Emergency Medicine (EM) personnel in both military and civilian prehospital settings are often exposed to stressful and extreme events. Therefore, a cross-pollination between both contexts in terms of coping strategies may generate new information for purposes of training, prevention, and support programs. In the current study, we aimed at comparing both contexts to understand the type of stress events personnel experience; whether experience differs between civilian and military personnel; and how they cope with it.We used a mixed method approach, combining the results of a quantitative questionnaire and a thematic analysis of 23 in-depth semi-structured interviews to gain additional qualitative information.Whereas the questionnaire pointed to a significant preference for task-oriented coping over avoidant and emotion-oriented coping, the interviews offered a more nuanced insight, showing a constant aim to position themselves on a continuum between emotional disconnection from the patient to preserve operationality on the one hand; and remaining enough empathic to preserve humanity on the other hand. We further identified an ambivalent awareness regarding emotions and stress, a vulnerable disbalance between an excessive passion for the job with the sacrifice of own's personal life (for a growing volatile and dangerous working environment) and a lack of recognition from both the patient and organizational environment. The combination of these factors may carry the risk for moral injury and compassion fatigue. Therefore, mutual trust between the organizational level and EM personnel as well as among team members is crucial.The results are discussed from a systemic SHELL perspective, indicating how the specific profile of EM personnel relates to the software, hardware, environmental and liveware components of their professional and private life. Trainings on stress- and risk awareness should be approached both on an individual and systemic level, knowing that there is clearly no “one-size-fits-all” manner. According to the International Federation for Emergency Medicine (IFEM), emergency medicine (EM) is “a field of practice based on the knowledge and skills required for the prevention, diagnosis and management of acute and urgent aspects of illness and injury affecting patients of all age groups, with a full spectrum of episodic undifferentiated physical and behavioral disorders; it further encompasses an understanding of the development of pre-hospital and in-hospital emergency medical systems and the skills necessary for this development” . This deAs stated by Totten and Bellou , “war haAlthough the working conditions and injuries may thus differ a great deal between military and civilian contexts, EM personnel in both are exposed to stressful and extreme events. They both operate under high workloads, being regularly confronted with critical incidents  , 13. ThiOne of the main mitigators between stress exposure and the development of PTSSs is a well-functioning and resilient stress-coping system . AccordiCurrently, there is a growing consensus that coping is context-dependent —which maThe participants were a unique target group of EM professionals without any psychological antecedents nor long-duration sick leave, recruited in three different settings. The first setting considered prehospital EM personnel of a military hospital (MH) in an urban environment; the second setting considered prehospital EM personnel of the Special Operations Surgical Team (SOST), which is a special military unit of medical doctors, nurses, and medical technicians than can be deployed in conflict theaters with little to no medical capacity present but who can be operational in civilian hospitals in between deployments as well; and the third setting considered prehospital EM personnel of a large urban civilian hospital (CH) in the capital city. Twenty-three persons out of 58 contacted persons agreed to participate see . The intBy selecting the three settings , we aimed at developing a “semi cross-over design.” “Cross-over” since it provided information to compare military and civilian personnel, both operating in a civilian context; “semi” since—inherent to the job requirements—only the military personnel and not the civilian personnel could operate on military terrain.Each interviewee completed the questionnaire under the supervision and was then interviewed. Each interview lasted between 60 and 90 min and was completed in person, recorded, and transcribed. The interview questions consisted of four main sections: 1/demographics, career, training, and mission specifics, 2/extreme stress exposure: what do EM personnel perceive as extreme and what is the eventual impact of it with as leading questions “do you think that medical emergency personnel are at risk for extreme stress exposure?” and “have extreme stress events an impact on you?”, 3/coping strategies and experience, which explored how the participant coped with extreme stress exposure and whether experience played a role in coping success, and, 4/job motivation, to explore the core motivation and worthwhile professional memories of the participant. These questions were constructed through an iterative explorative discussion by operational EM experts and trauma psychologists of the Center for Mental Health in the Military Hospital in Brussels. The questions were tested out for feasibility .In the quantitative part, we used the Coping Inventory for Stressful Situations  . ThIn the qualitative part, semi-structured in-depth interviews were conducted, transcribed, coded, and analyzed, using NVivo .The analyses were conducted using the inductive thematic analysis approach of Braun and Clarke , which wTo ensure the truth value  or credip-value for significance adjusted with the Bonferroni correction.To compare the CISS dimensions over the three settings, a 3 × 3 [coping  × setting ] mixed ANOVA; a 3 × 3 [coping  × years of service ] mixed ANOVA; and a 3 × 2 [coping  × gender ] mixed ANOVA were calculated with the coping style as within-subjects, the setting/years of service/gender as between-subjects factors, and the scores as dependent variables. The usual cutoffs to interpret effect sizes were used for small, medium, and large effect sizes . AdditioFor reasons of anonymity, we indicated neither the participant number nor the specialization  in the text citations in the Results section. We only mentioned the EM setting . The text citations were evenly distributed among the different participants.The third researcher confirmed the validity of the themes identified through analysis as well as the final model presented at the end of the results section that interconnected these themes.In this section, we will present the main themes generated by the inductive bottom-up analysis. Additionally, to differentiate between the three settings—per discussed phenomenon—we indicated by how many interviewees (%) a respective topic was discussed.All the interviewees described several examples of what (extreme) stress means to them, depicting mass events, accidents, events with serious injuries and/or vulnerable victims , extremely high workload, and patient flux. Being exposed to danger was often mentioned  but there was a difference in the type of danger between the three settings. In SOST personnel, the danger was war-related, and people felt mentally prepared for it, whereas, in CH and MH personnel, the danger was experienced as an unpredictive and individually directed, personal threat for which they did not feel prepared see .you feel there is a silence afterwards, but afterwards we talk about it in the team” (MH). The death of a child is experienced as unjust, and therefore sometimes as a personal unacceptable failure. It raises associations with their own children, making it difficult or sometimes impossible to keep an emotional distance from the patient. For the same reasons, treating a familiar person was said to be very stressful. Furthermore, the unbearable grief of the family was mentioned repeatedly as potentially traumatic. In a military setting, the 2016 terrorist attacks in Brussels were the most impactful:In a civilian setting, the most mentioned impactful event  was the injury or death of a(n) (unborn) child : “The most impactful was March 22. It was the worst situation we had, for me, because it was at home, with us… if you're on deployment, you get on the plane and you return to Belgium and in fact you can switch your button … when you're returning you're resetting yourself… but on March 22 you didn't have a button to switch because suddenly they were all standing here … it had more impact than all the missions together, March 22, I find.” (SOST).“ he has started to shout and yell and 10 min later he had arranged everything… he really rose above himself ” (MH). Physiological stress was also said to be an ideal observation tool to be aware of one's inner state: “I know when I am stressed, my voice starts to change, if my heart rate starts to increase, you know immediately…” (CH). On the other hand, stress could also carry the risk to freeze and block further adequate operational performance:Acute physiological stress responses, in terms of fight, flight, or freeze responses were reported recurrently. Some personnel  reported the positive impact of stress that it makes you do things that you would never think you could: “… it really shocked me, it is not something that stayed, but at that point it frightened me, because it was the first time that I was not capable to come into action. And thus, the nurse, who was with me, she kept on prodding me and talking to me, to bring me back into the moment. I told her afterwards, it was such a luck, she did that because I was useless at that point.” (CH).“…if you can't give it a place in your mind, you will not be able to persevere” (MH). Ten interviewees  argued that stress events did not impact them (anymore): “it doesn't touch me … I think I have put barriers: for me, whether there is one dead person or there are ten, it will not change anything, I just want to do my work well and I am not touched anymore with regard to humans” (MH). The majority of interviewees  testified that they learned through the years to better manage stress and that the impact of certain interventions decreased with experience. “I remember, the first interventions …. pfff…. I returned home, I was empty, incapable to say a word … but you need to find a solution, euhm, because if it doesn't go well, you need to stop, you know” (SOST). However, one person added that age and experience can have a reversed effect as well, in the sense that you think “my, goodness, I have survived all that, I hope it will go well once again” (SOST).Regarding chronic stress exposure, the responses were more complex in a way that the explicit responses to the questions “do you think that medical emergency personnel are at risk for extreme stress exposure?” and “do extreme stress events have an impact on you?” did not always correspond with what interviewees described throughout the interview implicitly (without that the interviewer asked for it) using examples that contained several illustrations of PTSSs' (changes in) behavior, cognitions, and mood that were given throughout the interview. Independent of how interviewees perceived stress exposure, it was regularly mentioned that every person has a limit in coping with stress and only three interviewees agreed that stressful events have an impact without stating conditions. They all reported PTSSs and reflected on the potential risk of stress exposure in their job:These are memories, I know that the day I will have a situation, not necessarily malicious, a knife attack, bullet wound, maybe just a difficult situation with a patient or family, it will certainly come back to me again…” (CH).