Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID- 19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. Psychiatry Research Communications 3 (2023) 100126 Contents lists available at ScienceDirect Psychiatry Research Communications journal homepage: www.sciencedirect.com/journal/Psychiatry-Research-Communications Social connectedness and resilience post COVID-19 pandemic: Buffering against trauma, stress, and psychosis Alena Gizdic a, *, Tatiana Baxter b, Neus Barrantes-Vidal a, c, d, Sohee Park b a Department of Clinical and Health Psychology, Universitat Autonoma de Barcelona, Barcelona, Spain b Department of Psychology, Vanderbilt University, Nashville, TN, USA c Sant Pere Claver – Fundacio Sanit aria, Barcelona, Spain d Centro de Investigaci on Biomedica en Red de Salud Mental, Instituto de Salud Carlos III, Barcelona, Spain A R T I C L E I N F O A B S T R A C T Handling Editor: Dr. Leonardo Fontenelle The present study investigated psychosocial predictors of psychosis-risk, depression, anxiety, and stress in Croatia two years after the onset of the COVID-19 pandemic. Given the existing transgenerational war trauma and Keywords: associated psychiatric consequences in Croatian population, a significant pandemic-related deterioration of Post COVID-19 mental health was expected. Recent studies suggest that after an initial increase in psychiatric disorders during the Social connectedness pandemic in Croatia, depression, stress, and anxiety rapidly declined. These findings highlight the role of social Resilience connectedness and resilience in the face of the global pandemic. We examined resilience and psychiatric disorder Trauma Psychosis risk in 377 Croatian adults using an anonymous online mental health survey. Results indicate that there was an Mental health exacerbation of all mental ill health variables, including depression, anxiety, stress, and a doubled risk for psy- chosis outcome post-COVID pandemic. Stress decreased levels of resilience, however, those exposed to previous traumatic experience and greater social connectedness had higher resilience levels. These findings suggest that individual differences in underlying stress sensitization of Croatian population due to past trauma may continue to influence mental health consequences two years after COVID-19 pandemic. It is essential to promote the importance of social connectedness and resilience in preventing the development of variety of mental health disorders. 1. Introduction COVID-19 patients (Taquet et al., 2021; Desai et al., 2021; Cao et al., 2022). One year post-pandemic, an increased prevalence of fatigue, sleep The COVID-19 pandemic has severely disrupted every aspect of daily problems, memory loss, and concentration difficulties was reported life, resulting in countless economic, social, and behavioral changes. Two globally (Boscolo-Rizzo et al., 2021; Liu et al., 2022; Han et al., 2022), as years after the outbreak of the COVID-19 pandemic, research has pri- well as a persistent increase in anxiety, stress, and depression (Lakhan marily focused on elucidating the effects of the first pandemic wave on et al., 2020; Brooks et al., 2020; Shah et al., 2021; Joshi et al., 2021; general and mental health (Orfei et al., 2022; Taylor et al., 2021; Penninx Pierce et al., 2020; Meaklim et al., 2023), and psychotic-like symptoms et al., 2022). Numerous studies have reported substantial increases in (Lim et al., 2020; Taquet et al., 2021; Brown et al., 2020; Wu et al., 2021). psychiatric morbidity, including anxiety, depression, insomnia, and Even after the lockdown restrictions were eased, general physical and post-traumatic stress disorder (PTSD) (Wang et al., 2020; Goldberg et al., mental health has deteriorated since the beginning of COVID-19 (Patel 2022; Raina et al., 2021), as well as a dramatic increase in loneliness and et al., 2022; Vadivel et al., 2021). psychosis prevalence (Carvalho et al., 2020), which has further eluci- Furthermore, a number of studies across the globe have also identi- dated the role of loneliness as a significant and important risk factor for fied a variety of risk factors for psychosis during the COVID-19 pandemic, psychosis-risk (Gizdic et al., 2022; Tso and Park, 2020). The development including younger age, female gender identity, unemployment, loneli- of psychotic symptoms, depression, stress, and anxiety symptoms in in- ness, and a history of trauma (Tso and Park, 2020; Dean et al., 2021; dividuals with no history of psychiatric disorders is supported by evi- Bauer et al., 2021; Lee et al., 2021; Proto and Quintana-Domeque, 2021). dence indicating an increased incidence of first-case psychopathology in Previous exposure to trauma, in particular, is predicted to increase the * Corresponding author. E-mail addresses: gizdic.alena@gmail.com (A. Gizdic), sohee.park@vanderbilt.edu (S. Park). https://doi.org/10.1016/j.psycom.2023.100126 Received 7 February 2023; Received in revised form 24 April 2023; Accepted 25 April 2023 2772-5987/© 2023 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). A. Gizdic et al. Psychiatry Research Communications 3 (2023) 100126 prevalence of psychopathology and mental disorders during COVID-19 was distributed via online platforms and channels (such as the university (Gizdic et al., 2022), given that trauma is widely predictive of nearly emailing lists, social media platforms etc.) and in person. Before starting all subclinical and clinical psychopathology and negative outcomes (Lu the survey, participants were informed of the study goals and aims, et al., 2013; Aux emery, 2012). Although the intensity of trauma triggers introduced to the type of questions and amount of time for completion of may diminish over time (Howell et al., 2015), it is important to consider the study, as well as their ability to stop at any time. Participation was their continued association with poor wellbeing, particularly among anonymous, voluntary, and open to everyone aged 18 and up (detailed in Croatians who have experienced war and natural disasters (e.g., earth- Gizdic et al., 2022). The survey took an average of 17 min to complete quakes). War-related trauma and post-traumatic reminders have had a (74%). Data collection occurred between February and May 2022, devastating and lasting effect on the mental health and quality of life of following two peak waves of the COVID-19 pandemic (1.7 years after this population (Babic-Banaszak et al., 2002; Vukojevic et al., 2020; data collection during the first wave; survey 1 ran from July to September Jeftic et al., 2021). Specifically, the first wave of the COVID-19 pandemic 2020; Gizdic et al., 2022). This study received exempt status from the increased the prevalence of nearly all psychopathology symptoms in Vanderbilt University Institutional Review Board (Vanderbilt IRB exempt Croatia (Jokic Begic et al., 2020; Gizdic et al., 2022). Surprisingly, these #200337). rates decreased