Psychological distress and risk for dementia

The concept of mild cognitive impairment (MCI) primarily emphasizes changes in individuals’ mental abilities, but it has recently been suggested that neuropsychiatric symptoms should also be considered important factors in age-related neurodegeneration. Psychological distress, defined as a reaction of an individual to external and internal stresses, is characterized by a mixture of psychological symptoms. It also may be considered a neuropsychiatric symptom encompassing depression, anxiety, and apathy. This paper reviews and summarizes recent evidence and relevant issues regarding the presence of psychological distress in healthy older adults and MCI patients and its relationship to risk for developing dementia. Results presented in this review show that psychological distress and depressive, anxious, and apathetic symptoms can be present in MCI and may predict progression to dementia. This article also provides suggestions for future research.     

Gender differences in psychosocial risk factors for psychological distress among immigrants

The reasons for a greater prevalence of psychological distress among women than men remain unknown. We sought to test two hypotheses that gender operates either as (1) a moderator or (2) a mediator between psychosocial risk factors and experienced distress. A cross-sectional community survey of 1,062 adult Russian-born Jewish immigrants to Israel was conducted. The Demographic Psychosocial Inventory (DPSI) and the Talbieh Brief Distress Inventory (TBDI) were used to measure the parameters of interest. Univariate and multivariate analyses were used to test the moderation versus mediational hypotheses of gender in the stress-distress relationship. The aggregate levels of psychological distress and depression, anxiety, and obsessive symptoms were significantly higher for women than for men. Five sources of distress were more likely to be reported by women: family problems, inappropriate climatic conditions, anxiety about the future, poor health status, and uncertainty in the present life situation. Men scored higher on three stress-protective factors: the number of reasons for immigration, commitment to the host country, and job adequacy. Results of multiple regression and multivariate analysis of variance (MANOVA) supported the mediation hypothesis that gender differences in psychological distress stem from women's greater exposure to specific psychosocial stressors. Our findings demonstrate the validity of gender as an important mediating mechanism underlying the differential perception of risk factors for the development of psychological distress.     

A protective genetic variant for adverse environments? The role of childhood traumas and serotonin transporter gene on resilience and depressive severity in a high-risk population

Genetic aspects may influence the effect of early adverse events on psychological well being in adulthood. In particular, a common polymorphism within the serotonin transporter gene (5-HTTLPR short/long) has been associated to the risk for stress-induced psychopathology. In the present study we investigated the role of childhood traumas and 5-HTTLPR on measures of psychological resilience and depression in a sample of individuals at a high risk for psychological distress (763 male prisoners). The 5-HTTLPR genotype did not influence resilience and depressive severity. However, a significant interaction was observed between 5-HTTLPR and childhood traumas on both resilience and depressive severity. In particular, among subjects exposed to severe childhood trauma only, the long-allele was associated to lower resilience scores and increased current depressive severity as compared to short/short homozygous. Sex specific effects, difference in type and duration of stressors and the specific composition of the sample may explain discrepancy with many studies reporting the short-allele as a vulnerability factor for reactivity to stress. We here speculated that in males the long-allele may confer lower resilience and therefore higher vulnerability for depressive symptoms in subjects exposed to early stress and currently living in stressful environments.     

Resilience as a focus of suicide research and prevention

Suicide is a major medical and social problem. Decades of suicide research have mostly focused on risk factors for suicidal behaviour while overlooking protective factors such as resilience that may help to address this important public health issue. Resilience is the capacity and dynamic process of adaptively overcoming stress and adversity while maintaining normal psychological and physical functioning. Studies conducted over the past 10–15 years suggest that resilience is a protective factor against suicide risk. Resilience is becoming a focus of suicide research and prevention. Building resilience should be a part of universal, selective, and indicated suicide prevention interventions. Promoting resilience may reduce suicide risk in the general population, in groups at elevated suicide risk, and among high‐risk individuals. Building resilience in the general population may reduce the incidence of stress‐related disorders and, consequently, suicidal behaviour. Improving resilience should be a part of a treatment plan of every psychiatric patient. Mental health professionals will probably have the best success in reducing suicide risk in psychiatric patients if they actively concentrate on increasing stress resilience using both psychosocial and pharmacological interventions. It is critically important to move forward the development of pharmacological and psychological interventions for enhancing resilience.     