“Emergency medicine field conditions are seldom optimal . Moreover, heat, noise, seasickness, and unhealthy or irregular food intake may impact the mental and/or physical condition of the personnel (87.5% of SOST) see also .that's why people leave” (SOST), “a lack of recognition, … that's a gigantic source of stress in our profession” (CH) . A lack of personnel was the main recurring complaint, followed by the lack of budget to follow necessary training and a lack of logistic support for military personnel when on deployment (75% SOST). Finally, SOST personnel often complained about a lack of tactical preparation . When resources are limited, this may feed physical fatigue, burn-out, and above all, a loss of trust, creating a sense of not feeling recognized or disrespectfully treated. This negative cycle was said to carry the risk for a decrease in motivation and commitment in both a military and civilian setting: “… see also .Most of the interviewees mentioned the big impact the job has on their family life  and vice versa . The life partner must be strong, flexible, monitoring, and supporting and should accept the sacrifices made by the EM personnel see also .F = 86.31, ηp2 = 0.797, p < 0.001, Bonferroni corrected) and more avoidant than emotion-oriented coping . There were no effects of years of service (p = 0.943), setting  (p = 0.445), or sex (p = 0.869). Comparisons with CISS normative tables showed that the task-oriented and avoidant coping style was within norms in both male and female participants and the emotion-oriented coping was below average in both male and female participants. Hence, in the current population, emotion-oriented coping was underrepresented. Although no significant effects of setting were found based on ANOVA, when comparing with normative tables, an underrepresentation was most present in the SOST-male category and persons with lower years of service . Inherent to an EM the setting is a short-in-duration contact with the patient (contrary to an intensive care unit where a doctor–patient contact is long and intensive). This fleetingness facilitates taking distance from the patient and helps to avoid feeling too emotionally engaged. The disadvantage, however, is a potential lack of information about the patient's outcome, and thus about the outcome of one's work. A lot of interviewees testified to the urge to inquire in the hospital about the patient's state. Moreover, there is no time or space for patients to express their gratitude: “We are not in the setting where you receive chocolate boxes from the family.” During military missions, very similar experiences were reported. The lack of close and sustained contact with the patient, i.e., just the time to stabilize the patient and prepare them for transport, created enough distance to avoid emotional engagement . Becoming indifferent, alcohol use, and suicide were mentioned as examples of escapism and also relaxing activities such as sports or sleeping : “see also .You know with whom you can talk … I know that some people can't because they think they will be judged and that you show weakness…” (CH). Some interviewees agreed that more emotional persons may not be made for the job whereas others argued that a macho mentality may hamper searching for support and talking or showing sincere empathy for the patient and their family  confirmed that a macho culture did exist and 12 persons  explained that a macho culture is an existing part of what you could define as “a flashing light culture”  and that it is more present in the older colleagues than in the younger generation: “see also .The most reported way of emotional coping was to talk about an intervention . Within a professional context, informal debriefings are the most common and preferred way . These moments allow us to evaluate the actions and decisions made and to find reassurance that everyone did the best they could. The latter appeared crucial when dealing with the loss of a patient, that is, to learn to accept that one cannot save everybody .Some interviewees preferred not to discuss interventions with colleagues but were happy to listen to others when necessary. Some SOST members mentioned that they would never discuss their missions with non-SOST members due to former experiences in which they were not believed. For similar reasons, about half of the interviewees avoided discussing their work with family or friends since, according to them, the outside world is incapable of understanding their job. They strictly separated their professional and private life (to the point of hiding from family and friends that they experienced the 2016 terrorist attacks in Brussels). Concerning consulting a psychologist, barriers existed. Less than half of the interviewees mentioned having (limited) experience with a psychologist. For about 63%, this experience was positive, 27% neutral, and for one person, it was negative. Finally, humor and staying positive were regularly used coping strategies  see also .Focusing on the task, the protocol or algorithm facilitates emotional disconnection toward the patient and their family , and following a structured problem-solving approach, guided by protocols, aids to be sure to have done the best they could. Procedures and protocols were said to structure the operational performance, facilitate post-intervention debriefings, and improve situational awareness in mass events , whereas a checklist is common in single interventions . Protocols and procedures may have disadvantages as well and are still far from up to date . They may overshoot the goal of a particular situation or give a false sense of safety see .The emergency units are small, horizontally functioning units. In CH personnel, the medical doctor and nurse work closely together, as a binomial, alternating in taking decisions and relying on one another. Hence, the differentiation between doctors and nurses often fades away. Within a SOST team, no military rank counts when a patient is on the table. Moreover, in SOST members, during deployments, besides working together 24/7, the team also must live and sleep together in a small space, as a family, as they phrase it themselves. Obviously, transparent communication and mutual respect for one's privacy are primordial when working closely in small teams. Mutual respect is the interpersonal glue between members, and any conflict among team members is a huge source of stress and may block proper working conditions (75% MH/SOST and 57 CH). A threat to trust may, therefore, put at risk the entire team functioning whereas positive team dynamics reinforce self-confidence on an individual level. Furthermore, in the military setting, about 50% of the interviewees emphasized the importance to know one another and to dare to speak up see .We encountered several descriptions of situations that may comprise a risk for skill or knowledge decay  . Nevertheless, explicitly, only six interviewees  discussed the importance and/or lack of (re)training:I always was afraid of children and childbirths. I have paid for a specific training to learn that by myself and thus now I am comfortable with it. Even in a difficult situation… (describes an intervention with a baby) … other colleagues will certainly have a loss of competence…” (CH).“Medical personnel goes on, despite the stress they are exposed to, and the sacrifices of their private life because of their passion or almost addiction to the job :I became a junkie… addicted to the way of cooperating, humanity. You are full blown doing something good, you score in a good way, you have a good team, you can count on everybody… It is so intensive that it makes you a junkie, I find.” (SOST)“They are eager to learn and the job teaches them important life lessons such as putting things into perspective, appreciating the meaning of life, and getting to know other cultures (mainly SOST). Moreover, the desire to help and save people is a strong motivator and EM personnel always search to generate moments of happiness:these two girls, on Monday, they were 10 and 3 years old. We had brought them to the same hospital and one girl had already arrived, lying there. The other was laid next to her older sister, only 10 years, and she takes the hand of her little sister…” (CH)“Emergency medicine personnel are attracted to challenges and adventure, and sometimes even enjoy being in danger. They prefer variation above routine (>50%) and possess the flexibility and capacity to adapt quickly to acute, unpredictable, and changeable situations. Problem-solving thinking is crucial and the team makes it worthwhile to continue.The obtained categories correspond with the key components of the SHELL model , 56. TheIn the current study, we aimed at examining the profile and working environment of EM personnel in both a civilian and military context in order to understand the type of stressful events they are exposed to and how they cope with them, and how their experiences are framed in their wider personal and professional context. We used the CISS questionnaire and conducted semi-structured interviews to gain additional qualitative information. The interviews showed that there was no one-size-fits-all and straightforward answer to our research questions. Instead, the responses of the interviewees showed a strong multifactorial character, showing an interaction between the individual and the different interrelated layers of the operating system in which EM personnel is functioning. In this discussion, we aim to highlight the most important topics by respecting these multifactorial context properties.The CISS questionnaire showed a significant preference for task-oriented over avoidant and emotion-oriented coping, with the latter being below norms. Similar findings have been reported in previous studies e.g., –34, 37]., 37.34, e.g., “… this was horrible, sick making. Because of its extremity, I guess…,” SOST). According to Lane ],Indeed, mutual trust among team members was recurrently mentioned as one of the most crucial components of the interviewees' life, even more in SOST members than non-SOST members. In a military context, the team is the building block of a larger functional unit  and intevolatile, uncertain, complex, and ambiguous (VUCA) environment ]To summarize, based on an in-depth qualitative analysis of how EM personnel in three settings  experience stress-full interventions, we want to plea for a systemic approach to preserve mental health. In 2005, a panning article  stronglyThe datasets presented in this article are not readily available in accordance with the ethical procedures of ICH-GCP and GDPR, and due to the data's military classification.The studies involving human participants were reviewed and approved by Brugmann University Hospital. The patients/participants provided their written informed consent to participate in this study.MV and NP: writing. MV, DG, and NP: analysis. JVH and FG: data-collection. NP, FG, FD, and JVB: expert knowledge. NP, JVB, and FG: design. MV, NP, and FD: manuscript redaction. NP: supervision. All authors contributed to the article and approved the submitted version.


