'You're just there, alone in your room with your thoughts': a qualitative study about the psychosocial impact of the COVID-19 pandemic among young people living in the UK

Types of Client Perceptions Regarding Counselling Experiences at Psychological Counselling Centres: Utilising Q Methodology

This study used Q methodology to explore the various types and characteristics of clients' subjective perceptions concerning their experiences at psychological counselling centres. We selected 33 Q samples from a Q population of 135; of the Q sample, 31 P samples underwent Q sorting. Subsequently, we analysed the data using the Quanl Program. The study categorised perception into four distinct types. Type 1 values therapeutic counselling relationships, Type 2 prioritises counselling services, Type 3 values counsellor assignment, and Type 4 prioritises the counselling structure. This study provides valuable basic data to clients, counsellors, and counselling institutions.

"People don't have the answers": A qualitative exploration of the experiences of young people with Long COVID

Young people living with Long COVID are learning to navigate life with a constellation of poorly understood symptoms. Most qualitative studies on experiences living with Long COVID focus on adult populations. This study aimed to understand the experiences of young people living with Long COVID. Qualitative, semi-structured interviews were conducted (n = 16); 11 young people (aged 13-19) and five parents were recruited from the Children and Young People with Long COVID (CLoCk) study (n = 11) or its patient and public involvement and engagement (PPIE) group (n = 5). Thematic analysis generated four themes: (i) Unravelling Long COVID: Exploring Symptom Journeys and Diagnostic Dilemmas; (ii) Identity Disruption and Adjustment; (iii) Long COVID's Ripple Effect: the impact on Mental Health, Connections, and Education; and (iv) Navigating Long COVID: barriers to support and accessing services. Treatment options were perceived as not widely available or ineffective, emphasising the need for viable and accessible interventions for young people living with Long COVID.

University Students with Current Suicidal Ideation and Perceived Changes during the COVID-19 Pandemic: A Qualitative Study

INTRODUCTION

Mental health problems seemed to have increased among university students during the COVID-19 pandemic. To deepen our understanding of the pandemic's effects in this population, we conducted qualitative research to investigate any perceived changes in students during the pandemic, differentiating the sample based on the presence or absence of current suicidal ideation (SI).

METHODS

A wide sample of Italian university students (n = 1,214) completed an online questionnaire during the COVID-19 pandemic, March 2020-June 2021. We conducted a computer-assisted content analysis of an open-ended question about the perceived changes that occurred to them during the pandemic.

RESULTS

(1) Four thematic clusters were identified: "The psychological impact of the pandemic," "New ties and new loneliness," "An uncertain forethought" and "Discovering the value of relationships." (2) In subjects characterized by severe SI, the state of confinement at home was related to the most intense emotional states and worries. (3) Students with severe SI were different from the others, in particular using the lemma "panic," which was the only psychological state specifically associated with this group.

CONCLUSIONS

Students with current severe SI experienced higher level of psychological distress and suffering compared to the other groups during the pandemic.

Comparison of first-year nursing students' GAD-7 scores: a pilot study focusing on Generation Z

BACKGROUND

In a post-pandemic landscape, Generation Z (Gen Z) nursing students are increasingly facing mental health challenges, notably anxiety. This study investigated these challenges among first-year nursing students.

AIMS

The primary objective was to assess self-reported anxiety levels in first-year undergraduate nursing students, focusing on Gen Z, before or at the onset of their initial clinical placement post-pandemic.

METHODS

Employing a cross-sectional design, this study used the Generalized Anxiety Disorder-7 (GAD-7) questionnaire to evaluate anxiety levels. It encompassed first-year nursing students from various fields at a university in North East England, considering generational differences, field of nursing, and demographic variables.

FINDINGS

Results indicated anxiety levels among generational groups, with Gen Z students exhibiting extreme variations. Notably, students in Mental Health Nursing reported less anxiety than their counterparts in other nursing fields. The study also sheds light on the ramifications of the COVID-19 pandemic on student mental health.

CONCLUSIONS

The study underscores the necessity for bespoke support systems in educational and clinical environments, particularly for Gen Z students. It advocates for comprehensive strategies in universities and clinical settings to nurture nursing students' emotional health, thereby enhancing their resilience and long-term career prospects.

Facilitating Access to Mental Health Services: A Stakeholder-Driven Improvement of the Children and Young People (CYP) as One Referral Platform

(1) Background: Pre-pandemic, child and adolescent mental health service (CAMHS) referrals were paper based in Liverpool and Sefton (England, United Kingdom), causing delays in waiting times. The "CYP as One" online mental health referral platform was co-created to overcome these challenges. (2) Methods: This study aims to improve "CYP as One" accessibility and usability and, subsequently, support CAMHS to improve waiting times. The current study utilised the Living Lab approach. We conducted content analysis on completed online referrals extracted from the "CYP as One" platform. These findings were supplemented by seven online focus groups, with 16-19-year-old young people, parents of children under 16, and health service providers. Thematic analysis was conducted on all data. (3) Results: The thematic analysis returned seven themes, namely (i) "CYP as One" vs. Traditional Referrals, (ii) Gender and Language Dynamics, (iii) Digital Empathy in Action, (iv) the Influence of the Provider Perspective, (v) Age and Social Sensitivity, (vi) Enhancing Access to Information, and (vii) Boosting Admin and Clinical Efficiency. (4) Conclusions: Digital content that seeks to replace in-person referrals can provide adequate support to children and young people who have faced difficulties accessing mental health services.

"An escape from the isolation": Youth thoughts about the impact of COVID-19 on adolescent sexual behavior and alcohol use

INTRODUCTION

The COVID-19 pandemic likely affected adolescent sexual behaviors and alcohol use, although how is not well understood.

METHOD

Youth were sampled from the national, online longitudinal Growing up with Media study. They responded via text messaging to open-ended questions about how the COVID-19 pandemic may have impacted the sexual behavior and alcohol use of adolescents. Conventional content analysis summarized open-ended responses.

RESULTS

416 responses were analyzed from 335 participants (aged 15-30, US residents), 81 of whom provided data for both topics. Participants suggested that the pandemic affected some youths' sexual health precautions (increased and varying) and attitudes about sex (positive and negative). They discussed how adolescents met partners during the pandemic, including increased use of online platforms. Participants also suggested researchers investigate sexual risk in the realm of COVID-19 transmission and the practice of "safe sex." Many participants believed adolescents were drinking alcohol more as a result of the pandemic, both alone and with friends; however, others perceived adolescents were drinking less. Participants proposed researchers investigate adolescent drinking habits during the pandemic, as well as how this compares to before the pandemic and the type and quantity of alcohol consumed.

CONCLUSIONS

Young people believe adolescent sexual relationships and drinking behaviors changed due to the pandemic, though how varied. Future research could examine the contexts and individual differences that shape these varying behaviors. Overall, this study highlights the importance of directly asking youth about their pandemic experiences and the diversity of views on how the pandemic has influenced adolescent behavior.

