Functionality, rather than feeling good, may lead to higher achievement

Only some types of wellbeing show links with higher academic achievement in new study.

24 July 2023

By Emily Reynolds


As mental health awareness has gained prominence, schools have put an increasing focus on wellbeing for students. However, pressure to achieve academically can complicate this. In the moment, pressure can decrease wellbeing, yet the fruits of academic efforts can increase future wellbeing.

A new study, conducted by a team at the University of Cambridge, looks more closely at what ‘wellbeing’ actually means in these contexts. They explore different forms of wellbeing — overall wellbeing, feeling good (life satisfaction), and functioning well (eudaimonia) — and tease apart whether the relationships between these types of wellbeing and academic achievement differ.

The study was part of a larger research project focused on children’s experiences of wellbeing at school, with data on the relationship between wellbeing and attainment for secondary school pupils pulled out of a larger dataset featuring children from a broader age range. Participants were 607 teenagers aged 14 or 15, who were in their penultimate year of secondary school in East England.

Wellbeing was measured using four constructs: life satisfaction (“feeling things are fun”), eudaimonia or ‘functioning well’ (“feeling confident”), negative emotions (“feeling stressed”), and how much students felt interpersonally related to others (“feeling cared for”). The reason for separating out these factors, the team says, was to create clarity on how each element interacts with academic achievement.

The team also gathered data on the participants’ academic achievements through their achievements in their mock GCSEs in English and Maths. Achievement in three previous exams was also analysed, with the team looking to see whether students achieved the expected standard in reading, grammar, punctuation and spelling, and maths. Achievement goals were also looked at, with participants indicating how much they agreed with statements such as “one of my goals in Maths lessons is to learn as much as I can,” or “it’s important to me that I don’t look stupid in my English lessons”.

Finally, the team looked at mindset. The scale used by researchers looked at two different mindsets: fixed mindset, measured by statements such as “I don’t think I can do much to increase my intelligence”, and growth mindset, measured by statements such as “I believe I can always substantially improve on my intelligence”.

Overall wellbeing predicted academic achievement: teenagers with higher overall wellbeing, combining general life satisfaction and eudaimonia, had significantly higher academic achievement than those with lower wellbeing. This suggests that efforts to increase wellbeing in schools could have a positive impact on academic attainment as well as mental health.

However, the results also show the importance of separating out different forms of wellbeing. Eudaimonia was significantly associated with attainment, while life satisfaction was not. This runs counter to other research, which suggested eudaimonia was the least important facet in attainment for young people. The team suggests may be to do with its England-centric focus, or analyses including only teenagers. Future research focusing on eudaimonia and attainment could clarify the relationship between the two further.

Finally, mindset was related to some forms of wellbeing — but, perhaps surprisingly, not to attainment. Those with both higher overall wellbeing and higher eudaimonia were also more likely to agree with statements reflecting a growth mindset, while there was no such relationship with life satisfaction.

Participants of this study were largely White, male, and not in receipt of free school meals, meaning the findings may not be generalisable to other demographics. Similarly, mock exams are assessed by teachers, rather than external examiners, which other research has suggested can be a process influenced by significant gendered and racialised bias.

Overall, the study suggests that life satisfaction is less important than eudaimonia when it comes to attainment. This highlights not only that increasing eudaimonia may be a crucial element to focus on for policymakers and teachers, but that different forms of wellbeing can have a different impact on material outcomes.

Read the paper in full: https://doi.org/10.1080/2372966X.2023.2217980

SOURCE:

https://www.bps.org.uk/research-digest/functionality-rather-feeling-good-may-lead-higher-achievement(accessed 26.7.23)

Καύσωνας και ψυχική υγεία

Οσοι συνάνθρωποί μας εμφανίζουν οξέα ή χρόνια προβλήματα ψυχικής υγείας, αν για μεγάλα χρονικά διαστήματα δεν μπορέσουν να βρουν ανακούφιση από τις υψηλές θερμοκρασίες, μπορεί να εκδηλώσουν πυροδότηση συμπεριφορών ευερεθιστότητας, ψυχολογικής δυσφορίας ή και επικινδυνότητα
2' 43" χρόνος ανάγνωσης


Οι καλοκαιρινοί καύσωνες με τις ακραίες θερμοκρασίες τους, όπως αυτές που βιώνει το τελευταίο διάστημα η χώρα μας, έχουν συσχετισθεί με αύξηση της θνησιμότητας στον γενικό πληθυσμό και ειδικότερα στις ευπαθείς ομάδες, όπως είναι οι ασθενείς με καρδιαγγειακό ιστορικό, οι πάσχοντες από νόσους τους αναπνευστικού ή από σακχαρώδη διαβήτη και οι ηλικιωμένοι.

