key: cord-300617-sntnel5p
authors: Hill, Patrick L.; Burrow, Anthony L.
title: Derailment as a Risk Factor for Greater Mental Health Issues following Pandemic
date: 2020-05-13
journal: Psychiatry Res
DOI: 10.1016/j.psychres.2020.113093
sha: 
doc_id: 300617
cord_uid: sntnel5p

nan

The recent pandemic has proven to be a destabilizing force worldwide, sending economies and social arrangements off course to an extent that will be felt for years to come.

Similarly, COVID-19 has thrown nearly everyone's personal lives off their typical course. Just as policymakers are dealing with how to restructure a derailed world, people are also left to determine how much of their "normal lives" can continue in this uncertain time. Often missing in discussions is the immense mental health challenge we are facing as a result of the pandemic and our response (Schwartz, 2020) . Given the need for mental health professionals to target interventions and limited resources to those most in need, we suggest there is value for mental RUNNING HEAD: Derailment in a Pandemic 2 health professionals to assess these feelings of derailment -an individual's sense of disconnection from their past selves, life directions, and motivations (Burrow, Hill, Ratner, & Fuller-Rowell, 2020) . This recommendation is rooted in the construct's clinical relevance, ease of assessment, ability for intervention, and connection to the ongoing crisis.

When considering the current environment, the COVID-19 pandemic presents with several factors that researchers for decades have suggested will lead to greater impact from major life events (for a review, see Luhmann, Fassbender, Alcock, & Haehner, 2020) . Given this event is truly a once-in-a-lifetime pandemic (World Health Organization, 2020), most individuals will view the event as extremely negative in valence, unpredictable, largely outside their own ability to control it, and relatively extraordinary in nature, insofar that it is unlike any past events they have experienced. All of these factors will likely play a contributing role with respect to several mental health concerns. In addition, the potential for derailment to prove a lingering concern arises from the fact that the pandemic, and our response to it, has been an emotionally significant challenge for several individuals, and one that may have impacted their lives, worldviews, and social statuses. Indeed, if one believes that the world has changed in fundamental ways, it would be difficult to perceive one's own life as having continuity in the same direction as before the event. Moreover, shifting social ties may lead individuals to reset their motivations, or at least question the ambitions they once held. With calls for continued self-isolation and social distancing, several individuals are at risk for disconnection from their past selves and motives, and left questioning whether their lives will be continuously discontinuous as a result.

The importance of studying derailment comes from its apparent clinical significance, and ease of a recently validated self-report assessment. Namely, derailed individuals tend to report greater depressive symptoms, anxiety, and psychological distress, largely distinct from related RUNNING HEAD: Derailment in a Pandemic 3 self and identity constructs (Burrow et al., 2020; Ratner, Mendle, Burrow, & Thoemmes, 2019) .

What makes the concept of derailment unique is also what makes it particularly relevant to the current crisis. Namely, derailment captures not only a sense of perceived self-change but also whether individuals feel that their motivations and life directions have been continuous over time. Items from the Derailment Scale (Burrow et al., 2020) reflect how many people have felt during recent weeks and months. For instance, most people have probably noticed "how different (they) are now from who (they) used to be," or even are starting to doubt that their lives have "been heading in the same direction for a long time." In addition, several people may no longer feel that their "motivations in life have been the same over time," as they are more focused now on resolving basic needs or completing work-related tasks remotely.

As such, derailment may be an especially important indicator of who is in greater need of mental health care in this time of crisis, by helping to identify those individuals most susceptible to trauma rather than resilience following the event. Moreover, it is important to note that some symptoms of derailment may be treated even with limited resources. Though more malignant forms likely require one-on-one therapy, similar to identity disorders, research has shown that journaling activities at home at least can temporarily help individuals reduce their derailment symptoms (Burrow et al., 2020) . Given the clear challenges faced by mental health professionals due to the widespread impact of this pandemic, and ongoing public health policies that limit social interaction, derailment may be uniquely positioned as a construct both of great significance for clinicians, and one that may be intervened upon in part without significant inperson care. 

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Depression and derailment: A cyclical model of mental illness and perceived identity change

COVID-19 and mental health: A message that needs to be heard

Coronavirus disease (COVID-19). who.int/emergencies/diseases/novel-coronavirus-2019


