Richard G. Cowden

To identify potential protective mechanisms that might buffer the effects of the COVID-19 pandemic on well-being, the current set of studies (NStudy 1 = 1172, NStudy 2 = 451) examined the roles of hope and religious coping (positive and negative) in promoting well-being during periods when stringent stay-at-home orders were implemented in Colombia and South Africa to control the spread of SARS-CoV-2. After controlling for relevant sociodemographic characteristics (Studies 1 and 2), subjective health complaints, and sleep quality (Study 2), hope was positively associated with well-being and the relation between hope and well-being was moderated by religious coping. Whilst well-being was highest when levels of hope were high (irrespective of positive or negative religious coping levels), when reported hope was low, well-being tended to be higher when positive religious coping was high (Study 1) and negative religious coping was low (Study 2). Implications of the findings for maintaining well-being during a public health crisis are discussed.

BACKGROUND: The sustainable development goals (SDGs) aim to end HIV/AIDS as a public health threat by 2030. Understanding the current state of the HIV epidemic and its change over time is essential to this effort. This study assesses the current sex-specific HIV burden in 204 countries and territories and measures progress in the control of the epidemic. METHODS: To estimate age-specific and sex-specific trends in 48 of 204 countries, we extended the Estimation and Projection Package Age-Sex Model to also implement the spectrum paediatric model. We used this model in cases where age and sex specific HIV-seroprevalence surveys and antenatal care-clinic sentinel surveillance data were available. For the remaining 156 of 204 locations, we developed a cohort-incidence bias adjustment to derive incidence as a function of cause-of-death data from vital registration systems. The incidence was input to a custom Spectrum model. To assess progress, we measured the percentage change in incident cases and deaths between 2010 and 2019 (threshold >75% decline), the ratio of incident cases to number of people living with HIV (incidence-to-prevalence ratio threshold <0·03), and the ratio of incident cases to deaths (incidence-to-mortality ratio threshold <1·0). FINDINGS: In 2019, there were 36·8 million (95% uncertainty interval [UI] 35·1-38·9) people living with HIV worldwide. There were 0·84 males (95% UI 0·78-0·91) per female living with HIV in 2019, 0·99 male infections (0·91-1·10) for every female infection, and 1·02 male deaths (0·95-1·10) per female death. Global progress in incident cases and deaths between 2010 and 2019 was driven by sub-Saharan Africa (with a 28·52% decrease in incident cases, 95% UI 19·58-35·43, and a 39·66% decrease in deaths, 36·49-42·36). Elsewhere, the incidence remained stable or increased, whereas deaths generally decreased. In 2019, the global incidence-to-prevalence ratio was 0·05 (95% UI 0·05-0·06) and the global incidence-to-mortality ratio was 1·94 (1·76-2·12). No regions met suggested thresholds for progress. INTERPRETATION: Sub-Saharan Africa had both the highest HIV burden and the greatest progress between 1990 and 2019. The number of incident cases and deaths in males and females approached parity in 2019, although there remained more females with HIV than males with HIV. Globally, the HIV epidemic is far from the UNAIDS benchmarks on progress metrics. FUNDING: The Bill & Melinda Gates Foundation, the National Institute of Mental Health of the US National Institutes of Health (NIH), and the National Institute on Aging of the NIH.

Background: Mental toughness (MT) is often referred to as one of the most important psychological attributes underpinning the success of athletes. Although selected studies have examined this common supposition, research in this area has yet to be synthesized. Objective: The purpose of this study was to review the quantitative literature on MT, competitive standard, achievement level, and performance (competitive and non-competitive) in sport. Method: Searches using a specified key term were performed in 10 databases during August 2016. Following an initial screening of the unique records that were identified (N = 1025), 19 peer-reviewed articles met the eligibility criteria for inclusion in the review. Results: The majority of MT-competitive standard studies (N = 10) found total (66.7%) or subcomponent (71.4%) MT differences, with mentally tougher athletes participating at higher levels of competition. Of the remaining studies (N = 9), most indicated (77.8%) mentally tougher athletes tend to achieve more or perform better. Conclusion: Collectively, the results point to mentally tougher athletes’ superior levels of success. The findings are discussed alongside the limitations associated with this part of the current MT in sport literature, with several important areas outlined for scholars to consider and pursue when conducting future research.

