The Mediating Role of Posttraumatic Cognitions in the Relationship Between Psychological Vulnerability and Depression in Individuals With a History of Covid-19

The Mediating Role of Posttraumatic Cognitions in the Relationship Between Psychological Vulnerability and Depression in Individuals With a History of Covid-19 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Mediating Role of Posttraumatic Cognitions in the Relationship Between Psychological Vulnerability and Depression in Individuals With a History of Covid-19 Ahmet Çağlar ÖZDOĞAN This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6565326/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: This paper examined the psychological vulnerability and mediating role of cognitions after the trauma of COVID-19. Methods: The sample of this relational study consisted of 486 (F=276,M=210) students studying at a state university in …. Participants were recruited through convenience sampling. Participants completed the online versions of the DASS-21 scale, the Posttraumatic Cognitions Inventory, and the Psychological Vulnerability Scale. The hypothetical model was tested via the bootstrapping procedure for regression and mediating effect. Results: Psychological vulnerability had direct and significant effects on all sub-dimensions of posttraumatic cognitions. On the other hand, posttraumatic cognitions had a direct and significant effect on depression. Besides, the psychological vulnerability was found to be a significant predictor of depression. The analysis of mediating effect showed that cognitions had a mediating effect on the relationship between psychological vulnerability and depression after COVID-19 trauma. The explained variance for the whole model was 23%. Conclusion: According to findings, psychological vulnerability increased the level of depression by increasing posttraumatic cognitions, and both psychological vulnerability and posttraumatic cognitions had a direct and significant effect on depression. Depression Psychological Vulnerability Posttraumatic Cognitions COVID-19 Figures Figure 1 Background According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [DSM-5], published by the American Psychiatric Association [4], traumas are grouped under three main headings: those caused by people, those that occur as a result of accidents, and natural disasters and events [such as epidemics]. Disasters are a variety of occurrences brought on by a threat that impacts social groupings, results in material and human losses, and impairs the community's ability to cope through social processes [77]. Accordingly, effective in recent years, the still continuing COVID-19 pandemic is considered as a traumatic event evaluated under the natural disasters and epidemics [72]. Although the COVID-19 pandemic has had many adverse effects from the beginning to the present, the most important reflection of this effect has been witnessed on individual and community mental health [40]. After the outbreak of COVID-19 on January 30, 2020, the World Health Organization [WHO] evaluated the outbreak as a global health crisis and declared it a pandemic. The COVID-19 pandemic, like other pandemics, poses a threat to the psychological well-being of individuals, but also has a negative impact on individuals' lifestyles, especially with a number of restrictions [70]. Taking into account the COVID-19 pandemic and its effects, the pandemic is considered one of the deadliest cases of this century. According to data, over six million people have died since the beginning of the outbreak [71]. While these numbers reveal the impact of the pandemic, the pandemic is also considered as a traumatic event deeply affecting individuals’ psychological health [33; 40; 72]. Similar psychological disorders also showed their effect in previous epidemics. For instance, studies conducted during the 2002-2004 SARS epidemic in China that was identified and spread before COVID-19 also revealed that behavioral changes in infected individuals should not be ignored [14; 15]. As a result, every pandemic-sized outbreak has a psychological effect on people [49]. Although COVID-19 deeply affects many people, the degree of this impact varies within the periodic structure of individuals. For instance, older individuals experience difficulties due to increased death rates, while younger individuals experience difficulties due to the threat to their health, certain restrictions that came with the pandemic, and their negative impact on their social, academic and family lives. Periodically, there are normally various stressors in university students’ lives and this has increased with the pandemic [20]. Factors such as the transition to distance learning, the isolation process, and academic uncertainty showed their effects with the pandemic [50]. The studies conducted before the pandemic period put forth that these individuals normally go through certain difficulties in their developmental stressors. These difficulties are factors such as academic pressure, program changes, economic difficulties, and social isolation [58]. Studies show that the possible effects of these difficulties and students’ developmental period are effective in increasing the level of depression [30; 60]. Also, a study in which the amount of depression experienced by university students was assessed and other studies on the topic were addressed indicated that 30.6% of university students suffer depression [36]. In a different study conducted in 21 countries, 18.5% of university students had at least one major depressive episode [6]. Therefore, it can be stated that depression is one of the most important psychological disorders experienced by university students. With the negative impact of the pandemic, it is seen that this situation, which potentially exists among university students, has increased even more [25; 30; 39]. With the increasing adverse impact of the pandemic in different countries, studies reported psychological symptoms and maladaptive behaviors [37; 40; 69]. These studies draw attention to the increase in depression levels during periods of intense isolation with the pandemic even though vaccination provides social relief [albeit partially] [57; 48]. Although the effects of the pandemic were global, certain people were more affected by the pandemic and experience it at a more pathological level. The relevant literature shows that individuals most affected by the pandemic are also individuals with high levels of psychological vulnerability [17; 78]. Research on the subject shows a positive relationship between depression and psychological vulnerability [13; 50] and a negative effect on psychological resilience [42; 76]. The concept of psychological vulnerability is a construct that expresses a predisposition to an undesirable outcome and also underlies the development of mood disorders [35]. Thus, vulnerability in biological, emotional, cognitive, and behavioral stress responses is not conducive to successful adaptation or self-regulation and consequently contributes to the development of various adjustment problems and disorders [1; 38]. The degree of vulnerability that individuals experience is significantly influenced by personal, cognitive, and environmental factors [32]. Among the environmental factors, the experiences in the COVID-19 process are effective. For example, a study by Silveria et al. [78] revealed that these changing living conditions with the COVID-19 pandemic increased the psychological vulnerability of individuals and negatively affected mental health. Conceptual explanations about psychological vulnerability put forth that this state is caused by two main factors, environmental and cognitive processes [65]. Related studies reported that environmental process involves learning experiences more, whereas cognitive process involves dysfunctional cognitions more [11; 16]. Ingram and Luxton [38] emphasized that individuals’ “belief patterns” and “dysfunctional learning” acquired through their childhood experiences constitute the genesis of psychological vulnerability. Thus, psychological vulnerability is made up of dysfunctional cognitive structures and environmental