Attachment styles impact on pet visitation effectiveness

Abstract

This paper describes a field study on the effects of attachment styles on the subjective well-being of institutionalized older persons after participating in a pet visitation program. We compared how attachment style (i.e., secure, anxious ambivalent, dismissive avoidant, and fearful avoidant) moderated the impact of a dog visitation program in 52 elderly residents of an assisted-living facility. Controlling for pre-visitation mood, the results revealed that the secure style related to increases in positive mood after interacting with the dogs. The anxious ambivalent style related to increases in positive mood and decreases in ratings of depression. Most importantly, the fearful avoidant style related to increases in depression after interacting with the dogs. The results highlight the notion that not all participants benefit from taking part in pet visitation programs. Theoretically, this study presents preliminary evidence for the relevance of attachment styles in understanding human–pet interactions.     

The Mediating Role of Resilience in the Relationship between Big Five Personality and Anxiety among Chinese Medical Students: A Cross-Sectional Study

Backgrounds

The psychological distress of medical students is a major concern of public health worldwide. However, few studies have been conducted to evaluate anxiety symptoms of medical students in China. The purpose of this study was to investigate the anxiety symptoms among Chinese medical students, to examine the relationships between big five personality traits and anxiety symptoms among medical students, and to explore the mediating role of resilience in these relationships.

Methods

This multicenter cross-sectional study was conducted in June 2014. Self-reported questionnaires consisting of the Zung Self-Rating Anxiety Scale (SAS), Big Five Inventory (BFI), Wagnild and Young Resilience Scale (RS-14) and demographic section were distributed to the subjects. A stratified random cluster sampling method was used to select 2925 medical students (effective response rate: 83.57%) at four medical colleges and universities in Liaoning province, China. Asymptotic and resampling strategies were used to explore the mediating role of resilience.

Results

The prevalence of anxiety symptoms was 47.3% (SAS index score≥50) among Chinese medical students. After adjusting for the demographic factors, the traits of agreeableness, conscientiousness and openness were all negatively associated with anxiety whereas neuroticism was positively associated with it. Resilience functioned as a mediator in the relationships between agreeableness/conscientiousness/openness and anxiety symptoms.

Conclusions

Among Chinese medical students, the prevalence of anxiety symptoms was high and resilience mediated the relationships between big five personality traits and anxiety symptoms. Identifying at-risk individuals and undertaking appropriate intervention strategies that focus on both personality traits and resilience might be more effective to prevent and reduce anxiety symptoms.     

Teaching biophysics. Strategies for recruiting and retaining minorities in physics and biophysics.

Several strategies directed toward increasing the participation of minority students in physics and biophysics are presented. Since the number of minority students entering college with an interest in science and mathematics must be increased if we expect to see more students graduating in science, several programs aimed at increasing the level of instruction of physics and biology in urban middle schools and high schools are outlined. We also describe approaches designed to increase the retention of science major during the freshman core physics course where many potential science majors are lost. Increasing the number of minority students at the PhD level will rely increasingly on partnerships between research universities and historically black colleges and universities (HBCUs) and several programs already in effect are given as examples of such linkages.     

The Psychological and Physiological Effects of Using a Therapy Dog in Mindfulness Training

ABSTRACT

The present study was a randomized controlled trial examining the psychological and physiological effects of adding animal-assisted therapy (AAT) to a modified Mindfulness-Based Stress Reduction program (MBSR) for clients experiencing psychological distress. It was hypothesized that AAT would complement mindfulness-based interventions because the therapy dog will provide a focus for attention to the current experience and exemplify acceptance and “being,” enabling the understanding and practice of the main aspects of mindfulness. Participants (n=21) were randomly assigned to an MBSR or MBSR+AAT group and then completed an intervention consisting of six 50-minute individual therapy sessions. Each session included didactic and experiential components modified for delivery with or without a certified therapy dog. State and trait mindfulness, psychological distress measures, blood pressure, and heart rate were assessed at each session. Results indicate that all participants experienced fewer anxiety and depressive symptoms, decreased psychological distress, and increased mindfulness skills from preto post-treatment. Additionally, state anxiety, blood pressure, and heart rate decreased within sessions. No significant difference was found between the control and experimental groups, indicating that interaction with a therapy dog had no impact on symptom reduction, skill acquisition, or client satisfaction in the current study. However, moderate to large effect size estimates indicate clinically significant differences between groups, with higher ratings for the MBSR+AAT group on therapist efficacy, recommending the training, and participating in future treatment. Future studies need to increase methodological rigor by including multiple therapist/dog teams and increasing sample size. Moreover, researchers must more thoroughly examine the role the dog might have in altering the social environment, such as reducing stigma surrounding mental health services and enhancing the therapeutic alliance.     

