BackgroundWith the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pande... more BackgroundWith the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, the aging population has been shown to be highly vulnerable. As a result, policy makers and the media urged older adults to restrict social interactions, placing them at greater risk of mental health problems, such as depression. However, there has been a little previous attempt to examine coronavirus disease-2019 (COVID-19) vaccine-related risk factors and depressive symptoms amongst older adults.MethodsParticipants (938 older adults, Mage = 68.99, s.d. = 3.41, range 65–85) answered an online questionnaire at the start of the COVID-19 vaccination program in Israel. Participants completed measures of background characteristics, world assumptions, COVID-19 vaccine-related variables, and symptoms of depression.ResultsUnivariate logistic regression revealed that more negative world assumptions were linked with clinical depression levels.ConclusionsOlder adults in our sample were suscep...
Background: People with posttraumatic stress disorder (PTSD) may have cognitive decline, a risk w... more Background: People with posttraumatic stress disorder (PTSD) may have cognitive decline, a risk which can be particularly threatening at old age. However, it is yet unclear whether initial cognitive decline renders one more susceptible to subsequent PTSD following exposure to traumatic events, whether initial PTSD precedes cognitive decline or whether the effects are reciprocal. Objective: This study examined the bidirectional longitudinal associations between cognitive function and PTSD symptoms and whether this association is mediated by depressive symptoms. Method: The study used data from two waves of the Israeli component of the Survey of Health, Ageing, and Retirement in Europe (SHARE), collected in 2013 and 2015. This study focused on adults aged 50 years and above (N = 567, mean age = 65.9 years). Each wave used three measures of cognition (recall, fluency, and numeracy) and PTSD symptoms following exposure to war-related events. Data were analyzed using mediation analysis with path analysis. Results: Initial PTSD symptoms predicted cognitive decline in recall and fluency two years later, while baseline cognitive function did not impact subsequent PTSD symptoms. Partial mediation showed that older adults with more PTSD symptoms had higher depressive symptoms, which in turn were linked to subsequent cognitive decline across all three measures. Conclusions: This study reveals that PTSD symptoms are linked with subsequent cognitive decline, supporting approaches addressing this direction. It further indicates that part of this effect can be explained by increased depressive symptoms. Thus, treatment for depressive symptoms may help reduce cognitive decline due to PTSD.
The Journals of Gerontology: Series B, Oct 5, 2021
OBJECTIVES The present study examined the longitudinal relationships between subjective age (SA) ... more OBJECTIVES The present study examined the longitudinal relationships between subjective age (SA) and future functional status in later life, via depressive symptoms. Additionally, we assessed the role of subjective nearness to death (SNtD) as a potential moderator within these pathways. METHODS Older adults (average age 81.14 at T1) were interviewed once a year for three consecutive years (N=224 at T1, N=178 at T2, and N=164 at T3), Participants reported their SA, SNtD, depressive symptoms, and functional status. Additionally, grip strength was employed as an objective measure of functional status. RESULTS Data analysis revealed distinct pathways leading from T1 SA to T3 functional status through T2 depressive symptoms. Moreover, T1 SNtD was found to significantly moderate most of these indirect pathways, so that the mediation model of T1 SA-T2 depressive symptoms-T3 functional status was mostly significant among those who felt closer to death. DISCUSSION The findings contribute to our understanding of the underlying mechanism through which SA predicts long-term functioning sequelae by underscoring the indirect effect of depressive symptoms. They further indicate the importance of gauging the effects of SNtD on these longitudinal relationships. Present results may further contribute to establishing an integrative model for predicting long-term functional outcomes based on older adults' earlier subjective views of aging.
Previous studies have shown that a young subjective age can buffer against trauma effects. The cu... more Previous studies have shown that a young subjective age can buffer against trauma effects. The current study, highlighted in this chapter, examined if this fortifying effect will also be critically observed in older adults suffering from PTSD-depression comorbidity. We used data from the Israeli component of the Survey of Health, Ageing and Retirement in Europe (SHARE-Israel; N = 1793, mean age = 69.65, age range = 50–105). These data include missile attacks exposure and ensuing PTSD symptoms, depressive symptoms and indices of health and subjective age.