learning experiences. Furthermore, developed by Beck, the Cognitive Behavioral Approach, is the most important model explaining depression. The approach indicates that the mediating effect of cognitions between depression and psychological vulnerability along with the evaluations related to cognitive factors may be the basis of depression. Theoretical Structure of Depression and the Mediating Role of Cognitions of Traumatic Experiences One of the most comprehensive studies on depression in the literature was presented by Beck [7]. The depression model introduced by Beck puts forth depression and the structures that cause depression in the light of data obtained from clinical practices. Beck's model of depression is based on three main psychological factors, the cognitive triad [the individual's negative perception of oneself, the future, and the world], schemas, and cognitive distortions. Although cognitive structures form the basis of the model put forward by Beck, the concept of cognitive triad reveals in detail the causality of depression based on traumatic events and the way these events are perceived [8; 79]. According to APA [4], trauma refers to exposure to death of a loved one or a relative or threat on a person’s life. After a traumatic experience, the response of individuals to trauma may differ. While some people experience depression due to fear and anxiety experienced after trauma, some people go through positive changes such as increased meaning in life and individual empowerment [62]. Studies report that cognitive processes are behind this state [46; 51; 54; 66]. Furthermore, studies especially draw attention to the low cognitive performance caused by COVID-19 [3; 53]. According to cognitive depression theorists, people's thoughts, attitudes, and interpretations increase the risk of depression. In addition, the degree to which individuals remember negative experiences as a result of their experiences also affects their depression levels [9]. In addition to negative views about oneself, the future, and the world, repetitive and uncontrollable negative thoughts that usually revolve around the self are symptoms of depression [31]. After a traumatic experience, a person’s evaluation style structure about oneself and the world is important, and this structure is effective on depressive mood [10]. In summary, with the COVID-19 pandemic, individuals with higher levels of psychological vulnerability and with negative cognitive structures have been affected more after trauma. Regarding the COVID-19 pandemic, public health experts suggest that even if the course of the pandemic decreased, its impact will continue [26; 29]. Although the pandemic is believed to be effective on levels, we have limited information on the variables directly or indirectly affecting individuals’ psychological health. It is crucial to look into how the pandemic, which is considered a trauma, has affected people's propensities for depression both directly and indirectly. So, the current study's objective is to investigate how posttraumatic cognitions mediate the link between psychological vulnerability and depression in people who have a history of COVID-19. The study results may help to make the process more effective in the future by broadening our understanding of the COVID-19 pandemic and the role of traumatic experiences in general. METHODS Study design and participants Correlational research method was used in this study. The study sample consisted of 486 (F=276, M=210) university students attending various state universities in …. The participants’ ages ranged between 18 and 29, with a mean of 22.16 (SD= 3.02). The criteria for inclusion of the participants to the study was being infected by COVID-19. Using the measurement tools that were given to the students online, the study's data was gathered. The students were first made aware of the study prior to data collection, and only those who volunteered for the study were used for data collection. The university's ethical committee gave its approval to the study, which was also conducted in accordance with the Helsinki Declaration. All participants were informed about the study purpose and the confidentiality of their responses. Instruments Depression-Anxiety-Stress Scale: The Depression, Anxiety and Stress Scale (DAS-21) was developed by Lovinond and Lovibond [52] to determine individuals’ depression, anxiety and stress levels. The scale was adapted to Turkish by Sarıçam [59]. In the present study, only the depression subscale of the scale was used. The four-point Likert-type depression subscale consists of seven items. The internal consistency coefficient of the original scale development study was found as .88, and the internal consistency coefficient of the adaptation study as .87. The internal consistency coefficient calculated within the scope of the present study was determined as .90. Psychological Vulnerability Scale: Developed by Sinclair and Wallston [64], the Psychological Vulnerability Scale was adapted to Turkish by Akın and Eker [2]. The scale was developed to determine individuals’ psychological vulnerability levels. The five-point Likert-type scale has six items. The original and adapted scales were found to have an internal consistency coefficient of.75. The internal consistency coefficient calculated in this study was .77. Posttraumatic Cognitions Inventory: Developed by Foa et al. [27], the Posttraumatic Cognitions Inventory evaluates individuals' post-traumatic cognitions after trauma. The inventory was adapted to Turkish by Yağcı- Yetkiner [73]. Three subscales make up the scale: self-blame, world-blame, and negative cognitions about oneself. The seven-point Likert type scale has 33 items. In the original scale, the internal consistency coefficient was found .97 for Negative Cognitions about Self subscale, .88 for the Negative Cognitions about the World subscale, .86 for Self-Blame subscale, and .97 for the total scale. In the adaptation study, the internal consistency coefficient was found .97 for Negative Cognitions about Self subscale, .88 for the Negative Cognitions about the World subscale, .86 for Self-Blame subscale, and .97 for the total scale. Within the scope of the present study, the internal consistency coefficient was found .96 for Negative Cognitions about Self subscale, .87 for the Negative Cognitions about the World subscale, .89 for Self-Blame subscale, and .95 for the total scale. Statistical Analysis The study data were analyzed using the SPSS 23.0 statistical package programs. In addition, Hayes Process macro was used for mediation analysis. In the study, before performing the procedural analyses, first, the data were summarized using descriptive statistical techniques. Then, prerequisite analyses and assumptions were checked for the necessary analyses of the study. In this context, skewness and kurtosis coefficients were taken into account in the examination of the univariate and multivariate normality distributions of the variables. The Mardia’ test was also performed. First, a one-way outlier analysis was carried out. In the one-way outlier analysis, 27 outliers outside the ±3.29 were removed from the dataset. In the multivariate outlier analysis, the value of Mahalanobis distance was used and nine more outliers determined according to this value were removed from the analysis. For multicollinearity analysis, the condition index (CI), the Variance Inflation Factor (VIF) and tolerance values were examined. If the CI value of the variables is below 30, the VIF value is less than 10, or the tolerance values are .10 or more, there is no multicollinearity [34]. The analysis revealed that all values were within the specified ranges (CI=.74-.83; VIF= 1.20-1.35). As a result, after the necessary assumptions were met, the analysis continued with a total of 486 students. Pearson moments multiplication correlation coefficient analysis was performed to determine the relationships between the variables in the study. Then, inter-variable regression analysis was performed and after the significance value obtained, the mediation test was employed. Finally, the bootstrapping procedure (Model 4) was used