Understanding the similarities and differences between great apes' and humans’ willingness to exchange food is important for our models regarding the origins of uniquely human forms of cooperation. Here, we demonstrate in-kind food exchanges in experimental settings with great apes for the first time. The initial sample consisted of 13 chimpanzees and 5 bonobos in the control phases, and the test phases included 10 chimpanzees and 2 bonobos, compared with a sample of 48 human children aged 4 years. First, we replicated prior findings showing no spontaneous food exchanges in great apes. Second, we discovered that when apes believe that conspecifics have ‘intentionally’ transferred food to them, positive reciprocal food exchanges (food-for-food) are not only possible but reach the same levels as in young children (approx. 75–80%). Third, we found that great apes engage in negative reciprocal food exchanges (no-food for no-food) but to a lower extent than children. This provides evidence for reciprocal food exchange in great apes in experimental settings and suggests that while a potential mechanism of  SuchA recent review of reciprocal help in non-human species covered about 130 observational and experimental studies and noted several differences that may contribute to the current gap regarding reciprocity in chimpanzees . The firet al.  and zero for you [point to the camera] (v)One experimenter, blinded to the research hypothesis, sat individually with every child in a quiet room in their kindergarten. The experimenter opened with, ‘In this game, you can win gummy bears and sweets, but first, let me explain how the game works'. A short warm-up phase was done to introduce the game and ensure that children understood the directionality of the rewards and that they could count the number of rewards correctly. In this warm-up phase, we used small plastic discs as rewards, the distributive options were 2–2/2–0, and no partner was presented. Thus, participants were unfamiliar with the rewards, the distributive options, and the partners used in the experimental conditions. The experimenter then introduced the game and stated, ‘Now you will play with another child, the other child will play first, then it will be your turn, and that is it. Let us see whom you will play with’. The experimenter played the first video and said, ‘This is Dan/Dana. What type of rewards are on the board?’ . Following the partner's choice (1–1/1–0), the experimenter asked, ‘So, how many gummy bears did Dan/Dana choose for himself/herself? … and how many did you get?’. All children answered correctly, and the experimenter placed the appropriate number of rewards in an envelope with the child's name. Children continued to play as passive recipients for one more round, with different rewards . Finally, a third round was played in which children played as active distributors. Specifically, the experimenter said, ‘OK, so now it is your turn to choose!’, then placed gummy bears in front of the child, played the third video, and wondered, ‘let us see whom you are going to play with … oh, it is Dan/Dana’. Children made their choice, and the game was over. (b) (i)preliminary phase included 18 subjects—13 chimpanzees  and 5 bonobos —all housed at the Wolfgang Kohler Primate Research Center in Leipzig, Germany. The test phase included 12 subjects—10 chimpanzees and 2 bonobos—for reasons that will be explained shortly, and the post-hoc phase was done with 10 chimpanzees. All available subjects participated in the preliminary phase, but we had to exclude a few from participating in the test and post-hoc phases for two main reasons. First, the test phase required a ‘stooge’ for the role of player ‘A’. The ‘stooge’ becomes aware that he/she does not have a ‘free choice’ between egalitarian or selfish distributive options since the apparatus is rigged. Since the test phase paired sex-matched dyads, we thus had to choose 3 subjects that would not participate in the test phase – one female chimpanzee , one male chimpanzee , and one female bonobo (Fimi), and assigning them as stooges (i.e. the role of player ‘A’). In addition, one male bonobo participated in the preliminary phase but could not be paired with another male for the test phase since there was none. Second, one female chimpanzee and one female bonobo were unmotivated to participate in the test phase . Notably, all chimpanzee subjects who participated in the test phase participated in the post-hoc phase and with the same partners as in the test phase.The  (ii)preliminary phase, one female chimpanzee was chosen to play as a ‘stooge’ in the test phase (i.e. Corrie as player ‘A’). After interacting positively and negatively with another female , we now doubled the number of available ‘stooges’ and could assign either Corrie or Riet as ‘stooges’ to interact with other females. The same procedure was done with male chimpanzees and female bonobo. Overall, the first subjects in each species and sex group interacted with the same stooge (positively and negatively with a 2–3-weeks gap in between), and other subjects interacted with two different stooges , and in counterbalanced order (i.e. benefactor first or second). The order of interacting with a benefactor or a malefactor had no impact on subjects' behaviour, and looking separately at those who interacted with a benefactor first (versus benefactor second) follows the behavioural pattern as in figure 3a .A round-robin design was implemented . To illustrate, once all subjects completed the  (iii)preliminary, test, and post-hoc), representing the standard setup others have used to assess prosociality [We used one apparatus for all phases (ociality . Subject


Snakebite envenoming remains a public health threat in many tropical countries including Malawi. Traditional healers (THs) have been consulted by victims of snakebites as primary caregivers for millennia. There are no studies in Malawi to understand this phenomenon, therefore, our study aimed to explore the experiences and practices of THs regarding snakebite treatment and prevention in rural Malawi. Between August and September 2022, we conducted semi-structured interviews with 16 THs who were purposefully selected from various locations across Neno District, Malawi. We analysed the interview data using Dedoose software, where we generated codes and grouped them into themes. Out of the 16 THs interviewed, 68.8% (n = 11) were male, and 43.8% were aged between 40 and 60 years. Our study identified five themes: THs’ knowledge of snakes and treatment, the continuum of care they provide, payment procedures, snakebite prevention, and their relationship with health facilities. They claimed a good understanding of the snakes in their area, including the seasons with more snakebites, and were confident in their ability to provide treatment, however, this was not scientifically proven. They offered a comprehensive care package, including diagnosis, first aid, main treatment, and follow-up care to monitor the victim’s condition and adjust treatment as needed. THs provide free treatment for snakebites or use a “pay later” model of service delivery. All THs claimed a “vaccine” for snakebites that could prevent bites or neutralize the venom. However, no formal relationship existed between THs and Health Care Workers (HCWs). We recommend collaboration between HCWs and THs, establishing clear referral pathways for snakebite victims and educating THs on identifying danger signs requiring prompt referral to healthcare facilities. Snakebite victims in the community continue to seek care from traditional healers for a variety of reasons including cultural influences, socio-economic factors, and the lack of snake antivenom in healthcare facilities among others. Thus, traditional healers play a vital role in the treatment of snakebites. However, one limitation of relying on traditional care is the potential delay or failure of patients to present themselves at hospitals for timely administration of antivenom for those who may require it. We interviewed sixteen traditional healers in Neno, Malawi, to explore their experiences and practices regarding snakebite treatment and prevention. The traditional healers displayed confidence in their treatment methods and offered a comprehensive approach to addressing snakebite cases from diagnosis to medication and follow-up, however, their claims were not scientifically proven. Some traditional healers provided their services free of charge, with some healers requesting payment only when their clients had recovered. Furthermore, traditional healers claimed to possess a snakebite vaccine, and there appeared to be no collaboration or relationship between them and healthcare workers for the management of snakebite cases. We recommend creating spaces for joint learning and collaboration between healthcare workers and traditional healers as they share a common goal of ensuring the recovery of snakebite victims. Neglected Tropical Diseases (NTDs) are diseases of poverty that impose a devastating human, social and economic burden on more than 1 billion people worldwide, predominantly in tropical and subtropical areas . DesignaWorld Health Organization estimates that 5.4 million snakebite cases occur worldwide each year, resulting in 1.8 to 2.7 million cases of envenoming with South East Asia topping the list seconded by Sub-Saharan Africa ,10.Traditional methods, mostly herbal remedies, and concoctions, have been heavily used for snakebite management for generations –16. StudIn Sub-Saharan Africa (SSA), THs are frequently consulted as primary caregivers for snakebite victims ,18,21,22Malawi is home to 66 different snakes of which 11 are medically important . While tWhile there is limited literature regarding snakebites in Malawi in general, no study has looked at the practices and experiences regarding snakebite treatment and prevention in the country. Studies done in Ghana and Myanmar found that THs are the gateway for snakebite patients, therefore, establishing referral pathways to health facilities for those who first visit the THs remains critical ,16. In tInstitutional support was obtained from the Neno District Health Research Coordinating Committee and Ethical clearance from the Institutional Review Board of Malawi National Health Science Research Committee . We also obtained written informed consent from all THs, who either signed or used their fingerprints in case they were illiterate. THs were free to withdraw from the study at any point. We assigned unique numbers to transcripts and recordings and securely stored them on a password-protected computer.We used an exploratory qualitative design of semi-structured interviews with THs to understand practices and experiences on snake and snakebite treatment and prevention. We used semi-structured interviews to gather rich data, uncover new insights and allow for profound conversation with THs’ despite being time-consuming and labour-intensive.We conducted the study in Neno, Malawi. Malawi, a low-income southern African country bordering Zambia to the west, Tanzania to the northeast and Mozambique forming its southwest, south and southeast borders is home to 18.4 million people as of 2022 . The couOur study defined “a traditional healer” as anyone who knows and treats snakebites using traditional medicine. We used purposive sampling to identify THs with the help of Partners in Health’s (PIH) site supervisors who are based at a Health facility supervising Community Health Workers (CHWs) in their catchment areas. Partners In Health, known locally in Malawi as Abwenzi Pa Za Umoyo (APZU), has accompanied the Government of Malawi through the Ministry of Health since 2007 and utilizes CHWs in the delivery of rural community-based primary health care in Neno district . The sitWe obtained the “Base map and data from OpenStreetMap and OpenStreetMap Foundation” repository  and extrWe developed a semi-structured interview guide (S1 Interview Guide) based on the literature and the objectives of the study ,15,16.The guide had questions on (1) awareness and knowledge of common snakes found in the area, (2) season and time with more snakebites, (3) signs and symptoms presented by snakebite victims, (4) treatment of snakebite, (5) prevention of snakebites, (6) referral and collaboration between THs and HCWs from the facility. In addition, we collected demographic data including village, age, and sex. The interview guide was initially created in English and subsequently translated into Chichewa, which is the official local language of Malawi and the most spoken language in the Neno District. A back translation was performed to ensure that the questions retained their intended meaning. Following this, the interview guide was tested through a pilot interview with a single traditional healer from the Matandani area in the district, and adjustments were made based on the feedback received. Between 10 August 2022 and 1 September 2022, a member of the study team (B.M.) who has a Bachelor of Science degree and training in Clinical medicine conducted and recorded the interviews at the homes of THs or the practising site in a quiet place following all COVID-19 preventive measures. The shortest interview lasted 20 minutes and the longest was 45 minutes. At the end of the interviews, THs were invited to ask questions and supplement their information with anything relevant to what had been discussed. A second member of the study team (M.B.A.) who has a Master of Public Health reviewed the audio recordings daily and conferred with the interviewer regarding patterns and saturation, which were identified after the 14th interview. Nevertheless, two more interviews were conducted subsequently with female traditional healers to ensure sex dynamics. Furthermore, the interviewer collected some field notes including pictures of medicinal herbs, constituted powders, or poultices used by THs to supplement the collected data.We analysed age and sex using Excel and reported counts and percentages. Interviews were verbatim transcribed in Chichewa and then translated into English. However, the transcripts were not returned to participants for comment. Three members of the study team  each repeatedly read the transcripts, developed a codebook, simultaneously coded sample interviews, and resolved any discordant codes. We analysed the transcripts using thematic analysis as described by Braun and Clarke . The decMBA is a Malawian with a background in public health statistics and has been residing in Neno since 2017. MM is another Malawian, specializing in psychology and has worked in Neno for three years. BM, LD, CK, EN, and CS are all Malawian physicians and BM, CK and LD have been living in Neno for over 10 years. BK and JB, are German physicians and have over two decades of experience in studying snakebites in Africa and Asia. FM, a public health expert from Rwanda and living in Neno since 2020, while AR, an Israeli anthropologist, has dedicated more than two decades to conducting research in Malawi. The diverse team, composed of professionals in public health, clinical medicine, anthropology, and psychology, ensured that research was conducted critically and objectively, with a commitment to minimizing personal biases that could influence the outcomes.Of the 16 THs who participated in this study, 68.8% (n = 11) were males. Seven (43.8%) were aged between 40–60 years and five (31.2%) were above 60 years old. The demographic characteristics of participants are summarised in We identified five main themes including 1). Knowledge about snakes and snakebites, 2). Continuum of care, 3). Payment procedures, 4). Snakebite prevention and 5). THs’ relationship with health facilities. Sub-themes and codes derived from the data are shown in the analysis process map .THs claimed to have a vast knowledge of snakes, their habitat and seasonality, as well as treatment options for snakebites. They were able to describe various snakes including how they could be differentiated, even noting that some species are becoming extinct. Furthermore, THs claimed to know places where snakes could be commonly found in their area, as well as the seasons and times when snakebites were most prevalent as one of the healers explained:“…well, a puff adder is a beautiful snake and has some mixed colours with square or rectangular boxes like grey, brown, and other colours depending on where the snake is. Puff adders are also short but fatty with a small flat head…” TH, Zidala village, Magaleta.Traditional healers’ knowledge was not limited to the identification of snakes, but also extended to an understanding of their habitat and character, as another healer explained:“… yes, ‘Nsalulu’ is one of the fastest snakes and very clever, and then there are big snakes like pythons though not common these days, I have reserved a forest on that side of my land, you can find some of these snakes over there. Pythons also come in different forms and sizes, there are some small while others can grow up to 2.5 meters or even beyond…” TH, Nelson village, LisungwiNote: Due to the snake naming challenges that exist in Malawi, “Nsalulu” may apply to most Psammophis and Psammophylax snake families and in some instances as Naja annuliferaFurthermore, THs were confident and comfortable with their knowledge regarding treatment and reported that people positively perceived their treatment. One traditional healer reported that he is called by HCWs at the facility to go and attend to a snakebite patient.Actually, they are sent from the hospital to here for treatment. A phone call comes; a person has been bitten by a snake and is here at the hospital but is not feeling well; we are trying to assist but he/she is still not getting better.…yes, they call and I go, it is not just a mere person who calls but the hospital doctor himself…” TH, Kaligwenjere village, Matope“…The vast experience and confidence expressed in the interviews form the basis for the treatment they offered to their patients.THs offer a full package of care for the snakebite victim. The treatment is systematic and organized with stages from diagnosis, treatment and follow-ups. THs diagnose the victim based on the signs and symptoms including swelling of the bitten part, sweating, and shortness of breath among others. In addition, they also probe the victim or their relatives about the incident:“…sometimes people are bitten by something else and come claiming snakebites. For example, certain scorpions are venomous. So normally a person will present with some small marking on the spot where it had bitten, and it will leave teeth. If bitten by a puff adder, the marks are larger and some blisters will develop after some minutes around the mark. They are some that do sweat a lot including the bitten part, their eyes change to red and have difficulties in breathing and the saliva dries or they feel as if they don’t have saliva in their mouth…” TH, Zidala village, Magareta.In their interviews, THs also shared their diagnosis routines:“…Aah, I normally ask where, and they say here. When the snake bites, it leaves teeth, and in those teeth thus where the venom is and it is the venom that will rush and go to the heart. Some come with a swollen leg, feel pain and the heart beat fast…” TH, Chivuta village, ZalewaBefore the actual treatment is offered, all THs interviewed give first aid to the snakebite victims which includes medicine for pain relief, one that causes a person to vomit to reduce the effects of snake venom and remove snake teeth or fangs:“…As I explained, all this is done with urgency, I don’t know exactly what type of snake in case the person does not say, therefore, I give pain relief medicine and also that the person vomits or rushes to the toilet to reduce the power which otherwise goes to the heart. That is part of first aid for me…” TH, Nelson village, LisungwiOf the 16 THs, only one mentioned the application of a tourniquet as a first-aid procedure:“…At first, I start by giving the person oral medicine to vomit as a snakebite leaves poison in the person’s body. And then you see that the bitten area is darkening, there I don’t take long to tie here with a string, and then the person vomits and defecates from there I can give ‘Mphini’…” TH, Ngwenyama village, LuwaniNote: Mphini is a traditional method that involves creating small incisions on the skin using a razor blade, with the purpose of introducing powdered or poultice herbal medicine into the body. In the long run, small tattoos are formed, often appearing in pairs.