Impact of the COVID-19 pandemic on young adults' mental health and beyond: a qualitative investigation nested within an ongoing general population cohort study

PURPOSE

Initial discussions about the COVID-19 pandemic often overlooked its impact on young adults. By employing a qualitative approach nested within an ongoing general population cohort study, we seek to fill a gap in the literature by providing insights into the longer-term impact on this demographic.

METHODS

Data collection involved the use of in-depth semi-structured interviews. Using a pre-determined sampling frame, we purposively recruited 30 participants based on age, gender, ethnicity, and deprivation from the Neuroscience in Psychiatry Network (NSPN). The NSPN cohort, established in 2012, consists of 2403 young people aged 14-24 at baseline, recruited from Greater London and Cambridgeshire. Interviews were conducted in Autumn 2022; data were analysed using the framework method.

RESULTS

Participants were on average 28 years old (SD = 3 years, range 24-34 years; 53.3% female). The sample comprised individuals from diverse ethnic backgrounds, with 40% from non-White ethnic groups. Many young adults reported profound personal growth and a stronger sense of resilience, a perception observed across varying levels of anxiety or depression. Nevertheless, we observed substantial disruptions to their personal and professional lives such as returning to their parents' homes, often deferring other life plans, lacking mental health support, and encountering significant career challenges.

CONCLUSION

Our findings highlight the complexity of pandemic impacts, demonstrating the need for supportive policies and further research to understand the circumstances under which genuine personal growth occurs, whether it is enduring or transient, and which factors influence it.

Depressive symptoms in youth before and during the COVID-19 pandemic: longitudinal investigation of patterns dependent on age, sex, and family history of mental illness

BACKGROUND

Cross-sectional studies report high levels of depressive symptoms during the COVID-19 pandemic, especially in youth and females. However, longitudinal research comparing depressive symptoms before and during the pandemic is lacking. Little is known about how the pandemic affected individuals with familial history of mental illness. The present study examines the impact of the pandemic on youth depressive symptoms, including offspring of parents with major mood and psychotic disorders.

METHODS

Between March 2018 and February 2020, we measured depressive symptoms in 412 youth aged 5-25 years. We measured depressive symptoms again in 371 (90%) of these youth between April 2020 and May 2022. Two thirds (249) participants had a biological parent with a major mood or psychotic disorder. We tested the effect of the pandemic by comparing depression symptoms before and after March 2020. We examined age, sex, and family history as potential moderators.

RESULTS

We found an overall small increase in youth depressive symptoms (b = 0.07, 95% CI -0.01 to 0.15, p = 0.062). This was driven by an increase in female youth without familial history of mental illness (b = 0.35, 95% CI 0.14 to 0.56, p = 0.001). There was no change in depressive symptoms among offspring of parents with mental illness or males.

CONCLUSIONS

Our results provide reassurance about the wellbeing of children of parents with mental illness during a period of restricted access to resources outside the family. Rather than increasing symptoms in established risk groups, the pandemic led to a redistribution of depression burden towards segments of the youth population that were previously considered to be low-risk.

The impact of COVID-19 on young people's mental health, wellbeing and routine from a European perspective: A co-produced qualitative systematic review

BACKGROUND

The impact of the Covid-19 pandemic on young people's (YP) mental health has been mixed. Systematic reviews to date have focused predominantly on quantitative studies and lacked involvement from YP with lived experience of mental health difficulties. Therefore, our primary aim was to conduct a qualitative systematic review to examine the perceived impact of the Covid-19 pandemic on YP's (aged 10-24) mental health and wellbeing across Europe.

METHODS AND FINDINGS

We searched MEDLINE, PsycINFO, Embase, Web of Science, MEDRXIV, OSF preprints, Google, and voluntary sector websites for studies published from 1st January 2020 to 15th November 2022. European studies were included if they reported qualitative data that could be extracted on YP's (aged 10-24) own perspectives of their experiences of Covid-19 and related disruptions to their mental health and wellbeing. Screening, data extraction and appraisal was conducted independently in duplicate by researchers and YP with lived experience of mental health difficulties (co-researchers). Confidence was assessed using the Confidence in the Evidence from Reviews of Qualitative Research (CERQual) approach. We co-produced an adapted narrative thematic synthesis with co-researchers. This study is registered with PROSPERO, CRD42021251578. We found 82 publications and included 77 unique studies in our narrative synthesis. Most studies were from the UK (n = 50; 65%); and generated data during the first Covid-19 wave (March-May 2020; n = 33; 43%). Across the 79,491 participants, views, and experiences of YP minoritised by ethnicity and sexual orientation, and from marginalised or vulnerable YP were limited. Five synthesised themes were identified: negative impact of pandemic information and restrictions on wellbeing; education and learning on wellbeing; social connection to prevent loneliness and disconnection; emotional, lifestyle and behavioural changes; and mental health support. YP's mental health and wellbeing across Europe were reported to have fluctuated during the pandemic. Challenges were similar but coping strategies to manage the impact of these challenges on mental health varied across person, study, and country. Short-term impacts were related to the consequences of changing restrictions on social connection, day-to-day lifestyle, and education set-up. However, YP identified potential issues in these areas going forward, and therefore stressed the importance of ongoing long-term support in education, learning and mental health post-Covid-19.

CONCLUSIONS

Our findings map onto the complex picture seen from quantitative systematic reviews regarding the impact of Covid-19 on YP's mental health. The comparatively little qualitative data found in our review means there is an urgent need for more high-quality qualitative research outside of the UK and/or about the experiences of minoritised groups to ensure all voices are heard and everyone is getting the support they need following the pandemic. YP's voices need to be prioritised in decision-making processes on education, self-care strategies, and mental health and wellbeing, to drive impactful, meaningful policy changes in anticipation of a future systemic crisis.

Uptake of COVID-19 vaccinations amongst 3,433,483 children and young people: meta-analysis of UK prospective cohorts

SARS-CoV-2 infection in children and young people (CYP) can lead to life-threatening COVID-19, transmission within households and schools, and the development of long COVID. Using linked health and administrative data, we investigated vaccine uptake among 3,433,483 CYP aged 5-17 years across all UK nations between 4th August 2021 and 31st May 2022. We constructed national cohorts and undertook multi-state modelling and meta-analysis to identify associations between demographic variables and vaccine uptake. We found that uptake of the first COVID-19 vaccine among CYP was low across all four nations compared to other age groups and diminished with subsequent doses. Age and vaccination status of adults living in the same household were identified as important risk factors associated with vaccine uptake in CYP. For example, 5-11 year-olds were less likely to receive their first vaccine compared to 16-17 year-olds (adjusted Hazard Ratio [aHR]: 0.10 (95%CI: 0.06-0.19)), and CYP in unvaccinated households were less likely to receive their first vaccine compared to CYP in partially vaccinated households (aHR: 0.19, 95%CI 0.13-0.29).