“Social Jetlag” in Morning-Type College Students Living On Campus: Implications for Physical and Psychological Well-being

Although on-campus residence allows easier access to campus facilities, existing studies showed mixed results regarding the relationship between college residence and students’ well-being indicators, such as sleep behaviors and mood. There was also a lack of studies investigating the role of chronotype in the relationship between on-campus residence and well-being. In particular, the temporal relationships among these factors were unclear. Hence, this longitudinal study aims to fill in these gaps by first reporting the well-being (measured in terms of mood, sleep, and quality of life) among students living on and off campus across two academic semesters. We explored factors predicting students’ dropout in university residences. Although students living on campus differ in their chronotypes, activities in campus residence (if any) are mostly scheduled in the nighttime. We therefore tested if individual differences in chronotype interact with campus residence in affecting well-being. Our final sample consisted of 215 campus residents and 924 off-campus-living students from 10 different universities or colleges in Hong Kong or Macau. Their mean age was 20.2 years (SD?=?2.3); 6.5% of the participants are female. Participants completed self-reported questionnaires online on their sleep duration, sleep quality, chronotype, mood, and physical and psychological quality of life. Across two academic semesters, we assessed if students living on and off campus differed in our well-being measures after we partialed out the effects of demographic information (including age, sex, family income, and parents’ education) and the well-being measures at baseline (T1). The results showed that, campus residents exhibited longer sleep duration, greater sleep efficiency, better sleep quality, and less feeling of stress than off-campus-living students. From one semester to the next, around 10% of campus residents did not continue to live on campus. Logistic regression showed that a morning type was the strongest factor predicting dropout from campus residence. Chronotype significantly moderated the effects of campus residence on participants’ physical and psychological quality of life. Although morning-type off-campus-living students have better well-being than their evening-type peers living off campus, morning-type campus residents had worse well-being than other campus residents and they were more likely to discontinue living on campus after one semester. Our findings bear practical significance to college management that morning-type campus residents are shown to be experiencing deteriorating well-being. The authorities may need to review and revise the room-allocation policy in campus residence in improving the well-being among campus residents.     

Therapy Dogs Improve Student Affect but Not Memory

ABSTRACT

While students are increasingly struggling with anxiety and depression, the effects of therapy dogs on student stress has only recently been explored. This study was conducted to investigate whether therapy dogs can improve student affect and to determine if these benefits extend to cognition in the form of enhanced ability to remember information. Forty-four college students were randomly assigned to interact with a therapy dog or not during both learning (session 1) and testing (session 2) in a paired-associates procedure. Arousal, stress, and mood were measured at the beginning and end of each session. As predicted, therapy dogs increased happiness and decreased stress and arousal. However, there was no difference in recognition memory for the paired associates between the therapy dog and control conditions. Mood was a significant predictor of memory, such that decreased happiness in session 2 predicted better recognition performance. These findings indicate that the benefits of therapy dogs are primarily affective and not cognitive.     

Virtual reality and music therapy as distraction interventions to alleviate anxiety and improve mood states in breast cancer patients during chemotherapy

Psychological distress is a common consequence of breast cancer diagnosis and treatment and could further exacerbate therapy side effects. Interventions increasing treatment tolerance are crucial to improve both patients' quality of life and adherence to therapies. Virtual reality (VR) has emerged as an effective distraction tool for different medical procedures. Here, we assessed the efficacy of immersive and interactive VR in alleviating chemotherapy-related psychological distress in a cohort of Italian breast cancer patients, also comparing its effects with those of music therapy (MT). Thirty patients were included in the VR group, 30 in the MT group, and 34 in the control group, consisting of patients receiving standard care during chemotherapy. Our data suggest that both VR and MT are useful interventions for alleviating anxiety and for improving mood states in breast cancer patients during chemotherapy. Moreover, VR seems more effective than MT in relieving anxiety, depression, and fatigue.     

Affective and Personality Characteristics in Function of Nightmare Prevalence, Nightmare Distress, and Interference Due to Nightmares.