“Mphini”. THs also built the trust of the people by applying the medicine to themselves first before giving it to the snakebite victim, as one of the healers explained:The main snakebite treatment given by THs includes various medicinal herbs that are constituted and applied through “… It is a traditional medicine from trees and herbs, for example, this tree shrub, locally called “Bwazi”. I scratch the stem and take a few leaves, put them in a cup, and stir then it produces a foam. I then take a bit before giving it to the victim so that in case a person dies, they should not say that I gave him/her poison. Then we have another herb locally called “Dululu” which is for teeth removal and healing, I make a poultice and then apply it on the bitten part and also give it through “Mphini” as a snakebite vaccine…” TH, Mwamdaza village, MagaretaNote: Bwazi and Dululu are local herbs used by traditional healers for snakebite treatment  while others give 7000 kwachas (USD7.00) considering that we also go and look for these in the bush…” TH, Chivuta village, Zalewa“…While all THs saw themselves as professional service providers, their payment approach was deeply rooted in their relationships with community members.All THs interviewed in the study saw themselves as providing prevention services from clearing the bush, applying snake repellent by spraying the grounded powder around their house or surrounding, or planting the medicine herbs around their house. These environmental prevention measures were explained in the interviews:“…Okay, here we just take care of our surrounding, clearing bushes so that it is clear. Again, I take some medicine and spread it inside or around the house so that it turns back when the snake smells the medicine. This medicine is a plant called “bwazi”, we prepare and sprinkle it around and when the snake smells it does not come any close. If it was inside the house, it goes away by itself…” TH, Yela village, MidzembaThe THs’ role in planting medicinal plans was also addressed:“…We dig the roots of a certain tree, this tree when we dig, we grind in a mortar and then spread the medicine around the home sometimes we plant the seeds of the tree if we have them. From there we sprinkle it inside the house or just put it inside the house, and the snake cannot enter…” TH, Salafosi village, ZalewaIn addition, all the study’s THs claimed they had a “Vaccine” for snakebite. The vaccine can be given to someone to prevent being bitten by snakes or if accidentally bitten, assuring that the bite is harmless. According to the THs, the vaccine is applied through “Mphini” and can be given at any age even to children, and will remain active in a person’s lifetime:“…I give the medicine which vaccinates one from snakebite through ‘Mphini’. For example, a small child like one over there, if you vaccinate him, the snake will never bite him or if bitten, the venom will not work on him. You will find him walking on the same day and wonder, is it the same person? Thus, if he was vaccinated against snakebite…” TH, Chivuta village, ZalewaSeveral healers described the vaccine as prepared purely from herbs, while others use a mixture of the herbs and heads of the snakes –they cut“…I mix different kinds of heads of snakes, every kind of snake found in our area, a puff adder, cut off its head, mambas do the same, “Mbuvi”, equally as well as boomslang and then dry them off. I combine them with other stems–about five trees we get them in the bushes, but I don’t burn them, just dry them completely. I take a mortar and pestle and start grinding to powder. I then put them in a clean bottle, get used engine oil, add, and then stir. I cover it and leave it in the house. Anyone willing to get this vaccine through ‘Mphini’ would be protected for life. No matter what, even if you come across a snake, it cannot bite you, the snake surely will run away…” TH, Donda 4, Neno districtNote: Due to the snake naming challenges that exist in Malawi, this local name applies to most Lycodonomorphus and Natriciteres snake familiesSnakebite prevention measures offered by THs were understood as both environmental and individual protecting the home, garden, and individual body.Our study identified the complex relationship between THs and the biomedical health system. In their interviews, THs described part relationships with health workers and even previous instances of professional forums of THs and HCWs. Some healers noted that they had more interaction with healthcare providers when they worked as traditional birth attendants, while others were involved in messaging campaigns during the onset of the COVID-19 pandemic, both to promote prevention and to learn how they could protect themselves from the disease. THs expressed a desire for a stronger collaboration on snakebite treatment, just as they had done for other diseases:“…I was a traditional birth attendant, we used to go to Lisungwi before Zalewa had a health facility. They used to give us cotton plus other tools for that work… as traditional birth attendants’ work ended due to the risk of HIV and also that women can die, there has been no interaction with the hospital and so even for the snakebites…” TH, Chivuta village, ZalewaThe same sentiment addressing the loss of the relationship with health workers in the context of the COVID-19 pandemic:“… ah, currently, there is no relationship. I would be happy if we could have one, I remember at the onset of COVID-19, healthcare workers came here with masks, gloves, and hand sanitisers for my work, of course, this was not about snakebite. I was very happy to receive those items as they protected me from my work…” TH, Nelson village, LisungwiThe idea of a formalized space for collaboration with health workers was also discussed in the interviews:“… as traditional healers, we used to have interface meetings with the health care providers so that they know what exactly we work on and what they do, but after our president died, we no longer do that. The health care workers should tell us what we should be doing, for example, giving us some signs that we can be observed in our patient that can qualify for a straight-away referral or if it is something we can try from this end…” TH, Kasamba village, MidzembaAlongside the desire for more collaboration with the health system, THs had a strong mixed reaction to the snakebite treatment at the health facility. While some acknowledged that healthcare facilities do offer treatment for snakebites and recommended that victims who live near such facilities should seek treatment there directly, others expressed doubts about the effectiveness of treatment offered at such facilities. One traditional healer even reported that healthcare facilities could not treat snakebites and that seeking treatment there could result in disability for a patient who would otherwise have recovered fully:“…I know that the health facility has medication for snakebites for example when you go there, they will give you an injection or some fluids which I believe treat snakebites. I think it depends on the area, some are very close to the health facility, my recommendation would be that they go directly to the hospital but maybe those very far like here, they should get assistance. I have never heard that someone has died at the hospital due to snakebite, which means they can also assist…” TH, Zidala village, Magareta.THs’ criticism of hospital care was often expressed with regard to patients and their health outcomes:“…what they do at the hospital is just to add the patient’s pain. I feel so sorry for that. My other grandchild was bitten by a snake near Neno Church of Central African Presbyterian Church, she stayed in the hospital for so long and never thought she would put shoes again on her feet. She was discharged from the hospital with a very big wound at first. When they came here, I challenged them that if a week goes without this wound getting better, ask for other better help, but it went well…” TH, Chifenthe village Neno DHThe complexity of the relationship between THs and health facilities was woven into what could be understood as conflicting expectations. On one hand, there is a professional criticism of the facilities’ ability to provide quality care for snakebite victims, while at the same time a desire to collaborate and create shared spaces for mutual learning.Studies have shown that THs play an important role in the care of snakebite victims –16,18,21Our study found that THs claimed to be knowledgeable of the snakes found in the area, the seasons with more bites, and very confident regarding the treatment they offer. However, their claims were not scientifically proven compared to HCWs as stated in a previous study in Neno . The conTHs’ “pay later” model of service delivery and humanitarian treatment is deeply rooted in the community and has an impact on health-seeking behaviour. Although biomedical health services are considered "free" in Malawi, studies have shown that patients still have to bear the expenses of transportation, hospitalization, and medication purchase in case of stockouts at health facilities ,50. GiveIn Neno, THs plant herbs that act as "snake repellent" around their homes and sprinkle them inside their houses for prevention. Similar approaches have been used by people in Benin, Ethiopia, Zimbabwe, Uganda, and Oman –55. HoweIn the context of the broader health community in the district, our study found a weak and somewhat undefined relationship between THs and healthcare facilities when it comes to snakebite treatment, despite the shared goal of promoting patient recovery and well-being. The presence of both support and opposition to collaboration between THs and HCWs, as observed in our study, was anticipated. Unlike HCWs, who undergo standardized medical training, the training of traditional healers is intricate and diverse. Some traditional healers acquire their knowledge through generational teachings, while others attribute their expertise to spiritual influences which may be against biomedicine. Therefore, there is not uniformity in their perspectives on the relationship with medical institutions. Similar findings were reported in a synthesized review aimed at enhancing snakebite care in rural settings . The treOur study has some limitations. Firstly, the interviews were conducted in Chichewa, transcribed, and then translated into English, which may have compromised the quality of the data. Nonetheless, we took measures to ensure the accuracy of the translations by back-translating four transcripts to ensure that their meaning was not lost. Secondly, our research was confined to THs in Neno exclusively, and the perspectives we gathered may be influenced by area-specific cultural mannerisms. Nevertheless, we believe that the experiences and practices of THs in rural Malawi and other similar rural settings could be comparable.Overall, traditional healers were confident in their snake knowledge and snakebite treatment, however, these were not scientifically proven. THs provided their services on humanitarian grounds with others using the “pay later” model of service delivery. In addition, THs claimed to have a snakebite vaccine that would protect one for life and similarly, this was not proven scientifically to be effective. And finally, there was no relationship between THs and the HCWs. We recommend that HCWs and THs collaborate and learn from each other, rather than disregarding the value of THs who have gained the trust of the community. One viable solution is to create a forum where THs can interface with HCWs, as seen during the onset of the COVID-19 pandemic and traditional birth attendants’ work. Furthermore, it is crucial to establish clear referral pathways for snakebite victims, involving both THs and HCWs. To ensure that referrals are made promptly and appropriately, traditional healers need to be educated on recognizing danger signs that require immediate referral to healthcare facilities. Further research is required to assess the perception of the community toward THs for snakebite treatmentS1 Interview Guide(DOCX)Click here for additional data file.S1 COREQ Checklist(PDF)Click here for additional data file.