Specific learning disorders (SLD) persist into adulthood. Persons with SLD frequently experience ... more Specific learning disorders (SLD) persist into adulthood. Persons with SLD frequently experience emotional and social difficulties. Following qualitative descriptions of individuals with SLD who experienced learning, as traumatic, we hypothesized that individuals reporting SLD would report higher levels of learning-based post-traumatic-stress-disorder (PTSD) symptoms. In Study 1 (N = 216), participants responded to questionnaires concerning SLD and learning-based PTSD. A separate sample (N = 43) was queried about adjustment disorder symptoms. Study 2 (N = 176) examined if current psychological distress was predicted by levels of learning-based PTSD at each developmental stage (elementary/high-school/post-high-school) and whether SLD links to current psychological distress. Finally, we assessed if SLD-psychological distress associations are mediated by cumulative levels of learning-based PTSD across these school periods. In Study 1 individuals reporting SLD displayed higher learning-...
The directionality between vaccine hesitancy and COVID-19 vaccine side-effects was not hitherto e... more The directionality between vaccine hesitancy and COVID-19 vaccine side-effects was not hitherto examined. Aligned with nocebo effects, vaccine hesitancy to the second Pfizer vaccination dose should predict subsequent side-effects to the booster dose, over and beyond all other effects. Furthermore, consistent with nocebo effects being driven by (mis)information in males, and by prior experience in females, compatible sex differences were predicted. A representative sample of older adults (n = 756, mean age = 68.9 ± 3.43) were questioned in a typical cross-lagged design (wave 1 following the second Pfizer dose, wave 2 after their booster shot). Vaccine hesitancy, side-effect severity and demographics were reported at each wave. All predictions were confirmed. First, only the direction of earlier vaccine hesitancy predicting subsequent booster side-effects was significant, for females (β = 0.10 p = .025, f 2=.02) and males (β = 0.34, p < 0.001, f 2 = .16 ). Second, this effect was s...
. This study had three goals: (1) to address daily links between subjective age and the three psy... more . This study had three goals: (1) to address daily links between subjective age and the three psychological distress facets (depression/anxiety/somatization); (2) to examine whether such links would be stronger under higher posttraumatic stress disorder (PTSD) levels; (3) to assess which PTSD cluster is most relevant. The sample (168 community-dwelling-older-adults, mean age = 73.48, 46% female) completed an online, web-based questionnaire across 14 consecutive days. Results show that on the days participants felt older, they reported higher psychological distress, which was further exacerbated by higher PTSD levels. The PTSD cluster of intrusive thoughts was most relevant. The discussion addresses the “double-burden” view, two theories of subjective age (resource/stress vs. ageism), and finally interventions for daily psychological distress reduction amongst older adults.
Background Rationality biases, such as the gambling fallacy (e.g., predicting future coin-tosses ... more Background Rationality biases, such as the gambling fallacy (e.g., predicting future coin-tosses based on previous tosses) and the famous “Linda” conjunction fallacy (estimating the conjunction that “Linda” is both teller and feminist based on her description) have not been examined in people suffering from acute stress disorder (ASD). We analyze potential outcomes and align them with different theories. Methods To discern the precise pattern of rationality biases in persons with ASD, we examined performance on these 2 tasks within a month of the Hayian Super-Typhoon (August 27th, 2013). Out of a sample of 1001 persons, 82 had clinical ASD and their performance was compared to the remaining 919 participants. Results A specific link between ASD and rationality biases revealed that although conjunction task performance was not associated with ASD diagnosis, coin-task performance was. Namely, responding “Heads” to a 6th coin-toss after 5 successive “Heads” (reverse gambling fallacy) was robustly linked with ASD diagnosis. Conclusion The results align with the bridging of trauma theories claiming that trauma symptoms are generated by disequilibrium following trauma exposure, with prospect theory’s notion of chance, which is conceived as belief in equilibrium restoration . Such disequilibrium following trauma exposure is thus linked with the belief underlying reverse gambling fallacy biases, namely “what-was-will-be”. Implications regarding themes important to address in therapy are mentioned.