A cross-sectional investigation on remote working, loneliness, workplace isolation, well-being and perceived social support in healthcare workers

BACKGROUND

Following the onset of the COVID-19 pandemic, healthcare trusts began to implement remote working arrangements, with little knowledge of their impact on staff well-being.

AIMS

To investigate how remote working of healthcare workers during the pandemic may have been associated with stress, productivity and work satisfaction at that time, and associations between loneliness, workplace isolation, perceived social support and well-being.

METHOD

A questionnaire was developed to explore remote working and productivity, stress and work satisfaction during time spent working remotely. Associations between current loneliness, workplace isolation and well-being, and the influence of perceived social support, were explored with perceived social support as a potential moderator.

RESULTS

A total of 520 participants responded to the study, of whom 112 were men (21.5%) and 406 were women (78.1%), with an age range of 21-77 years (mean 40.0, s.d. = 12.1). Very few (3.1%) worked remotely before the COVID-19 pandemic, and this had increased significantly (96.9%). Those who worked ≥31 h a week remotely reported higher stress and lower workplace satisfaction at that time, compared with office work, yet also felt more productive. Current loneliness, workplace isolation and perceived social support were cross-sectionally associated with lower current well-being.

CONCLUSIONS

Those who worked more hours a week remotely during the pandemic reported increased stress, which may be related to the lack of resources in place to support this change in work.

School students' burdens and resources after 2 years of COVID-19 in Austria: a qualitative study using content analysis

Introduction

The mental health of young people has been severely affected by the COVID-19 pandemic and the measures associated with it. Mental health symptoms increased across various domains during the pandemic and subjective wellbeing decreased.

Methods

This study examined the burdens and resources of Austrian school students (M = 16.63 years old) in the third year of the pandemic and compared them descriptively with the burdens and resources identified in a comparative study in 2021. A cross-sectional online survey with open-ended questions from April to May 2022 provided data that was analyzed using qualitative content analysis. A sub-sample of N = 214 was selected from the larger sample. This sub-sample is representative for the Austrian population aged 15-19 in terms of gender and migrant background.

Results

Analysis of the open-ended questions showed that concerns about the pandemic and the burdens of the measures were no longer on young people's minds at the time of the survey in 2022. On the other hand, stress at school was increasing and the opening of schools and the resumption of face-to-face teaching were challenging for respondents. While resuming social contacts and leisure activities was mentioned as a resource by many respondents, some also expressed a desire for more time off and a retreat into coping strategies such as sleeping more or avoiding problems.

Discussion

Our findings suggest that there is a need for low-threshold support from teachers and parents to help students catch up on missed lessons and to empathize with the mas they make the transition back to "old normal".

Social experiences and youth psychopathology during the COVID-19 pandemic: A longitudinal study

The early stages of the COVID-19 pandemic and associated stay-at-home orders resulted in a stark reduction in daily social interactions for children and adolescents. Given that peer relationships are especially important during this developmental stage, it is crucial to understand the impact of the COVID-19 pandemic on social behavior and risk for psychopathology in children and adolescents. In a longitudinal sample (N=224) of children (7-10y) and adolescents (13-15y) assessed at three strategic time points (before the pandemic, during the initial stay-at-home order period, and six months later after the initial stay-at-home order period was lifted), we examine whether certain social factors protect against increases in stress-related psychopathology during the pandemic, controlling for pre-pandemic symptoms. Youth who reported less in-person and digital socialization, greater social isolation, and less social support had worsened psychopathology during the pandemic. Greater social isolation and decreased digital socialization during the pandemic were associated with greater risk for psychopathology after experiencing pandemic-related stressors. In addition, children, but not adolescents, who maintained some in-person socialization were less likely to develop internalizing symptoms following exposure to pandemic-related stressors. We identify social factors that promote well-being and resilience in youth during this societal event.

The impact of COVID-19 and long COVID on sexual function in cisgender women

BACKGROUND

Research suggests that COVID-19 impairs sexual function in men, but little is known about the impact of COVID-19 (or long COVID) on sexual function in women.

AIM

We sought to compare the sexual function of cisgender women who had never had COVID-19, who had COVID-19 but not long COVID, and who had long COVID, and assessed whether long COVID symptoms and/or emotional distress mediate the relationship between COVID-19 history and sexual function.

METHODS

In total, 2329 adult cisgender women were recruited online as study participants. Half of these women reported having had COVID-19, and the other half reported never having had COVID-19. Of those who had COVID-19, 25% (n = 170) reported having long COVID. We compared the mean Female Sexual Function Index (FSFI) scores by using t-tests for each of the primary comparison categories (never COVID vs COVID and only COVID vs long COVID). Four path models were used to test the hypotheses that (1) long COVID symptoms or (2) depression, anxiety, and/or stress assessed with the subscales of the 21-item Depression, Anxiety, and Stress Scale (DASS-21) mediated the relationship between COVID-19 and sexual function.

OUTCOMES

Sexual function was measured with the FSFI, long COVID symptoms were assessed using the Centers for Disease Control working symptom set, and emotional distress was measured with the DASS-21.

RESULTS

In total, 1313 participants provided data suitable for analysis. The never-COVID group (n = 645, 49.1%) had higher scores on the Desire, Arousal, Lubrication, and Satisfaction subscales of the FSFI (mean [M] [SD] FSFI total Mnever COVID = 27.98 [4.84] vs MCOVID = 27.05 [5.21]) than the combined only-COVID (n = 498, 37.9%) and long-COVID (n = 170, 12.9%) groups. The FSFI subscale scores were significantly higher in the only-COVID group than in the long-COVID group for the Arousal, Lubrication, and Orgasm and lower for the Pain subscales and higher for overall sexual function (FSFI total Monly COVID = 27.49 [5.00] vs Mlong COVID = 25.77 [5.61]. None of the proposed mediation models had adequate model fit.

CLINICAL IMPLICATIONS

Clinicians treating cisgender women who have COVID-19 should consider proactively discussing sexual function with their patients and offering available resources.

STRENGTHS AND LIMITATIONS

In this study we used a large and diverse sample, but this sample did not include transgender or gender-diverse persons. This study was also correlational; as such, causal conclusions cannot be drawn. Further, the mechanism of action remains unexplained.

CONCLUSIONS

The study findings suggest the following: (1) COVID-19 infection is associated with impaired sexual function in cisgender women, and (2) that women with long COVID experienced incrementally more impaired sexual function than women with COVID-19 who did not develop long COVID.

The experiences and impact of the COVID-19 pandemic on young carers: practice implications and planning for future health emergencies

BACKGROUND

Young carers are children or young people aged up to 25 years old who undertake unpaid caring responsibilities for a friend or family member. Young carers faced significant challenges brought on by the COVID-19 pandemic. We explored the impact of the pandemic and associated restrictions on mental health, wellbeing and access to support in young carers in the United Kingdom (UK) to understand how to improve services, as well as support this population in future health emergencies.

