Flexibility predicts chronic anxiety and depression during the first year of the COVID-19 pandemic—A longitudinal investigation of mental health trajectories.

Abstract

Objective: The COVID-19 pandemic is a significant stressor, potentially putting the well-being of the general population at risk. However, a significant proportion of the population exhibits resilience, raising questions regarding psychological constructs that could contribute to resilient coping. Studies indicate that flexibility, defined as the ability to adapt to changing contextual demands by employing various emotional, cognitive, and behavioral strategies, may significantly contribute to coping with long-term stressors such as COVID-19. Method: Cognitive and coping flexibility domains and longitudinal trajectories of anxiety and depression were assessed at three-time points across 13 months in 571 Israelis. Results: Analyses revealed four different trajectories for anxiety: resilient (66%), chronic (22%), emerging (7%), and improving (6%), and two trajectories for depression: resilient (87%) and chronic (13%). Individuals in the chronic trajectory group (for both anxiety and depression) exhibited lower cognitive flexibility and coping flexibility levels than individuals in the resilient trajectory group. Across time, anxiety and depression were linked to clinically significant posttraumatic stress disorder-like symptoms. Conclusions: Low cognitive and coping flexibility are linked to the probability of experiencing chronic mental health problems, making them a potential target for prevention and treatment. Clinical Impact StatementThe COVID-19 pandemic is a multidimensional long-term stressor, potentially putting the well-being of the general population at risk. However, a significant proportion of the population exhibits resilience, raising questions regarding psychological constructs that could contribute to resilient coping. Analyses of anxiety and depression trajectories across time revealed that, while most of the population exhibits resilience, a substantial percentage of participants experiences chronically elevated levels of depression and anxiety, further characterized by high posttraumatic stress disorder-like symptoms. Cognitive and coping flexibility emerged as significant predictors of resilience, suggesting that training cognitive and coping flexibilities may help individuals respond better to psychosocial stressors.

Individual, social and societal resilience factors in the face of societal challenges and crises: A systematic review of adult populations from OECD member states

“…In contrast to consistent calls for more research into resilience mechanisms 6,9,14,77,78 , such research is still almost absent. Research into different aspects of flexibility 33,34,72 might be interpreted as such a higher-level individual resilience mechanism, while research into social and societal resilience mechanisms is missing in studies on individual responses to societal challenges.…”

Regulatory flexibility and school climate moderate the relationship between stress exposure and depression severity in school educators

“…The Perceived Ability to Cope with Trauma (PACT) 43 is a 20-item questionnaire that measures the ability to cope and apply various regulatory strategies flexibly on a 7-point scale ranging from 1 (unable) to 7 (extremely able). The scale's internal consistency in the current study was α = 0.91.…”

“…Studies on first responders and the general population that examined regulatory flexibility have demonstrated a significant link between low levels of regulatory flexibility and elevated levels of depression 43 , 44 . Moreover, it was found that regulatory flexibility moderates the relationship between traumatic exposure and the tendency to develop PTSD symptoms among first responders.…”

A nation at (ongoing) war: The effect of societal and intrapersonal coping on symptoms of continuous traumatic stress.

“…It has been demonstrated that a combination of trauma focused coping and forward focused coping predicts optimal adjustment following traumatic events [37]. This has been demonstrated in acute traumatic events (such as after 9/11) [38], general trauma exposures [39] and also during COVID-19 [40]. On the other hand, there is evidence that in states of CTS, forward focused coping may be more predictive of a resilience to PTSD symptoms [18].…”