The Economist and Expansión), covering both the pre-COVID and pandemic periods. Our corpus-based, contrastive EN-ES analysis of lexically polarized words and emotions allows us to describe the publications’ positioning in the two periods. We further filter lexical items using the CNN Business Fear and Greed Index, as fear and greed are the opposing emotional states most often linked to financial market unpredictability and volatility. This novel analysis is expected to provide a holistic picture of how these specialist periodicals in English and Spanish have emotionally verbalized the economic havoc of the COVID-19 period compared to their previous linguistic behaviour. By doing so, our study contributes to the understanding of sentiment and emotion in financial journalism, shedding light on how crises can reshape the linguistic landscape of the industry.Sentiment and emotion play a crucial role in financial journalism, influencing market perceptions and reactions. However, the impact of the COVID-19 crisis on the language used in financial newspapers remains underexplored. The present study addresses this gap by comparing data from specialized financial newspapers in English and Spanish, focusing on the years immediately prior to the COVID-19 crisis (2018–2019) and during the pandemic itself (2020–2021). We aim to explore how the economic upheaval of the latter period was conveyed in these publications and investigate the changes in sentiment and emotion in their language compared to the previous timeframe. To this end, we compiled comparable corpora of news items from two respected financial newspapers ( After years of seemingly unending prosperity, the onset of the Global Systemic Crisis in 2008 engendered a new discourse on economic meltdown, bringing into public prominence the language of finance and economics in the broadcast and print media, with these outlets effectively coming to act as spokespeople for banks, financial institutions and even governments in the ensuing years  and one in Spanish , each comprising two sub-corpora from the immediate pre-COVID period (2018–2019) and the main years of the pandemic itself (2020–2022). These are compiled of news items from two prestigious financial periodicals, The following lexical study can be seen within the following contextualisation. In the immediate pre-COVID period 2018–2019), the effects of the 2008 meltdown were still making themselves felt: even after a decade, recovery in some sectors remained sluggish. Exceptional and indeed unprecedented policies had been adopted by most countries in response to the recession, but momentum had been slow-moving and subdued macroeconomically , shipping/transport bottlenecks, shortages in the global food supply, and crises in the services sector . All of the above paved the way for stagflation, that is, rising inflation and negative economic growth, and with it increases in shipping rates, rising global food prices, fuel prices at record levels, generally spiralling prices, the hoarding of resources, and the redirection of service demands towards goods, at the same time as a new fiscal orthodoxy on the part of major central banks began to tighten banking rates, with measures for economic stimulus beginning to be withdrawn in many areas. At the same time, according to the IMF’s reports, climate change has become a pressing issue, as governments have started to calculate transition costs and risks, at a time when they are also submitting financial institutions to severe stress tests in preparation for a new, more sustainable futureEmotion and sentiment are essential elements in people’s lives and are expressed linguistically through various forms of communication, not least in written texts of all kinds . Sentiment is defined by Taboada , p. 326 As we noted in the Introduction, this paper seeks to link sentiment and emotion with the discourse of economics and to do so both implicitly and explicitly. In the area of linguistics, however, the connection between emotions and economic language has seldom been addressed, albeit with some recent exceptions , and its opposite, greed, which we conceive as a far more complex sentiment than fear, and one which is not considered a primary emotion by Plutchik.For the purposes of our study, and within the context of the financial markets, the eight emotions exist in a range from very high to mild emotional intensity, where the extremes are Because fear constitutes a dulling of the self, a cowardly shying away from obstacles  are both avoidance-oriented and intuitive, a “recoiling and reaction to dangerous and undesirable situations”  or negative , almost in equal proportions. When Surprise is negative, it is because of a thwarting of expectations due to a mismatch between what is predictable, or new and unfavourable information, like in the following examples taken from The Economist: (1) “On top of uncertainty in Iran, disruption in Venezuela, Libya, Nigeria or Iraq could squeeze global supply”; (2) “But a shock could put corporate America into trouble”; or (3) “These speculative positions are vulnerable to a shock, such as a sudden rise in interest rates, which can turn into a fully-fledged crisis”; anticipation, on the other hand, is definitely positive, both in English and Spanish according to the data in our corpus  or it was tagged without polarity ; when tagged positively in words, it constitutes the capacity to (successfully) infer something from previously acquired information.What we call fear, sadness, disgust, or surprise will reveal themselves, to a greater or lesser extent, in a risk-aversion response to investing, while an increase in anger/joy, trust and anticipation will be  indicators of a willingness to invest. We will first analyse the occurrence of these indicators in our general financial corpora, before focusing more closely on the main emotions that move financial markets: fear and greed.In sum, an increase in For the present study, we adopted a corpus-based methodology, which involved compiling a representative sample of the material under examination, plus the use of a series of electronic tools to extract quantitative and qualitative data. The identification of sentiment and emotion in text corpora is an increasingly productive line of research, in that it allows us to understand in more detail the mood, opinion, subjectivity, and point of view expressed about certain products, services, places, governments, and public or private organizations; as such it helps us to better interpret the human experience here by means of text analysis Taboada, . In finaThe composition of the corpora and the tools used for the analysis are described in what follows.The Economist and Expansión. The former is a world-renowned newspaper based in London which originally targeted a British readership, but today has a global, well-educated, and literate middle-to-upper class readership; while its content is basically economic and business related, it also covers political affairs, world news and a miscellanea of general news, plus art-related and literary items. The latter is a respected national Spanish newspaper with significant financial content, including translated extracts from the English Financial Times. It is aimed at a Spanish-speaking, semi-specialized middle-to-upper class readership and is one of the most-read publications of its kind.A corpus was built in English  and another in Spanish , both based on news items that appeared in two prestigious financial economic newspapers: The Economist, and Dow Jones Factiva, for Expansión. We sought all news items dealing with climate change, the economic crisis, interest rates, and the COVID pandemic. Consequently, the search terms in the two languages were the same, although specific to each period. For the period 2018–2019 the search terms were: “climate change” AND “economic crisis” OR “havoc” OR “interest rates”; for 2020 and 2021 years the words were: “covid” AND “climate change” AND “economic crisis” OR “havoc” OR “interest rates” OR “pandemic”. For the overall Expansión corpus, the resulting sample size was smaller  than the overall data set for The Economist (3735 files), hence a difference of some 2146 news items across the two periods, representing a difference of about one and a half million words  corpora, which comprised fewer than one million words in each language  in each year for both corpora and thus arrived at the number of words we needed, as shown in Table fear) to the positive (greed) with the aid of EmoLex, a word-emotion lexicon which will be described below. Through conducting the study in layers, our goal was to provide a holistic explanation of how English and Spanish periodicals had emotionally verbalized the economic havoc taking place immediately before and during the COVID pandemic.Lexical items were filtered through CNN’s Fear and Greed Index, in that these are the two opposing emotional states that cause unpredictability and volatility in financial markets. To identify this kind of inscribed or indirect meaning, Plutchik’s model was used along these two scalar polarities: from the negative  with the EmoLex list by language. The assignment of emotions to a word in our frequency lists was done automatically using advanced Excel conditional search formulas. The condition was set up as follows:With the word limit imposed by EmoLex, the result of the automatic search function is a list of unigrams by frequency with the polarity and emotions marked, as shown in Fig. Figure In this study, we aim to explore the relationship between sentiment and emotion in financial journalism across languages and periods. Our investigation is grounded on two hypotheses and a guiding premise.1: There will be differences in sentiment polarity and intensity  between the pre-COVID and COVID periods in each newspaper, becoming more negative in tone in the second period. In other words, no salient variations will be perceived between the EN and ES sub-corpora for the same period, both being similarly (if slightly) positive in the period before the crisis and significantly negative after the onset of the pandemic.H2: The topics covered will change depending on the newspaper since their origins and scope are not the same, but the content will revolve mainly around critical financial matters in the first period but will focus on the havoc wrought by the global health crisis in the second period.Hfear and greed scale.Premise: Given the linguistic variability of sentiment, we assume there will be notable variation in the ways the eight emotions appear in each sub-corpus, with even stronger differences between the two periods under analysis. The emotional lexicon should reveal different degrees of risk aversion and attraction according to our By examining these hypotheses and premises, we aim to provide a comprehensive understanding of the role of sentiment and emotion in financial journalism across languages and time periods studied.pre-covid expansión, pre-covid economist, covid expansión and covid economist samples, respectively. As we can see, lexical items are rated as either positive/negative in terms of polarity (TSS) and as factual/slightly/fairly/very/extremely intense (TSI). Figures An initial analysis with a million-word sample per sub-corpus was made with Lingmotif 2, for the reasons explained above. The results shown in Figs. pre-covid expansión has 64% positive sentences (257 positive sentences), against 36% (or 145) negative ones , TSI being ‘very intense’ (TSI average of 74). In pre-covid economist, by contrast, whereas the intensity values are similar to those of the Spanish periodical (TSI average of 75), polarity is ‘fairly negative’, with 42 positives (22%) compared to 151 negative items (78%), which indicates that the English newspaper is considerably less optimistic than the Spanish one.As the graphs show, Overall, the samples from the English periodical were rather more subdued in tone than those in Spanish with regard to economic expectations in the period before the pandemic, but emotional activity is almost identical in the two periodicals.In the 2020–2021 period, however, the Spanish samples show a substantial reduction in positive items. Although negative and positive items have very similar values during this period, the sub-corpus as a whole tends marginally towards the negative, Lingmotif 2 classifying it as ‘slightly negative’ overall. The Spanish sub-corpus is as intense as the English one during this period , while the polarity values of the latter are rather