METHOD

We conducted 22 qualitative semi-structured interviews from May to November 2021 with 14 young carers and eight staff working in organisations that supported them. Interviews took place remotely over video or telephone call and explored participant experiences of the pandemic and its impact on their health, wellbeing and caring responsibilities. We used reflexive thematic analysis to analyse interview transcripts.

RESULTS

We identified four overarching themes pertaining to the impact of the pandemic and associated restrictions on mental health, wellbeing and access to support in young carers in the UK: (1) challenges in protecting loved ones from the virus, (2) changes to and loss of routine, (3) reduced access to pre-pandemic informal and formal support structures and (4) better understanding of inner resilience and goals. Many participants struggled with their mental health and wellbeing as a result of pandemic related restrictions which impacted on support structures for themselves and the individual they cared for. However, positive impacts pertained to additional support provided by local authority and third sector organisations.

CONCLUSIONS

Our findings highlight some of the changes that affected young carers during the COVID-19 pandemic. The impact of changes to routine and a reduction in pre-pandemic support were the greatest concerns reported by participants in this study. The additional support provided by local authority and third sector organisations during social restrictions suggests such organisations could play a greater role in supporting this population going forward and that schools and Governments may wish to put in additional strategies and provisions to protect young carers in the future.

Individual Differences on Wellbeing Indices during the COVID-19 Quarantine in Greece: A National Study

The impact of COVID-19 and the associated lockdown measures on people's physical and mental wellbeing, as well as their daily lives and functioning, has been extensively studied. This study takes the approach of investigating the consequences of COVID-19 on a national scale, considering sociodemographic factors. The main objective is to make a contribution to ongoing research by specifically examining how age, gender, and marital status influence the overall impact of COVID-19 and wellbeing indicators during the second lockdown period that was implemented in response to the COVID-19 pandemic in the Greek population. The study involved a sample of 16,906 individuals of all age groups in Greece who completed an online questionnaire encompassing measurements related to personal wellbeing, the presence and search for meaning in life, positive relationships, as well as symptoms of depression, anxiety, and stress. Additionally, to gauge the levels of the perceived COVID-19-related impact, a valid and reliable scale was developed. The results reveal that a higher perception of COVID-19 consequences is positively associated with psychological symptoms and the search for meaning in life, while being negatively correlated with personal wellbeing and the sense of meaning in life. In terms of individual differences, the findings indicate that unmarried individuals, young adults, and females tend to report higher levels of psychological symptoms, a greater search for meaning in life, and a heightened perception of COVID-19-related impact. These findings are analyzed in depth, and suggestions for potential directions for future research are put forth.

Adolescents' and young people's experiences of social relationships and health concerns during COVID-19

PURPOSE

To illuminate the meaning of social relationships and health concerns as experienced by adolescents and young people during the COVID-19 pandemic.

METHODS

A longitudinal qualitative study was conducted. Data reported from 172 adolescents and young people aged 12-24 years in five countries; Chile, South Africa, Sweden, the United Kingdom and the United States collected from May 2020 to June 2021 were analysed via thematic analysis.

RESULTS

Adolescents and young peoples' experiences of social relationships and health concerns were described in seven themes: Family proximity, conflicts and frustration; difficulties and challenges related to limited living space; peer relations and maintaining friendship in times of social distancing; the importance of school as a place for interaction; vulnerability, emotional distress and uncertainty about the future; health concerns and sense of caring for others; and worries and concerns related to financial hardship. These reports show that the changes to everyday life that were introduced by public responses to the pandemic generated feelings of loneliness, vulnerability, and emotional distress, as well as increased sense of togetherness with family.

CONCLUSIONS

The everyday lives of adolescents and young people were restricted and affected more by the consequences of the pandemic than by the COVID-19 virus. These experiences had various impacts on well-being and mental health, where some individuals felt more exposed and vulnerable to emotional distress and loneliness than others. Family and peer relationships could be protective and support a sense of togetherness and belonging. Hence, social relationships are important to provide emotional support. Support for adolescents and young people should be tailored accordingly around social and emotional concerns, to encourage health and well-being.

Mental health in clinically referred children and young people before and during the Covid-19 pandemic

The Covid-19 pandemic and mitigation approaches, including lockdowns and school closures, are thought to have negatively impacted children and young people's (CYP) mental health. However, the impact for clinically referred CYP is less clear. We investigated differences in the mental health of CYP referred to specialist Child and Adolescent Mental Health Services (CAMHS) before and since the onset of the pandemic. Using baseline data (self- and parent- completed Mood and Feelings Questionnaire and Strengths and Difficulties Questionnaire) from an ongoing RCT (STADIA; ISRCTN: 15748675) in England involving 5-17-year-olds with emotional difficulties recently referred to CAMHS (non-urgent referrals), with repeated cross-sectional comparisons of CYP (n = 1028) recruited during 5 different time  periods: (1) Before schools were closed (Group 1 (pre-pandemic); n = 308; 27.08.2019-20.03.2020). (2) Early pandemic period until schools fully re-opened, which included the first national lockdown, its easing and the summer holidays (Group 2 (in-pandemic); n = 183; 21.03.2020-31.08.2020). (3) The following school-term-schools fully re-opened and remained open, including during the second national lockdown (Group 3 (in-pandemic); n = 204; 01.09.2020-18.12.2020). (4) Schools closed as part of the third national lockdown (Group 4 (in-pandemic); n = 101; 05.01.2021-07.03.2021). (5) Schools re-opened and remained open, until the school summer holidays (Group 5 (in-pandemic); n = 232; 08.03.2021-16.07.2021). Most CYP scored above cutoff for emotional problems and depression, with three-quarters meeting criteria for a probable disorder ('caseness'). The groups did not differ on parent-rated mental health measures. However, self-rated emotional problems, depression, functional impairment and caseness appeared to be higher amongst participants recruited in the two periods following school re-openings. In particular, functional impairment and caseness were greater in Group 5 compared with Group 2. Although symptom severity or impairment did not change in the initial pandemic period, self-reported difficulties were greater during the periods after schools re-opened. This suggests possible greater stresses in the adjustment to re-starting school following recurrent lockdowns and school closures.

The impact of COVID-19 lockdown measures on symptoms control in children with asthma: A systematic review and meta-analysis of observational cohort studies

OBJECTIVES

Reported reductions in emergency department visits and hospitalizations for asthma in previous studies have suggested a beneficial effect of the coronavirus disease of 2019 (COVID-19) lockdown measures on asthma morbidity. Nevertheless, studies relying on administrative data may overestimate the true impact of lockdowns due to changes in health-seeking behavior and reduced availability of pediatric asthma services during the pandemic. In this study, we systematically reviewed the literature and identified observational cohort studies that focused on nonadministrative data to assess the true impact of COVID-19 lockdowns on symptom control in children with asthma.