after a few months (from May to July 2020), when re- strictions were partially relaxed (Ajdukovic et al., 2020). In comparison 2.2. Measures to other European countries (and parts of Asia), Croatia seemed to have a relatively lower incidence of depression, stress, and anxiety (Newby Following the previous survey (Gizdic et al., 2022), we repeated the et al., 2020; Park et al., 2020; Rossi et al., 2020). Although continuous same patterns of questions with slight modifications and addition of new increases in symptoms were anticipated through 2020, these results are scales. The present survey consisted of 159 questions regarding partici- suggestive of high levels of resilience and adaptability among this pop- pant demographics, COVID-19 concern, general and mental health, ulation throughout the pandemic. including well-validated mental health measures of depression, anxiety, As a result, researchers have examined the concept of resilience and stress, psychosis, social connectedness, and social isolation. We also discovered that it may serve as a protective factor not only against trauma inquired about COVID-19 vaccination hesitancy, resilience, and exposure exposures but also against the development of psychopathology symp- to trauma. toms (Pietrzak et al., 2011), despite the fact that patterns of vulnerability General information regarding COVID-19 diagnosis, concern, vacci- levels vary among individuals (Sominsky et al., 2020). Psychological nation, and dosage, was requested to examine the overall effects of the resilience is an active, process-oriented defense mechanism that appears pandemic on participants’ daily lives. Ratings were given with appro- to be derived in part from having meaningful, supportive, and functional priate responses to each item (i.e., for level of COVID concern, questions social networks. For instance, individuals with a higher degree of social were scored on a 4-point Likert scale, ranging from 0¼not at all concerned connectedness and a lower level of loneliness tend to have a higher level to 4¼extremely concerned). Participants self-reported the changes in their of general wellbeing and are better protected against mental health issues current living situation, employment, number of days feeling positive during the COVID-19 pandemic (Lee et al., 2021; Killgore et al., 2020; emotions (love, happiness, and hope), as well as changes in their general Groarke et al., 2020). However, social connectedness appears to be an health. To better understand previous trauma exposures, we included especially important protective factor among trauma survivors. In some questions asking about adversity in childhood–emotional, physical, and cases, individuals within a traumatized group become more resilient to sexual abuse; emotional and physical neglect; and included the Brief adversity to the extent that their functioning is sometimes enhanced Trauma Questionnaire (BTQ; Schnurr et al., 2002)–a 10-item, self-report following exposure to adversity (Ayed et al., 2019; Finstad et al., 2021). questionnaire that asks general trauma questions (e.g., Have you ever been During stressful and uncertain events, for instance, people tend to imitate in an active war zone or served in a job that exposed you to war-related ca- the behavior and emotions of those around them (Duan et al., 2019), sualties?) with follow up questions rating the severity of each traumatic indicating that there is a collective social impulse that protects us. The event endorsed (e.g., If so, did you think your life was in danger or were you 2020 study by Vukojevic et al. suggested that, when people are together possibly seriously injured?). in a catastrophic situation, the catchphrase "we are in this together" has a The Short Scale for Measuring Loneliness (the UCLA Loneliness-short; deeper meaning due to the protective effect of crowd influence on our Hughes et al., 2004) was used to assess subjective feelings of loneliness psyche. A possible explanation can be found in the Croatian experience of and social isolation; the Social Network Index (SNI; Cohen, 1997) was war (as well as the recent earthquake). Shared pain during a shared used to assess social connectedness including social network quality, size, experience of disaster can unite people and inspire them to help each and diversity (e.g., number of social high contact roles, embedded social other, which promotes solidarity and increases social resilience, ulti- networks, and regular people contacts); depression, anxiety, and stress mately resulting in better mental health outcomes (Bastian et al., 2014; subscales was assessed with Depression, Anxiety and Stress Scale – Garcia and Rime, 2019). According to Bastian et al. (2014) study, shared 21-item version (DASS-21; Lovibond and Lovibond, 1995), and psychosis pain can increase cooperation and social bonding by acting as "social risk and distress was assessed with the Prodromal Questionnaire-16 glue." (PQ-16; Ising et al., 2012). In this study, we investigated a) psychosocial predictors of general We also included a measure of vaccination hesitancy (adult Vaccine and mental health in the Croatian population two years after the COVID- Hesitancy Scale, aVHS; Akel et al., 2022) asking participants about their 19 pandemic, and b) the role of mental health status and social own hesitancy and perceptions of effectiveness, reliability, and potential connectedness in influencing resilience among Croatian individuals. We risks of vaccinations (e.g., Vaccines are important to my health). The re- hypothesized based on our previous research (Gizdic et al., 2022), mental sponses were rated on a 5-point Likert scale ranging from strongly disagree health symptomatology and social connectedness would play a signifi- to strongly agree. We added the 4-item Brief Resilient Coping Scale (BRCS; cant role in resilience levels, particularly among those who had experi- Sinclair and Wallston, 2004), which assesses participants’ levels of enced trauma in the past. resilience (i.e., successful recovery from stressful situations). 