Stress overload in the spread of coronavirus.
TL;DR: Assessment of stress overload is proposed as essential to understanding viral spread in the current pandemic, and the 10-item Stress Overload Scale-Short is offered as a potentially useful tool for researchers and clinicians working to map, and stem, the proliferation of coronavirus.
Abstract: Background and Objectives: The incidence of novel coronavirus infection across the globe has been uneven, hitting some population subgroups harder than others. Media coverage has proffered explanations for this differential vulnerability, but psychosocial risk factors have been largely ignored. In contrast, multiple theories, medical and psychological, point to one psychosocial factor - stress - as important to the etiology of disease. They also agree that pathogenic stress arises from the particular circumstance in which adaptational demands overwhelm a person's resources, creating "stress overload" that deregulates normal functioning and increases susceptibility to illness. Assessment of stress overload is proposed as essential to understanding viral spread in the current pandemic.Methods: Studies are reviewed explicating (1) stress overload theories and relevant empirical evidence, (2) construction of a stress overload measure and related validity evidence.Results: Findings support the role of stress overload in illness and the accuracy of the measure in predicting illness.Conclusion: It is concluded that assessment of stress overload may help to explain the observed coronavirus disparities, and to identify populations at risk for imminent infection. The 10-item Stress Overload Scale-Short is offered as a potentially useful tool for researchers and clinicians working to map, and stem, the proliferation of coronavirus.
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TL;DR: In this paper, the authors examined associations among COVID-related stress, sleep quality, and mental health, and found that COVIDrelated stressors were associated with both anxiety and depression, and these associations were mediated by sleep disturbances.
31 citations
TL;DR: In this article, the authors review recent research trends like virtual reality, pre-recordings and online adaptations regarding their usefulness for established stress induction paradigms and propose new experimental variations that may advance procedures as well as the conceptualization of stress itself.
17 citations
TL;DR: This article applied a control-based model of coping to contribute to the development of evidence-based interventions to promote resilience in the COVID-19 pandemic in the U.S. and globally.
Abstract: The COVID-19 pandemic has brought unprecedented levels of stress to individuals in the U.S. and throughout the world. These high stress levels place individuals at risk for symptoms of anxiety, depression, and other psychiatric disorders. The current study applies a control-based model of coping to contribute to the development of evidence-based interventions to promote resilience. Data were collected online from April 22 through July 12, 2020. Data from two samples of U. S. community adults who completed an online battery of standardized questionnaires were combined (N = 709). More than a quarter reported moderate to severe levels of depression symptoms, and more than one-fifth reported moderate to severe levels of anxiety symptoms; symptom levels were higher among adults who reported more COVID-19-related stress. As hypothesized, multiple regression analyses indicated that greater use of primary and secondary control coping was associated with lower symptom levels, whereas greater use of disengagement coping was associated with higher symptom levels, above and beyond the association of stress with symptoms. Race and ethnicity emerged as important moderators of these associations, indicating that what constitutes adaptive coping varies according to characteristics of the individual. Implications for public health policy and clinical practice are discussed.
15 citations
TL;DR: In this paper , the authors identified COVID-19 cases and severity (hospitalization, intensive care, and death) in a large, diverse HIV cohort during March 1, 2020-December 31, 2020.