more negative than in the pre-COVID period .Expansión does not want to create alarm among its readership, and this leads to the use of positive and negative lexis in roughly equal proportions. The English periodical is negative in both periods, as we have noted, but significant variations are seen between the pre-COVID and COVID periods, with a notable increase in negative (from 151 to 306) and positive (from 42 to 102) items in the second. It should be borne in mind that the emotional activity in both periodicals is ‘very intense’ in both periods.Comparing results by periodical during the pandemic, the English sample shows a considerable increase in negative items in relation to the pre-COVID samples. In the Spanish case, the most notable decrease observed in the second period is that of positive words. Whereas in the pre-COVID period, 64% of the words were positive, during the COVID period there was a relative balance . It seems that the Spanish Newspaper A closer analysis of the corpus using Lingmotif 2 allows us to group the semantic character of positive and negative items around different lexical fields and their topic areas  and sostenible , respectively. Other matters of interest include business innovation, that is, a (positive) change in business models  and (negative) economic affairs, with words like riesgo , crisis  and deuda . Covid expansión, on the other hand, addresses these areas much less frequently, instead concentrating mainly on the health crisis, with strongly negative items such as pandemia , contagio  and fallecido . Some attention is also paid to political matters, but there is little reference to basic or directly economic issues. However, the number of topic areas addressed increases enormously in the English periodical, which also shows considerable uniformity in subject matter. Covid economist shows less lexical variability in terms of economic matters, but there is a clear abundance of words like ‘pandemic’ , ‘virus’ and ‘lockdown’ (both with 350). Pre-covid economist shows an equally impressive array of macro- and micro-economic topics as its COVID equivalent but focuses mainly on negative issues such as the financial crisis and interest rates, using negative words such as ‘debt’ (206 occurrences) and ‘inflation’ (197). There is a surprising presence of the words ‘help’, ‘support’ and ‘rich’, which appear towards the top of the frequency lists of positive words in both pre-covid economist and covid economist, again illustrating the uniform editorial focus of this periodical.As can be seen in Table pre-covid expansión, pre-covid economist, covid expansión and covid economist , while negative ones increase (30.02–38.66%). Although declining positive and increasing negative trends are also identified in Economist, the differences are not as strong . This suggests that the approach of the English periodical to news reporting is more stable than its Spanish counterpart.Figure expansión) and economist) show the occurrence of the eight emotions in each corpus for each period.Figures expansión corpus, we see that the most notable of these in the first period are, in order: trust (31.96%), anticipation (16.68%) and joy, (10.29%). The negative emotions are relatively less frequent, for example, sadness (7.77%), fear (14.80%) and disgust (4.62%), while anger (7.61%)—in which the value is ambivalent, though mostly negative (more than 90% of the time) and seldom interpreted as positive by EmoLex—and the negative surprise (6.17%), both have intermediate values. Figure trust has the highest value, despite dropping to 26.48%, and the incidence of joy also falls (7.93%). fear and sadness both increase in the covid sample , as does anticipation (18.64%), while anger, disgust and surprise remain at the lowest values.If we look at the prevalent emotions in the economist data, these are shown in Fig. Turning to the Trust is again the most frequent, although it decreases in the second period (from 26.07 to 23.18%), while fear is the second most frequent emotion, although, by contrast, it increases in the second period, from 15.16 to 16.97%. Sadness also increases (from 10.58 to 11.98%). Anticipation is also an important emotion in the context of our material, yet contrary to the Spanish corpus, it decreases slightly in the second period (16.54–16.21%), as does joy (9.78–9.33%). Less dominant emotions are surprise and disgust, which show almost no change between periods. Figures One of the evident issues arising from the analysis of this corpus is that the frequencies of emotions are similar in number to those in the Spanish corpus. pre-covid expansión to covid periods is sadness, followed by fear; that which decreases the most is trust. It is also interesting to compare the expansión and economist corpora here, in that the data are also striking in their differences; trust decreases substantially in both corpora, while sadness and fear increase; as with all the other emotions, though, the degree of variation is much less in both economist sub-corpora. Coincidences in the greater or lesser expression of emotions in the two periodicals are notable since it provides evidence that the economic atmosphere is similar in the narratives of both periodicals in both periods.The emotions which have undergone the most variation from one period to the other are easily identified in the above graphs. Thus, the emotion that increased most in the Spanish fear and greed taxonomy. Accordingly, we studied the 10 most frequent nouns exclusively relating to those two tendencies, some presented below along with their absolute frequency in brackets. Nouns were chosen because they represent the most frequently occurring word class in both corpora. This may be because specialized language is highly nominalized , and those relating to investor passivity or reticence, as represented by the emotional category of fear. Figure pre-covid data for both periodicals.The second stage of our analysis sought to focus specifically on the greed was higher than fear (53% against 47%) in the English periodical during the same period. While it is true that we are only focusing on the extremes of the scale, we believe that this constitutes a useful means of exemplifying the e-implicatures that occur in nouns in regard to these extremes. Hence, words relating to fear in pre-covid expansión include cambio , riesgo , lucha , pérdida , amenaza , guerra , while those relating to anger+joy include reto , desafío , dinero , confianza , mejora . In pre-covid economist, the most frequent words representing a stimulus towards investing include ‘money’ (735.30), ‘share’ (690.62), ‘income’ (371.05), ‘demand’ (362.30), ‘cash’ (304.02), ‘wealth’ (189.41), ‘progress’ (146.67), ‘confidence’ (124.33), and ‘success’ (124.33), while those representing reticence to do so are ‘government’ (2259.33), ‘inflation’ (914.03), ‘change’ (610), ‘risk’ (582.80), ‘problem’ (505.10) ‘war’ (461.38), ‘recession’ (313.74), ‘threat’ (219.52), ‘loss’ (186.50), and ‘fear’ (165.13). Some examples from 2018, taken from both periodicals, are provided below.cambio climático aparecen por primera vez entre los cinco principales riesgos globales (…)Los eventos climáticos extremos, los desastres naturales y la falta de adaptación al Extreme weather events, natural disasters, and failure to adapt to climate change appear for the first time among the top five global risks)..En cuanto al futuro de estas energías en España, el regulador expresó su Regarding the future of these types of energy in Spain, the regulator expressed its confidence in the market, which should be able to accommodate the generation of renewable energy). prior to the pandemic. By contrast, Figure fear in both periodicals compared to the period before the pandemic. The COVID period in both sub-corpora manifest fear through words relating to the health crisis, such as ‘pandemic’ (1463.63), ‘case’ (671.41)—with modifiers such as ‘covid-19’, ‘daily’, ‘severe’, ‘coronavirus’, ‘asymptomatic’—‘lockdown’ (495.32), ‘death’ (420.42), ‘disease’ (337.06) and ‘war’ (328.60) in the English sub-corpus. The Spanish counterpart for the same emotion is very similar, with words like caso , pandemia , contagio , riesgo (‘risk’ 551.44) muerte  and confinamiento . The most frequent words relating to anger+joy in covid economist are ‘share’ (566), ‘money’ (506.8), ‘demand’ (353.97), ‘deal’ (315.02), ‘cash’ (300.82). In covid expansión, the most frequent words representing investing stimulus are demanda , ganador , lucha , reto , desafío , dinero , esfuerzo , mejora , and libertad . Below are some examples of this period (2020–2021).pandemia, Urkullu ha decretado el cierre de la hostelería y limitado el horario comercial de establecimientos de otros sectores, con la idea de no tener que recurrir al confinamiento domiciliario.Para contener la To contain the pandemic, Urkullu has ordered by decree the closure of the hotel and catering industries and limited business hours for establishments in other sectors, with the idea of not having to resort to lockdown).., formulated as follows:Consequently, to test the hypothesis, we put forward the null hypothesis (H0: there are no significant differences in the levels of negative sentiment expressed in selected newspapers before and after the declaration of COVID-19 as a pandemic.Ht-test because of our two related groups of data (the pre-COVID and the COVID variables) for the following reasons:Our study contains values collected before and after the onset of the pandemic, which makes it a longitudinal study.We had two fixed variables: the pre-pandemic variable (2018–2019) and the post-pandemic variable (2020–2021).The random variable being the number of occurrences of terms in our samples is a numerical variable, suitable for our test.We decided to use a paired sample p-value is a measure of the evidence against the null hypothesis. It represents the probability of obtaining a test statistic as extreme as, or more extreme than, the one observed, assuming the null hypothesis is true  chosen by the researcher , then the null hypothesis is rejected in favour of the alternative hypothesis (H1). On the other hand, if the p-value is >α, then there is not enough evidence to reject the null hypothesis. If the probability obtained  is ≤α, being α = 0.05 in our case, we reject the null hypothesis (H0) and accept the alternative hypothesis (H1). Conversely, if the obtained probability  is >α, H0 is not rejected and H1 is not accepted.In hypothesis testing, Brezina, . If the pre-covid and covid corpus  or 0.056 (two-sided) at a significance level of 0.05. The mean difference between the negative frequencies before and after the pandemic is −17,788.875, with a standard deviation of 21,935.973 and a standard error of 7755.537. The 95% confidence interval of the difference ranges from −36,127.807 to 550.057.The results of the paired sample The Economist and Expansión.The negative mean difference suggests that the negative frequency of the selected newspapers increased after the pandemic was evident. This finding is consistent with the increases in negative sentiment observed across all parts of speech in both r = 0.996) between the pre-pandemic and post-pandemic data pairs further supports the validity of the Student’s t-test results, indicating that the data is consistent and reliable.The strong correlation  from Sketch Engine, as it allowed us to compare the relative frequency of different topics in each newspaper corpus and identify differences between the two periods. We then compared the relative frequency of topics related to critical financial matters and the global health crisis in each newspaper corpus in the first and second periods, respectively.For HWe studied nouns, as they often represent concrete or abstract concepts, entities, or ideas, which makes them particularly useful for identifying the main topics and themes within a corpus. Nouns often provide a more stable and consistent representation of topics and tend to be more specific and less ambiguous than other parts of speech, such as adjectives or verbs. We selected those nouns which had a DOCF higher than 20% in pre-COVID and 25% in COVID periods to focus on the topics that appear in a substantial proportion of the documents, ensuring that our analysis captured the main subjects that are frequently discussed across the corpus and making the analysis more manageable and easier to interpretExpansión newspaper corpus during the years 2018 and 2019, it seems that the articles cover a wide range of topics.Based on