This study analyzes the relationships among nightmare frequency, nightmare distress, and interference due to nightmares, sleep quality, psychopathology (anxiety and depression), and personality (neuroticism, psychoticism, and boundaries). The nightmare parameters were evaluated with the Nightmare Frequency Questionnaire (B. Krakow et al., 2000; see also record 2000-16731-002), the Nightmare Distress Questionnaire (K. Belicki, 1992b; see also record 1993-08389-001), and the Nightmare Effects Survey (Krakow et al., 2000). The sample was composed of 147 healthy students. The results demonstrated that the 2 measurements of distress (subjective distress associated with nightmares and, especially, deterioration of psychosocial functioning) were the dimensions that best related to the variables studied, although the relationships were modulated by nightmare frequency. The parameter of nightmare frequency was found to be useful as an indicator of certain personality characteristics rather than psychological perturbation. Having nightmares on a weekly basis was strongly associated with depressed mood. The knowledge about these relations is relevant not only theoretically but also as a practical guide. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Selected Neurophysiological,Psychological, and Behavioral Influences on Subjective Sleep Quality in Nurses: A Structure Equation Model

Few studies have examined relationships among neurophysiological, psychological, and behavioral factors with regard to their effects on sleep quality. We used a structure equation model to investigate behavioral and psychological factors that influence neurophysiological regulation of sleep in shift workers. Using a cross-sectional study design, we tested the model with a sample of 338 female nurses working rotating shifts at an urban regional hospital. The Morningness-Eveningness Questionnaire (MEQ) and short-form Menstrual Distress Questionnaire (MDQ) were used to measure neurophysiological factors involved in morningness-eveningness and menstrual distress. The Sleep Hygiene Awareness and Practice Scale (SHAPS) and Profile of Mood States Short Form (POMS-SF) were completed to measure behavioral factors of sleep hygiene practices and psychological factors of mood states. In addition, the Pittsburgh Sleep Quality Index (PSQI) measured participant''s self-reported sleep quality. The results revealed that sleep hygiene practices and mood states mediated the effects of morningness-eveningness and menstrual distress on sleep quality. Our findings provide support for developing interventions to enhance sleep hygiene and maintain positive mood states to reduce the influence of neurophysiological factors on sleep quality among shift workers.     

Nonverbal Communication and Human–Dog Interaction

Human–dog interaction relies to a large extent on nonverbal communication, and it is therefore plausible that human sensitivity to nonverbal signals affects interactions between human and dog. Experience with dogs is also likely to influence human–dog interactions, and it has been suggested that it influences human social skills. The present study investigated possible links between human nonverbal sensitivity, experience with dogs, and the quality of human–dog interactions. Two studies are reported. In study 1, 97 veterinary students took a psychometric test assessing human nonverbal sensitivity and answered a questionnaire on their experience with dogs. The data obtained were then used to investigate the relationship between experience with dogs and sensitivity to human nonverbal communication. The results did not indicate that experience with dogs improves human nonverbal sensitivity. In study 2, 16 students with high, and 15 students with low, levels of human nonverbal sensitivity were selected. Each of the 31 students interacted once with an unknown dog in a greeting situation, and these human–dog interactions were videoed. We found that a combined score of dog behaviors relating to insecurity was associated with the students' level of nonverbal sensitivity and experience with dogs: the dog showed more of the insecure behavior when interacting with students with a low level of nonverbal sensitivity and no experience with dogs than it did when interacting with students with a high level of nonverbal sensitivity (irrespective of experience with dogs).     

Psychiatric consequences of road traffic accidents.

OBJECTIVE--To determine the psychiatric consequences of being a road traffic accident victim. DESIGN--Follow up study of road accident victims for up to one year. SETTING--Emergency department of the John Radcliffe Hospital, Oxford. SUBJECTS--188 consecutive road accident victims aged 18-70 with multiple injuries (motorcycle or car) or whiplash neck injury, who had not been unconscious for more than 15 minutes, and who lived in the catchment area. MAIN OUTCOME MEASURES--Present state examination "caseness"; post-traumatic stress disorder and travel anxiety; effects on driving and on being a passenger. RESULTS--Acute, moderately severe emotional distress was common. Almost one fifth of subjects, however, suffered from an acute stress syndrome characterised by mood disturbance and horrific memories of the accident. Anxiety and depression usually improved over the 12 months, though one tenth of patients had mood disorders at one year. In addition, specific post-traumatic symptoms were common. Post-traumatic stress disorder occurred during follow up in one tenth of patients, and phobic travel anxiety as a driver or passenger was more common and frequently disabling. Emotional disorder was associated with having pre-accident psychological or social problems and, in patients with multiple injuries, continuing medical complications. Post-traumatic syndromes were not associated with a neurotic predisposition but were strongly associated with horrific memories of the accident. They did not occur in subjects who had been briefly unconscious and were amnesic for the accident. Mental state at three months was highly predictive of mental state at one year. CONCLUSIONS--Psychiatric symptoms and disorder are frequent after major and less severe road accident injury. Post-traumatic symptoms are common and disabling. Early information and advice might reduce psychological distress and travel anxiety and contribute to road safety and assessing "nervous shock."     