Πληθαίνουν οι καύσωνες διαρκείας

Συγκεκριμένα, για κάθε 1 °C μέσης ημερήσιας θερμοκρασίας άνω των 24 °C, η θνησιμότητα αυξάνεται κατά 1,9%, ενώ το αντίστοιχο ποσοστό αύξησης φτάνει στο 5,5% για όσους έχουν και συνυπάρχοντα ψυχιατρικά προβλήματα. Γενικά, φαίνεται πως, μία προϋπάρχουσα ψυχιατρική νόσος μπορεί να υπερτριπλασιάσει τον κίνδυνο θανάτου στη διάρκεια ενός κύματος καύσωνα.

Επιπλέον, όσοι από τους συνανθρώπους μας εμφανίζουν οξέα ή χρόνια προβλήματα ψυχικής υγείας, αν για μεγάλα χρονικά διαστήματα δεν μπορέσουν να βρουν ανακούφιση από τις υψηλές θερμοκρασίες, μπορεί να εκδηλώσουν πυροδότηση συμπεριφορών ευερεθιστότητας, ψυχολογικής δυσφορίας ή και επικινδυνότητας που σχετίζεται με βίαιες και επιθετικές εκρήξεις θυμού και υπερβολική κατανάλωση αλκοόλ που, υπό συνθήκες καύσωνα, καθίσταται ακόμη πιο επιβλαβής.

Ερχεται ο καύσωνας «Κλέων» με 43άρια και εξαήμερη διάρκεια – Συστάσεις προς τους πολίτες

Οι επιδράσεις των παρατεταμένα υψηλών θερμοκρασιών, σε συνδυασμό με ενδεχόμενα προβλήματα στην ηλεκτροδότηση ή την υδροδότηση και την εκδήλωση απειλητικών πυρκαγιών έχουν έντονα αρνητικό αποτύπωμα στην ψυχική υγεία των πολιτών, τόσο σε αστικές όσο και σε αγροτικές περιοχές, με πιθανές αυξήσεις στα επίπεδα του χρόνιου ή του παροξυσμικού stress, της απελπισίας και της κατάθλιψης, καθώς και με ενδεχόμενη ανάδυση αυτοκαταστροφικών συμπεριφορών. Κάθε ψυχική νόσος μπορεί να αποτελέσει επιπλέον παράγοντα κινδύνου για αύξηση της συνδεόμενης με τον καύσωνα θνησιμότητας, την ίδια στιγμή που η υπερβολική άνοδος της θερμοκρασίας αποτελεί ξεχωριστό παράγοντα υποτροπής ή παρόξυνσης ψυχικών διαταραχών.

Σε ιδιαίτερα ευάλωτη θέση βρίσκονται οι συνάνθρωποί μας που εμφανίζουν ανοϊκές διαταραχές, όπως η νόσος του Alzheimer, καθώς είναι πιθανό να μην μπορούν να απαρτιώσουν μία πλήρη νοητική επεξεργασία των περιβαλλοντικών συνθηκών ώστε να αναλάβουν προσαρμοστικές συμπεριφορές όπως είναι η αυξημένη πρόσληψη υγρών και η κατάλληλη ένδυση με ελαφρά ρούχα. Ανάλογο βαθμό ευαλωτότητας εμφανίζουν και όσοι πάσχουν από ψυχωτικές διαταραχές (όπως π.χ. η σχιζοφρένεια), βαριές διαταραχές του συναισθήματος ή αναπτυξιακές διαταραχές, την ίδια στιγμή που τόσο αυτές καθ’ εαυτές οι παθήσεις όσο και οι αναγκαίες για την αντιμετώπισή τους χορηγούμενες φαρμακευτικές αγωγές μπορούν να επηρεάσουν δυσμενώς το θερμορυθμιστικό σύστημα των πασχόντων και την ικανότητα της ομοιοστατικής προσαρμογής του οργανισμού σε περιβάλλοντα υψηλών θερμοκρασιών. Ασθενείς με κατάθλιψη, για παράδειγμα, έχει βρεθεί πως εμφανίζουν μειωμένη θερμορρυθμιστική ικανότητα, ενώ χρειάζεται αυξημένη προσοχή, καθώς πολλά από τα αντικαταθλιπτικά και τα υπόλοιπα ψυχοτρόπα φάρμακα, μπορεί να επιδεινώσουν τις διαταραχές των ηλεκτρολυτών που αποτελούν σύνηθες φαινόμενο, εν μέσω κυμάτων καύσωνα.