Resilience in trauma-exposed refugees: the moderating effect of coping style on resilience variables

Research with survivors of torture has generated considerable variability in prevalence rates of posttraumatic stress disorder (PTSD). Multiple risk and resilience factors may affect this variability, increasing or decreasing the likelihood of experiencing psychological distress. This study sought to investigate the effect of several such resilience factors, coping style, social support, cognitive appraisals, and social comparisons on PTSD symptom severity. Furthermore, this study examined whether coping style moderated the relationship between resilience variables and PTSD symptoms. Seventy-five torture survivors completed an intake interview and several self-report measures upon entry into a treatment program for survivors of torture. Results indicated that emotion-focused coping styles significantly moderated the relationship between cognitive appraisal and social comparison variables and PTSD, and usually increased the likelihood of developing severe symptoms. These results indicate that the salience of resilience variables may differ depending on the individual's coping style, which present implications for clinical practice with torture survivors.     

Resilience: research evidence and conceptual considerations for posttraumatic stress disorder

The growing recognition and occurrence of traumatic exposure in the general population has given increased salience to the need to understand the concept of resilience. More than just the "flip side" of a risk factor, the notion of resilience encompasses psychological and biological characteristics, intrinsic to an individual, that might be modifiable and that confer protection against the development of psychopathology in the face of stress. In this review, we provide some perspective on the concept of "resilience" by examining early use of the term in research on "children at risk" and discuss the relationship between risk and resilience factors. We then review psychological and biological factors that may confer resilience to the development of posttraumatic stress disorder (PTSD) following trauma, examine how resilience has been assessed and measured, and discuss issues to be addressed in furthering our understanding of this critical concept going forward.     

Resilience and depressive symptoms in mainland Chinese immigrants to Hong Kong

Purpose

Immigrants are highly vulnerable to the development of psychological problems such as depressive symptoms, which calls for further study of immigration in the Eastern context. Identification of factors that protect against depressive symptoms would inform interventions to enhance immigrant adaptation.

Methods

This survey recruited 1,205 individuals who are adult immigrants from mainland China to Hong Kong. The Patient Health Questionnaire-9 (PHQ-9) was used to screen them for depressive symptoms. Participants also completed assessments for acculturative stress, discrimination and rejection, and personal and family resilience.

Results

The results showed that participants reported considerable depressive symptoms. After controlling for socio-demographic characteristics, acculturative stress, and discrimination and rejection, personal resilience was associated with fewer depressive symptoms. Family resilience added significant explanation of variance to predict depressive symptoms over and above the individual variables, including personal resilience.

Conclusions

Our findings draw attention to the role of resilience as a protective factor against mental distress when facing adversities, while highlighting the central importance of family as an emotional resource for immigrant adjustment in the Chinese context. As personal resilience can increase with interventions, our results can inform trials to enhance adaptation among mainland Chinese immigrants in Hong Kong.     

Impact of environmental and personality factors upon adolescents before and after psychotherapeutic intervention

It is important to understand the risk factors and resilience factors that contribute to psychological distress or to a sense of well-being in adolescents.     

Earthquake-related psychological distress and associated factors 4 years after the Parnitha earthquake in Greece.

Exposure to earthquakes has been associated with psychological distress and in particular the development of post-traumatic stress disorder (PTSD). Earthquake-related psychological distress can be longstanding. The present study involved 157 Greek survivors of the 1999 Parnitha earthquake assessed approximately 4 years after the earthquake. Assessments were based on the Traumatic Stress Symptom Checklist (TSSC). Using stringent calibrations for the estimation of symptom presence 25% of the survivors endorsed at least 5 and 12% at least 10 TSSC symptoms. Approximately 22% of the survivors reported subjective distress and 15% impaired adjustment due to their symptoms. Intensity of fear during the earthquake and participation in rescue operations related to greater post-earthquake psychological distress. The results suggest that the psychological consequences of earthquakes can be serious and long-standing even when the magnitude of the earthquake is moderate. Psychological treatments that have been proven to reduce fear and PTSD symptoms need to be made available to the survivors. Such treatments may also increase the survivors' psychological preparedness and emotional resilience in view of future earthquakes.     