Psychological status and weight-related distress in overweight or at-risk-for-overweight children

Objective: To associate psychological status, weight‐related distress, and weight status during childhood in overweight or at‐risk‐for‐overweight children. Research Methods and Procedures: We associated self‐report of depression, trait anxiety, and weight‐related distress (body size dissatisfaction and weight‐related peer teasing after controlling for the effects of weight) in 164 children (black 35%; age 11.9 ± 2.5 years; girls 51%) who were overweight or at‐high‐risk‐for‐overweight and were not seeking weight loss. Results: Overall, heavier children reported more psychological and weight‐related distress. Black children reported more anxiety and body size dissatisfaction than white children, despite equivalent weights. However, psychological distress was not significantly associated with weight in white children. Girls reported more weight‐related distress than boys. Depression was associated with weight‐related teasing in all predictive models, except in the model using only black subjects. Trait anxiety was associated with report of peer teasing when using all subjects. Depression was also significantly associated with children's report of body size dissatisfaction in models using all subjects, only girls, or white subjects, but not in analyses using only boys or black subjects. For boys peer teasing was associated with body size dissatisfaction. In models including only black children, depression and trait anxiety were not significantly associated with either report of peer teasing or body size dissatisfaction. Discussion: Regardless of race or sex, increasing weight is associated with emotional and weight‐related distress in children. However, associations of psychological status, weight, and weight‐related distress differ for girls and boys, and for black and white children.     

Early inequalities in excellent health and performance among young adult women and men in Sweden

Background: Although health inequality between young adult women and men has been strikingly evident in symptoms of ill health, we found no studies examining these inequalities with a focus on positive health and performance.Objective: The aim of the present study was to examine possible inequalities between young adult women and men in a combined assessment of positive health and health-related performance.Methods: Women and men aged 18 to 25 years studying medicine or computer science at 6 colleges/universities in 5 cities in Sweden were recruited for this study. All respondents answered a Web-based questionnaire regarding health, health-related performance, information and communication technology exposure, mood, and individual factors. A combined assessment of excellent health and health-related performance (EHHP) was defined and tested. Prevalence ratios (PRs) with 95% CIs of EHHP were calculated separately for female and male respondents. To assess potential determinants of EHHP, differences in the relationships between EHHP and the explanatory factors were compared for both sexes.Results: In a study group of young adult students consisting of 1046 women and 1312 men, women were less likely than men to have EHHP (PR 0.90 [95% CI, 0.83–0.98]). This inequality was even stronger within each course of study (medicine or computer science). Health-related factors showed similar patterns of relationship to EHHP for women and men; however, the strength of these relationships differed between the sexes. Logical relationships were observed between EHHP and almost all of the symptoms as well as between EHHP, the mood index, and health-related behavior.Conclusions: The well-known inequality in symptoms of ill health between young adult women and men was prevalent even in a combined assessment of positive health and health-related performance. That this inequality was prevalent in a relatively homogeneous sample of young adults indicates the importance of gender-based psychological and psychosocial factors beyond the more well-known structural gender-differentiating factors of vertical and horizontal segregation and disproportional responsibilities for domestic work. It may therefore be essential to emphasize these gender-based psychological and psychosocial factors when designing future studies and health promotion programs.     