2. Methods 2.3. Statistical analysis 2.1. Participants and procedures Descriptive statistics were used to assess participants' health, trau- matic experiences, COVID-19 concern, and vaccination hesitancy. To All participants were Croatian adults (aged 18 and above) who achieve the first study goal, hierarchical linear regressions were per- completed an online survey created via Survey Monkey in Croatian that formed that examined the role of psychosocial predictors, loneliness, 2 A. Gizdic et al. Psychiatry Research Communications 3 (2023) 100126 vaccination hesitancy, resilience, and social networks, in determining Table 1 general and mental health. In the first step, independent variables for Demographic information. age, gender, social distancing adherence, childhood abuse and neglect, N (Total) M (SD) Range general traumas, and COVID-19 concern were used to form the basic Age 377 29.40 (12.31) 18–78 model. In the second step, the full model included social network di- N % versity, size, embedded social networks, loneliness, vaccination hesi- Gender tancy, and resilience. For each dependent variable (e.g., self-reported Male 85 22.5 general health, days feeling happy, feeling hopefully, and loving, DASS Female 292 77.5 Education depression, stress, and anxiety, and PQ-scores), the change in R2 between Elementary school 1 0.3 the basic model and full model was used to examine whether adding High school 134 35.5 social network variables, loneliness, and/or vaccination hesitancy and Technical school 15 4.0 resilience explained more variance after controlling for age, gender, Bachelor's degree 101 26.8 Master's degree 89 23.6 trauma, social distancing, and COVID concern. Doctoral degree 31 8.2 To achieve the second goal of the study, we again tested the re- Other 3 0.8 lationships between resilience, trauma, social networks, loneliness, Prefer not to answer 3 0.8 vaccination, and mental health variables. However, to gain further clarity Employment status on the role and directionality of resilience as a factor in wellbeing, we Full time (including full time students) 214 56.8 Part time ((including part time students) 40 10.6 repeated the regression analysis but used resilience as a dependent var- Unemployed 56 14.9 iable to examine whether psychosocial variables predict the levels of Retired 8 2.1 resilience. In the first step, the same independent variables as in the Other 59 15.6 previous model were entered (e.g., age, gender, etc.) as a basic model. In Healthcare Worker Yes 31 8.2 the second step, social network diversity, social network size, and No 237 62.9 embedded social networks, as well as loneliness, vaccination hesitancy, n/a 109 28.9 DASS scales, and PQ total and distress, were included in the full model. Current Living situation After controlling for age, gender, traumas, social distancing, and COVID Living alone 43 11.4 concern, the change in R2 between models was used to determine if Living with friends/roommates 38 10.1 Living with partner 40 10.6 adding social network variables, loneliness, vaccination hesitancy, DASS Living with family 237 62.9 scales, and PQ total and distress explained more variance in resilience. A Homeless 1 0.3 Bonferroni correction of p < 0.0045 was applied to both analyses to Other 5 1.3 minimize Type I Errors. General Health Poor 11 2.9 Fair 37 9.8 3. Results Good 69 18.3 Very good 156 41.4 A total of 377 Croatian adults (78% females; mean age ¼ 29.2, SD ¼ Excellent 71 18.8 12.31) participated in the study. Table 1 displays descriptive statistics for n/a 33 8.8 Medical Condition all study variables. Two years after the pandemic, participants reported Yes 23 6.1 overall good general health (42%), but they were still concerned with the No 321 85.1 pandemic (54%). 57% of participants received a COVID-19 vaccination, n/a 33 91.2 with a slight decrease in average general health before (mean ¼ 2.31; SD Mental Health Diagnosis Yes 112 29.7 ¼ 1.02) and after vaccination (mean ¼ 2.29; SD ¼ 1.24). Overall, par- No 264 70.0 ticipants reported a relatively high number of days when they felt love, n/a 1 0.3 happiness, or hope (Table 2). Questions assessing social connectedness, COVID Diagnosis levels of loneliness and social isolation, and resilience were completed by Yes 192 50.9 approximately 83-86% of participants, whereas the DASS was completed No 137 36.3 I do not know 15 4.0 by 79% of participants and the PQ-16 was completed by 77% of partic- n/a 33 8.8 ipants, of whom 28% were at high risk for psychosis (see Table 3). COVID-19 concern In the first goal of the study, we examined the psychosocial predictors Not concerned 76 20.2 of health two years after the first wave of the pandemic. Concern with Somewhat concerned 203 53.8 Moderately concerned 54 14.3 COVID, childhood abuse and neglect, general trauma, loneliness, and Extremely concerned 11 2.9 vaccination hesitancy were negatively associated with general health n/a 33 8.8 status. On the other hand, SNI embedded social network and resilience COVID-19 Vaccination were positively associated with overall general health. COVID concern, Yes 214 56.8 age, and loneliness decreased the number of days when participants felt No 130 34.5 n/a 33 8.8 happy. Loneliness decreased the number of days when the participants General Health Post-vaccination felt hopeful and loving. SNI embedded social network and resilience both Not vaccinated 130 34.5 increased the number of days feeling happy and hopeful. Social Poor 3 0.8 distancing, SNI high contact role, and resilience all increased the number Fair 10 2.7 Good 52 13.8 of days when participants felt love. Furthermore, age and resilience were Very good 84 22.3 found to be negatively associated with DASS depression, DASS stress, and Excellent 65 17.2 DASS anxiety. Childhood abuse and neglect, loneliness, and COVID n/a 33 8.8 concern were found to be positively associated with DASS stress. Only COVID-19 Vaccination childhood abuse and neglect and loneliness were linked to depression Yes 214 56.8 No 130 34.5 and anxiety symptoms from DASS. With respect to psychosis-risk, there n/a 33 8.8 was a negative relationship between age and psychosis symptoms and Trauma Experience related distress. In contrast, there was a positive association between (continued on next page) psychosis symptoms (PQ-16 score) and the following: childhood abuse 3 A. Gizdic et al. Psychiatry Research Communications 3 (2023) 100126 Table 1 (continued ) resilience–a particularly relevant topic for the Croatian population given N (Total) M (SD) Range the country's previous transgenerational war trauma and natural di- sasters. Although most participants reported good general health and an Childhood abuse and neglect 0 (no trauma) 133 40.1 increase in the number of days, they felt positive emotions compared to 1 (single) 62 18.7 our previous study (Gizdic et al., 2022), the current findings show that 2 59 17.8 people are still concerned about the COVID-19 pandemic, even two years 3 58 17.5 after the first wave. There was a higher level of vaccination hesitancy 4 20 6.0 within this population. Nonetheless, according to Think Global Health General Trauma 0 (no trauma) 79 23.8 (2021), the average vaccination rate in the European Union (EU) is 65%, 1 (single) 95 28.6 and in comparison, to Croatia, Bulgaria, for example, had only 22% of its 2 94 28.3 population vaccinated and a very high death rate. Thus, this may appear 3 48 14.5 to be a matter applicable to the global population rather than Croatia in 4 16 5.0 particular. Note: M ¼ Mean; SD¼Standard deviation; n/a ¼ not answered. Concern about COVID, vaccination hesitancy, but also past trauma and increased loneliness post-pandemic may have contributed to a decline in overall general health. In turn, the number of embedded social Table 2 networks (i.e., the number of different