included in the present study (see table for all sample characteristics). the entire survey lasted approximately min. the study was approved by the board of the department of human neuroscience, faculty of medicine and dentistry, sapienza university of rome and all participants provided their consent to participate. the study was administered as a battery of questionnaires using the qualtrics survey software. the entire survey consisted of two ad hoc questionnaires and two standardized measures, described below. also, a set of socio-demographic questions were presented. specifically, based on the study hypothesis, we examined gender (male vs. female), work status (full-time worker vs. unemployed), education level (high school degree or less vs. more than high school degree), and home-living condition (not alone vs. alone). socio-demographic data are shown in table . the eight items in the questionnaire were specifically created for the covid- emergency and referred to either self or loved ones' health. these items are presented in table . participants answered on a scale from (not at all) to (extremely). the component structure and reliability of the questionnaire was explored in a larger sample (n = ), using principal component analysis (pca) and cronbach's alpha. the results from these analyses revealed two factors, with four items per factor. a first factor, "belief of contagion, " reflects the conviction of being infected, either in the past or in the future. the second factor, "consequences of contagion, " reflects the possibility of suffering severe consequences due to the contagion (i.e., to be hospitalized or to die). two scores ranging from to were computed by averaging the items in each scale. the factor structure of the questionnaire was evaluated using pca. an oblique (promax) rotation was used. the scree plot, eigenvalues, and parallel analysis (with replications) were used to guide the retention of components. the results showed a structure of two moderately correlated factors, r = . . the pattern matrix is reported in table . four items showed satisfactory loadings (i.e., > . ) on the first factor. these items reflected the conviction to be infected, either in the past or in the future, as well as the beliefs that a loved one has been/will be infected. we labeled this factor "belief of contagion." the second factor comprises four items regarding the possibility of suffering severe consequences following contagion (i.e., to be hospitalized, to die), both for her/himself and for a loved one. this factor was labeled "consequences of contagion." only one item showed cross-loadings (i.e., a difference < . between the loadings on two or more components), which was excluded from the final measure (howard, ) . internal consistency of the final -item measure was tested with cronbach's alpha. the results showed excellent values for both the belief of contagion scale, α = . , and consequences of contagion scale, α = . . two of the questions in the survey dealt with perceived economic stability, either before or during the pandemic. specifically, the questions were presented as follows: "before the emergency, i considered my family and i to be economically stable"; and: "during the emergency, i consider my family and i to be economically stable." answers were given on a scale from (not at all), to (extremely). to determine the change in the perceived economic stability, we computed a difference score, labeled as "economic stability, " between these two items (before the emergency -during the emergency). therefore, higher scores on this variable should reflect severe decline in perceived economic stability, while scores approaching zero indicated no changes in personal economic stability. negative scores, possible but not likely, indicated an improvement in economic stability during the pandemic. the big five inventory -item (bfi- ) the big five inventory -item (bfi- ) is a short scale (rammstedt and john, ) measuring the big five personality traits: agreeableness/antagonism, conscientiousness/lack of direction, emotional stability/neuroticism, extraversion/introversion, and openness/closedness to experience. the bfi- has two bidirectional items for each of the big five personality factors. participants are asked to respond to each item indicating whether they agree or disagree with the statement, using a -point likert-type scale, ranging from (not agree at all) to (totally agree). the scale was developed based on the item big five inventory (rammstedt, ) and designed for contexts in which respondents' time is severely limited. a previously validated italian version was used in this study (guido et al., ) . in the current study, we focused on neuroticism (anxiety, angry hostility, depression, self-consciousness, impulsiveness, vulnerability). the impact of event scale -revised (ies-r) (christianson and marren, ) assesses the intensity of post-traumatic symptoms pertaining to intrusion, avoidance, and hyper-arousal on a likert-type scale ranging from (not at all) to (extremely). the ies-r was designed and validated providing a specific traumatic event and a specific time frame, as a reference for the subjects. the scale has been found to successfully discriminate between subjects with probable diagnosis of ptsd and subjects with non-probable diagnosis of ptsd. a cut-off score of was found to provide the best accuracy for detection of high levels of ptsd symptoms (creamer et al., ) . in this study "covid- epidemic" and "during the emergency" are respectively used for the subjects as a reference of a traumatic event and a specific time frame. first, we categorized participants in two groups based on their ies-r total raw score. specifically, we adopted the optimal cut-off of (creamer et al., ) to distinguish between low ptsd symptoms (low-ptsds) and high ptsd symptoms (high-ptsds). we compared the ptsds groups in terms of individual differences (gender, work status, education, and home-living conditions) performing two-by-two tables chi-squared tests (campbell, ) . based on correlation analysis, we performed a binary logistic regression to predict people's belonging to low-ptsds or high-ptsds group. specifically, we entered individual differences, perceived change in economic stability, and psychological factors (i.e., neuroticism and fear for covid- ) as predictors. our aim was to examine the factors leading to high ptsd symptoms related to covid- pandemic. the first striking result was that . % (n = ) of our sample belonged to the high-ptsds group, reporting a score on ies-r above the cut-off. furthermore, the low-ptsds and high-ptsds groups differed on all individual differences. specifically, women, full time workers, individuals with high school degree or less, and individuals who did not live alone were more inclined to develop ptsd symptoms compared to men, unemployed individuals, subjects with a higher level of education, and individuals who lived alone respectively. all values are reported in table . results of the point-biserial correlations indicated that there was a significant positive association between the ies-r group and "belief of contagion, " "consequences of contagion, " and "economic stability." therefore, all these variables could further impact the development of high ptsd symptoms. furthermore, a significant negative association was found between the "ies-r group" and "neuroticism, " therefore this personality trait is related to a greater probability of developing ptsd symptoms due to the covid- pandemic. detailed results of correlations, including means and standard deviations for all variables, are shown in table . finally, results of the binary logistic regression analysis showed that all entered variables predict the belonging on ies-r groups (see table ). specifically, in the first step gender, work status, education, and home-living conditions were entered. this model explained . % of the variance and only gender resulted as a significant predictor, suggesting that women report higher scores on ies-r. neuroticism was entered in step . the resulting model explained a significant amount of further variance, leading to a total explained variance of . %. step included perceived change in economic stability, and the effect of this variable was also significant. specifically, as economic stability goes up, which represents a greater perception of economic instability during the covid- emergency compared to before, the ptsd symptomatology measured by ies-r increases. the total explained variance in step was . %. finally, in step "belief of contagion" and "consequences of contagion" were entered, and both variables resulted as significant predictors. hence, increased fear of covid- expressed as the "belief of contagion" and the "consequences of the contagion" also increase the likelihood of being in the high-ptsds group. the variance explained by the final model was equal to . %. the covid- epidemic has caused a largescale lockdown worldwide. this pandemic is already showing a high negative impact on physical and mental health. consequences at the socio-economic level will also be significant which, in turn, will possibly negatively affect mental and emotional stability amongst all individuals. little is known about the long-term psychological impact of this pandemic which is characterized by the implementation of public health measures of immense unprecedented magnitude. it appears reasonable to expect an increase of acute stress disorders, ptsds, emotional, sleep, and depressive disorders because of the emerging effect of several factors, such as the fear of being personally infected or that someone close could be infected (mucci et al., ) , and the experience of very negative economic consequences (marazziti and stahl, ) . furthermore, the impact of all these factors may occur in relation to individual differences. several studies have been conducted in china; the first country affected by the covid- epidemic. a longitudinal study conducted on respondents reported the average mean ies-r scores of respondents was above the cut-off score, suggesting a substantial presence of ptsd symptoms among the population (wang et al., b) . moreover, comparing two-time responses, they found that a prolonged lockdown had an incremental psychological impact on mental health, especially among younger respondents. drawing from these findings and considerations, the current study has investigated multiple factors that would influence the step step step step psychological impact of covid- among the italian general population. our hypothesis about the relation among individual factors, economic stability, and fear of contagion as risk factors for pstd symptoms related to covid- was supported. the main striking result of the present study is that, during the peak of the covid- epidemic, more than one-third of the respondents ( . %; n = ) reported high ptsd symptoms. the rate of individuals with ptsd symptomatology on the italian population was two times the rate shown in spain (gonzález-sanguino et al., ) . we may hypothesize that higher rates of contagion registered in italy, at the time of data collection, have caused higher psychological distress in the italian population. also, our results are in line with literature which recognizes the female gender as a risk factor for ptsd symptoms (christiansen and elklit, ; ditlevsen and elklit, ) . a study reported that women are . times more likely to have ptsd than men (pyari et al., ) . biological factors are expected to play a role in these differences. for example, women are reported to be more sensitive to stress hormones and threats, less likely to use adaptive coping strategies, and more likely to provide negative appraisal to emergency situations than men (zhou et al., ; tang et al., ) . it has also been reported that women tend to assume more caregiving responsibilities. having to balance work and/or household tasks makes them a group at risk in highly demanding situations (gonzález-sanguino et al., ) . it has also been showed that higher ptsd rates were reported among people with a lower education compared to those with a higher education. despite conflicting results about the potential relationship between education level and ptsd (perrin et al., ) , the strongest evidence seems to suggest that lower levels of education were associated with a higher risk for ptsd (carmassi et al., ; kvestad et al., ) in previous epidemics as well (wu et al., ) . as recently highlighted, individuals with a higher level of education and socio-economic status might use better coping strategies because of greater social and economic resources, and ultimately be less impacted by environmental disaster, which in turn reduces the prevalence of ptsd (tang et al., ) . the findings regarding the role of individual factors increasing the risk for ptsd symptomatology, support the consideration that women with a lower educational level, not employed, with higher levels of neuroticism are more at risk to develop emergency trauma-related ptsd symptomatology. it is well known that individuals with higher levels of neuroticism tend to respond with strong emotions to stressful events, experience anxious and depressive affects, tend to appraise events more negatively, and have more difficulty in coping with stressful situations (suls and martin, ) . each of these factors have been previously considered to propose neuroticism as a risk factor for ptsd in several potential traumatic experiences such as earthquakes, terrorism, and domestic accidents (breslau and schultz, ; stevanoviae et al., ; yin et al., ) . following our regression results, all considered factors, excluding age, work status, education, and the living situation variables, appeared to be important factors in determining high ptsd symptoms due to covid- . specifically, the contributing factors to worsening psychological impact of covid- were gender, neuroticism trait, fear of contagion, and reduced economic stability. a similar study conducted at the time of sars on adult patients in hong kong found higher scores on the avoidance dimension of the ies-r among women (wu et al., ) . this evidence was also found among the spanish population in relation to covid- (gonzález-sanguino et al., ) . considering that ptsd is a fear-based disorder, belief of contagion and consequences of contagion were predictors of ptsd symptoms in italian adults. not surprisingly, neuroticism shows a consistent association with higher post-traumatic stress symptoms (holeva and tarrier, ) , and the present study contributes to this knowledge extending the evidence on a pandemic scenario. the results of the present cross-sectional survey provide relevant data about the post-traumatic psychological distress of covid- in italy, suggesting the need for greater psychological support in general and especially for highrisk groups. in addition to psychological support, cognitive behavioral therapy (cbt) and eye movement desensitization reprocessing (emdr) may provide positive effects on core ptsd symptoms. emdr treatment (lang, ; bower, ) seems to obtain greater results (moghadam et al., ) . reprocessing of eye movement desensitization leads people to overcome feelings of guilt, anxiety, and fear that are typical symptoms deriving from traumatic experiences in general. since fear of contagion of inappropriate magnitude may result in ptsd (rau et al., ) cbt may help to reduce the level of fear about the dangerousness of covid- and to encourage adaptive emotional responses (taylor et al., ) . furthermore, the practice of mindfulness is widely used in women (katz and toner, ; rojiani et al., ) in order to restore a sense of awareness of one's own experience. the mindfulness based stress reduction (mbsr) technique allows to increase the awareness of responses at a sensorial, affective, and cognitive level. mindfulness does not require direct exposure of the traumatic event as in most therapeutic strategies targeting ptsd but focuses on the here and now of the subject's experience (dutton et al., ) . assimilated mindfulness skills can reduce avoidant behaviors related to ptsd by promoting selfmanagement (gregg et al., ) and improving self-compassion (shapiro et al., ; thompson and waltz, ) . our results may be helpful to mental health professionals to recognize individuals who are at a higher risk and most in need of interventions, in order to prevent a possible rise of high posttraumatic stress for future infectious disease outbreaks. some caveats of the current study need to be acknowledged. first, the data were collected through an online survey, and this may result in participants' self-selection; hence, we cannot exclude a systematic sampling bias. second, we used a selfreported questionnaire to investigate ptsd symptoms, however, this administration format may have some biases. the ies-r is a widely used screening tool, scores should not be confused with a diagnosis, which can be obtained only by mental health professionals. also, the study was conducted during the initial stage of the covid- outbreak; hence, it is possible that we underestimated the actual occurrence of traumatic stress in the population, as delayed onset of ptsd symptoms is conceivable. third, our study allowed discriminating between people at risk and not at risk for high ptsd symptoms during the covid- pandemic, yet the use of a cross-sectional study design prevented to directly examine causal effects. notwithstanding these limitations, this study is a first attempt to elucidate the occurrence of ptsd symptoms in relation to covid- pandemic in the italian population. current results extend our knowledge of the links between individual and psychological factors and distress, with potential implication for the general populations' mental health. our results showed that the covid- pandemic has already had a great psychological impact on the italian population. crucially, in the present study more than one-third of the respondents reported ptsd symptoms during the peak of the covid- pandemic. moreover, it has been highlighted that several individual, economic, and psychological factors play a role in the development of higher levels of ptsd symptomatology. taken together, these results can provide a benchmark for future studies that aim to focus on the long-term effects of the covid- pandemic. furthermore, these data can be fundamental in identifying high-risk individuals to reduce the probability of developing ptsd. however, the most important aspect showed in the present study is the need to improve mental healthcare in the immediate future. therefore, the national health system and politicians must move in this direction to improve treatment for mental health problems and financial assistance. more professionals (i.e., psychologists, psychiatrists, nurses) should be hired in hospitals and clinics to cope with this emergency in the short and long term (mucci et al., ) . in this context, government institutions are called upon to make an effort to provide immediate and long-term financial support in order to fight the war against covid- and try to limit as much as possible the physical, mental, and economic burden. the raw data supporting the conclusions of this article will be made available by the authors, without undue reservation. the studies involving human participants were reviewed and approved by the board of the department of human neuroscience, faculty of medicine and dentistry, sapienza university of rome. the patients/participants provided their written informed consent to participate in this study. add, mcv, rp, dm, ic, and nm: conceptualization. adc, plm, rm, and mcv: data collection. adc, ic, rp, dm, and pr: data analyses and interpretation. all authors contributed to writing and review the manuscript. the fear of 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covid- among chinese residents during the rapid rise period of the covid- outbreak: a quick online cross-sectional survey prevalence and risk factors of post-traumatic stress disorder among adult survivors six months after the wenchuan earthquake we thank all the participants in our study. the supplementary material for this article can be found online at: https://www.frontiersin.org/articles/ . /fpsyg. . /full#supplementary-material key: cord- -ff fpsq authors: miller, eric d. title: loneliness in the era of covid- date: - - journal: front psychol doi: . /fpsyg. . sha: doc_id: cord_uid: ff fpsq nan covid- is proving to be a particularly cruel disease not just because of its pathophysiology but also due to its potentially devastating consequences for engendering loneliness. from the outset of the pandemic, we have learned of countless individuals having to die alone or loved ones not being able to grieve by providing burial services (miller, ) . this disease holds particularly dire consequences for many populations-most notably the elderly and those with compromised health conditions but also minorities and the homeless; these groups have also faced unique difficulties in contending with loneliness well before this crisis (rokach, ) . for as much attention that this disease has rightfully focused on the elderly, individuals can experience different developmental challenges with loneliness throughout the lifespan including adolescence and young adulthood (luhmann and hawkley, ) -and, indeed, there is already evidence of heightened psychological problems amongst chinese youth in the wake of this pandemic (liang et al., ) . accordingly, it will be important for psychologists to assess how age-based threats to loneliness evolve in the era of covid- . social distancing and isolation are critical to preventing the transmission of this highly contagious virus; yet, these are acts that are intrinsically linked with various adverse psychological effects including loneliness and adherence to these sorts of strategies are likely to decrease over time (armitage and nellums, ; galea et al., ) . given the great reliance on technology during this time, it has been suggested that devices like smartphones can help combat isolation and loneliness during the pandemic particularly among the elderly (banskota et al., ) . however, there is a rather conflicting literature as to how internet-based and social media usage impacts loneliness (miller, ) . for instance, kim ( ) found that social media discussions about covid- were less likely to feature uncivil comments amongst south korean users with larger social networks. in short, it would be inaccurate to presume that technology provides an absolute clear means of minimizing feelings of loneliness during this crisis. even before the pandemic, the world health organization declared that social disconnection was a major public health crisis and there is growing concern that the lonely and socially isolated may face heightened morbidity and mortality risks including suicide as a result of this crisis (courtet et al., ) . much more research needs to be done with respect to possible direct or indirect effects from this pandemic that have either created newly found feelings of loneliness or reduced previous such feelings. on one hand, in the wake of this crisis, consistent with basic themes from both terror management theory and attachment theory, a fear of loss of loved ones and love itself should produce a fundamental sense of fear so as to potentially bolster earlier bonds (steele, ). yet, we are facing what many are terming alarming rises of upwards of - % increased year-to-year rates of domestic violence in select u.s. cities in the immediate aftermath of the crisis (boserup et al., ) . more generally, this pandemic may adjust our appraisals of others as they relate to our perceptions of loneliness as it has also served as a reminder of the importance of maintaining health and the fragility of life. accordingly, it is possible that this crisis may cause individuals to reevaluate aspects of their lives that have contributed to prior perceptions of loneliness. though, in this era of social distancing and quarantining, quite notably, the sheer act of being alone is not inherently tantamount to producing loneliness (russell et al., ) nor does the physical company of others (such as spouses) inherently prevent loneliness either (moorman, ) . this pandemic will also likely cause us to reflect about our physical environments in a more thoughtful way and this too will have significant relevance to the study of loneliness. a classic paper from milgram ( ) examined the irony of how urban life can actually allow individuals to feel disconnected from others. indeed, even though much of the industrialized world is largely urban, such environments can pose challenges to loneliness due to their design and the psychological effects of dense living (imrie, ) . the need to address these challenges has likely grown given the newfound perils of physical proximity to others that is largely synonymous with urban life. and, though it may not necessarily be tied to loneliness experienced vis-à-vis close others, feeling connected to nature appears to be associated with a larger connection for humanity and others (moreton et al., ) . since the original covid- source almost certainly was a bat and the point of transmission from animal to human likely occurred at the wuhan seafood market, this experience should force us to realize that in our interdependent world, our actions have clear global consequences and it is critical to have health policies with environmental regulations. in doing so, while it is fair to critique governmental policies or responses that may have contributed to this crisis, it is also important to not do so in a way that further foments racism or stigmatization (ang, ) as these conditions are also associated with the promotion of loneliness. over the course of human history, individuals have borne witness to various atrocities and disasters such as war, genocide, and pandemics-and individuals and society generally adapt to these conditions. however, though there remains some debate whether loneliness should be viewed as a modern epidemic, alberti ( ) contends that it should be looked at it this way when considered through a historical lens and particularly since in the twenty-first century, it is often intertwined by broader social, economic, and political crises. the covid- pandemic features all of these aforesaid crises (miller, ) . though covid- may hold some unique consequences for perceptions of loneliness, so does the potential for technology to help foster self-care during this crisis (saltzman et al., ) . some of the common reasons why loneliness may occur (such as distance from close others or feeling alienated) or ways we cope with loneliness (such as increased activity) may be hindered due to the nature of the pandemic; likewise, preexisting mental, and physical health risks of loneliness may be exacerbated too during this pandemic. but, indeed, there are effective techniques (that do not necessarily require an online component) such as increased self-reflection and acceptance that can potentially be utilized during this crisis (sønderby and wagoner, ) . psychological theory, practice, and research must accordingly work to address what will likely be an everburgeoning loneliness crisis in the coming years as a result of this pandemic. the author confirms being the sole contributor of this work and has approved it for publication. a biography of loneliness: the history of an emotion smartphone apps for older adults to use while in isolation during the covid- pandemic alarming trends in us domestic violence during the covid- pandemic keep socially (but not physically) connected and carry on: preventing suicide in the age of covid- the mental health consequences of covid- and physical distancing: the 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( ) . when covid- meets centralized, personalized power. nat. hum. behav. , [ ] [ ] [ ] the author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.copyright © miller. this is an open-access article distributed under the terms of the creative commons attribution license (cc by). the use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. no use, distribution or reproduction is permitted which does not comply with these terms. key: cord- -t b wpe authors: falcone, rino; colì, elisa; felletti, silvia; sapienza, alessandro; castelfranchi, cristiano; paglieri, fabio title: all we need is trust: how the covid- outbreak reconfigured trust in italian public institutions date: - - journal: front psychol doi: . /fpsyg. . sha: doc_id: cord_uid: t b wpe the central focus of this research is the fast and crucial impact of the covid- pandemic on a crucial psychological, relational, and political construct: trust. we investigate how the consequences of the pandemic, in terms of healthcare, state intervention and impositions, and daily life and habits, have affected trust in public institutions in italy, at the time when the contagion was rapidly spreading in the country (early march ). in this survey, addressed to italian citizens, we analyzed and measured such impact, focusing on various aspects of trust. this attention to multiple dimensions of trust constitutes the key conceptual advantage of this research, since trust is a complex and layered construct, with its own internal dynamics. in particular, the analysis focuses on how citizens attribute trust to public authorities, in relation to the management of the health crisis: with regard to the measures and guidelines adopted, the purposes pursued, the motivations that determine them, their capacity for involvement, and their effectiveness for the containment of the virus itself. a pandemic creates a bilateral need for trust, both in public authorities (they have to rely on citizens’ compliance and must try to promote and maintain their trust in order to be effective) and in citizens, since they need to feel that somebody can do something, can (has the power to) protect them, to act at the needed collective level. we are interested to explore how this need for trust affects the attributional process, regarding both attitudes and the corresponding decisions and actions. the most striking result of this survey is the very high level of institutional trust expressed by respondents: % of them trust italian public authorities to be able to deal with the covid- emergency. this is in sharp contrast with the relatively low levels of institutional trust characteristic of italy, both historically and in recent surveys. moreover, the survey allowed the discrimination of several potential predictors for trust, thus emphasizing factors that, during this crisis, are exhibiting an anomalous impact on trust. the great societal challenge presented by the covid- pandemic has prompted extraordinary efforts to meet such a challenge, from public authorities, civil society, and the scientific community. extreme policies for containment, mitigation, and co-existence with the virus have been implemented by the governments of most afflicted countries, as well as by relevant international institutions (e.g., the who and the eu). at the same time, scientific research worldwide has focused on tackling the many facets of this dramatic phenomenon, including its impact on social relationships and psychological well-being, as well as the key socio-cognitive factors in promoting effectiveness of the proposed countermeasures. several of these studies have highlighted the crucial and complex role of trust in dealing with the covid- pandemic. llewellyn ( ) puts it very succinctly and effectively: "in times of crisis, trust is the most important thing to consider if you want to communicate health advice." this blanket pronouncement is well-supported by previous evidence: in their systematic review on the importance of trust when preparing for and during a pandemic, siegrist and zingg ( ) found confirmation that "trust in health agencies positively influenced people's willingness to adopt recommended behavior." in addition, among the five recommendations for crisis communication highlighted by the authors' survey, two directly concern trust management: "the focus should be not only on trust but also on confidence, and establishing trust in health authorities before a pandemic occurs is important." this latter point is also stressed by lewnard and lo ( ) , with reference to the current pandemic: "the effectiveness and societal impact of quarantine and social distancing will depend on the credibility of public health authorities, political leaders, and institutions. it is important that policy makers maintain the public's trust through use of evidence-based interventions and fully transparent, factbased communication." it is worth noting that this emphasis on evidence and transparency, albeit crucial, describes only part of the relevant socio-cognitive dynamics that affect trust in public institutions: in particular, it collapses trust to confidence in information sources and their credibility, while a crucial problem is also trust in the institution's power to intervene, as well as trust in collective compliance with the proposed measures. finally, in specific circumstances, interesting inversions in cognitive causeeffect relationships can occur, as widely studied in cognitive sciences and social psychology (e.g., festinger, ; koller, ; kunda, ; epley and gilovich, ) . in fact, the relevance of trust for dealing with health emergencies is also linked to the limits of direct enforcement of the required behavioral change: without the active cooperation of the population, any drastic intervention is doomed to fail, because the desired behaviors (e.g., frequently sanitizing one's hands, wearing a facemask, and keeping a safe distance from others) cannot be effectively monitored on the required scale and with sufficient frequency. in a broad and comprehensive survey of social and behavioral results to support covid- pandemic response, van bavel et al. ( ) highlight how most measures needed to contain an epidemic are, by their very nature, difficult to enforce directly: this, in turn, makes trust in public authorities all the more relevant. based on scientific evidence gathered during previous outbreaks, van bavel et al. ( ) argue that "trust in institutions and governments (. . .) may play an important role." for example, trust in the liberian government was correlated with decisions to abide by mandated social distancing policies and utilizing clinics for care during the ebola outbreak. trust was also related to decisions to adopt preventive measures such as ebola vaccinations in the drc. conversely, a lack of trust in public health officials may lead to negative effects on utilization of health services. reliable information and public health messages are needed from national leaders and central health officials. however, local voices can amplify these messages and help build the trust that is needed to spur behavioral change (van bavel et al., ) . these expectations on the positive role of trust in promoting adherence and compliance with preventive regulations and guidance are finding ample confirmation also in recent studies on the ongoing crisis, both within and across various countries. in a nationally representative survey conducted in denmark during the covid- pandemic (n = ), olsen and hjorth ( ) measured the respondents' willingness to apply social distancing in order to reduce contagion: they found that both lower levels of political trust and lower generalized social trust are negatively associated with willingness to distance and that younger male respondents with the lowest levels of education and least political trust report lower willingness to distance. in a nationally representative survey of italian adults (n = ) conducted between the th and th of march , barari et al. ( ) observed high levels of understanding and self-reported compliance with containment measures, and noted that "even those who do not trust the government, or think the government has been untruthful about the crisis believe the messaging and claim to be acting in accordance." trust acts as a precious commodity both for institutions and for scientists, both of which are crucial actors in the public response to the covid- pandemic. in a large-scale background analysis of european social survey data on european countries (n = , ) focused on the covid- epidemic from january to april , , oksanen et al. ( ) found that institutional trust acts as a protective factor: countries with low levels of institutional trust prior to the outbreak (including italy) experienced significantly higher mortality rates during the crisis; moreover, their governments introduced restrictions against contagion later than countries with higher levels of institutional trust (calculated as the delta between the date when the restrictions came into effect and when the first confirmed covid- death was reported in that nation), which in turn contributed to the severity of their death toll. these results on the relevance of trust as a protective factor are in line with previous studies on other epidemics, e.g., ebola, showing how people with higher institutional trust are more likely to follow the advice and guidelines given by the health authorities (blair et al., ; vinck et al., ) , as well as investigating the interplay between scientific and non-scientific sources in modulating people's trust in healthcare information (falade and coultas, ) . as for trust in science, its role has been highlighted in a recent study by plohl and musil ( ) : using structural equation modeling (sem) on a sample of international, english-speaking respondents, the authors investigated whether and how risk perception and norm compliance for the covid- pandemic may be affected by several constructs, i.e., religious orthodoxy, conspiracy ideation, intellectual curiosity, and trust in science, all measured with validated scales. their results indicate that trust in science is by far the most important factor in producing appropriate risk assessment and high level of norm compliance. at the same time, trust in science, as opposed to the tendency to believe in alternative non-official sources, has been observed to be deeply affected by polarization and homophily (bessi et al., ) . looking at the specifics of the covid- pandemic, so far the most insidious threat posed by the virus has been the combination of the rapidity of its spread with the high number of patients requiring treatment in intensive care, resulting in unprecedented strain on the healthcare system of affected countries. this in turn has prompted an increasing number of national governments to adopt extreme measures to limit the spread of the virus, often imposing very demanding limitations on citizens' basic rights (e.g., social isolation, lockdown, and quarantine) and with dire socio-economic consequences (e.g., job insecurity, rising unemployment, loss of revenues, and inequalities). in such a unique scenario, the relevance of studying citizens' trust in public institutions is manifold: on the one hand, the effectiveness of these measures and the collective ability to overcome their costs is conditional on the compliance of the population, which in turn is affected by trust in institutions; for this same reason, institutions actively seek to promote citizens' trust, as a means to achieve their prevention goals; on the other hand, the very nature of the current crisis is likely to affect and shape how citizens conceptualize trust, and such socio-cognitive impact of the covid- pandemic needs to be understood. indeed, the current crisis acts as a magnifying glass in highlighting the essential role of trust in our societies (trust as "vinculum societatis, " the bond of society, to borrow john locke's famous expression), both for the psychological well-being of individuals and for the effective functioning of institutions. the study presented in this paper contributes to this fastgrowing body of knowledge on the interplay between trust in institutions and the covid- pandemic, by discussing the results of a large scale survey (n = ) conducted on italian citizens between march and march , . at that time, italy had the most active outbreak of the virus worldwide, and its death count was growing at alarming rates; at the same time, extreme prevention measures were still relatively recent and rapidly changing in nature, sometimes from day to day (e.g., on march new restrictions were introduced by the government, closing public places such as restaurants, pubs, and most shops). thus, our data offer insight into a time window in which the phenomenon was already in its acute phase in medical terms, yet still novel and unexpected for the population: this offers a privileged vantage point to observe how a pre-existing construct, trust in institutions, was affected by a sudden and profound change in the everyday functioning of the whole country, by a complete (albeit hopefully temporary) re-representation of one's role in society and in personal relationships, as well as in the relationship between citizens and institutions. the survey was theoretically inspired by the socio-cognitive model of trust developed by castelfranchi and falcone ( ) : we chose this theoretical framework because it provides a rich and nuanced description of various reasons for trust, thus allowing us to probe not only the degree by which italian citizens expressed trust toward the relevant public authorities engaged in the response to covid- but also on what grounds such attitude was based. our purpose, however, was not to look for direct validation of the theoretical model, but rather to collect as many detailed data as possible on the rapidly evolving italian response to the covid- emergency, from the standpoint of institutional trust: in this sense, this study was mostly intended as explorative. in particular, we wanted to compare our results with the welldocumented low levels of trust in institutions exhibited by italians before the onset of the crisis, which some have associated with tardiness in responding to the covid- emergency across various european countries (oksanen et al., ) : we intended to see whether such widespread distrust toward public institutions would be confirmed or subverted during the initial stages of the covid- outbreak in italy and to offer some insights and suggestions regarding the original and peculiar nature of any discontinuity in institutional trust that may be associated with the current pandemic. moreover, we intended to take a closer look at the cognitive and social factors responsible for trust toward public institutions in the face of pandemic threats: the survey was designed both to discriminate several potential predictors for trust, so that subsequent analysis would allow us to individuate the most relevant ones, and to facilitate comparison with the underlying theoretical model, thus emphasizing factors that, during this crisis, are exhibiting an anomalous impact on trust-either because they determine trust more intensely than usual (overcharged factors) or because their impact is minimal or non-existent (anesthetized factors). indeed, a key hypothesis that we wanted to test concerns the impact of covid- on the very nature of the institutional trust construct: not only the overall trust in public institutions is affected by the pandemic and how these institutions respond to it, but also the determinants of trust in institutions change and adapt to this crisis, in comparison with other situations. desperate times require desperate measures, and desperate measures induce a drastic reconfiguration of the cognitive underpinnings of trust in institutions. our survey was designed to collect data on such paradigm shift in how institutional trust was conceptualized by italian citizens during the early stages of the national response to the covid- pandemic. we used a snowball sampling method to determine the respondents: we collected a large sample (n = , % women, mean age = years, range = - years, sd = . ), relatively well-balanced in terms of geographical provenance ( % northern italy, % central italy, and % southern italy and main islands), with a significant portion of respondents ( %) residing in the regions most affected by covid- at that time (lombardy, veneto, emilia-romagna, marche, and piedmont) . the relatively uniform geographical distribution of the sample among the three macro-areas of italy, as well as the significant proportion of respondents from highly affected regions, allows interesting comparisons based on participants' residence. moreover, the introduction of more drastic restrictions by the italian government at the end of march , , invites considering also this temporal dimension in analyzing the data: in this respect, it is important that a fairly large set of participants (n = ) completed the survey after those new restrictions had been introduced. finally, it should be noted that the mean educational level of participants is very high: almost three quarters of respondents have a degree ( %) or postgraduate specialization ( %). the main characteristics of the sample are synthetized in table . data were collected with a -item questionnaire, using a fivepoint likert scale for most items: an english translation of the whole questionnaire is available in the supplementary materials. the questionnaire was based on the socio-cognitive model of trust developed by castelfranchi and falcone ( ) and explored the questionnaire was administered online using the google forms platform. the questionnaire fully complied with ethical guidelines for human subject research and participation was conditional on the preliminary approval of an informed consent by each subject; the compilation took an average time of min. data analysis was performed using the spss (version ) statistical software: the collected data were first analyzed through correlation analyses (given the asymmetric distribution of most variables, we considered spearman correlation values); secondly, given the high number of items in the questionnaire, we conducted a principal component analysis (pca) on each subsection of the questionnaire prior to running regression analyses on the aggregated data. full details on descriptive statistics for each item in the questionnaire are included in the supplementary materials, differentiating also based on geographical factors (northern, central, and southern italy; more affected vs. less affected regions) and temporal boundaries (before vs. after the march announcement of new restrictions by the national government). here, we report only the most relevant findings, prior to more in-depth analysis, and only in terms of aggregate data, since no significant differences emerged at this level between different areas and different dates (albeit some interesting patterns were detected via regression analysis, see section "regression analyses"). when asked to indicate which public authority is the most adequate to take decisions concerning the covid- emergency (item in the questionnaire), . % indicated the national government, . % indicated the civil protection, . % indicated the presidency of the republic, . % indicated the regional government, . % indicated the municipal authority, and . % indicated others. hence, the overwhelming majority ( . %) of respondents consider pandemics as a matter of national concern, which should be primarily addressed by national authorities. this should be taken into account while interpreting all other results, since most of the attitudes expressed by participants regarding features of public authorities (competence, intentionality, trust, etc.) should be understood with reference to national institutions, unless otherwise specified. moreover, it is remarkable that the presidency of the republic, which is mostly a moral authority, is seen as having a greater role than regional governments, in spite of their leading role in the healthcare system, which in italy is organized on a regional basis. equally significant is the fact that only . % of respondents (within the broader category "others") indicated any kind of international entity, including the european union, as having a primary role in facing a pandemic outbreak. in short, at this stage of the covid- emergency, italian citizens strongly believed that this pandemic was not to be prominently addressed by either regional or international authorities, but was rather mostly a matter of national concern. when asked to rank their overall trust in public authorities for the management of the covid- emergency (item in the questionnaire), % of respondents manifested either extreme ( . %) or high ( . %) levels of trust, . % were non-committal, and only . % expressed distrust (see figure , left panel). as we will see in the section "discussion and conclusions, " these numbers are in sharp contrast, to say the least, with the average institutional trust reported for italian citizens prior to the covid- crisis, especially considering that the main target of this newfound trust was national public authorities (see above). the competence of public authorities was assessed as their ability in planning both the right prescriptive measures (e.g., lockdown) and the appropriate behavioral guidelines (e.g., personal hygiene recommendations). on both counts, the majority of respondents expressed a positive belief in the public authorities' competence ( . % for measures, . % for guidelines), whereas only a relatively small minority was either undecided ( . % for measures, . % for guidelines) or skeptical ( . % for measures, . % for guidelines). moreover, correlational analysis indicates that competence scores for measures and guidelines are strongly and positively related (r = . , p < . ), suggesting that respondents did not really discriminate between prescriptive measures and behavioral guidelines, at least with respect to trust in public institutions: for this reason, in subsequent analyses, we collapsed these two items into a single competence value, calculated as the mean response for each subject to items (competence on measures) and (competence on guidelines) of the questionnaire (these are also the data reported in figure , central panel). other items in this section of the survey were designed to investigate the reasons behind participants' beliefs on the public authorities' competence: in summary, the overwhelming majority of the sample ( . %) believed that it was the public authorities' proper prerogative to take action and issue containment measures against the pandemic (item ), and most respondents ( . %) positively evaluated the use of experts' advice by the public authorities during the covid- crisis (item ); there was instead less confidence in the organizational capacity demonstrated by public authorities in the early stages of the emergency (item : . % expressed a positive evaluation, . % were undecided, and . % were critical), and the majority of the sample ( . %) agreed that institutional communication on the covid- presented some contradictions, either between different authorities or over time (item ). in spite of these partial concerns, a significant majority of the sample ( . %) did not express any skepticism on the competence of the public authorities in handling the emergency (item ). as for the competence, we inquired on the intentionality of public institutions separately for prescriptive measures and behavioral guidelines, asking participants whether they believed either type of intervention was both actively and honestly aimed at containing the covid- pandemic. again, respondents expressed an overwhelmingly positive belief in the good faith of public institutions, both in promulgating prescriptive measures ( . %) and in issuing behavioral guidelines ( . %): only a small minority was either undecided ( . % for measures, . % for guidelines) or skeptical ( . % for measures, . % for guidelines). correlational analysis reveals again that intentionality scores for measures and guidelines are strongly and positively related (r = . , p < . ), further confirming that respondents did not really discriminate between prescriptive measures and behavioral guidelines, when it comes to assessing the public authorities' trustworthiness in this emergency: hence, these two items on intentionality were collapsed into a unique intentionality value in subsequent analyses, using the mean response for each subject to items (intentionality on measures) and (intentionality on guidelines). other items in this section of the survey were designed to investigate the reasons behind participants' confidence, or lack thereof, in the nature of the public authorities' intentions: in summary, we found confirmation of the fact that most respondents ( . %) did not doubt that the intentions of the public authorities were consistent with their public statements (item ), whereas a smaller majority ( . %) considered the economic investment mobilized by the italian public authorities sufficient to fight the pandemic (item : notice that only . % considered it insufficient, with a significant portion of the sample, . %, remaining undecided). finally, asked whether other interests, e.g., political or economic, were at stake (item ), the larger part of the sample ( . %) answered in the negative, whereas . % acknowledged the presence of such ulterior motives and . % were unsure: as we will discuss further on, this question was probably easy to interpret in two markedly different senses-either negatively, as an accusation of having some hidden and problematic agenda, or positively, as the capacity to take into account all the key ramifications of the covid- crisis, including its political and socio-economic aftermath. overall, we registered strong confidence in the good faith of the intentions manifested by public institutions (figure , right panel): this parallels the belief in the public authorities' competence, and together, these attitudes support the high levels of institutional trust expressed by this sample. part of the survey was focused on the measures issued by public authorities as a response to the covid- pandemic, in order to estimate both their perceived usefulness and the goal attributed to these interventions by the participants. the vast majority of our sample ( %) perceived these measures as being either useful ( . %) or very useful ( . %) in fighting the pandemic, whereas only a tiny minority was skeptical ( . %), with the remaining . % being undecided (item ). when asked to assess the adequacy of the public authorities' intervention (item ), a more abstract notion involving a counterfactual comparison with alternative strategies, the majority rated current measures as adequate ( . %), . % were undecided, and only % considered them inadequate. in terms of the motivations associated with these measures, we asked participants to express agreement on three potential, non-mutually exclusive aims: reassuring the population (item ), curbing the spread of covid- (item ), and creating unmotivated alarm (item ). the vast majority ( %) agreed that the rationale of the public authorities' intervention is indeed to contain the pandemic, whereas only . % attributed to the public authorities the goal of reassuring citizens, and even fewer respondents ( %) regarded the proposed measures as a way of spreading unnecessary panic. when rating the personal burden of the proposed restrictions on their own lives (item ), % of participants expressed to feel a high level of impact, whereas . % indicated little discomfort for the current situation and the remaining . % reported medium levels of distress. however, regardless of the perceived impact on the public authorities' intervention, the overwhelming majority of respondents agreed that such sacrifices were crucially beneficial for themselves and their families (item , . % of agreement), for the society as a whole (item , . %), and for both (item , . %). moreover, when asked to assess the usefulness of one's personal contribution to these preventive measures, since they were intended for the whole population (item , a question aimed at implicitly measuring any "free-riding inclination" in our sample), as many as . % of the participants considered their personal role relevant for the collective effort. taken together, these data show that, albeit different people suffered more or less because of the containment measures, almost all agreed on their usefulness and on the necessity of personal sacrifice to deal with the pandemic: this suggests a mindset in which the shared goal of public safety trumps any individual concern, including personal discomfort, fear, and anxiety (an interpretation later confirmed by regression analysis, see section "regression analyses"). in terms of expectations on compliance with the sanitary restrictions by other fellow citizens (items - ), we observe a fairly varied pattern of response (see figure ): the most widespread belief ( . % of agreement) is that enough italian citizens, albeit not all, will comply with the regulations, thus making them effective (item ); in contrast, there is skepticism both on the most optimistic scenario, i.e., full compliance (item , . % of disagreement), and on the bleakest outcome, i.e., insufficient compliance (item , . % of disagreement), although it is worth noting that pessimism is rejected much more strongly than optimism. the possibility that only few people will comply, and yet their efforts will be useful (item ), is also rejected by the relative majority of the sample ( . % of disagreement), yet interpreting this result requires caution, since it could either express skepticism on figure | expectations on compliance by others. frontiers in psychology | www.frontiersin.org how many people will comply, or on the chances that limited compliance may indeed be useful. regarding the motivations useful to induce compliance, we asked participants to express agreement on four possible motivational triggers: the expectation that everybody else will follow the new regulations (item ), a personal concern for dangers (item ), a spirit of collaboration in the face of the emergency (item ), and trust in the fact that public authorities are doing everything in their power (item ). all four motivations engendered significant levels of agreement, with the highest being the feeling of a common cause against a shared threat ( %), followed by trust in maximum effort by the public authorities ( . %), concern for the associated risks ( . %), and expecting others to comply as well ( . %). it is interesting to note that a motivation tied to the collaborative dimension of trust in civil society, i.e., being united in pursuing a common goal, shows more than percentage points of distance from a motivation inspired instead by the sanctioning view of trust, i.e., being able to monitor compliance by others, possibly to punish free-riders, as well as from fear of personal harm: this suggests that emphasizing collaborative motives (a strategy employed quite consistently by the italian government in its public communications during the early stage of the covid- outbreak) may be more effective in promoting compliance than stressing individualistic goals. this section of the survey asked respondents to provide a metacognitive evaluation of the most relevant factors promoting their trust in how public institutions are handling the covid- crisis. of the eight factors explored, the type of measures adopted by the authorities was the most frequently cited as important (item , . %), followed by the information received on the crisis (item , . %), the capacity of public authorities to actually enforce protective measures (item , . %), the respondent's profession (item , . %) and his/her health condition (item , . %), the opinions expressed by social relations such as friends and relatives (item , . %) or colleagues (item , . %), and the political connotation of the relevant authorities (item , . %). later on, we will use regression analysis to investigate the extent by which these self-reported data correspond to the relative weight of the actual factors affecting participants' trust in institutions. for now, it appears that participants self-describe their theory of trust in fairly objective terms, giving priority to the factual nature of the proposed measures, the information they gathered (apparently with the exception of social channels; see below), and the extent by which public authority is able to enforce their recommendations; in contrast, relatively little weight is given to personal factors and social networks, and none at all to political partisanship. this last result suggests that the public response to the covid- crisis was initially perceived as a matter of shared concern of all political parties, which in turn prompted a temporary truce in the usual partisanship characteristic of italian politics; moreover, in their efforts to deal with the emergency, public authorities were regarded mostly for their institutional role, with little attention to their political affiliation (even when such authorities were the expression of certain political parties, as it was the case with the national government). this interpretation also helps to explain the extremely high level of trust in public institutions with respect to the covid- emergency during those few days, in a population well-known for its deep-seated distrust of politicians in general, and of political parties in particular: further analysis of this interesting anomaly will be presented in the section "discussion and conclusion." this section of the survey investigated both frequency of use (items - ) and perceived trustworthiness (items - and ) of various types of information sources in relation to the covid- pandemic, to get a better sense of what channels were most influential in affecting participants' opinions on this topic; in addition, we collected data on the trustworthiness directly assigned to public institutions as information sources (item ), which was high for . % of the sample, average for . %, and low only for . % of respondents. with respect to other information channels, the data summarized in table highlight four main findings: (i) official online channels, e.g., the website of the civil protection, and scientists are both frequently used and considered reliable as information sources; (ii) in contrast, traditional media, albeit often consulted, are regarded as reliable only by less than half of our sample; (iii) family physicians are in general considered trustworthy, yet they are rarely used as information sources; (iv), finally, both social relationships and unofficial online sources, e.g., social media, are neither frequently used, nor widely believed. the result on unofficial online channels is especially surprising: whereas the very low credibility associated to these sources is understandable and even commendable, the fact that only one respondent out of four admits to using them frequently is hard to swallow, especially at a time in which personal contact was severely limited in italy, thus making social media an even more attractive outlet for users. besides, recent national statistics on internet use in italy do not agree with the picture painted by these data: according to the global digital report , compiled annually by wearesocial and hootsuite, in , % of italian citizens were active social media users (with a growing trend with respect to ), and the average time spent on social media every day was a little less than h per person. besides social desirability effects (respondents may have been reluctant to admit gathering information via unofficial channels on such delicate topics), a possible explanation for this anomaly is in a common misperception of the role of social media as gatekeepers: someone who finds on facebook a link to an article on a traditional newspaper, or is made aware by a post on twitter of the latest press release on the official website of the civil protection, may be inclined to disregard the role of the social media in bringing these information to the user's attention. yet, this is how we use social media as information sources, often without even realizing it: we take advantage (or succumb, depending on the circumstances) of their agenda setting algorithms, which allow these platforms to act as powerful information brokers, rather than information producers. expectations on long-term impact on trust the final section of the survey intended to probe participants' expectations on the long-term impact of the covid- crisis on trust relationships between citizens and public institutions (item ), between citizens and the dominant economic model of development (item ), between citizens and the scientific community (item ), and among citizens as peers (item ). here, the big winner is expected to be science: . % of respondents believe that the current crisis will strengthen the trustworthiness of scientists as public figures. expectations on the impact of trust toward public institutions and among citizens are less triumphant, yet still positive: . % predict an increase in institutional trust after the covid- pandemic, whereas % make the same prediction with respect to social trust, i.e., trust among peers. finally, on future trust in the dominant model of economic development, our sample is evenly divided: % think that we will trust it more than before, . % are undecided, and . % expect an increase in distrust toward that model. as a preliminary step before running regression analyses, we used pca to identify strongly correlated items in the data set and simplify the variables' structure, in order to avoid multicollinearity issues in our regression models. since the survey was theoretically motivated by the socio-cognitive model of trust (castelfranchi and falcone, ) , we performed separate pca on subsets of items, to preserve relevant theory-based distinctions in the participants' responses. item , degree of trust toward public authorities in relation to the covid- pandemic, was not included in the pcas, since it was intended to act as the target of the regression models; we also excluded items (doubts on public authorities' competence) and (doubts on public authorities' intentions), since these were included in the survey merely as control questions for, respectively, items - and items - ; moreover, we kept separate from the pcas item (personal discomfort associated with public authorities' measures), item (usefulness of one's own personal contribution to the collective effort), and item (overall adequacy of public authorities' measures), since we wanted to test their role as individual predictors in the regression models; finally, item (expectation of very limited yet useful compliance by other citizens) was excluded for the pca and regression analysis, due to the ambiguity in its interpretation already mentioned in section "descriptive statistics." the remaining items led to the individuation of principal components, as summarized in table (full details on the pcas methods and results are provided in the supplementary materials). in order to be considered satisfactory, each pca had to explain at least % of the cumulative variance, and further components were added only if they improved by more than % the explained variance. in order to test our main hypotheses, we performed a multivariate regression model on raw data using ibm-spss software. the dependent variable to be predicted was the overall trust manifested by participants toward public authorities involved in the covid- response, i.e., item in the survey. after some explorative iterations and based on theoretical considerations, we decided to include independent variables in the final model: principal components identified via pcas (indicated with an asterisk in table ), individual items that were conceptually independent from the other sections of the survey (personal discomfort associated with public authorities' measures, usefulness of personal contribution to the collective effort, overall adequacy of public authorities' measures), and socio-demographic variables-age (coded as = - , = - , = - years of age), educational level (coded as = high school diploma or lower, = university degree or higher), region of residence (coded as = most affected regions, i.e., lombardy, emilia-romagna, veneto, marche, and piedmont, = all other regions), and time of data collection (coded as = before, = after the march new restrictions were announced). preliminary analyses indicated that the respondent's profession did not affect responses, so we excluded it from the model; as for gender, preliminary regressions showed no difference in the predictors of institutional trust between male and female respondents, so we excluded it from the final regression model and performed a separate set of analyses to assess its impact in our data (see section "gender effects"). we first run the regression analysis on the whole sample: the model had a good fit (r = . ) and explained % of the variance in the overall trust evaluation; out of independent variables were significantly correlated with trust (p < . ), and the most powerful predictors were positive indicators of competence of public authorities (β = . , p < . ), perceived adequacy of the adopted measures (β = . , p < . ), trustworthiness of official information sources (β = . , p < . ), public authorities' intention to ( ) the numbering used for items follows the order of presentation in the survey: the relevant items are from to , since item was the informed consent, whereas items - asked for demographic information. the asterisk (*) indicates principal components that were later used for regressions. contain the pandemic (β = . , p < . ), and perception that public authorities' efforts were focused on public safety, with no other agenda (β = . , p < . ). all other significant predictors had an absolute value of β equal to or lower than . . the non-significant predictors were personal discomfort due to the adopted measures, perceived usefulness of personal sacrifice, expectation of sufficient compliance (but notice that expectation of universal compliance was positively correlated with trust, whereas expectation of insufficient compliance was negatively correlated with it, both p < . , suggesting an "all or nothing" attitude toward compliance), individualistic reasons for compliance (while collectivist reasons for compliance were strongly and positively associated with trust, p < . ), educational level, time of data collection, and age (the last one showed a marginally significant negative correlation, β = − . , p = . ). we also applied the same regression model to subsets of participants, distinguishing first geographically (most afflicted regions vs. all other regions), then temporally (before and after the announcement of new restrictions by the italian government on march ), in order to detect differences in how trust was processed depending on the severity of the sanitary emergency in various areas, and the strictness of the measures implemented by public authorities while the pandemic was still progressing. we already knew from descriptive statistics that no overall change in trust toward public authorities was observed across these contexts, yet we wanted to probe for more subtle differences, e.g., different predictors of trust, or different contribution of the same predictors, depending on region of residence and time of data submission. all β and p-values for the various multiple regressions are reported in table ; in what follows, we will focus only on the most relevant results. applying the model only to participants from the most affected regions in italy at that time (lombardy, emilia-romagna, veneto, marche, and piedmont) revealed again a good fit (r = . ), explaining . % of variance in trust assessment; the same model also had a good fit when applied only to participants from all other italian regions (r = . , . % of explained variance). in both cases, the strongest predictors remained the same as in the whole sample, and also their order of importance was identical across regions, regardless of current outbreak severity (p < . for all the following predictors): positive indicators of competence (most affected: β = . ; other regions: β = . ), adequacy of the adopted measures (most affected: β = . ; other regions: β = . ), trustworthiness of official information sources (most affected: β = . ; other regions: β = . ), pa's intention to contain the pandemic (most affected: β = . ; other regions: β = . ), and perception that public authorities' efforts are focused on public safety, with no other agenda (most affected: β = . ; other regions: β = . ). in spite of the substantial similarity in how trust in public authorities was attributed by respondents in different areas of the country, some fine-grained distinctions emerge looking at those factors that were significant in one context but not in the other-and also exercising due caution, since a difference in significance does not necessarily imply a significant difference. in the most affected regions, we observed eight non-significant predictors, whereas there were only six in the other regions: four of these factors were irrelevant across both contexts (personal discomfort, perceived usefulness of the sacrifices, individualistic reasons for compliance, and time of data collection), whereas negative factors affecting competence of public authorities, intention to downplay the emergency, impact of personal effort, and trustworthiness of unofficial information sources were immaterial for respondents from the most affected areas, whereas they acted as significant predictors (albeit weak ones) for participants from other regions of italy; in contrast, an expectation of sufficient compliance from other people had a significant negative correlation with trust in the most affected regions (β = − . , p = . ), whereas it had a marginally significant positive correlation with it elsewhere (β = . , p = . ). taken together, these results suggest that participants living in areas that were currently experiencing very severe outbreaks of covid- had a more focused mindset when deciding whether to trust public authorities to deal with the emergency: less factors were considered relevant, and in particular, it was probably taken for granted that some inconsistency in public communication and intervention may occur, without necessarily jeopardizing trust (negative factors on competence), and that unofficial sources were not to be taken seriously when deciding whom to trust; at the same time, expecting that only a sufficient number of people would comply with the emergency measures had a negative impact on trust in public authorities, probably highlighting the fact that, in those regions, people believed that "enough is not enough"that is, either everybody cooperates in facing the crisis (universal compliance) or we will not be successful in overcoming it. this extreme mindset is confirmed by the fact that the relevance of one's own personal contribution did not affect trust attribution to public authorities in the most affected regions, whereas it did in other areas: this indicates again that collective compliance, not personal efforts, are perceived as the key to success by people currently facing the worst of the covid- pandemic. looking instead for short-term shifts in trust assessment over time, in relation to relevant public events (i.e., the introduction of new measures by the italian government on march ), we divided our sample based on time of data submission: before or after the public press release when the prime minister giuseppe conte announced the new restrictions to be implemented nationwide, to contain the covid- outbreak. the model performed well across both time windows (before: r = . , . % explained variance; after: r = . , . % explained variance) and the strongest predictors remained the same, as well as their relative order of importance (p < . for all the following predictors): positive factors affecting competence of public authorities (before: β = . ; after: β = . ), perceived adequacy of the adopted measures (before: β = . ; after: β = . ), trustworthiness of official information sources (before: β = . ; after: β = . ), attributing to public authorities the intention to contain the pandemic (before: β = . ; after: β = . ), and the perception that their efforts were focused on public safety, with no other agenda (before: β = . ; after: β = . ). again, we observed substantial stability over time in how trust in public authorities was attributed, with minor differences emerging only by comparing the significance and direction of some secondary variables. in general, the introduction of more severe restrictions had the effect of simplifying the metrics used to