A Propensity-Score-Weighted Population-Based Study of the Health Benefits of Dogs and Cats for Children

There is a widely held belief that children’s general and psychological health benefits from owning and/or interacting with pets. In our study, we aimed to determine whether children who live with a dog or cat in their home have better mental and physical health outcomes compared with children without such a pet. Our study design consisted of a secondary analysis of household survey data from the 2003 California Health Interview Survey. Children in pet-owning households (n = 2,236 households with a dog or cat) were compared with children in non-pet owning households (n = 2,955 house-holds) using a weighted propensity score regression approach. Double robust regression analyses were used to examine the association between living with a dog or cat and health outcomes, while accounting for confounding factors. Our results demonstrated strong confounding effects. Unadjusted analyses found that children in pet-owning households were significantly healthier than children in non-owning households in terms of, for example, better general health, higher activity level, and less concern from parents regarding mood, behavior, and learning ability. However, when estimates were adjusted using the double robust approach, the effects were smaller and no longer statistically significant. The results indicate that the benefits of owning pets observed in this study were largely explained by confounding factors.     

Psychological Distress and Coping amongst Higher Education Students: A Mixed Method Enquiry

Background

Psychological distress among higher education students is of global concern. Students on programmes with practicum components such as nursing and teacher education are exposed to additional stressors which may further increase their risk for psychological distress. The ways in which these students cope with distress has potential consequences for their health and academic performance. An in-depth understanding of how nursing/midwifery and teacher education students experience psychological distress and coping is necessary to enable higher education providers to adequately support these students.

Methods

This mixed method study was employed to establish self-reported psychological distress (General Health Questionnaire), coping processes (Ways of Coping Questionnaire) and lifestyle behaviour (Lifestyle Behaviour Questionnaire) of a total sample (n = 1557) of undergraduate nursing/midwifery and teacher education students in one university in Ireland. Individual interviews (n = 59) provided an in-depth understanding of students experiences of psychological distress and coping.

Results

A significant percentage (41.9%) of respondents was psychologically distressed. The factors which contributed to their distress, included study, financial, living and social pressures. Students used varied coping strategies including seeking social support, problem solving and escape avoidance. The positive relationship between elevated psychological distress and escape avoidance behaviours including substance use (alcohol, tobacco and cannabis) and unhealthy diet is of particular concern. Statistically significant relationships were identified between “escape-avoidance” and gender, age, marital status, place of residence, programme/year of study and lifestyle behaviours such as diet, substance use and physical inactivity.

Conclusion

The paper adds to existing research by illuminating the psychological distress experienced by undergraduate nursing/midwifery and teacher education students. It also identifies their distress, maladaptive coping and the relationship to their lifestyle behaviours. The findings can inform strategies to minimise student distress and maladaptive coping during college and in future professional years.     

Meetings

ABSTRACT

This exploratory study builds on existing research on the physiological stress response to human–animal interactions in a non-clinical sample of adult dog-owners interacting with their own or an unfamiliar therapy dog under similar conditions. Participants were therapy-dog owners (TDO group; n = 5) interacting with their own dogs and dog owners interacting with an unfamiliar therapy dog (AAA group; n = 5). Following a 30minute baseline period, participants completed a stress task followed by a 30-minute dog interaction and then watched a neutral video for 60 minutes. The outcome variable of interest was the bio-behavioral stress response, measured by systolic and diastolic blood pressure (SBP, DBP), heart rate (HR), salivary cortisol, salivary alpha-amylase, and self-report. Trait anxiety and attitudes toward pets were assessed as moderating variables. Results revealed consistent physiological patterns, showing modest increases with the stressor and decreases from baseline following the intervention, for salivary cortisol, SBP, DBP, HR, and self reported anxiety and stress for both groups. In general, although the TDO group tended to perceive less stress and anxiety during the intervention than the AAA group, greater reductions in physiological measures were observed in the AAA group. Positive attitudes toward pets in the total sample of dog owners were associated with decreased levels of self-reported stress (p < 0.05), salivary cortisol, and SBP, while higher levels of trait anxiety were associated with higher levels of salivary cortisol (p < 0.05). In addition, higher levels of trait anxiety were associated with lower levels of autonomic nervous system indicators of stress (HR; SBP, p < 0.05; DBP, p < 0.05). Results support a buffering effect on the stress response associated with owners interacting with their dogs that may extend to interactions with unfamiliar therapy dogs in AAA, and supports the need for replication studies with larger sample sizes.     