to evaluate the statistical significance of the indirect effects in the model. RESULTS In this section, descriptive findings regarding the variables of the study are presented before proceeding to the analysis. Then, the findings and results obtained from the analyzes related to the research questions are presented. Normality values, descriptive findings and correlation results obtained from the study were presented in Table 1. Table 1 . Descriptive statistics and correlations among study variables Table 1 displays descriptive statistics and zero-order correlations for the study variables. The scores were 15.78 (±4.53) for depression, 28.46 (±6.43) for the negative cognitions about self subscale, 31.16 (±10.75) for the negative cognitions about the world subscale, 20.23 (±8.25) for the self-blame subscale, and 16.53 (±5.70) for psychological vulnerability. Skewness and kurtosis values were between +1.5 and -1.5, which are considered the cut-off values [68], and Mardia's multivariate coefficient was less than 5 [12], indicating that the univariate and multivariate normality assumptions were met. According to the correlation results, depression was positively correlated with the negative cognitions about self subscale (r=.42, p<.01), the negative cognitions about the world subscale (r=.56, p<.01), self-blame subscale (r=. 40, p<.01) and psychological vulnerability (r=.48, p<.01). In addition, there was a positive correlation between psychological vulnerability and the negative cognitions about self subscale (r=.38, p<.01), negative cognitions about the world subscale (r=.39, p<.01) and self-blame subscale (r=.35, p<.01). The values obtained were presented in table 1. In the study, bootstrapping was employed to test the mediating effect model. However, prior to this, a series of regression analyses were conducted. Psychological vulnerability significantly predicted the negative cognitions about self subscale (ß= .38, t= 9.12, p<.001), the negative cognitions about the world subscale (ß= .39, t= 9.38, p<.001), the self-blame subscale scale (ß= .35, t= 8.21, p<.001) and depression (ß= .48, t= 12.02, p<.001). Also, depression significantly predicted the negative cognitions about self subscale (ß= .52, t= 15.00, p<.001), the negative cognitions about the world scale (ß= .44, t= 12.15, p<.001) and the self-blame subscale (ß= .41, t= 10.97, p<.001). After the direct analyses, the mediating effect was tested. After including posttraumatic cognitions in the regression equation between depression and psychological vulnerability, the beta value between depression and psychological vulnerability decreased (ß= .35, t= 9.41, p<.001). According to Preacher and Hayes (2008), whether the indirect effect is significant or not is determined by whether the lower and upper limits of the 95% confidence interval values do not include zero. The examined values revealed that the mediating effect between the negative cognitions about self subscale (bootstrap coefficient= .05, Sh= .03, 95% CI= .046, .015), the negative cognitions about world subscale (bootstrap coefficient= .05, Sh= .04, 95% CI=.021, .016), and the self-blame subscale (bootstrap coefficient= .05, Sh= .02, 95% CI= .030, .012) was significant. Furthermore, the variance explained regarding the mediating effect in the model obtained in terms of total effect was determined as 23% (bootstrap coefficient= .05, Sh= .05, 95% CI= .017, .036). The values related to the model were presented in Figure 1. Discussion Based on the existing literature showing the negative repercussions of the COVID-19 pandemic on the psychological health of society, this study tested the mediating effect of posttraumatic cognitions on the levels of depression and psychological vulnerability of individuals with COVID-19. Accordingly, the study determined a positive and direct relationship between psychological vulnerability and posttraumatic cognitions and depression, and the statistical significance of the mediation of posttraumatic [COVID-19 trauma] cognitions between depression and psychological vulnerability. Positive correlations between psychological susceptibility and depression were discovered, as was expected. Results from both before and after the pandemic period demonstrate that people with higher psychological vulnerability levels suffer depression more frequently [18; 44; 67]. According to Cox and et al [ 19 ], there are various challenging individual and environmental factors that may increase psychological vulnerability. One of them is cognitively dysfunctional styles. Thus, cognitive structures are the basis of the relationship between depression and psychological vulnerability. This also demonstrates that the emergence of mood disorders is fundamentally influenced by psychological vulnerability [ 35 ]. Therefore, those with a high level of psychological vulnerability It can be stated that individuals are also likely to experience depression. Also, contrary to psychological vulnerability, the negative relationship between psychological resilience and depression supports this finding [42; 47; 61]. During the COVID-19 pandemic, the uncertainty brought by the pandemic and pandemic’s negative reflections on the increased individuals’ depression by increasing their psychological vulnerability levels. Another finding of the current study was the positive association between posttraumatic cognitions and depression. The COVID-19 pandemic has posed a serious threat to the mental health of individuals worldwide by increasing depression, anxiety, PTSD and negative social behaviors [ 63 ]. As COVID-19 cases rise, one of the most important indicators of this increasing threat has been the development of a trauma and stress-related disorders such as acute stress disorder, adjustment disorders or PTSD [ 24 ]. Therefore, with the COVID-19 pandemic, it can be stated that the dysfunction of personal cognitive structures that include evaluations of this pandemic constitutes the causality of psychological symptoms. One of the most detailed explanations regarding this result was made by Janoff-Bulman [ 41 ]. Janoff-Bulman [ 41 ] explained the changes observed in individuals after traumatic experiences with the “Basic Assumptions Model”. According to this model, people make a positive assumption about themselves and their lives in general. These assumptions are “The self is worthy”, “The world is benevolent” and “The world is meaningful”. However, these assumptions are deeply shattered by a traumatic experience and individuals begin to question these assumptions while experiencing a traumatic event in their own vulnerability. Thus, the change that begins with the questioning of individuals’ cognitive structures after trauma and the structure of this change are the main determinants of psychological adjustment and trigger depressive mood [5; 22]. Also, the negative cognitive structures that people attributed to the pandemic may have been sparked by the uncertainty brought on by the COVID-19 epidemic, the inadequacy of the vaccines to avoid symptoms, and the ambiguity in treatment. In addition, the fact that diagnosed clinically depressed individuals have lower levels of developing positive coping skills that protect themselves from depression [ 21 ] may have an effect on their posttraumatic cognitive structures and therefore increase the level of depression. Another finding of the study was the significant mediation of posttraumatic [COVID-19 trauma] cognitions between psychological vulnerability and depression. In other words, the study put forth that the COVID-19-induced cognitive structures of individuals with high psychological vulnerability were adversely affected and thus these individuals experienced depression. According to the cognitive model [ 7 ], one of the most important theories explaining depression, there are three basic mechanisms underlying depression. These are the cognitive triad, schemas, and cognitive distortions. The cognitive triad concept refers to the individuals’ negative perception of themselves, their experiences and the future. In this sense, negative cognitive structures that develop after the COVID-19 pandemic have triggered depression. This is