METHODS

A systematic literature search was conducted between January 2020 and August 2022 (International Prospective Register of Systematic Reviews ID: CRD42022354369). The impact of COVID-19 lockdowns across studies was expressed as a standardized mean difference (SMD) for continuous outcomes and as a summary relative risk (RR) for binary outcomes.

RESULTS

During the lockdown periods, the pooled asthma symptoms control test score (SMD: 1.99, 95% confidence interval [CI]: 0.75, 3.24, I2 : 98.4%) and the proportion of children with well-controlled asthma (RR: 1.35, 95% CI: 1.06, 1.71, I2 : 77.6%) were significantly increased. On the other hand, the pooled proportion of children with poorly controlled asthma (RR: 0.47, 95% CI: 0.38, 0.57, I2 : 0.0%) was significantly decreased.

CONCLUSIONS

During COVID-19 lockdowns, asthma symptoms and breakthrough disease exacerbations were significantly reduced in children with asthma. Further research is warranted on potential interventions aiming to enhance asthma control after the pandemic while taking into consideration their acceptability and potential tradeoffs.

Changes in economic activity and mental distress among young adults during the COVID-19 pandemic: Differences between the first and second infection waves in the UK

BACKGROUND

While infection rates, lockdown policies, and labor market conditions substantially varied across COVID-19 waves, the majority of evidence on young adults' mental health remains focused on initial responses in early 2020. The variability of the relationship between economic activity and mental health over time therefore remains poorly understood in this age group.

METHODS

Using linear mixed models, we investigated the relationship between current activity and changes in activity and mental distress (GHQ-12) among 1,390 young adults aged 16-34 via the UK Household Longitudinal Study COVID-19 survey. The association was explored in the first (from April to July 2020) and second (from September 2020 to March 2021) infection waves. Current activity was defined as "not working", "working <17.5 hours/week", "17.5-35 hours/week", and "> = 35 hours/week". Changes in activity were derived from current and pre-pandemic working hours and divided into four categories: "working with no reduced hours", "working fewer hours", "no longer working", and "did not work before the pandemic".

RESULTS

During the first wave, no association reached statistical significance. During the second wave: 1) compared to "currently not working", working 35 or more hours was associated with decreased distress (b = -1.54; 95%CI -2.39, -0.69) and working less than 17.5 hours was not (b = -0.62; 95%CI -1.66, 0.41); 2) compared to "working with no reduced hours compared with before the outbreak", no longer working was associated with increased distress (b = 1.58, 95%CI 0.61, 2.55) and working with reduced hours was not (b = 0.47, 95%CI -0.24, 1.17).

CONCLUSION

Above the mental health inequalities experienced at the start of the pandemic, full-time work-even with variation in work hours-continued to be a protective factor against mental distress among young adults during the second wave in the UK. Stable, full-time work can better support this age group's mental well-being over time.

Uncertainty as a driver of the youth mental health crisis

Mental health problems in young people have been on the rise for over a decade, with that trend accelerating during the pandemic. This review proposes that the catalyst effect of the pandemic offers insights into a key driver of increases in youth depression and anxiety: greater uncertainty. Uncertainty about many aspects of everyday life, including social connections, education, job security and health, increased during the pandemic, and this coincided with increasing rates of depression and anxiety. Lab-based developmental cognitive and clinical neuroscience research on tolerance of uncertainty and adolescent mental health shows that when adolescents fail to show age-typical tolerance of uncertainty, they are at greater risk of mental health problems. Avenues for future research to understand and promote tolerance of uncertainty in adolescents are proposed.

Generational, sex, and socioeconomic inequalities in mental and social wellbeing during the COVID-19 pandemic: prospective longitudinal observational study of five UK cohorts

BACKGROUND

Research suggests that there have been inequalities in the impact of the coronavirus disease 2019 (COVID-19) pandemic and related non-pharmaceutical interventions on population mental health. We explored generational, sex, and socioeconomic inequalities during the first year of the pandemic using nationally representative cohorts from the UK.

METHODS

We analysed data from 26772 participants from five longitudinal cohorts representing generations born between 1946 and 2000, collected in May 2020, September-October 2020, and February-March 2021 across all five cohorts. We used a multilevel growth curve modelling approach to investigate generational, sex, and socioeconomic differences in levels of anxiety and depressive symptomatology, loneliness, and life satisfaction (LS) over time.

RESULTS

Younger generations had worse levels of mental and social wellbeing throughout the first year of the pandemic. Whereas these generational inequalities narrowed between the first and last observation periods for LS [-0.33 (95% CI -0.51 to -0.15)], they became larger for anxiety [0.22 (0.10, 0.33)]. Generational inequalities in depression and loneliness did not change between the first and last observation periods, but initial depression levels of the youngest cohort were worse than expected if the generational inequalities had not accelerated. Women and those experiencing financial difficulties had worse initial mental and social wellbeing levels than men and those financially living comfortably, respectively, and these gaps did not substantially differ between the first and last observation periods.

CONCLUSIONS

By March 2021, mental and social wellbeing inequalities persisted in the UK adult population. Pre-existing generational inequalities may have been exacerbated with the pandemic onset. Policies aimed at protecting vulnerable groups are needed.

A Mental Health Pandemic? Assessing the Impact of COVID-19 on Young People's Mental Health

BACKGROUND

Research indicates that young people have been a particularly vulnerable group when it comes to negative mental health outcomes following COVID-19, with some authors warning of a 'mental health pandemic'.

MATERIALS AND METHOD

Using a survey approach, this study explored the effects of lockdowns on the mental health of 1995 16-year-olds in Northern Ireland. Respondents completed the 12-item version of the General Health Questionnaire (GHQ-12) along with closed- and open-ended questions about COVID-19.

RESULTS

Results from regression analysis showed that being female, identifying as non-heterosexual and perceiving that mental health had worsened during lockdown were the best predictors of poor mental health. In the open responses, young people reported significant concerns about their mental health and their educational outcomes. They also felt that their needs were not given the same priority as those of adults during lockdown.

CONCLUSIONS

The results suggest that the COVID-19 lockdowns adversely affected the mental health of many young people in Northern Ireland with the effects most acute for females and those identifying as non-heterosexual. Future research should explore the longer-term impact of the pandemic on the mental health of these vulnerable young people and identify what support mechanisms need to be put in place to mitigate the negative effects of any future crises.