Όσοι υποφέρουν από ψυχικές διαταραχές ενδέχεται, επίσης, να εμφανίζονται αρκετά επιρρεπείς σε, προκαλούμενες από την υπερβολική ζέστη, παρορμητικές συμπεριφορές ή άλλες εκδηλώσεις άρσης αναστολών, καθώς και σε άμβλυνση των νοητικών ικανοτήτων, καταστάσεις που μπορεί να οδηγήσουν στην αύξηση των θανατηφόρων ατυχημάτων και ευρύτερα των ετερο-βλαπτικών ή και των αυτό-βλαπτικών συμπεριφορών, στις οποίες συμπεριλαμβάνονται και οι αυτοκτονίες που συσχετίζονται, επίσης, με την παρόξυνση και παράταση φαινομένων καύσωνα.

Γίνεται, λοιπόν, απολύτως κατανοητό γιατί τα σχέδια προστασίας της Δημόσιας Υγείας, εν μέσω περιόδων καύσωνα θα πρέπει να συμπεριλαμβάνουν στις ευπαθείς ομάδες και τους συνανθρώπους μας οι οποίοι πάσχουν από ψυχικές διαταραχές, με την προσοχή να εστιάζεται όχι μόνον σε όσους εμφανίζουν χρόνιες και βαριές ψυχικές παθήσεις, αλλά και στους πάσχοντες από ηπιότερες ψυχιατρικές διαταραχές.

*Xρίστος Χ. Λιάπης, Ψυχίατρος – Διδάκτωρ Παν/μίου Αθηνών, Πρόεδρος ΔΣ ΚΕΘΕΑ

ΠΗΓΗ:

https://www.kathimerini.gr/life/health/562515430/kaysonas-kai-psychiki-ygeia/(accessed 19.7.23)

Bodily sensations seem clearer for blind people

New study finds heartbeat counting performance was better in a blind sample than a sighted sample, suggesting enhanced interoceptive abilities in those with limited sight.

14 July 2023

By Emma Young


Sensing the world around us and sensing our own body are sometimes linked in surprising ways. For example, previous research has shown blind people to have more sensitive hearing and be better at detecting touch and smells than those with typical vision.

Now new research, published in the Journal of Experimental Psychology: General, shows for the first time that blind people are also better at a form of inner, bodily sensing — heartbeat counting, or ‘cardiac interoception’. Previous work has found that the sensing of bodily signals plays a key role in our emotional lives, so this new research could help to explain results from other studies finding that blind people may have superior emotional processing, too.

The James-Lange theory of emotion holds that emotional states arise from physiological changes inside the body. Over the past few decades, a growing number of studies have linked variations in people’s ability to sense these changes — including changes in heart rate — to variations in their emotional experiences. People who are better at sensing their own heart rate, without feeling for a pulse, report more intense, and also more nuanced, emotions.

For this new investigation, Dominika Radziun at the Karolinska Institute and colleagues recruited 36 blind people and 36 sighted matched controls. Thirty-one were congenitally blind, two became blind before the age of two, and three became blind later in life. For each blind participant, the team also recruited an age- and gender-matched sighted control.

All the participants completed a standard heartbeat counting task, reporting on their number of heartbeats during six trials of different durations, without feeling for a pulse. They were given these instructions: “Without manually checking, can you silently count each heartbeat you feel in your body from the time you hear ‘start’ to when you hear ‘stop’?” The researchers used a pulse oximeter to assess the actual number of heartbeats during the trials, and created a heartbeat counting accuracy score for each person.

Their analysis showed that the blind participants were significantly more accurate than the sighted controls. Where a score of ‘1’ would have indicated complete accuracy and 0 complete inaccuracy, the mean score for the blind participants was 0.779, versus 0.630 for the sighted group. The performance of the sighted group was in line with the results of previous heartbeat counting studies on the general population, the team notes. These results do seem to suggest that blind people perform better.