also consistent with the dysfunctional cognitive structure model that Beck suggests causes depression. According to Beck's cognitive model, depression is characterized by negative perceptions of oneself, the environment and the future, along with deterioration in thought processes [ 7 ]. In the first part of the cognitive triad, the individuals assess themselves with negative labels and in this sense attribute certain adjectives to themselves such as incomplete or inadequate. In the second part of the cognitive triad, the individuals’ assessment of the world is negative. The world is perceived as a dangerous and painful place to live. In the last part of the cognitive triad, the individuals have hopeless perceptions especially towards the future and believe that negative processes will continue throughout life [ 56 ]. In all these processes, a negative life event is the trigger. The study findings revealed that all the cognitions [negative cognitions about the world, negative cognitions about self and self-blame] were significant according to this model after the COVID-19 trauma and support the relevant model. Also, studies discussing automatic thoughts [23; 45; 74; 75] report that cognitive schemas of individuals change after traumatic events because traumatic events affect the individuals’ thoughts and feelings about the world, themselves and others. Changing cognitive schemas also increase the probability of experiencing depression by contributing to the individuals’ automatic thoughts [43; 55]. Therefore, individuals having negative cognitions about themselves and life and blaming themselves for this may form a triggering factor on depression. Janoff-Bulman stated that people process information based on their own cognitive schemas, that cognitive schemas are important in understanding their own and others' memories, perceptions and inferences, and that schemas are resistant to change [ 41 ]. Considering that psychological vulnerability is also the basis of mood disorders [ 35 ], this increases depression by affecting the cognitive structures of individuals. Limitations As in every study, there are some limitations in this research. The fact that this study was conducted in …. and the sample group was within this country is a limitation for the generalization of the research on different samples. Another limitation of the study is that it was conducted on a correlational basis. Correlational studies have limitations in the context of cause and effect due to their nature [ 28 ]. Therefore, the study has a limitation in terms of cause and effect due to the study’s nature. Finally, the study data were obtained from a non-clinical sample. In this sense, the findings may not be generalized to a clinical group. Conclusion In conclusion, our findings show that the cognitions of individuals with high levels of psychological vulnerability during the current pandemic process may be adversely affected due to their trauma experience and that this may increase depression. In terms of compliance with preventive health behaviors, psychological resilience, another dimension of psychological vulnerability, is a protective factor, and maladaptive cognitions are a risk factor. These inferences can help produce more effective policies to reduce the spread of the pandemic and its individual-societal impact. Declarations Ethics Approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The ethical permission for this study was obtained from Yozgat Bozok University Commission No. 147472, decision number 04/50. Also, the written informed consent was obtained from study participants. Consent for publication Not applicable. Availability of data and material Upon reasonable request, the corresponding author will provide datasets created and/or used during the current work. Competing interest The authors declare that they have no conflict of interest. Funding The current study was not financially supported by any institution or group, according to the authors. Authors’Contributions All the stages in the article were carried out by A.Ç.Ö. 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Psychol Health Med. 2021;26(1):13-22. Worldometers. Worldometers COVID-19 coronavirus pandemic [Internet]. 2023 [cited 2023 Mar 24]. Available from: https://www.worldometers.info/coronavirus/#countries Xie Y, Xu E, Al-Aly Z. Risks of mental health outcomes in people with covid-19: Cohort study. BMJ. 2022;376 Yağcı-Yetkiner D. Travma Sonrası Bilişler Ölçeği (Posttraumatic Cognitions Inventory) Türkçe uyarlama ve üniversite öğrencileri üzerinde geçerlik güvenirlik çalışması [master's thesis]. Kocaeli: Kocaeli Üniversitesi, Sağlık Bilimleri Enstitüsü; 2010. Yapan S. Depresyon ve anksiyete belirtilerinin yordayıcıları olarak ruminasyon, otomatik düşünceler, işlevsel olmayan tutumlar ve düşünce baskılama [master's thesis]. Gaziantep: Hasan Kalyoncu Üniversitesi; 2018. Yapan S, Türkçapar M-H, Boysan M. Rumination, automatic thoughts, dysfunctional attitudes, and thought suppression as transdiagnostic factors in depression and anxiety. Curr Psychol. 2022;41(9):5896-912. Yıldırım M, Geçer E, Akgül Ö. The impacts of vulnerability, perceived risk, and fear on preventive behaviours against COVID-19. Psychol Health Med. 2021;26(1):35-43. Lopez-Ibor J-J. Disasters and mental health: New challenges for the psychiatric profession. World J Biol Psychiatry. 2006;7:171-82. Silveira S, Hecht M, Matthaeus H, Adli M, Voelkle M-C, Singer T. Coping with the COVID-19 Pandemic: Perceived Changes in Psychological Vulnerability, Resilience and Social Cohesion before, during and after Lockdown. Int J Environ Res Public Health. 2022;19(6):3290. Erarslan Ö, Işikli S. Bilişsel Üçlü Envanteri'nin Türkçe Uyarlanması: Geçerlik ve Güvenirlik Çalışması. Arch Neuropsychiatry. 2019;56(1):52-6. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6565326","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":491461870,"identity":"611fb48b-a930-485a-93ac-ea027b11098c","order_by":0,"name":"Ahmet Çağlar ÖZDOĞAN","email":"data:image/png;base64,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","orcid":"","institution":"Izmir Democracy University","correspondingAuthor":true,"prefix":"","firstName":"Ahmet","middleName":"Çağlar","lastName":"ÖZDOĞAN","suffix":""}],"badges":[],"createdAt":"2025-04-30 13:23:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6565326/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6565326/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":87817301,"identity":"329845ed-f5e0-4b22-8d8c-52ba09805a53","added_by":"auto","created_at":"2025-07-29 10:23:09","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":70891,"visible":true,"origin":"","legend":"\u003cp\u003eMediator model\u003c/p\u003e\n\u003cp\u003eNote: Psy.Vul: Psychological Vulnerability, NCSC: Negative Cognitions about Self, NCW: Negative Cognitions about World, SBS: Self Blame\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6565326/v1/a1347f913948e2a253219622.png"},{"id":91149125,"identity":"6850bce4-f259-4ebc-a7d0-ae667aa57cca","added_by":"auto","created_at":"2025-09-12 06:47:03","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":608424,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6565326/v1/f57e2669-0b2c-40ab-990d-d5bc387002f0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eThe Mediating Role of Posttraumatic Cognitions in the Relationship Between Psychological Vulnerability and Depression in Individuals With a History of Covid-19\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eAccording to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [DSM-5], published by the American Psychiatric Association [4], traumas are grouped under three main headings: those caused by people, those that occur as a result of accidents, and natural disasters and events [such as epidemics]. Disasters are a variety of occurrences brought on by a threat that impacts social groupings, results in material and human losses, and impairs the community\u0026apos;s ability to cope through social processes [77]. Accordingly, effective in recent years, the still continuing COVID-19 pandemic is considered as a traumatic event evaluated under the natural disasters and epidemics [72]. Although the COVID-19 pandemic has had many adverse effects from the beginning to the present, the most important reflection of this effect has been witnessed on individual and community mental health [40].