assess trust toward public authorities: before the march announcement, only four variables failed to correlate significantly with trust, whereas after it, the number of irrelevant predictors increased to , indicating a more narrowly focused mindset in assessing the trustworthiness of the institutions in charge of dealing with the emergency. in particular, intention to downplay the emergency, personal discomfort associated with the proposed measures, and trustworthiness of unofficial information sources became irrelevant for trust in public authorities; unfortunately, the expectation of universal compliance also became equally irrelevant (before: β = . , p = . ; after: β = − . , p = . ), while the negative correlation between expectation of insufficient compliance and trust was much stronger after the march announcement (before: β = − . , p = . ; after: β = − . , p = . ). this suggests a turn for the worst in people's expectations: before the new restrictions, trust was positively supported by expectation of universal compliance (the more i believe all others will behave responsibly, the more i trust the authorities), whereas after them, the influence of pessimistic fear became dominant (the more i doubt enough people will comply, the less i trust the authorities). as a possible reaction to this shift, it is worth noting that the positive correlation between impact of personal efforts in the covid- response and trust in public authorities became significant only after march (before: β = . , p = . ; after: β = . , p = . ), suggesting that the new measures strengthened in italian citizens a sense of personal responsibility for the collective reaction to the virus. finally, region of residence was a significant (albeit weak) predictor of trust before, but not after, the announcement of new restrictions by the italian government (before: β = − . , p < . ; after: β = − . , p = . ): this shows a stronger tendency to trust public authorities in the most affected regions before march , whereas this was no longer true after that date. since overall trust in public authorities did not decrease after march in the whole sample, this indicates a leveling in trust attribution across the country after the introduction of new measures, which in turn could be interpreted as a shift in the perception of the emergency: whereas in early march, a significant part of the italian population still believed the outbreak to be somehow contained to specific regions, and thus a local problem unlikely to affect everybody in the same way, the nationwide interventions announced on march made it crystal clear to all that covid- was indeed a national concern. overall, these regression analyses show that, in italy, trust in the capacity of public authorities to deal with the covid- emergency was attributed in a fairly consistent manner during the time window of this survey (march - , ) across different areas of the country, giving central prominence to positive indicators of competence in public institutions, assessing the adequacy of the proposed measures, verifying that proper intentions supported their application, and paying attention mostly to official information sources. all considered, this suggests a fairly reasonable and well-balanced judgment-making process for trust attribution, while the true anomaly remains the high levels of trust in public authorities recorded during the early stages of this emergency (see section "descriptive statistics"), which are in sharp contrast with both long-term trends and recent surveys on institutional trust in italy, prior to the covid- pandemic. at a more fine-grained level, region of residence and time of data completion did reveal some interesting shifts in trust assessment, yet these insights should be interpreted carefully, since they concern relatively minor changes in the significance of secondary predictors, within a regression model with a high number of independent variables. comparing male and female respondents, a χ test revealed a small but significant difference (p = . ) in institutional trust in relation to the covid- emergency: in particular, men were more likely to express high levels of trust toward public authorities involved in contrasting the outbreak ( . % men vs. . % women), whereas women were more often neutral ( . % women vs. . % men). running the regression model described in section "regression analyses" separately on male and female respondents showed that, although the main predictors remained the same (positive indicators of competence, adequacy of the measures, trustworthiness of official information sources, public intention to contain the pandemic, and institutional focus on public safety), age and region of residence were significant predictors only for women and not for men (age: women β = − . , p = . , men β = − . , p = . ; region: women β = − . , p < . , men β = . , p = . ). to further investigate this interaction between gender and other socio-demographic factors influencing institutional trust during the covid- emergency, we run a trivariate analysis on, respectively, gender × age × trust and gender × region × trust. the first analysis revealed that gender effects on institutional trust are significant (p = . ) only in the age range - years, which is also the most vulnerable to the virus: among respondents in this age range, the majority of those that expressed low levels of institutional trust were male ( %), whereas most of those neutral or highly trustful were female ( . and . %, respectively). it is also worth noting that, after performing a bivariate analysis on the impact of age on trust, we found a highly significant effect (p < . ), with . % of elderly respondents ( - years old) expressing high trust in public authorities, whereas this percentage drops to . % for participants in between and years of age: this further confirms the role of vulnerability to the covid- virus in eliciting higher attributions of trust, and it is consistent with previous findings on a negative correlation between age and willingness to comply with social distancing measures during the covid- pandemic (wirz et al., ) . the second analysis showed that the relationship between gender and institutional trust is significant (p = . ) only in those regions that were most affected by the covid- outbreak: in these areas, most of the respondents that manifested distrust in public authorities were men ( . %), while the majority of the neutral and trustful participants were women ( . and . %, respectively). taken together, these results suggest that, whenever the situation was most critical (i.e., for the most vulnerable age range and in the most affected regions), men were overrepresented in the (small) group of people expressing distrust toward public authorities, whereas women were overrepresented among those neutral or trustful. although this may suggest an interesting gender effect on resilience under extreme stress (women seem more likely than men to suspend judgment or look on the bright side, precisely when the situation is the most dire), it is worth noting that, regardless of gender, only a small minority of respondents were expressing distrust toward public authorities, even in the most affected age range (men . %, female . %) and in the most affected regions (men . %, female . %). thus, these gender effects invite further investigation, but on their own, they do not justify any hasty conclusion on how different genders may react against health emergencies. the most striking result of this survey is the very high level of institutional trust expressed by respondents: % of them trust italian public authorities to be able to deal with the covid- emergency. this is in sharp contrast with the relatively low levels of institutional trust characteristic of italy, both historically and in recent surveys: according to the demos & pi nd annual report on "the italians and the state" , based on a large representative sample (n = ) of italian citizens over years of age interviewed in december , only % respondents trusted the state, whereas both regional governments ( %), european union ( %), and municipal authorities ( %) fared better, while political parties were in the worst shape, with only italians out of willing to trust them; in fact, of the main national institutions, the only one with decent levels of trust was the presidency of the republic ( %, still in sharp decline with comparison to years before, in , when it was as high as %). also international estimates indicated relatively low levels of institutional trust: according to the eurofound report on eurofound ( ) , italians' trust in the national government has been declining in the last few decades and is now below %, while the more recent data of the eurispes report-italy , presented in february , indicated trust in institutions at . % ( . points lower than in ). institutional trust in italy in recent years is extremely weak not only in absolute terms but also in relation to other european countries: in their comparison of eu states, based on data from the european social survey, oksanen et al. ( ) reported very low levels of institutional trust in italy, measured by respondents' trust in five institutions (parliament, politicians, political parties, the police, and the legal system); in fact, only cyprus, poland, slovakia, and bulgaria expressed stronger institutional distrust than italy. moreover, this trend toward widespread distrust of public institutions is not a particularly recent feature of italian politics: while in recent decades, it developed mostly against the backdrop of increasing tensions between populist movements and traditional political parties (urbinati, ) , massive erosion of public confidence in political figures was already ongoing in italy well before the recent resurgence of populism worldwidein the last decade of the th century, following the corruption scandals of tangentopoli and its media resonance (giglioli, ; vannucci, ) , and with the largely failed shift toward bipolarism during the berlusconi age (viroli, ) . even before that, a longitudinal analysis reveals that the confidence gap between electors and political institutions, characteristic of many post-wwii democracies, appeared in italy much earlier than in other countries (segatti, )-so much so, that already in the s lapalombara ( ), a highly influential political scientist, described italians' attitudes toward politics with three emblematic words: alienation, fragmentation, and isolation. such a deeply rooted tradition of distrust in public institutions underscores the importance of the opposite trend registered in our survey, i.e., a sudden boost in institutional trust prompted by the covid- crisis-a significant result that is also supported by other data collected in this survey, as seen in the "results" section. moreover, insofar as this newfound trust is grounded on trust in the expertise of the scientific authorities involved, it is also at odds with the widespread anti-scientific sentiment considered to be on the rise at the global level, variously stigmatized as "the death of expertise" (nichols, ) and the crisis of epistemic deference (marconi, ) . surprising as it may be, there are several reasons to consider this finding on trust as reliable: (i) internal consistency: as discussed in section "results, " all other responses to the survey are consistent with a high attribution of trust to public authorities and indeed provide justification for such attribution. (ii) external validation: just a few days after data collection for this study was concluded, a survey on a representative sample of italian citizens (n = , - march ) was conducted by the independent research center demos & pi , providing substantial support to our main results: e.g., % trust both the italian government and the current prime minister, with % approval of the adopted measures, strong endorsement for the sanitary system ( %), the civil protection ( %), and the national government ( %), coupled with lower levels of confidence in political parties (none of them above % of approval) and a rising skepticism toward the european union ( % of respondents believe the italian response to the covid- emergency to be better than that of other eu countries, and only % consider the role played by the eu as positive in this crisis). (iii) low chances of social desirability effects: as demonstrated by the very low levels of institutional trust recorded in previous surveys, including recent ones, italians have no qualms expressing public distrust toward public authorities-quite the opposite, in fact. thus, there is no reason to assume that the current data on trust are inflated by social desirability effects. thus, there is a genuine phenomenon to be explained here: a veridical "trust boom" during the early stages of the covid- crisis in italy. the socio-cognitive theory of trust (castelfranchi and falcone, ) that inspired our survey provides the tools needed to craft a tentative interpretation of this remarkable fact, although the questionnaire itself was designed to record such a phenomenon, rather than explain it. thus, the speculative nature of our interpretation cannot be stressed enough: our study revealed a highly significant and surprising phenomenon, for which now we look for an explanation. the interpretation we favor is the one that, to the best of our knowledge, appears more adequate to account for the pattern of results obtained in this survey; later on, we will contrast it with other alternative explanations and argue in favor of its superiority. nonetheless, such interpretation remains tentative, and it is intended as a springboard and an inspiration for further studies that may either confirm or falsify it, rather than as something set in stone. with this in mind, let us focus on the fact that trust, at its cognitive core, entails the decision to delegate to someone else (the trustee) the realization of a goal that is important to the agent who is expressing trust (the trustor). as a result, being able to choose not to trust someone requires either having alternative means to achieve the desired goal (e.g., "i will do it myself " or "i will delegate it to someone else") or being ready to forsake that goal. however, neither of these options are available in the face of a pandemic: the relevant goal is personal and public safety, which is non-negotiable, i.e., it is not something we can decide to forget about, and the only course of action that offers reasonable chances of achieving it is to put our collective trust in public authorities, since there are no other available agencies we might appeal to (indeed, the only choice we have concerns the level of public authority we should confide in, and our sample clearly indicated the national level as the most pertinent one). in other words, a pandemic like covid- creates the preconditions for a collective case of necessary trust in public authorities, or institutional trust by force majeure: not in the sense that we are being manipulated by some hidden power, as some conspiracy theorists may be prone to believe, but because the very nature of the health crisis leaves us with no other option than to put our trust in public authorities (that is why we emphasize a need, a necessity for trust). it is worth noting that these pressures toward trust between citizens and public authorities in times of sanitary crisis are symmetrical: citizens have no alternatives to reliance in the relevant public institutions, yet these institutions themselves cannot help but trust in civic compliance to the proposed regulations, on pain of failure in containing the contagion, due to the limits of enforcement already emphasized in previous studies (siegrist and zingg, ; lewnard and lo, ; olsen and hjorth, ; van bavel et al., ) . necessary trust is a two-way street in health emergencies, for both citizens and public authorities. moreover, this two-way street is often cyclically traveled: in fact, the citizens themselves become fully aware (perceive the request and expectation) of the need for public authorities to receive the right degree of trust from citizens as a tool for achieving the common goal, and this awareness becomes one of the reasons for citizens to trust public authorities themselves. in other words, in the best-case scenario, this becomes a trust-based "alliance" toward a supreme common purpose. this civic alliance, or social pact, is grounded in a specific dynamic of trust: the trustor deliberately bestows trust on the trustee, even if partially skeptical of the trustee's qualities, in an attempt of motivating the trustee to "rise to the occasion" and become trustworthy. this is the sense in which trust breeds trust, as noted both by trust theorists (e.g., falcone and castelfranchi, b) and by political economists (e.g., feld and frey, ) . in the context of the early stages of the covid- pandemic in italy, we suggest that italian citizens put their trust in public authorities in charge of facing the crisis as a way of opening up a "trust credit line" and thus putting pressure on such authorities to prove themselves worthy of that credit. similarly, public authorities frequently manifested full trust in citizens' compliance with regulations (a topos often belabored on public occasions by all institutional actors, including the prime minister, the president of the republic, and representatives of the civil protection), precisely for the same reason: by declaring their trust in the common sense and civic responsibility of italian citizens, they were putting pressure on citizens to actually demonstrate such qualities. clearly, the objective need for trust created by a pandemic does not automatically evolve in greater trust toward public institutions. that need may find different outlets, so that other, bleaker outcomes may be equally possible: for instance, an already vulnerable trust relationship between citizens and public authorities may be shattered completely by a sudden crisis, especially if such crisis (or its poor management) are blamed on those authorities, possibly leading to a severe governmental crisis, and maybe even a takeover by authoritarian forces, or, in another scenario, public trust toward central authorities may dissolve, with citizens taking a turn toward tribalism and trying to face the crisis at the local level. while these options are certainly viable in general, our results suggest that neither of these paths was being seriously considered by most italian citizens in early march : our survey revealed a sudden increase of trust toward public institutions, rather than its collapse or further erosion, and that trust was directed toward national authorities, not toward specific charismatic leaders or local powers. according to our findings, faced with an unexpected need for public trust, the italian people in early march opted for putting their trust (at long last) in their elected representatives at the national level, rather than turning to authoritarian figures or local authorities for solutions. beyond the evidence of our data, how the management of the pandemic unfolded over those weeks provides further support to this interpretation. the italian government consistently acted as a mediator between all the social forces affected by the crisis, repeatedly demonstrating high reliance on the indications of the experts in crafting every containment measure: in short, the national authorities acted as the very antithesis of an authoritarian leader. at the same time, local authorities at all levels were relying on the guidance of the national government for facing the pandemic and, in some cases, were actively asking for its direct intervention to solve a crisis that they were not equipped to deal with; more generally, there was widespread consensus, both in political debate and in the media, on the need for a national response to the covid- emergency (a need well understood by our participants, as seen in the section "results"). again, an attitude that stands in sharp contrast with any shift toward tribalism. thus, assuming that the need for public trust prompted the high levels of institutional trust manifested by participants, we propose to interpret their other responses within the broad framework of motivated reasoning (kunda, ) and cognitive dissonance theory (festinger, ) : as the chosen path to pursue the paramount goal of personal and public safety, trusting public authorities became in turn a necessary instrumental goal, thus coloring all other attitudes expressed by the respondents; more precisely, it prompted them to actively look for reasons to justify their (unavoidable) trust in public authorities, in order to minimize cognitive dissonance. indeed, the need for trust experienced by italian citizens during the covid- emergency was at odds with their widespread attitude of distrust toward the very same public authorities they now needed to rely upon in the face of the outbreak: this, we argue, produced a massive and sudden shift in their perception of those public authorities, to better accommodate the new reality they had to deal with. in this interpretation, the trust boom observed in the survey was not produced by any collective epiphany on the actual qualities of the public institutions involved, but rather by a cognitive realignment of individual attributions to the current needs citizens were experiencing. all of a sudden, italian citizens found themselves pressured to rely on some key public authorities in ways and to a degree never experienced before, at least since the worst days of world war ii. regardless of how well these authorities behaved in the first stages of the covid- crisis, italians opted to re-frame their attributional states in a way that made this novel institutional trust justified, thus flipping the usual causal connection involved in acts of trust: it is not a case of detecting the appropriate qualities in public authorities and therefore deciding to trust them, but rather an instance of having first the need to trust those authorities and then justify such trust by assuming that these authorities would manifest the qualities required to warrant that trust. this is also justified and supported by the implicit pact with which public authorities communicated the need for this responsible and trusted attitude toward them as decisive for the achievement of the common purpose. it is worth noting that our reliance on motivated reasoning to explain some of these survey data is very different from the most common use of this notion in recent studies on public opinion: although originally conceived in much broader terms (kunda, ) , motivated reasoning in recent decades has become more and more associated with political ideology, with several studies investigating how partisan affiliations affect and filter our beliefs on matters of public interest (e.g., redlawsk, ; slothuus and de vreese, ; kahan, ; bolsen et al., ) . in fact, the same approach has been applied, with mixed results, to the public reaction to the covid- pandemic, e.g., looking at how political partisanship affected people's ability to discriminate between reliable information and fake news (pennycook et al., ) , timeliness in the adoption of restriction measures (rosenfeld, ) , health behaviors (kushner gadarian et al., ) , and compliance with social distancing guidelines (rothgerber et al., ) and stay-athome regulations (goldstein and wiedemann, ) . while the relevance of politically grounded motivated reasoning provides an interesting perspective on public opinion dynamics, other predictors have been found to be more relevant in explaining some of the target phenomena (e.g., fake news vulnerability, see pennycook and rand, ) ; more to the point, this is not the type of motivated reasoning we are discussing here. on the contrary, our data show no effect of political partisanship on trust attributions toward italian public authorities in charge of coordinating the covid- response, including those that did have a clear political connotation, e.g., the national government. instead, we appeal to the notion of motivated reasoning in relation to a manifestly non-partisan goal, i.e., public safety, and the related need to trust public authorities to be able to ensure such goal: this is the kind of motivated reasoning we argue influenced responses in our sample, independently from the political affiliation of either the survey participants or the relevant public authorities. alongside the preservation of consistency in citizens' beliefs toward public authorities, there is also another, more emotional path through which a need for trust may generate broader shifts in public perception. as noted by many trust theorists (luhmann, ; gambetta, ; batson, ; hardin, ) and also described in the socio-cognitive model adopted here (falcone and castelfranchi, a; castelfranchi and falcone, ) , a fundamental function of trust is to allow both individuals and groups to face uncertainty, to moderate it and deal with it. trusting someone or something immediately reduces the perception of risk; in this sense, trust offers the advantage of a subjective sense of safety, before and without being able to reach that safety objectively. it allows us to face the risk and take it, partially by giving us control over part of that risk, since trusting implies actively choosing to expose ourselves to a risk, i.e., the risk of having our trust betrayed (mayer et al., ) . this is why koller ( ) individuated risk as a key determinant of trust, in the sense that a risky situation may bias people toward trustworthiness when assessing potential allies in facing such risk: "to the degree that the individual fears the occurrence of an event of negative valence (...) he exaggerates the subjective probability of an event of positive valence, which implies that he expects the interaction partner to behave promotively" (koller, , p. ) . this is very much in line with the higher levels of trust we observed in the most vulnerable age groups and in the italian regions most affected by the covid- outbreak (see section "gender effects"). in the context of a health emergency such as the covid- pandemic, this subjective dimension of trust becomes particularly apparent: consider how physicians and nurses in italy turned overnight from marginalized workers in a distrusted field to the most revered national heroes. the individual and collective gain of this sudden change of perception is obvious: faced with the danger of contracting a deadly virus, the belief that your life will be in the hands of trusted professionals is incredibly valuable, not only for the unlucky few that will actually have to rely on those professionals, but for everybody, since it greatly helps in calming down their fear and anxiety. in this perspective, the trust boom recorded in our survey should be considered not only as a merely intellectualistic attitude but also as a response with deep emotional undertones: this is the type of trust that is not only cognitively justified, but also felt, insofar as it provides us with the calmness needed to remain productive under the extreme stress of a pandemic. it is worth noting that emphasizing the motivated nature of institutional trust during a pandemic is not the same as treating this newfound trust in italian public authorities as a fiction, just a desperate figment of the imagination of a population looking for solace from a terrible crisis. nothing could be farther from the truth: precisely because this institutional trust was experienced as a matter of necessity by the italian people, it is also genuinely (and dramatically) authentic. italian citizens, during those terrible days in early march , truly believed that public authorities would prove themselves worthy of their trust-possibly for the first time after many decades of increasing institutional distrust. yet, it is a very fragile belief, because it is massively based on assumptions: should the public authorities subsequently fail to prove themselves equal to the task at hand, this huge "trust credit" would come due, producing an even bigger backlash in terms of the gap between citizens and institutions. this would indicate the clear failure of an "alliance" in which citizens have invested their trust in public authorities. on the other hand, an actual demonstration of trustworthiness by the public authorities during the covid- emergency may engender a more durable and long overdue step change in institutional trust in italy. as the nobel prize joseph stiglitz put it in a recent interview to the italian newspaper la repubblica ( april ), we should "not waste this crisis, " since it opens up genuinely new opportunities for rethinking the fabric of our societies. what is more, respondents in our sample were fairly optimistic on the future of trust relationships with their institutions, with scientists, and among themselves, while expressing reservations on the adequacy of the current economic model (see section "descriptive statistics"). however, optimism is, by its very nature, a delicate thing, so the danger of experiencing a "trust crack" right after the initial trust boom is as real as ever. indeed, other ongoing research on the relationship between institutional trust and public response to the covid- emergency may invite a bleaker outlook on how things will unfold: in their comparison of data from european countries, oksanen et al. ( ) highlighted a negative correlation between institutional trust prior to the crisis and the delay in introducing restrictions to curtail contagion-the less trust was manifested in public authorities before the covid- outbreak, the more time passed after the first confirmed virus-related death and the introduction of containment measures. while we do not dispute the role of institutional trust as a protective factor against virus outbreaks (already well documented with ebola, see blair et al., ; vinck et al., ) , we are skeptical of the particular correlation observed by oksanen et al. ( ) , since it does not take into account the fact that different european countries were affected by the covid- outbreak at different times: in particular, italy, france, and spain [all "late intervention countries, " according to oksanen et al. ( ) ] were among the first countries to record severe outbreaks, and much of the measures later adopted by other countries were largely based on the evidence coming in from these first, unwilling testbeds for the public response to the virus. this is confirmed by the same data used by oksanen et al. ( ) : in terms of absolute dates, italy was among the first countries to endorse all the five types of interventions considered in their study, much earlier than many others that are instead regarded as "early adopters." moreover, the alleged correlation considers only the adoption of some form of interventions, without discriminating between countries that adopted all of them (like italy) or just a few, sometimes even only one (as in the case of sweden). this is probably why subsequent data do not seem to support the proposed correlation: for instance, sweden, one of the countries with one of the highest levels of institutional trust before covid- , as of may , has a very high ratio to the number of deaths per million inhabitants (among the top six nations in the world); similarly, belgium, where containment measures were adopted much more promptly than in italy according to oksanen et al. ( ) , in early may had the world's highest number of covid- confirmed deaths per million inhabitants. for all these reasons, we are not persuaded that prior institutional trust was the main factor determining timely adoption of containment measures by public authorities: while early intervention remains critical in facing virus outbreak, in the case of covid- , we believe that this was determined mostly by other factors, e.g., where the outbreak manifested sooner in europe. looking at the main predictors of trust highlighted by our regression analyses, respondents exhibited a matter-of-fact, evidence-based attributional strategy toward public authorities: consistently with the socio-cognitive model of castelfranchi and falcone ( ) , competence, intentionality, trustworthiness as information sources, and the perceived adequacy of the proposed interventions were the most relevant factors in justifying trust in public authorities. the relevance given to the role of public authorities as information sources is also consistent with the significant weight that information has in shaping participants' institutional trust, based both on their own self-report and on regression analysis (see sections "descriptive statistics" and "regression analyses"): this highlights the importance of feedback and control for trust. even when trust on public authorities is perceived as a necessity by citizens, they try to retain a measure of control over it, by monitoring the quality of institutional information channels. equally suggestive are some of the factors that failed to impact institutional trust in our sample: most notably, the amount of personal sacrifice imposed upon participants by the restrictions introduced by the government. significantly, this dimension did not affect citizens' trust in public authorities, contrary to what would be reasonable to expect under different circumstances: this, in turn, provides further support to our interpretation of the observed trust boom as a matter of necessity-insofar as public safety is the paramount goal, the severity of the necessary costs are immaterial in modulating institutional trust. this provides a nice illustration of the complex and context-dependent nature of feedback mechanisms on trust attributions: whether or not a certain observable feature of the situation (in this case, personal costs) will affect trust depends on its role within a broader attributional process, which cannot be oversimplified as a single feedback loop (for discussion, see falcone and castelfranchi, ) . finally, it is worth stressing that the main predictors of trust remained stable both geographically and temporally: nonetheless, controlling for region of residence allowed us to notice a more focused mindset for trust attribution in the most affected regions, whereas comparing responses before and after the new restrictions introduced in italy on march highlighted a leveling effect of these measures, which made us realize the national character of the covid- crisis to everybody, including citizens living in areas with only minor outbreaks. this last point underscores a common pattern to many of our main results: a shift from the particular to the general in how institutional trust is granted and justified by citizens, apparently caused by the unique circumstances of the covid- pandemic. as we discussed in section "results, " the responsibility of dealing with this emergency was clearly assigned to the national government, whereas regional and local authorities were perceived as marginal; moreover, high confidence was granted to public institutions, largely ignoring their political affiliation, unlike what happened in other countries, e.g., the united states (goldstein and wiedemann, ; kushner gadarian et al., ) , and without concern for any further agenda they might serve (in fact, trust in public authorities was paralleled by distrust in the various political parties, including those currently in power); consistently with this mindset, collectivistic reasons for institutional trust trumped individualistic concerns, and the perception of a common effort toward shared goals overshadowed any personal sacrifice that may be required to individuals and groups (this also relates to the fact that personal health itself obliges to look and reflect primarily on collective health, on which the former strictly depends); finally, confidence in each other's compliance with general rules was high, and the future outlook on trust was positive for public institutions, science, and civic society, not so much for the overall model of development. in short, participants responded to this survey not as individuals calculating trust based on likelihood of personal gains or losses (the standard economic view of trust), but rather as members of a collective subject, jointly engaged in facing a problematic situation. this tendency to make common cause against a shared concern is one of the most valuable assets any society can leverage to fight a public crisis, so in this sense, our data paint a positive picture of how italian citizens responded to the covid- emergency, as far as trust in public authorities is concerned. however, as repeatedly stressed above, this asset is also incredibly delicate, especially in a country with a complex and thorny history of institutional distrust, like italy. hence, a crucial research priority for future research, both in the short run and in the long term, is to keep monitoring how trust dynamics between citizens and public authorities will be affected by the next stages of the covid- pandemic: in fact, while our data suggest a generally positive reaction in the early phases of the emergency, they provide no guarantee of the fact that such trend will continue in the same direction. on the contrary, as mentioned, things could either turn for the best, as our respondents chose to believe, or turn for the worst, should public authorities fail to live up to their citizens' high expectations. all datasets generated for this study are included in the article/supplementary material. this study complied with all the ethical guidelines and standards for online surveys with human participants, in accordance with the local legislation and institutional requirements. the participants provided their written informed consent to participate in this study and were free to quit the survey at any time. rf led the design of the survey. ec, as, and sf performed data analysis. rf and fp wrote most of the manuscript. all authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication. evaluating covid- public health messaging in italy: self-reported compliance and growing mental health concerns the altruism question: towards a social social-psychological answer homophily and polarization in the age of misinformation public health and public trust: survey evidence from the ebola virus disease 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attitudes in the early stages of the covid- italy: fragmentation, isolation and alienation scientific and ethical basis for socialdistancing interventions against covid- covid- : how to be careful with trust and expertise on social media trust: a mechanism for the reduction of social complexity fake news, the crisis of deference, and epistemic democracy an integrative model of organizational trust the death of expertise: the campaign against established knowledge and why it matters regulation and trust: a social science perspective on covid- predictors of attitudes and misperceptions about covid- in canada, the lazy, not biased: susceptibility to partisan fake news is better explained by lack of reasoning than by motivated reasoning modeling compliance with covid- prevention guidelines: the critical role of trust in science hot cognition or cool consideration? testing the effects of motivated reasoning on political decision making political ideology and the outbreak of covid- in the united states politicizing the covid- pandemic: ideological differences in adherence to social distancing italy, forty years of political disaffection: a longitudinal exploration the role of public trust during pandemics political parties, motivated reasoning, and issue framing effects me the people. how populism transforms democracy using social and behavioural science to support covid- pandemic response the controversial legacy of 'mani pulite': a critical analysis of italian corruption and anti-corruption policies institutional trust and misinformation in the response to the - ebola outbreak in north kivu. dr congo: a population-based survey the liberty of servants: berlusconi's italy self-reported compliance and attitudes about social distancing during the covid- outbreak the supplementary material for this article can be found online at: https://www.frontiersin.org/articles/ . /fpsyg. . /full#supplementary-material key: cord- -xy o mhs authors: caci, barbara; miceli, silvana; scrima, fabrizio; cardaci, maurizio title: neuroticism and fear of covid- . the interplay between boredom, fantasy engagement, and perceived control over time date: - - journal: front psychol doi: . /fpsyg. . sha: doc_id: cord_uid: xy o mhs the italian government adopted measures to prevent the spread of coronavirus (covid- ) infection from march , , to may , and imposed a phase of social distancing and self-isolation to all adult citizens. although justified and necessary, psychologists question the impact of this process of covid- isolation on the mental health of the population. hence, this paper investigated the relationship between neuroticism, boredom, fantasy engagement, perceived control over time, and the fear of covid- . specifically, we performed a cross-sectional study aimed at testing an integrative moderated mediation model. our model assigned the boredom to the mediation role and both the fantasy engagement and perceived control of time to the role of moderators in the relationship between neuroticism and the fear of covid- . a sample of subjects, mainly women ( . %), aged between and years (m(age) = . years; sd = . ), participated in a survey conducted in the st-week lockdown phase in italy from may to , . results suggested that neuroticism is crucial in coping with the covid- pandemic, in line with literature showing high neurotic people having greater emotional reactivity and scarce resources to manage stress. we also found that people with high neuroticism tend to feel bored, and the relationship between neuroticism and boredom seems enhanced if one is involved in negative fantasies. therefore, this result could also explain the positive effect between boredom and fear of covid- we found in the current study. however, our data show that perceived control over time moderates the association between boredom and fear toward covid- . having a high perceived control over time allows people to reduce boredom’s effect on fear of covid- . in conclusion, we retain that psychological treatment programs could improve the individuals’ perceived control over time to modulate anxiety toward the fear of covid- and promote psychological well-being. since its first identification by the wuhan municipal health commission, china, the coronavirus (covid- ) has become a pandemic (world health organization, ) . the exceptionally high infection rate and relatively high mortality led the government's advice of many countries for all citizens to move toward self-isolation and social distancing to reduce transmission rates, the risk of severe illness, and the impact on the acute health services. regarding italy, the lockdown started on march with a first phase (from march , , to may , imposing to only one person for family, usually an adult, to go out for buying food or medicines and taking care of the relatives with special needs. productive activities aimed to distribute and commercialize necessities (i.e., food, journals, and medicines) were allowed. other kinds of activities were closed or permitted only with smart working. similarly, schools and universities were locked, and only distance learning activities were permitted. physical or sports activities and other kinds of recreational activities such as going to the cinema, theater, pub, or restaurants were not authorized and joining friends at home. the government launched a second phase from may to , , maintaining smart working instead, but allowing some kinds of commercials (e.g., shops for baby clothes), professionals (e.g., psychologists), or factory activities. people were also left to do individual physical activities outside the houses or recreational activities such as going to restaurants for take-away and meeting relatives, but not friends at home. however, distance learning for students continued as the only permitted educational activities. although justified and necessary, psychiatrists, and psychologists question the impact of this process of covid- isolation on the mental health of the population (e.g., lee et al., ) . people start developing a new fear of covid- , as recently described by ahorsu et al. ( ) , and changing their social habits utterly and coping with new psychological demands. from a psychological point of view, we must consider that individual dispositions could make a difference along with other contextual variables. although considering the importance of analyzing the entire spectrum of personality traits, in the current study, we specifically focus on neuroticism as defined by the five factors model (ffm; john and srivastava, ; mccrae and costa, ) . according to ffm, neurotic people experience unpleasant emotions, such as anger, anxiety, depression, or vulnerability (john and srivastava, ; mccrae and costa, ) . some experimental researchers have found neuroticism is the most significant trait that leads people to more robust conditioned fear responses (e.g., orleans-pobee, ), consistently with theory of eysenck ( eysenck ( , , and also suggesting that neurotic people are more sensitive to signals of punishment (gray, (gray, , . garcia and zoellner ( ) reported that people with high levels of neuroticism perceive higher levels of risk and show attentional biases toward ambiguous stimuli. hence, the authors suggested that both neuroticism and lack of predictability about the likelihood of feared events increase the degree to which fear generalizes (garcia and zoellner, ) . a recent meta-analysis also showed that healthy individuals with high neurotic personality traits have a significantly greater generalization of fear of safe and novel cues and contexts (sep et al., ) . these outcomes are coherent with prior works reporting significant associations between neuroticism and adverse emotional outcomes in stressful life experiences (penley and tomaka, ) . high neurotic individuals also have a high susceptibility to psychological distress (watts et al., ) , inefficient coping with stress, and an inability to control urges (ormel and wohlfarth, ) . they are also are prone to experiencing anxiety, anger, sadness, and disgust (mccrae, ; schwebel and suls, ) . besides, the lockdown state imposed by the covid- pandemic has significantly changed our rhythms of life: time always flows the same, and in these conditions, one must learn to manage one's time without using the daily "official timing" routines. thus, the perceived control of time, defined as the perception of the individual's control over how time has passed (macan et al., ) , becomes a crucial psychological variable. scholars suggested that the individual's perceived control over time has a mediator effect on time management behaviors on self-reported job performance, work and life satisfaction, role ambiguity, and job-induced and somatic tensions (macan, ) . other studies also highlight how perceived control over time intervenes to modulate the relationship between personality dimensions and psychological well-being. specifically, poor perceived control over time is associated with personality dimensions such as neuroticism (feather and bond, ) and psychological stress, anxiety, or depression (griffiths, ; chang and nguyen, ) . as well, during the covid- pandemic, individuals also live a series of "empty moments" they wish to fill with new activities such as reading, watching tv, or playing videogames, so devoting considerable time and resources to the pursuit of fantasy (e.g., daydreaming or doing multiplayer nonreality games). in all these daily activities, they could live a sort of fantasy engagement that is a "conscious and deliberate suspension of disbelief in nonreality. a person is said to be engaging in fantasy if he or she chooses to engage with an instance of nonreality as though it were reality. for example, a person watching a film portraying fictional events has been engaging in fantasy. viewers likely know that the on-screen events are not happening. nevertheless, they can choose to temporarily suspend this disbelief or awareness in the nonreality status of the film, allowing them to experience authentic affective responses to its content (e.g., crying, exhilaration)" (plante et al., , p. ) . however, we must distinguish between negative and positive fantasy engagement. the former refers to fantasies with harmful contents such as violence, sex, or antisocial themes that can amplify addiction and desire (andrade et al., ) , leading people to maladaptive or dysfunctional behaviors. the latter refers to positive themes and has potential benefits, including healthy childhood development, motivating goal pursuit, and physical and psychological well-being (overby, ) . styles of thought aimed at elaborating fantasies (i.e., the fantasy engagement) such as the daydreaming activities or the elaboration of possible scenarios, while watching a film or reading a book, can both represent useful mental distractors from perceived stress situations and to promote motivating actions in subjects frontiers in psychology | www.frontiersin.org aimed at implementing health promotion behaviors such as exercise, or healthy diet (sheeran et al., ) . finally, we argue that coping with covid- pandemic individuals might also feel annoyed or bored. this detrimental impact of boredom may, in turn, lead them to cope with various mental health conditions, such as traumatic head injury (e.g., seel and kreutzer, ) , depression and anxiety (sommers and vodanovich, ) , apathy (ahmed, ) , negative affect (gordon et al., ) , hostility and anger (rupp and vodanovich, ) , job dissatisfaction (kass et al., ) , and low achievement in school (jarvis and seifert, ) . starting from the state of the art above-described, in the current study, we aimed at analyzing the relationship between neuroticism, boredom, the fantasy engagement, the perceived control over time, and the fear of covid- during the phase of social distancing. specifically, we tested a mediationmoderation model (figure ) , assigning the boredom to the mediation role and both the fantasy engagement and perceived control of time to the role of moderators in the relationship between neuroticism and the fear of covid- . explicitly, we stated the following hypotheses: h : neuroticism is positively related to fear of covid- . h : neuroticism is positively related to boredom. h a: negative fantasy engagement is a moderator between neuroticism and boredom. h b: positive fantasy engagement is a moderator between neuroticism and boredom. h : boredom is positively related to covid- . h : perceived control over time moderates the relationship between boredom and fear of covid- . h : boredom mediates the relationship between neuroticism and fear of covid- . the bioethics committee of the university of palermo has approved the current study (n. / ). participants gave written consent about the anonymity of data handling, according to the declaration of helsinki. a total of subjects, aged between and years, with a mean age of . years (sd = . ), participated in the survey. most of the participants were female ( . %). almost all participants came from southern italy ( . %). according to educational levels, almost all participants completed higher education ( . %), while some have a degree ( . %) or a middle school diploma ( . %). the survey was made available on the distance learning university courses of the researchers. participants were recruited by responding voluntarily to the survey administered online via google form in the st week of lockdown phase in italy from may to , . this choice is justified by wanting to observe the effects of more restrictive lockdown phase on the studied dimensions. the google form presented the study information sheet in the first section. data were automatically collected when participants filled the google form online, reporting the electronic version of the assessment instrument consisting of demographic questions (i.e., gender, age, and education) and apposite measures of the studied variables. we used the neuroticism subscale of the -item personality inventory (pi; caci et al., ) for measuring neuroticism. in general, pi is a measure of personality traits as defined by the ffm (costa and mccrae, ) , and it has five subscales, consisting of four items related to one of the personality factors (i.e., extroversion, conscientiousness, neuroticism, openness, and agreeableness). each item scored on a fivepoint likert scale with anchors from = strongly disagree to = strongly agree. for the present study, we analyzed only data from the neuroticism subscale (example of item: i am relatively stable from an emotional point of view). we computed the total score by averaging participants' scores for each of the items of the scale. in the present study, frontiers in psychology | www.frontiersin.org a standardized cronbach α coefficient was . , similarly to those reported by caci et al. ( ) in the first validation study. the multidimensional state boredom scale (msbs; fahlman et al., ) is a -item scale measuring state boredom (example of item: i am stuck in a situation that i feel is irrelevant). it consists of five subscales (i.e., disengagement, high arousal, low arousal, inattention, and time perception) with item scoring on a five-point likert scale having anchors from = strongly disagree to = strongly agree. however, we assessed a general state of boredom by adding the scores given in all items. in the present study, a standardized cronbach α coefficient of overall boredom was . . the fear of covid- (fcv- s) is a recent seven-item scale developed by ahorsu et al. ( ) to measure the fear of covid- in the adult population (example of item: "i am most afraid of coronavirus- "). each item scores on a five-point likert scale having anchors from = strongly disagree to = strongly agree. we computed the total score by averaging the participants' scores for each of the items of the scale (cronbach α = . ). the fantasy engagement scale (fes; plante et al., ) is an eight-item scale measuring positive (pfe) and negative (nfe) facets of fantasy engagement. for instance, "fantasizing about this makes me more creative" is a pfe item, whereas "my interest in this fantasy has caused problems with my family and me" is nfe one. participants rated their agreement with each of the eight items on a five-point likert scale with anchors from = strongly disagree to = strongly agree. we computed the total score for pfe and nfe by averaging participants' scores obtained for each of the items of the scale. in the present study, standardized cronbach α coefficients were . for pfe and . for nfe. the subscale of the time management behavior scale of macan ( ) the first step was to calculate descriptive statistics and zero-order correlations. second, we carried out preliminary analyses to verify the moderating effects of positive and negative fantasy engagement on the relationship between neuroticism and boredom using process model (hayes, ). an integrative dual-stage moderated mediation model using process model (hayes, ) tested the research hypotheses. a dual-stage moderated mediation model is an integrative model consisting of the main effect, and one or more mediation or moderation effects. in the present study, the model tested the main effect of neuroticism on fear of covid- ; the mediation effect in which boredom mediates the relationship between neuroticism and fear of covid- (stage ); the moderation effects in which negative fantasy engagement moderates the effect of neuroticism on boredom and perceived control over time moderates the effect of boredom on fear of covid- (stage ). all effects are measured simultaneously. before testing the model, all variables were standardized (hayes, ) . the parameters were estimated using the bootstrap method with , samples and using a % confidence interval (ci) and using the percentile method bias-corrected (hayes, ) . the parameters are significant if the ci does not include zero. to conclude, two simple slope analyses were performed to interpret the moderation effects. table shows the results in two steps of the research hypotheses. in step , regressions results are reported without the interaction terms; in step , the interaction terms have been added. an f test was used on the variation of r between step and step to verify if the interaction terms bring a greater understanding of the phenomenon. hypothesis predicted that neuroticism is significantly associated with fear of covid- . as shown in figure and table , neuroticism is positively associated with fear of covid- (b = . , p < . , ci: ll = . ul = . ). this result would mean that subjects with higher neuroticism scores tend to be more feared about the impact of covid- on daily life. hypothesis predicted that neuroticism is positively associated with boredom. this hypothesis is also confirmed (b = . , p < . , ci: ll = . ul = . ). the more neurotic subjects would tend to feel more bored. hypothesis a established that negative fantasy engagement moderates the direct relationship between neuroticism and boredom. this hypothesis is confirmed, in fact, it has a negative and significant interaction effect (b = − . , p < . , ci: ll = − . ul = − . ). the simple slope analysis (figure ) indicates that subjects with high neuroticism and more engaged in negative fantasies are those who will be most bored; conversely, subjects with low levels of neuroticism and low tendency to implicate themselves in negative fantasies tend to have shallow levels of boredom. hypothesis stated that boredom has a direct effect on fear of covid- . this hypothesis is confirmed. boredom is positively associated with fear of covid- (b = . , p < . , ci: ll = . ul = . ). hypothesis established the effect of the moderating role of perceived time control on the relationship between boredom and fear of covid- . in fact, a negative significant effect is indicated in table (b = − . , p < . , ci: ll = − . ul = − . ). as shown in figure , subjects with high boredom and low perceived control over time tend to have higher scores on the fear of the covid- scale than subjects with low boredom and low perceived control over time. hypothesis corroborated the entire model's indirect conditional effects (table ) . this analysis indicates three stages where significant effects are present. these stages coincide with low scores on the perceived control over time scale, confirming the moderated mediation effect of the entire model. the current study tested a moderate-mediation model seeking suggestions to reduce perceived fear of covid- , given the numerous pieces of evidence of the indirect impact of covid- on the mental health of worldwide populations (li et al., ) . we collected data in a sample of italian participants after phase of the quarantine imposed on them by the government to better cope with the virus's spread. this lockdown led to a drastic change in lifestyle since people not only reduced at minimum their physical and social relationships but also have had to face a series of potential physical or mental health problems like distress (cheval et al., ; satici et al., ) as far as even suicide (mamun and griffiths, ) . our results evidenced that neuroticism is crucial in coping with the covid- pandemic. indeed, we found that neuroticism is positively associated with the fear of covid- , in line with literature showing its associations with many other fears as, for example, the fear of pain (goubert et al., ) , the fear of loss (blackwell et al., ) , and the fear of death (loo, ) . this result confirms the descriptive definition of the neurotic personality. high neurotic people show greater emotional reactivity and have scarce resources to manage stress (larsen and ketelaar, ) . hence, in the presence of a condition where it is impossible to control the situation, likewise the covid- pandemic, they will tend to develop fear (gunthert et al., ) . following the results of our second hypothesis, we also found that neuroticism is related to boredom. this result is consistent with other studies in individual differences and could depend on the lack of purpose typical of the neurotic trait. people with high neuroticism tend to have no purpose in life, which would cause them to feel bored (bond and feather, ) . furthermore, our results show that the relationship between neuroticism and boredom seems enhanced if one is involved in negative fantasies. plante et al. ( ) have reported a significant relationship between involvement in negative fantasies and denial of daily problems. so, the lack of purpose typical of subjects with an important neurotic trait and the tendency to deny daily problems would enhance their boredom feeling. we also found a significant positive association between boredom and fear of covid- . this is probably due to the fact that boredom is a temporary state linked to a lack of external stimulation and not only an effect of individual differences (vodanovich, ) . indeed, contextual factors step step step step , ) . although boredom may sometimes instigate positive behaviors such as reflection, creativity, and prosocial behavior (van tilburg and igou, ) , it is more commonly associated with individuals' adverse outcomes. for instance, negative outcomes of boredom might include reduced motivation and effort (pekrun et al., ) , frustration (van tilburg and igou, ) , and distress (melamed et al., ; van hooff and van hooft, ) . previous works have already shown the relationship between boredom and fear (brotherton and eser, ) and reported that high feeling of boredom is related to the tendency to paranoid ideas (von gemmingen et al., ) . this could, therefore, explain the positive effect between boredom and fear of covid- we found in the current study. besides, our data show that perceived control over time moderates the association between boredom and fear toward covid- . having a high perceived control over time allows people to reduce the effect of boredom on fear of covid- . this finding is consistent with prior works demonstrating that boredom might determine individual differences in the subjective perception of the passage of time (watt, ) . specifically, high boredom individuals usually have a subjective perception of the slow passage of their "mental" time, but not a slow perception of the objective passage of the "official frontiers in psychology | www.frontiersin.org october | volume | article time" measured by the clock (watt, ; cardaci, ) , so experiencing negative feelings or emotions. conversely, the improvement in perceived control over time has a significant effect on modulating anxiety disorders (gallagher et al., ) . moreover, it could also promote psychological well-being (chang and nguyen, ) . we must evidence that our sample's gender composition, with a high predominance of females, might be responsible for the present results. however, our findings are in line with previous literature, which evidenced well-documented gender differences in neuroticism and showed females reporting higher scores than males (see for a review schmitt et al., ) . moreover, recent study findings indicate boredom has been increasing among young over the past several years, with more significant increases among females. such increases in the perceived levels of boredom in females are concomitant with recent increases in mental health difficulties (weybright et al., ) . researchers typically find females reporting lower levels of subjective well-being and higher tendency on depression than males, mainly due to women's enhanced negative emotional responsivity (schmitt et al., ) . finally, women also have higher time management skills in different behavioral domains such as domestic outsourcing or housework shares (craig and baxter, ) , and academic performance (trueman and hartley, ) . although our tested model offers a first view for understanding the processes underlying the fear of covid- , the present study has some limitations to report. first, the sample consists of university students with predominantly female gender. this limit does not allow generalizing the results to the entire population. future research is necessary on more representative samples. a second limitation is the study's cross-sectional design, which does not determine the cause-effect relationship between the variables. a third limitation is that we have used self-report measures in the current work, causing common-method bias (podsakoff et al., ) . to overcome these limitations, we would carry out future studies based on a longitudinal design since they give more information about the causality of the effects and minimizes the common-method bias. despite its intrinsic limitations, we deem that the current study results could contribute to understanding psychological variables crucial for evidencing individual differences in coping with the fear of covid- , helping mental health practitioners develop treatment programs in the forthcoming months. because of the moderating role of fantasy engagement on the relationship between neuroticism and boredom, we believe that specific clinical and/or educational programs should aim to improve people's abilities to develop positive fantasies about their future. cultivating positive fantasies about goal completion could be an excellent motivational exercise for persisting in future goal pursuit (oettingen and mayer, ) , so contrasting the negative effect of the association between neuroticism personality trait and boredom. indeed, scholars reported motivational benefits of positive fantasies in the context of academic performance (gollwitzer et al., ) , exercise and healthy eating (sheeran et al., ) , and persistence despite adversity (kappes et al., ) . as well, in light of the moderating role of perceived time control on the relationship between boredom and fear of covid- , treatment programs in mental health should aim to improve time management strategies in individuals so balancing the negative effect of the association mentioned above. time management behaviors positively predict psychological well-being (macan, ; griffiths, ; see mckee-ryan et al., ) . in addition to providing essential elements for reflection about mental health programs for individuals, our results suggest practical implications for the development of social policy interventions to address situations of psychological vulnerability that, while not at the heart of the health emergency, risk producing long-term effects and high social costs. moreover, the pandemic's current scenario does not entirely exclude the possibility of new lockdown situations capable of significantly affecting the mental balance of young people. hence it would be useful to develop, especially within the school context of all levels, albeit remotely, social-psychological programs that emphasize positive fantasies, creativity, time management, and motivation. above all, young people, deprived in many cases of the necessary social face to face interactions, need to experience boredom constructively, through adequate time management. in this vein, the italian ministry of education has recently published guidelines for school managers stressing the necessity of having psychologists inside the schools. the raw data supporting the conclusions of this article will be made available by the authors, without undue reservation. the 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effect of boredom proneness on time perception clarifying the associations between big five personality domains and higher-order psychopathology dimensions in youth more bored today than yesterday? national trends in adolescent boredom from coronavirus disease (covid- ): situation report- the authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. in this journal is cited, in accordance with accepted academic practice. no use, distribution or reproduction is permitted which does not comply with these terms. key: cord- -w k fnpo authors: nielsen, morten birkeland; christensen, jan olav; hetland, jørn; finne, live bakke title: organizational prevention and management strategies for workplace aggression among child protection workers: a project protocol for the oslo workplace aggression survey (owas) date: - - journal: front psychol doi: . /fpsyg. . sha: doc_id: cord_uid: w k fnpo background: previous research has established exposure to workplace aggression as a significant risk factor for employee functioning, well-being, and health. however, less is known about effective prevention and management strategies. the main objectives of the current project were to determine the impact of physical and psychological aggression on the well-being, health, and work ability of employees in the child welfare service and to establish whether a strong psychosocial safety climate and an ethical infrastructure are effective with regard to protecting employees against aggression. this project may help identify the specific risks child welfare workers are exposed to, the impact of workplace aggression on their health and well-being, and the most effective strategies to manage the problem. furthermore, the findings should be central for developing laws and regulations and to any political decision on measures to tackle aggression in the workplace. methods: the study will employ two prospective data collections. firstly, a three-wave longitudinal survey with a -month time lag between measurement points will be conducted among all , employees in the child welfare services in oslo municipality, norway. data will have a multilevel structure and will be linked to registry data on sickness absence. secondly, a quantitative daily diary study over a -day period will include of the respondents from the main survey study. the survey questionnaires mainly comprise well-established and psychometrically validated indicators of workplace aggression, health and well-being, psychosocial safety climate, ethical infrastructure, and other relevant factors. the regional committees for medical and health research ethics (rec) in norway (rec south east) have approved this project (project no. ). discussion: this project will identify the impact of workplace aggression on child protection workers as well as provide information on how organizations can actively manage exposure to workplace aggression. the findings may serve as a starting point for intervention studies as well as the development of policies and guidelines on how to handle workplace aggression. child welfare work is concerned with ensuring the welfare and well-being of children by assisting parents in giving their children the best possible upbringing. however, working with children, and especially in cases of maltreated children, is also a risk factor for child welfare workers' own psychological well-being (baugerud et al., ) . in addition to having to deal with cases that are challenging and even traumatic, many employees in the child welfare service are exposed to physical and psychological aggression from both the clients and their relatives (littlechild, ) . with previous research showing that a stressful working environment is a main cause of bullying and harassment (hauge et al., ; van den brande et al., ) , employees in the child welfare service are also at increased risk of being exposed to aggression from co-workers. workplace aggression involves experiencing behavior that ( ) is potentially harmful, ( ) the target is motivated to avoid, and ( ) occurs while the target is working (schat and frone, , p. ) . the two main categories of workplace aggression are physical violence and psychological aggression. physical violence involves behavior characterized by a physical act where the typical immediate and primary effect is physical harm. examples of physical violence are beating, kicking, slapping, stabbing, pushing, biting, and pinching, as well as direct threats of such behaviors. psychological aggression involves behavior characterized by a verbal or symbolic act where the typical immediate effect is psychological harm (schat and frone, ) . psychological aggression can often be indirect and abstract and can include verbal abuse, ostracism, slander, humiliation, unreasonable criticism, and bullying. when seen from the perspective of the perpetrator, differentiating between hostile aggression and instrumental aggression is also common (anderson and bushman, ) : hostile aggression is conceived as being impulsive, thoughtless (i.e., unplanned), driven by anger, having the ultimate motive of harming the target, and occurring as a reaction to some perceived provocation. instrumental aggression is conceived as a premeditated means of obtaining some goal other than harming the victim and being proactive rather than reactive. in the present project, we will, however, only investigate workplace aggression as seen from the target perspective. the focus will therefore be on the individual consequences of being exposed to aggression at the workplace rather than on identifying the motives or intent behind the perpetrated aggression. the transactional model of stress and coping (lazarus and folkman, ) and the shattering of basic assumptions theory (janoff-bulman, ) are theoretical frameworks that can explain the individual consequences following exposure to workplace aggression. according to the transactional model, the ability to cope with negative life events, such as aggression, is determined by two consecutive appraisal processes. the primary appraisal process consists of the cognitive appraisal of the adversity of the aggressive situation for its potential for harm or loss. if the target perceives the situation as threatening, a secondary appraisal process is initiated, centering on whether one has available options or adequate resources to handle the aggression in order to prevent the threat of harm or loss. if individuals perceive that the exposure is taxing or exceeding the available options and resources, the transactional model proposes that individuals experience strain (i.e., an imbalance between demands and resources). strain over an extended time period may produce mental distress (e.g., anxiety, depression, and exhaustion), which, again, can develop into somatic complaints and disorders (watson and pennebaker, ) . janoff-bulman's ( ) theory on "shattered basic assumptions" extends the transactional model by providing a mechanism that can explain how workplace aggression can impact the health and wellbeing of those exposed. according to janoff-bulman's theory, aggression is likely to break down the targets' assumptions of themselves as valuable and worthy individuals, of other people as benevolent, and of the world as meaningful (mikkelsen, ; mikkelsen and einarsen, ) . such abrupt changes in the core conceptual beliefs about ourselves and the world are threatening and can inflict worrying, rumination, and psychological crisis, which subsequently lead to mental disorders (janoff-bulman, ) . as for specific health consequences following workplace aggression, several systematic reviews and meta-analyses show that those exposed are at significantly higher risk of developing mental and somatic health complaints (lanctot and guay, ; nielsen et al., ; rudkjoebing et al., ) , symptoms of posttraumatic stress (jacobowitz, ; nielsen et al., b) , and suicidal ideation (leach et al., ) . targets also report higher turnover and lower affective commitment (leblanc and barling, ; bowling and beehr, ) , lower productivity (bowling and beehr, ) , reduced work ability as manifested through higher sickness absence rates , and risk of disability retirement (nielsen et al., a) . a prospective study of female health and social workers in norway found that employees exposed to threats and violence had a % increased risk of long-term medically certified sickness absence (aagestad et al., ) . hence, workrelated aggression has significant costs for both individuals, employers, stakeholders, and the society (lanctot and guay, ; hassard et al., ) , and it has been estimated that workplace aggression represents an annual financial burden for society ranging between us $ . million and us $ . billion (hassard et al., ) . these extensive costs suggest that knowledge regarding how employees can be protected against the impact of workplace aggression is highly important. as previous research has shown that personal resources only have a protective effect in cases of no or only low exposure to aggression, and not in cases of high exposure , resources provided by the employer seem to be especially vital with regard to