The precise mechanisms underpinning the sensory superiorities previously observed in blind people are still debated. Some studies have suggested that superior touch, for example, results not from a lack of vision per se, but a heavier reliance on touch in exploring the world, and this extra use trains that sense. Other studies have suggested that the lack of visual experience causes structural changes in a number of brain areas involved in processing sensory information, as well as alterations to connections between these areas, and it is these changes that drive superior sensory performance. As heartbeat sensing isn’t something that most of us train in daily life, the new results fit better within the framework of this latter theory.

Earlier studies have also found that blind people are better at processing emotional information in sounds, for example. Since research shows that the sensing of heartbeats is involved in emotion, this new work suggests that improved heartbeat sensing might contribute to this superior performance. “Our results could provide a missing explanatory link between improved emotional processing and increased sensory acuity in blind individuals,” the team writes.

The validity of the heartbeat counting task used in this study has been criticised, though the evidence on this is mixed. However, the other widely used method for counting heartbeats requires participants to decide whether their heartbeats coincide or not with a series of tones, and as the integration of information from different senses is known to be altered in blind people, this task wouldn’t have been appropriate for this study.

No doubt, the potential impact of heartbeat accuracy on emotion processing in blind people will be explored further in future studies. As authors note, these findings spur further questions about cross-modal plasticity after vision loss, bodily self awareness, and links between bodily sensations and our emotional experiences. This new study will surely prompt new efforts into understanding how various sensory losses and changes — even beyond vision — might affect inner sensing, too.

Read the paper in full: https://doi.org/10.1037/xge0001366

SOURCE:

https://www.bps.org.uk/research-digest/bodily-sensations-seem-clearer-blind-people(accessed 19.7.23)

Νέα έρευνα: Γιατί οι χωρισμένοι γονείς δυσκολεύονται να βρουν νέους συντρόφους;

Μια νέα έρευνα που πραγματοποιηθήκε στη Μεγάλη Βρετανία αποκάλυψε γιατί οι singles που ψάχνουν για σύντροφο αποκλείουν τους χωρισμένους γονείς και ως αποτέλεσμα, οι singles με παιδιά δυσκολεύονται να βρουν νέους συντρόφους!

Σύμφωνα με την έρευνα που πραγματοποίησε η εφαρμογή γνωριμιών για single γονείς ‘Even’, ένας στους τέσσερις Βρετανούς δήλωσαν ότι δεν θα έβγαιναν ραντεβού με χωρισμένο γονιό καθώς ανησυχούν ότι θα έμπαιναν σε μια μπερδεμένη κατάσταση όπου ο πρώην σύντροφος θα δημιουργούσε θέματα σε μια πιθανή σχέση, ενώ το 14% των ερωτηθέντων δήλωσε ότι φοβάται ότι ένας χωρισμένος γονιός δεν θα έχει αρκετά χρήματα!

Ένας στους δέκα δήλωσε ότι δεν θα είχαν προτεραιότητα στη ζωή των συντρόφων τους αφού προτεραιότητα θα είναι πάντα τα παιδιά, το 14% δήλωσε ότι φοβάται ότι δεν θα τα πηγαίνουν καλά με τα παιδιά ενώ το 8% δήλωσε ότι το γεγονός ότι υπάρχει μια αποτυχημένη σχέση δείχνει κάτι αρνητικό.

Ένας στους δέκα δήλωσε ότι φοβούνται ότι ο χωρισμένος γονιός απλά ψάχνει για αντικαταστάτη του “πατέρα” ή της “μητέρας” στη ζωή των παιδιών, ενώ το 19% δήλωσε πως ένας χωρισμένος γονιός μπορεί να έχει ακόμα μεγάλο συναισθηματικό φορτίο για τον πρώην σύζυγό του, είτε θετικά συναισθήματα είτε θυμό. Το 15% μάλιστα δήλωσαν ότι δεν θα επιθυμούσαν να μεγαλώσουν παιδιά που δεν είναι δικά τους!