\u003c/p\u003e\n\u003cp\u003eAfter the outbreak of COVID-19 on January 30, 2020, the World Health Organization [WHO] evaluated the outbreak as a global health crisis and declared it a pandemic. The COVID-19 pandemic, like other pandemics, poses a threat to the psychological well-being of individuals, but also has a negative impact on individuals\u0026apos; lifestyles, especially with a number of restrictions [70]. Taking into account the COVID-19 pandemic and its effects, the pandemic is considered one of the deadliest cases of this century. According to data, over six million people have died since the beginning of the outbreak [71]. While these numbers reveal the impact of the pandemic, the pandemic is also considered as a traumatic event deeply affecting individuals\u0026rsquo; psychological health [33; 40; 72]. Similar psychological disorders also showed their effect in previous epidemics. For instance, studies conducted during the 2002-2004 SARS epidemic in China that was identified and spread before COVID-19 also revealed that behavioral changes in infected individuals should not be ignored [14; 15]. As a result, every pandemic-sized outbreak has a psychological effect on people [49].\u003c/p\u003e\n\u003cp\u003eAlthough COVID-19 deeply affects many people, the degree of this impact varies within the periodic structure of individuals. For instance, older individuals experience difficulties due to increased death rates, while younger individuals experience difficulties due to the threat to their health, certain restrictions that came with the pandemic, and their negative impact on their social, academic and family lives. Periodically, there are normally various stressors in university students\u0026rsquo; lives and this has increased with the pandemic [20]. Factors such as the transition to distance learning, the isolation process, and academic uncertainty showed their effects with the pandemic [50]. The studies conducted before the pandemic period put forth that these individuals normally go through certain difficulties in their developmental stressors. These difficulties are factors such as academic pressure, program changes, economic difficulties, and social isolation [58]. Studies show that the possible effects of these difficulties and students\u0026rsquo; developmental period are effective in increasing the level of depression [30; 60]. Also, a study in which the amount of depression experienced by university students was assessed and other studies on the topic were addressed indicated that 30.6% of university students suffer depression [36]. In a different study conducted in 21 countries, 18.5% of university students had at least one major depressive episode [6]. Therefore, it can be stated that depression is one of the most important psychological disorders experienced by university students. With the negative impact of the pandemic, it is seen that this situation, which potentially exists among university students, has increased even more [25; 30; 39].\u003c/p\u003e\n\u003cp\u003eWith the increasing adverse impact of the pandemic in different countries, studies reported psychological symptoms and maladaptive behaviors [37; 40; 69]. These studies draw attention to the increase in depression levels during periods of intense isolation with the pandemic even though vaccination provides social relief [albeit partially] [57; 48]. Although the effects of the pandemic were global, certain people were more affected by the pandemic and experience it at a more pathological level. The relevant literature shows that individuals most affected by the pandemic are also individuals with high levels of psychological vulnerability [17; 78].\u003c/p\u003e\n\u003cp\u003eResearch on the subject shows a positive relationship between depression and psychological vulnerability [13; 50] and a negative effect on psychological resilience [42; 76]. The concept of psychological vulnerability is a construct that expresses a predisposition to an undesirable outcome and also underlies the development of mood disorders [35]. Thus, vulnerability in biological, emotional, cognitive, and behavioral stress responses is not conducive to successful adaptation or self-regulation and consequently contributes to the development of various adjustment problems and disorders [1; 38]. The degree of vulnerability that individuals experience is significantly influenced by personal, cognitive, and environmental factors [32]. Among the environmental factors, the experiences in the COVID-19 process are effective. For example, a study by Silveria et al. [78] revealed that these changing living conditions with the COVID-19 pandemic increased the psychological vulnerability of individuals and negatively affected mental health. Conceptual explanations about psychological vulnerability put forth that this state is caused by two main factors, environmental and cognitive processes [65]. Related studies reported that environmental process involves learning experiences more, whereas cognitive process involves dysfunctional cognitions more [11; 16].\u003c/p\u003e\n\u003cp\u003eIngram and Luxton [38] emphasized that individuals\u0026rsquo; \u0026ldquo;belief patterns\u0026rdquo; and \u0026ldquo;dysfunctional learning\u0026rdquo; acquired through their childhood experiences constitute the genesis of psychological vulnerability. Thus, psychological vulnerability is made up of dysfunctional cognitive structures and environmental learning experiences. Furthermore, developed by Beck, the Cognitive Behavioral Approach, is the most important model explaining depression. The approach indicates that the mediating effect of cognitions between depression and psychological vulnerability along with the evaluations related to cognitive factors may be the basis of depression.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheoretical Structure of Depression and the Mediating Role of Cognitions of Traumatic Experiences\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOne of the most comprehensive studies on depression in the literature was presented by Beck [7]. The depression model introduced by Beck puts forth depression and the structures that cause depression in the light of data obtained from clinical practices. Beck\u0026apos;s model of depression is based on three main psychological factors, the cognitive triad [the individual\u0026apos;s negative perception of oneself, the future, and the world], schemas, and cognitive distortions. Although cognitive structures form the basis of the model put forward by Beck, the concept of cognitive triad reveals in detail the causality of depression based on traumatic events and the way these events are perceived [8; 79].\u003c/p\u003e\n\u003cp\u003eAccording to APA [4], trauma refers to exposure to death of a loved one or a relative or threat on a person\u0026rsquo;s life. After a traumatic experience, the response of individuals to trauma may differ. While some people experience depression due to fear and anxiety experienced after trauma, some people go through positive changes such as increased meaning in life and individual empowerment [62]. Studies report that cognitive processes are behind this state [46; 51; 54; 66]. Furthermore, studies especially draw attention to the low cognitive performance caused by COVID-19 [3; 53]. According to cognitive depression theorists, people\u0026apos;s thoughts, attitudes, and interpretations increase the risk of depression. In addition, the degree to which individuals remember negative experiences as a result of their experiences also affects their depression levels [9]. In addition to negative views about oneself, the future, and the world, repetitive and uncontrollable negative thoughts that usually revolve around the self are symptoms of depression [31]. After a traumatic experience, a person\u0026rsquo;s evaluation style structure about oneself and the world is important, and this structure is effective on depressive mood [10]. In summary, with the COVID-19 pandemic, individuals with higher levels of psychological vulnerability and with negative cognitive structures have been affected more after trauma.