Distinguishing distress and psychopathology among survivors of the Oakland/Berkeley firestorm

Disaster mental health research has historically focused on assessment of psychopathology, using measures of psychiatric symptoms and disorders. The Oakland/Berkeley firestorm provided an opportunity to explore resilience among highly exposed survivors through consideration of psychiatric variables in the context of personality. The Diagnostic Interview Schedule/Disaster Supplement was administered to 62 firestorm survivors at approximately 4, 16, and 39 months and the Temperament and Character Inventory administered at 16 months postdisaster. Few individuals had postdisaster psychopathology (16% with any diagnosis, 5%with PTSD). There was considerable evidence of distress, however, indicated by an abundance of reported posttraumatic symptoms, functional impairments, and endorsement of emotional upset, all of which decreased substantially over time. Group C (avoidance/numbing) posttraumatic symptoms were relatively uncommon and were specifically associated with elevated Self-Transcendence. Groups B (intrusion) and D (hyperarousal) symptoms were prevalent and were associated with high Harm Avoidance and low Self-Directedness. The generally healthy personality profiles of these firestorm survivors reflected their psychological resilience. Examination of symptoms and distress in the context of psychiatric disorders after this disaster demonstrated that symptomatic distress is not inconsistent with psychological resilience. The choice of research focus and methods can provide very different portraits of outcomes post-disaster.     

Perceived burden in spouses of National Guard/Reserve service members deployed during Operations Enduring and Iraqi Freedom

Spouses of combat veterans with posttraumatic stress disorder (PTSD) experience elevated psychological distress. Recent research indicates that spouses’ perceptions of burden may be one mechanism of such distress, but there are several gaps in this literature. No research has examined perceived burden in relation to symptoms other than PTSD or subclinical levels of psychological distress, and very little research has focused on characteristics of spouses that may be related to their perceptions of burden. The current study examined these variables in 130 spouses of reserve component troops deployed during Operations Enduring/Iraqi Freedom. Spouses’ burden was positively associated with symptoms of PTSD, depression, and anxiety in service members, regardless of clinical severity. Moreover, burden fully mediated the relation between each type of symptom and spouses’ own psychological distress. Furthermore, levels of burden were significantly related to spouses’ neuroticism, avoidant coping, and self-efficacy, but only avoidant coping remained a significant predictor of burden when accounting for service members’ distress. These results suggest that a broad range of service members’ symptoms are related to spouses’ burden and distress, and although individual characteristics of spouses may be related to their perceptions of burden, service members’ symptoms play a primary role.     

Psychological resilience in U.S. military veterans: A 2-year,nationally representative prospective cohort study

Although many cross-sectional studies have examined the correlates of psychological resilience in U.S. military veterans, few longitudinal studies have identified long-term predictors of resilience in this population. The current prospective cohort study utilized data from a nationally representative sample of 2157 U.S. military veterans who completed web-based surveys in two waves (2011 and 2013) as part of the National Health and Resilience in Veterans Study (NHRVS). Cluster analysis of cumulative lifetime exposure to potentially traumatic events and Wave 2 measures of current symptoms of posttraumatic stress, major depressive, and generalized anxiety disorders was performed to characterize different profiles of current trauma-related psychological symptoms. Different profiles were compared with respect to sociodemographic, clinical, and psychosocial characteristics. A three-group cluster analysis revealed a Control group with low lifetime trauma exposure and low current psychological distress (59.5%), a Resilient group with high lifetime trauma and low current distress (27.4%), and a Distressed group with both high trauma exposure and current distress symptoms (13.1%). These results suggest that the majority of trauma-exposed veterans (67.7%) are psychologically resilient. Compared with the Distressed group, the Resilient group was younger, more likely to be Caucasian, and scored lower on measures of physical health difficulties, past psychiatric history, and substance abuse. Higher levels of emotional stability, extraversion, dispositional gratitude, purpose in life, and altruism, and lower levels of openness to experiences predicted resilient status. Prevention and treatment efforts designed to enhance modifiable factors such as gratitude, sense of purpose, and altruism may help promote resilience in highly trauma-exposed veterans.     

Resilience and suicidality among homeless youth

Homeless and street-involved youth are considered an extremely high risk group, with many studies highlighting trajectories characterized by abusive, neglectful, and unstable family histories, victimization and criminal involvement while on the streets, high rates of physical and mental illness, and extremely high rates of mortality. While there exists a substantial body of knowledge regarding risk, in recent years attention has been increasingly shifting to the examination of resilience, intervention, and service delivery models for these young people. The present study describes the findings from a quantitative examination of personal and street-related demographics, psychological distress, self-esteem, resilience, and suicidality among 47 homeless and street-involved youth. Key findings indicate that the apparent erosion of mental health variables, including resilience, occurs as a function of how long the youths have been without stable housing. Finally, those youths’ perceived resilience was associated with less suicidal ideation whereas higher psychological distress was associated with higher suicidal ideation, even when accounting for resiliency.     