Abstract: Understanding the spectrum of COVID-19 in people with HIV (PWH) is critical to provide clinical guidance and risk reduction strategies.Centers for AIDS Research Network of Integrated Clinic System, a US multisite clinical cohort of PWH in care.We identified COVID-19 cases and severity (hospitalization, intensive care, and death) in a large, diverse HIV cohort during March 1, 2020-December 31, 2020. We determined predictors and relative risks of hospitalization among PWH with COVID-19, adjusted for disease risk scores.Of 16,056 PWH in care, 649 were diagnosed with COVID-19 between March and December 2020. Case fatality was 2%; 106 (16.3%) were hospitalized, and 12 died. PWH with current CD4 count <350 cells/mm 3 [aRR 2.68; 95% confidence interval (CI): 1.93 to 3.71; P < 0.001] or lowest recorded CD4 count <200 cells/mm 3 (aRR 1.67; 95% CI: 1.18 to 2.36; P < 0.005) had greater risks of hospitalization. HIV viral load and antiretroviral therapy status were not associated with hospitalization, although most of the PWH were suppressed (86%). Black PWH were 51% more likely to be hospitalized with COVID-19 compared with other racial/ethnic groups (aRR 1.51; 95% CI: 1.04 to 2.19; P = 0.03). Chronic kidney disease, chronic obstructive pulmonary disease, diabetes, hypertension, obesity, and increased cardiovascular and hepatic fibrosis risk scores were associated with higher hospitalization risk. PWH who were older, not on antiretroviral therapy, and with current CD4 count <350 cells/mm 3 , diabetes, and chronic kidney disease were overrepresented among PWH who required intubation or died.PWH with CD4 count <350 cells/mm 3 , and a history of CD4 count <200 cells/mm 3 , have a clear excess risk of severe COVID-19, accounting for comorbidities associated with severe outcomes. PWH with these risk factors should be prioritized for COVID-19 vaccination and early treatment and monitored closely for worsening illness.
15 citations
Adrienne E Shapiro, Rachel A Bender Ignacio, Bridget M. Whitney, Joseph A C Delaney, Robin M. Nance, Laura Bamford, Darcy Wooten, Jeanne C. Keruly, Greer A. Burkholder, Sonia Napravnik, Kenneth H. Mayer, Allison R. Webel, H. Nina Kim, Stephen E. Van Rompaey, Katerina A. Christopoulos, Jeffrey M. Jacobson, Maile Ay Karris, Davey Smith, Mallory O. Johnson, Amanda L. Willig, Joseph J. Eron, Peter W. Hunt, Richard D. Moore, Michael S. Saag, W. Christopher Mathews, Heidi M. Crane, Edward R. Cachay, Mari M. Kitahata
TL;DR: PWH who were older, not on antiretroviral therapy, and with current CD4 count <350 cells/mm3, diabetes, and chronic kidney disease were overrepresented among PWH who required intubation or died, accounting for comorbidities associated with severe outcomes.
Abstract: Supplemental Digital Content is Available in the Text. Background: Understanding the spectrum of COVID-19 in people with HIV (PWH) is critical to provide clinical guidance and risk reduction strategies. Setting: Centers for AIDS Research Network of Integrated Clinic System, a US multisite clinical cohort of PWH in care. Methods: We identified COVID-19 cases and severity (hospitalization, intensive care, and death) in a large, diverse HIV cohort during March 1, 2020–December 31, 2020. We determined predictors and relative risks of hospitalization among PWH with COVID-19, adjusted for disease risk scores. Results: Of 16,056 PWH in care, 649 were diagnosed with COVID-19 between March and December 2020. Case fatality was 2%; 106 (16.3%) were hospitalized, and 12 died. PWH with current CD4 count <350 cells/mm3 [aRR 2.68; 95% confidence interval (CI): 1.93 to 3.71; P < 0.001] or lowest recorded CD4 count <200 cells/mm3 (aRR 1.67; 95% CI: 1.18 to 2.36; P < 0.005) had greater risks of hospitalization. HIV viral load and antiretroviral therapy status were not associated with hospitalization, although most of the PWH were suppressed (86%). Black PWH were 51% more likely to be hospitalized with COVID-19 compared with other racial/ethnic groups (aRR 1.51; 95% CI: 1.04 to 2.19; P = 0.03). Chronic kidney disease, chronic obstructive pulmonary disease, diabetes, hypertension, obesity, and increased cardiovascular and hepatic fibrosis risk scores were associated with higher hospitalization risk. PWH who were older, not on antiretroviral therapy, and with current CD4 count <350 cells/mm3, diabetes, and chronic kidney disease were overrepresented among PWH who required intubation or died. Conclusions: PWH with CD4 count <350 cells/mm3, and a history of CD4 count <200 cells/mm3, have a clear excess risk of severe COVID-19, accounting for comorbidities associated with severe outcomes. PWH with these risk factors should be prioritized for COVID-19 vaccination and early treatment and monitored closely for worsening illness.