Exposure is one of the most robust predictors of post-traumatic stress disorder (PTSD) symptoms i... more Exposure is one of the most robust predictors of post-traumatic stress disorder (PTSD) symptoms in warfare situations. Yet, while many are sensitive to exposure, others do not develop PTSD. In the current study, we address how perceived media control along with external locus of control moderate effects of exposure on PTSD symptoms among 1268 individuals exposed to missile attacks (mean age=36.97). We expected that the coupling of low perceived media control, whereby one feels poor control over media consumption (an inability to stop), especially when irrelevant and non-informative (e.g., involuntarily viewing the same terror incident shown repeatedly in a looped fashion) along with a self-perception of external locus of control, will render participants highly vulnerable to exposure. As expected, results suggest that effects of exposure on PTSD are not automatic, rather, the coupling of both low media control along with believing that life event are controlled by external factors exacerbates effects of exposure. These findings bear practical implications, as both media control and locus of control can be modified by therapeutic interventions, rendering one less vulnerable to the detrimental effects of traumatic exposure.
BackgroundThe present study examined whether subjective accelerated aging moderated the relations... more BackgroundThe present study examined whether subjective accelerated aging moderated the relationship between COVID-19 health worries and COVID-19 peritraumatic distress among older adults.MethodThe sample consisted of 277 older adults (M = 69.58,s.d.= 6.73, range 60–92) who answered an online questionnaire during the outbreak of COVID-19 pandemic in Israel. Participants completed the measures of background characteristics, exposure to COVID-19, COVID-19 health worries, subjective accelerated aging and COVID-19-based peritraumatic distress.ResultsHigher levels of COVID-19 health worries were correlated with higher levels of peritraumatic distress symptoms among older adults. Moreover, those reporting accelerated aging also reported a higher level of peritraumatic distress. Finally, the interaction between COVID-19 health worries and subjective accelerated aging predicted peritraumatic distress, suggesting that COVID-19 worries were associated with peritraumatic distress to a stronger...
Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on ... more Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
The current set of studies was aimed at examining the theoretical basis, development process, and... more The current set of studies was aimed at examining the theoretical basis, development process, and psychometric properties of a new scale for measuring positive solitude (PS). The theoretical idea behind the development of this construct was to develop a stand-alone scale for measuring the positive aspects of an individual's ability to volitionally choose to spend time by him/herself. Using five different samples, we examined the face validity, exploratory/confirmatory factor analysis results, construct validity, and test–retest reliability of the new scale. The results were replicated across five studies, demonstrating a single factor for the 9-item PS scale which had good convergent and divergent validity and acceptable test–retest reliability. Overall, this new short scale has excellent psychometric properties. This scale may serve as a tool for further examining the phenomenon of PS, a concept that is under-developed in the psychological literature. PS can also be perceived as an important personal asset, when other personal resources may be depleted. A better understanding of the PS phenomenon may thus enhance development of interventions aimed at improving this ability. PS may be especially important for older adults, who sometimes face challenges with engaging in varied social activities and need to cope with more time alone.
This is the first study to examine COVID-19 vaccine-related stressors in the context of current p... more This is the first study to examine COVID-19 vaccine-related stressors in the context of current posttraumatic stress disorder (PTSD) symptoms amongst older adults exposed to traumatic events prior to the COVID-19 outbreak, with particular focus on the associations between ageism, vaccine-related stressors and PTSD. Five hundred and sixty-three participants aged 65 and above reported exposure to at least one traumatic event, their current PTSD level, physical and mental health, ageist attitudes, and vaccine related stressors. Univariate logistic regression revealed that depressive symptoms, ageism, vaccine hesitancy and severity of side effects were the main factors associated with clinical levels of current PTSD. These results suggest that older adults were vulnerable to intensified PTSD symptoms, not only as a result of greater depression, but also as a consequence of other factors, including ageism, vaccination hesitancy and vaccination side effects. Practitioners would benefit from awareness to these factors.