Selecting Mechanism as a Concept for Psychiatry

Abstract

Disaster mental health research has historically focused on assessment of psychopathology, using measures of psychiatric symptoms and disorders. The Oakland/Berkeley firestorm provided an opportunity to explore resilience among highly exposed survivors through consideration of psychiatric variables in the context of personality. The Diagnostic Interview Schedule/Disaster Supplement was administered to 62 firestorm survivors at approximately 4, 16, and 39 months and the Temperament and Character Inventory administered at 16 months postdisaster. Few individuals had postdisaster psychopathology (16% with any diagnosis, 5%with PTSD). There was considerable evidence of distress, however, indicated by an abundance of reported posttraumatic symptoms, functional impairments, and endorsement of emotional upset, all of which decreased substantially over time. Group C (avoidance/numbing) posttraumatic symptoms were relatively uncommon and were specifically associated with elevated Self-Transcendence. Groups B (intrusion) and D (hyperarousal) symptoms were prevalent and were associated with high Harm Avoidance and low Self–Directedness. The generally healthy personality profiles of these firestorm survivors reflected their psychological resilience. Examination of symptoms and distress in the context of psychiatric disorders after this disaster demonstrated that symptomatic distress is not inconsistent with psychological resilience. The choice of research focus and methods can provide very different portraits of outcomes post–disaster.     

Sexual revictimization in a clinical sample of women reporting childhood sexual abuse

Background: Child and adolescent sexual abuse (CSA) increases the risk for adult sexual assault (ASA), and psychological vulnerability as well as aspects of CSA and upbringing might influence the risk. Aims: The aims of this study were to investigate whether women who reported both CSA and ASA: 1) have been exposed to more severe CSA and 2) have greater psychological distress and vulnerability than women who were not revictimized. Methods: The study was a cross-sectional study of 161 adult women with a reported history of intrafamilial CSA. Thirty-six per cent of the women stated they had been exposed to ASA. The severity of CSA, psychological distress (Symptoms Checklist-90-R) and Cognitive Distortion were assessed. Five factors of Cognitive Distortion (fearful, scared, shy, mistrust and vulnerable) were identified by factor analysis of Symptoms Checklist-90-R sub-scale. Results: The CSA was significantly more severe (penetration: 77%/60%; multiple offenders: 67%/25%) in women exposed to ASA compared with their counterparts, as was the rate of suicide attempts (47%/30%). Also, the psychological distress and the factors: fearful, scared, shy and mistrust were significant higher. Conclusion: The results showed an increased psychological vulnerability among women with ASA, but whether the results are cause or effect of sexual revictimization or can be generalized to other clinical samples are not clear. Interventions targeting the increased risk of ASA should be developed, implemented and tested in prevention as well treatment programmes.     

The association between neuroticism and self-reported common somatic symptoms in a population cohort

OBJECTIVE: To test the hypotheses that (1) neuroticism is associated with self-reported somatic symptoms; (2) this association is especially found with regard to psychosomatic symptoms; and (3) it is not solemnly explained by somatic reflections of psychological distress. METHODS: We studied the cross-sectional association between neuroticism (as measured by EPQ-RSS-N), psychological distress (as measured by GHQ-12 sum score), and the occurrence of 22 common somatic symptoms by linear and logistic regression analyses in a population cohort of 6894 participants. RESULTS: Neuroticism is more strongly associated with the total number of somatic symptoms reported (beta=.32) than GHQ-12 sum score (beta=.15) and well-established risk markers such as gender (beta=.11) and age (beta=.04). Neuroticism was associated with all symptoms in individual logistic regressions controlled for age, gender, and psychological distress. Neuroticism is significantly more strongly related to psychosomatic symptoms (beta=.36) than to infectious/allergic symptoms (beta=.28). CONCLUSION: In a large, population-based cohort, we confirmed that neuroticism is associated with self-reported somatic symptoms. The associations were not attributable to somatic reflections of psychological distress associated with neuroticism and were relatively strong with respect to psychosomatic symptoms. Future studies should include both objective and subjective measures of health to study the mechanisms that connect neuroticism and ill health.     