counteracting the impact of workplace aggression. one such resource is psychosocial safety climate, which refers to the organizational policies, practices, and procedures for the protection of workers' psychological health and safety (dollard and bakker, ) . in contrast to safety culture, which encompasses a set of shared beliefs, values, attitudes, and customs concerning workplace safety, safety climate is the perceived value placed on safety in an organization at a particular point in time (christian et al., ) . hence, safety climate can be considered as a snapshot, and thereby a measureable component, of an organization's culture. a closely related concept is "ethical infrastructure, " which consists of the formal and informal systems, each including communication, surveillance, and sanctioning components, that are used to counteract workplace aggression (tenbrunsel et al., ; einarsen et al., ) . due to its focus on safeguarding employees, ethical infrastructure constitutes the basis for psychosocial safety climate. it appears that when ethical systems are present, the psychosocial safety climate is likely to be perceived as stronger (einarsen et al., ) , and it is therefore important to assess both phenomena in order to understand how organizations can protect employees against the impact of workplace aggression. based on the main assumptions of the "psychosocial safety climate model" (pscm; dollard et al., ) , a workplace with a strong psychosocial safety climate and an ethical infrastructure should have available policies and procedures that actively manage psychosocial risk factors. human resource divisions, health and safety personnel, and managers should have clear methods for the promotion and protection of worker health and well-being. employees are encouraged to utilize the available tools to improve well-being and to report incidences of aggression (dollard et al., ; dollard et al., ) . in order to be effective, all levels of the organization (executive, management, and worker) need to have implemented these policies, procedures, and practices relating to health and wellbeing. however, leaders and the management seem to play an especially important role. evidence shows that both toplevel management and supervisor-level management serve as role models that can influence employee behavior luria, , ; walumbwa and hartnell, ) , and leaders are also highly important with regard to shaping the organizational culture (schein, ) . in the context of workplace aggression, leaders may directly prevent employees from future exposure to aggression, for instance by considering prevention in decisions concerning staffing and the intake of clients (gadegaard et al., ) , and they may also contribute to buffering the effect of aggression if employees perceive that cases of aggression are handled effectively. hence, in the perspective of the pscm, a strong psychosocial safety climate and an ethical infrastructure function as preeminent protective factors against the occurrence of workplace aggression while also being protective resources against negative outcomes if aggression does occur (dollard and bakker, ) . this means that having a strong psychosocial safety climate and an ethical infrastructure should reduce the occurrence and, in addition, alleviate the consequences of aggression. in this project, we will empirically examine the role of ethical infrastructure and psychosocial safety climate with regard to exposure to multiple forms of workplace aggression among child welfare workers. the forms of aggression that will be investigated can stem from both clients and colleagues and include physical aggression, as displayed through verbal and physical threats and actual physical violence, and psychological aggression, as displayed through verbal abuse, threats to family members, online harassment, and bullying. the main reason for examining multiple forms of workplace aggression from different aggressors (e.g., clients and colleagues) is that both the nature of the aggression and the identity of the aggressor are likely to result in different outcomes. consequently, specific intervention strategies will be needed for each form of aggression. figure provides a graphical overview of the associations that will be examined in the project. specifically, we will investigate how the psychosocial safety climate and ethical infrastructure influence the risk of physical and psychological aggression, as well as the outcomes of these exposures, among child welfare workers. we expect that workers with a strong psychosocial safety climate and with the ethical infrastructure in their workplace are at lower risk of workplace aggression and that these workers have a lower risk of health complaints if experiencing aggression. in order to understand the health effects of workplace aggression, it is also important to identify the mechanisms that determine how workplace aggression creates health problems. to this date, only a few studies, mainly based on cross-sectional self-report data from small and specific samples, have examined such explanatory variables (neall and tuckey, ; nielsen and einarsen, ; rudkjoebing et al., ) . in this project, we will therefore examine these mechanisms applying longitudinal data. these kinds of prospective studies have been requested in the literature on workplace aggression (rudkjoebing et al., ) . based on the theory of shattered basic assumptions described above (janoff-bulman, ; mikkelsen and einarsen, ; nielsen and einarsen, ) , it is likely that workplace aggression influences the health and well-being of those exposed through factors such as worrying (rosario-hernández et al., ; demsky et al., ) , job dissatisfaction (devonish, ) , psychological detachment (demsky et al., (demsky et al., , , and job engagement . the following primary research questions will be addressed: . what is the prevalence of physical and psychological aggressions among employees in the child welfare service? . to what extent do the psychosocial safety climate and ethical infrastructure influence the occurrence of physical and psychological aggression? . how and when do physical and psychological aggressions impact the health and well-being of employees in the child welfare service? the following general hypotheses will be tested with regard to the third research question: a. worrying, job dissatisfaction, psychological detachment, and job engagement mediate the association between workplace aggression and outcomes related to health and well-being. b. strong psychosocial safety climates and ethical infrastructures will reduce the negative impact of workplace aggression on the health and well-being of employees. specific hypotheses about the relationships between variables, causal associations, and moderator and mediating variables will be developed and tested in individual studies based on data from the current project. a reference group was set up to advise on the project. the reference group comprised stakeholders with knowledge about child protection work. the members were recruited from oslo municipality (including first-line employees, managers, and safety representatives) and from the major union for child protection workers (the norwegian union of social educators and social workers). the main tasks of the reference group in the implementation phase of the project were to provide suggestions for the study questionnaire and to oversee the practical implications of the project. this project applies two different study designs. firstly, all employees in the child welfare service in oslo municipality will be invited to participate in a prospective questionnaire survey that includes three measurement points over months. the questionnaire will be identical at all three assessments. this kind of longitudinal design allows for ( ) establishing the sequence of events; ( ) following change over time in particular individuals within the cohort; ( ) excluding recall bias in participants by collecting data prospectively and prior to knowledge of a possible subsequent event occurring; and ( ) the ability to correct for potential cohort effects (caruana et al., ) . hence, compared to cross-sectional designs, the utilized study design allows for determining directions of the studied associations and thereby provides indications about causal relationships. a time lag of months between the survey time points is applied in order to reduce the risk of recall bias, which is likely to be present in longer intervals. data will be collected at the work unit and team levels, enabling a multilevel approach to data analysis. secondly, respondents who give their consent in the questionnaire survey will be contacted and asked to also participate in a quantitative diary study. the diary study will be conducted electronically using a web-based questionnaire that can be filled out using a smartphone, tablet, or a computer. the purpose of the diary study was to map day-today variations in employee emotions and how these emotions are influenced by exposure to threats and violence related to work. a graphical overview of the study design is presented in figure . the project will be conducted in accordance with the world medical association declaration of helsinki. the regional committees for medical and health research ethics (rec) in norway (rec south east) have approved this project (project no. ). in line with the general data protection regulation (gdpr), the national institute of occupational health (nioh) has acquired permission from the norwegian centre for research data (nsd; approval: ) to process the personal data in this project for research purposes. following the approval from rec, the project will be finished by december . anonymized data will be available for use until december . all participants who are included in the questionnaire survey and the diary study will sign an informed consent before participation. this procedure for securing informed consent was approved by the ethics committee. all data will be collected through the resource center for psychological and social factors at work, developed by the nioh in norway. this is a web-based system for the secure administration of questionnaires. the system is developed for the purpose of tracking individuals over time and to couple data to registries in a way that satisfies the demands for anonymity and personal security. when accessing the web-based questionnaire using a personal login code, the respondents need to confirm their informed consent before responding to the questionnaire. no personally identifiable information about the respondents will be available to researchers as data will be de-identified prior to analyses. in the prospective survey part of the project, all , employees in the child welfare services and childcare institutions in the oslo municipality will be invited to participate. the survey will be conducted electronically (although paper forms will be available if needed). based on previous studies from similar settings (nielsen et al., ; finne et al., ; aagestad et al., ) , the expected response rate is between and % at each of the measurement points. the magnitude of the questionnaire will be reduced at survey points and in order to retain the response rate across all measurement points. items will excluded on the basis of the responses on the first survey (e.g., through factor analysis). for the baseline measurement, the expected response rate will give a sample size in the area of - , respondents. across all three time points, the sample size will range from to respondents, depending on the response rate. given a prevalence rate of % for workplace aggression, as is the case in earlier studies (aagestad et al., ) , the necessary sample size for a power of . and α = . in the analyses of two groups (exposed/non-exposed) with a dichotomous outcome variable is estimated to be . hence, by inviting , potential respondents with a response rate of at least %, it is likely that the needed sample size is achieved. respondents with more than % missing data on the study variables will be excluded from the analyses. the remaining missing data will be handled with multiple imputation or with full information maximum likelihood (fiml) estimation with robust standard errors (graham, ) . to be able to assess the impact of threats and violence, only employees that have face-to-face sessions with children, youths, or their relatives will be recruited for the diary study. in the first round of the questionnaire survey, employees will be asked whether they will give their consent to also participate in the diary study. the selection mechanism will thereby be self-selection as only those employees who are willing to participate are invited. the intake for the study will be closed when employees are recruited. with employees and daily measurements, the diary study will collect a total of , measurement points. the information from the diary study will be linked to the survey data. the questionnaire contains items and inventories that can be classified into the following five main categories: ( ) demographics and background information; ( ) physical and psychological aggression; ( ) psychosocial safety climate and ethical infrastructure; ( ) psychosocial work factors; and ( ) health and well-being. a complete overview of the included scales and inventories for the questionnaire survey is found in table , whereas the inventories for the diary study are presented in table . in the following, we will present the assessment of the demographic factors, violence, threats, and aggression and the indicators of the prevention and management of violence and aggression. the scales included to assess the psychosocial work factors and health and well-being are all well-established instruments with previously demonstrated psychometric properties and therefore will not be further described in this protocol (please see the cited studies for information about these inventories). the background and demographic factors that will be recorded in the survey include age, gender, marital status, employment status (part-vs. full-time), seniority, education, shift work, leadership responsibility, position as a union representative, and number of child protection cases worked with during the last months. exposure to physical violence and threats of violence from children, youths, and their relatives will be assessed using a -item questionnaire. the majority of the items are taken from two established indicators for assessing workplace violence (barling et al., ; gadegaard et al., ) , whereas some were developed for this study in order to fully capture the forms of violence that child protection employees can experience. the added items were based on suggestions from the reference group. this inventory captures exposure to specific forms of violence rather than to more general categories, such as those found in other scales like the perception of aggression scale (palmstierna and barredal, ; de benedictis et al., ) . the utilized scale will be psychometrically tested and validated as a part of the current project. the respondents are asked to indicate their exposure during the last months before the survey. example items are: "been cornered or placed in a position that was difficult to get out of " and "someone threatened to kill you." the response alternatives are: "never, " "once, " "twice, " "three times, " "four times, " and "five or more times." in addition, the respondents will be asked several single-item questions related to threats and violence, including questions about the perpetrator, previous exposure to threats and violence, threats to family members, perceptions of physical safety, and perceived competence to deal with threats and violence. exposure to online harassment and threats will be surveyed using eight items developed for this study. these items were developed through discussions with employees in the child protection service and with the reference group for this project. after explaining that the context of the questions is online media, the respondents are asked to indicate their agreement with the included items using a -month time frame. example items are: "received messages with threats" and "having personal information shared without your consent." responses will be given on a five-point scale ranging from "never" through "rarely, " "sometimes, " "often" to "very often." exposure to psychological aggression from colleagues in the workplace is measured with the nine-item version of the negative acts questionnaire-revised (naq-r) inventory (einarsen et al., ) . naq-r describes negative and unwanted behaviors that may be perceived as bullying if occurring on a regular basis. this inventory assesses multiple forms of psychological aggression, including verbal abuse, social exclusion, slander, and humiliation. all items are formulated in behavioral terms and focus on the mere exposure to inappropriate behaviors while at work, with no references to the term "bullying" (einarsen and nielsen, ) . example items are "spreading of gossip and rumors about you" and "being shouted at or being the target of spontaneous anger or rage." the respondents are asked to indicate how often they have been exposed to each specific item in the questionnaire at their present worksite during the last months. the response categories range from to ("never, " "now and then, " "monthly, " "weekly, " and "daily"). building on the study findings by nielsen et al. ( b) , power imbalance with regard to the bully will be measured with a fiveitem scale developed for this project. referring to the items in the naq, the scale asks about whether respondents exposed to bullying behavior experience an imbalance of power opposite the perceived bully. an example item is "felt a sense of hopelessness and resignation in relation to what you have experienced." responses are given on a scale ranging from "never, " through "sometimes, " "occasionally, " "often, " to "every time." self-labeled victimization from workplace bullying will be measured with a single item used in several previous studies on bullying (olweus, ; einarsen and skogstad, ; solberg and olweus, ; nielsen et al., ) . after being presented with the following definition -"bullying (harassment, badgering, niggling, freezing out, offending someone) is a problem in some workplaces and for some workers. to label something bullying it has to occur repeatedly over a period of time, and the person confronted has to have difficulties defending himself/herself. it is not bullying if two parties of approximately equal 'strength' are in conflict or the incident is an isolated event" (einarsen and skogstad, , p. ) -the respondents are asked, "have you been subjected to bullying at the workplace during the last months?" the response categories are "no, " "rarely, " "now and then, " "once a week, " and "several times a week." nine items adapted from the conflict management climate scale (rivlin, ) will measure climate for conflict management and climate for violence management. the scale assesses the fairness of the dispute resolution and was designed to measure the perceived quality of the organizational procedures and managers' abilities to handle interpersonal conflicts, bullying, and harassment. for four items, the wording was retained from the original scale in order to reflect the management procedures for conflict, whereas the wording for five items was changed in order to reflect the management procedures in cases of threats and violence. example items are: "we have good procedures and methods for resolving disagreements and conflicts at my workplace" (conflict management climate) and "the management handles cases of violence and threats well" (violence management climate). three items from the psychosocial safety climate scale (hall et al., ) are included to assess the respondents' perceptions regarding the organizations' policies, practices, and procedures for the protection of workers' psychological health and safety. an example item is "employees' psychological health is taken seriously at my workplace." violent prevention behavior at the top management, supervisor, and co-worker levels will be measured with the nine-item scale developed by gadegaard et al. ( ) . example items are "invests a lot of time and money in violence-prevention training for workers" (top management), "your supervisor encourages staff to report physical violence" (supervisor), and "your co-workers give sufficient help and support after a violent or threatening incident" (co-worker). a five-point likert scale from ("do not agree") to ("agree completely") will be used for the responses for all items related to the above scales. the effectiveness of the procedures for reporting exposure to threats, violence, bullying, and other inappropriate behavior at the workplace will be assessed with the four-item scale developed for this project. an example item is "we have good reporting procedures that should be used when one has been subjected to violence." the response categories for this scale are given on a five-point likert scale from ("do not agree") to ("agree completely"). "do not know" was added as a response alternative for respondents not familiar with reporting procedures. training with regard to handling threats, violence, and aggression will be surveyed using five single-item questions asking about whether or not the respondents have received training during the last years with regard to (a) threats and violence, (b) conflicts in general, (c) bullying and harassment, and (d) sexual harassment. the response alternatives are "no, " "yes, " and "yes, but more than years ago." in addition, the respondents are asked about whether they are satisfied with the quality of the training. providing informed consent from participants, the survey data will be linked to registry data on sickness absence from the employer. the data on sickness absence will include the total number of episodes with absence and the total number of days with absence during the last year before the survey and throughout the survey period. following the described aims, this project will determine the prevalence rates; group differences; and direct, indirect, and conditional associations between the study variables both crosssectionally and over time. group differences will be tested with chi-square tests and anova. associations between variables will be examined using correlation-and regression-based approaches. indirect and conditional effects will be analyzed with process, which is an observed variable ordinary least squares (ols) and logistic regression path analysis modeling tool (hayes, ) , as well as with structural equation models. longitudinal associations between variables will be adjusted for stability in variables in order to model changes over time (little, ) . in order to capture the multilevel structure of the quantitative diary study data, where the daily measurements (level ) of the study constructs are nested within individuals (level ), multilevel analyses will be carried out using mlwin and mplus software packages. associations with registry data will be analyzed with a modified model for count data, the negative binomial hurdle (nbh) model. this analysis is capable of capturing both overdispersion and excess of zero values (mullahy, ). the nbh model analyzes data in two steps: ( ) a log-binomial regression analysis which estimates the risk ratio of having at least day of medically certified sickness absence vs. none and ( ) a zero-truncated negative binomial analysis which produces incidence rate ratios for the number of days absent among the subsample being at least day absent (indregard et al., ) . potential control variables and confounders for the adjusted models, e.g., demographic variables, will be considered only when theoretically applicable (spector and brannick, ) . this project will address some important knowledge gaps in research on workplace aggression. firstly, by using behavioral inventories to assess specific forms of physical and psychological aggression, the findings will provide prevalence estimates as well as an in-depth understanding of how these forms of aggression influence individuals and organizations. secondly, whereas previous studies on workplace aggression have mainly used cross-sectional data (neall and tuckey, ; rudkjoebing et al., ) , the present project is based on longitudinal research designs, including a quantitative diary study, which is a novel approach within this field of research. thirdly, by examining mediating and moderating variables in the relationship between aggression and outcomes, this project will generate novel knowledge important for extending and developing the theoretical basis of our understanding of workplace aggression, which is critical in order to adequately design upcoming studies. finally, the current project will elucidate whether strong psychosocial climates and ethical infrastructures are beneficial with regard to protecting employees against the detrimental effects of workplace aggression. the resulting knowledge will aid efforts to improve public health and the overall quality of life of child welfare workers, as well as for other employees working with customers and clients. by identifying modifiable moderators at the organizational level that protect against the adverse consequences of aggression, the findings can be used to develop appropriate prevention and intervention programs. being able to alleviate the impact of workplace aggression on health and well-being can significantly reduce the costs related to sickness absence, productivity loss, turnover, and disability retirement. the project will thereby have major benefits for individuals, organizations, and society at large. the project has several strengths. through a prospective design, the data are based on repeated measurements of workplace aggression, intervening variables, and outcomes. this provides more reliable information about exposures (independent variables) than what has been common until now. as conducting an experimental study on overt workplace aggression is ethically problematic, prospective designs are the strongest form of scientific evidence for the causal association between aggression and potential effects. another strength is that the survey builds on well-established and standardized inventories, psychometrically tested for validity and reliability. the included registry data are objective data and the data structure allows for multilevel models, where individual-level data can be aggregated to department and organizational levels. the selection of respondents is based on a probability mechanism as all child welfare workers in the surveyed municipality are invited to participate. depending on the response rate, it is likely that the sample will be representative of the population. there are also some limitations of the planned project. the included survey instruments are all self-report measures and the project is thus subject to limitations specific to self-report instruments, such as response-set tendencies. the survey data are measured from the same source. as such, common method variance may inflate the relations between constructs (podsakoff et al., ) . however, the use of a longitudinal design as well as the opportunity to obtain co-worker reports of working conditions at the team and work unit levels should limit the risk of common method variance caused by self-report biases (caruana et al., ) . the main survey questionnaire is quite extensive and the time needed to participate may inflate the attrition and dropout rates. ill health can be associated with non-response (drivsholm et al., ) , and it can be questioned whether the final sample is representative of the overall population or survey pool. however, research indicates that this health bias is not a major problem in occupational health research (nielsen and knardahl, ) . due to their personal experiences, employees may be more inclined to participate in the survey and the quantitative diary study if they have been exposed to aggression or mistreatment at the workplace. this situation is likely to inflate the prevalence estimates found in our sample in case of substantial non-response among non-exposed workers. we attempt to evade this problem by informing the respondents of their value to the study even though they have not experienced aggression. to motivate all employees and managers to participate, they will be informed about how the survey findings can be used as a tool to assess and improve working conditions. the strict procedures for the confidential treatment of data will be emphasized. moreover, non-respondents will receive several reminders during the survey collection period. as is common with questionnaire surveys asking about a person's past experiences, there is a risk of recall bias. to minimize this risk, we have included a relatively short and specific time period for most items (the last months before the survey), and the items have a relatively low level of abstraction and should therefore be likely to be associated with specific events. as aggression represents a violation of a person's physical and psychological integrity, people are likely to remember such events. as all employees in the child welfare services and childcare institutions in the oslo municipality are invited to participate in the survey, the risk of selection bias is low. the prospective associations between workplace aggression and employee functioning, including findings on the prevention and management strategies, will be submitted to international peer-reviewed scientific journals. the results will be presented at national and international conferences. oslo municipality will be informed about the findings through a series of feedback meetings. central decision makers will also be informed about the findings. given the limited evidence for effective strategies in preventing and managing workplace aggression, this study is important and timely and may help identify specific risks 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institutions share cost for data collection. nioh was the project owner and the municipality of oslo has no impact on the design of the study, data collection, data analyses, interpretation of data, writing of and publications of manuscripts, or any other aspects of the study. the authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.copyright © nielsen, christensen, hetland and finne. this is an open-access article distributed under the terms of the creative commons attribution license (cc by). the use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. no use, distribution or reproduction is permitted which does not comply with these terms. key: cord- -u vnbhvn authors: charry, claudia; goig, rosa; martínez, isabel title: psychological well-being and youth autonomy: comparative analysis of spain and colombia date: - - journal: front psychol doi: . /fpsyg. . sha: doc_id: cord_uid: u vnbhvn the construct of autonomy appears in literature associated with individual psychological wellbeing. in ryff’s model, autonomy is presented as one of the dimensions of wellbeing, along with self-acceptance, positive relationships with others, environmental mastery, purpose in life, and personal growth. the present study compared the levels of autonomy and psychological wellbeing between spanish and colombian young people. ryff’s scale of psychological wellbeing and the transition to adulthood autonomy (edatva) scales were used on a sample of , young people aged between and ; spaniards and colombians. results showed differences in autonomy and in two of the four dimensions proposed by the edatva: self-organization and critical thinking. similarly, important differences were observed in the subscales of positive relations and purpose in life. the importance of contextual factors in the development of psychological well-being and autonomy in young people in transition to adulthood is discussed. psychological well-being is a multidimensional and dynamic construct composed of a framework of dimensions where enjoying positive experiences and meeting basic needs are considered essential. psychological well-being has been examined from multiple perspectives, and different academic fields have taken an interest in the construct due to its influence on other dimensions, such as individual performance, satisfaction levels, or the characteristics of interpersonal interactions (gao and mclellan, ; ryff, ryff, , . psychological well-being involves subjective, social, and psychological dimensions, health-related behaviors, and practices that add meaning to an indiviual's life and allow them to attain their maximum potential (ryff, ; ferrari et al., ; lun and bond, ; friedman et al., ; brim et al., ) . most researchers agree that well-being is a sign of an optimal psychological functioning that improves one's life experience; therefore, it is understood as a set of factors that motivate people to pursue the satisfaction of their expectations (crous, ; maurya and ojha, ; bojanowska and piotrowski, ) . yough ( ) stresses the individual's personal circumstances in the context of well-being; people are unable to change these circumstances, for example, their country of residence or physical gender. partaking from the relationship between psychological well-being and individual non-modifiable characteristics, different studies have analyzed the construct from different perspectives (mota and matos, ; lun and bond, ) . according to these studies, subjective psychological wellbeing is an important factor for human beings to achieve an optimal performance, that is, fully meeting one's expectations in life; therefore, meeting expectations is frequently regarded as a predictive variable of positive individual development and is associated with high levels of overall well-being (mcdowall, ; reis et al., ) . the sociocultural context where a young person develops represents the universe of possible expectations that they can envision for their lives and the possible strategies that they can deploy to meet those expectations (lacomba and cloquell, ; uribe et al., ) . for instance, when comparing spain and colombia, the weight of the social support network appears to be higher in colombia (uribe et al., ) . therefore, psychological well-being is an idiosyncratic feature of each population, modulated by the visible types of occupations and interests that inspire the expectations of the individual (güngör and perdu, ; alivernini et al., ; mansoory et al., ; klainin-yobas et al., ) . the context can also present special challenges, for instance the covid- pandemic, characterized by the anxiety and fear of entire populations, especially for people with lower levels of autonomy and resilience (koenig, ) . in colombian youth, subjective psychological well-being has been associated with social interaction needs, often met within the immediate social context, whose additional function is to provide security during the transition to adulthood. these young people tend to develop hedonistic hobbies, such as watching television or listening to music, which are also used as distraction and evasion practices. during their transition to adult life, young people with higher levels of well-being begin to focus their energy on personal satisfaction and fulfillment, whereas young people with lower levels of psychological well-being tend to focus on social activities (bahamón et al., ; cabrera et al., ) . psychological well-being seems to be unrelated to gender, except for attitudes toward personal success, which suggests that coping strategies for men and women are similar but a certain sociocultural influence modulates gender-based roles and expectations (blanco et al., ; cabas et al., ) . in young spaniards, psychological well-being is associated with the meaning of life and self-competence, both of which contribute to autonomy. additionally, an adolescent's adaptive capacity allows them to take a strategic approach toward their goals, which has been associated with high levels of intrinsic motivation (garcía, ; mayordomo et al., ; meléndez et al., ; garcía et al., ) . in general terms, two philosophical positions have guided psychological research on psychological well-being: hedonism, which focuses on happiness in life, and eudaimonism, centered on the enjoyment of significant experiences (ryff, ; yough, ) . different theoretical models of well-being have been proposed in accordance with these two philosophical positions. the hedonistic perspective emphasizes the evaluation of positive dimensions, such as satisfaction with life and positive affect (ryff, ) ; the psychological well-being construct is built around the affective and cognitive evaluations of one's life. on the other hand, in the eudaimonic perspective, the focus of attention is on intentional commitment, personal fulfillment, autonomy, and self-acceptance. these approaches diverge from each other, and consequently, the results of a given study will be presented from a specific angle (ruini and ryff, ; ryff, ryff, , . nevertheless, psychological well-being is usually quantified based on the interaction of the individual with positive and negative experiences (weiss et al., ; reis et al., ) . soenens et al. ( ) argued that the feelings of happiness and satisfaction with life are universal, although the sources of happiness and satisfaction can differ between societies and cultures. ryff ( ryff ( , ) proposed a theoretical model of psychological well-being comprising six different aspects of positive functioning: autonomy, environmental mastery, personal growth, purpose in life, positive relationships with others, and self-acceptance. ryff 's six-factor psychological well-being model provides a comprehensive theoretical framework to analyze positive performance in young people (sulimani-aidan, ) . according to sulimani-aidan ( ) and gao and mclellan ( ) , research on psychological well-being has traditionally been conducted using a series of different variables, such as resilience, coping strategies, or capacity to adapt to difficult contexts, to establish possible associations. in this regard, xi et al. ( ) have stressed the importance of having a purpose in life to achieve psychological well-being, which correlates with good physical and mental health during all stages of life. hung and appleton ( ) reported on the significance of formulating one's purpose in life for young people in caregiving situations; the authors conclude that the possibility of achieving such an ideal becomes an engine of proactivity that motivates the individual toward development within his or her context using different skills connected with the achievement of the purpose, such as their ability to reflect on the problems that they face or to achieve autonomy. in ryff 's model, the definitions of autonomy and positive relationships with others correspond to the basic needs of autonomy and relationships for any individual (gao and mclellan, ) . according to inguglia et al. ( ) , autonomy is a fundamental dimension in shaping the psychological well-being of adolescents and young adults and is negatively correlated with loneliness and self-perceived isolation during this life stage. parra et al. ( ) refer to autonomy as a key factor in a successful transition to adult life consisting of behaviors (individual capacity to act independently from others), cognitions (including self-efficacy, which empowers individuals to take action in different areas of their lives), and emotions (bonds built with others). in the framework of family relationships during adolescence, there are at least three dimensions related to autonomy. the first dimension is behavioral, and it refers to the ability of a young person to act independently. the second dimension is cognitive, and it involves the acquisition of a sense of competence and agency that enables the person to decide how to take control of their lives. the third dimension is emotional; it refers to perceived independence in the form of self-confidence and individuality as well as the formation of new emotional links of increased symmetricity compared to those formed in childhood relationships (parra et al., ; soenens et al., ; reis et al., ; bojanowska and piotrowski, ) . in the academic literature, autonomy is also positively associated with freedom, and negatively associated with the obstacles individuals face in order to fully enjoy their civil rights and participate in community life (inguglia et al., ; merrill et al., ; vinayak and judge, ; carneiro et al., ) . hung and appleton ( ) and van der kaap-deeder et al. ( highlight the roles played by environmental conditions and social agents to encourage self-determination as a prerequisite to achieve autonomy. in an adverse context, where individuals experience deficiencies or inequalities with respect to others, community tools can eradicate these shortfalls by generating spaces for dialog and information in which young people can identify advantages or, at least, strengths to exploit in order to maximize their capacity to act toward the achievement of their own goals. the first endorsement of autonomy resides in the social rights that come with being part of a community; they are defined and protected by the legal system and, therefore, associated with the enactment of citizenship (balluerka et al., ; krys et al., ) . therefore, autonomy acquires a political and social dimension associated with the mechanisms that guarantee the possibility of exercising self-determination in society; being aware of such rights is a first step (hung and appleton, ) . in this regard, the multiple relationships built by individuals and the infinite possibilities for experimentation allow for the development of commitment with one's expectations and the increase of psychological well-being, two dimensions that have an effect on an individual's ability to overcome personal challenges (gaxiola and palomar, ; maurya and ojha, ; vinayak and judge, ; dutra-thomé et al., ) . sulimani-aidan ( ) considers that social adjustment is conditioned by one's future expectations in life and perceived self-efficacy, which facilitate the assumption that one's behaviors will have an effect on subsequent success; therefore, young people who have positive beliefs about their academic and employment outlook adopt behaviors that favor self-fulfillment. these traits become protective and motivating factors that support people's drive toward achievement and increase their psychological wellbeing in the future (glynn et al., ; crous, ; dickens, ) . kaya et al. ( ) highlighted the influence of gender roles and the individual's willingness to assume them as conditioning factors to their ability to adjust to their environment. for these authors, the current discussion on gender roles among men is centered around their refusal to interpret these roles in the normative sense relayed by their culture, which translates into a conflict that affects their level of psychological well-being. in this context, studies that fail to include the analysis of this impact may be missing on its explanatory power to understand psychological well-being. according to ryff ( ) and kaya et al. ( ) the nature of a person's transition into adulthood affects their psychological well-being, but also events that have an adverse effect on this process, supporting factors, and personality variables; for instance, young people who are open to experiencing adulthood as a period of expansion, maintain positive relationships with their environment, are outgoing, and have set personal goals tent to be successful in facing this stage. additionally, self-esteem has been associated with a higher level of autonomy and with higher psychological well-being. similarly, skowron et al. ( ) suggest that psychological well-being determines young people's success during the transition; mota and matos ( ) consider it essential for young people to develop resilience as a mechanism to improve their preparedness to face the challenges of adult life, when their ability to adapt to new environments and face vital challenges is crucial. merrill et al. ( ) have identified the comprehension of other people's challenging experiences as models that help one's interpretation of our own transition to adult life. these experiences, often consisting of stories relayed by parents to their children, can be unknown for people who are raised in unstructured environments, which could restrict their ability to achieve psychological well-being (kouros et al., ; gao and mclellan, ) . in this context, the present study sought to compare psychological well-being and autonomy between groups of spanish and colombian young people as fundamental aspects for an adequate transition to adulthood. the present study used a descriptive-correlational approach. it was approved by the ethics committee of the participating universities. the results of the study are part of a larger research project carried out by the national university of distance education (madrid, spain) and saint thomas aquinas university (bogotá, colombia). the purpose of the present study was to examine possible differences between colombian and spanish youths in terms of psychological well-being based on the dimensions proposed by ryff 's model and the construct of autonomy, but in the latter case not only based on ryff 's definition, but also involving reflection and decision-making processes focused on oneself and on other people. differences between boys and girls in spain and colombia are presented and analyzed and the scores obtained by participants from both countries are compared by schooling, employment, and state protection status. a total of spanish and colombian youths, selected by convenience sampling, participated in the study. a total of spanish and colombian institutions were contacted, including educational institutions of different types, protection institutions, and companies, in order to observe the different conditions young people in this age range could face. inclusion criteria included being within the age range established for the study, that is, between and years of age, as well as having basic reading and writing skills to respond to the instruments. the mean age for the sample of spanish young people was . (sd = . ), and . for the colombian group (sd = . ). among the participants from spain, ( . %) were girls and ( . %) were boys, and participants from colombia were ( . %) girls and ( . %) boys. participants responded to a scale designed to measure autonomy during the transition to adult life (edatva, bernal et al., a) intended for young people between and years of age. the scale indicates an estimated degree of autonomy during the transition to adult life. it consists of items grouped in four dimensions: self-organization (involving cognitive, organizational, and planning exercises focused on the subject); comprehension of context (including cognitive, organizational, and planning exercises, but now with respect to broader systems); critical capacity (the subject's ability to define their position and defend their own interests), and socio-political involvement (understanding the consequences of one's decisions on other systems and making decisions that take into account social responsibility). the edatva uses a response four-category response scale from (i completely disagree) to (i completely agree). intermediate values ( and ) have no assigned labels. the score for each dimension is obtained by adding the direct scores obtained for the corresponding items (there are no inverse items), and performing a conversion as described by the authors in the scale's manual (bernal et al., b) . the final score is obtained by adding these transformed values. the instrument showed excellent psychometric qualities, including a cronbach's alpha of . for the total scale, . for the self-organization dimension, . for context comprehension, . for critical capacity, and . for sociopolitical involvement (bernal et al., a) . additionally, participants responded to ryff 's psychological well-being scale (díaz et al., ) . this instrument sought to evaluate psychological well-being based on the multidimensional model proposed by ryff, and its psychometric properties were evaluated in adults, elderly adults, and adolescents (ryff, a (ryff, ,b, van dierendonck, ; vleioras and bosma, ; fernandes et al., ) . this scale consists of questions grouped in six dimensions: self-acceptance (recognition and acceptance of one's positive and negative traits), positive relationships (presence of close and stable relationships), autonomy (self-regulation of opinions and decision-making), control of the environment (management of day-to-day responsibilities), personal growth (creating conditions to develop one's potential and evolve), and purpose in life (ability to clearly define life goals). although the well-being scale has a set of items aimed at assessing autonomy, its approach is mainly intrasubjective, focused on the person's internal processes, whereas the edatva takes into account the inter-subjective psychological dimension, that is, the systems in which people interact. items are answered on a six-category scale in the well-being scale: (i totally disagree), (i disagree), (i partially disagree), (i partially agree), (i disagree), and (i totally disagree). the final score is obtained by adding the values obtained for the items, considering inverse items distributed among the instrument's six dimensions. the values of corresponding items are added to obtain the score of each dimension, and inverse items are recoded. the scale presents internal consistency levels between . and . (self-acceptance . , positive relationships . , autonomy . , environmental mastery . , personal growth . , and life purpose . ) (díaz et al., ) . different public and private institutions were contacted to obtain official authorization and validate the participants' informed consent forms, as well as their parents' in the case of underage participants. electronic and hard copy versions of the instruments were created, which were administered considering the pertinence of each case and the participants' access to electronic media and the internet. both scales were administered in a single session. in some cases, the instruments were administered to groups and in other cases individually, depending on the participants' schedules and availability of physical spaces. data were analyzed using descriptive statistics, and multivariate analysis of variance (manova) was carried out to obtain the desired comparisons between the groups of young people from both countries, focusing on the constructs of well-being and autonomy; for this purpose, we evaluated normality and homogeneity of data variance. univariate normality was evaluated using the kolmogorov-smirnov test; p < . values were obtained, which indicated the absence of normality for most variables. however, given the robust nature of the technique with respect to type i error and effect size, the size of the sample, and the similar size of the spanish and colombian groups (when the n value of the larger group was divided by the n value of the smaller group, the result was smaller than . ), manova was maintained (pituch and stevens, ) . considering the lack of data normality, levene's median-based test was employed to assess variance homogeneity. variance inhomogeneity was observed in most well-being subscales of the well-being test and in two of the edatva subscales (levene test: p < . ). also in this case, manova showed robustness to the violation of the assumption as long as the size of the groups were the same. for this reason, as suggested by different authors (nimon, ; pituch and stevens, ) , random sampling (using spss software) was used in the largest group (n = , colombia) in order to compare the groups. manova was carried out separately for the dimensions of each scale, along with their respective total scores, based on the construct of similarity. in order to evaluate differences between the groups at the subscale level and in the total score of each instrument, multiple comparisons were made using a t-test for independent samples and mann-whitney u test, depending on the case; the bonferroni correction was used to control for type i error (huang, ) . table shows the means obtained for each group in each dimension of the well-being scale. the main similarities between the groups are related to the dimensions of personal growth and self-acceptance. the total mean of the well-being scale for the sample of spanish young people was . (sd = . ), and . for the colombian group (sd = . ). the manova test was used to analyze the scores obtained by the two groups in the different subscales of the wellbeing scale (dependent variables), whose independent variable was the country to which they belonged. the multivariate contrasts obtained by wilks' lambda showed that the country has a statistically significant multivariate effect on the linear combination of the subscales composing the instrument ( = . ; f = . ; p = . , partial square eta = . ). these results suggest the possible relationship between the country and the psychological well-being construct, in accordance with the model proposed by ryff. the unstandardized discriminant function coefficients for the first multivariate combination are reported in tables , presents correlation indices between dependent variables. table shows the average scores obtained by colombians and spanish young people in each edatva dimension. the mean overall edatva score for the spanish group was . (sd = . ), and . (sd = . ) for the colombian group. in general, manova results for the edatva subscales showed an important effect of the country variable on overall autonomy ( = . ; f = . , p = . , partial square eta = . ). the unstandardized discriminant function coefficients for the first multivariate combination are reported in tables , shows the correlation indices between edatva subscales. multiple comparisons using the mann-whitney u test were made between the colombian and spanish groups for the different subscales of the instruments. table shows the results of these comparisons and the effect sizes for each case. statistically significant differences are observed in the positive relationships subscale, where spanish participants obtained a higher mean than colombian participants (see table ), as well as in purpose in life, in which colombian participants scored higher than spanish participants. concerning the edatva, significant differences were found in the dimensions of self-organization, critical capacity, and overall scale score; in the three cases, colombians obtained higher scores than spaniards (see table ). comparisons by sex between spaniards and colombians were made using the mann-whitney u test as a function of sex (again, considering the lack of data normality), and important differences were observed among boys in the subscale of positive relationships in the well-being scale, where the mean for spaniards was higher than for colombians, as well as in edatva's self-organization and critical capacity dimensions, in which colombians presented higher average values than spaniards (see table ). a significant difference in the positive relationships subscale was also found among girls (highest mean in spanish groups), as well as in the purposein-life subscale, where the colombian youth group showed a higher mean. significant differences between spanish and colombian girls were found in almost every edatva dimension; colombians showed higher mean scores in self-organization and critical thinking, and spaniards presented the highest context analysis mean. different contrasts were found when considering differences in autonomy and well-being among young spaniards and colombians depending on whether they were studying, working, or receiving state welfare. a total of spanish participants ( . %) were studying, ( . %) were working, and ( . %) were living on state welfare; in the colombian sample, ( . %) participants were studying, ( . %) were working, and ( . %) were living on state welfare. table shows that colombians obtained significantly different means when compared with spaniards in terms of purpose in life, self-organization, and critical thinking, while spaniards obtained the highest and most significant mean score in the positive relationships subscale. among participants who were working, significantly higher scores for the colombian sample were observed in the critical thinking and self-organization subscales and in total edatva scores; for the spanish sample, the positive relationships subscale (well-being scale) spaniards showed the highest mean, a statistically significant difference as compared to colombians. none of the instruments detected statistically significant differences when comparing spaniards and colombians who lived on welfare. the present study sought to examine the differences in psychological well-being between groups of colombian and spanish young people based on the dimensions proposed by ryff. autonomy was also taken into account, however, unlike in ryff 's definition, we considered autonomy as a construct involving cognitive and decision-making processes in relation to other people besides oneself. the study showed the existence of significant differences between the spanish sample and the colombian sample on the ryff psychological well-being scale, with higher scores in the sample of spanish youth, which reveals that the interpretation of this construct could be mediated by the country of residence and sociocultural factors (lacomba and cloquell, ; uribe et al., ; alivernini et al., ) . an intrinsic analysis of the scores obtained using the different elements of ryff 's scale showed higher scores for the colombian group in the dimensions of purpose in life and domain over the environment, where they achieved an average score above *rosenthal's r for all cases except those in which the t-test was applied to independent groups. cohen's d was used in these cases. **significant considering bonferroni's adjustment. ***mann-whitney u test for all cases except for well-being and edatva total scores among employed participants, as well as for the subscales of positive relationships, autonomy, environmental mastery, personal growth, and total well-being score among welfare recipients. in these cases, the t-test was applied for independent groups. the spanish group. on the other hand, the scores obtained by the spanish sample were higher in the dimensions of personal growth, autonomy, and positive relationships, and the self-acceptance dimension was found to be equivalent between both groups. in this regard, following crous ( ) , it could be argued that the perception of well-being in each dimension would be, for each subject, a consequence of their individual trajectories, not something derived exclusively from their country of residence but from the idiosyncrasies of the social provision present in the national environment as well as the influence of values existing in each sphere. however, cultural factors have an enormous impact on an individual's sense of autonomy, as well as the prevalent values and guiding principles in an individual's cultural context, which shape their global perception of right and wrong and the different roles that they are expected to take on throughout their lives, one of which is the process through which young people separate from their parents (parra et al., ; blanco et al., ; cabas et al., ) . psychological well-being is also harmonized by the influence of the environment and, especially, by the support received during the process through which young people access their autonomy (greeson et al., ; kouros et al., ) and the socialization process (lun and bond, ; alonso-stuyck et al., ) . concerning the edatva, the mean score for the spanish group was . (sd = . ), and . for the colombian group (sd = . ). for prioste et al. ( ) , the social circle in which an individual exists represents an outline for the process through which he or she moves toward the achievement of full autonomy. according to glynn and mayock ( ) and isakov and hrnčić ( ) , the strength of a young person's family environment translates into differences in their psychological well-being; hence the need to develop interventions specifically designed to provide stability during people's transition to adulthood. similarly, authors such as fousiani et al. ( ) ; liga et al. ( ) , schofield et al. ( ), and dutra-thomé et al. ( ) consider that the possibility of achieving autonomy and independence is shaped by certain contextual variables that affect the configuration of the expectations forged by each individual throughout their life; this requires assessing whether the lack of equality during this transition has any effect on the way in which people decide on their longterm goals. further analysis of the dimensions measured by the edatva showed that the colombian sample presented higher scores in the critical capacity and self-organization dimensions, and the mean scores of the context analysis and sociopolitical involvement dimensions were very similar for both samples. comparisons between colombian and spanish young people based on the different subscales of the well-being and autonomy scales show the presence of a statistically significant difference in the dimension of positive relationships, in which the mean was higher for young spaniards, whereas colombians scored higher in purpose in life. statistically significant differences were also observed in self-organization and critical thinking, as well as in the overall score edatva score; these three scores were higher for the colombian sample. the acquisition of autonomy and the development of positive relationships with others play a central role in the psychological health and well-being of young people, but age modulates the intensity of this relationship (inguglia et al., ; lun and bond, ) . autonomy can be analyzed from an individual perspective, which is understood as the individual's capacity to make decisions that differ from their parents' and from a collective perspective (gao and mclellan, ) . similarly, according to volkova et al. ( ) , perceived support and the possibility of maintaining positive relationships with the environment are essential, both while the person is being raised and afterward. on the other hand, there is a widespread consensus in the literature on the inequality of opportunities for people to achieve autonomy; these difference is related to one's social group or gender, among other factors (inguglia et al., ; van der kaap-deeder et al., ; dickens, ; pinkerton and mccrea, ) . these factors will influence with greater or lesser intensity depending on the environment studied, which could explain the differences observed in the level of autonomy between spanish and colombian youth, in addition to interacting with individual barriers that reduce the subject's ability to access autonomy within of the same analysis scenario (brim et al., ) . in addition, it should be borne in mind that the knowledge about the problems individuals face in achieving their autonomy is limited, despite the indirect relevance of these on psychological well-being (dutra- thomé et al., ) . along the same lines, van der kaap-deeder et al. ( ) have stated that psychological well-being is facilitated in an environment where the individual can develop autonomy and exercise the ability to self-regulate emotions and behavior. for these authors, context has a large effect on psychosocial adjustment, and individuals who are given the opportunity to experience freedom and autonomy usually show psychological well-being (van der kaap-deeder et al., ; isakov and hrnčić, ) , which is associated with quality of life (krabbenborg et al., ) . the possible differences between boys and girls from spain and colombia were analyzed. sex-based differences were significant in the different dimensions; specifically, the spanish average was found to be higher in the dimension of positive relationships among boys, whereas the rest of the dimensions of the well-being scale self-acceptance, autonomy, environmental mastery, personal growth, and purpose in life were very similar for both spanish and colombian boys. as suggested by cabas et al. ( ) , the differences may be due to the different role played by support networks in each context, which according to the authors, are more necessary for colombian population because their opportunities require the exploitation of personal contacts in order to obtain help and meet individual expectations, which is clearly lower for young spaniards, for whom autonomy toward subjective goals is a distinctive feature (meléndez et al., ) . concerning the edatva, colombians achieved higher scores in the dimensions of self-organization and critical thinking. edatva results for colombian girls were similar to those obtained by boys; they obtained higher mean scores than spanish girls in self-organization and critical thinking, whereas spanish girls scored better in the context analysis dimension. in their study, maurya and ojha ( ) identified similar scores among young people from the same country, demonstrating the influence of context on the configuration of the trend experienced by both boys and girls; the slight differences in certain dimensions that can be explained by the different gender approaches, as interpreted by salleh and mustaffa ( ) or xi et al. ( ) . other studies have shown that gender affects the level of psychological well-being: it has been shown that women enjoy less psychological well-being than men after adolescence (akhter, ; glynn et al., ; sun et al., ; twenge and martin, ) . these differences, quantifiable by psychometrics, could be derived from cognitive style and coping style. in our study, the mean values obtained by the different subscales of the two instruments used (well-being scale and edatva) varied as a function of the current situations of the study participants. in this regard, the differences found between young people who were studying and those who were not in each country were statistically significant. the largest difference was observed in the dimension of positive relationships, which was higher for the spanish sample. it should be highlighted that, except in the context analysis and socio-political involvement dimension, the mean among spanish young people was lower in all the dimensions examined by the edatva. regarding young people who were working and those who were not, the data showed that spaniards scored higher in the dimension of positive relationships, as in the case of students and non-students. similarly, colombian young people obtained higher scores in the all edatva dimensions, except for the context analysis dimension. no statistically significant differences were observed between spanish and colombian welfare recipients. in line with these results, schofield et al. ( ) considers that the achievement of autonomy depends on the environment in which the young person develops, and as shown by the results of the present study, a person's country of residence can represent a shortfall of resources that may decrease their ability to become adults. cahill et al. ( ) and glynn and mayock ( ) have also stated that the construction of quality relationships should be an active ingredient in the design of effective interventions; therefore, it should be key in addressing the demands of young people who are on the road to independent life. this process may require a review of the social and communicative skills of the health-care staff who carry out the interventions to provide a solid background for developing the abilities and resources needed by people in this transition. studies such as those by mota and matos ( ) ; vinayak and judge ( ) , and schofield et al. ( ) stress that young people's resilience is affected by their relationships with their social environment, their upbringing, and their current support; therefore, resilience differs as a function of one's social support model. this mechanism has an impact on how identity is constructed and on how psychological and emotional needs are perceived throughout life. thus, these results provide clues to the role of contextual factors on the development of constructs such as psychological well-being and autonomy in young people who are in transition to adulthood. consistent with studies such as rodríguez's ( ) on constructs associated with subjective well-being, the existence of a common core to constructs such as psychological well-being and autonomy can be proposed, as well as the effect of contextual aspects typical of an individual person's social context, its institutions, and available life choices. the evaluation of contextual factors specific to the studied national populations were out of the scope of the present study. future research on these topics should be geared toward a broader assessment of these aspects. certain studies have already taken in this direction, such as the compilation by gaxiola and palomar ( ) , which presents a regional overview of the construct of psychological well-being focused on specific aspects in countries such as mexico, colombia, puerto rico, and cuba; an article by domínguez ( ) which analyzes the trajectories of adult life among young spaniards in comparison with other european populations; or the study by bontempi ( ) , which examines autonomy trajectories among young people in specific cases in spain, italy, and france. another limitation of the present study is that only three conditions were considered for young people: study, work, and protection; clearly, many young people present different conditions than those covered by these three categories, and they are outside the scope of the present analysis. it is also important to evaluate the effects of covid- on levels of psychological well-being and autonomy among young people, and to identify possible contextual changes in the expectations of young people and their capacity to adapt to change. additionally, this study object could be associated with resilience, which could have a moderating effect on scale scores. the raw data supporting the conclusions of this article will be made available by the authors, without undue reservation. the studies involving human participants were reviewed and approved by ethics committee of the santo tomás university (bogotá, colombia) and the ethics committee of the national university of distance education (madrid, spain). written informed consent to participate in this study was provided by the participants' legal guardian/next of kin. psychological well-being in student of gender difference relationships between sociocultural factors (gender, immigrant and socioeconomic background), peer relatedness and positive affect in adolescents emotional separation, autonomy in decision-making, and psychosocial adjustment in adolescence: a proposed typology bienestar psicológico en adolescentes colombianos peer attachment and class emotional intelligence as predictors of adolescents' psychological well-being: a multilevel approach transition to adulthood autonomy scale for young people: design and validation manual escala de autonomía para el tránsito a la vida adulta (edatva) (unpublished work) invarianza factorial del cuestionario de bienestar psicológico de ryff en universitarios, de acuerdo al género values and psychological well-being among adolescents-are some values 'healthier'than others? 