network domains in which a General health items (n ¼ 344). participant is active) and resilience levels led to better general health and Mean SD Range more days when participants felt happy and hopeful. The number of days Feeling happy 16.37 9.16 0–30 participants felt love increased with social network diversity (i.e., the Feeling hopeful 12.54 9.86 0–30 number of people with whom the participant has regular contact), Feeling love 15.39 10.84 0–30 resilience, and, unexpectedly, with social distancing adherence. Social Note: Number of days (over the past 30 days) participant felt positive emotions; distancing measures have been put in place throughout the pandemic to SD ¼ standard deviation. curb the spread of the COVID-19 virus. In many places, social distancing is seen as a pro-social behavior–one that protects the community from COVID-19 (Wider et al., 2022). Evidence suggests that widespread Table 3 experience of hardship or pain increases cooperation, collaboration, and Descriptive data for the main psychosocial predictors. social bonding (Bastian et al., 2014). Given the history of shared trauma N (%) Mean SD Range experienced by the Croatian population (e.g., war, earthquake), it is DASS 298 (79%) possible that increased social distancing adherence is viewed as Depression 6.82 5.22 0–21 extremely pro-social, collaborative, and benevolent behavior, thereby Anxiety 5.38 4.50 0–21 increasing feelings of love in participants' daily lives. Furthermore, Stress 8.11 5.06 0–21 Croatian social contacts are relatively reserved; for example, culturally PQ 289 (76.7%) Items endorsed 4.24 3.38 0–16 normative public interpersonal greetings do not typically involve phys- Distress endorsed 5.42 6.72 0–37 ical contact (such as hugging or kissing). As a result, it is possible that SNI 311 (82.5%) adherence to social distancing conforms to Croatian social norms and High-Contact Roles 3.95 1.71 0–12 expectations and may involve less significant change in daily life routines People in Social Network 15.61 8.10 1–46 Embedded Networks 3.12 1.42 0–8 than other aspects of the pandemic. Loneliness 309 (82%) 5.31 1.83 3–9 Overall, our findings are consistent with previous research on the Resilience 325 (86.2%) 14.01 2.89 4–10 detrimental and enduring effects of the COVID-19 pandemic on mental Vaccination hesitancy 340 (90.2%) 27.70 6.62 14–46 health, indicating that the pandemic and related social isolation, as well Note: DASS ¼ Depression, Anxiety and Stress; PQ¼ Prodromal questionnaire; as past trauma, continue to have a large and pervasive impact on indi- SNI¼Social Network Index; Loneliness ¼ the UCLA Loneliness scale; Resilience vidual wellbeing (Patel et al., 2022; Vadivel et al., 2021). However, our ¼ BRCS Resilience scale; Vaccination hesitancy ¼ VHS Vaccination hesitancy results also highlight social connectedness (i.e., social network domains) scale; SD¼Standard deviation. and resilience as promising protective factors in preventing the further development of unfavorable mental and general health outcomes. and neglect, loneliness, and vaccination hesitancy. Similarly, there was a In addressing the first aim of the study, we noted a drastic increase in positive association between childhood abuse and neglect, loneliness the prevalence of stress, depression, and anxiety symptoms. Surprisingly, with levels of distress surrounding psychosis symptoms (PQ-16 distress). the rate of psychosis risk post-pandemic nearly doubled when compared These findings suggest that greater vaccination hesitancy, childhood to the prevalence of high-risk psychosis rates at the beginning of the abuse and neglect, and increased loneliness all contribute to an increased pandemic (Gizdic et al., 2022). These findings reflect the impact of risk of psychosis (Table 4). ongoing and continued stress caused by the COVID-19 pandemic and A second set of analyses revealed that stress was negatively associated suggest the pandemic will continue to have long-lasting consequences on with levels of resilience, whereas general trauma and SNI high contact individuals’ functioning and wellbeing (Goldberg et al., 2022). These role were positively associated with resilience (Table 5). As such, results are also supported by previous findings from the Severe Acute although stress decreased levels of resilience, those with previous expo- Respiratory Syndrome (SARS) outbreak in 2003, which showed that sure to general trauma and greater social connectedness (i.e., a high almost 82% of SARS survivors continued to experience poor mental number of people in their social network) had increased resilience levels. health and related outcomes, including stress disorders such as PTSD (Mak et al., 2010). While the effects of viral pandemics on stress around 4. Discussion the world are clear, it is also important to consider the nuances of pop- ulations with high exposure to adversity, such as the Croatian population. The present study sought to investigate the long-term mental health Early adversity has been shown to leave neurobiological vulnerabil- consequences of the COVID-19 pandemic in the Croatian population, ities that make individuals more sensitive to future stress (Read et al., emphasizing the importance of psychosocial factors in determining 2014; Crist obal-Narvaez et al., 2016; Russell et al., 2018; Smith and mental wellbeing. We specifically highlighted the effects of previous Pollak, 2020), thereby increasing the risk of developing anxiety disor- traumatic experience and the important role of social connectedness in ders, depression, and other broad dimensions of psychopathology 4 A. Gizdic et al. Psychiatry Research Communications 3 (2023) 100126 Table 4 Psychosocial predictors of general and mental health status. Model statistics Variable statistics df ΔR 2 ΔF p β T p General health Step 1 6 0.096 5.350 <0.001 Step 2 4 0.114 2.583 0.025 Age 0.087 1.489 0.138 Gender 0.030 0.559 0.577 Social distancing 0.090 1.377 0.170 COVID concern 0.123 2.092 0.037* Childhood abuse/neglect 0.142 2.460 0.014* Trauma general 0.158 2.867 0.004* SNI High contact role 0.227 1.942 0.053 SNI People sum 0.031 0.373 0.709 SNI Embedded network 0.172 2.883 0.004* Loneliness 0.134 2.258 0.025* Vaccination hesitancy 0.153 2.374 0.018* Resilience 0.174 3.145 0.002* Days feeling happy Step 1 6 0.077 4.223 <0.001 Step 2 3 0.257 12.399 <0.001 Age 0.148 2.799 0.005* Gender 0.051 1.033 0.302 Social distancing 0.024 0.464 0.643 COVID concern 0.113 2.131 0.034* Childhood abuse/neglect 0.091 1.712 0.088 Trauma general 0.047 0.942 0.347 SNI High contact role 0.078 0.728 0.467 SNI People sum 0.066 0.863 0.389 SNI Embedded network 0.237 4.328 <0.001* Loneliness 0.377 6.926 <0.001* Vaccination hesitancy 0.106 1.807 0.072 Resilience 0.155 3.048 0.003* Days feeling hopeful Step 1 6 0.083 4.529 <0.001 Step 2 3 0.229 10.557 <0.001 Age 0.052 0.962 0.337 Gender 0.076 1.519 0.130 Social distancing 0.065 1.222 0.223 COVID concern 0.021 