Adolescent Mental Health during the COVID-19 Pandemic: The Interplay of Age, Gender, and Mental Health Outcomes in Two Consecutive Cross-Sectional Surveys in Northern Italy

The coronavirus disease 2019 (COVID-19) pandemic has had a profound impact on the mental health and well-being of adolescents. This study aimed to investigate the development of health-related quality of life (HRQoL) and mental health among adolescents in Northern Italy by comparing cross-sectional surveys conducted in 2021 and 2022, with a particular focus on the influence of age and gender. The sample included adolescents aged 11-19 years from public schools in South Tyrol. Validated psychometric instruments were used to assess HRQoL, anxiety and depression symptoms, and psychosomatic complaints. Sociodemographic variables, COVID-19 burden, and pandemic-related factors were measured. Statistical analyses included chi-square tests, correlation coefficients, and logistic regression analyses. The results indicated that while the self-reported burden of adolescents decreased significantly in 2022 (n = 1885) compared to 2021 (n = 1760), there were no significant differences in symptoms of anxiety, depressive symptoms, low HRQoL, and increased psychosomatic complaints between the two surveys for both early and late adolescents. Females consistently had higher percentages for all outcome variables, and symptoms of anxiety increased with age in females, but not in males. Both genders experienced an increase in depressive symptoms and low HRQoL with age. The co-occurrence of mental health outcomes was observed, suggesting overlapping patterns among anxiety, depression, low HRQoL, and psychosomatic complaints. These findings underscore the intricate relationship between age, gender, and mental health outcomes among adolescents during the pandemic. It is important to recognize that late adolescents may exhibit distinct vulnerabilities and may require tailored support approaches to address their specific mental health challenges, differing from those needed for early adolescents.

How does the COVID-19 pandemic affect the personal lives and care realities of people with a schizophrenia spectrum disorder? A qualitative interview study

BACKGROUND

The COVID-19 pandemic constitutes one of the greatest recent public crises. This study explored its influence on the lives and care realities of people with a schizophrenia spectrum disorder (SSD).

METHODS

Between October 2020 and April 2021, semi-structured in-depth interviews were conducted with 30 volunteers with SSDs receiving inpatient or outpatient treatment in Vienna (Austria). Interviews were audio-recorded, transcribed verbatim and analysed thematically.

RESULTS

Three main themes were identified. First, 'Pandemic life is deprived, lonely and surreal - though certain aspects can be perceived as positive'. Second, 'Bio-psycho-social support systems were struck at their core by the pandemic and were left severely compromised'. Last, 'There is a complex interplay between one's prior experience of psychosis and the experience of the COVID-19 pandemic'. The pandemic situation affected interviewees in various ways. For many, it led to a drastic reduction in day-to-day and social activities and contributed to an atmosphere of strangeness and threat. Bio-psycho-social support providers frequently suspended their services and offered alternatives were not always helpful. Participants indicated that whilst having an SSD might render them vulnerable to the pandemic situation, prior experience with psychotic crises can also provide knowledge, skills and self-confidence which enable better coping. Some interviewees also perceived aspects of the pandemic situation as helpful for recovering from psychosis.

CONCLUSION

Healthcare providers must acknowledge the perspectives and needs of people with SSDs in present and future public health crises to ensure proper clinical support.

'How I'm feeling today, I probably won't be feeling tomorrow'. Using I-Poems to explore young people's changing emotions during the Covid-19 pandemic - A qualitative, longitudinal study

Background

Relatively little published qualitative research has explored children and young people's (CYP) prolonged or longitudinal experiences of the pandemic, and their emotional responses to such unreserved change to everyday life. As part of a broader, qualitative longitudinal study, this paper explores change and continuity in young people's emotions over time during the Covid-19 pandemic in North East England.

Methods

I-Poems were curated for each of the 26 young people in this study from serial interview transcripts and diary entries, collected over the course of 16 months. Creation of I-Poems require researchers to focus on sentences made by the interviewee that include the word "I," and without changing the order of those sentences, to present them in poetic stanzas.

Findings

Young people's voices and experiences became more poignant and powerful when their 'I' narrative was centralised, silencing the presence of the researcher. Further, presenting the data in this way allowed us to see how the following emotions shifted over time: grief, sadness, frustration, anger, anxiety, joy, pleasure, excitement. We contend that young people experienced significant rupture and change over the course of our 16 month project, with both positive and negative repercussions for their emotional wellbeing.

Conclusions

Large scale (quantitative and qualitative) studies remain much needed to focus on the long-term impacts of the pandemic on young people's social, emotional and cultural lives. Longitudinal and creative qualitative approaches (such as I-Poems) have the potential to centralise participant voice, break down power dynamics, and allow exploration of shifting experiences and emotions over time.

The corona pandemic and participatory governance: Responding to the vulnerabilities of secondary school students in Europe

Adolescents in secondary schools have limited susceptibility to the SARS-COV-2 virus, but paradoxically are considered to be carrying the highest psychosocial burden during this pandemic. The aim of our European multi-country qualitative research was to investigate the COVID-19 crisis response in secondary schools and the role of national, regional, and local stakeholders in contributing to a participatory governance approach. We carried out 11 months of qualitative fieldwork, which included 90 respondents from the Netherlands, Ireland, and Finland for in-depth interviews and/or group discussions. Participant observation was conducted in four secondary schools to explore the interplay of day-to-day formal and informal practices of crisis governance. Our findings contribute to a better understanding of what efforts were made to facilitate participatory governance and where a bottom-up approach would have served useful in successfully implementing the COVID-19 mitigation strategies. Moreover, we show how these mitigation strategies have led to unintended consequences, such as students' difficulties with isolation and associated mental health problems, and the struggles of socialization when returning to a physical school environment. Our findings highlight the importance of the school environment in the socio-emotional developments of adolescents. We introduce the TAPIC-R model to analyze good governance, advancing the existing TAPIC model with an emphasis on the role of resilience in shaping participatory governance. We argue this is urgently needed during crises to strengthen engagement of the community, including vulnerable groups and achieve positive outcomes within and across policy structures and action domains.

Liminality and insecurity: A qualitative study of young adults’ vulnerabilities during the first 12 months of the COVID-19 pandemic in Australia

COVID-19 has disrupted the normative social order, particularly for young adults. Their deteriorating mental health over 2020 has been associated with the economic and social conditions during the COVID-19 lockdowns. We conducted 19 semi-structured interviews with young adults aged 8 and 29 most of whom lived in Victoria, Australia. The interviews explored participants' experiences and responses to COVID-19, covering areas such disrupted everyday practices and future plans, impacts on their physical and mental health, and interactions community and services. Young adults were concerned about loss of social connectedness, their mental health and the complex interplay of issues such as employment, income, education and housing. They developed routines to protect their physical and mental health while in lockdown and some made the most of opportunities. However, the pandemic may have had a profound effect by disrupting some young adults’ plans for the future, thus contributing to a sense of ontological insecurity.

COVID-19 lockdowns and changes in loneliness among young people in the U.K

RATIONALE

There has been growing concern that loneliness has increased throughout the COVID-19 lockdowns, and that the burden has fallen heavily on young people. This is important because loneliness is strongly linked to worse health outcomes.

OBJECTIVE

We examine whether and how loneliness among young people changed during the pandemic across the different lockdown periods in 2020 and 2021. We also assess differences by gender, socioeconomic status, and economic activity before the COVID-19 outbreak.