BackgroundWith the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pande... more BackgroundWith the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, the aging population has been shown to be highly vulnerable. As a result, policy makers and the media urged older adults to restrict social interactions, placing them at greater risk of mental health problems, such as depression. However, there has been a little previous attempt to examine coronavirus disease-2019 (COVID-19) vaccine-related risk factors and depressive symptoms amongst older adults.MethodsParticipants (938 older adults, Mage = 68.99, s.d. = 3.41, range 65–85) answered an online questionnaire at the start of the COVID-19 vaccination program in Israel. Participants completed measures of background characteristics, world assumptions, COVID-19 vaccine-related variables, and symptoms of depression.ResultsUnivariate logistic regression revealed that more negative world assumptions were linked with clinical depression levels.ConclusionsOlder adults in our sample were suscep...
Background: People with posttraumatic stress disorder (PTSD) may have cognitive decline, a risk w... more Background: People with posttraumatic stress disorder (PTSD) may have cognitive decline, a risk which can be particularly threatening at old age. However, it is yet unclear whether initial cognitive decline renders one more susceptible to subsequent PTSD following exposure to traumatic events, whether initial PTSD precedes cognitive decline or whether the effects are reciprocal. Objective: This study examined the bidirectional longitudinal associations between cognitive function and PTSD symptoms and whether this association is mediated by depressive symptoms. Method: The study used data from two waves of the Israeli component of the Survey of Health, Ageing, and Retirement in Europe (SHARE), collected in 2013 and 2015. This study focused on adults aged 50 years and above (N = 567, mean age = 65.9 years). Each wave used three measures of cognition (recall, fluency, and numeracy) and PTSD symptoms following exposure to war-related events. Data were analyzed using mediation analysis with path analysis. Results: Initial PTSD symptoms predicted cognitive decline in recall and fluency two years later, while baseline cognitive function did not impact subsequent PTSD symptoms. Partial mediation showed that older adults with more PTSD symptoms had higher depressive symptoms, which in turn were linked to subsequent cognitive decline across all three measures. Conclusions: This study reveals that PTSD symptoms are linked with subsequent cognitive decline, supporting approaches addressing this direction. It further indicates that part of this effect can be explained by increased depressive symptoms. Thus, treatment for depressive symptoms may help reduce cognitive decline due to PTSD.
The Journals of Gerontology: Series B, Oct 5, 2021
OBJECTIVES The present study examined the longitudinal relationships between subjective age (SA) ... more OBJECTIVES The present study examined the longitudinal relationships between subjective age (SA) and future functional status in later life, via depressive symptoms. Additionally, we assessed the role of subjective nearness to death (SNtD) as a potential moderator within these pathways. METHODS Older adults (average age 81.14 at T1) were interviewed once a year for three consecutive years (N=224 at T1, N=178 at T2, and N=164 at T3), Participants reported their SA, SNtD, depressive symptoms, and functional status. Additionally, grip strength was employed as an objective measure of functional status. RESULTS Data analysis revealed distinct pathways leading from T1 SA to T3 functional status through T2 depressive symptoms. Moreover, T1 SNtD was found to significantly moderate most of these indirect pathways, so that the mediation model of T1 SA-T2 depressive symptoms-T3 functional status was mostly significant among those who felt closer to death. DISCUSSION The findings contribute to our understanding of the underlying mechanism through which SA predicts long-term functioning sequelae by underscoring the indirect effect of depressive symptoms. They further indicate the importance of gauging the effects of SNtD on these longitudinal relationships. Present results may further contribute to establishing an integrative model for predicting long-term functional outcomes based on older adults' earlier subjective views of aging.
Previous studies have shown that a young subjective age can buffer against trauma effects. The cu... more Previous studies have shown that a young subjective age can buffer against trauma effects. The current study, highlighted in this chapter, examined if this fortifying effect will also be critically observed in older adults suffering from PTSD-depression comorbidity. We used data from the Israeli component of the Survey of Health, Ageing and Retirement in Europe (SHARE-Israel; N = 1793, mean age = 69.65, age range = 50–105). These data include missile attacks exposure and ensuing PTSD symptoms, depressive symptoms and indices of health and subjective age.