the frequent words from the gobierno, presidente, empresa, economía, and país having high frequencies and DOCFs.The main topics in this period seem to be related to politics, economy, and business, with terms like euro and Europa.There is a notable focus on European issues, as indicated by the presence of words like energía, sostenibilidad, and cambio climático.Environmental and sustainability topics are present, as shown by terms like For the 2018–2019 period, the summary is as follows:pandemia, ‘covid-19’, ‘covid’, and ‘coronavirus’.The COVID-19 pandemic becomes a dominant topic, as evidenced by the high frequencies and DOCFs of words like gobierno, país, empresa, sector, España, and economía being frequently mentioned.There is still a strong focus on politics, economy, and business, with terms like Europa, ‘China’, fondo, inversión, and tecnología.The importance of international politics, investments, and development is visible through the presence of words like transición, energía, emisión, luchasostenibilidad.Environmental and sustainability issues continue to be covered, as indicated by terms like For the 2020–2021 period, the summary is:Expansión newspaper, we can conclude that the distribution of documents by topic shows that politics, economy, and business were the primary topics in both periods. The COVID-19 pandemic emerged as a dominant topic in the 2020–2021 period, reflecting its global impact. Environmental and sustainability issues were present in both periods, although not as dominant as other topics.Concerning these two periods in The Economist were, for the period 2018–2019:Strong focus on economic and financial topics, including macroeconomic issues, monetary policy, and financial markets. Examples of related words include ‘rate’, ‘interest’, ‘bank’, ‘market’, ‘economy’, ‘growth’, ‘price’, ‘investor’, ‘inflation’, ‘trade’, ‘job’, ‘tax’, ‘currency’, ‘dollar’, and ‘loan’.Frequent coverage of political events, leadership, and policy issues, with a focus on specific countries and regions such as America, China, and Europe. Examples of related words include ‘country’, ‘government’, ‘president’, ‘minister’, ‘election’, ‘party’, ‘law’, ‘reform’, ‘leader’, ‘union’, ‘politician’, ‘budget’, ‘European’, and ‘security’.Coverage of social issues and demographic topics, highlighting the newspaper’s interest in reporting on various aspects of society and the impact of economic and political developments on people’s lives. Examples of related words include ‘people’, ‘university’, ‘worker’, ‘home’, ‘job’, ‘income’, and ‘city’.The data in Increased coverage of health-related topics due to the global health crisis, with a focus on pandemic-related issues such as lockdowns, viruses, and deaths. Examples of related words include ‘pandemic’, ‘covid-19’, ‘lockdown’, ‘virus’, and ‘death’.Continued coverage of politics and government, with a focus on global affairs and geopolitical matters. Examples of related words include ‘government’, ‘president’, ‘state’, ‘policy’, ‘minister’, ‘party’, ‘election’, ‘law’, ‘rule’, and ‘order’.Continued coverage of economic and financial topics, including analysis of economic trends and business developments, as well as finance and investment topics. Examples of related words include ‘economy’, ‘firm’, ‘business’, ‘market’, ‘company’, ‘rate’, ‘bank’, ‘crisis’, ‘job’, and ‘growth’.Analysis of social concerns related to the pandemic, such as the impact on workers, cities, and schools. Examples of related words include ‘people’, ‘health’, ‘worker’, ‘city’, ‘population’, ‘family’, and ‘school’.Continued focus on financial markets and investment strategies. Examples of related words include ‘share’, ‘price’, ‘interest’, ‘capital’, ‘investment’, ‘investor’, ‘spending’, and ‘deal’.And for the period 2020–2021:The Economist, but there is a clear shift in focus in the 2020–2021 period due to the global health crisis. This shift is evident in the increased coverage of health-related topics and the analysis of social concerns related to the pandemic. At the same time, there is a continued emphasis on political and government issues, with a focus on global affairs and geopolitical matters. The changes in the topics covered suggest that the origins and scope of the newspaper have a significant influence on its content, but overall, the content revolves around critical financial matters in the first period and the havoc wrought by the global health crisis in the second period.The frequency of economic and financial topics is consistently high in both periods in this 2 is supported by the previous analysis of both newspapers, as they both reflect a shift in focus towards the impact of the global health crisis on different aspects of the economy and society.It can be concluded that HThis study was formulated on three hypotheses, all of which have been confirmed to a greater or lesser degree.First, we predicted that there would be differences between the pre-COVID and COVID periods in terms of intensity and sentiment, with both periodicals being similarly positive  in the period prior to the crisis, and considerably negative after the pandemic began. This hypothesis has not been fully supported, since the four sub-corpora have proved to be similarly intense in the high levels of emotional activity recorded, thus our initial assumption that economic reports are highly charged in emotional terms is not confirmed. Regarding polarity, it is true that both the Spanish and the English samples show a notable increase in negative items, this being especially so in the Spanish case, where a decrease in the number of positive items in the second period is also evident, as demonstrated by our initial study with Lingmotif 2, and subsequently confirmed in the analysis using EmoLex. The English data do not confirm our initial expectations either, since results are almost equally negative in both periods, albeit with slight variations which were more noticeable in the initial study than in the subsequent, overall analysis using the emotion lexicon.Expansión does focus on the economy in the first period, but in the second it focuses almost all its attention on the pandemic. By contrast, the range of economic and business topics covered is much broader in The Economist, both before and during the pandemic, confirming the more rounded and comprehensive nature of this publication. While it deals with a wide range of economic issues, it is also true that the main concern of the periodical in the second period is the pandemic and its effects, yet within these concerns, the interest rate crisis and inflation are realities that are mentioned in The Economist, whereas they are entirely absent from Expansión.Second, we predicted that the range of topics would change according to periodicals, in tune with the nature of each publication, and this was indeed confirmed through the close analysis of topics covered using Lingmotif 2 and DOCF in Sketch Engine for topic distribution. In our prediction, it was implicit that the subject matter in the pre-COVID period would be less sombre in tone than in the COVID period. This was seen to be true to a certain extent, in that the variation here is only very slight in the case of the English periodical. We predicted that the subject matter of the first period would revolve around economics and business, while the second period would focus on the COVID crisis, and this we assumed would be the case for both publications. But in fact, this is not entirely so, at least for the English newspaper. fear and greed scale of the financial markets. However, the typology of the most frequent emotions is in fact quite similar in both corpora, with trust in general being the most frequently occurring emotion in the periodicals, though it decreased in the second period, no doubt reflecting the turmoil of the pandemic. Regarding the FEAR-GREED scale that regulates behaviour in terms of investing or selling, the presence of TRUST suggests a moderate tendency towards attraction to risk, which in both periodicals decreases and is replaced by a growing sense of risk aversion in the second period, which is also characterized by the greater presence of SADNESS, another of the most common emotions in the two corpora, which also strongly rejects risk-taking.Our third hypothesis was that there would be clear variations in the way that the eight emotions were present, both in each sub-corpus and between sub-corpora, with even greater differences between the two periods. This would indicate diverse degrees of risk aversion and attraction, on the basis of our adaptation of the Other emotions are less commonly found, but ANGER and JOY —which taken together embody the intense emotion GREED, itself understood as competition for resources and goal achievement—are represented in greater proportions than the other emotions, but once again the reduction in their use in the second period suggests that the drive to succeed in terms of attaining and possessing also decreases in both corpora from the first to the second period. All in all, we find that both periodicals show a global tendency toward moderate risk-taking, which is greatly ameliorated by the presence of FEAR in the second period. Given that the two periodicals under investigation here are both very prominent in their respective spheres of influence, it seems probable that their dissemination would have had consequences in terms of the behaviour of investors in general.greed (anger+joy) and fear in both periodicals and both periods, and the trend towards retraction in investment in the more recent sub-corpora was confirmed: although greed was more common in the English publication than in the Spanish one in both periods, its decline in favour of fear was notable in both periodicals in the second period, with nouns providing clear evidence of the effects of the health crisis, this tendency adding to a latent one in the pre-COVID period that underlined risks relating to climate change, inflation, and the trade conflicts of the time.The second part of our study, involving the use of EmoLex for a finer analysis of the data in search of the words that best express the tendencies of attraction/aversion in the financial atmosphere, confirmed all the above claims. A sample was taken of the ten most frequent words representing the main emotions Expansión and The Economist, although the former maintained a more optimistic tone prior to the pandemic. This indicates that, in the pre-COVID period, with the effects of the financial crisis still biting, the texts published in the English periodical conveyed the belief that some grounds for optimism existed and that the reactivation and recovery of the economy would begin to appear on the horizon. Turning to emotional expression during the pandemic, we saw how both newspapers painted a gloomy picture of the economic situation, and while the outlook as detected in the Spanish corpus deteriorates relatively more acutely, the English periodical maintains a more measured, although still somewhat bleak, tone in both periods.The present study has explored the connection between sentiment and economic crises, as verbalized through the use of emotional words in two periodicals. In doing so, we have considered the ways in which the economic crisis, both immediately prior to and during the pandemic, was conveyed by two highly specialized newspapers, one in English, the other in Spanish, and how events influenced emotional expression and the language used to this end in the two periods. We have confirmed that emotional polarity was moderately negative to mildly positive in both To ascertain in greater detail how this expression of emotion would affect activity in the financial markets, we designed a scale based on Plutchik’s eight-emotion paradigm, which we applied to the CNN Stock Market Index (Fear & Greed). In theory, the Fear and Greed Index acts as a barometer for whether the stock market is fairly priced by looking at the emotions of investors. We know that market behaviour can be affected by emotions that transmit risk attraction or aversion and that the verbalization of these sentiments by such prestigious newspapers carries considerable weight in terms of investor outlook and behaviour. If this is so—and we have effectively found a way to connect mathematical algorithms (such as those used by stock markets) with emotion words—then it is probably possible to demonstrate that economics is indeed more intimately connected to feelings than purely rational economic theories would have us believe.