Abstract
The COVID-19 pandemic created a unique opportunity to examine health as a function of multiple real-life stressors, especially in people with a chronic disease. Early studies indicated that the pandemic had an impact on social, physical and emotional aspects of life. This thesis examined mental and physical health during the
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COVID-19 pandemic in people with and without a chronic illness. Psychological flexibility is assumed to help dealing with adverse circumstances. We examined whether and to what extend psychological flexibility played a health-protecting role during the pandemic and whether the questionnaire that was used to assess psychological flexibility might be shortened. The five studies of this thesis yielded the following main findings: Although patients with an Inflammatory Rheumatic Disease (IRD) were more worried and stressed during the acute peak of the COVID-19 pandemic in 2020 compared to those without an IRD, their level of mental well-being was not lower compared to that of patients before the pandemic in 2018. There was no indication that psychological flexibility was a protective factor against a deterioration of health. Higher worry and stress during the pandemic, having a Central Sensitivity Syndrome (CSS) and lower psychological flexibility were all associated with more severe somatic symptoms. However, the association of stress with somatic symptoms was not particularly strong in people with a CSS and psychological flexibility did not buffer this association. The hypothesis that COVID-19 stress augments somatic symptoms particularly in people with a CSS, was not confirmed by our research. Although health of women with fibromyalgia was persistently low, mental health was not lower and pain and physical functioning were even better during, compared to before the COVID-19 pandemic. Especially during the prolonged phase of the pandemic in 2021, young adults’ mental and physical health was low, with one exception: in young adults with a chronic illness and low psychological flexibility, physical health was found to be better during the prolonged phase, compared to the acute and pre-pandemic phases. Factor analysis on the sixty items of the FIT-60 yielded a 2-factor solution, representing items of the ‘mindfulness and acceptance’ dimension of psychological inflexibility and of the ‘commitment and behavior change’ dimension of psychological flexibility, which were also represented in a succinct 18 item questionnaire: the FIT-18. Overall, this thesis implies that, with exception of young adults, people were perhaps mentally and physically healthier than expected during the pandemic. The expected larger health-preserving role of psychological flexibility, in worse times of the pandemic and in people with a chronic illness, was hardly confirmed. This suggests that more nuanced research is needed, regarding interventions that could support people with low flexibility in putting up with life after the pandemic.
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