Στα θετικά της έρευνας είναι πως παρά τους φόβους τους αρκετοί – 6 στους δέκα- δήλωσαν ότι θα έμπαιναν στη διαδικασία να μπουν σε μια σχέση παρά τα παιδιά, ενώ μόλις το 16% δεν θα το σκέφτονταν καν. Ένας στους τέσσερις δήλωσαν πως θα έβλεπαν θετικά να βγουν με έναν χωρισμένο γονιό αφού θα ήταν ένας άνθρωπος χωρίς εγωισμό, ανεξάρτητος και υπεύθυνος.


Οι χωρισμένοι γονείς δήλωσαν – ένας στους δέκα- ότι φοβούνται να πουν στο πρώτο ραντεβού ότι έχουν παιδιά ενώ ένας στους έξι δεν το αποκαλύπτουν πριν το πρώτο ραντεβού αλλά κατά τη διάρκεια.

ΠΗΓΗ:

https://www.themamagers.gr/family/single-parents/nea-ereyna-giati-oi-chorismenoi-goneis-dyskoleyontai-na-vroyn-neoys-syntrofoys/(accessed 13.7.23)

Dying for company: Loneliness increases mortality risk, says meta-analysis

Extensive new look at past research reveals loneliness increases the risk of dying, both across disease states and in healthy individuals.

05 July 2023

By Emma Young


Claims that loneliness is harmful to our health regularly make media headlines. Certainly, there are plenty of studies that have found links between feeling lonely or being ‘socially isolated’ — an objective measure of a person’s social contacts — and an increased risk of dying prematurely. A 2010 study even famously concluded that loneliness is as damaging to our health as smoking 15 cigarettes a day.

However, some other large research efforts have not found the same links. Overall, the results to date have been inconsistent, write Yashuang Zhao and colleagues at Harbin Medical University, China, in a new paper in Nature Human Behaviour.

In a bid to get closer to the true picture, the team undertook a massive systematic review and meta-analysis of 90 prospective studies in the field. They used only results from individual analyses that had controlled for as many confounding factors as possible, such as alcohol use, depression or diabetes.

The team concluded that, among the general population, social isolation (SI) was linked to a 32% increased risk of dying prematurely from all causes. For loneliness, the figure was 14%. They also found that SI was linked to a 24% higher chance of dying from cancer, and a 34% higher risk of dying from cardiovascular disease. Loneliness increased the risk of dying from cancer by 9%.

The team also reports findings for specific patient groups. Socially isolated people with either breast cancer or cardiovascular disease had a higher risk of dying prematurely from all causes. Also, socially isolated participants with breast cancer were more likely to die from that cancer, compared with patients who had adequate levels of social contact.

The 90 studies, which had a total of just over 2.2 million participants, consisted of 29 from the US and 61 from other, mostly developed, countries — including the UK. Sixty-seven investigated the risk of dying from any cause in the general population. Seventeen looked specifically at the risk of death from cardiovascular disease or circulatory system diseases, and 11 investigated the risk of dying from cancer, again in the general population.

A further six studies looked for links between social isolation and the risk of dying from any cause among people diagnosed with either breast or colorectal cancer. A total of seven studies on patients with these cancers investigated whether was an association between social isolation and dying from that cancer, specifically.

Various ideas have been put forward for why loneliness and social isolation may both be harmful to our health. Socially isolated people could have a poorer diet and do less exercise, for example. SI has also been linked to a higher risk of body-wide inflammation and poorer immune function. Studies have also found ties between loneliness and a higher rate of sleep disorders and immune system dysfunction.

This new study will increase confidence in the idea that both social isolation and loneliness are indeed harmful to our health. Tackling these problems will mean developing more effective interventions, however, as those that have been tried to date have had limited success. Hopefully, these findings will boost efforts to develop programmes that really do work.

Read the paper in full: https://doi.org/10.1038/s41562-023-01617-6

SOURCE:

https://www.bps.org.uk/research-digest/dying-company-loneliness-increases-mortality-risk-says-meta-analysis(accessed 13.7.23)

Survivor identity may help Covid survivors cope with slow recovery

New study explores the experiences of recovered intensive care patients, relatives, and healthcare providers, and finds insights for recovery strategies.

28 June 2023

By Emma Barratt


Covid remains very much with us. Though the likelihood of dying from it has — for those able to access it — been mitigated by the rollout of the vaccine programme, swathes of the world’s population continue to process the grief, fear, and memories of the early stages of the pandemic.