BACKGROUND: Deaths from suicide are a tragic yet preventable cause of mortality. Quantifying the burden of suicide to understand its geographical distribution, temporal trends, and variation by age and sex is an essential step in suicide prevention. We aimed to present a comprehensive set of global, regional, and national estimates of suicide burden. METHODS: We produced estimates of the number of deaths and age-standardised mortality rates of suicide globally, regionally, and for 204 countries and territories from 1990 to 2021, and disaggregated these results by age and sex. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 estimates of deaths attributable to suicide were broken down into two comprehensive categories: those by firearms and those by other specified means. For this analysis, we also produced estimates of mean age at the time of death from suicide, incidence of suicide attempts compared with deaths, and age-standardised rates of suicide by firearm. We acquired data from vital registration, verbal autopsy, and mortality surveillance that included 23 782 study-location-years of data from GBD 2021. Point estimates were calculated from the average of 1000 randomly selected possible values of deaths from suicide by age, sex, and geographical location. 95% uncertainty intervals (UIs) were derived from the 2·5th and 97·5th percentiles from a 1000-draw distribution. FINDINGS: Globally, 746 000 deaths (95% UI 692 000-800 000) from suicide occurred in 2021, including 519 000 deaths (485 000-556 000) among males and 227 000 (200 000-255 000) among females. The age-standardised mortality rate has declined over time, from 14·9 deaths (12·8-15·7) per 100 000 population in 1990 to 9·0 (8·3-9·6) per 100 000 in 2021. Regionally, mortality rates due to suicide were highest in eastern Europe (19·2 [17·5-20·8] per 100 000), southern sub-Saharan Africa (16·1 [14·0-18·3] per 100 000), and central sub-Saharan Africa (14·4 [11·0-19·1] per 100 000). The mean age at which individuals died from suicide progressively increased during the study period. For males, the mean age at death by suicide in 1990 was 43·0 years (38·0-45·8), increasing to 47·0 years (43·5-50·6) in 2021. For females, it was 41·9 years (30·9-46·7) in 1990 and 46·9 years (41·2-52·8) in 2021. The incidence of suicide attempts requiring medical care was consistently higher at the regional level for females than for males. The number of deaths by suicide using firearms was higher for males than for females, and substantially varied by country and region. The countries with the highest age-standardised rate of suicides attributable to firearms in 2021 were the USA, Uruguay, and Venezuela. INTERPRETATION: Deaths from suicide remain variable by age and sex and across geographical locations, although population mortality rates have continued to improve globally since the 1990s. This study presents, for the first time in GBD, a quantification of the mean age at the time of suicide death, alongside comprehensive estimates of the burden of suicide throughout the world. These analyses will help guide future approaches to reduce suicide mortality that consider a public health framework for prevention. FUNDING: Bill & Melinda Gates Foundation.

The Global Flourishing Study is a longitudinal panel study of over 200,000 participants in 22 geographically and culturally diverse countries, spanning all six populated continents, with nationally representative sampling and intended annual survey data collection for 5 years to assess numerous aspects of flourishing and its possible determinants. The study is intended to expand our knowledge of the distribution and determinants of flourishing around the world. Relations between a composite flourishing index and numerous demographic characteristics are reported. Participants were also surveyed about their childhood experiences, which were analyzed to determine their associations with subsequent adult flourishing. Analyses are presented both across and within countries, and discussion is given as to how the demographic and childhood relationships vary by country and which patterns appear to be universal versus culturally specific. Brief comment is also given on the results of a whole series of papers in the Global Flourishing Study Special Collection, employing similar analyses, but with more-specific aspects of well-being. The Global Flourishing Study expands our knowledge of the distribution and determinants of well-being and provides foundational knowledge for the promotion of societal flourishing.