Apport de la génétique dans les études sur la résilience : l’exemple de l’autisme

Resilience refers to patterns of positive adaptation in the context of significant risk or adversity. In the early 1970s, researchers began to discuss the importance of observing why some individuals did not develop psychopathological troubles in spite of being at risk. Over the past 30 years, real advances have occurred in understanding the complexity of causality and the interaction of multiple risks and protective factors in the process of resilience.Two major approaches have characterized the research in this domain: the variable-focused approach and the person-focused approach. Many variable-based models conceptualized interactions and/or correlations between individual environmental risk and protective factors. These models have been extended with recent studies investigating the link between genetic risks and resilience. From a genetic perspective, resilience could be understood as the extent to which an individual who possesses a genetic risk for psychopathology does not develop troubles. But, even if most studies have been concerned with dividing population variance into effects attributable to genes and those attributable to environment, it now seems clear that other effects exist. Examples of correlation models (rGE) underline the need to differentiate the genetic and environmental mediation of risk processes and of moderation or resistance to them.To clarify this new framework, an example of study of resilience in families having an autistic child was proposed. Data from twin studies and family studies offered strong support for the genetic contribution to autism. Studies in relatives of autistic persons extended these results by indicating a similar pattern of social and/or communication difficulties in first degree or more distant relatives of the child (the broader autism phenotype). In addition to genetic factors, growing up with an autistic sibling is expected to cause psychological and emotional difficulties in family members. Studies in siblings of autistic individuals have shown that they were at risk of psychiatric disorders as major depression and anxiety disorders in these subjects have been found to be twofold greater than in controls. However, studies investigating the psychological adjustment in siblings of autistic individuals showed no significant differences with controls. Some of these contradictions may be attributed to methodological issues, but the question remains concerning the validity of employing the term of ’resilience’ in this research domain. There is a growing acceptance of the need to study and question the various methodological hazards that could lead to false impressions of resilience. Studies in the area of resilience should follow interdisciplinary and multiple levels of analysis perspectives. Such investigations may reveal that genes may also serve as a protective function for individuals facing adversity. Resilience could help to broaden the understanding of developmental processes that may not be so evident in normative environments.     

Migrations,trauma and mental health: A literature update on psychological assessment

IntroductionMigrants and refugees often face potentially traumatic events and post-migratory stressors. Upon arrival in the host country, they can be referred to mental health services to assess the impact of their previous experiences. These cross-cultural clinical encounters may raise questions, particularly regarding the assessment of mental health using models based on Western conceptions of psychopathology.Objectives and methodThe objective of the present non-systematic review of the literature is to discuss the psychological evaluation of post-traumatic reactions in migrants and refugees. More specifically, we present current research on psychopathology, resilience and post-traumatic development (PTG) among the migrant and refugee population. We also examine the cross-cultural validity of concepts such as Post-Traumatic Stress Disorder, resilience and PTG. Finally, we describe the most frequently used tools in cross-cultural psychological assessment and briefly reflect on the question of cultural sensitivity of mental health professionals. A bibliographic search was carried out using the databases: PILOTS, Pubmed, APA PsycNET, and Google Scholar using the following keywords: “migrants”, “refugees”, “posttraumatic stress disorder”, “mental health”, “Psychopathology”, “risk factors”, “protection factors”, “posttraumatic growth” and “resilience”. We have also reviewed the reference lists of articles encountered from database searches.ResultsResponses to a potentially traumatic situation are multiple. Regarding the migrant and refugee population, the reviewed articles studied different post-traumatic reactions such as resilience, post-traumatic development, and psychopathologies. The most studied psychopathological responses were depression, anxiety and Post-traumatic Stress Disorder. After reviewing these studies, we asked the following question: considering the complexity of the migration process, what are the factors associated with the development of these different post-traumatic responses? Indeed, several individual and social factors before, during and after migration influence the mental health of individuals in a migration situation. Among the most cited risk factors identified were: to be a victim of or witness to violence in the country of origin and, after migration, to face post-migration difficulties such as asylum denial, to be in a precarious situation with regard to housing and work, as well as the difficulties linked to adaptation to the new culture. We have also described protective factors for the mental health of this population, such as: social support, psychological support, and a good quality of life in the host country. The reviewed articles also describe an important influence of cultural aspects on mental health, such as the perception of an event as traumatic. Although the authors of the reviewed articles accept this influence of culture on post-traumatic responses, most of the tools used to assess the mental health of migrants and refugees were created in a Western context. Studies show a growing concern with these cultural aspects, and certain tools that allow a more culturally sensitive evaluation, such as the “Cultural Formulation Interview”, are being developed.Discussion and conclusionEven if the concern with the sensitivity of the tools used in cross-cultural assessment seems to be more present in the international literature, researchers seem to encounter difficulties in better understanding the effects of culture on the mental health of individuals. With increasingly diverse societies, new research should not be based on participants’ geographic or ethnic origins, but rather try to “unpack” culture with, for example, the exploration of the relationships between certain values or orientations and the different expressions of psychological distress. Finally, given the still lacking development in the field of cross-cultural research, certain practices, such as the participation of interpreters, the supervision of cultural mediators or the use of culturally sensitive tools, can help the clinician to maintain good practices with patients from different cultures in the diagnostic and psychotherapeutical processes.     