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distance socialpsychological support for care-leavers. elearn can we increase psychological well-being? the effects of interventions on psychological wellbeing: a meta-analysis of randomized controlled trials gender differences in purpose in life: the mediation effect of altruism personal autonomy: beyond negative and positive liberty. london: routledge all authors listed have made a substantial, direct and intellectual contribution to the present study, and approved it for publication. we thank all members of the taba international research group for their contributions that made this study possible. likewise, we also thank the young people and the different institutions that decided to participate and allowed us to carry out this study. key: cord- - q gm n authors: pearman, ann; hughes, mackenzie l.; smith, emily l.; neupert, shevaun d. title: mental health challenges of united states healthcare professionals during covid- date: - - journal: front psychol doi: . /fpsyg. . sha: doc_id: cord_uid: q gm n as covid- continues to impact global society, healthcare professionals (hcps) are at risk for a number of negative well-being outcomes due to their role as care providers. the objective of this study was to better understand the current psychological impact of covid- on hcps in the united states this study used an online survey tool to collect demographic data and measures of well-being of adults age and older living in the united states between march , and may , . measures included anxiety and stress related to covid- , depressive symptoms, current general anxiety, health questions, tiredness, control beliefs, proactive coping, and past and future appraisals of covid-related stress. the sample included hcps and age-matched controls (m(age) = . years, sd = . , range = – ) from states of the united states. a multivariate analysis of variance was performed, using education as a covariate, to identify group differences in the mental and physical health measures. hcps reported higher levels of depressive symptoms, past and future appraisal of covid-related stress, concern about their health, tiredness, current general anxiety, and constraint, in addition to lower levels of proactive coping compared to those who were not hcps (p < . , η( ) = . ). within the context of this pandemic, hcps were at increased risk for a number of negative well-being outcomes. potential targets, such as adaptive coping training, for intervention are discussed. on may , , the united states had , , confirmed covid- cases with , deaths (world health organization, ) and was considered the epicenter of the pandemic. although social distancing and quarantine guidelines have slowed the pandemic's spread, the recent relaxing of guidelines suggests continued challenges to the healthcare systems and healthcare professionals (hcps). indeed, there are calls for covid- to be considered as a new occupational hazard for h around the globe (godderis et al., ) . not only are many hcps more likely to be exposed to and, therefore, contract covid- , but providing care during a pandemic can place tremendous pressure on hcps caring for very sick and dying patients, helping the families of the sick, and dealing with the frustrations of healthcare systems, all while trying to take care of their own families and loved ones (maunder et al., ; bai et al., ) . studies out of china have examined the experiences of hcps during the height of their covid- outbreak. in a sample of , medical staff workers in china working during the covid- pandemic, . % reported stress-related symptoms, . % reported symptoms of depression, . % reported anxiety, and . % reported experiencing insomnia (liu et al., ) . lai et al. ( ) found evidence for higher rates of anxiety, depression, and distress among hcps in wuhan compared to hcps in other regions in china. other studies examined the need for and impact of services offered to healthcare workers, such as adjusting shifts to allow time for rest kang et al., ) . while there have been several well-written opinion pieces and commentaries regarding the well-being of healthcare workers in the united states during this pandemic (godderis et al., ; gold, ; greenberg et al., ) , we are aware of only one descriptive study with data from new york city (shechter et al., ) that did not include a control group. there have been several meta-analyses and reviews of the impact of this pandemic on hcps internationally (chew et al., ; pappa et al., ; rajkumar, ) , but no studies from the united states were available to be included in these studies. previous studies have shown that the mental health challenges hcps face during pandemics often impact their ability to continue to be part of the frontlines working to help treat and care for patients and their own families (maunder et al., ; shechter et al., ) . further, enduring psychological effects could negatively impact their ability to provide patient care in the future as well as impacting their quality of life (goulia et al., ) . a crucial mission for researchers during this time is enhancing our understanding of the experiences of hcps in order to plan for interventions and care both in the short-term (now) and in the long-term (over the next couple of years). the current study is designed to examine several critical outcomes such as depressive symptoms, anxiety (current general anxiety as well as anxiety about developing covid- ), covid-related stress, and health in hcps during the early months of the covid- pandemic across the entire united states. in addition, we also examine potentially beneficial indicators of resilience such as control beliefs and proactive coping. psychiatric morbidity in the forms of depression and/or anxiety not only is troubling in its own right, but is also highly correlated with burnout, higher rates of chronic diseases, reduced quality of life, and suicide (kumar, ) . during the severe acute respiratory syndrome (sars) pandemic in goulia et al. ( ) found that the pressure of the work environment combined with fears about the disease itself created negative outcomes in the form of anxiety and depression that had profound impacts on the well-being of healthcare workers during that time. additionally, follow-up studies revealed that the emotional distress from the pandemic was often long-lasting (maunder et al., ) . for instance, one to years after the sars outbreak, maunder et al. ( ) found that sars healthcare workers reported higher levels of burnout and distress, had increased smoking and alcohol consumption, were more likely to have reduced patient contact, and worked fewer hours compared to healthcare workers who did not treat sars. the sars outbreak was much more contained than the current worldwide pandemic which has even greater potential to have both ongoing and lasting consequences on society as a whole and hcps in particular. identifying opportunities for resilience will be especially critical to combat the negative consequences. control beliefs represent the subjective perceptions that one can influence what happens in one's life and include beliefs or expectations about the extent to which one's actions can bring about desired outcomes (agrigoroaei and lachman, ) . lachman and firth ( ) distinguished two main sources of control: one's own efficacy (internal control, competence, or personal mastery), and the responsiveness of the environment or other people (external control, contingency, or perceived constraints) (bandura, ) . the two control beliefs included in the present study are mastery and constraint. mastery is often described in terms of one's judgments about his or her ability to achieve a goal, while perceived constraints refers to the extent to which people believe factors exist which interfere with goal attainment (lachman and weaver, b) . pearlin and schooler ( ) suggested that personal mastery is an important psychological resource that mitigates the effects of stress and strain, and it is also associated with reduced reactivity to work-related stressors (neupert et al., ) . when faced with stressful situations, a strong sense of control has also been linked to low levels of selfreported perceived stress (cameron et al., ) and lower risk of depression (yates et al., ) . aspinwall and taylor ( ) characterized proactive coping as a series of steps one takes to preemptively modify or avoid stressful events. those who have higher levels of proactive coping compared to those with lower levels of proactive coping have more meaning in life (miao et al., ) , fewer symptoms of ptsd (vernon et al., ) , and higher levels of quality of life (cruz et al., ) . proactive coping is also associated with lower levels of depression, fewer declines in functional disability in aging, and larger systems of social support (greenglass et al., ; bokszczanin, ) . when stressors do occur, those with higher levels of proactive coping are able to maintain their emotional functioning better than those with lower levels of proactive coping (polk et al., ) . within the context of the covid- pandemic, individuals who are at high risk of exposure to the virus, hcps, could particularly benefit from engaging in proactive coping strategies in an effort to prevent exposure to future stressors. indeed, we know from our past work that older adults, who are vulnerable to the effects of the virus, had lower levels of stress when they were high in proactive coping (pearman et al., ) . this study is designed to examine the experiences of hcps in the united states during this pandemic. data collection took place between march and may , , a timeframe when the united states experienced a spike in new coronavirus cases, which limited the availability of important medical resources including appropriate personal protective equipment, and put tremendous strain on the nation's hcps. the sample is derived from a larger online study focused on individuals' psychological and behavioral responses to covid- (pearman et al., ). in the current study, we specifically examine the following variables: stress related to covid- , anxiety about developing covid- , depressive symptoms, current general anxiety, past and future appraisals of stress related to covid- , perceived health and health-related concern, tiredness, control beliefs (mastery and constraint), and proactive coping in a sample of hcps and age-matched controls. we hypothesized that hcps would show significantly more challenges on our measures of stress, mental and physical health issues, control, and coping. amazon mechanical turk (mturk.com) was used to recruit participants for a larger study on the impact of covid- . mturk is an international online crowdsourcing panel administered by amazon and used here for collecting data. potential participants responded to the description: the purpose of this study is to examine how people living across the united states are reacting to the current covid- pandemic. select the link below to complete the -min survey. participant requirements for the current study were as follows: years of age or older, living in the united states, native englishspeakers and free from a dementia diagnosis. once recruited and consented (see section "procedure"), the participants completed the survey through the qualtrics platform which is an online survey tool. the sample for the larger study consisted of , participants. participants answered "yes" or "no" to the question, "are you a hcp?" participants for the current study included all participants who answered "yes" to this question as well as age-matched controls drawn from the same dataset. because of concerns regarding age differences in our health indicators, we age-matched the controls. the final sample included hcps and age-matched controls (m age = . years, sd = . , range = - ) from states across the united states. sample characteristics, including type of hcp, are reported in table . informed consent was obtained online; participants who wished to participate in the study indicated electronically that they read and understood the study procedures. after indicating interest, participants were provided a qualtrics survey link on mturk between march , and may , , which was the time period that encompassed the majority of stay-at-home orders as well as many peaks in hospitalizations and death from covid- in the united states. human intelligence tasks (hits) were released approximately every days on mturk to promote continued enrollment and survey completion throughout the weeks of data collection. participants were compensated $ . for completing the -min survey. the study was approved by the georgia institute of technology institutional review board. participants indicated their year of birth, gender, their education from a checklist (e.g., ged, associates), and their race. hcps were also asked to report the specific profession within the healthcare field from a checklist (see table ). participants indicated their level of anxiety related to contracting coronavirus by answering the question, "how anxious are you about developing (covid- )?" on a (not at all anxious) to (very anxious) scale. on a (not at all) to (extremely) scale, participants indicated their level of stress by answering the question, "how stressed are you about the covid- outbreak?" participants completed the -item geriatric depression scale short form (gds) (yesavage, ). the gds is a self-report screening tool that examines depressive symptoms. reflecting over the past week, participants respond "yes" or "no" to other healthcare occupations include n = administration, n = facility manager, n = legal operations, n = counselor, n = exercise physiologist, n = health insurance, n = medical student, n = optometry, n = registered dental hygienist. each item. an example item includes, "do you feel that your situation is helpless?" the scale has been shown to have good diagnostic sensitivity and specificity for adults across the adult lifespan (guerin et al., ) . the scale was not used for diagnostic purposes in this study, but higher scores indicate greater depressive symptoms (α = . ). ten state anxiety items from the state-trait anxiety inventory (spielberger et al., ) were rated on a four-point scale ranging from (not at all) to (very much so). participants indicated how they were feeling in the current moment. example items include "i am tense" and "i feel frightened." five items were reverse coded. a mean was calculated across the items with higher scores indicating more state anxiety (α = . ). participants self-rated their health on a five-point scale ranging from (poor) to (excellent) by answering the question, "how would you rate your overall health?" in addition, participants rated their health concern on a (no concern) to (very serious concern) scale, responding to the question, "how much concern/distress do you feel about your health at this time?" both items were included in analyses as one focuses on current health status while the other focuses more specifically on how concerned the individual is about their health. on a five-point scale ranging from (not at all tired) to (very tired), participants were asked "in general, how tired are you right now?" control beliefs were measured using the mastery (four items, α = . ) and constraint (eight items, α = . ) scales from the sense of control scales from the midlife development inventory (lachman and weaver, a) . on a (strongly disagree) to (strongly agree) scale, participants rated their agreement with statements such as "what happens in my life is often beyond my control" (constraint) and "i can do just about anything i really set my mind to" (mastery). the proactive coping scale (aspinwall et al., ) includes six items rated on a five-point scale ranging from (strongly disagree) to (strongly agree). an example item includes, "i prepare for adverse events." one item was reverse coded. higher scores indicate more proactive coping (α = . ). on a four-point scale ranging from (not at all) to (a lot), participants rated the extent to which covid- affected different areas of their lives in the past h (past appraisal, α = . ) as well as the extent to which they expected covid- to affect their lives in the next h (future appraisal, α = . ). example items include, "your physical health or safety?" and "your plans for the future?" (lazarus, ) . items were scored so that higher scores indicate covid- having a greater impact on one's life. all data analyses were performed using spss version (ibm corp.). the significance level was set at α = . and all tests were two-tailed. a manova was conducted with education (degree) as a covariate and hcp ( = no, = yes) as the independent variable and covid- stress and anxiety, depressive symptoms, current anxiety, self-reported health, health concern, tiredness, mastery, constraint, proactive coping and appraisal (past and future) as continuous dependent variables. because healthcare positions commonly require postsecondary education, education was included as a covariate to account for group differences. significant multivariate tests were followed up with tests of between-subjects effects for each dependent variable individually. there were no significant differences between hcps and the control group on gender [χ ( , n = ) = . , p = . ] or race [χ ( , n = ) = . , p = . ]. as expected, there were significant differences on education [χ ( , n = ) = . , p = . ] such that hcps had more education than non-hcps. results from the manova ( table ) controlling for education show that hcps reported significantly higher levels of depressive symptoms, current anxiety, concern about their health, tiredness, constraint, and past and future appraisal of covid-related stress, but lower levels of proactive coping compared to non-hcps (pillai's trace = . , f( , ) = . , p < . , η = . ). of note, there were also no significant group differences on covidrelated stress or on the specific anxiety of developing covid- . this study is a timely look into the experiences of hcps across the united states during the covid- pandemic. using an age-matched comparison group, the hcps were significantly more depressed and generally anxious than the non-hcps during the first months of the pandemic. in line with shechter et al. ( ) who documented high rates of lack of control and sleep disturbances within hcps in new york city, our results show that hcps across the united states had significantly higher rates of lack of control and tiredness compared to controls. additionally, the hcp group on average fell into the clinically depressed range on the gds (guerin et al., ) . while some of the other findings (e.g., fatigue) may represent the nature of professional differences sometimes seen between hcps and other professions in non-pandemic times (dyrbye et al., ) , meeting the criteria for depressive disorder should not. we believe that the heightened level of depressive symptoms in hcps may be due to not just occupational differences but occupational differences during a pandemic. clearly, this is of concern not just for understanding and, perhaps, helping the current situation but also to look ahead to the potential lasting influence of this experience (see maunder et al., ; lee et al., ) . it is wellunderstood that the long-term consequences of depression and anxiety can create enduring negative impacts (sareen et al., ; musliner et al., ) . finding ways to intervene and support hcps, such as cognitive behavioral therapy or support groups, will be an important goal to healthcare systems and workplaces now and in the future. in addition to increased general anxiety and depressive symptoms, hcps were more tired and more concerned about their health than the age-matched controls. there are many possible reasons for the health concerns of hcps during this pandemic (centers for disease control, ). to start, hcps are more likely to be exposed to covid- which increases hcp's health risk. other health risks include long work hours and mental and physical exhaustion (shanafelt et al., ; the lancet, ) . it is not surprising therefore that the hcps also have higher perceived constraints and are more tired. the real experiences in healthcare settings during the pandemic may present hcps with what seem like insurmountable pressure when it comes to finding ways to accomplish their goals both in terms of maintaining their own health and well-being. helping hcps find ways to differentiate between immovable constraints, such as personal protective equipment deficits, and possible malleable constraints, such as feeling as though there is no opportunity to engage in self-care, may be a possible avenue for buoying the well-being of hcps (de raedt and hooley, ) . along these same lines, the hcps showed lower proactive coping and fewer resources to dedicate to adaptive coping behaviors. we know from past work that proactive coping (polk et al., ) and control beliefs (neupert et al., ) are key ingredients for resilient stress responses, representing potential targets for intervention. for instance, stauder et al. ( stauder et al. ( , found that using coping skills training with employees from work-environments that were stressful, but unchanging, helped reduce stress and improve well-being. although statistically equivalent on covid- -related stress and anxiety, the hcps in the current study scored significantly higher on both current and future stress appraisal when compared to controls. in their real-time study of work stress in nurses, johnston et al. ( ) showed that appraisals of stress were more predictive of psychological and physiological reactivity than the actual tasks being performed. in addition, the perceived reward for the work actually helped reduce stress. given the high levels of stress appraisal both current and future in our sample, it may be beneficial during this time of crisis to help hcps recognize and focus on the reward of their work as a means of managing negative stress appraisals. we acknowledge several limitations in this study. the observational design limits our ability to make causal conclusions. future longitudinal studies should examine the long-term impact of this pandemic on the mental health of hcps. we also do not know the extent to which the hcps in the sample are serving on the frontlines of the pandemic. however, given that the hcps showed significant differences on most of our measures of interest, it is likely that our effects actually underestimate the experiences of frontline workers. in addition, smereka and szarpak ( ) note that covid- is an ongoing challenge for all hcps, not just the frontline workers. another potential limitation is that the professions of the control group nor the hours worked by either group were collected so we are unable to make finer distinctions between the experiences of hcp and the others. we do know, however, that the two groups are statistically equivalent in their stress and anxiety related to the pandemic, so we are reasonably confident that the differences that we do see in our study are associated with healthcare profession status. we encourage future work that seeks to further explore potential differences between professions, but note that our results suggest that all hcps are at risk for decreased wellbeing, perceived control, and coping resources during the covid- pandemic. finally, our sample was not random or nationally representative and was restricted to those living in the united states, the current epicenter of the pandemic. hcps' experiences during the covid- pandemic could differ for those living and working in countries outside of the united states. in conclusion, our results suggest that covid- may function as an occupational hazard for hcps (godderis et al., ) because we found evidence of higher levels of anxiety and depressive symptoms, more tiredness and concern for their health, and more severe stress appraisals of covid- , along with lower levels of perceived control and coping compared to age-matched controls. across a wide array of indicators, hcps appear to be at increased risk for mental health challenges. in addition, given that previous studies during other pandemics have shown lasting impacts of service during this time, including reduced workforce participation and increased traumatic symptomatology, this is a critical issue to address. we encourage efforts to intervene that can provide relief now and in the future. the dataset presented in this article is not readily available because data sharing options were not included in consent documents. requests to access the datasets should be directed to ap, ann.pearman@psych.gatech.edu. this study involved human participants was reviewed and approved by georgia institute of technology office research integrity assurance -institutional review board (protocol # h ). written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements for exempt studies. ap designed the study and funded it out of her internal funds and a grant both from georgia tech, as well as manuscript writing. mh managed the online portion of the project and the data, wrote the methods, helped to prepare the references, and helped with primary prose. es helped with data analyses, created the tables, helped to prepare the references, and helped with primary prose. sn helped with study design, primary data analyses, as well as manuscript writing. all authors 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inventory decreasing the negative effects of work-related stress in unchanged working environments quantifying multiple work-related psychosocial risk factors: proposal for a composite indicator based on the copsoq ii covid- : protecting health-care workers proactive coping, gratitude, and posttraumatic stress disorder in college women coronavirus disease (covid- ) situation report contributors to and mediators of psychological well-being for informal caregivers geriatric depression scale key: cord- -q g uqj authors: commodari, elena; la rosa, valentina lucia title: adolescents in quarantine during covid- pandemic in italy: perceived health risk, beliefs, psychological experiences and expectations for the future date: - - journal: front psychol doi: . /fpsyg. . sha: doc_id: cord_uid: q g uqj since march , many countries throughout the world have been in lockdown in response to the covid- pandemic. in italy, the quarantine began on march , , and containment measures were partially reduced only on may , . the quarantine experience has a significant psychological impact at all ages but can have it above all on adolescents who cannot go to school, play sports, and meet friends. in this scenario, this study aimed to provide a general overview of the perceived risk related to covid- and the psychological experience of quarantine in a large sample of italian adolescents. nine hundred and seventy eight adolescents (males = ; females = ) living in italian regions and attending upper secondary school (age range: – , m = . , sd = . ), responded to an internet-based questionnaire about perceived health risk related to covid- , knowledge and information on measures to control the pandemic, beliefs and opinions on stage two of the quarantine, and psychological experiences related to quarantine. . % of the participants lived in “red zones,” which are places where the government has imposed stricter measures of containment due to exponential and uncontrolled growth in contagion cases compared to other areas in italy. according to our results, italian adolescents had a low perception of risk of covid- . perceived comparative susceptibility and perceived seriousness were also very low. however, they were aware of the restriction measures necessary to contain the spread of the virus, and they agreed with the limitations imposed by the government. females and adolescents living in a “red zone” showed more significant psychological negative feelings about the quarantine experience. however, no significant differences were found about the regions where the teenagers of our sample live and the other variables related to the covid- experience. this is very interesting data, leading us to hypothesize that the participants’ negative feelings may be more related to the adolescent period than to the pandemic itself. since march , many countries throughout the world have been in lockdown in response to the covid- pandemic. in italy, the quarantine began on march , , and containment measures were partially reduced only on may , . people had to stay at home. all social and sporting activities were canceled, and many work activities were forbidden; schools were closed and will reopen only with the new academic year. many countries around the world have temporarily closed educational institutions to contain the spread of the covid- pandemic. according to the united nations educational, scientific and cultural organization (unesco), school closures have impacted over % of the world's student population (unesco, ) . italy and several other countries have used educational technologies, including online platforms, radio, television, and texting, to support access to remote learning during the covid- pandemic, and so guarantee the students' right to education (unesco, ) . changes in life caused by the pandemic were dramatic for people of all ages. however, the revolution of behavioral routines caused by quarantine can have been particularly hard to accept for young people who could not go to school, play sports, and meet friends. usually, adolescents spend much of their waking time in school or other social contexts, such as gyms or recreational spaces (mahoney et al., ). now they have had to stay home all day for months, with online relationships only with peers and adults, such as their teachers, except the persons that live with them. moreover, their home has become a "school." for these reasons, there was an extensive debate between scientists on the effects of quarantine, limitations of freedom, and school closures on adolescents' emotional and affective states. previous studies on the effect of quarantine, which is the separation and restriction of movement of people who can be potentially exposed to a contagious disease, report common psychological effects (brooks et al., ) . research conducted on the severe acute respiratory syndrome (sars) epidemic (hawryluck et al., ; mihashi et al., ; liu et al., ) reported a high prevalence of symptoms of psychological distress, such as insomnia, irritability, anger, and other mood disorders. however, although the risk for psychological disorders related to changes in life caused by an epidemic is largely documented, there is evidence that several sociodemographic and psychological variables influence the emotional responses to behavioral limitations (hawryluck et al., ) . in particular, the perceived health risk for disease affects the emotional responses to the prevention measures and the acceptance of limitations of behavior (tang and wong, ; commodari, ) . health-related perceived risk depends on perceived "seriousness" and perceived "susceptibility" to a disease. risk perception is one of the key drivers of health behavior (brewer et al., ; ibuka et al., ; commodari et al., ) and influences the adoption of precautionary measures. perceived seriousness refers to how at risk a person considers himself to develop a disease, while perceived susceptibility concerns the perceived probability of getting a disease. perceived susceptibility can be differentiated into perceived personal susceptibility, which is the perceived probability that one will be harmed by a hazard (rogers, ) , and perceived comparative susceptibility, which is the perceived probability that a hazard will hurt one compared with other people of the same age and gender. research on health-related risk perception in young people has shown that adolescents engaged in risky behavior do not have a complete appreciation of their exposure to harm (johnson et al., ) . however, there are no previous studies on the health risk perception for pandemic diseases and the psychological experiences related to quarantine in this stage of the life span. based on these considerations, the main goal of this study was to investigate the perceived risk related to covid- and the psychological experiences of adolescents during the pandemic. in particular, the purpose of the study was to analyze the perceived seriousness of and susceptibility to covid- , the beliefs of adolescents in the first phase of quarantine and their opinions on the stage two of quarantine, during which a partial reduction of behavioral measures was hypothesized. moreover, the study explored adolescents' moods, emotions, and feelings, with attention to expectations for the immediate future. more specifically, the study intended to verify the following hypotheses: hypothesis (h ): living in an area with more restrictions than in other areas of the country contributes significantly to increasing the disease's perception of risk. hypothesis (h ): living in an area with more restrictions than in other areas of the country significantly contributes to accentuating the negative psychological impact of the quarantine experience. hypothesis (h ): other sociodemographic variables influence health risk perception and psychological experiences of the adolescents in the sample. in particular, a higher perception of risk and a greater concern of contracting covid- were expected to predict more negative feelings during the quarantine. conversely, it was expected that higher adherence to government measures to contain the infection and greater confidence in the information received on covid- were predictors of positive emotions. participants were adolescents (males = ; females = ) who attended upper secondary school (age range: - , m = . , sd = . ), which corresponds to the international standard classification of education level . the participants lived in of the italian regions which are the first-level constituent entities of the italian republic. five hundred and seventy four of the respondents lived in a provincial seat, while lived in towns that are not the provincial seat. teachers and some students collaborated in the recruitment of the participants, sharing an online survey on the leading social networks and inviting students to respond to the questionnaire. data were collected using an internet-based questionnaire. in total, the questionnaire consisted of multiple-choice and open-ended questions. participation was voluntary, and the questionnaire required approximately - min to complete. the survey collected sociodemographic information, such as age, gender, area in which the respondents live, type of upper secondary school, academic grade, number of persons in the household, and other information. moreover, it explored perceived health risk related to covid- , knowledge and information on measures to control the pandemic, beliefs and opinions on stage two of the quarantine, routines and habits of life that adolescents miss most (such as going out with friends, meeting boyfriend or girlfriend, going to visit their relatives, for a total of six items), and psychological experiences related to quarantine. the survey also collected information on e-learning experiences during quarantine, but this subject is beyond the scope of this article. perceived seriousness, perceived personal susceptibility, and perceived comparative susceptibility to covid- , which are the main dimensions of risk perception related to health, were investigated using an adjustment of the italian version (commodari, ) of the risk perception of infectious diseases questionnaire (brug et al., ) . participants responded to questions using a five-point likert-type scale. the participants were invited to report (a) how serious it would be for them to get the disease, (b) how likely they think they are to contract the disease, (c) whether they would have a smaller or larger chance of getting the disease before summer, compared with their peers of the same age and gender, and (d) if they believed that students could be a category particularly at risk of contracting the virus. the original version of the risk perception of infectious diseases questionnaire was developed during the sars epidemic, and it was translated into several languages (de zwart et al., ) . its psychometric characteristics are good (cronbach's α = . ), and many international studies have used this measure in different contexts (de zwart et al., (de zwart et al., , commodari, ) . in this regard, a recent study by commodari ( ) used the italian adjustment of this questionnaire to investigate the risk perception of flu and the role of sociodemographic and psychological variables on perceived risk. a confirmatory factor analysis was run to assess the validity of this adapted version and a good model fit was obtained [χ ( ) = . ; p < . ; rmsea = . ; srmr = . ; cfi = . ; tli = . ]. the reliability is also good (cronbach's α = . ). regarding their opinions and beliefs, participants were asked to indicate whether they agreed with statements of reported information on covid- and quarantine (e.g., "there are some categories of people at higher risk for covid- than the general population"; "in stage two of the quarantine it is necessary to avoid the use of public transport to reduce the risk of contagion and to avoid a new increase in the epidemic, " and others). regarding feelings, emotions, and moods, participants were asked to complete a likert-type scale that focused on the personal feelings about one's cognitive, physiological, and behavioral state. participants indicated their level of agreement with several statements using a five-point likert-type scale (e.g., "in this period in which i have to stay at home, i feel well physically"; "in this period in which i have to stay home i am tense and i feel tight"). the scale measured two aspects: "negative feelings" and "positive feelings." a high score corresponded to high perception of negative or positive feelings, respectively. a cfa was also performed to assess the validity of these scores. regarding the model for the "negative feelings, " although the chi-square statistic resulted to be statistically significant [χ ( ) = ; p < . ], the other values were indicative of a good model fit (rmsea = . ; srmr = . ; cfi = . ; tli = . ). the same result was obtained also for the model of the "positive feelings" [χ ( ) = . ; p < . ; rmsea = . ; srmr = . ; cfi = . ; tli = . ]. both the scales showed a good reliability (negative feelings: cronbach's α = . ; positive feelings: cronbach's α = . ). the scores were converted into z scores for the purpose of statistical analyses. finally, participants were asked to answer questions about their routines and habits of life they missed most, and to complete, without a word limit, the sentence "in this period in which i have to stay home, i think my summer will be. . .". participants completed the online survey between april and may , . the statistical package for the social sciences (spss) version . (ibm corporation, armonk, ny, united states) was used for the statistical analyses. quantitative data were expressed as frequencies and percentages in the case of categorical and ordinal variables and as mean and standard deviation in the case of continuous variables. independent-samples t-test were run and the magnitude of the differences between the means were assessed using hedges's g formula (hedges, ) to calculate effect size (es), with . indicating a small es, . a medium es, and . a large es (cohen, ) . besides, two multiple regression analyses were calculated to investigate the impact of sociodemographic variables and risk perception on positive and negative feelings experienced during the lockdown. for this purpose, the main sociodemographic variables and risk perception values were the independent variables, and the "positive feelings" and "negative feelings" scores were the dependent variable. qualitative data were coded and analyzed to show emerging themes. the thematic coding structure's development and confirmation was an iterative process involving two researchers conducting individual, recursive reading of the textual data and group meetings to discuss and test the emerging themes. discrepancies were resolved by consulting specific instances in the data, discussing their relationship to establish themes, and reaching consensus as a group (corbin and strauss, ) . the participants' responses to some items were free, and these could be single words or full sentences. codification was realized using "thought unit, " also denoted "sense unit" or "unit of meaning." the units comprised one idea communicated, whether it was expressed as a sentence, a verb-object sequence, or a single word. the responses were first categorized into categories. then, these categories were progressively reduced. finally, the responses were coded in categories (srnka and koeszegi, ) . the study was performed following the ethical standards of the declaration of helsinki and followed the ethical code for italian psychologists (l. . . , n. ), italian law for data privacy (dlgs / ) , and the ethical code for psychological research (march , ) approved by the italian psychologists association. no sensitive data that could identify the participants was collected. the schools involved in the research had previously informed the students' parents to consent to the study's participation. the chair of school and family psychology, disfor, university of catania, approved this study. table shows the sociodemographic characteristics of the participants. participants lived in of the italian regions. covid- was not diffused equally throughout italy. the regions in which participants lived reported on may different levels of contagion, with a broader spread of the virus in the regions of northern italy. of the student participants, . % lived in "red zones, " which were places in which the government has imposed stricter measures of containment due to an exponential and uncontrolled growth in cases of contagion compared to other areas in italy. regarding the number of persons with whom respondents were spending quarantine, . % reported that the size of their household was more than four people, including themselves; . % reported four persons; . %, three persons; . %, two persons; and . % reported living alone during the quarantine. five of the respondents ( . %) had been or was currently suffering from covid- , while . % of the respondents reported that they were uncertain about having had this disease; . % of respondents reported that one or more family members living with them had been or was currently suffering from covid- . furthermore, . % of the sample had at least one family member who worked with people affected by covid- (health care or other essential services). table reports data on the perceived health risk in the sample. in general, adolescents considered the possibility of getting covid- before summer to be low: . % responded that their probability was very low or low, while only . % think that this probability was high or very high ( . % very low; . % low; . % neither low nor high; . % high; and . % very high). furthermore, most subjects believed they had a low or very low probability of contracting the virus before the summer compared to peers of the same age and gender ( . % very low; . % low; . % neither low nor high). only . % of the sample thought that this probability was high and . % very high. regarding the perceived seriousness of the disease, % of the sample believed that contracting the virus could be serious or very serious ( . % serious and . % very serious), and . % believed that it was neither serious nor not serious. only a limited there were no differences by regions in perceived health risk, although some of these regions were the most affected by the disease. moreover, the presence of parents or other family members who had been or was currently suffering from covid- did not influence risk perception. interestingly, both the perceived susceptibility (family member working with people who had covid- : m = . , sd = . ; no family member working with people who had covid- : m = . , sd = . ; t = . ; p = . ; g = . ) and comparative susceptibility (family member working with people who had covid- : m = . , sd = . ; no family member working with people who had covid- : m = . , sd = . ; t = . ; p < . ; g = . ) were higher in those adolescents whose parents or other relatives worked with persons sick with this disease and the es was medium. to better analyze the perception of the risk for covid- , students were also invited to report how frightened they were of getting covid- . the majority of the sample was not particularly afraid of contracting covid- . there were no significant differences in the responses of the students by region. the students who lived in the regions with higher diffusion of the disease did not show greater fear of the disease than their peers. however, the students who lived in a red zone were more fearful of covid- than their peers with a medium es (red zone: m = . , sd = . ; non-red zone: m = . , sd = . ; t = . ; p = . ; g = . ) ( table ) . ninety three percent of respondents believed that there were categories of people more at risk of getting covid- , but, interestingly, . % of the respondents did not consider students as a category at risk for covid- . the remaining participants ( . %) believed that students were an at-risk category for this disease. these students motivated their response with the argument that the school setting does not permit social distancing. the remaining . % did not answer the question. a significant percentage of the respondents reported having confidence in the information that they received on the disease ( . % trust enough; . % trust a lot; . % trust very much). moreover, the most critical information the adolescents would have liked to receive on covid- concerned on how to cure the disease ( . % of the respondents). interestingly, only . % of respondents were interested in how to prevent the infection. furthermore, . % wanted information on the likelihood of contracting the virus in an area of residence, . % how to recognize the symptoms of the disease, % the geographical areas where the virus is most present, and only . % would have liked to have been more informed about how the virus was transmitted. regarding adolescents' opinions of the behavioral measures that could be useful to maintain in stage of quarantine, during which there was a partial reduction of containment measures, a very high percentage of respondents ( . %) agreed on the need to avoid public transport, such as trains or busses, as well as to confined spaces such as bars, restaurants, cinemas, theaters, and school classrooms ( . %). similarly, . % of the respondents agreed with the need to avoid going into shops if not necessary and only with personal protective equipment, such as a face mask. further, . % of the respondents agreed with the need to avoid going to gyms or swimming pools, and . % considered it useful to avoid medical consultations if possible. however, adolescents did not think it will be necessary to maintain social distancing in the second quarantine stage. most respondents did not agree on the need to avoid staying with persons who are not cohabiting ( . %), and . % think that it is not necessary to avoid staying in open places such as parks. data are summarized in table . interestingly, adolescents showed a high awareness of the particularity of the moment in which italy was living. the vast majority of the sample reported having no difficulty complying with the government's restrictive provisions ( . %), and they substantially agreed with the restrictions imposed on citizens due to the pandemic ( . %). the majority of the adolescents interviewed said they had more homework than before due to the remote school activities ( . %), and a significant percentage of them ( . %) reported having little free time. however, a large percentage was coping with quarantine by dedicating at least h a day to a hobby ( . %), watching television or playing video games ( . %), or spending much more time on social networks such as facebook or instagram ( . %). more specifically, males tended to devote themselves to hobbies ( differences were small or approaching to medium. furthermore, adolescents living in a red zone tended to watch tv or play video games more than peers who did not live in a red zone but the difference was small (red zone: m = . , sd = . ; no red zone: m = . , sd = . ; t = . ; p = . ; g = . ) ( table ) . as for what the teenagers in the sample missed most in this time of restrictions, the majority of the participants stated that they especially missed being able to meet friends ( . %) and relatives ( . %) and staying out later in the evening due to the closure of premises such as restaurants, pubs and discos and the prohibition to go out except for reasons of absolute necessity ( %). to confirm this, a large majority of the sample said they found significant support from family ( . %) and friends ( . %) to face this time when they had to stay home. the responses of the adolescents show heterogeneous psychological reactions to the experience of quarantine. to better investigate the specific emotion and feeling they perceived, the responses to some of the more relevant items were first examined. this analysis aimed to capture a snapshot of the emotional state of adolescents during the quarantine. the majority of those interviewed stated that they stayed physically well ( . %). males felt better than females but the difference was small (males: m = . , sd = . ; females: m = . , sd = . ; t = . , p < . ; g = . ). however, quarantine influenced their sense of security and self-confidence: . % of the students reported feeling less secure than in the past. females were less self-confident than males with a medium es (females: m = . , sd = . ; males: m = . , sd = . ; t = . , p < . ; g = . ) while there were no significant differences by age, the area in which the person lived, and other socio-demographic variables. concerning psychological status, about % of students reported feeling tenser and sadder ( . %) and more irritable table . interestingly, the responses of the students showed their great empathy and interest in socialization. a high percentage of respondents said they were not bored listening to others' problems ( . %) and reported being able to manifest their emotions ( . %). these results agree with the findings discussed in the previous section, which showed that the things and situations students missed most were meeting friends, staying with relatives, and being out late in the evening. multiple regression analyses were performed to investigate the impact of sociodemographic and perceived health risk variables on the psychological outcomes (positive and negative feelings z scores). sociodemographic variables, perceived health risk, and adherence to government restrictive measures were used as independent variables while positive and negative feelings z scores were the dependent variable. all regression assumptions were checked. there was linearity as assessed by partial regression plots and a plot of studentized residuals against the predicted values. there was independence of residuals, as assessed by a durbin-watson statistic of . . there was homoscedasticity, as assessed by visual inspection of a plot of studentized residuals versus unstandardized predicted values. there was no evidence of multicollinearity, as assessed by tolerance values greater than . . there were no studentized deleted residuals greater than ± standard deviations, no leverage values greater than . , and values for cook's distance above . the assumption of normality was met, as assessed by a q-q plot. regarding positive feelings, a significant regression equation was found (f = . , p ≤ . ), with an r square of . . more specifically, significant predictors of positive feelings were gender (t = − . , p < . , std β = − . ), region (t = . , p = . , std β = . ), confidence in the information received on covid- (t = . , p = . , std β = . ), perceived susceptibility (t = − . , p = . , std β = − . ), ease in respecting government measures (t = . , p < . , std β = . ), and belief that the government measures were justified (t = . , p = . , std β = . ). according to these results, females reported less positive feelings than males on average as well as adolescents living in northern italy. furthermore, higher confidence in the information received on covid- , higher perceived susceptibility, higher ease in respecting government measures and higher beliefs that these measures are justified were predictive of positive feelings. table shows the significant results of the regression analyses and the contribution of each predictor to the dependent variable. regarding negative feelings, the regression model was significant (f = . , p < . ), with an r square of . . more in detail, significant predictors of negative feelings were gender (t = . , p < . , std β = . ), age (t = . , p < . , std β = . ), living in a red zone (t = . , p = . , std β = . ), perceived seriousness (t = . , p = . , std β = . ), fear of getting covid- (t = . , p = . , std β = . ), and compliance with government measures (t = − . , p = . , std β = . ). according to these results, females and older adolescents reported more negative feelings than males and younger adolescents on average. furthermore, living in a red zone, a higher perceived seriousness, a higher fear of getting covid- and a lower compliance with government measures were predictive of negative feelings. table presents the significant results of the regression analyses and shows the contribution of each predictor to the dependent variable. in summary, the model showed a moderate but significant impact of both the sociodemographic and the health risk perception variables related to covid- experience on the perception of negative and positive feelings. participants' expectations for the immediate future were also investigated through an open-ended question about how they imagined the upcoming summer holidays. data were codified according to the modality described in the procedure section. we first categorized the responses into categories and then progressively reduced these categories. the adolescents were aware that the experience of quarantine would continue to produce effects during the summer period. in this regard, a significant percentage of the adolescents in the sample said that their summer would be "different" or would have "different limitations" ( . %). uncertainty and doubt were widespread feelings, as expressed by these answers: "my summer will be full of anguish, doubts, and perplexity, but my friends are enough for me to feel good"; "i am very worried because i cannot imagine how it will be but i look forward to it as much as every year." in addition, . % of the sample thought that summer would be sad, boring, or horrible, as demonstrated by the following quotes: "if transportation does not reopen, my summer will be wasted, the collapse of different dreams and projects that have so far pushed me to go on and resist a very dense pool of mud in which i will struggle so much not to sink"; "like a prison, locked between the walls and between the screams, as if it were winter or autumn, without being able to see the seawater, which is freezing or boiling." in some cases, quarantine only highlighted pre-existing difficult situations, such as in this case: "it will be the usual summer in which it is amplified that i have no friends and that no one ever invites me to go out and i will spend the day in my pajamas eating food at will and watching netflix and sky until i vomit." however, . % thought summer would still be interesting and fun: "interesting, i have high school exams, a girl, and too many friends to share my life with. i'm curious to see how everything will evolve." in general, the teenagers in the sample looked to the future with the hope of overcoming the difficult period of the pandemic and resuming a normal life, even if different from the previous one: "i don't care what my summer will be like, i just hope that we will be able to get out of this situation with a new unitary spirit, i hope people understand that we are one family in one house"; "meeting again, with the necessary restrictions, my friends, my grandparents, will be difficult as if we had to learn to live in a different way from what we were used to until a couple of months ago. it will be exciting!". this study aimed to provide a general overview of the psychological experience of quarantine in a large sample of italian adolescents. according to other recent studies conducted on this topic in the italian population, the covid- emergency was a very difficult experience from an emotional point of view, and several categories such as health professionals have undergone significant stress with a consequent negative impact on their psychological well-being (ramaci et al., ) . to the best of the knowledge, this is the first study investigating the experience of the covid- pandemics in italian adolescents and with such a large number of subjects. first, the perceived seriousness and susceptibility to covid- were evaluated, as well as the impact of sociodemographic variables on the perception of health risk. according to the study results, italian adolescents had a low perception of risk of covid- . perceived comparative susceptibility and perceived seriousness in italian adolescents were also very low. these results show that young people think that covid- is not a potentially severe disease for them. indeed, there is some evidence that young people are less vulnerable to the effects of the new coronavirus sars-cov- (kolifarhood et al., ) , although the possibility of getting the disease depends on the diffusion within the population. they underestimate the probability of getting the disease and show a very high trust in their good health, neglecting that the probability of being infected, albeit slight, is similar to that of their peers and people of other age groups. interestingly, as hypothesized, teenagers residing in a red zone reported higher perceived seriousness and susceptibility than those who did not reside in these zones. furthermore, females showed a higher perceived seriousness than males. in both cases, the medium effect size suggests a role of these variables in influencing health risk perception. therefore, living in an area with more restrictions than in other areas of the country may have contributed significantly to increase the perception of risk about the disease. also, this information seems consistent with several studies demonstrating that women tend to have a higher perception of risk than men, thus avoiding risky behaviors to a greater extent (harris et al., ) . despite underestimating their risk of infection, however, the italian teenagers who participated in this study were aware of the restriction measures necessary to contain the spread of the virus and they agreed with the limitations imposed by the government. these responses show high awareness of the potential danger of covid- and acquire more value when considering that young people were conscious that they were not at serious risk, but that the risk was high for society as a whole. the study also wanted to investigate the emotional and psychological impact of the quarantine period on the youth population in italy. as underlined in the literature on this topic, prolonged school closure and home confinement during an epidemic can have a detrimental effect on children's and adolescents' physical and psychological well-being (brooks et al., ; wang et al., ) . according to the results, this study also shows that italian adolescents suffered the psychological effects of this quarantine period. indeed, they had more marked negative feelings. more specifically, females and adolescents residing in the red zones with more restrictions showed higher levels of negative feelings related to the quarantine, in accordance with the study's hypotheses. in this regard, effect sizes approaching to medium indicate a possible role of these variables in determining negative feelings in the adolescents of the sample, even if these feelings may be likely influenced also by other variables not considered in the study. however, it is essential to emphasize that these feelings are subjective perceptions rather than a psychopathological state. indeed, quarantine did not reduce the empathy and sociability of young people. in this regard, the adolescents who participated in this study reported that they engaged in school activities remotely and carried out the assigned homework. furthermore, they continued to listen to the problems of others and to express their emotions. no significant differences related to the regions where the teenagers lived were found. this is very interesting data, leading to hypothesize that the negative feelings reported by the participants may be more related to the adolescent period than to the pandemic itself. the results also showed a moderate but significant impact of both the sociodemographic and the health risk perception variables related to the covid- experience in the perception of negative and positive feelings. more specifically, being male, living in a region with less virus spread, reporting low levels of perceived susceptibility and high compliance and agreement with government measures were all variables associated with the perception of positive feelings. on the contrary, being female and older, living in a red zone, reporting high levels of perceived seriousness and fear of getting covid- , and being less compliant with government measures were associated with more negative feelings. as recently underlined by wang et al. ( ) , the adverse effects on psychological well-being are more significant when children and adolescents are confined to their homes without the possibility of carrying out activities outside and meeting peers. in confirmation of these considerations, this study showed that the majority of teenagers interviewed suffered in particular from not being able to meet friends and relatives, as well as from not being able to go out and stay out late in the evening. the results also confirmed the literature data demonstrating that when children and teenagers do not go to school and stay home, they are physically less active, are exposed to much more screen time, and have irregular sleep patterns. similarly, the teenagers in the sample had difficulty falling asleep and spent more time watching television, playing video games, or using social networks. however, a significant percentage stated that they dedicated at least an hour a day to playing a musical instrument, dancing, exercising, acting, or drawing. in light of these insights, it is important to promote healthy habits and lifestyles in adolescents to reduce psychosocial stress and improve the psychological and physical well-being of the young population. finally, the quarantine experience was also associated with a widespread sense of uncertainty about the near future in the adolescents interviewed in this study. although some participants were convinced that the virus would disappear during the summer, allowing a return to normal life, most believed that their near future would be unpredictable or different due to the various health and social distancing rules that must be respected. in this regard, it is important to support the youth population in addressing the uncertainties related to the period following the quarantine to ensure better adherence to the limitations that will have to be faced to avoid a new outbreak of the epidemic. this study has some important strengths. as already underlined, this is one of the first studies conducted in italy about the perceived seriousness and susceptibility for covid- as well as the effects of school closures and home confinement on the physical and psychological well-being of adolescents. another strength is certainly the large sample size, with almost italian teenagers interviewed from north, central, and south italy. however, there are also several limitations. first, this is a cross-sectional study so an exact causal relationship between the variables could not be established. secondly, an internetbased questionnaire with self-reported measures was used, so it was not possible to ascertain the accuracy of the answers to the questions and the possible influence of selfreport bias on the results. finally, not all italian regions are represented in the sample; however, it is representative of the three main areas in which italy is generally divided (north, central, and south). this study has several social and psychological implications. in particular, the results underline that the covid- emergency has undoubtedly had a significant impact on the lifestyle and psychological well-being of italian adolescents. in light of these findings, the physical and mental impact of the covid- epidemic on children and adolescents is a matter of fundamental importance both for governments and families and cannot be neglected, especially in this phase of a progressive resumption of ordinary life. therefore, it is necessary to prepare adequate strategies to support the youth population in addressing the uncertainty associated with the pandemic and the quarantine period to reduce the psychological impact of school closures and home confinement as much as possible and guarantee adequate support to deal with the return to school. the raw data supporting the conclusions of this article will be made available by the authors, without undue reservation. the studies involving human participants were reviewed and approved by chair of school and family psychology, disfor, university of catania. written informed consent to participate in this study was provided by the participants, and where necessary, the participants' legal guardian/next of kin. ec designed the study, analyzed the data, and wrote the first draft. vllr revised the manuscript. both authors contributed to the article and approved the submitted version. risk perceptions and their relation to risk behavior the psychological impact of quarantine and how to reduce it: rapid review of the evidence sars risk perception, knowledge, precautions, and information sources, the netherlands statistical power analysis for the behavioral sciences the role of sociodemographic and psychological variables on risk perception of the flu health risk perceptions in the era of the new coronavirus: are the italian people ready for a novel virus? a cross sectional study on perceived personal and comparative susceptibility for infectious diseases basics of qualitative research : techniques and procedures for developing grounded theory, edn perceived threat, risk perception, and efficacy beliefs related to sars and other (emerging) infectious diseases: results of an international survey monitoring of risk perceptions and correlates of precautionary behaviour related to human avian influenza during - in the netherlands: results of seven consecutive surveys gender differences in risk assessment: why do women take fewer risks than men? sars control and psychological effects of quarantine distribution theory for glass's estimator of effect size and related estimators the dynamics of risk perceptions and precautionary behavior in response to (h n ) pandemic influenza risk involvement and risk perception among adolescents and young adults epidemiological and clinical aspects of covid- ; a narrative review depression after exposure to stressful events: lessons learned from the severe acute respiratory syndrome epidemic adolescent out-of-school activities predictive factors of psychological disorder development during recovery following sars outbreak social stigma during covid- and its impact on hcws outcomes cognitive and physiological processes in fear appeals and attitude change: revised theory of protection motivation from words to numbers: how to transform qualitative data into meaningful quantitative results an outbreak of the severe acute respiratory syndrome: predictors of health behaviors and effect of community prevention measures in hong kong. china covid- educational disruption and response mitigate the effects of home confinement on children during the covid- outbreak the authors wish to thank the united network europe for the fundamental support in the diffusion of the online survey and dr. giulia carnemolla and dr. jessica parisi for the help in the data collection. the authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.copyright © commodari and la rosa. this is an open-access article distributed under the terms of the creative commons attribution license (cc by). the use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. no use, distribution or reproduction is permitted which does not comply with these terms. key: cord- -yi vbgwj authors: saladino, valeria; algeri, davide; auriemma, vincenzo title: the psychological and social impact of covid- : new perspectives of well-being date: - - journal: front psychol doi: . /fpsyg. . sha: doc_id: cord_uid: yi vbgwj the recent covid- pandemic has had significant psychological and social effects on the population. research has highlighted the impact on psychological well-being of the most exposed groups, including children, college students, and health workers, who are more likely to develop post-traumatic stress disorder, anxiety, depression, and other symptoms of distress. the social distance and the security measures have affected the relationship among people and their perception of empathy toward others. from this perspective, telepsychology and technological devices assume important roles to decrease the negative effects of the pandemic. these tools present benefits that could improve psychological treatment of patients online, such as the possibility to meet from home or from the workplace, saving money and time and maintaining the relationship between therapists and patients. the aim of this paper is to show empirical data from recent studies on the effect of the pandemic and reflect on possible interventions based on technological tools. the covid- pandemic led to a prolonged exposure to stress. as a consequence, researchers showed an increased interest in measuring social and community uneasiness in order to psychologically support the population. this increased attention might help in managing the current situation and other possible epidemics and pandemics. the security measures adopted in managing the pandemic had different consequences on individuals, according to the social role invested. some segments of the population seem to be more exposed to the risk of anxious, depressive, and post-traumatic symptoms because they are more sensitive to stress. the following article has two focuses of interest: ( ) the evaluation of the psychological and social effects of the pandemic on the population, mostly children, college students, and health professionals; and ( ) the identification of new perspectives of intervention based on digital devices and in line with the social security measures and mental health promotion. telepsychology, for instance, is a valid tool, effective in taking charge of the psychological suffering caused by the pandemic and in preventing the chronicity of the disease. the prolonged stress could involve anxiety, depression, and the inability to manage traumatic and negative emotions. furthermore, the constant fear of contagion affects daily life and leads to social isolation, modifying human relations. studies of pandemics faced over time, such as sars, ebola, h n , equine flu, and the current covid- , show that the psychological effects of contagion and quarantine is not limited on the fear of contracting the virus (barbisch et al., ) . there are some elements related to the pandemic that affect more the population, such as separation from loved ones, loss of freedom, uncertainty about the advancement of the disease, and the feeling of helplessness cao et al., ) . these aspects might lead to dramatic consequences (weir, ) , such as the rise of suicides (kawohl and nordt, ) . suicidal behaviors are often related to the feeling of anger associated with the stressful condition widely spread among people who lived/live in the most affected areas (miles, ; suicide awareness voices of education, ; mamun and griffiths, ) . in light of these consequences, a carefully evaluation of the potential benefits of the quarantine is needed, taking into account the high psychological costs (day et al., ; mazza et al., ) . as reported in a recent survey administered during the covid- pandemic, children and young adults are particularly at risk of developing anxious symptoms (orgilés et al., ) . the research involved a sample of , parents of italian and spanish children (range - ). in general, parents observed emotional and behavioral changes in their children during the quarantine: symptoms related to difficulty concentrating ( . %), boredom ( %), irritability ( %), restlessness ( . %), nervousness ( %), sense of loneliness ( . %), uneasiness ( . %), and worries ( . %). from the comparison between the two groups-spanish and italian parents-it emerged that the italian parents reported more symptoms in their children than the spanish parents. further data collected on a sample of college students at the time of the spread of the epidemic in china showed how anxiety levels in young adults are mediated by certain protective factors, such as living in urban areas, the economic stability of the family, and cohabitation with parents (cao et al., ) . on the contrary, having infected relatives or acquaintances leads to a worsening in anxiety symptoms. furthermore, the economic problems and the slowdown in academic activities are related with anxious symptoms (alvarez et al., ) . in addition, an online survey conducted on the general population in china found that college students are more likely to experiencing stress, anxiety, and depression than others during the pandemic . these results suggest monitoring and promoting mental health of youths in order to reduce the negative impact of the quarantine (csts, ; fessell and goleman, ; . health-care workers (hcws) are another segment of population particularly affected by stress (garcia-castrillo et al., ; lai et al., ) . hcws are at risk to develop symptoms common in catastrophic situations, such as post-traumatic stress disorder, burnout syndrome, physical and emotional exhaustion, depersonalization, and dissociation (grassi and magnani, ; mache et al., ; Øyane et al., ) . however, an epidemic presents different peculiarities compared to a catastrophic event, for instance, the stigmatizing attitudes in particular toward health professionals, who are in daily contact with the risk of infection (brooks et al., ) . during sars, up to % of health-care professionals suffered from acute psychological stress, exhaustion, and post-traumatic stress, caused by the fear of contagion of their family members and the prolonged social isolation (tam et al., ; maunder et al., ) . as a consequence of the pandemic, the health professionals who were overworked suffered high level of psychophysical stress (mohindra et al., ) . health professionals also lived/live in daily life a traumatic condition called secondary traumatic stress disorder (zaffina et al., ) , which describes the feeling of discomfort experienced in the helping relationship when treatments are not available for all patients and the professional must select who can access them and who cannot (roden-foreman et al., ; rana et al., ) . data from a survey on , hcws who assisted patients in covid- wards and in second-and third-line wards showed high percentages of depression ( %), anxiety ( . %), insomnia ( %), and distress ( . %) (lai et al., ) . also, the constant fear of contagion leads to obsessive thoughts (brooks et al., ) , increasing the progressive closure of the person and reducing social relationships. in line with these results, rossi et al. ( ) evaluated mental health outcomes among hcws in italy during the pandemic, confirming a high score of mental health issues, particularly among young women and front-line workers. furthermore, spoorthy et al. ( ) conducted a review on the gendered impact of covid- and found that . - . % of medical staff is composed of women, and the mean age ranged between and years. also, women are more likely to be affect by anxiety, depression, and distress (lai et al., ; zanardo et al., ) . liang et al. ( ) also found a relation between age and depressive symptoms associated with the pandemic. indeed, the medical staff at younger ages (< years) reports higher self-rated depression scores and more concern about infecting their families than those of older age. staff > years of age reported increased stress due to patient's death, the prolonged work hours, and the lack of personal protective equipment. cai et al. ( ) also found that nurses felt more nervous compared to doctors. as emerged by the recent literature, the promotion of psychological interventions on the specific population who is more likely to develop pathologies and suffering is needed. the lancet global mental health commission's observation (patel, ) reported that the use of digital technologies can provide mental health interventions in order to reduce anxiety and stress levels and increase self-efficacy (kang et al., ; xiao et al., ) . in order to reduce anxiety and depression symptoms widespread among the population, the world health organization ( ) and the centers for disease control and prevention ( ) proposed specific guidelines on the correct use of health protection with the aim to minimize the distress associated with health-care professions. at the same time, as a consequence of the emerging issues, psychotherapists provided psychological support online, addressing the technological challenge ; liu et al., ) . in line with the technological progress, professional organizations promoted specific guidelines and policies related to customer protection, privacy, screening, evaluation, and development of self-help products (duan and zhu, ; zhou et al., ) . technological development in mental health foreshadows future trends that include "smart" mobile devices, cloud computing, virtual worlds, virtual reality, and electronic games in addition to the traditional psychotherapy tools. in this perspective, it is important to help future generations of psychologists and patients to collaborate in the potential growth areas, through education and training on the benefits and effectiveness of telepsychology (maheu et al., ) . indeed, more awareness of the potentials of the online services is needed, exploring the main differences between the devices (chat, video-audio consultation, etc.) in order to use them in relation to the specific purposes identified by the professional. for example, the italian service of online psychology conducted a study based on a service of helpdesk on facebook. this service guided people in asking for psychological help, working on their personal motivation. at the same time, another helpdesk on skype provided some psychological sessions via webcam (gabri et al., ) . in this line, telecounseling is a diffuse online method used by counselors and psychologists during the recent pandemic (de luca and calabrò, ). one of the future goals of public and private psychological organizations should be the promotion of specific training for psychologists and psychotherapists, with the following aims: ( ) developing the basic skills in managing the effects of a pandemic and of emergency situations; and ( ) sensitizing patients to online therapeutic relationship, providing the main rules and benefits of the process (stoll et al., ; joint task force for the development of telepsychology guidelines for psychologists, ). on this line, a significant example is the virginia commonwealth university (vcu) which proposed phds in telepsychology, with the aim of training future psychologists in managing the psychological effects of the pandemic through an online psychology service (baylor et al., ) . the service provided by the vcu had been effective in reducing anxiety, depression , and hospital recoveries (lanoye et al., ) . as shown, telepsychology assumes a key role in the improvement of health care. online psychological services avoid geographical barriers and are suitable to become a useful integrated tool in addition to traditional psychotherapy (aps, ; perrin et al., ). online psychological services provide several advantages, especially in the current situation of pandemic. first of all, online services help people in a short period of time, reducing the risk of contagion and the strong feeling of anxiety in both psychotherapists and patients, who feel uncomfortable in doing traditional psychotherapy due to the pandemic (békés and aafjes-van doorn, ). furthermore, pietrabissa et al. ( ) identified some of the main advantages of telepsychology, such as the decrease in waiting for the consultation, because it takes place from home or from the workplace, saving time and expense, less travel and rental costs for the office, for those who provide the service and for those who use it. as reported by the authors, online psychological services facilitate access to people who struggle to find support close to their social environment, avoiding difficulties related to mobility. also, online services help people who have less confidence in psychotherapy. indeed, mostly online psychotherapy takes place in one's comfort zone, facilitating the expression of problems and feelings. according to the situations, online services could provide a different medium. for instance, the chat is a useful tool to establish a first assessment of a person who feels uncomfortable in using video. indeed, the online psychotherapy is perceived