METHODS

We use nine waves of longitudinal data from the COVID-19 supplement of the UK Household Longitudinal Study (Understanding Society), collected between April 2020 and September 2021. We apply an individual fixed-effects event study design, which compares the loneliness reported by the same individual over lockdown transitions. We focus on loneliness reported by 1870 respondents aged between 16 and 24 years and compare it with pre-pandemic baselines.

RESULTS

We find that the loneliness of young people tracked the extent of lockdown restrictions but had returned to baseline levels by September 2021. This loneliness response was more pronounced for females than males but similar for young people across higher and lower socioeconomic backgrounds.

CONCLUSIONS

These results suggest that policy interventions aimed at increasing opportunities for in-person social interactions for young people in 'normal' times, might have some success in tackling loneliness, particularly for young females.

'Everything turned upside down': A thematic analysis of adolescents' experiences of everyday life during COVID-19 restrictions

BACKGROUND

At the beginning of the COVID-19 pandemic, people were encouraged to practice social distancing, and schools and leisure venues closed.

AIMS

We aimed to explore the everyday experiences of Norwegian adolescents during COVID-19 restrictions, when in-person contact with peers was severely limited.

METHODS

A total of 622 high-school students (16-18 years of age) replied to an online survey containing open-ended questions about the changes they experienced in everyday life during the first three months of the pandemic.

RESULTS

Reflexive thematic analysis resulted in four themes: (a) 'Everyday life turned upside down - everything is on hold'; (b) 'Alone with my thoughts - new concerns'; (c) 'A loss of social life - a fear of wasting important time'; and (d) 'Gratitude - new perspectives in life'. The results are discussed according to mental-health concerns and psychological developmental challenges during adolescence, such as social exploration of roles with peers, autonomy and identity formation during a crisis.

CONCLUSIONS

The results underline individual variations and positive experiences among adolescents during the COVID-19 pandemic, despite social restrictions. Still, the lack of in-person contact with friends is related to an increased experience of loneliness and mental-health concerns for many adolescents.

Data-Driven Assessment of Adolescents' Mental Health During the COVID-19 Pandemic

OBJECTIVE

Adolescents' mental health was severely compromised during the COVID-19 pandemic. Longitudinal real-world studies on changes in the mental health of adolescents during the later phase of the pandemic are limited. We aimed to quantify the effect of COVID-19 pandemic on adolescents' mental health outcomes based on electronic health records.

METHOD

This was a retrospective cohort study using the computerized database of a 2.5 million members, state-mandated health organization in Israel. Rates of mental health diagnoses and psychiatric drug dispensations were measured among adolescents 12 to 17 years of age with and without pre-existing mental history, for the years 2017 to 2021. Relative risks were computed between the years, and interrupted time series (ITS) analyses evaluated changes in monthly incidence rates of psychiatric outcomes.

RESULTS

The average population size was 218,146 in 2021. During the COVID-19 period, a 36% increase was observed in the incidence of depression (95% CI = 25-47), 31% in anxiety (95% CI = 23-39), 20% in stress (95% CI = 13-27), 50% in eating disorders (95% CI = 35-67), 25% in antidepressant use (95% CI = 25-33), and 28% in antipsychotic use (95% CI = 18-40). A decreased rate of 26% (95% CI = 0.80-0.88) was observed in ADHD diagnoses. The increase of the examined outcomes was most prominent among youth without psychiatric history, female youth, general secular Jewish population, youth with medium-high socioeconomic status, and those 14 to 15 years of age. ITS analysis confirmed a significantly higher growth in the incidence of psychiatric outcomes during the COVID-19 period, compared to those in previous years.

CONCLUSION

This real-world study highlights the deterioration of adolescents' mental health during the COVID-19 pandemic and suggests that youth mental health should be considered during health policy decision making.

DIVERSITY & INCLUSION STATEMENT

We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We actively worked to promote sex and gender balance in our author group. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.

How the COVID-19 Pandemic Affected Young People’s Mental Health and Wellbeing in the UK: A Qualitative Study

There is emerging evidence of the detrimental impact of the pandemic and associated restrictions on young people’s mental health in the UK but to date, these data have been largely quantitative. The aim of the current study was to gain a deeper understanding of young people’s experiences in relation to their mental health and wellbeing during the pandemic. Seventeen young people, aged 11 to 16 years, sampled for diverse characteristics, and living in the UK, were interviewed virtually between December 2020 and February 2021. Reflexive thematic analysis was carried out by the research team, which included two young people, and five themes were developed: (1) positives; (2) worries and anxiety; (3) sadness and anger about losses; (4) mental exhaustion; and (5) support from others. Aspects of young people’s individual circumstances (e.g., pre-existing mental health difficulties; special educational needs and neurodevelopmental disorders) appeared to play a role in their experiences. Continued measurement of young people’s mental health, initiatives to identify young people who have been struggling and the provision of support (including evidence-based and accessible interventions) will be important for protecting young people from future adversities as we emerge from the pandemic.

"One and a Half Years of Things We Could Have Done": Multi-Method Analysis of the Narratives of Adolescents with Type 1 Diabetes during the COVID-19 Pandemic

BACKGROUND

Public health interventions for COVID-19 forced families to adopt changes in daily routines that affected children's and adolescents' psychological well-being. In youth with type 1 diabetes (T1D), psychological symptoms may compromise glycemic control and outcomes; however, evidence of improved glycemic control in children and adolescents with T1D emerged early during the pandemic. This qualitative study aims to provide a more in-depth understanding of how the COVID-19 pandemic affected adolescents' with T1D routines, experiences, T1D management, and psychological well-being.

METHODS

24 adolescents, aged 15-18 years, with T1D, joined focus-group discussions during the diabetes summer camp. Word frequency analysis and thematic analysis were conducted on adolescents' narratives. The average frequencies of use of words related to COVID-19 and to T1D were compared by t-test.

RESULTS

Word frequency analysis identified "friends", "family", and "home" as the most recurrent terms. Seven themes were highlighted: (1) COVID-19 and T1D; (2) emotional reactions to the COVID-19 pandemic; (3) changes in daily life; (4) feelings of loss; (5) coping with the COVID-19 pandemic; (6) the COVID-19 pandemic as opportunity; (7) return to (new) normality. COVID-19 related words were on average more frequent than words referring to T1D.

CONCLUSIONS

The COVID-19 pandemic may have represented a more stressful condition for adolescents with T1D, facing additional challenges compared to their healthy peers. Findings offer directions to the diabetes care team for customized interventions while the effects of the pandemic on adolescents' health continue.