\u003c/p\u003e\n\u003cp\u003eRegarding the COVID-19 pandemic, public health experts suggest that even if the course of the pandemic decreased, its impact will continue [26; 29]. Although the pandemic is believed to be effective on levels, we have limited information on the variables directly or indirectly affecting individuals\u0026rsquo; psychological health. It is crucial to look into how the pandemic, which is considered a trauma, has affected people\u0026apos;s propensities for depression both directly and indirectly. So, the current study\u0026apos;s objective is to investigate how posttraumatic cognitions mediate the link between psychological vulnerability and depression in people who have a history of COVID-19. The study results may help to make the process more effective in the future by broadening our understanding of the COVID-19 pandemic and the role of traumatic experiences in general.\u0026nbsp;\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003e\u003cstrong\u003eStudy design and participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCorrelational research method was used in this study. The study sample consisted of 486 (F=276, M=210) university students attending various state universities in …. The participants’ ages ranged between 18 and 29, with a mean of 22.16 (SD= 3.02). The criteria for inclusion of the participants to the study was being infected by COVID-19.\u003c/p\u003e\n\u003cp\u003eUsing the measurement tools that were given to the students online, the study's data was gathered. The students were\u0026nbsp;first made\u0026nbsp;aware\u0026nbsp;of\u0026nbsp;the\u0026nbsp;study\u0026nbsp;prior\u0026nbsp;to\u0026nbsp;data\u0026nbsp;collection,\u0026nbsp;and\u0026nbsp;only\u0026nbsp;those who\u0026nbsp;volunteered for\u0026nbsp;the study were used for data collection. The university's ethical committee gave its approval to the study, which was also conducted in accordance with the Helsinki Declaration. All participants were informed about the study purpose and the confidentiality of their responses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInstruments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDepression-Anxiety-Stress Scale:\u003c/strong\u003e The Depression, Anxiety and Stress Scale (DAS-21) was developed by Lovinond and Lovibond [52] to determine individuals’ depression, anxiety and stress levels. The scale was adapted to Turkish by Sarıçam [59]. In the present study, only the depression subscale of the scale was used. The four-point Likert-type depression subscale consists of seven items. The internal consistency coefficient of the original scale development study was found as .88, and the internal consistency coefficient of the adaptation study as .87. The internal consistency coefficient calculated within the scope of the present study was determined as .90.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePsychological Vulnerability Scale:\u003c/strong\u003e Developed by Sinclair and Wallston [64], the Psychological Vulnerability Scale was adapted to Turkish by Akın and Eker [2]. The scale was developed to determine individuals’ psychological vulnerability levels. The five-point Likert-type scale has six items. The original and adapted scales were found to have an internal consistency coefficient of.75. The internal consistency coefficient calculated in this study was .77.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePosttraumatic Cognitions Inventory:\u003c/strong\u003e Developed by Foa et al. [27], the Posttraumatic Cognitions Inventory evaluates individuals' post-traumatic cognitions after trauma. The inventory was adapted to Turkish by Yağcı- Yetkiner [73]. Three subscales make up the scale: self-blame, world-blame, and negative cognitions about oneself. The seven-point Likert type scale has 33 items. In the original scale, the internal consistency coefficient was found .97 for Negative Cognitions about Self subscale, .88 for the Negative Cognitions about the World subscale, .86 for Self-Blame subscale, and .97 for the total scale. In the adaptation study, the internal consistency coefficient was found .97 for Negative Cognitions about Self subscale, .88 for the Negative Cognitions about the World subscale, .86 for Self-Blame subscale, and .97 for the total scale. Within the scope of the present study, the internal consistency coefficient was found .96 for Negative Cognitions about Self subscale, .87 for the Negative Cognitions about the World subscale, .89 for Self-Blame subscale, and .95 for the total scale.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study data were analyzed using the SPSS 23.0 statistical package programs. In addition, Hayes Process macro was used for mediation analysis. In the study, before performing the procedural analyses, first, the data were summarized using descriptive statistical techniques. Then, prerequisite analyses and assumptions were checked for the necessary analyses of the study. In this context, skewness and kurtosis coefficients were taken into account in the examination of the univariate and multivariate normality distributions of the variables. The Mardia’ test was also performed. First, a one-way outlier analysis was carried out. In the one-way outlier analysis, 27 outliers outside the ±3.29 were removed from the dataset. In the multivariate outlier analysis, the value of Mahalanobis distance was used and nine more outliers determined according to this value were removed from the analysis. For multicollinearity analysis, the condition index (CI), the Variance Inflation Factor (VIF) and tolerance values were examined. If the CI value of the variables is below 30, the VIF value is less than 10, or the tolerance values are .10 or more, there is no multicollinearity [34]. The analysis revealed that all values were within the specified ranges (CI=.74-.83; VIF= 1.20-1.35). As a result, after the necessary assumptions were met, the analysis continued with a total of 486 students. Pearson moments multiplication correlation coefficient analysis was performed to determine the relationships between the variables in the study. Then, inter-variable regression analysis was performed and after the significance value obtained, the mediation test was employed. Finally, the bootstrapping procedure (Model 4) was used to evaluate the statistical significance of the indirect effects in the model.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eIn this section, descriptive findings regarding the variables of the study are presented before proceeding to the analysis. Then, the findings and results obtained from the analyzes related to the research questions are presented. Normality values, descriptive findings and correlation results obtained from the study were presented in Table 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;1\u003cem\u003e.\u003c/em\u003e\u0026nbsp;\u003c/strong\u003eDescriptive statistics and correlations among study variables\u003c/p\u003e\n\u003cdiv align=\"Left\"\u003e\u003cimg 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\"\u003e\u003c/div\u003e\n\u003cp\u003eTable 1 displays descriptive statistics and zero-order correlations for the study variables. The scores were 15.78 (\u0026plusmn;4.53) for depression, 28.46 (\u0026plusmn;6.43) for the negative cognitions about self subscale, 31.16 (\u0026plusmn;10.75) for the negative cognitions about the world subscale, 20.23 (\u0026plusmn;8.25) for the self-blame subscale, and 16.53 (\u0026plusmn;5.70) for psychological vulnerability. Skewness and kurtosis values were between +1.5 and -1.5, which are considered the cut-off values [68], and Mardia\u0026apos;s multivariate coefficient was less than 5 [12], indicating that the univariate and multivariate normality assumptions were met.\u003c/p\u003e\n\u003cp\u003eAccording to the correlation results, depression was positively correlated with the negative cognitions about self subscale (r=.42, p\u0026lt;.01), the negative cognitions about the world subscale (r=.56, p\u0026lt;.01), self-blame subscale (r=. 