as more "acceptable." suler ( ) defined the term online disinhibition effect demonstrating how the web, unlike the real life, leads to the failure of the hierarchical relationship based on dominant-dominated among individuals; this aspect, according to the author, allows a greater sense of freedom in expressing oneself and less concern related to judgment (ibid.). other researchers (mantovani, ; tosoni, ) have integrated to the construct of online disinhibition effect the concept of social space, emphasizing the role of the "situation, " of the "social norms" (brivio et al., , p. ) , of the tools ("artifacts"), and of the cyberplace, which allow different levels of interaction. each person has a different experience of the network and several levels of disinhibition. for instance, a mild disinhibition could be a person who chooses to ask for help talking with a psychologist about their problems; while a high disinhibition could be represented by flaming, an expression of online bullying or cyberstalking. online psychological services should be integrated with the various territorial services in order to provide the patients local references in relation to the specific health and economic needs. finally, the possibility for the therapist and for the patient to record the sessions via chat and in audio/video modewith the informed consent of the participants (wells et al., ) -provides another useful tool to compare the sessions and to underline the positive outcomes and the effectiveness of the therapeutic process. according to this perspective, online psychological support and psychotherapy become a resource for psychotherapists and patients in a co-build relationship (algeri et al., ) . in analyzing the psychological impact of the quarantine, the importance for individuals to feel integral part of the society emerged, an aspect often undervalued in psychological wellbeing. experts of public health believe that social distancing is the better solution to prevent the spread of the virus. however, although it is not possible to predict the duration of the pandemic, we know very well the serious impact of these measures on the society, on relationships and interactions, in particular on the empathic process. in the early s, empathy was described as a form of identification in the psychological and physiological states of others. this definition led to a debate between the disciplines of philosophy of psychology and philosophy of the mind (franks, ) . willard van orman quine ( quine ( - renewed attention to the debate on empathy with a thesis on the development of language and mind in the analytical philosophy. according to quine, the attribution of the so-called intentional states, through which the psychology commonly explains human behavior, is based on empathy (treccani, ) and leads people to attribute beliefs, desires, and perceptions (quine, , , pursuit of truth: revised edition, . analyzing this aspect within the recent situation of the pandemic, an increment of antithetical positions and attitudes could be noticed. on the one hand, people identify themselves with those who suffer (neighbors, friends, relatives who are living stressful events), promoting activities such as the so-called "suspended expenses." for instance, solidarity and humanitarian activities, food, and medicine delivery for people who are unable to go to the supermarket. on the other hand, there is a part of the population who experiences a feeling of "forced empathy." this aspect could be also emphasized by the use of technological devices that might lead to a depersonalization of relationships, forcing the sense of closeness, at least virtually. the hyperconnection of feelings becomes a way to reduce the self-isolation and its consequences, representing the contrary of the idea of durkheim ( durkheim ( - , who considered society as a specific entity, built on social facts (durkheim, ) . the sensation "to be forced to feel" could lead people to distance themselves from others after the emergency situation, incrementing social phobias. also, human communication is changing. the formal question "how are you?" at the beginning of a conversation is no longer just a formality, as before the pandemic. for example, the relationship between employee and the manager is different, leading to more responsibilities in listening and understanding feelings expressed during the video call, generating a forced reciprocity. hence, the aforementioned "forced empathy" may be common in this period because the social distance and the emergency situation make people want to be heard and appreciated, and the simple question "how are you?" becomes an anchor to express fears and emotions (pasetti, ) . the covid- pandemic has affected the way people live interpersonal relationships. the lockdown was characterized of a different organization of daily life, with an incrementation of time at home and a reduction of distance through digital devices. this period was also seen as an evolution in the concept of empathy, producing new perspectives in the study of the phenomenon according to a sociological and neurological points of view. indeed, empathy-defined as the ability to understand and share the feelings of another-involves several elements, such as: (a) social context and historical period of the individual, (b) neurological mechanisms, and (c) psychological and behavioral responses to feelings of others. the neurosociological perspective analyzes the mechanisms involved in the empathic process, focusing on human communication and interpersonal relationships (singer and lamm, ; decety and ickes, ) . specifically, in this historical period characterized by an increment in the man-machine relationship, neurosociology could become one of the principal sciences for the study of human relations and technology. "we live increasingly in a human-machine world. anyone who doesn't understand this, and who is not struggling to adapt to the new environmentwhether they like that environment or not-is already being left behind. adapting to the new, fast-changing, technologically enhanced context is one of the major challenges of our times. and that certainly goes for education" (prensky, , p. ) . according to the abovementioned considerations, our suggestion consists in: primary prevention. studying the impact of the pandemic toward an at-risk population to reduce symptoms related to stress and providing specific online psychological counseling based on the target (students, medical staff, parents, and teachers). secondary prevention. overcoming the limitations of the human interaction based on digital devices: ( ) developing new spaces of inter-and intrasocial communication and new tools of support and psychological treatment, reproducing the multisensory experienced during the face-to-face 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faasse, kate title: correlates of health-protective behavior during the initial days of the covid- outbreak in norway date: - - journal: front psychol doi: . /fpsyg. . sha: doc_id: cord_uid: biur xn the coronavirus outbreak manifested in norway in march . it was met with a combination of mandatory changes (closing of public institutions) and recommended changes (hygiene behavior, physical distancing). it has been emphasized that health-protective behavior such as increased hygiene or physical distancing are able to slow the spread of infections and flatten the curve. drawing on previous health-psychological studies during the outbreak of various pandemics, we investigated psychological and demographic factors predicting the adoption and engagement in health-protective behavior and changes in such behavior, attitudes, and emotions over time. we recruited a non-representative sample of norwegians (n = ) during a -day period (march – ) at the beginning of the covid- outbreak in norway. employing both traditional methods and exploratory machine learning, we replicated earlier findings that engagement in health-protective behavior is associated with specific demographic characteristics. further, we observed that increased media exposure, perceiving measures as effective, and perceiving the outbreak as serious was positively related to engagement in health-protective behavior. we also found indications that hygiene and physical distancing behaviors were related to somewhat different psychological and demographic factors. over the sampling period, reported engagement in physical distancing increased, while experienced concern or fear declined. contrary to previous studies, we found no or only small positive predictions by confidence in authorities, knowledge about the outbreak, and perceived individual risk, while all of those variables were rather high. these findings provide guidance for health communications or interventions targeting the adoption of health-protective behaviors in order to diminish the spread of covid- . on the th of january , the world health organization (who) declared the outbreak of a new coronavirus type (sars-cov- ) a public health emergency of international concern. while first cases of covid- , caused by this virus, were reported in the chinese city of wuhan at the end of december , by the end of march the virus had spread to all populated continents, resulting in exponential growth and more than . recorded infections and . fatalities worldwide. at that time, covid- had already significantly impacted physical and psychological health in many countries, with consequences for many individuals' daily lives and economic situations. increasing evidence about covid- suggests that adopting widespread public behavior change can have strong influences on controlling the virus' spread and limiting its harmful consequences on physical health and healthcare systems (ferguson et al., ; li et al., ) . some of these changes may be enforced by states (e.g., closure of schools), while others may be advised but not strictly enforced (e.g., reduction of group size in public), and others may be advised but outside of a state's control (e.g., hand washing in private). experiences from previous disease outbreaks such as ebola, sars, and the swine flu suggests that psychological factors including attitudes and affective reactions have a significant impact on whether individuals adopt health protective behavior or not (e.g., tang and wong, ; bish and michie, ; bults et al., ) . facilitating such behavior change during an outbreak is an important task of applied psychology during the covid- outbreak (lunn et al., ; van bavel et al., ) . in the current study, we explore what demographic and psychological variables predicted the adoption and engagement in health-protective behavior and how attitudes and self-reported behaviors changed over the course of a period of days during the covid- outbreak in norway. norway represents an interesting case as it featured the second highest rate of confirmed cases per capita (after italy) at the beginning of data collection ( th march), while having europe's third lowest population density. four weeks after the closing of schools and beginning of our data collection, norway had managed to reverse the growth of hospitalizations due to covid- . our data are collected during this period. while our data are cross-sectional rather than longitudinal, they allow the description of a social change process, in addition to exploring correlates of individual behavior. protective behavior in a pandemic can be categorized broadly into three types: preventive, avoidant, and management behavior. preventive behavior includes mainly increase in hygiene (e.g., handwashing), avoidant behavior refers mainly to physical distancing , and management includes taking medication and seeking help from health professionals and use of help lines. an important question to curb infections is, what individual factors predict this kind of behavior. bish and michie ( ) reviewed the literature on this following the sars crisis. they particularly focused on reported associations between demographic factors, attitudes, and behavioral measures (reported, intended, or actual behavior) . most reviewed studies were carried out in the middle of actual outbreaks, mostly of influenza and the sars coronavirus (sars-cov). the review found that preventive and avoidant behavior was predicted by a few demographic factors. these behaviors were more common among women, older people, and people indicating a higher education level (cf. ibuka et al., ; agüero et al., ; tooher et al., ; moran and del valle, ; zettler et al., ) . more recent evidence has also identified household size as a crucial variable. people living in larger households seem more likely to take precautions (ibuka et al., ) , presumably out of increased fear of getting infected or out of increased sense of responsibility for others, or both. the driving factor may be the presence of school-aged children (agüero et al., ; for contradicting findings, see bults et al., ) . preventive and avoidant behavior were also related to psychological factors. in particular, they were found to increase with perceived susceptibility to the disease (i.e., perceived likelihood of contracting the virus) and perceived severity of symptoms increase (tang and wong, ; agüero et al., ; tooher et al., ; gershon et al., ; webster et al., ) . in a spanish sample, the adoption of preventive measures during an influenza outbreak was increased by perceived effectiveness of these behaviors in reducing the risk of infection (agüero et al., ; see also tang and wong, ) . these observations are in line with classic and modern versions of expectancy-value theories, where expectancy equals susceptibility and severity equals value. for instance, the theory of planned behavior explains behavior as deriving from intentions that are influenced by attitudes, perceived social norms, and perceived behavioral control or effectiveness of the behavior (ajzen, ) . risk and severity may mediate effects of demographic variables, especially for gender. pandemics highlight the interdependence among individuals, and citizens' relations to their government. bish and michie ( , p. ) conclude from their review "that having a high level of trust in authorities and satisfaction with the communications received about the disease is associated with compliance with preventive, avoidant, and management behaviors." evidence from actual outbreaks confirms this bults et al., ) . it seems that little is known on how crucial psychological variables develop during the course of an epidemic. information on behavioral change over time is important for modeling a pandemic's course, and providing appropriate health messaging over time (poletti et al., ; collinson et al., ) . over the course of the first wave of the influenza (h n ) epidemic in hong kong, knowledge on modes of transmission did not improve, the adoption of avoidant behavior did not change, and, surprisingly, physical distancing declined, suggesting that changes might sometimes be counterintuitive . this may be due to the ongoing nature of the threat, the requirement to consistently engage in sometimes complex and unpleasant behaviors over a long period of time, and information or media fatigue resulting in reduced behavioral engagement. during the h n outbreak in the netherlands, perceived severity and anxiety decreased over time in line with better estimates of fatality, but also in line with claims that citizens can be fatigued by media reports (collinson et al., ) . it thus seems important to observe the time course of the involved psychological variables. wise et al. ( ) surveyed us-american participants between / / and / / , focusing on perceived risk from the virus and propensity to engage in protective behaviors. their sample (recruited through prolific.co) had roughly equal numbers of women and men and a median age of , skewing young. participants saw a medium risk of getting infected themselves ( %), which rose during the time of the sampling. participants reported that they washed their hands more and stayed at home more than usual, and this also increased during the sampling period. notably, they were able to reassess a subsample of participants, once at the beginning and once at the end of the sampling period, and confirmed that these changes also occurred within participants. self-reported increased hand-washing and physical distancing were predicted by perceived likelihood of becoming infected, but not severity of illness. to a lesser extent, perceived impact from global consequences also predicted both behaviors. wise et al. ( ) used multiple regressions with different risk perceptions as simultaneous predictors for these analyses and controlled for age. the other predictors (e.g., likelihood of infecting somebody else) did not predict behavior above risk to self, and neither did age. wise et al. ( ) also identified a subgroup in their sample that perceived low risk and disengaged from information seeking. in a non-representative sample of respondents from cities in china during the initial phase of the pandemic, about one third reported moderate to severe anxiety. interestingly, precautionary measures (e.g., hand hygiene, wearing a mask) were associated with lower levels of stress and anxiety, suggesting successful coping and belief in the behavior's effectiveness (wang et al., ) . in a small, mostly british, community sample (n = ) collected between march th and th, experiencing fear was the only positive and stable predictor of health-protective behavior (harper et al., ) . sampling us adolescents from the th to the nd of march, health-protective behavior including physical distancing and hand washing was positively predicted by perceived severity of the outbreak and social responsibility, as well as negatively predicted by self-interest (oosterhoff, ) . finally, a nearly identical version of the questionnaire employed in the current project was distributed among australian adults (n = ) between the nd and th of march (faasse and newby, ) . as the number of cases was considerably low in australia at that time (< ), the authors observed low prevalence of physical distancing behavior but rather high engagement with hygiene behavior. further, in the study engagement in health-protective behavior was positively predicted by the amount of media exposure, concern or worry about the outbreak, perceived severity of the outbreak, confidence in scientists and health professionals, and accurate knowledge about covid- . perceived likelihood of being infected was not a significant predictor of engagement with health behaviors. the first infected case in norway became known on february . the number of known infections grew at a relatively slow pace to until march , without much action by authorities or concern in the population. the total population of norway is . million. because authorities had been blindsided by an influx of infected people coming back from winter holidays in italian and austrian skiing locations, infections then suddenly increased to until march , and community spread was assumed. that day, on which we started data collection, was tumultuous: the first death was registered. because norway lacked testing capacity, a change in testing criteria was announced, prioritizing severely sick people and health personnel rather than travelers. mildly and moderately ill people did not have access to testing throughout the sampling period. also on march , the norwegian institute of public health (folkehelseinstitutet, fhi) published a report predicting that between and % of the norwegian population would be infected in the first wave, which was expected to take up to year (folkehelseinstiuttet, ). that report was widely publicized. finally, on the same day the government announced comprehensive measures to fight the virus, most notably shutting down schools and kindergartens, training facilities, and all cultural events. increased stocking up on food and supplies lead to empty shelves in some grocery shops, which was documented on social media. on march , it was reported that many norwegians left cities toward holiday homes in remote locations, which led to a rebuke by the authorities due to risk of spreading the virus. travel by foreigners without residence permits to norway via plane or boat was shut down march . the same day, in an extraordinary announcement, the norwegian king asked people to stand together and follow the authorities' advice. on march , fhi published a general call for increased physical distancing, and rules about quarantine, assemblies, and visiting cabins started being enforced with fines and short prison sentences. on the th, the national tv channel nrk aired a debate in which a medical doctor argued that norway should go into total isolation and that fhi was too lax. this was seen as controversial, praised by some, but criticized by many others. the number of hospitalizations passed on march , with people dead. three representative data sets are available with norwegian samples that help to anchor our data. saetrevik ( ) reported data from a representative sample of more than norwegians between march and march . respondents thought the average norwegian was likely to be infected by the coronavirus ( % of the panel said "somewhat high" or "very high"), while fewer thought that this would happen to themselves. quite few ( %) believed that they were at risk of becoming seriously ill themselves. kantar.no (gallup) conducted web interviews with representative samples n = and n = , on march - and march - , respectively, thus at the beginning and end of our first week of data collection (kantar, a,b) . on march / , the vast majority (> %) said that they had high or very high confidence that the health authorities would take the necessary measures to handle the situation in the best possible way, and that they provided accurate information on the situation. both numbers had increased compared to the week before. less than half, % (up from a week earlier), expected that they would likely or very likely be infected (up by % during the last week), while % said that was unlikely or very unlikely. a large group, %, was unsure, saying it was neither likely nor unlikely. answers judging infection as likely or very likely were more frequent than average among inhabitants of oslo and people younger than , but less frequent among people older than (only %). the same age effect was reported by saetrevik ( ) . when asked about behavioral changes in the last days, more than half and up to % reported increased hygiene behavior, reduced social contact, and increased purchasing of goods. from march - to march - , the number of people who were worried or very worried about the consequences for themselves or their families (the question did not specify what kind of consequences) increased by - %. opinion.no conducted a daily poll of norwegians from march to march (opinion, ) . n varied between and (gaute aas askheim, , march , , personal communication). on every day of that period, more than % of polled individuals expressed confidence in the measures taken by the authorities and trust in the information given by them to the public; confidence actually increased from % on march - % on march , and then fell again slightly. in the current project we investigated the influence of psychological and demographic variables in predicting healthprotective behavior in a norwegian sample. simultaneously, we focused on exploring the trajectories and developments of reported behavior, attitudes, and affective reactions during a -day period during the outbreak of covid- . we focused mainly on two aspects of protective behavior: preventive and avoidance behavior (bish and michie, ) . we did not focus on management behaviors, such as taking medicine or seeing healthprofessional, as no medication was available at the time of data collection and the main focus was on minimizing transmission and rapid dissemination by flattening the curve through hygiene practices and physical distancing (ferguson et al., ) . note that our sampling strategy primarily reached participants who were already engaged in discussing topics related to covid- , and are presumably more concerned than average. we were thus less likely to sample a lot of participants who viewed the risk as low and were disengaged from seeking information on covid- . our data are thus by no means representative. absolute means should be interpreted as being at the upper end of the real distribution. our analyses focus on relations between variables, which we assume to be generalizable to the larger population. also note that our data are not longitudinal, and we cannot draw causal conclusions. we nevertheless use the term prediction to describe the results of regression analyses for ease of phrasing. our analysis strategy in identifying important variables predicting engagement in health-protective behavior was twofold. first, we focused on a theory-driven strategy based on reviews and previous studies relating to health epidemics. second, we employed an exploratory data-driven machine learning approach in order to classify important variables. based on reviews concerning factors predicting behavior during pandemics and recent research (e.g., wise et al., ) , we derived the following hypotheses for the first strategy: (i) engagement in health-protective behavior was expected to be predicted by gender, education level, age, and household size. women, individuals with higher education level, older individuals, as well as those from larger households were expected to have more engagement in health-protective behavior. (ii) we expected that effects in i were mediated by own perceived risk (likelihood and severity; for gender, education level, and age) or by perceived risk of close others (likelihood and severity; for household size). females, individuals with higher education or older age should show increased perceived risk, which in turn should be associated with higher reports in healthprotective behavior. similarly, larger household size should be associated with higher perceived risk for close others, which in turn should positively predict healthprotective behavior. (iii) increased confidence and trust in authorities should positively predict engagement in health-protective behavior. note that these hypotheses were generated while performing data collection and not completely a priori. this was mostly due to time constraints as we wanted to ensure data collection during early periods of covid- outbreak in norway. the current project was ethically approved by the internal review board of the university of oslo. all materials, raw data, and syntaxes are available at our project page: https://osf. io/crs n/. we recruited a total of participants residing in norway through social media (e.g., facebook, twitter) and email lists. data collection took place for days from the th of march to the th of march . between march and march , we ran a paid ad on facebook, selecting norwegian users older than as the target group. the ad reached . viewers ( % female according to facebook), of which clicked through to the survey. the post was shared times and reached over . facebook users. the researchers did not themselves share the study in their own networks. after the ad campaign on facebook ended, the survey was shared on the website of the department of psychology (psi) of the university of oslo (uio) and in the facebook feeds of both psi and uio. after excluding participants who failed an attention check or spent less than min taking the questionnaire, we arrived at a final sample size of ( females, males, non-binary or different identity, preferred not to say, missing). the majority of participants were between and years of age. median age for both male and female participants was between and . the majority of participants reported residing in oslo county (n = , . %), while the fewest participants were from nordland (n = , . %). similarly, the majority indicated residing in a large city (n = , . %), while the lowest amount came from a rural area (n = , . %). the majority of the sample indicated a high degree of school education, having earned a college degree ( . %), whereas a smaller proportion indicated their highest education as less than high school or high school graduate ( . %). an participants were able to take part in a raffle getting the chance of winning one out of vouchers at a value of nok. this served mainly to jumpstart the participation; we did not anticipate the large sample ultimately achieved. to participate in the voucher draw, participants were invited to enter their email in a separate follow-up survey that was not linked to the main dataset. https://osf.io/crs n/ the main procedure was based on a similar survey conducted in australia and the us (faasse and newby, ). after providing informed consent, we checked whether potential respondents were residing in norway. those who did not were thanked and the survey was terminated. we then collected information on participants' postcodes and the county they resided in. based on the postcode data, we identified the municipality participants resided in. using these data, we added the amount of covid- cases for that given municipality on the day the respondent completed the survey based on numbers provided by the norwegian institute of health [folkehelseinstitutt (fhi)] and made accessible by the newspaper vg . similarly, we added information on population density per municipality level based on data from the statistisk sentralbyrå. in order to assess the variety and amount of media exposure, we asked participants how much they had seen, read, or heard about covid- [from nothing at all ( ) to a lot ( )], how much they think they know about covid- [nothing at all ( ) to a lot ( )], and how closely they had been following news about the recent outbreak [from not at all ( ) to very closely ( )]. these three items were combined into a mean media exposure score (α = . ). afterward, we instructed respondents to check all possible sources through which they had been getting information about the covid- outbreak [including news media, social media, official government websites, family member(s), colleague(s) or friend(s), none of the above, and other]. similarly, we asked participants which out of several sources they trusted the most concerning the outbreak [my doctor, my local hospital, folkehelseinstitutt, (norwegian) media, who, norwegian government, state department of health, none of the above, other]. to further investigate respondent's confidence, we asked how much confidence they had in different sources: the norwegian government providing full and accurate information, the chinese government providing full and accurate information, and scientists and medical experts understanding the outbreak. all items were completed on a -point scale (not at all confident to very confident, and don't understand at all to understand very clearly). respondents were also asked about how confident they thought health authorities, and hospitals and medical services were able to manage the covid- outbreak [from not at all confident ( ) to very confident ( )]. the four items (excluding the item on the chinese government) were averaged into a confidence score (α = . ). the item focusing on the chinese government was excluded as we mainly intended to focus on confidence in norwegian health authorities. additional analyses including the item are presented in the supplementary materials. respondents were asked how concerned or worried they were about the covid- outbreak [not at all concerned ( ) to extremely concerned ( )]. participants indicated how likely they thought it would be that they themselves would get infected by covid- and also how likely they thought it would be that close others (family/friends) would get infected [not at all likely ( ) to extremely likely ( )]. similarly, we asked how much participants thought they could do to protect themselves [effectiveness of behavior, i can't do anything to protect myself ( ) to i can do a lot to protect myself ( )]. asking about perceived severity, participants reported how serious they thought their symptoms would be if they got infected, and what the worst possible outcome could be for a family member or close friend that got the virus [no symptoms ( ) to severe symptoms leading to death ( )]. then, we asked whether participants had already wondered at some point whether they were infected [not at all ( ) to very much so ( )]. finally, we asked respondents whether they thought that too much fuss was being made about the risks of covid- [strongly disagree ( ) to strongly agree ( )]. this item was used previously to tap skepticism about warnings in public health crises (rubin et al., ) . affective reactions were captured with several items. participants reported whether they felt fearful, frightened, anxious, optimistic, encouraged, hopeful, relaxed, furious, outraged, depressed, and sad [strongly disagree ( ) to strongly agree ( )] . we averaged the first three items to create a fear score (α = . ), items four to six to create a hope score (α = . ), items eight and nine to create an anger score (α = . ), and the last two items to create a sadness score (α = . ). we included items on specific basic negative emotions (ekman, ; ahorsu et al., ) and futureoriented positive emotions (fredrickson, ) that we expected to occur commonly in response to health epidemics (kleinberg et al., ; though see fiske, for a critique of this approach). in order to test participant's knowledge about the covid- outbreak, we first asked them to judge whether statements about the virus and disease were true (answer alternatives true, false, and unsure). we then asked participants to indicate what the most common symptoms of covid- were from a list of seven possible symptoms (fever, cough, sore throat, shortness of breath, nausea, vomiting, diarrhea) . afterward, respondents were prompted to indicate how covid- could spread, according to their knowledge (by air, by water, by mosquitoes, droplets spread through coughing or sneezing, touching surfaces that have been recently touched by someone who is sick, and touching or shaking hands with a person who is sick). the symptoms and transmission items used the same scale (yes, no, unsure) . because the employment of face masks has been a popular debate, we asked who should be wearing a face mask to minimize transmission (healthy people -to prevent infection, sick people -to stop them spreading the virus, everyone, and no one) . finally, we asked participants to estimate what percentage of people who had been infected with covid- had died from the in a first version of the questionnaire the scale went from "strongly agree ( )" to "strongly agree ( )" due to a clerical error. this was corrected immediately after the first approximately responses. at the time the survey was started, symptoms like nausea or diarrhea were not regarded as typical symptoms of covid- . however, as the outbreak proceeded the who added these to the list of possible symptoms (https://www.who.int/health-topics/coronavirus#tab=tab_ ). thus, these responses were not part of the final knowledge score. during the time the study was conducted there was a general recommendation that face masks should only be worn by infected people. this recommendation changed after the project was terminated, highlighting the usefulness of face masks also for healthy people. virus. respondents were able to provide an answer between and %. out of all correct answers we constructed a knowledge sum score (ranging from to ). for the last item, we took the range between and % as a correct answer, as official indications had been varying somewhat during the period the study was conducted. we then asked respondents to indicate whether they performed different health-protective behaviors in response to the covid- outbreak during the past weeks. these behaviors consisted of physical distancing behavior ( items, e.g., reduced or avoided going to work or university), hygiene behavior ( items, e.g., used sanitizing hand gel to clean your hands more often than usual), prosocial behavior ( items, e.g., helped buying groceries and supplies for people who are in quarantine), and two additional items (e.g., worn a face mask when going out in public) . responses could be made using four alternatives (yes, no, unsure, not applicable). for each type of behavior, we computed a sum score based on whether the behavior was performed or not. in addition, we computed an overall health/communal-protective behavior sum score based on the physical distancing, hygiene, and prosocial items (summing up all items). finally, respondents were able to write down whether they did anything else in response to the covid- outbreak. we collected several items on demographic information and health-related behavior and characteristics. first, participants were asked how likely they would be to get vaccinated in case an effective vaccine for covid- had been developed [would definitely get the vaccine ( ) to would definitely not get the vaccine ( )]. we then asked to what age groups respondents belonged to (e.g., - , - , - , - , . . ., +) and with what gender they identified (male, female, non-binary, different identity, prefer not to say). participants then indicated how many children they had (none, , , more than ) and the level of their highest education (less than high school, high school graduate, some college, ba degree, ma degree, professional degree, doctorate). we then asked what type of community they lived in (large city, suburb, small city/town, rural area) and how many people (including them) lived in their household (from to or more). participants then completed some items about their health status, including how they would rate their health in general [poor ( ) to excellent ( )], whether they had a flu vaccine within the last year (yes, no, unsure), whether they had been in an affected area with high transmission within the past weeks, whether they had been in close contact with people who are suspected to be infected, whether they had experienced any covid- symptoms, whether close others experienced any symptoms (on all yes, no, unsure), whether they had any chronic health problems that increased their risk, and whether close others had any chronic health problems (both items yes, no, unsure, prefer not to say). finally, participants were thanked and provided with several links to websites from official sources (who, ecdc, fhi) that provided information about the covid- outbreak. when analyzing data using null hypothesis significance testing (nhst), we set our alpha level at p < . . this decision was based on the fact that we employed a considerably large dataset and our findings might have important healthpsychological implications (see lakens et al., ) . as even small effects will reach statistical significance given large samples, we primarily focus on interpreting effect sizes and their direction and magnitude. as said above, our analytic strategy was twofold: first a theorydriven step and second an exploratory data-driven machine learning step. for the theory-driven step, we used regular linear regression. the mediation models also tested in this first step employed a bootstrapping method (n = ) to calculate confidence intervals around the indirect effect. for the data-driven step, the goal was to classify what variables predicted health-protective behavior out of all predictors we had available in a bottom-up fashion. to do so, we combined supervised machine learning with a partially confirmatory approach (split-half validation) as employed in previous research dealing with large numbers of predictors (e.g., ijzerman et al., ). as a supervised machine learning technique, we used conditional random forests, a bootstrap-like algorithm that assesses the relative contribution of each variable on the dependent variable (the signal), therefore being considered a supervised approach (breiman, ) . as the name suggests, the algorithm "plants a forest consisting of several trees" that represent the importance of a predictor randomly sampled from the dataset. this procedure is based on out of bag estimates, also called bagging, that features repeated sampling from the original data. in essence, the technique bootstraps several nonparametric regression models and summarizes the importance of each predictor by aggregating and weighting the predictors into a parsimonious set (see breiman, ; ijzerman et al., ; yarkoni and westfall, ) . as summarized by ijzerman et al. ( ) , employing a supervised machine learning algorithm has several advantages in comparison to classical regression models, and especially using them for exploratory analyses. the algorithm is naive to non-linear relationships, does not assume the direction of a relationship, has less problems with multicollinearity, and has the advantage of assessing each predictors individual role, but also its multivariate interactions with other variables (strobl et al., ) . for our analyses we employed r (version . . ) and several packages including: dplyr (wickham and françois, ) , car (fox et al., ) , sjmisc (lüdecke et al., ) , tidyr (wickham and henry, ) , and stringr (wickham, ) for data recode and wrangling routines, ggpubr (kassambara, ) , sp (pebesma et al., ) , viridis (garnier et al., ) , cowplot (wilke, ) , fhidata (white, ) for plotting, apatables (stanley, ) for tables, lavaan (rosseel et al., ) for mediation analyses, and randomforest (breiman et al., ) , party (hothorn et al., ) , tree (ripley, ) , lattice (sarkar, ) for the machine learning analyses. considering respondents' information sources, the majority indicated that they received their information about the covid- outbreak from several different sources -on average, participants indicated m = . different sources (sd = . ). a total of % reported news media as an information source, with a smaller number using official government websites ( %) or social media ( %). less than half of all participants indicated that they used colleagues ( %) or family members ( %) as an information source. no participant reported relying on no source at all. the majority of participants expressed trust in advice and information from the norwegian health institute (fhi; %). this trust was much smaller for the norwegian department of health ( %), the norwegian government in general ( %), and the european centre for disease prevention and control (ecdc; %). a total of % of respondents reported trusting (norwegian) media, and the overall lowest trust was indicated for one's doctor or general practitioner ( %), and one's local hospital ( %). respondents rated their own perceived likelihood of catching covid- on average somewhat over the midpoint of the point scale (m = . , sd = . ). assuming they would get infected, the majority predicted to have mild or moderate symptoms ( . %), while a small proportion reported to expect no ( . %) or more severe symptoms ( . %). participants saw it as even more likely that someone from their family or a close friend would get infected (m = . , sd = . ). when imagining the worst possible outcome for a family member or friend who would get infected, the majority ( . %) also foresaw potentially worse outcomes including severe symptoms or severe symptoms leading to hospitalization or death. participants reported that they had already wondered whether they were infected somewhat lower than the midpoint of the scale (m = . , sd = . ). finally, on average respondents tended to disagree that too much fuss was being made about the risks of the covid- outbreak (m = . , sd = . on a - scale), with only around . % tending to agree or strongly agree. on average, participants indicated that they were moderately concerned or worried about the outbreak (m = . , sd = . ), with . % being very or extremely concerned. similarly, on average respondents reported to show the highest levels of fear (m = . , sd = . ), followed by sadness (m = . , sd = . ), hope (m = . , sd = . ), and anger (m = . , sd = . ). considering behavior responses, the majority of respondents reported that they had reduced or avoided going to public events ( %), taking public transport ( %) or going to shops ( %). similarly, a high percentage of participants disclosed that they had washed their hands more often ( %) and more thoroughly ( %), tried to stay away more than m from others coughing or sneezing ( %), as well as tried to sneeze into the crook of their arm ( %). for prosocial behavior, a majority of respondents indicated that they talked to others and tried reminding them of protective behavior ( %). a rather low occurrence of participants reported that they had avoided chinese restaurants or neighborhoods specifically ( %) or donated money to charity focusing on combating the covid- outbreak ( %). an overview of all behaviors is provided in figure . in order to classify important variables predicting engagement in health-protective behavior we employed two different strategies: a highly confirmatory theory-driven strategy based on reviews and previous studies on the covid- outbreak, and a highly exploratory data-driven approach using a supervised machine learning procedure combined with split-half validation. in order to test hypothesis i, we conducted a linear regression using the health-protective behavior sum score as the outcome and gender, education, age, and household size as predictors (see table and figure for results). as predicted, reporting one's gender as female, indicating a higher education level, as well as a bigger household was associated with significantly more engagement in health-protective behavior. contrary to our prediction, age showed a negative association with healthprotective behavior. however, when inspecting the relationship between age and engagement in health-protective behavior, we observed a non-linear relationship showing first an increase in behavior with increasing age that leveled off at around - years of age ( figure b) . notably, our sample included few individuals over the age of , suggesting that these findings should be interpreted with caution. similarly, when repeating the model with time as a covariate the age effect was not significant, while the other predictors still showed positive effects (see supplementary material). to test hypothesis iii, we regressed the confidence score (mean score based on ratings of confidence in norwegian government, scientists, health authorities, and medical services) on engagement in health-protective behavior (table and figure d ). contrary to our prediction, we observed a small negative association. the more confidence respondents expressed in authorities, the less health-protective behavior they reported. we tested four mediation models. the tests are documented in detail in the supplementary material (supplementary figure s ) . in all models, health-protective behavior was the dependent variable. the first three models tested separately whether the effects of gender, age, and education level, respectively, were mediated by two mediators, likelihood and severity of perceived risk. the fourth model tested whether the effect of household size on health-protective behavior was mediated by likelihood and severity of risk to close others. in short, we found some evidence for mediation of the demographic variables gender, age and education level through likelihood and severity of risk, confirming classic notions of expectancy × value theories. this was especially true for age and education, and the mediation through likelihood. however, all observed mediations were small and partial, and the patterns varied between the different models. this suggests that the demographic variables impact behavior through other channels that were not captured by our measured constructs. we thus do not go into further detail on these here; see the supplementary material for further information. following the strategy laid out above, we employed a data driven approach to identify the strongest predictors that parsimoniously predict health-protective behavior from all predictors we had available. for this purpose, we first split the dataset randomly in half and performed conditional random forests on one half, the training dataset (n = ). for reproducibility, we actually performed the algorithm using two different seeds and two versions of the amount of variables sampled at each tree (mtry, the square root of the number of variables, or ). the spearman rank correlation among the replications was between . and gender was dummy coded ( = male; = female). a significant b-weight indicates the beta-weight and semi-partial correlation are also significant. b represents unstandardized regression weights. beta indicates the standardized regression weights. r represents the zero-order correlation. ll and ul indicate the lower and upper limits of a confidence interval, respectively. *indicates p < . . . and therefore considered as stable. according to this analysis of the training dataset, health-protective behavior was best predicted by (in order; see also supplementary figure s ): concern/worry, fear, household size, thinking that too much fuss is made, number of children, perceived effectiveness of behavior, media exposure, sadness, anger, age, relaxation, symptoms (close others), symptoms, perceived risk (likelihood), being to an area with a high number of cases, gender, contact to other individuals showing symptoms, community type, education level, perceived health, knowledge, perceived risk (severity), population density at municipality level. we observed no evidence that perceived risk (severity) of close others, feeling hope, perceived risk (likelihood) of close others, amount of media sources consumed, actual number of cases per municipality, confidence in authorities and scientists, or taking a flu vaccine within the last year predicted better than random noise. we then continued to run a regression analysis on healthprotective behavior using the second half of the data, the test dataset (n = ) with the predictors found in training dataset. this was done to reduce random noise from the first step. an overview of the results is provided in table . healthprotective behavior was positively and significantly (at the . level) predicted by household size, number of children, perceived effectiveness of the behavior, and media exposure, when controlling for all other variables. similarly, we observed that thinking that people made a fuss about the outbreak and reported age showed significant negative predictions when controlling for the other predictors. as mentioned earlier, the negative finding concerning age should be interpreted with caution since we sampled a small number of older adults exceeding years of age and considering the relationship between age and health-protective behavior showed a non-linear association, resembling a reverse u-shaped curve. while other variables such as concern or fear showed the strongest variable importance in the first step, they did not emerge as significant predictors from the second step. however, they still showed a similar positive effect as for example media exposure and medium zero-order correlations. the same was true for symptoms and relaxation, with the latter showing a negative prediction. we repeated the procedure of training machine learning and test using linear regression for hygiene and physical distancing behavior separately. results differed only minimally and can be found in the supplementary materials. for physical distancing, perceived effectiveness of the behavior and respondent's symptoms had a stronger variable importance. for hygiene behavior, the amount of media sources they were exposed to and whether respondents received a flu vaccine within the last year were more important. physical distancing was positively and significantly predicted by household size, number of children, whether the respondent experienced symptoms, and perceived effectiveness of one's own behavior. on the other hand, thinking that people made a fuss and age predicted physical distancing negatively. for hygiene behavior, concern/worry, fear, and media exposure showed a significant positive association when controlling for the other variables. thinking that 'too much fuss' was being made about the risk of covid- predicted hygiene behavior negatively. in general, it seemed that being surrounded with more people, and regarding staying away from others as effective, predicted physical distancing, whereas emotional reactions and media exposure were more important for in engaging in hygiene behavior. finally, we explored the development of behaviors, attitudes, and affective reactions over time. we focused specifically on physical distancing and hygiene behavior (behavior), confidence in authorities, perceived risk likelihood, perceived risk severity (attitudes), and concern/worry, fear, and hope (affective reactions). we regressed each variable on day and day squared. we excluded dates that included less than participants, which was true for the beginning (march , n = ) and end of data collection (march , n = ) . the first day of the time series was thus coded as . thus, we focused on data points per variable (n = ). notably, we did not employ a repeated measurement design. we can thus only model changes between participants, but not within, and changes observed over time could be due partially to changes in the sample composition. in order to control for changes in demographics per day we computed four logistic regression models regressing age, gender, education level, and household size on day and day squared. we only observed statistically significant effects for age showing a negative linear effect (b = − . , se = . ) and a positive quadratic effect (b = . , se = . ), suggesting that the sample in general became younger over time, but then increased in age at the end of the sampling period. as previous analyses suggested that age predicted health-protective behavior and other variables, we added age as a covariate to all models in order to control for it. results are provided in table and time series can be found in figure . for behavior, we observed that physical distancing showed a significant positive linear trend. overall, engagement in physical distancing behavior increased during the days of data collection. on the other hand, hygiene behavior showed no significant linear or quadratic effect. instead, it showed a small decrease during the first days, but remained rather stable. a significant b-weight indicates the beta-weight are also significant. b represents unstandardized regression weights. beta indicates the standardized regression weights. r represents the zero-order correlation. ll and ul indicate the lower and upper limits of a confidence interval, respectively. *indicates p < . . considering attitudes, we observed that confidence in authorities slightly increased during the testing period, though this effect was not statistically significant. perceived likelihood of catching covid- showed both a significant positive linear trend and a significant negative quadratic trend, first increasing, but later showing a small decrease. severity of the disease combined a significant negative linear and a positive quadratic trend, first decreasing and then increasing. taken together, it seems that the more likely catching covid- was reported to be, the less severe respondents estimated it to be over time. finally, experiencing concern or worry showed a significant negative linear effect decreasing over time. at the same time, we also observed a significant positive quadratic trend, suggesting that concern increased at the end of the testing period. experiencing fear showed a small decrease over time. for experiencing hope, we did not find any significant linear or quadratic trends. we sampled over . norwegian participants in the first weeks after schools were closed and many employees were sent to work from home, at the beginning of the covid- outbreak in norway. we observed self-reported health-protective behavior and emotions in real time, while numbers of registered infections rose from to , the number of hospitalized patients rose from to , and the number of deceased patients rose from to . although policy setting may be the main determinant of behavior, psychological factors play an important role in responses to health crises as they modulate how people adopt the guidelines. in the present project we focused on what factors are correlated to engagement in two variants of protective behavior: preventive, such as hygiene behavior, and avoidance, including physical distancing. we employed both a theory-and a data-driven approach, and we explored how attitudes, behavior, and affective reactions changed over the course of the -day sampling period. to protect us from overinterpreting spurious effects, which would be costly in the current situation, we set our significance level to p < . . in our sample, main news sources were news media, government websites, and social media in that order, more than colleagues and family members. when indicating whom they trusted most, participants mainly pointed to the norwegian institute of health (fhi), more so than other norwegian government sources or european sources. one's own doctor and hospital was rarely reported as the most trusted source. confidence was high that authorities, including the norwegian government, scientists, health professionals, and medical services, were able to manage the outbreak. despite the increase in infected cases, we observed that confidence stayed stable and even slightly (but not significantly) increased over the time of days. respondents expected that they too would likely get infected, with an average above the midpoint on our likelihood rating scale ( %). this average was at the upper end of fhi's prediction for the general population from / , and higher than the number in wise et al.'s ( ) sample (m = ) and the representative sample analyzed by saetrevik ( ) , suggesting that due to our sampling strategy our participants might be more concerned and engaged with the topic than the norwegian population on average. at the same time, perceived severity was predominantly rated with mild or moderate symptoms. ratings were higher for the perceived likelihood of close others catching the disease ( %) and similarly, a high proportion of respondents ( %) could imagine that someone from their family would show severe symptoms or even die when imagining the worst case. this was also in line with the observations made in parallel by saetrevik ( ) . self-reported behavior was very much in line with policies asking for (but not mandating by law) physical distancing and protective hygienic behavior. even behavior that is sometimes difficult to avoid like taking public transport and going to shops was reported as being reduced or avoided by more than % of the sample. more than % reported other-protective behavior in the form of reminding other individuals of proper behavior or not visiting older individuals. fewer people actively helped others by for instance buying groceries or even giving money to charities combating covid- . only a small minority reported irrational avoidant behavior (e.g., avoiding chinese restaurantsgiven that the main group bringing infections into norway were norwegians coming from winter holidays in the alps rather than travelers associated with china). in line with previous findings during other pandemics and also covid- (bish and michie, ; harper et al., ; wise et al., ) , the elevated level of appropriate protective and avoidant behavior was predicted by demographic variables: female participants, higher education levels, and larger household sizes. to some extent, these effects were mediated by elevated perceptions of likelihood and severity of the disease for self and others, but these mediations did not explain much variance and indirect effects were considerably small. these models may underestimate the true effect, however, because expectations and behavior changed over the course of the sampling period. there might be other factors that explain this pattern of results. for instance, recent findings show that compassion and empathy play an important role for the engagement in physical distancing during the covid- outbreak (pfattheicher et al., ) and such reactions have been observed to a higher degree in women (christov-moore et al., ) . previous studies also reported that older age predicted more engagement in health-protective behavior. we failed to find a clear replication in the current sample. in fact, our regression analyses point in the direction that older age is associated with less adoption of health-protective behavior. when exploring this association in more detail, we observed four important boundaries. first, we observed a non-linear relationship between age and protective behavior, suggesting that engagement in health-protective behavior increased with age as predicted by previous literature, but then leveled off at around the age of - and decreased with older age. second, our sample included only a few participants above the age of . their estimates are therefore highly imprecise compared to younger respondents (that we sampled around times more often) and when excluding age groups with less than participants the relationship between age and protective behavior was reduced to near zero. third, the effect was reduced when controlling for time. fourth, when constructing the main outcome variable in a different way in order to account for the possibility that some behaviors from our list were not applicable for older adults (e.g., avoiding work) we observed a weaker effect (see supplementary material) . thus, given the composition of our sample we can be more certain that respondents at the age of engage in more protective behavior than respondents at the age of . however, whether engagement in health-protective behavior again decreases for individuals at the age of should be interpreted with caution. if this is indeed the case, this would represent an important finding as risk factors and susceptibility increase with age. we recommend testing this question with a representative sample. in a second step, we tested the influence of more than variables on health-protective behavior employing a supervised machine learning algorithm. we observed that higher engagement in health-protective behavior was associated with ( ) larger household size, ( ) more children, ( ) higher perceived effectiveness of the protective behavior, ( ) more media exposure, and ( ) reduced belief that 'too much fuss' was made about the outbreak (i.e., discrediting the severity and credibility of the crisis, rubin et al., ) above and beyond other factors such as knowledge, perceived risk, living in a municipality with a high amount of recorded cases or one's own perceived health. the simultaneous presence of demographic and psychological predictors indicates that the psychological mediators of the remaining demographic factors remain unclear. when considering preventive and avoidance behaviors separately, we observed that household size (i.e., being surrounded by more people) and regarding staying away from others as effective predicted physical distancing, whereas emotional reactions such as concern, worry, or fear and media exposure had a stronger importance in engaging in hygiene behavior. our findings replicate previous studies suggesting that high perceived effectiveness is important as a predictor of engaging in health-protective, and specifically avoidance behavior (ajzen and timko, ; agüero et al., ) . the importance of household size and the number of children, especially for the adoption of avoidance behavior, points to the possibility that individuals might feel more personally responsible for their co-habitants. literature on the effectiveness of health communications suggests that personal relevance represents an important factor for engaging in protective behavior, which is likely higher if more people within one's social proximity could be affected (ruiter et al., ) . similarly, household size is typically conflated with age showing an inverse u-shaped curve, which fits our observations concerning the association between age and protective behavior. in addition, individuals that need to care for others might show more empathy or compassion, thereby increasing engagement of avoidance behavior as a means of prosociality (pfattheicher et al., ) . on the other hand, engagement in preventive behavior such as hand washing or using hand sanitizing gel was associated less with social-contextual variables, but to a higher degree with felt concern, fear, or worry, as well as increased engagement with the topics. for both types of behaviors, we found that believing there is too much fuss made about the outbreak reduced it. this relation could have several reasons. wise et al. ( ) identified a subgroup that was disengaged from the news, unaware of risks, and not practicing recommended behavioral change. participants who indicated that "too much fuss was made" may have belonged to a similar subgroup. on the other hand, there might be a group of people who for some reason cannot change their behavior, and consequently adapt their attitudes to be consistent. in any case, if that group is large enough, it could counteract quarantine measures in communities. it thus seems important to follow up on this effect, again ideally with representative samples. contrary to our predictions, we observed that increased confidence in authorities reduced the adoption of healthprotective behaviors. similar findings were observed in the sister study of the current project with an australian sample (faasse and newby, ) . while confidence in governments, health professionals, and medical services has been reported as crucial for individuals to adopt behavioral change (bish and michie, ) , it is possible that overconfidence results in reckless behavior, as it is assumed that everything will be under control no matter what individual actions are performed. this finding points at a dilemma, as confidence in authorities is needed to establish protective behavior in the first place and reduce panicking or intense fear of the outbreak (asmundson and taylor, ) . health communications therefore need to highlight the importance of individuals actions as part of greater societal outcomes, and simultaneously communicate conviction in recommended measures and risk. during the -day sampling period, we observed a significant increase in avoidance behaviors. these changes could be explained by individual psychological factors such as increased personal relevance or concern, group behavior and attitudes (such as injunctive norms), or contextual factors. for instance, throughout norway schools and universities were closed on the th of march, creating a uniform behavior change. similarly, most public events such as sports or concerts were canceled. it is not possible for the present data to show whether changes in avoidance behavior were based on psychological factors or situational constraints. interestingly, we observed little change in hygiene behavior during the sampling period. it could be possible that hygiene behavior was already quite high at the beginning of data collection: over % indicated engaging in more thorough hand washing behavior. on the other hand, increased self-isolation through avoidance behavior could have resulted in neglecting additional preventive behavior. in contrast to previous studies on responses to pandemics or specifically covid- , we failed to find strong associations between perceived risk or knowledge and engagement in protective behavior. while perceived likelihood and severity showed positive relations with health-protective behavior, these effects were considerably small and smaller than factors such as the number of children or experienced concern. similarly, knowledge showed no or even a negative relationship with engagement in protective behavior. as knowledge and media exposure were on average quite high, it could be that we simply did not have enough variation in the sample to detect a larger effect. nevertheless, the implication seems to be that motivating people to practice protective behavior works best by emphasizing that it is effective, rather than by exaggerating risks of not engaging in it. the present findings mostly replicate an earlier study using nearly identical methods in an australian sample in an earlier stage of the pandemic (faasse and newby, ) . similar to this study, we found positive relations to media exposure, concern and worry, as well as effectiveness of behavior. in addition, we also replicated the finding that confidence in authorities and believing that too much fuss was made resulted in less healthprotective behavior. our observed effect sizes ranged from zero-order correlations (r) of . between concern/worry and health-protective behavior to standardized regression coefficients (beta) of . for the prediction by media exposure when controlling for the other variables, or less. the estimated effect sizes are in line with published literature focusing on attitude-behavior relationships (bosco et al., ) and can be considered as small to medium effects. similarly, our effects are comparable to previous research exploring predictors of health-protective behavior during the covid- outbreak (faasse and newby, ; harper et al., ; wise et al., ) . it would have been helpful to define a smallest effect size of interest in order to be able to conclude when an effect is absent by for example applying equivalence testing (lakens, ) . however, given the exponential nature of the growth of infections it is difficult to decide on a cut-off regarding which effects might not be of practical importance anymore. while standardized regression or correlation coefficients of . might be typically considered as too small to be of practical importance, they could still be informative in the current context. answers to that can only come from models that integrate behavior and epidemiological effects (e.g., poletti et al., ) . in general, we note that our effects were on average comparable small. our study has several limitations that should be considered when interpreting the findings. first, although large, our sample was not collected in a way that makes it representative. women, younger people, and individuals with a higher education level are overrepresented; this should be taken into account when interpreting the presented findings. nevertheless, our total sample size was large enough that we trust our estimates for male participants. notably, percentage of people expecting to become infected, confidence in the government to handle the crisis, and percentage of those worried about family members are similar to numbers found in two representative survey studies among the norwegian population (kantar, a,b) , suggesting that our sample might be quite similar to the norwegian population at large. nevertheless, our study provides a snapshot of a -day period, focusing on a non-representative sample representing a specific culture with all its societal and normative implications, as well as certain healthcare systems and authorities that are hardly generalizable to different countries, healthcare systems, or timepoints in a pandemic. second, although time is a meaningful variable in the days window that we observed, our sample is cross-sectional, not longitudinal. changes over time can thus be caused by various confounding variables and simply be due to sampling variation, despite our efforts to control for that. strong inferences about intra-individual change need repeated measures in a longitudinal design, which we do not have (borsboom et al., ; fisher et al., ) . third, we did not pre-register our research methods and analysis plan. indeed, we largely adopted an existing instrument and developed the literature review and hypothesis in parallel to data collection. the main research scope of the present project was exploratory in nature and we did our best to increase the reliability of our findings by conducting a split-half validation method (ijzerman et al., ) . due to the exploratory approach, we included several variables that have been found to predict protective behavior in past literature or were deemed important. of course, it is possible that we failed to include important variables associated with health-protective outcomes, such as compassion or empathy (pfattheicher et al., ) . fourth, the measurement of some of the included variables, especially our outcome variable, could be improved. in the current project we assessed protective behavior using a dichotomous format (answer alternatives yes/no, we also added unsure, and not applicable). a likert-scale type measurement might be superior in capturing the whole breadth of responses in the outcome variable. at the moment a respondent will answer yes if she avoided specific situations once or several times within the last weeks. using more response options would allow us to differentiate among such responses. similarly, we focused on self-report of behavior, not actual behavior and there might be a gap between reported and actual health-protective behavior. however, recent research focusing on gps movement data in the us during the covid- outbreak suggests that self-report data might be used as a proxy for actual behavior (gollwitzer et al., ) . our measures of protective and avoidant behavior were much more comprehensive than our measure of other-supporting behavior. as the crisis proceeds, various behaviors that support the community through donating food, equipment, and money, making masks, supporting each other through buying food, and taking care of children become important, and it is known that such communal behavior emerges in crises and can be stifled by authorities reacting the wrong way (solnit, ; drury et al., ) . future studies should place more emphasis on such measures. finally, we believe that our understanding of the motives behind protective and avoidant behavior is not ideal. unless one knows for sure whether oneself or another person is infected, most behavior serves both to protect oneself and others. for instance, the discussion about wearing non-clinical facial masks has moved from initial arguments that they are not providing total protection for the wearer to the insight that they do protect others if the wearer is infected -and if everybody protects everybody else, then everybody is protected. in our data, we are not able to tease apart motivation to protect the self and otherprotection motivation, either for close others or the community. again, this remains a crucial topic for future work. the present project provides a snapshot of individuals' attitudes, behavioral actions, and affective reactions during weeks following the covid- outbreak in norway. while our findings do not generalize to the whole norwegian population, nor to other countries with different courses of action responding to the outbreak or different healthcare systems, they provide important information on the nature of what psychological and demographic variables might influence health-protective behavior and how such variables change over time. the findings can provide insights and indications in order to improve healthcare communications: ( ) perceptions of effectiveness of protective behavior are important; they emerge as crucial especially when trying to predict physical distancing. they could be increased by tailoring communication strategies to various groups, emphasizing how different people can engage in effective preventive (hygienic) or avoidance (distancing) behavior. ( ) people differ, and these differences matter for the adoption of protective behavior: being female, household size, and number of children all seem to play a role. on one hand, these factors point to how early on in a crisis first changes can be reached quickly by targeting such response groups. on the other hand, this again shows that tailored messaging and targeted behavior change campaigns are indicated. ( ) physical distancing and hygiene seem to be driven by somewhat different factors: the former more by social variables and beliefs of effectiveness, the second more by emotional processes. again, campaigns targeting these complementary protections should be aware of that. ( ) in line with previous literature, there is a subset of the population that discredits severity and credibility of the crisis, indexed in our study as the belief that "too much fuss is being made" about this, which is in turn associated with less engagement in health-protective actions (cf. rubin et al., ) . it may be fruitful to model and investigate the potential impact