15 citations
References
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01 Jan 1974TL;DR: In this paper, the authors present a detailed theory of psychological stress, building on the concepts of cognitive appraisal and coping, which have become major themes of theory and investigation in psychology.
Abstract: Here is a monumental work that continues in the tradition pioneered by co-author Richard Lazarus in his classic book Psychological Stress and the Coping Process. Dr. Lazarus and his collaborator, Dr. Susan Folkman, present here a detailed theory of psychological stress, building on the concepts of cognitive appraisal and coping which have become major themes of theory and investigation. As an integrative theoretical analysis, this volume pulls together two decades of research and thought on issues in behavioral medicine, emotion, stress management, treatment, and life span development. A selective review of the most pertinent literature is included in each chapter. The total reference listing for the book extends to 60 pages. This work is necessarily multidisciplinary, reflecting the many dimensions of stress-related problems and their situation within a complex social context. While the emphasis is on psychological aspects of stress, the book is oriented towards professionals in various disciplines, as well as advanced students and educated laypersons. The intended audience ranges from psychiatrists, clinical psychologists, nurses, and social workers to sociologists, anthropologists, medical researchers, and physiologists.
37,447 citations
TL;DR: The Perceived Stress Scale showed adequate reliability and, as predicted, was correlated with life-event scores, depressive and physical symptomatology, utilization of health services, social anxiety, and smoking-reduction maintenance and was a better predictor of the outcome in question than were life- event scores.
Abstract: This paper presents evidence from three samples, two of college students and one of participants in a community smoking-cessation program, for the reliability and validity of a 14-item instrument, the Perceived Stress Scale (PSS), designed to measure the degree to which situations in one's life are appraised as stressful. The PSS showed adequate reliability and, as predicted, was correlated with life-event scores, depressive and physical symptomatology, utilization of health services, social anxiety, and smoking-reduction maintenance. In all comparisons, the PSS was a better predictor of the outcome in question than were life-event scores. When compared to a depressive symptomatology scale, the PSS was found to measure a different and independently predictive construct. Additional data indicate adequate reliability and validity of a four-item version of the PSS for telephone interviews. The PSS is suggested for examining the role of nonspecific appraised stress in the etiology of disease and behavioral disorders and as an outcome measure of experienced levels of stress.
23,500 citations
TL;DR: This report defines a method which achieves etiologic significance as a necessary but not sufficient cause of illness and accounts in part for the time of onset of disease and provides a quantitative basis for new epidemiological studies of diseases.
10,629 citations
TL;DR: A new stress model called the model of conservation of resources is presented, based on the supposition that people strive to retain, project, and build resources and that what is threatening to them is the potential or actual loss of these valued resources.
Abstract: Major perspectives concerning stress are presented with the goal of clarifying the nature of what has proved to be a heuristic but vague construct. Current conceptualizations of stress are challenged as being too phenomenological and ambiguous, and consequently, not given to direct empirical testing. Indeed, it is argued that researchers have tended to avoid the problem of defining stress, choosing to study stress without reference to a clear framework. A new stress model called the model of conservation of resources is presented as an alternative. This resource-oriented model is based on the supposition that people strive to retain, project, and build resources and that what is threatening to them is the potential or actual loss of these valued resources. Implications of the model of conservation of resources for new research directions are discussed.
9,782 citations
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TL;DR: This study takes involuntary job disruptions as illustrating life events and shows how they adversely affect enduring role strains, economic strains in particular, which erode positive concepts of self, such as self-esteem and mastery.
Abstract: This study uses longitudinal data to observe how life events, chronic life strains, self concepts, coping, and social supports come together to form a process of stress. It takes involuntary job disruptions as illustrating life events and shows how they adversely affect enduring role strains, economic strains in particular. These exacerbated strains, in turn, erode positive concepts of self, such as self-esteem and mastery. The diminished self-concepts then leave one especially vulnerable to experiencing symptoms of stress, of which depression is of special interest to this analysis. The interventions of coping and social supports are mainly indirect; that is, they do not act directly to buffer depression. Instead, they minimize the elevation of depression by dampening the antecedent process.
5,694 citations