The effect of short-term (10- and 15-min) running at self-selected intensity on mood alteration

The primary purpose of this study was to contrast the effects of two short-duration exercises on mood changes. A secondary goal was to examine the relationship between pre-exercise and post-exercise mood states. The subjects were 15 healthy male graduate students. They were involved in a within-subject design in which each individual completed two trials of running on a treadmill, one trial for 10 minutes and the other for 15 minutes. The Mood Checklist Short-form 1 (MCL-S1) used in the present study represents the participants' mood states before, during, and after exercise. This questionnaire has three sub-scales measuring (a) pleasantness, (b) relaxation, and (c) anxiety. Participants ran on a treadmill for the assigned time at a self-selected intensity after being told to run at a rate that felt good and was not painful. ANOVA results showed that both of the short bouts of exercise affected the subjects' mood, because the main effect of time spent exercising was observed in all sub-scales of the MCL-S1 and there were no significant differences in trial-by-time interaction. In addition to these results, there was a significant correlation between the two trial lengths in the amount of pleasantness and the amount of anxiety felt at post-exercise. There were moderate differences in the effect size (ES) for pre- and post-exercise pleasantness and anxiety levels. These results revealed similar patterns of change. It seems reasonable to conclude, based on this study, that exercise between 10 and 15 minutes results in similar psychological benefits for the person exercising.     

Examining Effects of Anticipated Stigma,Centrality, Salience,Internalization, and Outness on Psychological Distress for People with Concealable Stigmatized Identities

Understanding how stigmatized identities contribute to increased rates of depression and anxiety is critical to stigma reduction and mental health treatment. There has been little research testing multiple aspects of stigmatized identities simultaneously. In the current study, we collected data from a diverse, urban, adult community sample of people with a concealed stigmatized identity (CSI). We targeted 5 specific CSIs – mental illness, substance abuse, experience of domestic violence, experience of sexual assault, and experience of childhood abuse – that have been shown to put people at risk for increased psychological distress. We collected measures of the anticipation of being devalued by others if the identity became known (anticipated stigma), the level of defining oneself by the stigmatized identity (centrality), the frequency of thinking about the identity (salience), the extent of agreement with negative stereotypes about the identity (internalized stigma), and extent to which other people currently know about the identity (outness). Results showed that greater anticipated stigma, greater identity salience, and lower levels of outness each uniquely and significantly predicted variance in increased psychological distress (a composite of depression and anxiety). In examining communalities and differences across the five identities, we found that mean levels of the stigma variables differed across the identities, with people with substance abuse and mental illness reporting greater anticipated and internalized stigma. However, the prediction pattern of the variables for psychological distress was similar across the substance abuse, mental illness, domestic violence, and childhood abuse identities (but not sexual assault). Understanding which components of stigmatized identities predict distress can lead to more effective treatment for people experiencing psychological distress.     

World Health Organization's low-intensity psychosocial interventions: a systematic review and meta-analysis of the effects of Problem Management Plus and Step-by-Step

Many societies have been recently exposed to humanitarian and health emergencies, which have resulted in a large number of people experiencing significant distress and being at risk to develop mental disorders such as depression, anxiety and post-traumatic stress disorder. The World Health Organization has released a series of scalable psychosocial interventions for people impaired by distress in communities exposed to adversities. Prominent among these is a low-intensity transdiagnostic psychosocial intervention, Problem Management Plus (PM+), and its digital adaptation Step-by-Step (SbS). This systematic review is the first to summarize the available evidence on the effects of PM+ and SbS. Up to March 8, 2023, five databases were searched for randomized controlled trials examining the effects of PM+ or SbS on distress indicators (i.e., general distress; anxiety, depressive or post-traumatic stress disorder symptoms; functional impairment, self-identified problems) and positive mental health outcomes (i.e., well-being, quality of life, social support/relationships). We performed random-effects multilevel meta-analyses on standardized mean differences (SMDs) at post-intervention and short-term follow-up assessments. Our search yielded 23 eligible studies, including 5,298 participants. We found a small to medium favorable effect on distress indicators (SMD=–0.45, 95% CI: –0.56 to –0.34) and a small beneficial effect on positive mental health outcomes (SMD=0.31, 95% CI: 0.14-0.47), which both remained significant at follow-up assessment and were robust in sensitivity analyses. However, our analyses pointed to substantial between-study heterogeneity, which was only partially explained by moderators, and the certainty of evidence was very low across all outcomes. These results provide evidence for the effectiveness of PM+ and SbS in reducing distress indicators and promoting positive mental health in populations exposed to adversities, but a larger high-quality evidence base is needed, as well as research on participant-level moderators of the effects of these interventions, their suitability for stepped-care programs, and their cost-effectiveness.