0.396 0.693 Childhood abuse/neglect 0.087 1.617 0.107 Trauma general 0.012 0.231 0.818 SNI High contact role 0.106 0.972 0.332 SNI People sum 0.007 0.096 0.923 SNI Embedded network 0.195 3.497 0.001* Loneliness 0.320 5.787 <0.001* Vaccination hesitancy 0.066 1.104 0.270 Resilience 0.219 4.239 <0.001* Days feeling love Step 1 6 0.090 5.004 <0.001 Step 2 3 0.181 7.538 <0.001 Age 0.056 0.965 0.335 Gender 0.036 0.692 0.490 Social distancing 0.115 2.076 0.039* COVID concern 0.054 0.959 0.338 Childhood abuse/neglect 0.098 1.771 0.078 Trauma general 0.045 0.853 0.394 SNI High contact role 0.190 3.152 0.002* SNI People sum 0.015 0.202 0.840 SNI Embedded network 0.109 1.021 0.308 Loneliness 0.309 5.452 <0.001* Vaccination hesitancy 0.062 1.010 0.313 Resilience 0.165 3.110 0.002* DASS stress Step 1 6 0.234 14.824 <0.001 Step 2 2 0.203 13.173 <0.001 Age 0.194 4.158 <0.001* Gender 0.072 1.564 0.119 Social distancing 0.048 1.002 0.317 COVID concern 0.110 2.264 0.024* Childhood abuse/neglect 0.114 2.294 0.022* Trauma general 0.076 1.614 0.108 SNI High contact role 0.049 0.914 0.361 SNI People sum 0.010 0.205 0.838 SNI Embedded network 0.007 0.142 0.887 Loneliness 0.360 7.163 <0.001* (continued on next page) 5 A. Gizdic et al. Psychiatry Research Communications 3 (2023) 100126 Table 4 (continued ) Model statistics Variable statistics Vaccination hesitancy 0.050 0.908 0.364 Resilience 0.234 4.933 <0.001* DASS anxiety Step 1 6 0.217 13.421 <0.001 Step 2 2 0.193 11.710 <0.001 Age 0.175 3.668 <0.001* Gender 0.045 0.962 0.337 Social distancing 0.062 1.253 0.211 COVID concern 0.091 1.825 0.069 Childhood abuse/neglect 0.117 2.296 0.022* Trauma general 0.075 1.553 0.122 SNI High contact role 0.034 0.615 0.539 SNI People sum 0.015 0.291 0.771 SNI Embedded network <0.001 0.009 0.993 Loneliness 0.380 7.386 <0.001* Vaccination hesitancy 0.094 1.673 0.095 Resilience 0.194 4.003 <0.001* DASS depression Step 1 6 0.236 15.021 <0.001 Step 2 2 0.198 12.735 <0.001 Age 0.155 3.315 0.001* Gender 0.079 1.720 0.087 Social distancing 0.087 1.807 0.072 COVID concern 0.092 1.878 0.061 Childhood abuse/neglect 0.149 2.998 0.003* Trauma general 0.069 1.457 0.146 SNI High contact role 0.009 0.165 0.869 SNI People sum 0.064 1.300 0.195 SNI Embedded network 0.029 0.568 0.570 Loneliness 0.363 7.217 <0.001* Vaccination hesitancy 0.065 1.183 0.238 Resilience 0.222 4.684 <0.001* PQ total Step 1 6 0.218 13.090 <0.001 Step 2 2 0.087 2.266 <0.001 Age 0.218 4.132 <0.001* Gender 0.017 0.319 0.750 Social distancing 0.013 0.210 0.834 COVID concern 0.015 0.266 0.790 Childhood abuse/neglect 0.250 4.433 <0.001* Trauma general 0.023 0.432 0.666 SNI High contact role 0.027 0.452 0.651 SNI People sum 0.023 0.408 0.683 SNI Embedded network 0.040 0.701 0.484 Loneliness 0.287 5.252 <0.001* Vaccination hesitancy 0.153 2.479 0.014* Resilience 0.052 0.981 0.328 PQ distress Step 1 6 0.233 14.276 <0.001 Step 2 1 0.087 35.953 <0.001 Age 0.192 3.748 <0.001* Gender 0.037 0.717 0.474 Social distancing 0.028 0.528 0.598 COVID concern 0.068 1.263 0.208 Childhood abuse/neglect 0.244 4.382 <0.001* Trauma general 0.014 0.264 0.792 SNI High contact role 0.069 1.174 0.241 SNI People sum 0.047 0.852 0.395 SNI Embedded network 0.069 1.220 0.223 Loneliness 0.323 5.996 <0.001* Vaccination hesitancy 0.084 1.379 0.169 Resilience 0.045 0.843 0.400 Note1. Predictive variables kept in the second step: age, gender, social distancing, level of concern about COVID-19, and traumatic experience (childhood abuse and neglect, and trauma general). Note2. DASS ¼ Depression, Anxiety and Stress; PQ ¼ prodromal questionnaire; SNI¼Social Network Index. *p<0.05. (Vaessen et al., 2017; Stroud, 2020; Wade et al., 2019). The stress sensi- exposure, such as the COVID pandemic, exacerbated depression, anxiety, tization model sheds light on the link between stress and the prevalence of and stress, particularly psychosis symptoms. These findings may add to affective disorders (Post, 1992; Stroud, 2020). According to this model the evidence of an underlying mechanism of increased stress-sensitivity. and considering previous war- and natural disaster-related trauma, the Contrary to our expectations, resilience had no effect on levels of psy- Croatian population would be expected to be more sensitive to the chosis, but it did lead to a decrease in stress levels. Thus, it may be changes caused by the pandemic relative to other populations. As a plausible to think that building on resilience levels would lead to result, it appears that childhood adversity and subsequent stress decreased stress levels and an amelioration of sensitivity to further stress. 6 A. Gizdic et al. Psychiatry Research Communications 3 (2023) 100126 Table 5 Resilience and psychosocial predictors of mental health status. Model statistics Variable statistics df ΔR 2 ΔF p β T p Resilience Step 1 6 0.063 3.172 0.005 Step 2 2 0.152 6.439 <0.001 Age 0.027 0.419 0.675 Gender 0.090 1.624 0.106 Social distancing 0.008 0.144 0.886 COVID concern 0.040 0.665 0.507 Childhood abuse/neglect 0.009 0.148 0.882 Trauma general 0.119 2.103 0.036* SNI High contact role 0.215 3.423 0.001* SNI People sum 0.074 0.916 0.361 SNI Embedded network 0.024 0.202 0.840 Loneliness 0.108 1.643 0.101 Vaccination hesitancy 0.039 0.202 0.840 DASS Depression 0.136 1.064 0.288 DASS Stress 0.382 6.278 <0001* DASS Anxiety 0.098 0.952 0.342 PQ symptoms 0.011 0.178 0.859 PQ distress 0.059 0.862 0.390 Note1. Predictive variables kept in the second step: age, gender, social distancing, level of concern about COVID-19, and traumatic experience (childhood abuse and neglect, and trauma general). Note2. DASS ¼ Depression, Anxiety and Stress; PQ¼ Prodromal questionnaire. SNI¼Social Network Index; Vaccination hesitancy ¼ VHS Vaccination hesitancy scale. p<0.05. Loneliness is another important factor to consider in this interplay. CRediT authorship contribution statement Following our previous findings (Gizdic et al., 2022), this psychosocial factor remains a highly important risk factor in predicting a variety of Alena Gizdic: Conceptualization, Methodology, Formal analysis, symptom developments, particularly psychosis, even after two years of Investigation, Data curation, Writing – original draft, Writing – review & the pandemic, while social connectedness appears to serve as both a editing, Visualization. Tatiana Baxter: Methodology, Software, Writing preventive and protective factor. As a result, strengthening social net- – review & editing, Visualization. Neus Barrantes-Vidal: Supervision, works may have plausible effects on alleviating psychopathology symp- Writing – review & editing. Sohee Park: Conceptualization, Methodol- toms, reducing levels of loneliness, and protecting against future stress. ogy, Software, Resources, Writing – review & editing, Supervision, There are several limitations to our study. First, despite the relatively Project administration, Funding acquisition. large sample size, many participants did not complete