Specific learning disorders (SLD) persist into adulthood. Persons with SLD frequently experience ... more Specific learning disorders (SLD) persist into adulthood. Persons with SLD frequently experience emotional and social difficulties. Following qualitative descriptions of individuals with SLD who experienced learning, as traumatic, we hypothesized that individuals reporting SLD would report higher levels of learning-based post-traumatic-stress-disorder (PTSD) symptoms. In Study 1 (N = 216), participants responded to questionnaires concerning SLD and learning-based PTSD. A separate sample (N = 43) was queried about adjustment disorder symptoms. Study 2 (N = 176) examined if current psychological distress was predicted by levels of learning-based PTSD at each developmental stage (elementary/high-school/post-high-school) and whether SLD links to current psychological distress. Finally, we assessed if SLD-psychological distress associations are mediated by cumulative levels of learning-based PTSD across these school periods. In Study 1 individuals reporting SLD displayed higher learning-...
The directionality between vaccine hesitancy and COVID-19 vaccine side-effects was not hitherto e... more The directionality between vaccine hesitancy and COVID-19 vaccine side-effects was not hitherto examined. Aligned with nocebo effects, vaccine hesitancy to the second Pfizer vaccination dose should predict subsequent side-effects to the booster dose, over and beyond all other effects. Furthermore, consistent with nocebo effects being driven by (mis)information in males, and by prior experience in females, compatible sex differences were predicted. A representative sample of older adults (n = 756, mean age = 68.9 ± 3.43) were questioned in a typical cross-lagged design (wave 1 following the second Pfizer dose, wave 2 after their booster shot). Vaccine hesitancy, side-effect severity and demographics were reported at each wave. All predictions were confirmed. First, only the direction of earlier vaccine hesitancy predicting subsequent booster side-effects was significant, for females (β = 0.10 p = .025, f 2=.02) and males (β = 0.34, p < 0.001, f 2 = .16 ). Second, this effect was s...
. This study had three goals: (1) to address daily links between subjective age and the three psy... more . This study had three goals: (1) to address daily links between subjective age and the three psychological distress facets (depression/anxiety/somatization); (2) to examine whether such links would be stronger under higher posttraumatic stress disorder (PTSD) levels; (3) to assess which PTSD cluster is most relevant. The sample (168 community-dwelling-older-adults, mean age = 73.48, 46% female) completed an online, web-based questionnaire across 14 consecutive days. Results show that on the days participants felt older, they reported higher psychological distress, which was further exacerbated by higher PTSD levels. The PTSD cluster of intrusive thoughts was most relevant. The discussion addresses the “double-burden” view, two theories of subjective age (resource/stress vs. ageism), and finally interventions for daily psychological distress reduction amongst older adults.
Background Rationality biases, such as the gambling fallacy (e.g., predicting future coin-tosses ... more Background Rationality biases, such as the gambling fallacy (e.g., predicting future coin-tosses based on previous tosses) and the famous “Linda” conjunction fallacy (estimating the conjunction that “Linda” is both teller and feminist based on her description) have not been examined in people suffering from acute stress disorder (ASD). We analyze potential outcomes and align them with different theories. Methods To discern the precise pattern of rationality biases in persons with ASD, we examined performance on these 2 tasks within a month of the Hayian Super-Typhoon (August 27th, 2013). Out of a sample of 1001 persons, 82 had clinical ASD and their performance was compared to the remaining 919 participants. Results A specific link between ASD and rationality biases revealed that although conjunction task performance was not associated with ASD diagnosis, coin-task performance was. Namely, responding “Heads” to a 6th coin-toss after 5 successive “Heads” (reverse gambling fallacy) was robustly linked with ASD diagnosis. Conclusion The results align with the bridging of trauma theories claiming that trauma symptoms are generated by disequilibrium following trauma exposure, with prospect theory’s notion of chance, which is conceived as belief in equilibrium restoration . Such disequilibrium following trauma exposure is thus linked with the belief underlying reverse gambling fallacy biases, namely “what-was-will-be”. Implications regarding themes important to address in therapy are mentioned.