40, p\u0026lt;.01) and psychological vulnerability (r=.48, p\u0026lt;.01). In addition, there was a positive correlation between psychological vulnerability and the negative cognitions about self subscale (r=.38, p\u0026lt;.01), negative cognitions about the world subscale (r=.39, p\u0026lt;.01) and self-blame subscale (r=.35, p\u0026lt;.01). The values obtained were presented in table 1.\u003c/p\u003e\n\u003cp\u003eIn the study, bootstrapping was employed to test the mediating effect model. However, prior to this, a series of regression analyses were conducted. Psychological vulnerability significantly predicted the negative cognitions about self subscale (\u0026szlig;= .38, t= 9.12, p\u0026lt;.001), the negative cognitions about the world subscale (\u0026szlig;= .39, t= 9.38, p\u0026lt;.001), the self-blame subscale scale (\u0026szlig;= .35, t= 8.21, p\u0026lt;.001) and depression (\u0026szlig;= .48, t= 12.02, p\u0026lt;.001). Also, depression significantly predicted the negative cognitions about self subscale (\u0026szlig;= .52, t= 15.00, p\u0026lt;.001), the negative cognitions about the world scale (\u0026szlig;= .44, t= 12.15, p\u0026lt;.001) and the self-blame subscale (\u0026szlig;= .41, t= 10.97, p\u0026lt;.001). After the direct analyses, the mediating effect was tested. After including posttraumatic cognitions in the regression equation between depression and psychological vulnerability, the beta value between depression and psychological vulnerability decreased (\u0026szlig;= .35, t= 9.41, p\u0026lt;.001). According to Preacher and Hayes (2008), whether the indirect effect is significant or not is determined by whether the lower and upper limits of the 95% confidence interval values do not include zero. The examined values revealed that the mediating effect between the negative cognitions about self subscale (bootstrap coefficient= .05, Sh= .03, 95% CI= .046, .015), the negative cognitions about world subscale (bootstrap coefficient= .05, Sh= .04, 95% CI=.021, .016), and the self-blame subscale (bootstrap coefficient= .05, Sh= .02, 95% CI= .030, .012) was significant. Furthermore, the variance explained regarding the mediating effect in the model obtained in terms of total effect was determined as 23% (bootstrap coefficient= .05, Sh= .05, 95% CI= .017, .036). The values related to the model were presented in Figure 1.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eBased on the existing literature showing the negative repercussions of the COVID-19 pandemic on the psychological health of society, this study tested the mediating effect of posttraumatic cognitions on the levels of depression and psychological vulnerability of individuals with COVID-19. Accordingly, the study determined a positive and direct relationship between psychological vulnerability and posttraumatic cognitions and depression, and the statistical significance of the mediation of posttraumatic [COVID-19 trauma] cognitions between depression and psychological vulnerability. Positive correlations between psychological susceptibility and depression were discovered, as was expected. Results from both before and after the pandemic period demonstrate that people with higher psychological vulnerability levels suffer depression more frequently [18; 44; 67]. According to Cox and et al [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], there are various challenging individual and environmental factors that may increase psychological vulnerability. One of them is cognitively dysfunctional styles. Thus, cognitive structures are the basis of the relationship between depression and psychological vulnerability. This also demonstrates that the emergence of mood disorders is fundamentally influenced by psychological vulnerability [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Therefore, those with a high level of psychological vulnerability It can be stated that individuals are also likely to experience depression. Also, contrary to psychological vulnerability, the negative relationship between psychological resilience and depression supports this finding [42; 47; 61]. During the COVID-19 pandemic, the uncertainty brought by the pandemic and pandemic\u0026rsquo;s negative reflections on the increased individuals\u0026rsquo; depression by increasing their psychological vulnerability levels.\u003c/p\u003e\u003cp\u003eAnother finding of the current study was the positive association between posttraumatic cognitions and depression. The COVID-19 pandemic has posed a serious threat to the mental health of individuals worldwide by increasing depression, anxiety, PTSD and negative social behaviors [\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e]. As COVID-19 cases rise, one of the most important indicators of this increasing threat has been the development of a trauma and stress-related disorders such as acute stress disorder, adjustment disorders or PTSD [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Therefore, with the COVID-19 pandemic, it can be stated that the dysfunction of personal cognitive structures that include evaluations of this pandemic constitutes the causality of psychological symptoms. One of the most detailed explanations regarding this result was made by Janoff-Bulman [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Janoff-Bulman [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e] explained the changes observed in individuals after traumatic experiences with the \u0026ldquo;Basic Assumptions Model\u0026rdquo;. According to this model, people make a positive assumption about themselves and their lives in general. These assumptions are \u0026ldquo;The self is worthy\u0026rdquo;, \u0026ldquo;The world is benevolent\u0026rdquo; and \u0026ldquo;The world is meaningful\u0026rdquo;. However, these assumptions are deeply shattered by a traumatic experience and individuals begin to question these assumptions while experiencing a traumatic event in their own vulnerability. Thus, the change that begins with the questioning of individuals\u0026rsquo; cognitive structures after trauma and the structure of this change are the main determinants of psychological adjustment and trigger depressive mood [5; 22]. Also, the negative cognitive structures that people attributed to the pandemic may have been sparked by the uncertainty brought on by the COVID-19 epidemic, the inadequacy of the vaccines to avoid symptoms, and the ambiguity in treatment. In addition, the fact that diagnosed clinically depressed individuals have lower levels of developing positive coping skills that protect themselves from depression [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] may have an effect on their posttraumatic cognitive structures and therefore increase the level of depression. Another finding of the study was the significant mediation of posttraumatic [COVID-19 trauma] cognitions between psychological vulnerability and depression. In other words, the study put forth that the COVID-19-induced cognitive structures of individuals with high psychological vulnerability were adversely affected and thus these individuals experienced depression. According to the cognitive model [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], one of the most important theories explaining depression, there are three basic mechanisms underlying depression. These are the cognitive triad, schemas, and cognitive distortions. The cognitive triad concept refers to the individuals\u0026rsquo; negative perception of themselves, their experiences and the future. In this sense, negative cognitive structures that develop after the COVID-19 pandemic have triggered depression. This is also consistent with the dysfunctional cognitive structure model that Beck suggests causes depression. According to Beck's cognitive model, depression is characterized by negative perceptions of oneself, the environment and the future, along with deterioration in thought processes [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In the first part of the cognitive triad, the individuals assess themselves with negative labels and in this sense attribute certain