the entire ques- tionnaire, resulting in a smaller sample size for some of the measures Declaration of competing interest (e.g., PQ-16 and DASS). Second, the majority of the sample consisted primarily of female participants, which may have limited its generaliz- The authors declare that they have no known competing financial ability. Regardless, the study enabled a comprehensive investigation of interests or personal relationships that could have appeared to influence multiple psychosocial predictors of psychopathology and psychosis-risk the work reported in this paper following two years after the COVID-19 pandemic, with evidence of long-term adverse effects of the pandemic and highlighting the signifi- Acknowledgments cance of resilience and social connectedness. To conclude, investigating the long-term mental health consequences We would like to thank Igna Brajevic-Gizdic, MD, PhD, psychiatrist of the COVID-19 pandemic and emphasizing the importance of psycho- from Public Health Institute of Split and Dalmatia County, Mental Health social factors on mental wellbeing may help further detect the potential Service Department for outpatient treatment of Addiction in Split, underlying mechanism of stress-sensitivity. We specifically highlighted Croatia for help with data collection. the effects of previous traumatic experiences as well as the critical role of social connectedness in association to levels of resilience. Therefore, to References mitigate the mental health consequences of large-scale traumatic events such as the pandemic in the future, it would be crucial to implement Ajdukovic, D., Rezo Bagaric, I., Bakic, H., Stevanovic, A., Franciskovic, T., Ajdukovic, M., public health strategies that enhance and support social connectedness 2020. Mental health status and risk factors during Covid-19 pandemic in the Croatia's adult population. EJPT 12, 1984050. https://doi.org/10.1080/ and resilience, especially for psychosis–a particularly relevant topic for 20008198.2021.1984050. the Croatian population given the lack of prodromal data and the coun- Akel, K.B., Masters, N.B., Shih, S.F., Lu, Y., Wagner, A.L., 2021. Modification of a vaccine try's history of exposure to transgenerational war trauma (including early hesitancy scale for use in adult vaccinations in the United States and China. Hum. Vaccines Immunother. 17, 2639–2646. https://doi:10.1080/21645515.2021 exposures) and natural disasters. .1884476. Auxemery, Y., 2012. Posttraumatic stress disorder (PTSD) as a consequence of the Funding sources interaction between an individual genetic susceptibility, a traumatogenic event and a social context. Encephale 38, 373–380. https://doi:10.1016/j.encep.2011.12.003. Ayed, N., Toner, S., Priebe, S., 2019. Conceptualizing resilience in adult mental health Gertrude Conaway Vanderbilt Endowment fund partly supported this literature: a systematic review and narrative synthesis. Psychol. Psychother. 92, project. 299–341. https://doi.org/10.1111/papt.12185. Babic-Banaszak, A., Kovacic, L., Kovacevic, L., Vuletic, G., Mujkic, A., Ebling, Z., 2002. Impact of war on health-related quality of life in Croatia: population study. Croat. Med. J. 43, 396–402. PMID: 12187516. Retrieved from: https://europepmc.org/art icle/med/12187516. 7 A. Gizdic et al. Psychiatry Research Communications 3 (2023) 100126 Bastian, B., Jetten, J., Ferris, L.J., 2014. Pain as social glue: shared pain increases psiholoska komora 415–460. URN:NBN. urn:nbn:hr:131:460432. Retrieved from: cooperation. Psychol. Sci. 25, 2079–2085. https://doi.org/10.1177/ https://repozitorij.ffzg.unizg.hr/islandora/object/ffzg:1823. 0956797614545886. Joshi, D., Gonzalez, A., Griffith, L., Duncan, L., MacMillan, H., Kimber, M., Vrkljan, B., Bauer, P., Brugger, J., Konig, F., Posch, M., 2021. An international comparison of age and MacKillop, J., Beauchamp, M., Kates, N., Raina, P., 2021. The trajectories of sex dependency of COVID-19 deaths in 2020: a descriptive analysis. Sci. Rep. 11, depressive symptoms among working adults during the COVID-19 pandemic: a 19143. https://doi.org/10.1038/s41598-021-97711-8. longitudinal analysis of the InHamilton COVID-19 study. BMC Publ. Health 21, 1895. Boscolo-Rizzo, P., Guida, F., Polesel, J., Marcuzzo, A.V., Capriotti, V., D'Alessandro, A., https://doi.org/10.1186/s12889-021-11900-8. Zanelli, E., Marzolino, R., Lazzarin, C., Antonucci, P., Sacchet, E., Tofanelli, M., Killgore, W.D.S., Taylor, E.C., Cloonan, S.A., Dailey, N.S., 2020. Psychological resilience Borsetto, D., Gardenal, N., Pengo, M., Tirelli, G., 2021. Sequelae in adults at 12 during the COVID-19 lockdown. Psychiatr. Res. 291, 113216. https://doi:10.101 months after mild-to-moderate coronavirus disease 2019 (COVID-19). IFAR 11, 6/j.psychres.2020.113216. 1685–1688. https://doi.org/10.1002/alr.22832. Lakhan, R., Agrawal, A., Sharma, M., 2020. Prevalence of depression, anxiety, and stress Brooks, S.K., Webster, R.K., Smith, L.E., Woodland, L., Wessley, S., Greenberg, N., during COVID-19 pandemic. JNRP 11, 519–525. https://doi:10.1055/s-0040-171644 Rubin, J.G., 2020. The psychological impact of quarantine and how to reduce it: 2. rapid review of the evidence. Lancet 395, 912–920. https://doi.org/10.1016/S0140- Lee, H.S., Dean, D., Baxter, T., Griffith, T., Park, S., 2021. Deterioration of mental health 6736(20)30460-8. despite successful control of the COVID-19 pandemic in South Korea. Psychiatr. Res. Brown, E., Gray, R., Lo Monaco, S., O’Donoghue, B., Nelson, B., Thompson, A., 295, 113570. https://doi.org/10.1016/j.psychres.2020.113570. Francey, S., McGorry, P., 2020. The potential impact of Covid-19 on psychosis: a Lim, S.T., Janaway, B., Costello, H., Trip, A., Price, G., 2020. Persistent psychotic rapid review of contemporary epidemic and pandemic research. Schizophr. Res. 222, symptoms following COVID-19 infection. BJ Psych. Open. 6, E105. https://doi.org/ 79–87. https://doi.org/10.1016/j.schres.2020.05.005. 10.1192/bjo.2020.76. Cao, C., Wang, L., Fang, R., Liu, P., Bi, Y., Luo, S., Grace, E., Olff, M., 2022. Anxiety, Liu, T., Wu, D., Yan, W., Wang, X., Zhang, X., Ma, K., Chen, H., Zeng, Z., Qin, Y., Wang, H., depression, and PTSD symptoms among high school students in China in response to Xing, M., Xu, D., Li, W., Ni, M., Zhu, L., Chen, L., Chen, G., Qi, W., Wu, T., Yu, H., the COVID-19 pandemic and lockdown. J. Affect. Disord. 296, 126–129. https:// Ning, Q., 2022. Twelve-month systemic consequences of coronavirus disease 2019 doi.org/10.1016/j.jad.2021.09.052. (COVID-19) in patients discharged from hospital: a prospective cohort study in Carvalho, P.M.M., Moreira, M.M., de Oliveira, M.N.A., Landim, J.M.M., Neto, M.L.R., Wuhan, China. CIDIEL 74, 1953–1965. https://doi.org/10.1093/cid/ciab703. 