Exposure is one of the most robust predictors of post-traumatic stress disorder (PTSD) symptoms i... more Exposure is one of the most robust predictors of post-traumatic stress disorder (PTSD) symptoms in warfare situations. Yet, while many are sensitive to exposure, others do not develop PTSD. In the current study, we address how perceived media control along with external locus of control moderate effects of exposure on PTSD symptoms among 1268 individuals exposed to missile attacks (mean age=36.97). We expected that the coupling of low perceived media control, whereby one feels poor control over media consumption (an inability to stop), especially when irrelevant and non-informative (e.g., involuntarily viewing the same terror incident shown repeatedly in a looped fashion) along with a self-perception of external locus of control, will render participants highly vulnerable to exposure. As expected, results suggest that effects of exposure on PTSD are not automatic, rather, the coupling of both low media control along with believing that life event are controlled by external factors exacerbates effects of exposure. These findings bear practical implications, as both media control and locus of control can be modified by therapeutic interventions, rendering one less vulnerable to the detrimental effects of traumatic exposure.
BackgroundThe present study examined whether subjective accelerated aging moderated the relations... more BackgroundThe present study examined whether subjective accelerated aging moderated the relationship between COVID-19 health worries and COVID-19 peritraumatic distress among older adults.MethodThe sample consisted of 277 older adults (M = 69.58,s.d.= 6.73, range 60–92) who answered an online questionnaire during the outbreak of COVID-19 pandemic in Israel. Participants completed the measures of background characteristics, exposure to COVID-19, COVID-19 health worries, subjective accelerated aging and COVID-19-based peritraumatic distress.ResultsHigher levels of COVID-19 health worries were correlated with higher levels of peritraumatic distress symptoms among older adults. Moreover, those reporting accelerated aging also reported a higher level of peritraumatic distress. Finally, the interaction between COVID-19 health worries and subjective accelerated aging predicted peritraumatic distress, suggesting that COVID-19 worries were associated with peritraumatic distress to a stronger...
Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on ... more Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
The current set of studies was aimed at examining the theoretical basis, development process, and... more The current set of studies was aimed at examining the theoretical basis, development process, and psychometric properties of a new scale for measuring positive solitude (PS). The theoretical idea behind the development of this construct was to develop a stand-alone scale for measuring the positive aspects of an individual's ability to volitionally choose to spend time by him/herself. Using five different samples, we examined the face validity, exploratory/confirmatory factor analysis results, construct validity, and test–retest reliability of the new scale. The results were replicated across five studies, demonstrating a single factor for the 9-item PS scale which had good convergent and divergent validity and acceptable test–retest reliability. Overall, this new short scale has excellent psychometric properties. This scale may serve as a tool for further examining the phenomenon of PS, a concept that is under-developed in the psychological literature. PS can also be perceived as an important personal asset, when other personal resources may be depleted. A better understanding of the PS phenomenon may thus enhance development of interventions aimed at improving this ability. PS may be especially important for older adults, who sometimes face challenges with engaging in varied social activities and need to cope with more time alone.
This is the first study to examine COVID-19 vaccine-related stressors in the context of current p... more This is the first study to examine COVID-19 vaccine-related stressors in the context of current posttraumatic stress disorder (PTSD) symptoms amongst older adults exposed to traumatic events prior to the COVID-19 outbreak, with particular focus on the associations between ageism, vaccine-related stressors and PTSD. Five hundred and sixty-three participants aged 65 and above reported exposure to at least one traumatic event, their current PTSD level, physical and mental health, ageist attitudes, and vaccine related stressors. Univariate logistic regression revealed that depressive symptoms, ageism, vaccine hesitancy and severity of side effects were the main factors associated with clinical levels of current PTSD. These results suggest that older adults were vulnerable to intensified PTSD symptoms, not only as a result of greater depression, but also as a consequence of other factors, including ageism, vaccination hesitancy and vaccination side effects. Practitioners would benefit from awareness to these factors.
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