adjectives to themselves such as incomplete or inadequate. In the second part of the cognitive triad, the individuals\u0026rsquo; assessment of the world is negative. The world is perceived as a dangerous and painful place to live. In the last part of the cognitive triad, the individuals have hopeless perceptions especially towards the future and believe that negative processes will continue throughout life [\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e]. In all these processes, a negative life event is the trigger. The study findings revealed that all the cognitions [negative cognitions about the world, negative cognitions about self and self-blame] were significant according to this model after the COVID-19 trauma and support the relevant model. Also, studies discussing automatic thoughts [23; 45; 74; 75] report that cognitive schemas of individuals change after traumatic events because traumatic events affect the individuals\u0026rsquo; thoughts and feelings about the world, themselves and others. Changing cognitive schemas also increase the probability of experiencing depression by contributing to the individuals\u0026rsquo; automatic thoughts [43; 55]. Therefore, individuals having negative cognitions about themselves and life and blaming themselves for this may form a triggering factor on depression. Janoff-Bulman stated that people process information based on their own cognitive schemas, that cognitive schemas are important in understanding their own and others' memories, perceptions and inferences, and that schemas are resistant to change [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Considering that psychological vulnerability is also the basis of mood disorders [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], this increases depression by affecting the cognitive structures of individuals.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Limitations","content":"\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eAs in every study, there are some limitations in this research. The fact that this study was conducted in \u0026hellip;. and the sample group was within this country is a limitation for the generalization of the research on different samples. Another limitation of the study is that it was conducted on a correlational basis. Correlational studies have limitations in the context of cause and effect due to their nature [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Therefore, the study has a limitation in terms of cause and effect due to the study\u0026rsquo;s nature. Finally, the study data were obtained from a non-clinical sample. In this sense, the findings may not be generalized to a clinical group.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, our findings show that the cognitions of individuals with high levels of psychological vulnerability during the current pandemic process may be adversely affected due to their trauma experience and that this may increase depression. In terms of compliance with preventive health behaviors, psychological resilience, another dimension of psychological vulnerability, is a protective factor, and maladaptive cognitions are a risk factor. These inferences can help produce more effective policies to reduce the spread of the pandemic and its individual-societal impact.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The ethical permission for this study was obtained from Yozgat Bozok University Commission No. 147472, decision number 04/50. Also, the written informed consent was obtained from study participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUpon reasonable request, the corresponding author will provide datasets created and/or used during the current work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflict of interest. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003cbr\u003e The current study was not financially supported by any institution or group, according to the authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’Contributions\u003c/strong\u003e\u003cbr\u003e All the stages in the article were carried out by A.Ç.Ö.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author would like to thank the participants of this study for their interest and understanding. I would also like to express my gratitude to my colleagues who contributed to the maturation of this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all individual participants included in the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAdger WN. Vulnerability. Global Environ Change. 2006;16:268-81.\u003c/li\u003e\n \u003cli\u003eAkın A, Eker H. Turkish version of the Psychological Vulnerability Scale: A study of validity and reliability. 32th International Conference of the Stress and Anxiety Research Society; 2011 Jul 18-20; M\u0026uuml;nster, Germany.\u003c/li\u003e\n \u003cli\u003eAlmeria M, Cejudo J-C, Sotoca J, Deus J, Krupinski J. Cognitive profile following COVID-19 infection: Clinical predictors leading to neuropsychological impairment. 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World J Biol Psychiatry. 2006;7:171-82.\u003c/li\u003e\n \u003cli\u003eSilveira S, Hecht M, Matthaeus H, Adli M, Voelkle M-C, Singer T. Coping with the COVID-19 Pandemic: Perceived Changes in Psychological Vulnerability, Resilience and Social Cohesion before, during and after Lockdown. Int J Environ Res Public Health. 2022;19(6):3290.\u003c/li\u003e\n \u003cli\u003eErarslan \u0026Ouml;, Işikli S. Bilişsel \u0026Uuml;\u0026ccedil;l\u0026uuml; Envanteri\u0026apos;nin T\u0026uuml;rk\u0026ccedil;e Uyarlanması: Ge\u0026ccedil;erlik ve G\u0026uuml;venirlik \u0026Ccedil;alışması. Arch Neuropsychiatry. 2019;56(1):52-6.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Depression, Psychological Vulnerability, Posttraumatic Cognitions, COVID-19","lastPublishedDoi":"10.21203/rs.3.rs-6565326/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6565326/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eThis paper examined the psychological vulnerability and mediating role of cognitions after the trauma of COVID-19.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThe sample of this relational study consisted of 486 (F=276,M=210) students studying at a state university in …. Participants were recruited through convenience sampling. Participants completed the online versions of the DASS-21 scale, the Posttraumatic Cognitions Inventory, and the Psychological Vulnerability Scale. The hypothetical model was tested via the bootstrapping procedure for regression and mediating effect.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003ePsychological vulnerability had direct and significant effects on all sub-dimensions of posttraumatic cognitions. On the other hand, posttraumatic cognitions had a direct and significant effect on depression. Besides, the psychological vulnerability was found to be a significant predictor of depression. The analysis of mediating effect showed that cognitions had a mediating effect on the relationship between psychological vulnerability and depression after COVID-19 trauma. The explained variance for the whole model was 23%.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eAccording to findings, psychological vulnerability increased the level of depression by increasing posttraumatic cognitions, and both psychological vulnerability and posttraumatic cognitions had a direct and significant effect on depression.\u003c/p\u003e","manuscriptTitle":"The Mediating Role of Posttraumatic Cognitions in the Relationship Between Psychological Vulnerability and Depression in Individuals With a History of Covid-19","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-29 10:23:04","doi":"10.21203/rs.3.rs-6565326/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7b7a9bd9-106d-4d2e-b4a3-62d2e225617f","owner":[],"postedDate":"July 29th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-11T05:23:26+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-29 10:23:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6565326","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6565326","identity":"rs-6565326","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}