2020. The psychiatric impact of the novel coronavirus outbreak. Psychiatr. Res. 286, Lovibond, P.F., Lovibond, S.H., 1995. The structure of negative emotional states: 112902. https://doi.org/10.1016/j.psychres.2020.112902. comparison of the depression anxiety stress scales (DASS) with the beck depression Cohen, S., Doyle, W.J., Skoner, D.P., Rabin, B.S., Gwaltney, J.M., 1997. Social ties and and anxiety inventories. Behav. Res. Ther. 33, 335–343. https://doi.org/10.1016/ susceptibility to the common cold. JAMA 277, 1940–1944. https://doi.org/10.1001/ 0005-7967(94)00075-u. jama.1997.03540480040036. Lu, W., Yanos, P.T., Silverstein, S.M., Mueser, K.T., Rosenberg, S.D., Gottlieb, J.D., Cristobal-Narvaez, P., Sheinbaum, T., Ballespí, S., Mitjavila, M., Myin-Germeys, I., Duva, S.M., Kularatne, T., Dove-Williams, S., Paterno, D., Hawthorne, D., Kwapil, T.R., Barrantes-Vidal, N., 2016. Impact of adverse childhood experiences on Giacobbe, G., 2013. Public mental health clients with severe mental illness and psychotic-like symptoms and stress reactivity in daily life in nonclinical young adults. probable posttraumatic stress disorder: trauma exposure and correlates of symptom Focus 14, 387–395. https://doi.org/10.1371/journal.pone.0153557. severity. J. Trauma Stress 26, 266–273. https://doi: 10.1002/jts.21791. Dean, D.J., Tso, I.F., Giersch, A., Lee, H.S., Baxter, T., Griffith, T., Song, L., Park, S., 2021. Mak, I.W., Chu, C.M., Pan, P.C., Yiu, M.G., Ho, S.C., Chan, V.L., 2010. Risk factors for Cross-cultural comparisons of psychosocial distress in the USA, South Korea, France, chronic post-traumatic stress disorder (PTSD) in SARS survivors. Gen. Hosp. and Hong Kong during the initial phase of COVID-19. Psychiatr. Res. 295, 113593. Psychiatr. 32, 590–598. https://doi.org/10.1016/j.genhosppsych.2010.07.007. https://doi.org/10.1016/j.psychres.2020.113593. Meaklim, H., Saunders, W.J., Byrne, M.L., Junge, M.F., Varma, P., Finck, W.A., Desai, S., Sheikh, B., Belzie, L., 2021. New-onset psychosis following COVID-19 infection. Jackson, M.L., 2023. Insomnia is a key risk factor for persistent anxiety and Cureus 13, e17904. https://doi.org/10.7759/cureus.17904. depressive symptoms: a 12-month longitudinal cohort study during the COVID-19 Duan, X., Ni, X., Shi, L., Zhang, L., Ye, Y., Mu, H., Li, Z., Liu, X., Fan, L., Wang, Y., 2019. pandemic. J. Affect. Disord. 322, 52–63. https://doi.org/10.1016/j.jad.2022.11.021. The impact of workplace violence on job satisfaction, job burnout, and turnover Newby, J.M., O’Moore, K., Tang, S., Christensen, H., Faasse, K., 2020. Acute mental intention: the mediating role of social support. Health Qual. Life Outcome 17, 93. health responses during the COVID-19 pandemic in Australia. PLoS One 15, https://doi.org/10.1186/s12955-019-1164-3. 0236562. https://doi.org/10.1371/journal.pone.0236562. Finstad, G.L., Giorgi, G., Lulli, L.G., Pandolfi, C., Foti, G., Leon-Perez, J.M., Cantero- Orfei, M.D., Bossi, F., D'Arcangelo, S., Maggi, F., Lattanzi, N., Malizia, A.P., Ricciardi, E., Sanchez, F.J., Mucci, N., 2021. Resilience, coping strategies and posttraumatic 2022. Mental health in the post-lockdown pandemic phase: relief or exacerbation of Growth in the workplace following COVID-19: a narrative review on the positive psychological distress? A cross-sectional study in the general population in Italy. Acta aspects of trauma. IJERPH 18, 9453. https://doi.org/10.3390/ijerph18189453. Psychol. 225, 103555. https://doi.org/10.1016/j.actpsy.2022.103555. Garcia, D., Rime, B., 2019. Collective emotions and social resilience in the digital traces Park, S.Y., Kim, Y.M., Yi, S., Lee, S., Na, B.J., Kim, C.B., Kim, J.I., Kim, H.S., Kim, Y.B., after a terrorist attack. Psychol. Sci. 30, 617–628. https://doi.org/10.1177/ Park, Y., Huh, I.S., Kim, H.K., Yoon, H.J., Jang, H., Kim, K., Chang, Y., Kim, I., Lee, H., 0956797619831964. Gwack, J., Kim, S.S., Jeong, E.K., 2020. Coronavirus disease outbreak in call center, Gizdic, A., Baxter, T., Barrantes-Vidal, N., Park, S., 2022. Loneliness and psychosocial South Korea. Emerg. Infect. Dis. 26, 1666–1670. https://doi.org/10.3201/ predictors of psychosis-proneness during COVID-19: preliminary findings from eid2608.201274. Croatia. Psychiatr. Res. 317, 114900. https://doi:10.1016/j.psychres.2022.114900. Patel, K., Robertson, E., Kwong, A.S.F., Griffith, G.J., Willan, K., Green, M.J., Di Gessa, G., Goldberg, X., Casta~ no-Vinyals, G., Espinosa, A., Carreras, A., Liutsko, L., Sicuri, E., Huggins, C.F., Mc Elroy, E., Thompson, E.J., Maddock, J., Niedzwiedz, C.L., Foraster, M., O'Callaghan-Gordo, C., Dadvand, P., Moncunill, G., Dobano, C., Henderson, M., Richards, M., Steptoe, A., Ploubidis, G.B., Moltrecht, B., Booth, C., Cortes, B., Pleguezuelos, V., Straif, K., Garcia-Aymerich, J., de Cid, R., Cardis, E., Fitzsimons, E., Katikireddi, S.V., 2022. Psychological distress before and during the Kogevinas, M., 2022. Mental health and COVID-19 in a general population cohort in COVID-19 pandemic among adults in the United Kingdom based on coordinated Spain (COVICAT study). Soc. Psychiatr. Psychiatr. Epidemiol. 57, 2457–2468. analyses of 11 longitudinal studies. JAMA Netw 5, 1–15. https://doi.org/10.1001/ https://doi.org/10.1007/s00127-022-02303-0. jamanetworkopen.2022.7629. Groarke, J.M., Berry, E., Graham-Wisener, L., McKenna-Plumley, P.E., McGlinchey, E., Penninx, B.W.J.H., Benros, M.E., Klein, R.S., Vinkers, C.H., 2022. How COVID-19 shaped Armour, C., 2020. Loneliness in the UK during the COVID-19 pandemic: cross- mental health: from infection to pandemic effects. Nat. Med. 28, 2027–2037. https:// sectional results from the COVID-19 psychological wellbeing study. PLoS One 15, doi.org/10.1038/s41591-022-02028-2. e0239698. https://doi.org/10.1371/journal.pone.0239698. Pierce, M., Hope, H., Ford, T., Hatch, S., Hotopf, M., John, A., Kontopantelis, E., Webb, R., Han, Q., Zheng, B., Daines, L., Sheikh, A., 2022. Long-term sequelae of COVID-19: a Wessely, S., McManus, S., Abel, K.M., 2020. Mental health before and during the systematic review and meta-analysis of one-year follow-up studies on post-COVID COVID-19 pandemic: a longitudinal probability sample survey of the UK population. symptoms. Pathogens 11, 269. https://doi.org/10.3390/pathogens11020269. Lancet Psychiatr. 7, 883–892. https://doi.org/10.1016/S2215-0366(20)30308-4. Howell, K.H., Kaplow, J.B., Layne, C.M., Benson, M.A., Compas, B.E., Katalinski, R., Pietrzak, R.H., Goldstein, R.B., Southwick, S.M., Grant, B.F., 2011. Personality disorders Pasalic, H., Bosankic, N., Pynoos, R., 2015. Predicting adolescent posttraumatic stress associated with full and partial posttraumatic stress disorder in the U.S. Population: in the aftermath of war: differential effects of coping strategies across trauma results from wave 2 of the national epidemiologic survey on alcohol and related reminder, loss reminder, and family conflict domains. Anxiety, Stress and Coping 28, conditions. J. Psychiatr. Res. 45, 678–686. https://doi.org/10.1016/ 88–104. https://doi.org/10.1080/10615806.2014.910596. j.jpsychires.2010.09.013. Hughes, M.E., Waite, L.J., Hawkley, L.C., Cacioppo, J.T., 2004. A Short scale for Post, R.M., 1992. Transduction of psychosocial stress into the neurobi-ology of recurrent measuring loneliness in large surveys: results from two population-based studies. Res. affective disorder. Am. J. Psychiatr. 