Understanding the psychological impact that Covid has on those that nearly lost their lives to it, as well those surrounding them, remains an ongoing effort for psychological researchers. Though many in therapeutic roles expect to hear about Covid for the rest of their careers, at the moment, little is known about how best to support this growing group of survivors.

However, new research is beginning to bring light to this issue, revealing potential psychological interventions to aid survivors’ transition through slow recovery and back to everyday life.

Using in-depth interviews, a UK-based team of scientists recently explored the experiences of illness and recovery of those admitted to critical care due to covid-19 (N=6), as well as the professionals who cared for critical care patients (N=12), and family of survivors (N=5). Conceived in the earliest days of the pandemic, these interviews took place between May and July 2020, with the team’s questions probing experiences of critical care and the first three months of survivors’ recoveries.

In these conversations, participants tended to speak about three main themes. The first related to the experience of health deteriorating quickly, and the downhill journey from symptom onset to critical care.

Like many of those watching the pandemic unfold in constant media coverage, survivors reported acute awareness and fear of what their symptoms may mean, as well as uncertainty of how to manage or treat it beyond self-isolating. When contacting emergency services, they faced some resistance due to services being overwhelmed, and were only admitted when ‘at breaking point’. One 70-year-old male participant described the situation as “getting too near the knuckle, really too close for comfort” in relation to his potential mortality.

Participants reported that short, potentially final goodbyes were said in the backs of ambulances. Many relatives were left fearing for their loved ones, as well as for their own health, having made contact with Covid. Isolation compounded the difficulty coping.

The second theme centred around facing a novel virus in a remote place. Survivors reflected on coping strategies while on the ward, including support from fellow patients, spiritual and emotional support from staff, and the use of video calling software to communicate with relatives.

Relatives also reported appreciating video calls, noting that it helped them gain more specific information on their loved ones conditions. Difficulty communicating with the hospital, and then passing on the information they learned, was a trigger for anxiety in them.

Hospital staff were aware of these communication difficulties, though often found it to be “emotionally exhausting” to communicate with families, if done continuously on top of their already highly increased workload. In the face of a surge in critically ill patients, a novel virus, and significant risks to their own health, many were left physically and mentally exhausted.

Last, but certainly not least, was the theme of returning home as a survivor. Unsurprisingly, patients were keen to return home, and relatives were often shocked when they were reunified, feeling ill-prepared for the fragile condition of survivors (though hospital staff made efforts to brief them ahead of time). Participants saw recovery as slow and full of unknowns. None of the participants knew how best to do rehabilitation, which brought its own stresses. Lack of available support made this transition more difficult; follow-ups with doctors were greatly valued.

When survivors spoke about their recovery, much of the language they used was rich in words that hinted at a ‘war with the virus’. Mentions of fighting, soldiering on, and determination suggested to the authors that patients were adopting a survivor identity in much the same way that has been documented in cancer patients. This comes with a lot of positives; recollections of camaraderie, new outlooks on life, and gratitude for being alive, for example. However, for some, survivors’ guilt also weighs heavily.

Though recalibrating to a survivor identity is known to often aid patients’ mental health, this study offers an extension to the existing definition, and suggests that it may offer a coping strategy which helps through the recovery process, rather than just upon attempts to return to a normal life. Analyses also offer hints that the process of building a survivor identity was more difficult during the pandemic, due in part to reduced contact with healthcare providers. The authors suggest that assisting with this in mind, and increasing communication between all parties, may be useful for the mental recovery of all involved.

Due to how time consuming it is to analyse interview data, the sample size of this study is rather small; despite being standard for this method, it does somewhat limits the generalisability of its findings. Further research may be needed to expand upon the themes uncovered. For example, it’s possible that those from non-British cultures, those holding other religious or cultural beliefs about mortality, or even different age groups may have different experiences.

These retellings make it easier to appreciate the life-changing experience of dealing with severe Covid. And, perhaps most relevantly to those recovering from — or supporting those recovering from — Covid, they point to the largely positive role of developing a survivor identity. Framing recovery in this way may provide a largely accessible way to maintaining mental health, and foster determination to continue with what can be a difficult recovery process.


Read the paper in full: https://doi.org/10.1111/nicc.12779

SOURCE:

https://www.bps.org.uk/research-digest/survivor-identity-may-help-covid-survivors-cope-slow-recovery(accessed 3.7.23)