such individuals can have on the spread of the disease, the reasons for their beliefs, and targeted ways to change their beliefs. finally, the present project highlights that although similar factors can be found across different countries or medical systems that seem to influence protective outcomes (e.g., harper et al., ; wise et al., ) , it is important to take the specific trajectories and developments in each country or healthcare systems into account to be able to successfully model and identify important variables predicting health-protective behavior (see maekelae et al., ) . the datasets presented in this study can be found in online repositories. the names of the repository/repositories and accession number(s) can be found in the article/ supplementary material. the studies involving human participants were reviewed and approved by internal review board, institute of psychology, university of oslo. the patients/participants provided their written informed consent to participate in this study. adoption of preventive measures during and after the influenza a (h n ) virus pandemic peak in spain the fear of covid- scale: development and initial validation the theory of planned behavior correspondence between health attitudes and behavior coronaphobia: fear and the -ncov outbreak demographic and attitudinal determinants of protective behaviours during a pandemic: a review the theoretical status of latent variables correlational effect size benchmarks random forests randomforest: breiman and cutler's random forests for classification and regression perceived risk, anxiety, and behavioural responses of the general public during the early phase of the influenza a (h n ) pandemic in the netherlands: results of three consecutive online surveys empathy: gender effects in brain and behavior the effects of media reports on disease spread and important public health measurements community psychological and behavioral responses through the first wave of the influenza a(h n ) pandemic in hong kong facilitating collective psychosocial resilience in the public in emergencies: twelve recommendations based on the social identity approach an argument for basic emotions public perceptions of covid- in australia: perceived risk, knowledge, health-protective behaviours, and vaccine intentions. medrxiv [preprint impact of non-pharmaceutical interventions (npis) to reduce covid- mortality and healthcare demand lack of group-toindividual generalizability is a threat to human subjects research the lexical fallacy in emotion research: mistaking vernacular words for psychological entities risikovurdering og respons i norge versjon . folkehelseinstiuttet. available online at car: companion to applied regression the role of positive emotions in positive psychology: the broaden-and-build theory of positive emotions viridis: default color maps from "matplotlib re: koronamonitor adherence to emergency public health measures for bioevents: review of us studies connecting self-reported social distancing to real-world behavior at the individual and us state level functional fear predicts public health compliance in the covid- pandemic party: a laboratory for recursive partytioning the dynamics of risk perceptions and precautionary behavior in response to (h n ) pandemic influenza the human penguin project: climate, social integration, and core body temperature what predicts stroop performance? a conditional random forest approach befolkningens holdninger til situasjonen med korona-smitte kantar koronabarometer befolkningens holdninger til situasjonen med koronasmitte ggpubr: "ggplot " based publication ready plots measuring emotions in the covid- real world worry dataset equivalence tests: a practical primer for t tests, correlations, and meta-analyses justify your alpha substantial undocumented infection facilitates the rapid dissemination of novel coronavirus (sars-cov ) situational awareness and health protective responses to pandemic influenza a (h n hong kong: a cross-sectional study sjmisc: data and variable transformation functions using behavioral science to help fight the coronavirus a meta-analysis of the association between gender and protective behaviors in response to respiratory epidemics and pandemics perceived efficacy of actions during the early phase of the covid- outbreak psychological correlates of news monitoring, social distancing, disinfecting, and hoarding behaviors among us adolescents during the covid- pandemic slik er tilliten til myndighetene dag for dag sp: classes and methods for spatial data. r package version . - the emotional path to action: empathy promotes physical distancing during the covid- pandemic risk perception and effectiveness of uncoordinated behavioral responses in an emerging epidemic tree: classification and regression trees. r package version . - lavaan: latent variable analysis. r package version . - who is sceptical about emerging public health threats? results from national surveys in the united kingdom scary warnings and rational precautions: a review of the psychology of fear appeals lattice: multivariate data visualization with r a paradise built in hell: the extraordinary communities that arise in disaster apatables: create american psychological association (apa) style tables conditional variable importance for random forests realistic expectations and pro-social behavioral intentions to the early phase of the covid- pandemic in the norwegian population an outbreak of the severe acute respiratory syndrome: predictors of health behaviors and effect of community prevention measures in hong kong, china community knowledge, behaviours and attitudes about the h n influenza pandemic: a systematic review using social and behavioural science to support covid- pandemic response immediate psychological responses and associated factors during the initial stage of the coronavirus cisease (covid- ) epidemic among the general population in china how to improve adherence with quarantine: rapid review of the evidence. medrxiv fhidata: structural data for norway. r package version . . stringr: simple, consistent wrappers for common string operations dplyr: a grammar of data manipulation tidyr: tidy messy data cowplot: streamlined plot theme and plot annotations for "ggplot changes in risk perception and protective behavior during the first week of the covid- pandemic in the united states choosing prediction over explanation in psychology: lessons from machine learning individual differences in accepting personal restrictions to fight the covid- pandemic: results from a danish adult sample jg and kf devised the original method. jz, ts, and ah adapted the original instrument for norway, and ah translated it into norwegian. jz analyzed the data and wrote the first draft. all authors contributed to revisions. we thank bjørn saetrevik, alf børre kanten, gerit pfuhl, torleif halkjelsvik, Øyvind ihlen, and beate seibt for helpful comments on earlier drafts and svein harald milde for help with promoting the survey. the supplementary material for this article can be found online at: https://www.frontiersin.org/articles/ . /fpsyg. . /full#supplementary-material the authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.copyright © zickfeld, schubert, herting, grahe and faasse. this is an openaccess article distributed under the terms of the creative commons attribution license (cc by). the use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. no use, distribution or reproduction is permitted which does not comply with these terms. key: cord- -z x wax authors: yao, yang; tian, yao; zhou, jing; diao, xin; cao, bogan; pan, shuang; di, ligai; liu, yan; chen, hui; xie, chunxia; yang, yuanli; li, feiyu; guo, yuqi; wang, shengyu title: psychological status and influencing factors of hospital medical staff during the covid- outbreak date: - - journal: front psychol doi: . /fpsyg. . sha: doc_id: cord_uid: z x wax background: the aim of this study was to analyze the psychological status of and its influencing factors in health care workers (hcws) during the coronavirus disease (covid- ) outbreak so as to provide sufficient theory and scientific basis for the formulation and implementation of relevant policies and measures in improving the psychological status of hcws. method: during february to february , , , members of the hcws from xi’an and wuhan completed a -item questionnaire regarding pressure about the covid- influenza pandemic, along with the -item general health questionnaire (ghq- ). the ghq- scale was divided by three points. the positive group was scored more than . all data were analyzed by spss. results: more than half of the participants ( . %) reported psychological distress. the hcws have sufficient information about the covid- symptoms, prognosis, treatment, infection route, and preventive measures (medians ranged from / to / ). female, engaged in clinic work less than years, married person, and working in wuhan were risk factors affecting the psychological status of hcws (p < . ). conclusion: psychological distress is common in hcws during the covid- outbreak. hospitals and relevant departments should provide psychological support to hcws, and strict infection control measures should be developed. last december , the epidemic of coronavirus disease (covid- ) has a breakout in wuhan, china (paraskevis et al., ; wang et al., ) , and spread rapidly around the world. on february , , who named the novel coronavirus pneumonia as "covid- , " and the new crown pneumonia is ncp. early studies mainly focused on clinical characteristics, treatment measures, and epidemiological features (chen n. et al., ; chen z.m. et al., ; guan and xian, ) . in addition, this research paid more attention to patients but ignoring the health of health care workers (hcws), especially psychological status. as of february , more than , hcws from medical teams across china have come to hubei for support. however, the understanding of covid- -related knowledge and prevention measures is still in its infancy, coupled with the increase of workload and the risk of infection, resulting in a serious impact on the psychological health of hcws. moreover, the psychological state of hcws is closely related to the therapeutic effect and prognosis of patients. previous studies on the impact of disease outbreaks on the psychological health of hcws have shown that many hcws show a high degree of psychological distress, the pressure over severe acute respiratory syndrome (sars) and middle east respiratory syndrome (mers) outbreak have been related to work pressure, social isolation, and health concerns (lee et al., ; wu et al., ) . however, there are few studies have been conducted to investigate the psychological distress of hcws at the height of the epidemic of covid- . this study aims to evaluate the psychological status of and influencing factors in hcws during the outbreak of covid- and to provide a scientific basis for improving the psychological status of the hcws and making relevant policies. the study was carried out by online survey from february to february , . a total of , respondents from the first affiliated hospital of xi'an medical university, xi'an chest hospital, xi'an eighth hospital, wuhan union hospital (hcws supported by shaanxi), and wuhan ninth hospital (hcws supported by shaanxi). the questionnaire consists of three parts: basic characteristics, online survey, and the -item general health questionnaire (ghq- ). the ghq- has been widely used to assess mental health status (montazeri et al., ) . ( ) basic characteristics: age, years of clinical work, marital status, education level, profession, and whether working in wuhan were included in the basic characteristics. ( ) online surveys: in order to reduce face-to-face communication and avoid infection, the existing research invites potential interviewees electronically. they completed the questionnaire in chinese through the online survey platform (surveystar, changsha ranxing science and technology, shanghai, china). previous surveys on the psychological impacts of sars and influenza outbreaks were reviewed (nickell et al., ; goulia et al., ) . authors included additional questions related to the covid- outbreak. finally, this section contains items which are all scored on a -point likert scale, a higher score indicated a strongly degree. ( ) twelve-item general health questionnaire: the questionnaire consists of items, of which six are positive items and six are negative, which are scored at four levels. ( ) never, ( ) rarely, ( ) sometimes, and ( ) often. the most common scoring methods bimodal ( - - - ) are used according to who scoring method. if the answer is "often" or "sometimes, " it is point. if the answer is "never" or "little, " it is point. results the higher the score, the lower the level of mental health. therefore, this gives scores ranging from to . the total score ≥ was poor mental health. the data were analyzed using spss software . (spss inc., chicago, il, united states). chi-square test or fisher's exact test was used for analysis of categorical variables. the anova test or student's t test was utilized to compare measurement variables. f test was used if related to non-normal distribution parameters. categorical variables were expressed as number (%) and mean (sd); logistic regression analysis was used to analyze the correlation before multiple factors. p < . was considered statistically significant. the basic characteristics of the participants were shown in as shown in figure , under stress (item ), able to concentrate (item ), and lose much sleep (item ) have the most participants with a score of . the numbers of participants were , , and , respectively. the major demographic, professional characteristics, and psychological distress scores were shown in table . six hundred twelve out of , participants ( . %) presented scores on ghq ≥ (positive), indicative of severe psychological distress. three hundred ninety ( . %) presented scores on ghq < (negative), indicative of mild to moderate psychological distress. in the positive group, there were ( . %) females and ( . %) males. the difference of positive psychological stress between different genders was statistically significant (p = . ). three hundred eight ( . %) of the positive participants have engaged in clinical work for less than years, and ( . %) participants had more than years of work (p = . ). for marital status, out of positive participants ( . %) were married, ( . %) were single, and ( . %) were divorced (p = . ). for educational level, . % were junior college, . % were undergraduate, . % were master, and . % were doctor (p = . ). for profession, . % of positive participants were nurses, . % were medical, . % were technicians, and . % were others (p < . ). five hundred eighty-nine of positive participants were working in wuhan, and were not (p = . ). there was no significant difference in age among the positive participants. as shown in table , we analyzed the source of psychological pressure according to occupations. the hcws have sufficient information about the covid- symptoms, prognosis, treatment, infection route, and preventive measures (medians ranged from / to / ). medical staff scored the highest in terms of symptoms, prognosis, and treatment compared to the other groups. the difference is statistically significant (p < . ). nurses have the highest score in infection route and preventive measures (p < . ). most hcws believe that their department provides clear information about covid- (median / ). the score of nurse group was . ± . , with the highest score compared with the other groups. medical staff and technicians have confidence in the cure after infection. the scores were . ± . and . ± . , respectively. while nurses and others were . ± . vs. . ± . (p < . ). the appeal for psychological support for medical staff is very high (median / ). but the differences between groups were not statistically significant. most of the participants will not stop working during the outbreak of covid- (median / ). with the psychological distress of health care workers as shown in table , female, engaged in clinic work less than years, married person, and working in wuhan were risk factors hospital medical staff show an absolutely important position in the outbreak of infectious diseases, but people often pay more attention to the cure rate, diagnosis, and treatment effect and prognosis of patients and ignore the psychological distress of hcws. studies that investigated the psychological status during sars and a/h n influenza pandemic indicated that a high level of distress is common (caputo et al., ; goulia et al., ) . in addition, we are dealing with an epidemic the likes of which we have never seen in this century. as of february , , , confirmed and , death cases have been reported in china and spread rapidly in chinese provinces or municipalities. therefore, it is urgent to investigate the psychological state of and related factors in medical staff and provide a certain scientific basis for improving the psychological status of hcws. our results showed that during the period of the covid- epidemic, more than half of hcw participants have suffered from psychological distress. the proportion of married female is relatively large. it may be related to women's physiological reasons. compared with men, their ability to bear pressure is slightly weaker. the main reason for married people's stress is that their work increases the risk of infection among family members. the score of physiological distress of nurses was higher than that of other staff. although both doctors and nurses are in contact with patients, medical staff expressed a lower degree of psychological distress. the possible reason may be that medical staff mostly regarded themselves as sufficiently informed, and it is generally true that medical staff are highly educated and have sufficient knowledge reserve, so they have a better understanding of the information they have acquired. in addition, nurses are the largest occupational group in the hospital. they have a direct and close relationship with patients and have a higher risk of infection. therefore, it is easy to understand that nurses think themselves have a full understanding of the infection pathway and prevention measures of covid- and have the highest voice for psychological support. the study also found that long-term clinical work can reduce psychological stress. this may be due to that the rich experience can be accumulated through long-term work, which can better cope with emergencies and complex situations. finally, the psychological distress of medical staff working in wuhan is higher than that out of wuhan. the covid- outbreak is in wuhan, and until now, wuhan is still the worsthit region of covid- infection. the number of confirmed cases and mortality rate in there have been ranked first in the country, accounting for % of total mortality rate. in addition, the disease has been confirmed to be human-human transmission (du et al., ; xu and kraemer, ) . according to reports, more than , medical staff have been infected with covid- . in addition, most of the medical staff are non-native. unfamiliarity with the local environment and language increases their psychological pressure. these results are consistent with the results of previous studies in sars. angelina om chan performed a study focused on psychological impact of the sars outbreak on hcws in singapore and found that % participants had psychological distress (chan and huak, ) . bai et al. ( ) also investigated stress reactions among staff members in a hospital in east taiwan and came to the conclusion that % suffered from an acute stress disorder during the sars outbreak. as the covid- epidemic continues to spread, our findings will provide important guidance for the development of psychological support strategies for china and other affected areas. our findings also have clinical and policy implications. the results show that female medical staff are suffering from greater psychological impact and higher levels of pressure in this epidemic. this will help health authorities to identify high-risk groups for early psychological intervention. moreover, as concerns about protective measures are a major source of stress, strict and detailed infection control measures should be developed. furthermore, to minimize face-to-face interaction, health authorities may consider providing online or smartphone-based psychological education and intervention. this study also has several limitations. firstly, there is gender bias in this study. comparison of the characteristics of the research samples in this epidemic suggested that the study sample is gender-specific. despite this, however, we cannot refute the criticism that an underlying response style might have led to our results. secondly, there is no classified analysis on the psychological status of medical staff in the intensive care unit (icu) and non-icu, which may also be a potential factor. finally, social discrimination is ignored in this study. there is a general psychological pressure among medical staff during the covid- pandemic. pressure was significantly associated with preventive measures and infection route. the perceived sufficiency of information and psychological intervention measures about covid- was associated with a reduced degree of pressure. all datasets presented in this study are included in the article/ supplementary material. ethical review and approval was not required for the study on human participants in accordance with the local legislation and institutional requirements. participation was anonymous via an online survey questionnaire. yuy and yt designed the study and drafted the work. jz and xd conducted the analysis. bc made substantial contribution to the design of the work. sp and ld contributed to the interpretation of the work and revising the draft for important intellectual content. yl, cx, and hc helped with access to the data and provided information and consulting. sw and fl made substantial contributions to the conception of the work. yg and sw revised the draft for important intellectual content and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. all authors reviewed and approved the final manuscript. survey of stress reactions among health care workers involved with the sars outbreak intubation of sars patients: infection and perspectives of healthcare workers psychological impact of the severe acuterespiratory syndrome outbreak on health care workers in a medium sizeregional general hospital in singapore diagnosis and treatment recommendations for pediatric respiratory infection caused by the novel coronavirus epidemiological and clinical characteristics of cases of novel coronavirus pneumonia in wuhan, china: a descriptive study risk for transportation of novel coronavirus disease from wuhan to other cities in china general hospital staff worries, perceived sufficiency of information and associated psychological distress during the a/h n influenza pandemic the progress of novel coronavirus ( -ncov) event in china psychological impact of the mers outbreak on hospital workers and quarantined hemodialysis patients the -item general health questionnaire (ghq- ): translation and validation study of the iranian version psychosocial effects of sars on hospital staff: survey of a large tertiary care institution full-genome evolutionary analysis of the novel corona virus ( -ncov) rejects the hypothesis of emergence as a result of a recent recombination event a novel coronavirus outbreak of global health concern the psychological impact of the sars epidemic on hospital employees in china: exposure, risk perception, and altruistic acceptance of risk open covid- data curation group.open access epidemiological data from the covid- outbreak we thank all the frontline health care staff fighting against covid- in china. key: cord- -ls q g v authors: balsamo, michela; carlucci, leonardo title: italians on the age of covid- : the self-reported depressive symptoms through web-based survey date: - - journal: front psychol doi: . /fpsyg. . sha: doc_id: cord_uid: ls q g v the pandemic of coronavirus disease (covid- ) has affected the italian community. the widespread use of quarantine had the desired impact of controlling the epidemic, although it caused many psychological consequences. to date, compliance of the italian public with voluntary home quarantine has been very high, but little is known about the impact of psychological health on sociodemographic categories during the quarantine. the purpose of this study was to assess the prevalence of depressive symptoms in specific sociodemographic categories during the covid- quarantine lockdown and the potential factors that contribute to, or mitigate, these effects. in the very early stage of the nationwide lockdown, , quarantined italian adult residents ( % females, ranging from to years) participated in a web-based cross-sectional survey, including measures of depressive symptoms, which were measured by the teate depression inventory, and state anxiety levels. the overall prevalence was . % for moderate and . % for severe levels of depressive symptoms. a generalized logistic model was used to identify the factors associated with mental health problems. among these factors, sociodemographic variables (e.g., sex, age, employment status) and adherence to quarantine guidelines were analyzed. females, younger people, students, singles, residents in northern italy, people who were reluctant to adhere to quarantine guidelines, and people less worried about being infected with covid- were at high risk of developing depressive symptoms during the covid- epidemic, also after controlling for state anxiety. these findings showed that public levels of depressive symptoms did not increase the greater likelihood of being infected. our study suggested that the monitoring of psychological outcomes for outbreaks could identify groups at higher risk of psychological morbidities due to the current pandemic in order to target future psychological interventions for implementation. the pandemic of coronavirus disease , caused by the severe acute respiratory syndrome coronavirus (sars-cov- , previously known as -ncov) has affected the italian community since late january. according to the imperial college covid- response team (ferguson et al., ) , cumulatively, . ( . - . ) million people had been infected as of march , giving an infection rate of . % ( . - %) of the italian population. to contain the rapid spread of this pandemic, the italian government ordered nationwide lockdown by march : all public places were closed (included educational, religious, and public/cultural institutions, such as schools, universities, museums, and law courts), all public events and any form of congregation were banned, and a distance of at least m had to be maintained (government of italy, ). all italian people were in quarantine at home (#iorestoacasa) until may : people had to stay at home apart from essential tasks. the slowing growth in daily reported deaths in italy was consistent with the significant impact of these restrictions. the effective reproduction number, rt, dropped to close to around the start of the lockdown, with , ( , - , ) deaths averted. the widespread use of quarantine had the desired effect of controlling the epidemic, this was also due to the fact that the compliance of the italian public with quarantine guidelines had been very high (carlucci et al., ) . yet, the pandemic created a breeding ground for direct psychological consequences, suddenly throwing many individuals into daily lives filled with health threats, existential depression, and generalized stress (holmes et al., ) . a recent review of the psychological impact of quarantine, due to earlier outbreaks, suggested that there were high rates of negative psychological effects among the public, including post-traumatic stress symptoms, persistent depression, substantial anger, panic attacks, and suicidality (liu et al., ; maunder et al., ; brooks et al., ) . social distancing and isolation exacerbate the burden of stress, and often cause effects on immune, cardiovascular, and mental health because these measures frustrate the deep-seated human instinct to connect with others. on this point, social connection helps people to regulate negative emotions, remain resilient during difficult times, and cope with stress (rimé, ; hawkley and cacioppo, ; haslam et al., ; doré et al., ; jetten et al., ) . remarkably, the mental impact of quarantine can depend largely on the characteristics of participants and the quarantine variables selected. as documented by reynolds et al. ( ) , taylor et al. ( ) , and brooks et al. ( ) , while compliance with quarantine guidelines requirements are significant factors behind a higher level of post-traumatic stress disorder (ptsd), healthcare workers were more likely to be affected than the public. in italy, in the early phase of quarantine ( - days after the decree of nationwide lockdown), deleterious consequences on the population's psychological health were analyzed in a nationally representative survey of , participants (barari et al., ) . different demographic groups were struggling with different aspects of quarantine. older adults expressed worry or anxiety, while those who were likely working parents ( - years) cited consistent economic distress and struggles with home-schooling and smart-working, compared to other groups. younger people were struggling with increased boredom, perceived immobility, and conflicts within family, while vulnerable groups, like the elderly and health-compromised people, cited consistent loneliness relative to others. overall, the average level of anxiety surrounding the crisis in the italian population was high: no respondents reported being completely without anxiety. according to barari et al. ( ) , the negative psychological consequences of the quarantine were beginning to wear on people and seemed likely to become more serious over time. further findings derived from an online survey showed the prevalence of psychiatric symptoms in , participants drawn from the general population from march to . female gender, negative affect, and detachment were associated with higher levels of stress, anxiety, and depression. having an acquaintance infected was associated with increased levels of both depression and stress, whereas a history of stressful situations and medical problems was associated with higher levels of anxiety and depression. finally, those with a family member infected and young people who had to work outside their domicile presented higher levels of anxiety and stress, respectively. thus, it is important that the potential advantages of home quarantine are weighed against the possible mental costs (rubin and wessely, ; torales et al., ) . quarantine as an efficacious public health measure also needs to lower the psychological strain associated with it. research evidence aims of this study were to explore ( ) the likely effects of quarantine on mental health (anxiety and depressive symptoms), immediately after the nationwide lockdown issued by the italian government, and ( ) the factors that contribute to, or mitigate, these consequences. among these factors, sociodemographic variables (gender, age, employment status, marital status, education, geographic area, and income per year), worry about being affected by covid- , and adherence with quarantine guidelines were analyzed. depression was the principal outcome, while anxiety was used as a covariate, given its close association with depression (clark and watson, ; barlow and campbell, ) . respondents were italian quarantined adults aged and older with access to a networked computer. an online cross-sectional study was conducted from march to , immediately after the nationwide lockdown issued by the italian government on march (#iorestoacasa). a virtual snowball sample via social media was used within a wider web-based study including other psychological measures (carlucci et al., ) . this study has been approved by the department of psychological sciences, health and territory, university of chieti, italy review board. written informed consent was obtained from all the participants included in the study. of psychiatric illnesses and medical problems (e.g., hospitalizations) were collected. the -item teate depression inventory (tdi; balsamo et al., , b , developed via rasch analysis (rasch, ) , was employed to evaluate depressive symptoms in participants in the past weeks. respondent answers were measured on a point likert scale ranging from "never" to "always." cronbach's α coefficient in our study was . . the -item state scale of the state-trait inventory for cognitive and somatic anxiety (sticsa) (ree et al., ; balsamo et al., ; carlucci et al., ) was administered to evaluate cognitive (e.g., "i have trouble remembering things") and somatic (e.g., "my muscles are tense") symptoms of state anxiety. individuals rated how often a statement was true in the past weeks, from "not at all" to "very much so." cronbach's α coefficient was . . adherence to quarantine guidelines in response to the covid- outbreak was measured by a global index composed of items classified into preventive (i.e., handwashing with soapy water/alcohol-based solution) and avoidant (i.e., avoidance of gatherings in public or open to public places, handshaking) disease behaviors (carlucci et al., ) . respondents were asked about the frequency of which they had carried out quarantine restrictions on a -point likert scale from "never" to "always." cronbach's α coefficient was . . worry about being infected with covid- was assessed by a single item drawn from a multidimensional questionnaire of risk perception for the covid- infectious disease outbreak. responses were classified according to three levels of worry severity: none ("not worried at all"), moderate ("slightly worried"), and quite a lot ("really worried"). descriptive statistics were computed for sociodemographic characteristics, physical symptoms and health service utilization variables, knowledge and concern-related variables, precautionary measure variables, and additional health information variables. prevalence of depressive and anxiety symptoms during the covid- outbreak in the italian population were also computed for sex and age. in line with similar studies (e.g., giallonardo et al., ; wang et al., ) , the tdi outcome score was categorized into "minimal, " "mild, " "moderate, " and "severe" depression levels . a sticsa-s score of points or greater was indicated as the cut-off point for the presence of anxiety symptoms (van dam et al., ) . sensitivity analysis was conducted using the hmisc r package (harrell and dupont, ) in order to assess the power and sample size of ordinal outcomes under the proportional odds ordinal logistic model. next, generalized linear regression (glms) was applied to the explanatory model to analyze whether the severity of depression during the covid- quarantine could be predicted by high levels of adherence to quarantine guidelines and worry about being infected with covid- , and by sociodemographic variables (model ), that resulted as significant in our previous study (carlucci et al., ) . since depression was measured in terms of severity levels, we specified multinomial (ordinal) as the distribution and cumulative logit as the link function. predictors were selected according to a two-step process. firstly, a potential set of considered variables were correlated with the outcome variable. all the potential variables that correlated significantly with the outcome were selected as predictors in the glms model. hence, based on the test of model effects (wald chi-square statistic and p-values), the predictors were compared (guisan et al., ) . only the resulting significant predictors (p < . ) were retained in the model. a wald test (and its % confidence interval) based on robust estimates of the coefficients and covariance matrix were used to assess the models, and residual deviance as a goodnessof-fit statistic was applied to evaluate model overdispersion (mccullagh, ) . the model with the deviance/df ratio closest to the unit was retained as the most parsimonious model (mccullagh, ) . in addition, due to the high comorbidity between depression and anxiety symptomatology (clark and watson, ; barlow and campbell, ) , the model was re-estimated controlling for anxiety as the covariate (model ), in order to increase the ability to detect differences on dependent variables (depression severity levels) by an independent variable inserted as the covariate. differences between the two models were interpreted in terms of unique contribution of any independent variable on depression severity symptoms. the data were statistically analyzed with spss for windows . (ibm corp, ). statistical significance was set by p-values of less than . . the characteristics of the participants are shown in table . of the , respondents, , ( . %) were male and , ( . %) were female. the mean (±sd) age of the participants was . ± . years. a total of . % of them were located in the south of italy (n = ). among these, , ( . %) respondents held a high school diploma, while , ( . %) held a higher education qualification (bachelor/master/doctorate). in terms of occupational status and income per year, , ( . %) participants were students, ( . %) were healthcare workers, and , ( . %) were employed. concerning marital status, , ( . %) participants were unmarried/single, ( . %) were married, ( . %) were divorced/separated, ( %) were cohabiting, and ( . %) were widowed. most of the subjects had a high level of health: , ( . %) were found to show no physical disease, while ( . %) were detected as "fragile, " having more than three diseases, and with a long history of chronic medical illness. a total of ( . %) participants had previously carried out psychotherapeutic treatment. among these, . % of respondents had carried out at least one psychotherapy treatment (individual, family/couple, and/or group treatment), . % had undergone psycho-pharmacological treatment, and . % had participated in other psychological treatments. most ( . %) of the participants spent their quarantine period with family members. a total of , ( . %) were found to be highly adherent to quarantine guidelines, and , ( . %) reported that they were worried about being infected with covid- . a sample size of , was used for the statistical power analyses, and a : odds ratio was used as a baseline. the alpha level used for this analysis was p < . . the post-hoc analyses showed that the statistical power for this study was . . thus, there was an adequate power at the moderate to large effect size level. an n of approximately , would be needed to obtain statistical power at the recommended . level (cohen, ) . the overall prevalence was . % for severe, . % for moderate, . % for mild, and . % for minimal depressive symptoms. the overall prevalence of anxiety symptoms was . %, using the cut-off of > . taking together, the prevalence of depressive symptoms and state anxiety severity was significantly higher in female participants, and those younger than years compared to participants aged years or older (p < . , as shown in tables , ). in addition, those who received psychotherapeutic treatment in the past reported higher severity levels of depressive [χ = . ( ), p < . ] and anxiety [χ = . ( ), p < . ] symptoms relative to the general public. preliminarily, nonparametric correlations (spearman's rho) were performed in order to select independent variables as predictors in the glms. as expected, all the sociodemographic variables, as well as worry were found to correlate negatively with the outcome variable (depressive symptom severity levels) ranging from rho = . (age, p < . ) to rho = − . (education, p < . ), except for sex and worry (rho = . , p < . and . , p < . , respectively). parameter estimates of the generalized linear model and the exponentiated values of the coefficients [the "exp(b)" column] are displayed in table . the first model resulted in an underestimation of the data with no statistical association for education [wχ (df ) = . ( ), p = . ], and income per year [wχ (df ) = . ( ), p = . ] as predictors of depressive symptoms. to improve model fit, we discharged them and reestimated the model. the omnibus test [χ (df ) = . ( ); p < . ], and residual deviance/df ratio (deviance/df = . ) of the re-estimated models suggested that the refined model fit significantly better than the proposed model (mccullagh, as expected, a preliminary analysis showed that depression and anxiety symptoms shared approximately % of the common variance, as derived by the spearman rho coefficient (rho = . , p < . ). thus, state anxiety, as measured by the state sticsa, as the covariate was inserted in our model (model ). compared to the previous model, no statistical differences were found in sex, age, and adherence level to quarantine guidelines groups when predicting depression symptom severity, when controlling for anxiety (see appendix a). statistically significant differences were maintained in depression symptom severity for marital status, geographic area, and occupational status groups, after controlling for anxiety. in detail, divorced/separated participants were less likely to experience depressive symptoms compared to single people, with a significant decreased risk of depressive symptoms (odds ratio: . [ % ci, . - . ]). on the other hand, no statistical differences on depressive symptom severity was found in cohabiting participants compared to unmarried participants in the second model. concerning geographic area, the participants living in central italy were found less likely to experience severe depressive symptoms (odds ratio: . [ % ci, . - . ]) compared to those living in north-west italy, after removing anxiety effects. far from the previous model, the healthcare professionals' group were not found to differ from other occupational groups in predicting high levels of depressive symptoms compared to unemployed participants. interestingly, participants "moderately" worried about being infected with covid- were more prone to experience high levels of depressive symptoms (odds ratio: . [ % ci, . - . ]) compared to participants who were "quite a lot" worried, after controlling for the state anxiety effect. we fitted both the glms models (without and with anxiety as the covariate) in the subsample of participants with healthcare professionals (β = − . ; se = . ; p < . ) were less depressed compared to unemployed participants, with a decreased risk of depressive symptom severity (odds ratio: . [ % ci, . - . ]). next, those who reported to adhere to the quarantine guidelines had significantly lower levels of depressive symptoms compared to those who were not adherent (β = − . ; se = . ; p < . ), with a decreased risk of depressive symptoms (odds ratio: . [ % ci, . - . ]). no statistical association was found for worry about being infected with covid- and geographic area. surprisingly, in model , no statistically significant differences were maintained in depression symptoms for the sex, marital status, and occupational status groups, after controlling for anxiety. participants aged from to years reported significantly lower levels of depression scores compared to the younger participants (β = − . . ; se = . ; p < . ), with a decreased risk of depressive symptoms (odds ratio range: . [ % ci, . - . ]). concerning geographic area, the participants living in south italy were less likely to experience severe depressive symptoms (odds ratio: . [ % ci, . - . ]) compared to those living in north-west italy, after removing anxiety effects. as expected, participants "moderately" and "none" worried about being infected with covid- were more prone to experience high levels of depressive symptoms (odds ratio: . / . [ % ci, . - . / . - . ]) compared to participants who were "quite a lot" worried, after controlling for the state anxiety effect. quarantine has been used extensively in all countries of the world to lower the spread of the covid- infection and to protect individuals' health, at different times (sohrabi et al., ) . quarantine includes the separation and restriction of movement of people who have potentially been exposed to a contagious disease to ascertain if they become unwell, so reducing the risk of them infecting others. it is an unpleasant experience for those affected (hiremath et al., ) . imposed isolation and separation from loved ones, loss of mental health needs (freedom, social contacts, stimulation), uncertainty over disease status, family conflict, and boredom can, on occasion, contribute to the onset of psychological disorders (brooks et al., ) . due to the fact that the psychological impact of quarantine depends largely on the characteristics of participants and the quarantine variables selected, several sociodemographic characteristics have been selected here, with depressive symptoms measured by the tdi as the outcome. in the second model, anxiety, as measured by the sticsa state scale, was inserted as the covariate, given the close relationship with depression (brooks et al., ) . about gender, depressive symptoms were more likely to occur in female participants, with a risk of developing depressive symptoms higher . compared to male participants in our sample. this finding was in accordance with studies by qiu et al. ( ) and wang et al. ( ) among the chinese general population in the first weeks following the outbreak, as well as broche-pérez et al. ( ) among the cuban population. also, among the italian general population higher levels of psychological distress were reported in the female gender compared to their male counterparts rossi et al., ) . sex differences in depression were not caused by a higher prevalence of covid- infection in women because mortality and vulnerability to the covid- disease indicated that more men are dying from covid- (lancet, ) . thus, these differences seem to be caused by the fact that women carry a different kind of burden from this epidemiological emergency. gender inequities disproportionately affect the wellbeing and economic resilience during lockdown. households are under strain, but children and elderly care, as well as housework generally fall on women (cluver et al., ) . by increasing caregiving needs, covid- has intensified the pressure on women to uphold prescriptive feminine norms. women have to bear more of the burdens of providing additional support for children's distance learning, and alleviating children's emotional tedium, isolation, and anxiety of shelter-in-place (rosenfeld et al., ) . in addition, increased intimate partner violence has grown during the quarantine due to covid- because women are required to stay uninterruptedly with their partners and away from those people who can give help or at least validate their experiences and, particularly if these women live in small houses (bradbury-jones and isham, ; van gelder et al., ) . indeed, some studies suggest that sudden forced proximity with their immediate household members is a risk factor for domestic violence, and aggression (taylor et al., ; brooks et al., ) . in italy, since the beginning of the covid- quarantine, three domestic homicides and murder-suicides have been registered to date. furthermore, while covid- has coincided with greater rises in unemployment for women than men, the rise in unemployment for men remains substantial (bureau of labor statistics, ). about the age groups, depressive symptoms were most likely to occur in younger people (aged - years). with increasing age, depressive symptoms were less prevalent during the italian lockdown due to the covid- outbreak. our results were similar to those from previous studies, such as a study during the sars outbreak in taiwan (su et al., ) , a study of horse owners quarantined because of equine influenza (taylor et al., ) , and one recent study during the covid- epidemic in china (huang and zhao, ) . as well, like gender, for this sociodemographic variable, the prevalence of the depressive symptoms in different age groups and the probability of risk of developing depressive symptoms depending on age do not relate to the greater likelihood of being infected. being elderly has been reported to correlate with adverse clinical outcomes, including hospitalization and mortality (applegate and ouslander, ; zhou et al., ) . indeed, in italy the mean age of covid- patients who died was years (remuzzi and remuzzi, ) and the case fatality rate was % from to years, . % from to years, and % for years and older (livingston and bucher, ) . despite this, respondents older than years had the lowest risk for developing depressive symptoms compared to the younger age groups. in a population where loneliness and isolation have already been described as an epidemic (luo et al., ) , the impact of even short-term social distancing measures and the resulting distress did not influence the vulnerability to mental health issues (jeste et al., ; vahia et al., ) . this finding is in accordance with part of the literature. although mixed results derive across current and previous studies on the association between participants' age and depression as a psychological outcome of health-related emergency (hawryluck et al., ; qiu et al., ) , some authors reported that only young age was found to be associated with increased distress as a psychological outcome of the covid- quarantine (barari et al., ; and of the sars quarantine (hawryluck et al., ) . the higher psychological distress reported by the younger population could be due to their greater and uncontrolled access to the amount of information ("infodemic") through social media, which can easily trigger distress (cheng et al., ) . as regards marital status, unmarried/single people were the most depressed group with quarantine policies in the event of this outbreak. it is plausible that single people had greater difficulty in relying on or obtaining the assistance of others during the italian lockdown, thus are at risk of depressive symptoms and lower self-confidence more than cohabiting and married participants. this datum is in line with part of previous literature reporting that being married was protective for depression or associated with a lower risk of depressive symptoms (inaba et al., ; yan et al., ; bulloch et al., ) , although other studies conducted during the sars outbreak suggested that demographic factors such as marital status, as well as living with other adults, and having children were not associated with psychological outcomes (hawryluck et al., ; mihashi et al., ) . as to geographic area of residence, people living in the south of italy showed the lowest risk of developing depressive symptoms among all the groups, followed by participants from regions of central italy compared to residents from northern regions and the islands. as expected, residents in the most severely affected regions are at the highest risk of developing depressive symptoms. southern and central regions recorded a smaller number of deaths and diagnosed cases ( , and , deaths, respectively), compared to the north-east and north-west regions ( , and , deaths, respectively), where the disease spread first on a large scale. to explain this datum, it should be considered that the authorities introduced control measures in the northern regions (the "red zone"), before any other region and carried out extraordinary efforts to restrict the movement of people (carlucci et al., ) . in addition, residents from northern italy were found less adherent to restrictive measures compared to the those from the south of italy. people who have shown more adherence were found less at risk of depressive symptoms compared to people with less adherence (see under). as for occupational status, this study highlighted students as suffering from the highest level of psychological distress among all the other groups, including the unemployed group. also, in this case, the public's level of depressive symptoms did not increase with an increased probability of contracting the disease. since the physical spaces of universities were closed, students' mental well-being was affected by the sudden interruption of social interactions. however, the possibility of having online lessons and maintaining social contacts through social networks would not explain the onset of the depressive symptoms compared to other groups, for example employees who had been laid off or were retired. the reason for students' greater risk of depressive symptoms, reported also by wang et al. ( ) among the chinese population, could lie in a sense of uncertainty toward the future that this emergency, not only in health, but also in economic, social, and political areas, is eliciting all over the world (chong et al., ; wenzel et al., ; tan and enderwick, ) . compared with other professions and the general population, healthcare workers were associated with a lower risk of psychological outcomes compared to the unemployed in our sample. "learned helplessness" (seligman, ) could explain why health professionals were the least depressed group. after being exposed to inescapable difficult events, people become passive and stop trying after being exposed to events such as uncontrollable bursts of noise (alloy et al., ) and as a result show greater levels of anxiety and depression. on the contrary, health professionals, considered the real heroes of this emergency, were associated with a lower risk of psychological outcomes compared to unemployed participants. through the practice of their profession, they felt more useful to society, despite their increased risk for infection and transmission (al-rabiaah et al., ) . after students, the unemployed were at a higher risk of depressive symptoms compared to the other groups (stuckler et al., ; reeves et al., ) . this datum is inserted within the context of the covid- -related risk unemployment and economic losses and insecurity with the closure of community services and the collapse of industries negatively impacting the national economy. it should be a critical public health priority to prevent suicide. indeed, during the most recent economic recession, a % rise in unemployment was correlated with a rise in the suicide rate of . % in the united states ( % ci: . - . , p < . ) (reeves et al., ) . similarly, each percentage point increase in unemployment was accompanied by . % rise in suicide ( % ci: . - . , p = . ) in europeans aged years or less. as to adherence, people with low adherence were more likely to exhibited depressive symptoms relative to people with a great level of adherence to covid- preventive measures. as expected, adherence has been found to be a protective factor against mental health problems (hawryluck et al., ; koenig and schultz, ; brooks et al., ) . adopting the preventive behaviors contribute to lower the uncertainty of the epidemic progression which would cause higher psychological pressure on the public. as to worry about being infected with covid- , people with more worry were more depressed than people with a low level of worry. as for the whole sample, also in the subsample of participants with psychotherapeutic treatment history, the same sociodemographic factors and behaviors that contribute to, or mitigate mental effects of the quarantine in terms of depressive symptoms were reported. however, when anxiety symptoms or concomitant stressful events were present in comorbidity, these participants were found to experience higher levels of worry associated with increased depression symptomatology, compared to the whole sample. current evidence showed similar results. a history of stressful situations and medical problems was associated with a greater degree of depression and anxiety during the covid- quarantine in the italian population (hao et al., ) . again, psychiatric patients were significantly more likely to experience a higher degree of the negative mental impact of the outbreak, including stress, anxiety, and depression, compared to the general public (hao et al., ) . during the covid- quarantine outbreak in italy, female participants, younger people, single people, students, people living in northern regions, and who were less compliant with quarantine guidelines and less worried about being infected with covid- were at a high risk of displaying psychological issues. these findings suggest public levels of depressive symptoms did not increase with the greater likelihood of being infected. for example, although female and younger people reported a lower risk of covid- infection, they experienced higher levels of depressive symptoms during the covid- quarantine in italy. therefore, ongoing monitoring of the psychological strain associated with outbreaks of epidemic-potential, life-threatening diseases should become routine as part of preparedness efforts worldwide by establishing early targeted mental health interventions. in other words, more vulnerable groups, likes those cited above, should benefit from personalized "moraleboosting" interventions. or, intervention research could be valuable to combat amplifications of gender inequalities, particularly to address the added challenges women are likely to face. this research can provide timely insights for government agencies toward improving and safeguarding the psychological well-being of women, younger people, and categories of subjects at a higher risk of suffering from psychological distress on the occasion of subsequent waves of the spread of covid- or other epidemic diseases. this study has several limitations. firstly, the analyses presented here were derived from a crosssectional design, thus it is difficult to make causal inferences. secondly, given that the research was conducted in close temporal proximity to the period of the covid- quarantine, a webbased survey method was necessary to recruit a convenience sample by avoiding possible infections. this limited sampling in our study. as a consequence, a self-selection effect may have occurred and should be considered with those people who were experiencing the greatest or least levels of distress responding to the survey (saggino et al., ) . in addition, participants were required to access the internet and to be familiar with online devices to respond, which suggests that they might be more educated, younger or/and have a higher socioeconomic status than the overall surveyed quarantined population. thirdly, due to the uncontrolled occurrence of this health-related emergency, an accurate picture of the individual's psychological conditions before the covid- outbreak was not conducted. although it would been interesting to conduct pre-post analyses, these data could provide a baseline for future research on the psychological consequences of quarantine in the italian population throughout the rest of the current covid- pandemic. fourthly, depressive and state anxiety symptoms were measured by means self-report inventories that are notably biased by response set, such as social desirability (innamorati et al., ; carlucci et al., ; balsamo et al., a,b) . thus, future research should include methods, such as observational methods and psychophysiological or behavioral assessment, in order to objectively record the levels of these mood states (campbell and fiske, ) . fifthly, the assessment of state anxiety could be completed or replaced by adding the specific fear of covid- scale (ahorsu et al., ; broche-pérez et al., ; soraci et al., ) . in addition, it should be acknowledged that the study was carried out was not sufficiently heterogeneous for sex, with marked female preponderance, and age sample, with a prevalence of juveniles. hence, these findings may not translate accurately to the public at large. finally, it could not evaluate whether the outcomes considered in this study will be long-lasting after the covid- outbreak. however, follow-up with these participants will continue in order to facilitate our understanding about how long these outcomes will last. a deeper understanding of how the epidemic affects italians' psychological health by identifying which groups were at a high risk of psychological morbidities due to the current pandemic can help to guide and target future psychological intervention implementations. the raw data supporting the conclusions of this article will be made available by the authors, without undue reservation, to any qualified researcher. the studies involving human participants were reviewed and approved by the department of psychological sciences, health and territory, university of chieti, italy, review board. the patients/participants provided their written informed consent to participate in this study. both authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication. we thank maria pia pugliese, ines d'ambrosio, and gianluca balsamo for their assistance and support in data collection 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the corporate purpose of spanish listed companies: neurocommunication research applied to organizational intangibles date: - - journal: front psychol doi: . /fpsyg. . sha: doc_id: cord_uid: r t o w purpose driven companies have developed their corporate culture with a commitment to stakeholders, sustainable development goals, and social responsibility, prioritizing the management of organizational intangibles over capital. the overall objective of this research is to gain knowledge regarding the attention and emotional intensity registered by young spanish university students when visualizing corporate purpose versus corporate visual identity, as well as the image of the chairman of the main spanish companies quoted on the ibex . the techniques of eye tracking and galvanic skin response have been used with spanish university students. the results suggest that brands with the highest brand equity in the interbrand ( ) ranking are also the ones that receive the highest levels of attention and emotional arousal, and that a well-formulated corporate purpose is not enough to satisfy the public if company credibility is low due to previous perceptions of an organization. purpose-driven companies are those that have redefined their corporate culture in order to introduce and enhance corporate purpose or brand purpose as an evolution of theories such as shared value (porter and kramer, ) , or triple bottom line (elkington, ) . their aim is to provide public benefits consistent with sustainable development goals, which in turn helps to improve the organization's performance and contribution to solving or alleviating some of the social or environmental problems of the society in which they conduct their business (fischer et al., ) . in recent decades, there has been a surge in corporate social responsibility and sustainability that has prompted a comprehensive business transformation (quinn and thakor, ) in which corporate purpose has managed to merge a commitment specifically stated by companies with a greater objective that society desires and values (clarke, ; wilson, ; berghoff and kelley, ) . as a result, important changes have taken place in large organizations. one example is the shift from the debate over whether stakeholders should be exclusively people (da-silva et al., ) to the reality that companies consider the environment to be a priority stakeholder (mañas-viniegra and gonzález-villa, ). however, this approach, which is both responsible and sustainable, can lead to friction with shareholders, who often put their own economic interests first (besley and ghatak, ) . despite the fact that enterprises have always combined their commercial activities with a public purpose, the 'friedman doctrine' (friedman, ) of maximizing profit started a shift in thinking that has led to the current radical redefinition of the corporate mission through corporate purpose. the objective is to promote greater social well-being rather than maximize shareholder value (mayer, ) , thereby providing the basis for improving corporate social responsibility (grinbaum and groves, ) . however, for organizations it has always been relevant to formally define their corporate culture or organizational culture, which is composed of a set of values, beliefs and standards that are shared and adopted as their own by the members of an organization, which are transmitted to the new members who enter the company (peters and watterman, ; schein, ) . corporate culture conditions the individual and group behavior of its members by establishing rules of conduct (o'reilly et al., ; shin et al., ) . its definition and internalization produce positive or negative behavior in an overall, general way within the organization (wiewiora et al., ) . corporate culture is essentially established by the mission, vision and corporate values of the organization. the mission is the reason for being, or the purpose of an organization (drucker, ) , and it states the way in which the entity intends to fulfill this mission through a long-term vision of the future (johnson and scholes, ) . using the mission and vision as a starting point, corporate values are established that shape the personality of the corporate brand in a relatively stable manner (christensen et al., ) , and guide the behavior and attitudes of the members of the organization. this also benefits the relationship with stakeholders (freeman, ) . as a result, values have traditionally been considered the main element of corporate culture (deal and kennedy, ) . in fact, once values have been established, a small proposal for change ends up generating resistance from the organization's members who have already assimilated these values to a great extent (ogbonna and harris, ) . with the advent of corporate purpose, there has been a necessary evolution of corporate culture of organizations toward the inclusion of universal values of a higher order, which are socially accepted, and which in turn awaken the emotions of stakeholders by satisfying their desire for solidarity, freedom, happiness and respect when it comes to achieving success. this leads to the development of corporate culture that is committed to society, and consequently enhances the credibility and reputation of organizations ( van-lee et al., ) , based on the confluence of business excellence, ethical behavior, and corporate social responsibility as values shared by all of those who belong to an enterprise (drucker, ; kotler and heskett, ; solomon, ; chell et al., ) . thus, corporations prioritize intangibles over capital (haskel and westlake, ) , and have the potential not only to determine their purpose, but also to ensure that the premise of 'doing well by doing good' is fulfilled (mayer, ) . the goal that states, 'avoid doing harm' , is thereby exceeded in order to aspire to the objective that states, 'do good' (scherer and voegtlin, ) . corporate purpose has been identified as one of the fundamental elements in improving corporate culture among banks in the united kingdom (cox and soobiah, ) . moreover, in france, the united kingdom and the united states, it has already been written into law that a corporation must be managed while bearing in mind the social and environmental impact produced by its activity, and to do so, the entity must define its social or environmental purposes in its bylaws (segrestin et al., ) . even though the usefulness of formally incorporating purpose into the constituent documents of corporations has been demanded (lin, ) , there is a risk of reducing the capability that an organization needs in order to adapt to the evolution of society, which would lessen the control it could exercise due to having a purpose that has already been defined (levillain and segrestin, ) . in short, despite the growing importance of corporate purpose, there is no clear or consistent definition beyond that of its long-term orientation and commitment to stakeholders (waitzer and sarro, ) . therefore, this purpose has been defined more clearly in the professional area rather than the academic field, which still has a scant amount of literature: 'businesses need to encapsulate it into a clear purpose. that purpose should be compatible with sustainable development goals, and it needs to shape the way the business is both designed and run' (deloitte, , p. ) . organizations are starting to become aware of their purpose, thereby clarifying their reason for being in order to fulfill their responsibilities related to economics, social issues, governance, ethics, and environmental matters, which they clearly express (white et al., ) . companies committed to fulfilling their responsibilities also disclose their best practice in corporate social responsibility to stakeholders (balmer and greyser, ) , based on the benefits resulting from the establishment of an ethical corporate identity (hildebrand et al., ) . this issue promotes the incorporation of best practice communication in the brand's core value proposition, thereby strengthening brand equity (muñiz et al., ) . although it must be consistent and credible, merely stating corporate purpose does not guarantee that it will contribute positively to society (serafeim, ) , or that the impact on company profits will be positive (quinn and thakor, ) . in spite of this, a correlation between purpose and the strengthening of corporate reputation has been confirmed (henderson and van-den-steen, ) , and it is not mere coincidence that the fastest growing brands worldwide in have defined their corporate purpose clearly, and have increased their shareholder value tenfold (cardona and tolsá, ) . it has traditionally been considered that the values of an organization should be compatible with the management style of its leaders (blanchard et al., ) , and next in order of importance, with the values of its employees (vveinhardt and gulbovaite, ) . however, some research that has focused on the influence of corporate purpose on financial performance suggests that it is not senior management, but rather the middle ranks of the organization, who drive this correlation (gartenberg et al., ) , which differs from classical theories that assign responsibility for fostering a common sense of purpose to senior management (bartlett and goshal, ) . in spite of this, the commitment and motivation of the organization's leaders is necessary in order for this corporate change to take place (seah et al., ) , and subsequently for the entity to be evaluated by initiatives that are starting to emerge, such as the b-corp certification (muñoz et al., ) . listed companies have been the pioneers in defining corporate purpose as they have also been the first to disassociate their product brands from their corporate brand (olins, ) , having enhanced the intangibles within their organizations through values, reputation, transparency, social responsibility and corporate governance (mañas-viniegra, ) . even though only % of listed spanish companies and % of listed portuguese companies have specifically defined their corporate purpose, the analysis of these enterprises has made it possible to identify the basis upon which their purpose is outlined. "the first pillar is built on concepts such as the future, the environment, the world, sustainability, social responsibility and life. these corporate purposes convey the intention of organizations to promote strong global improvement as a result of their activity. the second pillar revolves around the public that will benefit from this overall improvement: citizens, people, society in general, customers and shareholders, or other sectors of the public directly related to the business" (mañas-viniegra et al., c, p. ). as a continuation of previous research, and faced with a future that will include the commencement, development, and spread of corporate purpose in all companies during the next decade, this research uses neuromarketing techniques to analyze the cognitive perceptions of young spanish university students, who represent a new generation more concerned with social and environmental issues (gifford and nilsson, ; bhattacharya, ) . this research seeks to provide answers to the following research questions: (rq ) does corporate purpose awaken an emotional response in an audience of young university students? (rq ) does corporate purpose attract more attention than corporate visual identity, or the image of the president who leads the organization? (rq ) are there differences between the attention and emotion directed at brand purpose? the overall objective of this research is to understand the attention and emotional intensity experienced by young spanish university students when visualizing images of corporate purpose vs. corporate visual identity, and the image of the chairman of the main spanish companies quoted on the ibex . the sample of the experiment is composed of six companies among the top ten in the ranking of best spanish brands (interbrand, ) , which currently have a defined purpose: zara, movistar, santander bank, bbva, caixabank and iberdrola. this sample is not representative of diverse business sectors, but rather of the most highly valued companies, which means that some sectors are not represented, yet others that are more powerful have significant representation. to this end, the following specific objectives have been established: . o : to identify the attention and emotional intensity that the subjects display toward corporate purpose. . o : to establish the differences in attention and emotion between the diverse elements visualized in the stimuli: corporate visual identity (logo), image of the chairman, and corporate purpose. . o : to analyze differences in attention and emotion based on the presence or absence of corporate purpose. . o : to identify possible differences that may occur depending on the gender of the subjects. this research uses two non-intrusive techniques of neuromarketing, or applied neurocommunication (cuesta-cambra et al., ) . these have been fully validated (morin, ) for recording the cognitive processing of subjects based on neuroscience, psychology and economics (madan, ) . moreover, they have a reliability rating for predicting the effectiveness of communication stimuli between % and % (varan et al., ) : eye tracking was used to measure the subjects' attention to the areas of interest (aoi) of the stimuli presented, and galvanic skin response (gsr) was used to record the emotional intensity experienced by the participants. on the one hand, eye-tracking records the subjects' attention to the areas of interest (aoi) of the stimuli displayed. this is a biometric technique that differentiates between the attention focused on aois and the viewing of transitory areas where attention is not fixed (duchowski, ) . from the attention registered, the software generates heat maps in which you can visually see where the attention is concentrated with different intensities, depending on the color. red represents the center of the heat map where attention is most intense. on the other hand, galvanic skin response (gsr), or electrodermal activity (eda), identifies the emotional arousal from the small changes in the electrical conductance of the skin that are produced by sympathetic neuronal activity from phasic changes (critchley, ) . therefore, these two neuromarketing techniques allow us to record the unconscious responses of the participants to the visualized stimuli in the form of attention and emotional intensity, thereby allowing for the partial identification of whether or not an influence is produced, which is carried out by analyzing the cognitive and emotional processing (bornstein and d'agostino, ; pieters et al., ; goodrich, ) . this overcomes the difficulty demonstrated by subjects in reporting their own perceptions, attitudes or behaviors in surveys or focus groups (ariely and berns, ) . two groups of subjects each with gender parity participated in this research. they were randomly and voluntarily selected to form a convenience sample comprised of university students in the final year of their degree (on the verge of entering the labor market) in madrid, the capital of spain, which has a concentration of students from all regions of the country. although the research fieldwork had to be completed earlier than planned in february due to the covid- health crisis, the final sample size is adequate for a neuromarketing study, which is usually conducted with a sample of to subjects (kerr-gaffney et al., ) . the participants viewed six random stimuli interspersed with other stimuli related to brands, companies, or the job market, among others, without specifying which stimuli were of interest to the researchers. the first group (group -g ) viewed only the image of the chairman