149, 999–1010. Aging 26, 655–672. https://doi.org/10.1177/0164027504268574. Proto, E., Quintana-Domeque, C., 2021. COVID-19 and mental health deterioration by Ising, H.K., Veling, W., Loewy, R.L., Rietveld, M.W., Rietdijk, J., Dragt, S., Klaassen, R.M., ethnicity and gender in the UK. PLoS One 16, e0244419. https://doi.org/10.1371/ Nieman, D.H., Wunderink, L., Linszen, D.H., van der Gaag, M., 2012. The validity of journal.pone.0244419. the 16-item version of the Prodromal Questionnaire (PQ-16) to screen for ultra-high Raina, P., Wolfson, C., Griffith, L., Kirkland, S., McMillan, J., Basta, N., Joshi, D., Oz, U.E., risk of developing psychosis in the general help-seeking population. Schizophr. Bull. Sohel, N., Maimon, G., Thompson, M., CLSA team., 2021. A longitudinal analysis of 38, 1288–1296. https://doi.org/10.1093/schbul/sbs068. the impact of the COVID-19 pandemic on the mental health of middle-aged and older Jeftic, A., Ikizer, G., Tuominen, J., Chrona, S., Kumaga, R., 2021. Connection between the adults from the Canadian Longitudinal Study on Aging. Nat. Aging. 1, 1137–1147. COVID-19 pandemic, war trauma reminders, perceived stress, loneliness, and PTSD https://doi.org/10.1038/s43587-021-00128-1. in Bosnia and Herzegovina. Curr. Psycho. 22, 1–13. https://doi.org/10.1007/ Read, J., Fosse, R., Moskowitz, A., Perry, B., 2014. The traumagenic neurodevelopmental s12144-021-02407-x. model of psychosis revisited. Neuropsychiatry 4, 65–79. https://doi:10.2217/ Jokic-Begic, N., Hromatko, I., Jurin, T., Kamenov, Z., Kerestes, K., Kuterovac, Jagodic, K., npy.13.89. Sangster Jokic, C., 2020. How are we? Life in Croatia in time of corona. Koronavirus i Rossi, R., Socci, V., Talevi, D., Mensi, S., Niolu, C., Pacitti, F., Di Marco, A., Rossi, A., mentalno zdravlje: psiholoski aspekti, savjeti i preporuke. Andreja Bogdan, Hrvatska Siracusano, A., Di Lorenzo, G., 2020. COVID-19 pandemic and lockdown measures 8 A. Gizdic et al. Psychiatry Research Communications 3 (2023) 100126 impact on mental health among the general population in Italy. Front. Psychiatr. 11, Think Global Health, 2021. Countries Hit Hardest by COVID-19. https://www.thinkgl 790. https://doi.org/10.3389/fpsyt.2020.00790. obalhealth.org/article/countries-hit-hardest-covid-19. Russell, A.L., Tasker, J.G., Lucion, A.B., Fiedler, J., Munhoz, C.D., Wu, T.J., Deak, T., Tso, I.F., Park, S., 2020. Alarming levels of psychiatric symptoms and the role of 2018. Factors promoting vulnerability to dysregulated stress reactivity and stress- loneliness during the COVID-19 epidemic: a case study of Hong Kong. Psychiatr. Res. related disease. J. Neuroendocrinol. 30, e12641. https://doi.org/10.1111/jne.1264. 293, 113423. https://doi.org/10.1016/j.psychres.2020.113423. Schnurr, P.P., Spiro III, A., Vielhauer, M.J., Findler, M.N., Hamblen, J.L., 2002. Trauma in Vadivel, R., Shoib, S., El Halabi, S., El Hayek, S., Essam, L., Gashi Bytyçi, D., the lives of older men: findings from the normative aging study. J. Clin. Geropsychol. Karaliuniene, R., Schuh Teixeira, A.L., Nagendrappa, S., Ramalho, R., Ransing, R., 8, 175–187. https://doi: 10.1023/A:1015992110544. Pereira-Sanchez, V., Jatchavala, C., Adiukwu, F.N., Kudva Kundadak, G., 2021. Shah, S.M.A., Mohammad, D., Qureshi, M.F.H., Abbas, M.Z., Aleem, S., 2021. Prevalence, Mental health in the post-COVID-19 era: challenges and the way forward. Gen. psychological responses and associated correlates of depression, anxiety and stress in Psychiatr. 34, e100424. https://doi.org/10.1136/gpsych-2020-100424. a global population, during the Coronavirus Disease (COVID-19) pandemic. Vaessen, T., Van Nierop, M., Decoster, J., Delespaul, P., Derom, C., de Hert, M., Jacobs, N., Community Ment. Health J. 57, 101–110. https://doi.org/10.1007/s10597-020- Menne-Lothmann, C., Rutten, B., Thiery, E., van Os, J., van Winkel, R., Wichers, M., 00728-y. Myin-Germeys, I., 2017. Is sensitivity to daily stress predictive of onset or persistence Sinclair, V.G., Wallston, K.A., 2004. The development and psychometric evaluation of the of psychopathology? Eur. Psychiatr. 45, 167–173. https://doi.org/10.1016/ Brief resilient coping scale. Assessment 11, 94–101. https://doi.org/10.1177/ j.eurpsy.2017.07.002. 1073191103258144. Vukojevic, J., Susac, J., Brecic, P., 2020. Psychosis and pandemics: is there a secret Smith, K.E., Pollak, S.D., 2020. Early life stress and development: potential mechanisms protector? Psychiatr. Res. 291, 113199. https://doi.org/10.1016/ for adverse outcomes. J. Neurodev. Disord. 12, 34. https://doi.org/10.1186/s11689- j.psychres.2020.113199. 020-09337-y. Wade, M., Zeanah, C.H., Fox, N.A., Tibu, F., Ciolan, L.E., Nelson, C.A., 2019. Stress Sominsky, L., Walker, D.W., Spencer, S.J., 2020. One size does not fit all - patterns of sensitization among severely neglected children and protection by social enrichment. vulnerability and resilience in the COVID-19 pandemic and why heterogeneity of Nat. Commun. 10, 5771. https://doi.org/10.1038/s41467-019-13622-3. disease matters. BBI – Health 87, 1–3. https://doi.org/10.1016/j.bbi.2020.03.016. Wang, C., Pan, R., Wan, X., Tan, Y., Xu, L., Ho, C.S., Ho, R.C., 2020. Immediate Stroud, C.B., 2020. The stress sensitization model. In: Harkness, K.L., Hayden, E.P. (Eds.), psychological responses and associated factors during the initial stage of the 2019 The Oxford Handbook of Stress and Mental Health. Oxford University Press, Coronavirus Disease (COVID-19) epidemic among the general population in China. pp. 349–370. https://doi.org/10.1093/oxfordhb/9780190681777.001.0001. Int. J. Environ. Res. Publ. Health 17, 1729. https://doi.org/10.3390/ Taquet, M., Geddes, J.R., Husain, M., Luciano, S., Harrison, P.J., 2021. 6-month ijerph17051729. neurological and psychiatric outcomes in 236 379 survivors of COVID-19: a Wider, W., Lim, M.X., Wong, L.S., Chan, C.K., Maidin, S.S., 2022. Should I help? Prosocial retrospective cohort study using electronic health records. Lancet Psychiatr. 8, behavior during the COVID-19 Pandemic. Int. J. Environ. Res. Publ. Health 19, 416–427. https://doi.org/10.1016/S2215-0366(21)00084-5. 16084. https://doi.org/10.3390/ijerph192316084. Taylor, S., Fong, A., Asmundson, G.J.G., 2021. Predicting the severity of symptoms of the Wu, Z., Liu, Z., Zou, Z., Wang, F., Zhu, M., Zhang, W., Tao, H., Ross, B., Long, Y., 2021. COVID stress syndrome from personality traits: a prospective network analysis. Front. Changes of psychotic-like experiences and their association with anxiety/depression Psychol. 12, 632227. https://doi.org/10.3389/fpsyg.2021.632227. among young adolescents before COVID-19 and after the lockdown in China. Schizophr. Res. 237, 40–46. https://doi.org/10.1016/j.schres.2021.08.020. 9