60,000 disaster victims speak: Part I. An empirical review of the empirical literature, 1981-2001

Results for 160 samples of disaster victims were coded as to sample type, disaster type, disaster location, outcomes and risk factors observed, and overall severity of impairment. In order of frequency, outcomes included specific psychological problems, nonspecific distress, health problems, chronic problems in living, resource loss, and problems specific to youth. Regression analyses showed that samples were more likely to be impaired if they were composed of youth rather than adults, were from developing rather than developed countries, or experienced mass violence (e.g., terrorism, shooting sprees) rather than natural or technological disasters. Most samples of rescue and recovery workers showed remarkable resilience. Within adult samples, more severe exposure, female gender, middle age, ethnic minority status, secondary stressors, prior psychiatric problems, and weak or deteriorating psychosocial resources most consistently increased the likelihood of adverse outcomes. Among youth, family factors were primary. Implications of the research for clinical practice and community intervention are discussed in a companion article (Norris, Friedman, and Watson, this volume).     

What factors explain anger and mental health during the COVID-19 pandemic? The case of Israeli society

BACKGROUNDWhat factors affected the levels of anger and emotional distress experienced during the coronavirus disease 2019 (COVID-19) pandemic? We hypothesized that (1) sociodemographic factors and resiliency factors would partially explain psychological distress and anger, with stronger resiliency associated with lower levels of distress and anger; (2) women would report more trust in national leadership, as well as more psychological problems; (3) individuals of low socioeconomic status would report less resiliency, less trust in national leadership, and greater distress than individuals of higher socioeconomic status; and (4) hope would mediate the relationships between the other resiliency factors and both anger and distress.AIMTo explore whether community resilience, hope, and trust in leaders were associated with lower levels of anger and emotional distress during the COVID-19 pandemic.METHODSFor this observational study, data were gathered in Israel during the second wave of the COVID-19 pandemic, just before the Jewish New Year (mid-September 2020), as a second lockdown was announced. Data were gathered from 636 Israeli adults, who were recruited by the Midgam research panel. The participants filled out self-reported questionnaires including one on state anger, the Brief Symptom Inventory as a measure of mental-health problems (i.e., somatization, depression, and anxiety), and questionnaires about trust in the state’s leaders, community resilience (CCRAM), and hope as measures of coping resources and resiliency. t-tests were used to explore differences between men and women and between those of lower and higher socioeconomic status. A hierarchical multiple regression analysis was then used to examine whether and how the sociodemographic and resiliency variables explained state anger and psychological distress. A Sobel test was used to evaluate the possible effects of hope on community resilience and trust in leadership in the context of both distress and anger.RESULTSOur results revealed differences between women and men in terms of anger and mental-health problems, but not in terms of coping resources. Women reported higher levels of both anger and mental-health problems. Participants of lower socioeconomic status reported more mental-health problems, more anger, and greater trust in the state’s leaders; whereas those of higher socioeconomic status reported greater hope. Furthermore, hierarchical multiple regression analyses revealed that the sociodemographic factors of gender, age, and socioeconomic status, as well as community resilience, trust in the state’s leaders, and hope explained mental health with a total of 19% of the variance and anger with a total of 33% of the variance. The Sobel tests showed that hope mediated the relationships between community resilience and mental health (z = 3.46, P < 0.001), community resilience and anger (z = 2.90, P < 0.01), and trust in leaders and anger (z = 3.26, P < 0.01), but did not affect the relationship between trust in leaders and mental health (z = 1.53, P > 0.05).CONCLUSIONPersonal and communal factors affect psychological distress. Personal resilience is an important factor that should be strengthened throughout life. Trust in leadership is important for citizens’ mental health.