and the company logo (table ) , while the second group (group -g ) also viewed the branding purpose ( table ) . the exposure to each stimulus was limited to s, with a -s interval between stimuli to stabilize the registers of emotional intensity (mañas-viniegra et al., a). however, each participant was given instructions in order to be able to move on to the next stimulus earlier by pressing a key. this limited the bias usually present in this type of study in which participants are asked to view stimuli, which implies that total attention is greater than it otherwise would be in an unobserved environment. the fact that the participants do not know which of the viewed stimuli are of interest to researchers allows for the differences between stimuli to be studied more realistically. by limiting the viewing to s per stimulus, the software differentiates where attention is prioritized, since the young audience is more likely to quickly focus their attention on a stimulus with information that is relevant and of interest to them (añaños-carrasco, ) . this is the way in which an exploratory study is defined with an intra-subject design and random assignment on the various levels of experimental treatment (image sequences). this research has been reviewed and approved by the research ethics committee of the department of applied communication studies of the media and communication science school, complutense university of madrid. for data collection, the gazepoint gp hd hz sampling rate eye tracking equipment was used along with a gsr gazepoint biometrics system, integrating the analysis of the recorded data in the gazepoint analysis ux edition v. . . software. statistical exploitation of the results was carried out using spss v. software. all of the participants were notified of their voluntary participation and anonymous contribution, and informed consent was given following the guidelines of the declaration of helsinki. the dependent variables were the level of attention and peaks of emotional arousal recorded by the eye tracker and gsr systems, respectively. the independent variable was the gender of the participants, as the profile of the subjects was similar. the quantitative analysis was carried out on the basis of the seconds that elapsed from the appearance of the stimulus to the first fixation, or time from fixation (tff), the number of eye fixations, or fixation count (fc), the total number of seconds of attention toward each area of interest, or total fixation duration (tfd), and the gsr peaks that appeared from each minimummaximum pair starting from the beginning of the emotional activation. a qualitative content analysis was also performed using the attention toward the stimuli recorded by the heat maps, together with a conscious statement by the subjects about the positive, negative, or neutral emotion shown toward the aoi, which was carried out in a semi-mechanical, non-intrusive way using gsr gazepoint biometrics. group was exposed to stimuli without corporate purpose, and this group recorded a higher total fixation duration (tfd) toward the two most valued brands in the interbrand ranking (table ) , zara (tfd = . ), and movistar (tfd = . ), far behind iberdrola (tfd = . ). the brand with the worst total duration of attention was caixabank (tfd = . ). similarly, group was exposed to the same stimuli, but with brand purpose included, and they also registered greater attention duration to zara (tfd = . ) and movistar (tfd = . ), but this time there was less difference in attention duration toward iberdrola (tfd = . ). caixabank was again the brand with the lowest registered attention (tfd = . ). all of the stimuli that included corporate purpose obtained a longer total duration of attention in all areas of the stimulus (aoi ) from group compared to group , and the differences were statistically significant (p ≤ . ), except in the case of zara, which recorded similar attention in both groups of subjects (p = . ). the data on total duration of attention were confirmed by the total number of eye fixations (fc), also higher in all the stimuli with corporate purpose to which group was exposed (table ) , with significant differences in all cases (p ≤ . ). once again, zara registered the highest number of eye fixations of all the stimuli presented, both in group (fc = . ) and in group with purpose (fc = . ), followed by movistar (s , fc = . ; s , fc = . ) and iberdrola (s , fc = . ; s , fc = . ). (a) stimulus (s ): logo (aoi ), president (aoi ), all areas (aoi ). (b) stimulus (s ): logo (aoi ), president (aoi ), all areas (aoi ). (c) stimulus (s ): logo (aoi ), president (aoi ), all areas (aoi ). (e) stimulus (s ): logo (aoi ), president (aoi ), all areas (aoi ). (f) stimulus (s ): logo (aoi ), president (aoi ), all areas (aoi ). (g) stimulus (s ): logo (aoi ), president (aoi ), all areas (aoi ). (e) stimulus (s ): logo (aoi ), president (aoi ), all areas (aoi ), purpose (aoi ). (f) stimulus (s ): logo (aoi ), president (aoi ), all areas (aoi ), purpose (aoi ). (g) stimulus (s ): logo (aoi ), president (aoi ), all areas (aoi ), purpose (aoi ). frontiers in psychology | www.frontiersin.org again, the worst register recorded was for caixabank, which obtained the lowest number of eye fixations for both stimuli (s , fc = . ; s , fc = . ). the elapsed time from the appearance of each stimulus to the recording of the first visualization was immediate (tff = . ), although analysis of this parameter will be relevant when analyzing the differences in attention between the areas of interest (aoi) highlighted in the stimuli ( table ) . the brand logo registered greater attention duration than the image of the company president in all of the stimuli, except in the case of iberdrola, which obtained greater attention duration in both stimuli (s , tfd = . ; s , tfd = . ), and with telefónica, which was also higher in the stimulus with corporate purpose (s , tfd = . ), due to the path taken after reading the purpose. the logo also registered first attention faster than the image of the company president in all cases, and a greater number of eye fixations, despite two exceptions without significant differences: those exceptions were movistar in the stimulus with brand purpose (s , fc = . ), and iberdrola, also in the stimulus with purpose (s , fc = . ). it can be observed in the heat maps that the greatest attention toward the bbva logo was focused on the last letter of the logo, due to the fact that it rises slightly, which coincides with the novelty of a recently renewed corporate visual identity (figure ) . also noteworthy is the attention focused on zara's logo, described by the participants as "strange" due to the typography being too close together, a consequence of a recent redesign of their corporate visual identity (figure ) . content analysis carried out based on the heat maps shows that the highest level of attention registered by the chairman of iberdrola was due to the attention focused on the watch shown in the foreground (figure ) . the attention registered by amancio ortega's face (figure ) , on the other hand, was explained by the participants themselves in the informal conversations following the neuromarketing test, in which they said, "i wasn't sure whether or not it was amancio ortega. he looks much younger in that photograph." the scant attention received by the chairwoman of banco santander was explained by the participants, who simply said, "she didn't look good in the picture." they also mentioned their "lack of sympathy for banks", an issue that can also be seen in the other two banks analyzed (bbva and caixabank), which obtained the worst registers in all of the variables (figure ) . zara and movistar showed statistically significant differences (p ≤ . ) in attracting longer-lasting attention with more eye fixations on both the logo and the president in the stimulus without purpose, an issue that already anticipates that the purpose has attracted some attention that in group was directed toward other areas of interest. group visualized the stimuli with corporate purpose, and registered a longer total duration of attention toward the aoi of purpose in relation to the logo and the image of the company chairman, except in the case of bbva (s , tfd = . ), where the duration of attention to the logo was higher (tfd = . ). movistar's corporate purpose registered the longest total length of attention (tfd = . ), followed by that of iberdrola (tfd = . ), santander (tfd = . ), zara (tfd = . ), bbva (tfd = . ) and la caixa (tfd = . ). these data were supported by the number of ocular fixations, which showed an almost identical distribution. all corporate purpose stimuli were the last area of interest to be visualized, which is logical, as they were at the bottom of the stimulus, with the exception of movistar, which was the first area of interest to capture the subjects' attention (tff = . ). the subjects explained this issue during the informal discussion after the neuromarketing test in which they stated, "this happened because we were reading the purpose, but we didn't have time to finish reading it before the next stimulus appeared." it should also be noted that zara's corporate purpose had the largest number of words, and as the time allotted for each stimulus was limited to s, it seems that the greater initial attention to the logo and the image of the president resulted in the attention toward purpose being diminished (figure ) . even though the longer length of zara's corporate purpose reduced the attention it received, la caixa and bbva, which presented their brand purposes with fewer words, were also the ones that got the least attention, so it seems that the length is not as relevant to the public as brand equity and a few easily recognizable visual components. as in the case of bbva, the caixabank logo (in this case the logo icon) received a greater focus of attention than the other elements (figure ) . the gaze plots made it possible to check the visual journey made by the subjects while their attention was being registered. it was noted that after reading the corporate purpose, some subjects focused their attention on the president, and other participants focused on the company logo to a lesser extent. this behavior was mirrored in the registration of emotional arousal of the participants, which positively increased when a check was made once again of the brand that announced corporate purpose in the case of zara and movistar, but descended in the case of iberdrola and the banks because of "the discredit of these companies, which include purpose only to improve their reputation", as repeated by several participants in the semi-structured talks following the neuromarketing test. there were no significant differences according to the gender of the participants, so this variable has been omitted in the analysis carried out. the subjects' conscious responses were positive toward zara's stimulus, neutral in the case of telefónica, and neutral or negative in the case of the banks and iberdrola. as for the emotional intensity based on the participants' unconscious responses provided by the gsr data (figure ) , it remained constant during the stimuli, with a moderate rise during the visualization of the logos. there were two gsr peaks that occurred with the zara logo and the image of its chairman ( . kohm. and . kohm., respectively), as well as with the corporate purpose of iberdrola and telefónica ( . kohm. and . kohm., respectively). corporate purpose is currently undergoing professional and academic development, yet few listed companies in spain have adopted this concept despite its increasing importance within the corporate culture of organizations, and the constant request from stakeholders for companies to focus on sustainable development objectives and corporate social responsibility. the companies with the best rating on the interbrand ranking in spain are zara and movistar, which are the ones that registered the most attention toward their logo, the image of their president, and their corporate purpose. the emotional intensity of these two companies was also higher. however, the disaffection felt by young people toward banks resulted in caixabank, bbva and santander obtaining the worst results, both in attention and emotional arousal. one must consider that the level of affinity toward a brand is determined by the attraction and interest of the participants toward the brand (aaker and lee, ) , and this influences the self-regulating objective of the subjects when they process the information (petty and cacioppo, ) . even though iberdrola came in last place in the interbrand ranking of the companies analyzed, this brand was the second highest in registering a greater level of attention toward its purpose, despite the decrease in emotional intensity when the brand behind the purpose was visualized a second time. this result is consistent with corporate purpose identified in a successful case in previous investigations (mañas-viniegra et al., b) , even though the company in question does not seem to convey the credibility that such a purpose demands. even though word length does not appear to have influenced the results, participants noted that zara's purpose was excessively long and that the maximum stimulus display time ended before they could finish reading the text. in any case, the scientific literature has shown that young audiences easily focus their attention on areas that are interesting for them when time is limited (añaños-carrasco, ) . consequently, it can be concluded that in this case, corporate purpose was not the element they considered most important, but rather the visual aspects. the inclusion of corporate purpose increased the total duration toward the overall content of all the stimuli, and toward purpose itself, which amassed the longest total duration of attention, partly due to the required reading time, even though there was no mandatory requirement to remain in the stimulus, and even less obligation to read the purpose. these results are consistent with the fact that stakeholders are skeptical of the csr communication of brands (dhanesh and nekmat, ) , and of their communication of corporate purpose as well. specifically, younger stakeholders express commitment to responsible organizations that are purpose-driven, but their actions do not yet reflect their attitudes (dhanesh, ) . consequently, it may be in their interest to try to co-promote sustainable corporate brands with consumers (lahtinen and narvanen, ) . the logo registered more attention than the image of the president, unless there was some visual element that attracted attention, such as a watch in the foreground. contributing to this situation were updates to corporate visual identity undertaken recently by some brands, such as bbva and zara. these results substantiate the greater attention and emotional arousal that the redesigned logos generate through the use of flat design (gu and yu, ; mañas-viniegra et al., c) . logos are complex stimuli comprised of various visual elements (jiang et al., ) , which reflect the identity of a brand, thereby influencing public attitudes (kaur and kaur, ) . the design of a brand's logo and its positioning have a significant impact on the perception of its products (bettels and wiedmann, ) . the full meaning of a logo is achieved through the symbolic potential of its expressive forms (llorente-barroso and garcía-garcía, ) , and is developed through connections generated by communication structures surrounding the brand (kelly, ) . the shape of a logo and its size are features that are powerful enough to influence the perception of a brand and its personality (jiang et al., ; cai and mo, ) , while its colors create a strong identification used to engender consumer confidence in the brand (jin et al., ) . a logo change is seen as disruptive to the stability of a brand's image (villafañe, ; stuart and muzellec, ) . therefore, when faced with changes in corporate visual identity, it is advisable to guide consumers in their expectations, thus reducing the contrast between new logos and old ones (grobert et al., ) . the main limitations of this research are the nonrepresentativeness of the sample. even though the size is adequate for neuromarketing studies, it is limited to spanish university students. the lack of funding for the research has resulted in the authors not having access to affdex analysis of facial expression of emotions, which has been supplemented by registering emotional intensity together with a conscious statement of the type of emotion experienced by the participants. it should also be noted that simulating a real environment in a neuromarketing laboratory is quite difficult (mileti et al., ) . however, this issue has the advantage of allowing for further insight into causation when combined with qualitative research . consequently, future lines of research should focus on carrying out cross-cultural investigations in order to establish socio-cultural distinctions among diverse geographical regions (alsaleh et al., ) , as well as the analysis of facial micro expressions when funding is obtained. due to copyright restrictions, the figures displayed in this article are vector graphics of those used as stimuli in the presented experiment, and as such do not correspond in the degree of definition and detail of those previously exposed, but provide an approximation to enable a greater understanding of the obtained results. the original contributions presented in the study are included in the article, further inquiries can be directed to the corresponding author. this research has been reviewed and approved by the research ethics committee of the department of applied communication studies of the media and communication science school, complutense university of madrid. all of the participants were notified of their voluntary 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purpose-driven company is redefining the role of business in society the authors sincerely appreciate the contributions of all those who participated in this study. key: cord- -cnefwc i authors: marchetti, antonella; di dio, cinzia; massaro, davide; manzi, federico title: the psychosocial fuzziness of fear in the coronavirus (covid- ) era and the role of robots date: - - journal: front psychol doi: . /fpsyg. . sha: doc_id: cord_uid: cnefwc i nan the coronavirus disease pandemic has prompted much research on the possible use of robots in different areas of intervention. one of them is related to the deployment of social robots to cope with different needs elicited by and depending on the emergency. according to a recent article published in science (yang et al., , p. ) "social robots could be deployed to provide continued social interactions and adherence to treatment regimens without fear of spreading disease." in this context, social isolation and quarantine-often significantly prolonged due to the duration of the infection-have plausibly exerted a negative impact on well-being and perhaps mental health, whose jeopardy was even more likely if a previous psychological vulnerability was present. if historically robots have been employed in dangerous and risky duties, presently, some of the most promising domains of robots' development also include rehabilitation, caring, and educational and clinic intervention. we are witnessing a shift from the concept of "robot as slaves" to "robots as companions, nurses, teachers. . . " that, in a word, behave, interact, and work "like us" (cfr. marchetti et al., ) . yang et al. argue that social robots used to "adherence to treatment regimens without spreading of fear" need to be implemented following sophisticated human models, including mental states like emotions and beliefs, as well as the context and environment of the interaction (p. ). in our opinion, the "environments" are the affordances strictly linked to survival in an evolutionary sense. the "context" is represented by everyday life socio-material and socio-cognitive cues. furthermore, we believe that the implementation of social robots based on every possible human model cannot merely be the product of "a fusion of engineering and infectious disease professionals" (yang et al., , p. ). the model would require an interdisciplinary perspective that includes also the contribution of psychologists. the recent pandemic has in fact laid the foundations for rereading our daily relationships from the point of view of not only human relations but also other agents, such as robots. in the present opinion, we therefore suggest that the use of robots is not only a purely technical issue but also supported by important changes in the way we view relationships, particularly with those who are close to us. with this aim in mind, we focused on identifying some psychological components most subject to change due to the current global situation. let's take, for example, the emotion of fear mentioned above. fear will probably take (if not already has) a different form because of the virus. fear is a primary (ekman and friesen, ) and adaptive emotion developed through evolution to enable coping with danger and ensure survival. predators, contaminants, and invaders are the potentially dangerous enemies that are all risky variables toward which close relationships usually act as protective factors. in case of fear, the options for the individual are represented by the socalled "fight or flight" behaviors. on the relational level, it is the search for a secure base (bowlby, ) , where a place can be found for reassurance and affective supply. this tendency persists also in adulthood due to the transgenerational transmission of attachment patterns. nonetheless, covid- pandemic confronted us with a scenario where "fear has no face." now, it also involves close relationship partners, i.e., people who potentially are sources or recipients of care. this profoundly contrasts with a series of fundamental developmental achievements that make physical proximity the embodied prototype of psychological proximity. the individual undertakes a path in which the "known social other"/"unknown social other" dichotomy acts as an organizer of beliefs and attitudes, thus contributing to the construction of the self as a distinct and separate entity from the other. from a sensorineural point of view, the human baby is equipped to recognize and trustfully orient herself/himself toward primary figures of care and protection; it is precisely on this basis that trust is built in others and ourselves (di dio et al., manzi et al., a,b) . the so-called "anguish of the stranger" (spitz, ; schaffer, ) emerges around months of age. it marks the distinction between the caregivers and all the others: before becoming a neutral agent that the child will observe and know, the "other" per se is perceived as scary (worthy of fear in other words). this step appears to be in line with the older child's behavior observed within the strange situation (a paradigm aimed at evaluating attachment; ainsworth et al., ) : the response of distress and fear toward the stranger, who is generally more accepted if the mother is at the child's presence, and the reactions toward whom are predicted by the security of the child's attachment to the mother. later in life, the developing child can establish attachment bonds with other people in her/his life contexts: friends, schoolmates, relatives of the extended family, teachers, and educators in various contexts, from school to sports activities (pianta, ) . while the theoretical perspective of multiple attachments postulates that the widening of the "known social other" sphere is characterized by a differentiation of the functional roles played by multiple relationships, it maintains the fundamental developmental ability to identify the other as a "secure-safe social partner, " distinguishing him/her from the "risky-unsafe social partner." the possibility to create multiple attachments prevents a series of developmental risks and acts as an enhancer of positive primary attachment relationships and as a vicarious protective factor in the conditions of relational affective fragility. besides, not only are secure relationships with multiple figures-with the teacher, just to give an exampleconnected with the personal well-being within the affective sphere, but also with cognitive performance at school, as well as with socio-cognitive indexes like school climate, peer acceptance, and so on. in order to exert an enhancing-protective role, all these "others" (educators, teachers, relatives) have to be perceived as "besides me." the physical sense of "besides" -in its literal meaning-anticipates in development, and continues to support in the life span, the metaphorical sense of the human experience of psychological closeness and proximity. and it is precisely the impossibility to fully get the chances offered by the different meanings of "besideness" (physical proximity and security/safeness) that is responsible for the erosion of the feeling of being protected from fear within the contexts of affective bonds. although technology allows us to be connected even when physically separated, the experienced loneliness and isolation largely reported during covid- may depend both on the technological inability to embody affective relationships and perhaps also on more or less implicit awareness that "the known social other" (also my caregiver, daughter-son-teachergirlfriend/boyfriend-teacher, educator) could be dangerous for me. consequently, the pervasive mood of close relationships is no longer that of security but rather a widespread sense of fuzzy fear (furthermore, if people reflect on the possibility of being an active agent of contagion for their beloved ones, the basic emotion of fear should be added to the complex emotion of potential fuzzy guilt). so, if in-group/out-group dynamicsup to the attitudes toward the "stranger" in a geographical and political sense (antonietti and marchetti, ) -are the result of this primary articulation according to which "knownfamiliar" equals to reliable and "unknown-unfamiliar" equals to potentially dangerous (danger from which-phylogenetically and ontogenetically-the "known-familiar" is in charge of protecting us), the effect of the fuzziness of emotions, and especially of fear on mental health in a stressful situation like the one represented by the covid- pandemic, can be easily imagined. in fact, the covid- pandemic implies the possibility of indiscriminate contagion by anyone, including those closest to us in a psychic sense. because of this, it undermines the dynamics depicted above by eliciting an unprecedented form of fear, in which the boundaries between safety and risk fall. if infected, it is necessary to adhere to the rule of indiscriminate social distancing from everyone. the same applies if a relative is infected. the work of mercy to "visit the sick" cannot be accomplished, just as it is impossible to extend the final farewell to those who left us forever. in a word, covid- has completely changed the physiognomy of security/trust/danger/risk and fear, suddenly destroying a bond that evolution and ontogenetic development have taken a long time to build. the feelings of neglecting if not abandoning the beloved ones, or to be neglected if not abandoned by them to ensure the protective purposes of social distancing, are not easy to be managed from a psychological point of view; the experience of isolation, loneliness, and the worry of being forgotten are difficult to explain and to make comprehensible for children as well as the elderly. this is to say that the erosion of the foundations of the distinction between "known-familiar-safe/unknown-stranger-unsafe" could vary according to the developmental phases of the individual as well as the status of experts/novices. in terms of developmental phases, the cognitive, social, and affective resources typical of specific ages allow children to assimilate and elaborate differently information about the virus, its effects, and the dangers of proximity to beloved people. on the other end, if viewed from the perspective of expert/novices status, which is partially connected with the developmental phases, to have reliable information or real scientific knowledge on the spread of the virus could help to better manage the effect of the new form of fuzzy fear. going back to the role played by robotics within the psychological framework briefly outlined here, the use of robots may change depending on a series of factors that only the contribution of psychologists may help to highlight. first of all, the "like me experience, " which represents the basis of acceptance/refusal of social robots, changes with age. like the people's sense of people (to paraphrase legerstee, ) , also people's sense of social robots depends on the development, as well as the aims and contexts, of the robots' use (marchetti et al., ) . for these reasons, it is fundamental that the design of social robots meant to be deployed in situations of "fuzzy fear" like the one we are experiencing not only includes the purposes of assistance, companionship, or tutoring associated with medical regimens but also takes the real role of "fear-free" mediators of affective functions. in this way, robots do not become substitutes for close relationship partners from whom social distancing separates us, but act as relational bridges between those who are separated for health and safety reasons. as an effect of this rethinking the functions of social robots in emergency situations, some current negative attitudes toward social robots-from resistance and ambivalence up to the uncanny valley phenomenon (mori, ; macdorman and ishiguro, )-could significantly change. to pursue the goal of designing useful social robots for the psychological needs described here (i.e., coping with fuzzy fear and taking advantage of robots as affective mediators), a deep, psychologically driven afterthought will be needed around three basic axes of reflection. the first two axes are more general. the first one regards the psychological understanding of people involved in human-robot interactions during a sanitary emergency in terms of level of development, socio-demographic characteristics, and previous experience with social robots (see the experts/novices distinction above). expectations and attitudes toward social robots may in fact change according to both development and expertise. the second axis regards the construction of social robots that are able not only to take into account the needs of their human partners but also to relate with the human agent in an understandable way. this represents an extremely important feature that every human would expect from the interactive experience. the literature on robotics calls it "transparency"/"explainability" (holzinger et al., ) , which would correspond to the experience of the theory of mind (perner, ; wellman et al., ) in the domain of human-human interaction. the third axis of reflection relates to a goal that we hope to achieve in a not too distant future. specifically, it concerns the identification of the best way to devise social robots that are able to sensitively manage and respond to the behavior of a human partner with a possible acute temporary breakdown in the ability to scaffold the sense of emotional security-like some of us during this covid- emergency-that is the very basis of self construction. the theoretical reflections discussed in this opinion reread therefore the question of fear in the light of a danger that poses new questions and that, as is suggested, leads to rethinking particular psychological and social dynamics. in reading the new relational dynamics hypothesized in the present work, from which the robot is spared, covid- pandemics added novelty to the physiognomy of fear, which (unlike anxiety) is an emotion linked to objects and situational antecedents, and which may therefore be affected by the nature of its objects at the level of subjective experiences, behavioral reactions, as well as coping strategies. these theoretical suggestions may enrich knowledge from an interdisciplinary perspective, such as robotics and psychology, providing important starting points for future research by emphasizing which psychological components should be investigated in people interacting with robots. an example is the perception of in-group/out-group, as well as the components of fear that, in our opinion, are mitigated toward robots in the specific covid- situation, which forces us to adapt to the inclusion of new social agents devoted to care assistance. patterns of attachment: a psychological study of the strange situation migrazioni e psicologie. introduzione al forum a secure base it does not matter who you are: fairness in pre-schoolers interacting with human and robotic partners shall i trust you? from child human-robot interaction to trusting relationships come i bambini pensano alla mente del robot: il ruolo dell'attaccamento e della teoria della mente nell'attribuzione di stati mentali ad un agente robotico [how children think about the robot's mind. the role of attachment and theory of mind constants across cultures in the face and emotion causability and explainability of artificial intelligence in medicine infants' sense of people: precursors to a theory of mind the uncanny advantage of using androids in cognitive and social science research the understanding of congruent and incongruent referential gaze in -month-old infants: an eye-tracking study comparing human and robot a robot is not worth another: exploring children's mental state attribution to different humanoid robots theory of mind and humanoid robots from a lifespan perspective the uncanny valley understanding the representational mind the onset of fear of strangers and the incongruity hypothesis hospitalism: an inquiry into the genesis of psychiatric conditions in early childhood meta-analysis of theoryof-mind development: the truth about false belief combating covid- -the role of robotics in managing public health and infectious diseases all authors contributed to the writing of the manuscript. the authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.copyright © marchetti, di dio, massaro and manzi. this is an open-access article distributed under the terms of the creative commons attribution license (cc by). the use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. no use, distribution or reproduction is permitted which does not comply with these terms. key: cord- -pqdmo ln authors: dagnall, neil; drinkwater, kenneth g.; o’keeffe, ciarán; ventola, annalisa; laythe, brian; jawer, michael a.; massullo, brandon; caputo, giovanni b.; houran, james title: things that go bump in the literature: an environmental appraisal of “haunted houses” date: - - journal: front psychol doi: . /fpsyg. . sha: doc_id: cord_uid: pqdmo ln this paper contains a narrative overview of the past -years of environmental research on anomalous experiences attributed to “haunted house.” this exercise served as a much-needed update to an anthology of noteworthy overviews on ghosts, haunts, and poltergeists (houran and lange, b). we also considered whether new studies had incorporated certain recommendations made in this anthology. our search revealed a relative paucity of studies (n = ) on environmental factors that ostensibly stimulate haunt-type experiences. this literature was diverse and often lacked methodological consistency and adherence to the prior suggestions. however, critical consideration of the content revealed a recurring focus on six ambient variables: embedded (static) cues, lighting levels, air quality, temperature, infrasound, and electromagnetic fields. their relation to the onset or structure of witness reports showed mostly null, though sometimes inconsistent or weak outcomes. however, such research as related to haunts is arguably in its infancy and new designs are needed to account better for environmental and architectural phenomenology. future studies should therefore address four areas: (i) more consistent and precise measurements of discrete ambient variables; (ii) the potential role of “gestalt influences” that involve holistic environment-person interactions; (iii) individual differences in attentional or perceptual sensitivities of percipients to environmental variables; and (iv) the role of attitudinal and normative influences in the interpretation of environmental stimuli. focused scrutiny on these issues should clarify the explanatory power of evolutionary-environmental models for these and related anomalous experiences. it might sound like an amusing or curious claim, but "haunted houses" could be among the oldest problems in environmental psychology, i.e., the scientific study of the transactions and interrelationships between people and their surroundings (bell et al., ; devlin, ) . in this context, anthropologists note that haunt experiences have been important aspects of shamanism in both early and contemporary societies (hunter, ; mcclenon, ; winkelman, ) . for instance, "shaking tent" rituals involved a special cylindrical lodge or tent to contact "spirits" for guidance on hunting, healing, and even locating missing persons. and as the name of the ritual suggests, the tent is supposed to tremble mysteriously during the ceremony. moreman ( , p. ) credited "the earliest haunted house story in greek or roman literature" to a , -year-old play by plautus entitled "mostellaria" (ca - b.c.e) . this fictitious story reveals roman beliefs about such phenomena (felton, ) , which seemingly align well with modern presumptions (goldstein et al., ; hunter, ; massullo, ) . haunt-type experiences can also be found across many different societies and eras (carrington and fodor, ; owen, ; roll, ; gauld and cornell, / ; finucane, ; tuczay, ) . still, it is important to note that the sociocultural milieu influences the interpretation of these anomalous episodes and the ways people cope with them (for discussions, see houran, ; houran and lange, b) . haunted houses as social facts. . .and possibly more the term "haunted house" references two types of ostensibly anomalous episodes, which we will examine from a phenomenological perspective houran et al., a,b) . first, "poltergeist disturbances" can be described as clusters of unusual experiences (e.g., apparitions, sensed presences, hearing voices, and unusual somatic or emotional manifestations) and physical events (e.g., objects appearing to move by themselves, malfunctioning electrical or mechanical equipment, and inexplicable percussive sounds such as raps or knocks), which focus around certain people (roll, ; ventola et al., ) . similar anomalies that persist at specific locations are said to constitute a second classification, "haunts" or "hauntings" (gauld and cornell, / ; roll and persinger, ) . however, a firm distinction between these two types of occurrences is tenuous due to their overlapping characteristics (dixon et al., ; houran et al., b; ventola et al., ) and shared set of psychological and physical anomalies that conform to a unidimensional and probabilistic (rasch) hierarchy houran et al., b houran et al., , a . thus, a common source or set of mechanisms might underlie both kinds of episodes. skeptical readers should not trivialize these anomalous experiences because they can affect several facets of people's lives. fundamentally, belief in ghosts informs an individual's religio-cultural worldview (dyne, ; eaton, eaton, , hill et al., ) . one journalist detailed an interesting and practical example of this during the covid- pandemic (purwanto, ) . these beliefs likewise have implications for social identity theories of social rank, self esteem, and the belief systems that individuals hold for explanatory meaning in their lives (tajfel and turner, ; dagnall et al., b; hill et al., ) . reports of ghosts and haunts may also reinforce or contextualize the anxieties of individuals who are already fearful of the paranormal (lange and houran, ; de oliveira-souza, ) . the influence of haunt-type episodes is clearly widespread. gallup polls from gallup polls from , gallup polls from , and showed that a substantial proportion of respondents believe in ghosts and hauntings (dagnall et al., a (dagnall et al., , . the gallup poll found that % of those surveyed believed that houses could be haunted, with % stating that the spirits of deceased people could return to certain places or situations (moore, ) . other surveys have reported similar or even higher figures (e.g., pew research center, ; live science, ; lipka, ) . particularly, chapman university ( ) survey of american fears documented from to an % rise in respondents who "agree" or "strongly agree" with the statement: "places can be haunted by spirits." the percentage for (the last time the survey was conducted) was an astounding %. likewise, a yougov ( ) study reported that % of americans polled believe that ghosts "definitely" or "probably" exist. such beliefs can also spur various social consequences. for instance, the ghostly reputations of certain places have sometimes provoked real estate lawsuits concerning undisclosed "stigmatized properties" (murray, ) . in fact, houses rumored to be haunted often suffer significant value diminution, and this is especially true in countries such as taiwan and hong kong (china) where haunts have strong cultural associations with bad luck, vengeful ghosts, and ancestral spirit anger (emmons, ; chu, ; bhattacharya et al., ) . on the other hand, "haunted" buildings or sites in western culture are often promoted favorably as tourist destinations (hanks, ; houran et al., ) . sales of these places can bring high prices if a paranormal reputation is regarded as a benefit by buyers (behar, ) . hill et al. ( ) further discussed how entire industries have developed around "legend-tripping, " i.e., deliberately visiting spooky locations to seek paranormal experiences (cf. bird, ; holloway, ) , as well as virtual excursions pursued via livestreamed videos (kinsella, ) . folklorists might regard such pursuits as examples of "ostension, " which is showing or acting out a legend's narrative in real life (manning, ) . these trends relate to broader issues, such as maddern and adey ( ) concept of spectro-geographies. edensor ( ) echoed this perspective in asserting that "ghosts 'are a ubiquitous aspect of the phenomenology of place, ' 'ineffable and quasi-mystical' dimensions which emerge in encounters with the material, the mediated, the sensual and the affectual" (p. ). as such, spectral themes frequently appear in the popular media and academic literature. all of this serves to promote ghosts and haunted houses as pervasive cultural narratives (edwards, ; goldstein et al., ; booker, ; lecouteux, ; bader, ) , which can become highly engaging memes (hill et al., drinkwater et al., ) . overall, haunted houses exist as psychological, cultural, economic, and legal realities -with a strong and engaging "brand personality" akin to popular consumer products (annett et al., ; hill et al., hill et al., , houran et al., ) . although witness accounts are often explained away as instances of gullibility, overactive imaginations, or outright fraud (nickell, (nickell, , ashford, ) , researchers have occasionally documented the presence of independent environmental or physical mechanisms in spontaneous cases (e.g., persinger and koren, b; vinokur, vinokur, , nickell, ; colvin, ; laythe and houran, ) . the ontological status of these anomalous episodes beyond that of social facts thus remains a legitimate question. consistent with this perspective, our paper evaluates the broad explanatory power of environmental psychology for haunt-type experiences. this paper extends houran and lange ( b) noteworthy series of peer-reviewed and multidisciplinary research overviews on "ghostly episodes" (i.e., ghosts, haunts, and poltergeists) by focusing on subsequent academic work related to environmental factors. this update is needed as researchers have published an array of relevant articles over the past two decades. to be sure, it is good practice to perform a periodic synthesis of subject knowledge accruing from the rapid rate of publications (ferrari, ) , as well as to collate and share key research on a topic (bolderston, ) . we also checked whether methodological recommendations made by several authors in the anthology benefitted subsequent research. these recommendations called for (i) more holistic studies that simultaneously consider and measure a range of potential physical factors in haunted environments (e.g., radin, ; roll and persinger, ) , (ii) the use of proper control conditions to understand the naturally occurring presence (or expected fluctuations) of physical variables as compared to haunted locations (e.g., persinger and koren, b) , and (iii) extensive or competitive hypothesis testing involving cooperation between skeptics and parapsychologists (e.g., schmeidler, ) . critical consideration of the effectiveness of these refinements is vital to advance a scientific understanding of haunt-type experiences (for a discussion, see houran, ) . consequently, we conducted a non-systematic or narrative overview to identify, assess, and synthesize the relevant literature (ferrari, ) . this was done in preference to a systematic review for several reasons (cf. green et al., ; gregory and denniss, ) . our goal was to identify important research rather than all articles produced within the specified period. hence, our analysis focused on significant indicative research, intending neither to be exhaustive nor definitive. this methodology is potentially open to bias, but the use of specific research terms ensured that the studies assessed were thematically congruent with the topic of environmental factors in haunt-type experiences. we explicitly provide an overview of the relevant research area and evaluate the current status of the topic but note that a detailed critique of each identified study is not necessarily a property of this approach (cf. helewa and walker, ; green et al., ) . a systematic review, in contrast, locates all relevant published and unpublished studies with the intention of assessing publication impact and identifying bias. a systematic review also tests specific hypotheses or examines the impact of specific populations, outcomes, etc. (gregory and denniss, ) . commensurate with our stated aims, meta-analysis was deemed not appropriate. meta-analysis is a quantitative, formal study design used to systematically assess the results of previous research in order to derive conclusions about that literature (see e.g., forero et al., ) . however, several issues argue against the use of meta-analysis here. recent research shows that at least five compatible studies are needed to sufficiently overcome between study error variance (jackson and turner, ) . on this point, crucial disparities exist among the research methods and contexts in the literature that we sourced. these differences are substantial; they include purely field versus laboratory physical readings and, in some instances, a lack of either. moreover, in many instances the physical aspect of what was being assessed (e.g., emf variation, frequency, or magnitude, and sometimes infrasound) are not convertible to a standard metric given the information provided by the studies. a meta-analysis, therefore, could produce inaccurate results and interpretations. also, despite their popularity, meta-analytic techniques are not without criticism (thompson and pocock, ; sharpe, ; houran et al., ) . regardless of the method employed, a sound review is characterized by rigorous evaluation and critical analysis of relevant academic work (bolderston, ) . we reviewed conceptual and empirical research on "ghostly episodes" from environmental perspectives that was published primarily since the evaluations in houran and lange ( b) . we targeted studies using eighteen keywords or phrases frequently used in research examining haunt-type experiences: anomalous experience, apparition, demon, ego-alien intrusions, encounter experiences, ghost, ghost-hunting, haunt, haunting, metachoric experience, paranormal belief, paranormal experience, poltergeist, possession, séance, sensed presence, sitter-group work, and spirit. our search was limited to publications written in english. the procedure covered electronic search engines and repositories (i.e., google scholar, psycinfo, and researchgate), and examination of titles, abstracts, reference lists, and publications. finally, we included studies cited in the sourced works. this process yielded articles. of these, % (n = ) appeared in parapsychology journals or niche sources versus % (n = ) in mainstream journals or sources. the distribution appears reasonably balanced from an ideological standpoint, but this literature set averages just three articles per year. this implies slow and limited progress in examining the role of environmental factors in haunttype episodes. six environmental variables emerged from our qualitative inspection of the identified literature: (i) embedded (static) cues; (ii) lighting levels; (iii) air quality; (iv) temperature; (v) infrasound; and (vi) electromagnetic fields. study authors often characterized these factors as either conscious or unconscious stimulants of anomalous experiences. conscious stimulants are variables that can overtly capture attention and be interpreted as ghostly. unconscious (or non-conscious) stimulants refer to elements that are unwittingly or passively sensed and can stimulate unusual or anomalous perceptions. note that some variables might act as either type of stimulant. content or thematic analyses of haunt narratives have suggested that the perceptual details of percipients' experiences are often congruent with contextual variables attending the situation or location (harte, ; houran, ) . these "context effects" include tangible embedded cues in the physical environment, such as the mysterious aroma of lilacs in a room with a prominent violet hue or the mysterious sound of waltz music in an empty ballroom. unfortunately, few ecologically valid studies have empirically tested the premise that haunt experiences might involve such cues. there are two notable exceptions. first, houran ( ) examined the real-time anomalous experiences of research participants in tandem with salient environmental and aesthetic characteristics of haunted vs non-haunted rooms in a historic mansion with a quiet reputation for paranormal activity. for instance, certain locations were associated with reports of a sensed presence. these accounts correlated with rooms containing the most artwork (i.e., portrait paintings that conceivably created a sense that participants were literally being watched). nonetheless, analysis found no statistically significant differences between the haunted and non-haunted areas based on the number of pieces of artwork (specifically paintings and sculptures), or the ambient temperature, humidity, or the number of air vents in each room. consequently, there was no evidence that these environmental features acted as contextual variables to stimulate or shape participants' experiences. terhune et al. ( ) improved on this basic procedure in their field investigation of a reputed haunt (an unpublicized private residence) in comparison to a nearby control house. these researchers measured physical cues such as windows, mirrors, and the quantity and type of artwork (with and without human forms) using a research design that encompassed (i) potential differences between the target and control houses; and (ii) potential differences within haunted and non-haunted areas of the target house. these physical cues were also examined in relation to the presence of apparent photographic anomalies obtained across different film media during the study and rated by independent judges. similar to houran ( ) , no statistically significant effects (p < . ) were found for the environmental variables. however, there was a suggestive trend (p < . , two-tailed) for the control house (m = . , sd = . ) to contain more mirrors than the target house (m = . , sd = . ). this finding might seem surprising and counterintuitive, since mirrors and reflective surfaces in general are associated with anomalous experiences (caputo, a (caputo, ,b, (caputo, , (caputo, , (caputo, , (caputo, , caputo et al., ) . this correlation offers several interpretations. mirrors might, for example, serve as embedded (physical) cues that reinforce expectancy or suggestion effects. however, this possibility must be balanced against the evidence indicating that reflective surfaces can directly stimulate perceptual aberrations, independently of suggestion (caputo, b, in press ). indeed, unusual or anomalous perceptions (in different sensory modalities) predictably and systematically manifest when even healthy (i.e., non-clinical) individuals are directed to stare intently into a mirror, darkened space, or another person's face over a period of time and under low illumination (caputo, ) . psychomanteum, mirror-gazing, and eye-gazing protocols that are used to study these perceptual phenomena constitute a fascinating niche within consciousness studies and can aid model-building or theory-formation of haunttype experiences (cf. radin, ) . caputo ( ) proposed three distinct clusters (or factors) of anomalous experience that derive from different brain circuits stimulated during such facilitated sessions. he validated his idea with a questionnaire study that assessed the strength and frequency of a large list of apparitional and anomalous phenomena. this list generally aligned with baker ( ) definition of apparitions, which itself was adapted from thalbourne ( ) glossary: "a sensory experience in which there appears to be present a person or animal (deceased or living) who is in fact out of sensory range of the experient. . ." (p. ). a principal component analysis and quartimax rotation suggested that anomalous experiences during mirror and eyegazing sessions form three independent factors (caputo, ) . this same three-factor structure was confirmed via other methods (e.g., polychoric, alpha), suggesting that the perceptual anomalies derive from three distinct states of consciousness: (i) depersonalization (i.e., changes of multisensory integration on bodily-self, hence out-of-body presence); (ii) derealization (i.e., changes in sensory maps of visual processing, hence deformations in perceptions); and (iii) dissociated identity (i.e., changes with self-concept, thus apparitions of strange personalities in place of the subject's real face reflected in the mirror). the balance among these three processing levels apparently varies among observers (caputo, ) . illumination is an understudied topic in the relevant literature. settings with low-light appear to be normal operating procedure in many field investigations (e.g., houran et al., b; laythe and owen, ) , not to mention spiritualistic practice (e.g., laythe et al., ) . moreover, the horror film genre is an obvious example of darkness being used as a "theatrical artifice" (cf. loiselle, ) to reinforce conditions of spookiness or creepiness. therefore, it is reasonable to expect that darker settings bolster the expectancy set of percipients. of the few studies that have directly examined lighting in relation to haunts, terhune et al. ( ) found that overall lighting levels were not significantly different in an allegedly haunted site compared to a control site. yet, examination of the means and standard deviations do show lower mean levels of lighting (f-stop aperture: m = . vs. . ) and much less variability (sd = . vs. . ) at the haunted location, indicating an overall lower level of lighting (albeit non-significant). a serious limitation in this study was that measurements were not made simultaneous with real-time reports of anomalous experiences. in contrast, wiseman et al. ( b) measured the lighting levels both inside and directly outside the test areas of the haunted south bridge vaults (edinburgh, scotland). these researchers found a significant association between the lighting outside of target areas and anomalous reports of participants, as well as with those areas with a history of ghostly reports. nevertheless, "lighting levels" could be the wrong attribution for these findings if the absence of light or sensory deprivation is instead the principal effect. an oft-used explanation for ghostly anomalies as a function of darkness is visual pareidolia, or the tendency to make or perceive meaningful patterns in visual noise (myers, ) . nees and phillips ( ) similarly argued that auditory pareodolia accounted for so-called "electronic voice phenomena" (evp) and related experiences in some haunt episodes. evidence supports this model, although it typically derives from research with patients suffering from psychosis or disorders such as dementia. for instance, mamiya et al. ( ) standardized a short-form visual pareidolia test for use with dementia patients, which correlated positively (r = . ) with separate measures of pareidolia. this test provides a series of white noise and blurred image pictures for participants to interpret. notably, they do not measure low lighting images, but earlier work using this procedure (uchiyama et al., ) showed a significant increase in pareidolia hallucinations with dementia patients versus controls. unfortunately, the populations and methodologies in these studies undermine the generalizability of their findings for nonclinical samples or haunt-related contexts. more closely related to the dark bowers of a haunted location are daniel and mason ( ) sensory deprivation studies. these researchers placed participants (scoring either low or high on psychoticlike experience) in a sensory deprivation chamber for sound and light. both the low and high scoring groups reported a significant increase in psychotic-like experiences, which did not appear to be a function of either suggestibility or fantasy proneness. overall, lighting level seems a likely contributor to experiences deemed paranormal or ghostly. however, we note that light anomalies or other curious "artifacts" captured on film or video (lange and houran, b; storm, ; ventola, ; schwartz and creath, ; laythe and owen, ; mayer, ) or measured outside the visible light spectrum (joines et al., ) are not, strictly speaking, accounted for by pareidolia-like effects. relative to the former, wilson et al. ( ) demonstrated transient decreases in both infrared and visible light during environmental measurement of a single séance session of approximately minutes. further studies are needed to account for low-light pareidolia phenomena, while controlling for other environmental factors in haunt-related settings (e.g., jawer et al., ) . government agencies describe the general cleanliness of the air and potentially associated health effects via the air quality index (aqi: see and ). five major air pollutants are regulated by the clean air act in the united states: (i) ground-level ozone; (ii) particle pollution (e.g., acids, such as nitrates and sulfates); organic chemicals, metals, soil or dust particles, and allergens (e.g., fragments of pollen or mold spores); (iii) carbon monoxide; (iv) sulfur dioxide; and (v) nitrogen dioxide. for each of these, the environmental protection agency has established national air quality standards and calculates the aqi to protect public health. of the above categories, we found only references to particle pollution and carbon monoxide in the haunt literature. for instance, humidity or water vapor is a contributor to mold growth (environmental protection agency, ). numerous articles have bolstered public awareness of the acute and chronic illnesses that can result from exposure to biotoxins made by molds, dinoflagellates, spirochetes, and blue-green algae (shoemaker et al., ; ackerly, ; tsafrir, ) . the ensuing symptoms sometimes parallel the psychological experiences that characterize haunts, e.g., disorientation, mood swings, temperature regulation problems, and tingling (cf. tsafrir, , para. ) . since many haunted locations are older structures that are prime candidates for mold or other indoor air quality problems, some authors (clarkson university, ; kane, ) have proposed that ghostly experiences are indicative of exposure to toxic molds. to our knowledge, this speculation has yet to be validated by research showing differences in indoor air contamination between haunted and control locations. furthermore, the available evidence is not persuasive that haunts are even indirectly related to humidity levels (or mold growth). terhune et al. ( ) study of a target house and control house revealed significantly higher humidity levels in the target house, but there was no statistically significant difference in humidity levels between haunted versus non-haunted rooms of the target house. there were likewise no significant differences in humidity levels (or the number of air vents) in houran ( ) investigation of haunted and non-haunted rooms at a historic mansion. broadly speaking, the relevant literature has omitted the measurement of humidity. this is not to say that pertinent findings are completely absent. to be sure, "it's not the heat, it's the humidity" is an old adage with some empirical support. for instance, ding et al. ( ) found that humidity significantly compounds the negative association between hot weather and mental health, demonstrating a. % to. % increase in negative mental health effects based on logit model prediction of heat and humidity. still, the contribution of humidity to mental health appears to be small. conversely, the role of carbon monoxide has been clearly substantiated in a few reports. perhaps most famously, wilmer ( ) published a dramatic case study of a couple who moved into a "large, rambling, high-studded house, built around , and much out of repair." the pair soon began having anomalous experiences encompassing unusual bouts of headaches, strange sensations, feelings of listlessness, hearing phantom footsteps, and seeing mysterious figures. their complaints closely matched the classic signs or symptoms of a haunt (houran et al., a,b) , but these were eventually traced to carbon monoxide poisoning from a faulty furnace. according to the body odd ( ), a much more recent case involved a woman who was found delirious and hyperventilating after seeing a ghost while taking a shower. investigators discovered a new gas water heater had been improperly installed and thus flooded the house with carbon monoxide. beyond those two examples (including only one citation within our literature set), the available evidence does not implicate carbon monoxide poisoning in witness reports. telling in this respect is that joe nickell, a well-known skeptic and researcher of paranormal claims, stated that he has ". . .never encountered this scenario" (the body odd, , para. ). ghostly episodes can, but rarely, involve reports of an increase in temperature (houran et al., a) . for example, nickell ( ) discussed one account in which a phantom silhouette was reported by a naval captain in an unbearably hot bedroom. the most often reported temperature anomalies in haunt-type experiences, however, are so-called cold spots, i.e., a distinct perception of localized coldness (parsons and o'keeffe, ) . williams et al. ( ) online primer for paranormal enthusiasts noted that the duration of cold spots can range from a "fleeting feeling, or they may be persistent over time" (p. ). parapsychologists acknowledge that these subjective temperature drops or changes at haunts may stem from the predictable physiological reaction to fear in a purportedly haunted space (o'keeffe and parsons, ) . still, there is a paucity of laboratory research to verify the hypothesized causes of temperature anomalies. some experimental work on related anomalous experiences includes reports of temperature drops, such as with séance room phenomena (wiseman et al., a) . o'keeffe and parsons ( ) critically discussed one of the few studies in the last years -conducted by radin and rebman ( ) -that tested the correlation between temperature changes in the immediate environment and participants' mental states (albeit via the induction of an anomalous experience). the study's protocol involved an instrumented psychomanteum chamber: a small and dimly lit room with a mirror strategically placed to induce experiences of after-death communication (root, ) . o'keeffe and parsons ( , p. ) noted that "some of the significant ambient temperature and physiological correlations were possible artifacts of a common downward drift in temperature" exacerbated by the floor-level placement of the computerized thermometer. terhune et al. ( ) extensive field study of an allegedly haunted residence found that ambient temperature was significantly colder compared to a nearby designated control house, even when possible confounds were considered (e.g., number of windows). however, there was little difference within the haunted house itself, i.e., no relationship between areas associated with anomalous experiences and temperature readings. similarly, a series of field experiments conducted at hampton court palace and the edinburgh vaults to examine psychological mechanisms that might underlie participants' haunt experiences (cf. houran et al., b) also accumulated a wealth of data on environmental variables (wiseman et al., b) . the researchers found no significant relationship between temperature and the number of anomalous experiences that research participants reported (wiseman et al., b) . leventhall et al. ( ) defined infrasound as audio frequency energy that falls below the range of normal hearing, typically hz. it can be characterized simplistically as a hum you cannot hear. persinger ( persinger ( , noted the prevalence of both ambient infrasound within the environment (via natural phenomena such as geomagnetic activity, wind, etc.) and manmade infrasound (e.g., aircraft, large machinery, air movement in duct systems). the vibroacoustic effect of a wide spectrum of low-frequency sound (typically - hz) within a paranormal context has been argued from a physics perspective in two key articles (vinokur, (vinokur, , . in these papers, vinokur described how naturally occurring vibroacoustic phenomena can produce poltergeist-type effects (rattling windows, whispering galleries, etc.). we note that the proposed role of infrasound in haunt-type experiences dates a decade earlier to the research of tandy and lawrence ( ) . they posited a causal link between infrasound and apparitional experiences specifically noting that infrasound around hz appeared to cause visual effects derived from eyeball-vibration that might be interpreted as a ghostly sighting. this basic hypothesis was tested a few years later in a study of ambient infrasound in a reputedly haunted th century cellar beneath a tourist information centre in coventry (tandy, ) . parsons ( ) , however, conducted a series of infrasound measurements at the same venue in . his findings did not support those of tandy but instead implicated a "broad range of frequencies exceeding dbs between hz and hz, with a peak at dbs at . hz" (parsons, , p. ) . authorities have further voiced two major concerns about tandy's work (tandy and lawrence, ; tandy, ) : first, the lack of detail provided about the infrasound measurements themselves (weighting filter unspecified, room dimensions not taken into account, etc., parsons, ) ; and second, the lack of evidence demonstrating the physiological effects of such weak infrasound levels (braithwaite and townsend, ) . these criticisms challenge the relevance of infrasound (specifically around hz) to haunt-type experiences. field studies of haunts across the united kingdom led by , parsons ( ) , parsons and cooper ( ) , on the other hand, concluded that high ambient levels of infrasound (at varying frequencies) did contribute to witness accounts. that said, these findings did not support tandy and lawrence ( ) hypothesis that infrasound near hz induces visual disturbances that are intepreted as apparitional experiences. nevertheless, similarities exist between the physical and psychological effects of infrasound documented in the lab and those reported anecdotally by witnesses in haunt cases (o'keeffe and parsons, ; parsons, ) . participants in recent studies of pure infrasound tones at high sound-pressure levels have reported effects such as headaches, ear pressure, tiredness, change in heart rate, disorientation, and complications arising from the impact on the inner ear (chen and hanmin, ; hansen, ) . furthermore, tandy and lawrence ( ) original hypothesis has been re-examined in a series of unusual and highly public studies conducted since . music concerts that incorporated man-made infrasound were held at a venue in liverpool and again at the royal festival hall in london (arenda and thackara, ) . in a pre-specified number of pieces during the concert, infrasound was added and the audience's emotional response to the music correspondingly measured. although the environment and social context may have played a role in the way the audience reacted to the music, counter-balancing of the infrasound presence over two performances controlled some of this influence. in addition to questionnaire-based data, free response sections provided a rich source for more qualitative information. reactions ranged from low-arousal reports like "calm" and "sleepy" to more active states such as "aroused" and "excited." these accounts reflected experiences that varied in intensity from slight agitation or light-headedness to the more noticeable, e.g., increased heartbeat, facial tingle, and a marked sense of presence (arenda and thackara, ) . a similar approach to infrasound generating and testing was used in two further public performances in and , whereby the focus was on infrasound at . hz at a sound pressure level exceeding dbs (forsyth and pollard, ) . reactions noted by audience members included distinct physical discomfort and anxiety, yet it is unclear whether these responses were due to the generated infrasound, the ambient infrasound already present, or other environmental variables that factored into the performance (e.g., subliminal suggestion) (parsons, ) . a novel test of tandy's hypothesis involved the construction of a "completely empty, white, and circular room" that became "haunted" through the systematic variation of two key factors: electromagnetic fields and infrasound (french et al., , p. ) . in this so-called haunt project, participants were informed in advance that they might be exposed to varying emfs, infrasound, both or neither, and that they might experience mildly unusual sensations as a result (p. ). the participants spent nearly an hour wandering around the specially constructed room and were asked to record their impressions and experiences. participants reported many unusual or anomalous perceptions, but the frequency was unrelated to the environmental manipulations. the researchers therefore proposed that expectancy or suggestion effects accounted for the participants' experiences (french et al., ) . we should qualify that the apparent suggestion effects in this experiment might not have been independent of some confounding physical influences. particularly, french et al. ( ) stated that "informal pilot testing had suggested that dim illumination and a cool temperature would be the most suitable conditions for this study, insofar as they are the conditions typically associated with reputedly haunted locations" (p. ). furthermore, parsons and cooper ( ) were critical of the general results, raising concerns about the production of infrasound (combining two sine waves of . hz and . hz), the lack of detail regarding the sound recording equipment, and the absence of ambient infrasound data. if the public associates anything that is "scientific" with haunttype experiences, it is the apparent role of emfs (houran, ; massullo, ) . indeed, it can be argued that the majority of findings from fieldwork studies of haunts relate to emf effects (houran and lange, ) . interested readers are encouraged to consult important discussions of this topic for insight into the technicalities involved and corresponding debates concerning the issues of measurement and interpretation of research findings (see persinger and koren, b; williams et al., ; braithwaite, braithwaite, , braithwaite, , parsons, ) . as basic background, geomagnetic fields (gmf) are dc fields that are largely generated through the fluid motion of the earth's molten iron core (buffet, ) . although the gmf of the earth averages around -milligauss (mg), and is typically less than hz, several variables can produce notable changes in gmf strength around the globe. these include seismic activity along fault zones (persinger, (persinger, , , electrical activity during thunderstorms, and large amounts of magnetic or electrically conductive minerals present in the geology of a given area. in addition, increases in cosmic radiation -e.g., from sunspots, solar flares, or similar phenomena -can sometimes greatly change gmf strength and lead to geomagnetic storms as this radiation interacts with the boundary of the gmf in the upper atmosphere (lyon, ) . in contrast, electromagnetic fields are ac fields that are usually produced artificially by electrical power currents, though in some instances, em fields are produced naturally by geophysical sources. for instance, electricity can be produced through seismic pressure acting on conductive rock along fault zones (persinger, (persinger, , , as well as by very low frequency atmospherics, i.e., electromagnetic pulses produced from electrical discharges after a lightning strike averaging around . -mg (schienle et al., ) . gmf and emf are both phenomena associated with the electromagnetic spectrum at its slowest frequencies. whereas gmf resides in the single-digits frequencies, emf is typically shorthand for mains frequency (i.e. power lines) magnetic fields produced at either or hz, depending on your country of origin. nowhere are the issues of technology and measurement more problematic than with emfs (laythe, ; laythe et al., ) , particularly in the stark contrast between laboratory designs and field measurements. studies examining emfrelationships have been published sporadically for years, but considerable variations in methods and ontological assumptions have made it difficult to compare and contrast study outcomes and implications. foremost among these issues are incorrect assumptions about emf behavior in natural settings. laythe et al. ( ) have emphasized that emfs are subject to rapidly declining strength as a function of distance, which implies an exponential decay rate (tipler, ; thidé, ) . thus, power lines or electrical towers have been erroneously blamed for emf findings when actually these structures can be relatively close and not affect the emf levels of nearby environments. similarly, most of the magnetic force of artificially produced emf is diminished as a function of radio and broadcasting data (thidé, ) . further, triangulation is rarely used with emf in the field, which makes detection of the precise source of emfs nearly impossible. finally, the technology of emf meters is receptive, meaning these have a limited capacity to detect emf fields (which decay quickly). readings can consequently be significantly altered by moving an emf meter by two or three feet (laythe et al., ) . these statements are neither meant to imply that emfs do not generally affect environmental systems, nor that geophysical effects do not necessarily influence "haunted" environments. we conclude only that the methods of emf data collection in the field have inhibited effective cross-study comparisons. for example, some evidence suggests that sleep disturbances, mood shifts, and increases in anxiety can coincide with changes in geomagnetic field activity (persinger, ) . other studies suggest that people with particularly sensitive temporal lobes (a condition that may be caused by temporal lobe epilepsy or brain injury), may be more susceptible to changes in gmf activity (fuller et al., ; persinger, ; persinger and koren, b, pp. - ) . correlational research suggests that geomagnetic activity may be stronger on days when people report bereavement hallucinations (i.e., apparitions of people who have recently died) (persinger, ; persinger and schaut, ) . strong geomagnetic fields, around -mg or more above the average for the earth's gmf, have been documented at reputed haunts (roll and persinger, ) . it is important to note, however, that all these studies assume that within the mix of emf magnitude (i.e., field strength), a persistent frequency exists that corresponds to the precise frequency needed to produce a sensed presence or related hallucinatory-type phenomena. some experimental evidence also raises concern over the potential effects of emf exposure on mental health (o'connor, ; paneth, ) . for example, two studies have observed possible changes in brain wave activity on an electroencephalogram (eeg) following two-second exposure to emfs as strong as -mg (von klitzing, ; bell et al., ) . persinger et al. ( ) found changes in brain waves when lower strength magnetic fields ( -mg) were applied over several minutes, and these changes persisted a short time after the magnetic stimulation ceased. a review of experimental studies also suggests that brain chemistry and hormone levels may sometimes change in response to emf exposure (reiter, ) . some data also suggest that emf exposure can also affect sleep (sher, ) , which might contribute to haunt experiences that occur during sleeping hours. gangi and johansson ( ) even proposed that emf exposure can cause certain skin cells to release inflammatory substances that can cause itching and other skin sensations. such physiological effects might relate to unusual somatic complaints reported in some haunt experiences (houran et al., a; houran et al., a) . emf strength in buildings typically averages between . to -mg. several field investigations of haunts have measured emfs appreciably above this average (e.g., roll et al., ; persinger et al., ; roll and persinger, , pp. - ; wiseman et al., ) . in the laboratory, persinger et al. ( ) studied the experiences of a man who had reported haunt phenomena in his home. when they applied a -mg emf to his brain, the man reported experiencing brief rushes of fear and various odd sensations. this was followed by his perceiving a visual image that seemed to resemble the apparition he had remembered previously. changes in brain wave activity were also measured via eeg in conjunction with his anomalous perception (for discussions of this and related work, see persinger, ; persinger and koren, a,b) . laboratory research also shows that anomalous impressions can be artificially induced by stimulating the brain with temporally complex, weak-intensity magnetic fields (cook and persinger, ; persinger, , persinger, persinger et al., ; for reviews see persinger and koren, a,b) . according to persinger, anomalous perceptions are caused by temporally complex magnetic fields that induce partial microseizures (paroxysmal events) in temporal-lobe regions and the deep sub-cortical structures they house, such as the hippocampus and amygdala (persinger and koren, b) . essentially, persinger proposed that such micro-seizures can cascade through the neural landscape and, with enough intensity, affect the individual's thoughts, images, memories, and feelings, so that hallucinations, and anomalous perceptions result (persinger and healey, ) . his clear and testable prediction is that magnetic fields present at some reputed haunts can induce reports of sensed presences or other ghostly experiences persinger and koren, b; roll and persinger, ) . however, this "persinger effect" (i.e., emfinduced hallucinations) as a comprehensive explanation for haunted houses is insufficient for several reasons. first, it does not consider the low probability that all haunts exist at environments where a very specific and precisely patterned emf wave can affect temporal lobe functioning. braithwaite ( ) haunt investigations, for example, identified only two of approximately sites with magnetic fields that were temporally complex. this incidence rate ( %) might be better described as "coincidental" than "rare." similarly, laythe and owen ( ) found highly varied emf and gmf readings in a non-powered, electrical environment. this suggests that ostensibly anomalous emf/gmf is not stable over time. thus, it remains to be seen whether the waveforms measured and detailed in these studies have any implications for human experience, even in contextually and experientially rich settings. also notable is the fact that one particular study, while failing to replicate the persinger effect, implicated the role of suggestion and prior belief . persinger and koren ( ) subsequently criticized granqvist and colleagues by claiming that the fields used may not have been appropriate for eliciting a neurological response, possibly due to alterations in the temporal characteristics of the waveforms (for a reply, see larsson et al., ) . persinger's argument implies that a high degree of temporal specificity is required to elicit the hypothesized effects. his earlier studies, employing an apparatus known as the "god helmet" (where magnetic coils are strategically temporally placed) were, in fact, partially replicated by a team whose production of mg magnetic fields in the helmet resulted in participants reporting anomalous perceptions, including sensed presences (tinoco and ortiz, ). persinger's ideas presumably have limited applicability to most haunt sites since the requisite temporal complexity is unlikely to occur. we note, furthermore, that many studies have found no such effects. these include several field investigations (maher, ; wiseman et al., b) and laboratory experiments (french et al., ) . williams ( ) duly noted a lack of a historical relationship between reported haunts and manufactured emfs. cornell ( ) similarly pointed out that haunt accounts ". . .were widely reported long before the development and use of manmade electromagnetic utilities" (p. ). still, several haunt investigations have documented emf effects and found that the absolute strength or intensity of the magnetic fields might not be as important as their fluctuation over time. these studies have sought to quantify the magnetic fields at reputed haunts and compare them to appropriate baselines (wiseman et al., (wiseman et al., , b braithwaite, braithwaite, , braithwaite et al., ; braithwaite and townsend, ; terhune et al., ; laythe and owen, ) . in at least two field investigations by william g. roll (reported in roll and persinger, ) , the strength of the magnetic fields was found to be either gradually increasing or decreasing as one moved from one side of the haunted site to the other. during a study of haunt reports at historic hampton court palace, wiseman et al. ( wiseman et al. ( , b noted that changes in the magnetic fields in areas of the palace associated with anomalous experiences differed significantly from the emf changes in control areas in which no such experiences were reported. variance of the magnetic field correlated with the number of unusual experiences reported. braithwaite and colleagues examined a specific bedroom at the historic muncaster castle on multiple occasions (braithwaite, ; braithwaite et al., ) . witnesses sleeping in the room had reported hearing voices at night that resembled children crying. braithwaite's group took measurements around the head of the bed and then compared them to measurements taken toward the center of the room where the mysterious voices apparently originated. notable changes in magnetic field strength were observed over this short distance of a few meters. similarly, terhune et al. ( ) found noteworthy differences when comparing the magnetic field changes in areas where haunt phenomena were reported with control areas that had no reported phenomena. other researchers have suggested that the potential influence of magnetic fields might be greater if they exist within built environments that are 'spooky' (e.g., feature gothic architecture, dim lighting, or vintage paintings and furniture: lange and houran, a; houran, ; braithwaite and townsend, ; braithwaite, ; ralphs, ) . it might be possible that such contextual variables work together with magnetic fields to stimulate expectation as well as neural arousal. recent research further complicates the emf-haunted house relationship. wilson et al. ( ) found changes in emf during a séance session where light anomalies and rappings sounds occurred. additionally, two detailed studies appear to show significant real-time associations between emfs and clearly physical (vs. imagined) anomalies (laythe and owen, ; laythe and houran, ) . in these latter studies, anomalous phenomena captured in audio or video recordings were shown to correlate with significant micro-expansion or -suppression of the area's emf field during the time period of the documented anomalous event. also, hourly correlations of emf/gmf meters in the laythe and owen ( ) study varied wildly on an hourly basis in a location that was approximately a half-mile from any confounding electrical sources. further investigation by laythe et al. ( ) in a laboratory séance setting found significant variability of emf and gmf across sessions, and emfspikes were significantly associated with participants' anomalous experiences. this suggests that micro-expansion or microcontraction of emf may be a significant factor in haunttype experiences. laythe's three studies above appear to challenge conventional physical explanations for the observed emf effects. his work further undermines a hallucinatory-emf model as the sole explanation for haunt-type experiences. both laythe and owen ( ) and laythe and houran ( ) recorded objective anomalies (i.e., tangible and measurable) in tandem with significant emf fluctuations. given that emf manifests as either a vector (a focused wave with direction), or a general field with a source of origin, neither study could account for any emf source that could theoretically create localized variability in the emf field. although these micro emf expansion and suppression effects have been conceptually replicated three times in different environments, they require further independent validation. examination of the identified literature showed that the methodological recommendations put forward by previous authorities (i.e., persinger and koren, b; radin, ; roll and persinger, ; schmeidler, ) had not been consistently adopted by investigators. that is, few research designs considered either a range of environmental variables simultaneously, compared results from haunted locations to suitable control conditions, or applied extensive or competitive hypothesis testing using collaborations between investigators with ideological differences. researchers instead tended to pinpoint several conventional factors that can theoretically impact, though perhaps subtly or unwittingly, the psychological experience of natural and built environments. yet, this target literature offered neither abundantly clear, nor persuasive evidence for most of these ostensible unconscious or conscious stimulants as a robust model for haunted houses. specifically, it appears that the hypothetical influence of environmental variables touted by some authors (e.g., houran, ; tandy and lawrence, ; vinokur, vinokur, , alexander and muzzillo, / ; mcandrew, mcandrew, , does not consistently match their observed influence. we conclude therefore that an exclusively or chiefly environmental model -i.e., relying on discrete embedded cues, air quality, temperature, infrasound, lighting-levels, or electromagnetic fields -is presently insufficient as a general explanation for what imprints certain locations or settings with a haunted persona (or creepiness) or serves as the predominant source of anomalous experiences in these contexts. that said, it is highly questionable that evolutionaryenvironmental perspectives on ghostly episodes have been adequately explored or tested, despite the long legacy of fieldwork studies and instrumentation in haunt-related research (for overviews, see e.g., osis, ; houran and lange, ; braithwaite, ; bebergal, ; radford, ) . moreover, we continue to anticipate slow advancements in understanding "haunted houses" given their taboo standing within many academic circles and publications. amateur enthusiasts of the paranormal tend neither to be professionally trained nor scientifically oriented (potts, ; hill, ; hill et al., ; eaton, ) , yet they dominate the popular view of haunt investigation and accordingly taint a fascinating and valid subject. this situation is unfortunate, because empirical study in this domain transcends parapsychology to be potentially instructive for exploring or refining important issues across the social and biomedical sciences. these include sensory processing sensitivity and perceptual biases (van elk, ; partos et al., ; greven et al., ) , sick building syndrome (shoemaker and house, ) , mass (contagious) psychogenic illness (chen et al., ) , embodied-cognition (goldhagen, ) , the neurobiology and physiology of emotion (jawer and micozzi, ) , place identity and attachment (donohoe, ; seamon, ) , the nature of creepiness (mcandrew and koehnke, ; mcandrew, ) , extraordinary architectural experiences (bermudez, ; bermudez and ro, ) , and the psychology of sacred or enchanted spaces (lidov, ; holloway, ) . accordingly, scientific efforts to describe haunted houses and related phenomena in environmental terms should address several issues. first, our literature review revealed a dearth of detailed and quality research in this area. future studies must therefore strive to measure discrete physical factors more consistently, comprehensively, and precisely. fieldwork should include experts in architectural design, engineering, environmental sciences, and physics. such specialists in environmental and architectural phenomenology could be invaluable in developing or implementing new research designs. furthermore, investigations must consider individual differences in the attentional, emotional, and perceptual thresholds of experients versus non-experients in haunt-type cases (kumar and pekala, ; lange and houran, a,b; houran et al., a; jawer, ; romer, ; laythe et al., ; parra, ; ventola et al., ) . it could be that the types of physical variables reviewed here are germane to a subset of witness reports grounded in hypervigilance or heightened sensitivities to these conventional stimuli. "gestalt influences" are additional factors whose role in this domain have yet to be understood. these are ambient, structural, or contextual variables that have the capacity to influences a person's perceptions, feelings, and impressions of specific spaces and settings. jawer et al. ( ) discussed several examples relevant to haunt-type experiences, including: (i) affordance, (ii) atmosphere, (iii) ambiguity and threat anticipatory processes, (iv) immersion and presence, (v) legibility, and (vi) percipient memory and associations (e.g., transgenerational, transpersonal, and archetypal memories: jung, ; caputo, ) that can be involved in apparitional/spiritual phenomena and are specifically encoded or contextually re-encoded through haunted, enchanted, and sacred places. these effects might involve, but are not limited to, the discrete physical factors proposed as stimulants of anomalous experiences. gestalt influences instead speak to the larger concept of systems theory (i.e., environment-person bidirectional or enactive processes) (jelić et al., ; goldhagen, ) . this holistic view identifies psychosocial elements as important contributors to the onset or structure of personal experiences, which agrees with conclusions from our broad sociocultural analyses of ghost narratives (hill et al., drinkwater et al., ; houran et al., ) . to be sure, considerable evidence implicates attitudinal, normative, and situational influences in the phenomenology of witness accounts (houran, ; houran et al., b houran et al., , a wiseman et al., wiseman et al., , b french et al., ; drinkwater et al., drinkwater et al., , dagnall et al., a; laythe et al., ; pharino et al., ; langston and hubbard, ) . such findings underscore that physical variables might not be the primary culprits in most haunt cases. for instance, aulet and vidal ( ) stated that "sacred spaces are complex realities whose internal dynamics must be studied from a multidisciplinary and transversal perspective that draws on anthropology, sociology, theology, philosophy, tourism, culture and more" (p. ). likewise, haunted houses could be variants of enchanted or sacred spaces (jawer et al., ) and thus may have eluded definitive explanation for millennia due to roots in complex interactions (or dynamical systems; e.g., houran, , lange and among certain physical variables, sociocultural influences, situational context, and interpersonal dynamics -all of which shape the character of spaces and settings, as well as define how experiencers are ultimately situated inside them. in closing, we would be remiss not to mention an environmental model for haunts taken to the extreme. this is the possibility that human consciousness, and indeed all that we experience as reality, derives from a sophisticated hologram or computer program, as depicted in the sci-fi film franchise, the matrix. academics refer to this as the "simulation hypothesis", and if valid it implies that ghosts are quite literally in the machine. that is, the anomalies that characterize haunt-type episodes might represent glitches in the software or hardware that produces or operates the simulation. the idea that ghostly phenomena can be interpreted in informational terms parallels some thinking in parapsychology (radin, ) . more pointedly, merali ( ) outlined conceptual and empirical arguments consistent with the simulation hypothesis, and "is the universe a simulation?" was even the central topic of the isaac asimov memorial debate at the american museum of natural history (cf. moskowitz, ) . this intriguing notion, like that of ghosts and parapsychological agencies, might be a stretch and eventually prove incorrect. nevertheless, asking these types of questions underscores the fundamental need that human beings apparently have to explore and understand all facets of their holistic environments. we sympathize with paranormal experients in this regard because academia does not yet have a convincing, comprehensive, and scientific explanation for haunted houses -and without dedicated and inclusive research it never will. nd performed the theoretical focus, design, provided theoretical background and draft feedback. kd performed the theoretical focus and provided theoretical background and draft feedback. co'k 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eye the daniel experiment: sitter group contributions with field rng and mesa environmental recordings spirits as human nature and the fundamental structures of consciousness belief in the paranormal and suggestion in the séance room an investigation into the alleged haunting of hampton court palace: psychological variables and magnetic fields an investigation into alleged 'hauntings % of americans believe that ghosts and demons exist key: cord- -j wbcr authors: prado-gascó, vicente; gómez-domínguez, maría t.; soto-rubio, ana; díaz-rodríguez, luis; navarro-mateu, diego title: stay at home and teach: a comparative study of psychosocial risks between spain and mexico during the pandemic date: - - journal: front psychol doi: . /fpsyg. . sha: doc_id: cord_uid: j wbcr context: the emergency situation caused by coronavirus disease (covid- ) has affected different facets of society. although much of the attention is focused on the health sector, other sectors such as education have also experienced profound transformations and impacts. this sector is usually highly affected by psychosocial risks, and this could be aggravated during the current health emergency. psychosocial risks may cause health problems, lack of motivation, and a decrease of effectiveness at work, which in turn affect the quality of teaching. despite their importance, there are hardly any studies that analyze psychosocial risks of non-university teachers during a health emergency such as that caused by covid- . objectives: the aim of this study was to analyze the perception of covid- and the psychosocial risks of non-university teachers comparing spain and mexico during the state of alarm caused by covid- . methods: data were collected from non-university teachers ( . % women; . % from mexico, . % from spain) aged – (m = . , sd = . ) via a self-completed questionnaire during the pandemic from march to april . results: data analysis suggests that inequity is the most important risk, followed by work overload. teachers appear to be moderately satisfied with the information on covid- and the measures taken, while their satisfaction with the available resources is lower. when comparing the two countries, significant differences can be observed in every risk considered except for social support, with lower levels in mexican teachers compared to spanish ones. in the case of the perception of covid- and its impact, the perception in general of levels of information, measures, and resources is better among mexican teachers than among spanish ones, who present higher scores of the impact of the health emergency. conclusion: the results underline the importance of the professional’s perception of resources during a health emergency, which could prevent to some extent burnout and possible alterations associated with it. the measures taken by the responsible entities and the provision of information do affect teachers not only directly but also indirectly by making them more vulnerable to psychosocial risks that could affect their health and professional performance, thus affecting students as well. on january , , the china center for disease control and prevention (china cdc) reported that a novel coronavirus had been detected as the causative agent for of the cases of pneumonia (european centre for disease prevention and control, c; holmes, ) . on january , , the world health organization (who) declared this first outbreak of novel coronavirus a "public health emergency of international concern" (world health organization, a). on march , , the director general of the who declared coronavirus disease (covid- ) a global pandemic (european centre for disease prevention and control, d; world health organization, b). as of march , , all european union (eu)/european economic area (eea) countries and more than countries worldwide are affected (world health organization, a ,world health organization, b . as of april , , many eu/eea countries started to adjust their response measures (i.e., gradual opening of school, small shops, and other businesses, etc.) (european centre for disease prevention and control, a) . data from the eu/eea show that around - % of diagnosed covid- cases are hospitalized, and % have severe illness. hospitalization rates are higher for those aged years and above and for those with other underlying health conditions (european centre for disease prevention and control, b) . since december , , and as of may , , , , cases of covid- have been reported, including , deaths (european centre for disease prevention and control, b) . as this is a new virus, no vaccine is currently available; it may be many months or even more than a year before a vaccine has been tested and is ready for use in humans (european centre for disease prevention and control, d) . main global data on cases and death are shown in table . as can be seen in table , spain and mexico are among the most affected countries, with spain ranking third in europe in terms of deaths reported by covid- , and mexico ranking third in terms of deaths reported by covid- in the americas. on one hand, in spain, the situation has been particularly complicated. as of may , , there have been , confirmed cases in spain, and , have died according to official data from the european centre for disease prevention and control (ecdc) (european centre for disease prevention and control, d). the first positive diagnosis was confirmed on january , (linde, ) , while the first death occurred on february in the city of valencia (caparrós, ) . in view of the rapid spread of the virus, since march , the spanish government has decreed a state of alarm (boletín oficial del estado, ), restricting the mobility of citizens to certain cases, such as the purchase of food and medicines or visits to medical centers or the workplace. all face-to-face teaching activities have been interrupted in spain since march , after the state of alarm was decreed (boletín oficial del estado, ), although some communities such as madrid or la rioja imposed this measure on their schools a few days earlier. in total, some million students from all educational stages are currently following their academic year at a distance (faro de vigo, ) . a large number of teachers took on the tasks of distance teaching without being previously trained for them, nor having specific resources for all this in many cases. this whole situation of stress caused by the pandemic, together with changes in the usual working conditions, could negatively affect not only the psychosocial risks of teachers but also its main consequences such as burnout. on the other hand, in the case of mexico, the first positive diagnosis was confirmed on february in mexico city (british broadcasting corporation, ) , almost a month after in spain. on march , a "health emergency due to force majeure" was declared as a result of the evolution of confirmed cases and deaths from the disease in the country, which led to the implementation of additional actions for its prevention and control (secretaría de salud, gobierno de méxico, ). currently, there have been , cases, of which , have been discharged and , have died, according to official data from the mexican government and ecdc (european centre for disease prevention and control, d; secretaría de salud, gobierno de méxico, ) . despite the fact that spain is one of the countries most affected by the pandemic in europe, and mexico in america, we could say that the phase in which both countries are in this sense is different, since at the moment, it seems that spain has reached its peak long before mexico, with the former being in a phase of decreasing new cases, while the latter seems to be in the middle of a phase of increasing new cases. of the total number of cases of ) , only , have been recorded in the last days, while of the total number of cases in mexico ( , ), , have been recorded in the last days, i.e., the figure has practically doubled in the last weeks (as of may , ) (european centre for disease prevention and control, d). the pandemic caused by covid- generates a series of impacts in all spheres of society, posing a challenge in practically all areas. during the pandemic, the population has had to adapt to a number of situations where uncertainty, fear, and, in many cases, pain have been present. these effects may translate into a range of emotional reactions (such as distress or psychiatric conditions), unhealthy behaviors (such as excessive substance use), and non-compliance with public health directives (such as home confinement and vaccination) in people who contract the disease and in the general population (pfefferbaum, ) . one of the many sectors that has had to adapt to this new situation and the demands that it entails is that of education. teachers at all levels of education have tried to maintain their fundamental role and continue to carry out their teaching duties, despite the uncertainty of the situation, the difficulties related to their own health and that of their loved ones, the lack of resources (material and knowledge), and the huge amount of extra work that adaptation to teach from home entails, including helping their students to cope to this situation. in particular, nonuniversity teachers (primary and secondary education), aware of the fundamental importance of learning for the development and future school performance of their students, have faced this situation by providing, in most cases, distance education, even if resources were often not available and uncertainty about the situation has always been present. in this context, the factors that are normally important for the good professional performance and well-being of teachers become even more relevant. among them are the so-called psychosocial risks. cox and griffiths ( ) define psychosocial risks at work as aspects regarding work design as well as the social, organizational, and management contexts of work that could potentially cause physical or psychological harm. psychosocial risks and work-related stress are among the most challenging issues in occupational safety and health, impacting significantly on the health of individuals, organizations, and national economies (bailey et al., ; bergh et al., ) . psychosocial risks arise from poor work design, organization, and management, as well as a poor social context of work, and they may result in negative psychological, physical, and social outcomes such as work-related stress, burnout, or depression (european centre for disease prevention and control, d). more specifically, psychosocial risks have been shown to be related to low job satisfaction (guadix et al., ) , health problems (bergh et al., ) , work accidents (fornell et al., ) , work-related stress (junne et al., ) , and burnout (maslach et al., ; elshaer et al., ) . psychosocial risks are closely related to work-related stress, which has been associated with a reduction in social interaction and the ability to concentrate at work, an increase in physiological pain and cardiovascular problems, and a higher incidence of mental illness such as depression and anxiety (nielsen et al., ) . in this same vein, the right management of psychosocial risk helps to prevent accidents and absenteeism (maslach, ) , to increase productivity (bakker and demerouti, ; bakker and wang, ) and to promote well-being at the workplace (hammer et al., ) . among the different theoretical models that exist to explain the appearance of occupational stress, karasek ( ) model is the one with the most theoretical and empirical support and it is the one that currently has the most influence and attention. it explains work-related stress according to the imbalance between psychological demands at work (e.g., workload, role conflicts, interpersonal conflicts, job insecurity,. . .) and the control level or resources that the employee has. according to this model, the employee health or well-being depends on the balance of the work demands and the resources that the employees have. when the demands are higher than the resources, it can create a feeling of work-related stress in the employee. in addition, the chronic work-related stress can cause burnout syndrome, being able to appear as several physical or psychosomatic symptomatology. thus, an excess of demands will produce a negative consequence in the employee, as higher burnout; however, having enough resources benefits the employee, decreasing the probability of having higher burnout (hatch et al., ) . among the different psychosocial risks, the following stand out because of their importance in relation to the crisis situation and the theoretical reference model: (a) role conflict: this is the situation in which a worker cannot simultaneously satisfy the contradictory role expectations in which he or she is involved. there is role conflict when a worker is being given work tasks without enough resources to complete them and receiving contradictory requests from different people. previous research has shown that problematic levels of distress were % more likely for workers reporting role conflict (johannessen et al., ) . having to teach from your own home often can bring some role conflict, since familiar conciliation might get more challenging for those teachers who also have to perform other roles, such as being parents, partners, and caregivers in general. (b) lack of organizational justice: lack of organizational justice refers to the extent to which employees perceive they are treated unfairly in their workplace and the perception of the absence of reciprocity in social exchanges (moorman, ; kobayashi and kondo, ) . low organizational justice is known to be a potential risk factor for poor physical and psychological health among employees (fujishiro and heaney, ; kobayashi and kondo, ) . (c) workload: it assesses quantitative and qualitative workload. quantitative workload refers to the amount of activities to be performed in a given period of time, while qualitative workload refers to the difficulty of the task and the volume of information to be processed in relation to the time available (gil-monte, ). a high workload has been associated with low levels of well-being and higher risks of health problems (pace et al., ) . in general, the adaptation to the current pandemic situation requires an extra load of work that teachers (and family and students) have to deal with. (d) interpersonal conflicts: it assesses the frequency with which workers perceive conflicts coming from the school management, colleagues, students, or relatives of the students. interpersonal conflicts have been associated to health problems, particularly to depression (kubik et al., ) . in the context of the covid- pandemic, uncertainty has often made it difficult to reach an agreement between school, families, students, and teachers about the best way to proceed, which new measures to take in order to adapt, and for how long this measures should be maintained. (e) emotional work: it refers to the effort, planning, and control necessary to express the organizationally desirable emotions during interpersonal transactions (morris and feldman, ; ortiz et al., ) . previous research has shown that problematic levels of distress were % more likely for workers reporting high emotional work (johannessen et al., ) . in the context of a pandemic, an extra burden of negative emotions in teachers (such as worry, uncertainty, and fear) would be expected. (f) job insecurity: the perceived threat of losing one's current job in the near future (heaney et al., ) , or that the employer did not comply with his or her obligations or promises (breach of psychological contract) (vander elst et al., ) , can have equally serious consequences as actual job loss (de witte, ) . particularly, job insecurity is considered a stressor that affects negatively the physical, psychological, and social health of the employee (cheng and chan, ; de witte et al., ; de witte et al., ; selenko et al., ) . on the other hand, as the karasek model points out, one of the most important resources to cope with psychosocial risk factors is the social support at work. social support at work is defined as the social climate in the work context involving the relationship between the supervisor and coworkers (karasek and theorell, ) . it involves both social-emotional and instrumental support. the former refers to the degree of social and emotional integration between coworkers and the supervisor, while instrumental support refers to the collaboration between coworkers and the supervisor to carry out work tasks (martín-arribas, ). an important potential source of social support is the emotional support of family, friends, and colleagues, which is particularly difficult to have on a confinement situation such as that originated by the covid- pandemic. social support and resilience protect individuals from threats to their mental and physical health by reducing or balancing the negative effects of the stressful events they experience in life (woodhead et al., ; sun et al., ) . as previously stated, a large number of demands and low resources produce a series of negative consequences for workers (karasek, ) , of which psychosomatic health problems and burnout syndrome are the most important due to their prevalence and associated consequences. the term psychosomatic refers to all those alterations in which mental processes influence areas of the organism (montiel et al., ) . among the most common are various types of symptoms affecting multiple organs and systems. examples of these are back pain, tension headaches, sleep problems, chronic fatigue, heartburn, tension diarrhea, or heart palpitations (jaradat et al., ) . burnout syndrome is defined as a prolonged response to chronic emotional and interpersonal stressors at work and is defined by the three dimensions of burnout, cynicism, and inefficiency (maslach et al., ) . the prevalence of burnout in education oscillates between and . % depending on the country and the study considered (ratto et al., ; villaverde et al., ) . a eurofound study (aumayr-pintar et al., ) showed that, in portugal, % of educational professionals had a moderate risk of burnout, and the employees with burnout syndrome increased from to % between and . in addition, their study (king et al., ) with school counselors in australia found that % of the sample experiences burnout. given this prevalence in recent years, the study of burnout in the education sector has become increasingly important (kim and burić, ; mclean et al., a; schonfeld et al., ) . most researches pointed out the importance of burnout on teachers (kaur and singh, ; yerdelen et al., ; schonfeld et al., ) , considering it as a risk for teachers that can negatively affect effective teaching (travers, ) , their interaction with their students (travers, ) , and their motivation for the job (mclean et al., b) , resulting in absenteeism (makhdoom et al., ) , depression (martínez-monteagudo et al., ), insomnia (gu et al., ) , or a decrease in the capacity to give support to the students (zapf et al., ; jennings and greenberg, ) . despite the impact of pandemics on the health and wellbeing of citizens, and more specifically of workers, and their clear influence on working conditions, or more specifically on their psychosocial risks, there are hardly any studies that have addressed the effect of a pandemic on psychosocial risks. there are even fewer studies comparing these types of factors during a pandemic in spanish-speaking countries. although there are studies carried out within the framework of different crises, allowing for contextualization of stress situations, these do not focus on the specific case of a pandemic like the one we are facing due to covid- . this situation is even more limited if we consider the impact on teachers. likewise, the few studies traditionally available have been carried out retrospectively, ignoring their perception of the pandemic, as well as the associated psychosocial risks during the times of greatest severity. after conducting a review of the literature, we were unable to observe any studies focused on teachers that analyzed the psychosocial risks of this group and their perception of the pandemic comparing two spanish-speaking countries at different phases or moments of the pandemic. therefore, the study presented here aims to fill this gap in the literature by offering a first approach to the perception of covid- by teachers and its relationship with psychosocial risks, comparing data from spain and mexico. the main aim of this study was to analyze the perception of non-university teachers regarding measures and resources implemented by institutions and governments and its impact on their daily work. also, to analyze the psychosocial risks of these professionals and its relation to the sanitary emergency caused by covid- comparing two spanish-speaking countries, spain and mexico, at a moment where the two countries were at different phases of the pandemic. data were collected from a sample of non-university teachers ( . % women and . % men; . % from mexico and . % from spain) aged - years (m = . , sd = . ) via a selfcompleted questionnaire during the covid- pandemic from march to april . from spain, participants were aged - (m = . , sd = . ), . % of whom were women and . % were men. from mexico, participants were aged - (m = . , sd = . ), . % of whom were women and . % were men. at the beginning of the study, the research team contacted different associations and institutions of education in order to reach non-university teachers and invite them via e-mail to participate in the study. in the online invitation, teachers were informed about the purpose of the study and also about how their anonymity and confidentiality were guaranteed. the time cost of completing the questionnaire was min. the eligibility criteria for participants were as follows. inclusion criteria: (a) to be a teacher in an institution other than university. (b) to be actively working during the moment of assessment. (c) to have signed the informed consent document and confidentiality agreement within the framework of the principles of the declaration of helsinki. the research included the variables and measurement instruments: different questionnaires were used to measure demands, resources, and consequences: the unipsico battery (gil-monte, ), the burnout assessment tool (bat) (schaufeli et al., ) , and the job insecurity scale (vander elst et al., ) . the demand factors include: taken from unipsico battery (gil-monte, ). role conflict is the situation in which a worker cannot simultaneously satisfy the contradictory role expectations in which he or she is involved. the scale is composed of five items (e.g., "i receive incompatible demands from two or more people"). participants are asked to score the frequency with which they have experienced the situation described in each statement on a likert-type scale from to ( = never; = very frequently: every day), with higher scores indicating higher levels of role conflict (scores above . are considered high, whereas scores equal to or below . are considered low). the scale has obtained adequate psychometric properties in previous studies and in the present research (total sample: α = . ; mexico: α = . ; spain: α = . ). extracted from unipsico battery (gil-monte, ). lack of organizational justice is defined as the perception of the absence of reciprocity in social exchanges. the scale is made up of five items (e.g., "i give up my skin at work compared to what i receive in return"). the response format is on a likert-type scale from to ( = never; = very frequently: every day), with higher scores indicating higher lack of organizational justice (scores above . are considered high, whereas scores equal to or below . are considered low). the scale has obtained adequate psychometric properties in previous studies and in the present research (total sample: α = . ; mexico: α = . ; spain: α = . ). taken from unipsico battery (gil-monte, ). it assesses quantitative and qualitative workload on a likert-type scale from to ( = never; = very frequently: every day). quantitative workload refers to the amount of activities to be performed in a given period of time, while qualitative workload refers to the difficulty of the task and the volume of information to be processed in relation to the time available. it consists of six items, three quantitative (e.g., "is it possible for you to work at a relaxed pace?") and three qualitative (e.g., "when you are working, do you encounter particularly hard situations?"), with higher scores indicating higher workload (scores above . are considered high, whereas scores equal to or below . are considered low). the scale has obtained adequate psychometric properties in previous studies and in the present research (total sample: α = . ; mexico: α = . ; spain: α = . ). extracted from unipsico battery (gil-monte, ). it assesses the frequency ( = never; = very frequently: every day) that workers perceive conflicts coming from the hospital management, colleagues, patients, and relatives of the patient. the scale consists of six items (e.g., "how often do you have conflicts with your colleagues?"), with higher scores indicating higher interpersonal conflicts (scores above are considered high, whereas scores equal to or below . are considered low). the scale has obtained adequate psychometric properties in previous studies and in the present research (total sample: α = . ; mexico: α = . ; spain: α = . ). it was measured using the job insecurity scale (vander elst et al., ) . it consists of five items (e.g., "i feel insecure about the future of my job") designed to measure quantitative job insecurity (i.e., insecurity to lose the job as such). respondents were asked to rate these items on a -point likert-type scale, ranging from ("strongly disagree") to ("strongly agree"), with higher scores indicating higher levels of job insecurity. the scale has obtained adequate psychometric properties in previous studies and in the present research (total sample: α = . ; mexico: α = . ; spain: α = . ). the resource factors include: extracted from unipsico battery (gil-monte, ). this is defined as the availability of help from other people. it evaluates the social support offered by your head of studies, the management of the center, and by your colleagues, in all cases in the form of emotional support and technical support. it consists of six items (e.g., "how often do your colleagues help you when problems arise at work?"). this was answered on a -pont likerttype scale ( = never; = very frequently: every day), with higher scores indicating higher social support at work (scores above . are considered high, whereas scores equal to or below are considered low). the scale has obtained adequate psychometric properties in previous studies and in the present research (total sample: α = . ; mexico: α = . ; spain: α = . ). the consequence factors include: included in the unipsico battery (gil-monte, ). it assesses the frequency of occurrence of psychosomatic problems related to the perception of sources of stress at work. it consists of nine items related to different systems of the organism (e.g., "have you been worried that, without making any effort, your breathing would be cut off?"). it was answered on a -pont likert-type scale ( = never; = very frequently: every day), with higher scores indicating higher psychosomatic problems (scores above . are considered high, whereas scores equal to or below . are considered low). the scale has obtained adequate psychometric properties in previous studies and in the present research (total sample: α = . ; mexico: α = . ; spain: α = . ). it was assessed using the reduced version of the bat (schaufeli et al., ) . it consists of items that evaluate four scales: (european centre for disease prevention and control, c) exhaustion (e.g., "at work, i feel mentally exhausted"), mental distance (e.g., "at work, i have trouble staying focused"), emotional impairment (e.g., "i don't recognize myself in the way i react emotionally at work"), and cognitive impairment (e.g., "i make mistakes in my work because i have my mind on other things"). participants are asked to score the frequency that they have experienced the situation described in each statement on a likert-type scale from to ( = never; = very frequently: every day), with higher scores indicating higher levels of burnout. the instrument has obtained adequate psychometric properties in previous studies and in the present research (total sample: α = . ; mexico: α = . ; spain: α = . ). this is an ad hoc questionnaire of items constructed to measure different aspects related to the health emergency caused by the covid- . the aspects considered are: available resources (provided by the health center, regional government, and national government, e.g., "i feel that my center has put sufficient resources to deal with covid- in my daily work"), information {provided by the health center, regional government, and national government, e.g., "i consider that from the regional government [e.g., state of sinaloa (mexico)/or autonomous community (spain)] i have been given enough information to deal with covid- in my daily work"}, measures (taken by the health center, regional government, and national government, e.g., "i believe that sufficient measures have been taken by the national government to address covid- in my daily work"), and impact on work (workload, labor conflicts, work-related stress, and workrelated concerns and fears, e.g., "the covid- has increased my workload"). the subjects score on a likert-type scale his or her level of agreement or disagreement with the statements ( = totally disagree, = totally agree). scores range from to , with higher levels indicating greater satisfaction with the resources available, information, and measures taken, as well as higher levels of impact on work. the scale has obtained adequate psychometric properties ( a descriptive statistical analysis was performed for all study variables, as well as correlations and mean comparison analysis. all analyses were carried out using the statistical package spss (statistical package for the social sciences, version , armonk, ny, united states: ibm corp.). sociodemographic from the total sample of non-university teachers, were from mexico and from spain. the great majority worked in a public institute ( . %); % taught in kindergarten, as it can be seen in table , regarding psychosocial risks, that teachers in spain present medium levels on all of the psychosocial risks, whereas teachers in mexico present medium levels on lack of organizational justices and of social support and low levels on the rest of psychosocial risks. as it can be seen in table , during the pandemic, teachers in spain rated the resources, information available, and measures taken by the government and the hospital below the mean value of the answer scale, which points to a tendency to consider resources, information, and measures as insufficient. the highest scores from teachers in spain are regarding the impact of covid- on their jobs, although the scores in this case are also below the medium value of the answer scale. teachers in mexico, on the other hand, rated the resources and information available and the measures taken by government and the hospital above the mean value of the answer scale, which points to a tendency to consider resources, information, and measures as sufficient. the lowest score for teachers in mexico is the impact of covid- on their jobs. analysis of the mean comparison among the variables of the study was carried out between data from teachers in spain and mexico (table ). in general, it seems that the pandemic has a greater effect in the case of spain, since there are statistically significant differences in all dimensions except social support, with higher levels of risk and consequences in the spanish case. likewise, there is greater satisfaction with the available information, resources, and measures in the mexican case than in the spanish case, and finally, there seems to be a greater impact of the pandemic on the work and life of teachers in the spanish case in comparison with the mexican case. the results of the correlation analysis among the variables are shown in table . as it can be seen, almost all the variables are very strongly related. the only correlation that is not statistically significant is between the impact of covid- in the workplace and social support. when focusing on correlations among the variables in teachers from spain and mexico separately, the situation slightly changes ( table ). in the case of teachers in spain, many of the psychosocial risks correlate between them, except for job insecurity that does not appear related to any of the resting variables. also, from the covid- -related measures, information and measures are related with a higher number of psychosocial risks, whereas impact is less related to the rest of the variables (psychosocial risks as well as the resting covid- -related measures). on the other hand, in the case of teachers in mexico, variables are also very strongly related between them, although lack of organizational justice and job insecurity are less related to the rest of the variables. also, in contrast with the case of spain, impact appears related with the rest of the covid- -related measures. the current crisis caused by the coronavirus is a challenge not only in the health field but also in all spheres of society. in this context, professionals at all levels have had to adapt to new working conditions, in addition to dealing with the pandemic in their personal lives and as members of the community. among them, teachers of preschool and primary and secondary education have had to assume their important role in the best possible way, with limited means and resources and with the uncertainty of the moment and with the enormous responsibility that comes with educating and training children and adolescents, helping them to cope with the crisis and often providing relief as much as possible with homework and how to take school home (boletín oficial del estado, ; faro de vigo, ) . considering that teachers are vulnerable to burnout and job stress (zapf et al., ; jennings and greenberg, ; kaur and singh, ; yerdelen et al., ; travers, ; makhdoom et al., ; martínez-monteagudo et al., ; mclean et al., b; schonfeld et al., ; gu et al., ) , and therefore the negative consequences these can have on their health and professional performance (bergh et al., ; fornell et al., ; junne et al., ; european centre for disease prevention and control, d) , it is essential to study how psychosocial risks affect this group at a time of such vulnerability and general demand as the present. the literature on social risks to teachers in a pandemic context is extremely limited; however, it is critical to study the extent to which factors related to teachers' well-being may be affected during a health crisis such as the current one in order to ensure the well-being of teachers and, in turn, the children and adolescents in their care. this study has sought to explore the extent to which teachers are affected by psychosocial risks during the pandemic and how these risks relate to teachers' perceptions of the pandemic in terms of resources, measures, information, and impact. at the same time, it compares data of teachers in mexico with data of teachers in spain, two countries heavily affected by the pandemic and yet at very different stages of its development: spain in the midst of a drop in cases, mexico in the midst of a rise (european centre for disease prevention and control, d) . at the time of collecting the data, the coronavirus crisis was at its peak in spain, while in mexico, it was in a more initial phase. this facilitates the interpretation of some of the data found. the main results of the study show, on the one hand, that teachers in spain as well as teachers in mexico inform about perceiving lack of organizational justice during the pandemic but, at the same time, to perceive social support. teachers in spain, however, also inform about role conflict, workload, interpersonal conflict, psychosomatic problems, and burnout. these data go in line with previous literature about the social risks that teachers are exposed to (zapf et al., ; jennings and greenberg, ; kaur and singh, ; yerdelen et al., ; travers, ; makhdoom et al., ; martínez-monteagudo et al., ; mclean et al., b; schonfeld et al., ; gu et al., ) . regarding resources and information available about covid- , the impact of covid- on their jobs, as well as measures taken by responsible entities (national and regional government, as well as work center), data from teachers in spain point to a perception of insufficient resources, information, and measures and to a perception of a moderatehigh impact of covid- on their jobs. regarding teachers in mexico, data point to a perception of sufficient resources, information, and measures taken by responsible entities, as well as to a perception of a moderate impact of covid- on their jobs. when specifically comparing data from teachers in spain and mexico, the results highlight a difference between teachers in both countries: spanish teachers present more role conflict, lack of organizational justice, workload, interpersonal conflicts, job insecurity, psychosomatic problems, and burnout than teachers in mexico. at the same time, teachers in spain inform about less resources, information, and measures than teachers in mexico, but also about a bigger impact of covid- on their jobs, than teachers in mexico. the fact that teachers in spain are more affected by psychosocial risks during the pandemic and are more burned out by work could be due, on the one hand, to the phase of the pandemic at the time of data collection, as the pandemic situation was more severe in spain at the time that the study was conducted. however, it could also be due to the fact that teachers in spain perceive fewer resources, information, and measures taken by responsible institutions, which could in turn worsen some of the psychosocial risks and even be a direct risk factor for burnout. specifically, in terms of the relationship between psychosocial risk factors and covid- -related measures, these appear to be closely related, although it is true that in the case of teachers in spain, the relationship between covid- related measures and social risks is clearer than in the case of teachers in mexico. of the covid- -related measures, the least related to psychosocial risks is the impact of covid- on work, while of the psychosocial risks, the least related to the rest of the psychosocial risks and to covid- -related measures is job insecurity. these data indicate that teachers' perception of the measures taken by the responsible entities, as well as the perception of sufficient information and resources, could influence the psychosocial risks to which these professionals are exposed. as mentioned above, some of the differences are due, on the one hand, to the phase of the pandemic in which both countries were and, on the other hand, to the perception of resources by teachers to face the pandemic and the challenges it poses in their professional life. one of the main limitations of this study is that it presents an analysis of relationships between variables that does not allow for the establishment of causal relationships between them. furthermore, it is a cross-sectional study that does not allow for observing the evolution of the data as the pandemic caused by covid- progresses. future studies could make new measurements of the variables when the different phases of the pandemic have passed, which would allow the comparison of the variables taking into account the evolution of the health crisis, as well as the evolution of the psychosocial risks of teachers and the possible development of pathologies that, based on the scientific literature, have been related to the burnout and psychosocial risks described here. despite its limitations, this study shows data collected in a context never before seen, where data on psychosocial risks are not collected a posteriori but in the midst of a pandemic crisis. our data speak of a greater general attrition of teachers in spain, which indicates that the pandemic may indeed be related to greater sources of stress and psychosocial risks. at the same time, data from the present study underline the importance of the perception of resources by professionals, which could prevent to some extent the burnout and the possible alterations associated with it. it is difficult to carry out this type of study in these contexts for a number of reasons, but we believe that it is important to have data to support the fact that the measures taken by the responsible entities and the provision of information affect teachers not only directly but also indirectly by making them more vulnerable to psychosocial risks that could affect their health and professional performance, thus affecting students as well. if this is important in any context, it becomes even more important in a context where the emotional toll on society is more evident than ever. some of the main practical applications of this research would be to know the psychosocial risks during a pandemic in non-university teachers to discover the perception of resources, information, and measures adopted by the different public and private entities to deal with covid- , as well as to know the impact that this perception has had on the daily work of non-university teachers. these results can help make a difference between building resilience and developing burnout. any data that can clarify the relationships between the variables will be data that will benefit teachers, their students, and society in general. the results obtained in the present study allow to advance and consolidate the research on psychosocial risks during a pandemic while enabling the development of policies for action to improve teachers' coping with a pandemic and occupational health, which in turn will impact the outcomes of their work and society as a whole. the raw data supporting the conclusions of this article will be made available by the authors, without undue reservation, to any qualified researcher. ethical review and approval was not required for the study on human participants in accordance with the local legislation and institutional requirements. the patients/participants provided their written informed consent to participate in this study. vp-g made a substantial contribution to the concept and design of the work, as well as on analysis and interpretation of data, drafted the article and revised it critically for important intellectual content, approved the version to be published, and participated sufficiently in the work to take public responsibility for appropriate portions of the content. mg-d made a substantial contribution to the concept of the work and acquisition of data, revised the article, approved the version to be published, and participated sufficiently in the work to take public responsibility for appropriate portions of the content. as-r made a substantial contribution to the concept or design of the work and on interpretation of data, drafted the article and revised it critically for important intellectual content, approved the version to be published, and participated sufficiently in the work to take public responsibility for appropriate portions of the content. ld-r made a substantial contribution to the design of the work and the acquisition of data, revised the article critically for important intellectual content, approved the version to be published, and participated sufficiently in the work to take public responsibility for appropriate portions of the content. dn-m made a substantial contribution to the concept and design of the work and acquisition of data, drafted the article and revised it critically for important intellectual content, approved the version to be published, and participated sufficiently in the work to take public responsibility for appropriate portions of the content. all authors contributed to the article and approved the submitted version. burnout in the workplace: a review of the data and policy responses in the eu. eurofound a national standard for psychosocial safety climate (psc): psc as the benchmark for low risk of job strain and depressive symptoms job demands-resources theory: taking stock and looking forward self-undermining behaviour at work: evidence of construct and predictive validity tailoring psychosocial risk assessment in the oil and gas industry by exploring specific and common psychosocial risks real decreto / , de de marzo, por el que se declara el estado de alarma para la gestión de la 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scale: a psychometric evaluation across five european countries personality traits that predict the burnout syndrome on mexican teachers stress, social support, and burnout among long-term care nursing staff emergency committee regarding the outbreak of novel coronavirus ( -ncov). geneva: who who director-general's opening remarks at the media briefing on covid- relationship between turkish elementary science teachers' occupational well-being and some contextual and demographic characteristics: a multivariate analysis emotion work as a source of stress: the concept and development of an instrument we would like to thank all the teachers who have voluntarily participated in this study even though they had a high workload and stress as a result of the health emergency caused by covid- . we would also like to thank the reviewers and the editor of the journal for their valuable contributions to this paper. the authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.copyright © prado-gascó, gómez-domínguez, soto-rubio, díaz-rodríguez and navarro-mateu. this is an open-access article distributed under the terms of the creative commons attribution license (cc by). the use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. no use, distribution or reproduction is permitted which does not comply with these terms. key: cord- - r jhb authors: lakicevic, nemanja; gentile, ambra; mehrabi, samira; cassar, samuel; parker, kate; roklicer, roberto; bianco, antonino; drid, patrik title: make fitness fun: could novelty be the key determinant for physical activity adherence? date: - - journal: front psychol doi: . /fpsyg. . sha: doc_id: cord_uid: r jhb nan the benefits of physical activity (pa) are well known and are extensively delineated in the scientific literature. regular participation in pa, or exercise as its subset (structured, preplanned form of pa), is positively associated with numerous physical and psychological health benefits across all population subgroups (i.e., different age groups, gender, ethnicity, and socioeconomic status) (paterson and warburton, ; warburton and bredin, ) . the current pa guidelines for adults, proposed by the american college for sports medicine and american heart association (acsm/aha), recommend the accumulation of at least min of moderate intensity aerobic pa per week (nelson et al., ) . additionally, it is recommended that adults should engage in muscle-strengthening activities at least two times per week (garber et al., ) . despite this, sedentary behavior remains a major challenge, and insufficient pa rates have remained stable at the global level between and (guthold et al., ) . physical inactivity is the fourth leading cause of death worldwide and its annual health-care costs have been estimated at . billion us dollars in internationally (ding et al., ) . however, it has recently been shown that with sufficient pa, as many as . million premature deaths could be averted annually (strain et al., ) , and thus more needs to be done to improve engagement and maintenance of pa throughout the lifespan. the correlates and determinants of pa participation and maintenance are complex and diverse, and differ among various population subgroups (thiel et al., ; parker et al., ) . this can be best described using an ecological framework which posits that there are multiple levels of influence on an individual's pa behavior including: individual (i.e., motivation, competence, preference, and self-efficacy), environmental (including the social, natural, and built environment) and policy level factors (bauman et al., ) . it follows that these factors are the key pillars of pa adherence, which is defined as a habitual participation in pa on a voluntary basis (robison and rogers, ) . a lack of novelty regarding an individuals' exercise routine may also be a key factor contributing to low pa participation in the general population (dalle grave et al., ) . even among active individuals, continued engagement in the same exercise over time can halt progressive overload and potentially contribute to reversibility (retraction to baseline condition) (american college of sports et al., ) , and can ultimately reduce motivation to participate in pa out of boredom. this seemingly vicious cycle can possibly be tackled by introducing novel exercise regimens on a regular basis. generally, pa is distinguished in terms of the major metabolic pathway involved in energy contribution, predominantly aerobic or anaerobic. aerobic and anaerobic training have shown to have positive effects on cardiovascular health (patel et al., ) , both separately and when combined. indeed, the majority of pa modes include a mixture of both, thereby allowing participants to obtain benefits of both types of pa. additionally, the introduction of new exercises in the pa routine will lead to novel skill acquisition and mastery necessary for that particular pa (green and bavelier, ) . notably, engaging in new gestures can further develop an individual's skillset, enabling an expansion of the spectrum of pa options one can participate in. furthermore, exposing the body to a variety of novel activities leads to improvements in body composition and fitness among children (liu et al., ) and adults (wilhelm and pinto, ) . to this regards, youth who experience multiple sports, as a subset of pa, increase their scope for varied pa in adulthood and these experiences may foster an intrinsic motivation for lifelong participation (mostafavifar et al., ) . meanwhile, as the "feel good" effect of exercise is known to differ according to intensity among individuals (ekkekakis and brand, ) , varied pa participation may be an important pre-requisite for finding preferred and tolerable pa options which in turn may lead to longer term adherence. these findings underscore the importance of understanding not only the physiological effects of pa, but also the need to account for how varied pa is experienced in relation to pleasure and enjoyment. therefore, based on the aforementioned, the aim of this work is to highlight novelty as potentially a key determinant for pa adherence. few studies about the role of novelty in pa adherence exist. it is well known that intrinsic motivation predicts the pa adherence through interest (the desire to engage and expand skills), and enjoyment (the desire to have fun and pursue interest) (richard et al., ; teixeira et al., ; gardner and lally, ) . according to berlyne ( ) , novel stimuli may promote interest and enjoyment when they are simple, while familiar stimuli arouse interest when they contain variations that create complexity in movement variations (sylvester et al., ) . therefore, performing new and challenging exercises could increase enjoyment and interest while enhancing acquisition of new skills every time a new exercise is introduced. moreover, it has been recently hypothesized that the need for novelty, that is the need to experience something that stands out of the routine (gonzález-cutre et al., ), could be one of the basic psychological needs (bagheri and milyavskaya, ; fernández-espínola et al., ) . in this sense, creating programs satisfying the need for novelty, and stimulating interest and enjoyment at the same time, could also promote individuals' participation over time, through the introduction of new exercises in the pa routine, or the variation of familiar exercises (sylvester et al., ) . for example, fitness regimes such as crossfit, whereby participants are exposed to constantly varied functional movements, are shown to elicit higher levels of satisfaction and motivation for engagement (claudino et al., ) . nevertheless, since the repeated exposure to the same stimulus could lead to a decrease in interest and enjoyment, the introduction of novel exercise should be alternated with the familiar complex exercise (sylvester et al., ) . finally, enhancing intrinsic motivation through interest and enjoyment is expected to increase adherence to the pa program (richard et al., ) , leading to better health outcomes (robison and rogers, ) . one interesting outcome of performing new exercises, which also reinforces an individual's level of engagement, is the flow experience. flow experience is described as a sense of concentration and absorption, with suppression of irrelevant feelings and thoughts, resulting in a deep engagement in that activity (csikszentmihalyi and csikszentmihalyi, ; csikszentmihalyi, ) . this state is also related to future involvement in the same situation, and can lead to increased autonomous motivation, and a reduction of boredom. in a recent study by swann et al. ( ) , the authors explored the predictors of flow state in athletes, and found that this phenomenon is more likely to occur in the context of novelty, exploration, and flexible outcomes. therefore, flow state is induced when exercises are new, or are presented with some variations, and when low pressure or importance is placed on the outcome. in summary, the exercise features that may lead to sustained high pa engagement include novelty, challenging variation of familiar exercises, and flexible outcomes. engagement in long-term pa has many psychological, psychosocial and physical health benefits (both et al., ; warburton and bredin, ) . however, individuals' pa participation often decreases over time due to various environmental or personal factors (calvo et al., ) . one critical determinant ensuring long-term engagement in pa could be the reinforcement of intrinsic motivation, through interest and enjoyment. physical activity regimens comprised of new exercises or varying familiar exercises could rise participants' interest and enjoyment and enhance their adherence to pa, ultimately leading to better health. for example, interactive video-game systems that combine gaming and pa (also known as exergames), and exercise programs delivered via digital platforms (e.g., smartphone apps) also are plausible alternative strategies to encourage pa participation, and improve quality of life (sween et al., ; romeo et al., ) . exergaming through novel mediums such as virtual reality (vr), and digital behavior change apps provide a multisensory and immersive environment that is customizable to the user's functional abilities and personal preferences, and thus may increase motivation for regular pa participation or enhanced adherence (albergoni et al., ; ng et al., ; stockwell et al., ; bonato et al., ) . for individuals reluctant to participate in pa, the interactive environment of exergames can create a distraction from negative thoughts about pa and encourage the individual to participate in a non-traditional environment (molina et al., ; street et al., ) . further, apps that include social networking and media sites offer the additional benefits of social interaction and support shown to increase pa enjoyment and adherence (ferrer and ellis, ; petersen et al., ) . these platforms may be particularly useful in the current era of the covid- pandemic where governments around the world have imposed quarantine measures to reduce the risk of covid- infection which inevitably leads to lower pa levels in the overall population (lakicevic et al., ) , particularly among those who were already inactive (hall et al., ) . even though the long-term of effects of covid- will not be fully understood for some time, this health crisis has the potential to further impact and accelerate the existing physical inactivity pandemic (hall et al., ) . for this reason, acsm recently published pa guidelines emphasizing the importance of staying active while taking precautions to ensure safety in the midst of the covid- pandemic (denay et al., ) . physicians represent a key figure in the dissemination of pa recommendations to a broad segment of the population, with evidence that those who are guided to perform exercise by their physician, perform more moderate-to-vigorous intensity pa than those who do not receive any exercise prescription (taylor, ) . this can be particularly important for older individuals who are less likely to engage in pa, compared to their younger counterparts (gavin et al., ) . where an individual has previously acquired knowledge regarding safe, functional, and simple pa, medical clearance or a health appraisal prior to engaging in novel forms of pa might not be necessary. it is important to note that not all age groups will show the same level of eagerness to engage in a new form of pa (gavin et al., ) . instead, varying the intensity may provide the stimulus and novelty required to increase pa adherence and elicit significant health benefits. one plausible approach might be interval training, whereby the intensity of movement is intermittently varied. studies have shown that interval training can improve enjoyment (stork et al., ) , affective response (niven et al., in press) , and mental and physiological adaptations (martland et al., ) in comparison to continuous moderate intensity exercise. finally, enjoyment is an important factor mediating the level of pa adherence (wankel, ; jekauc, ) . knowing that non-communicable diseases are the leading threat to public health on a global scale (thornton et al., ) , the importance of regular pa, as a therapeutic agent tackling non-communicable diseases, cannot be overestimated. to increase the overall population rate of adherence to acsm/aha guidelines, we believe that novelty can play a key part in helping individuals reach these recommendations. accordingly, physicians, researchers, and practitioners should place a special emphasis on novelty, as, potentially, one of 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