A qualitative study of positive psychological experiences and helpful coping behaviours among young people and older adults in the UK during the COVID-19 pandemic

While much research has focused on challenges that younger and older people have faced during the COVID-19 pandemic, little attention has been given to the capacity for resilience among these groups. We therefore explored positive psychological experiences and coping behaviours that protected mental health and well-being. Participants were 40 young people (aged 13-24) and 28 older adults (aged 70+) living in the UK during the COVID-19 pandemic. Interviews were held between May 2020 and January 2021. We generated six themes using qualitative thematic analysis, including: engagement in self-fulfilling activities, increased sense of social cohesion, personal growth, use of problem-focused strategies to manage pandemic-related stressors, giving and receiving social and community support, and utilising strategies to regulate thoughts and emotions. While all six themes were relevant both to younger and older adults, there were nuances in how each was experienced and enacted. For example, many older adults adjusted their routines given worries about virus vulnerability, while some young people experienced greater personal growth amidst increased awareness of mental health as they navigated the various lockdown restrictions.

Risk and protective factors for new-onset binge eating, low weight, and self-harm symptoms in >35,000 individuals in the UK during the COVID-19 pandemic

OBJECTIVE

The disruption caused by the COVID-19 pandemic has been associated with poor mental health, including increases in eating disorders and self-harm symptoms. We investigated risk and protective factors for the new onset of these symptoms during the pandemic.

METHOD

Data were from the COVID-19 Psychiatry and Neurological Genetics study and the Repeated Assessment of Mental health in Pandemics Study (n = 36,715). Exposures were socio-demographic characteristics, lifetime psychiatric disorder, and COVID-related variables, including SARS-CoV-2 infection/illness with COVID-19. We identified four subsamples of participants without pre-pandemic experience of our outcomes: binge eating (n = 24,211), low weight (n = 24,364), suicidal and/or self-harm ideation (n = 18,040), and self-harm (n = 29,948). Participants reported on our outcomes at frequent intervals (fortnightly to monthly). We fitted multiple logistic regression models to identify factors associated with the new onset of our outcomes.

RESULTS

Within each subsample, new onset was reported by: 21% for binge eating, 10.8% for low weight, 23.5% for suicidal and/or self-harm ideation, and 3.5% for self-harm. Shared risk factors included having a lifetime psychiatric disorder, not being in paid employment, higher pandemic worry scores, and being racially minoritized. Conversely, infection with SARS-CoV-2/illness with COVID-19 was linked to lower odds of binge eating, low weight, and suicidal and/or self-harm ideation.

DISCUSSION

Overall, we detected shared risk factors that may drive the comorbidity between eating disorders and self-harm. Subgroups of individuals with these risk factors may require more frequent monitoring during future pandemics.

PUBLIC SIGNIFICANCE

In a sample of 35,000 UK residents, people who had a psychiatric disorder, identified as being part of a racially minoritized group, were not in paid employment, or were more worried about the pandemic were more likely to experience binge eating, low weight, suicidal and/or self-harm ideation, and self-harm for the first time during the pandemic. People with these risk factors may need particular attention during future pandemics to enable early identification of new psychiatric symptoms.

Severe COVID-19 anxiety among adults in the UK: protocol for a cohort study and nested feasibility trial of modified cognitive-behavioural therapy for health anxiety

INTRODUCTION

Some people are so anxious about COVID-19 that it impairs their functioning. However, little is known about the course of severe COVID-19 anxiety or what can be done to help people who experience it.

METHODS AND ANALYSIS

Cohort study with a nested feasibility trial with follow-up at 3 and 6 months. We recruited 306 people who were aged 18 and over, lived in the UK and had severe COVID-19 anxiety (indicated by a score of 9 or more on the Coronavirus Anxiety Scale (CAS)). To take part in the nested feasibility trial, participants also had to have a score of 20 or more on the Short Health Anxiety Inventory. We excluded people from the trial if they had had COVID-19 within the previous 4 weeks, if they were currently self-isolating or if they were already receiving psychological treatment.We publicised the study nationally through adverts, social media and posts on message boards. We also recruited participants via clinicians working in primary and secondary care NHS services in London. All those in the active arm will be offered 5-10 sessions of remotely delivered modified cognitive-behavioural therapy for health anxiety (CBT-HA). We will examine the proportion of participants who remain above threshold on the CAS at 3 and 6 months and factors that influence levels of COVID-19 anxiety over 6 months using mixed effects logistic regression. The key feasibility metrics for the nested trial are the level of uptake of CBT-HA and the rate of follow-up.

ETHICS AND DISSEMINATION

Approved by Leicester Central Research Ethics Committee (reference: 20/EM/0238). The results of the study will be published in peer-reviewed scientific journals.

TRIAL REGISTRATION NUMBER

ISRCTN14973494.

Exploring Barriers and Facilitators to Physical Activity during the COVID-19 Pandemic: A Qualitative Study

Quantitative data show that physical activity (PA) reduced during the COVID-19 pandemic, with differential impacts across demographic groups. Qualitative research is limited; thus, this study aimed to understand barriers and facilitators to PA during the pandemic, focusing on groups more likely to have been affected by restrictions, and to map these onto the capability, opportunity, motivation model of behaviour (COM-B). One-to-one interviews were conducted with younger (aged 18–24) and older adults (aged 70+), those with long-term physical or mental health conditions, and parents of young children. Themes were identified using reflexive thematic analysis and were mapped onto COM-B domains. A total of 116 participants contributed (aged 18–93, 61% female, 71% White British). Key themes were the importance of the outdoor environment, impact of COVID-19 restrictions, fear of contracting COVID-19, and level of engagement with home exercise. Caring responsibilities and conflicting priorities were a barrier. PA as a method of socialising, establishing new routines, and the importance of PA for protecting mental health were motivators. Most themes mapped onto the physical opportunity (environmental factors) and reflective motivation (evaluations/plans) COM-B domains. Future interventions should target these domains during pandemics (e.g., adapting PA guidance depending on location and giving education on the health benefits of PA).

Effects of COVID-19 on Adolescent Mental Health and Internet Use by Ethnicity and Gender: A Mixed–Method Study

Evidence suggests that mental health problems in young people have been exacerbated by COVID-19, possibly related to a lack of social connection. Young people report using the internet for connecting with their peers and mental health support. However, how they may have used the internet for support during COVID-19 is not clear. We wanted to know how mood and internet use may have changed in young people during COVID-19 and if this was different for those with and without depression symptoms. 108 adolescents were recruited. Participants with high and low levels of depressive symptomatology answered questions about their mood, internet use, loneliness and life satisfaction during July and August 2020. We found that the high depression group reported significantly more loneliness and less life satisfaction than the low depression group. We found that most young people used the internet for mental health information during COVID-19 but that the high depression group used the internet more for mental health information than the low depression group. The high depression group also had a worsening of mood compared to the low depression group during COVID-19. We found that Black, Asian and Minority Ethnic participants reported increased use of the internet compared to White participants during COVID-19 and that the role of the family facilitated coping during COVID-19 for some adolescents, but for others, it made the lockdown more difficult. Finally, we found that adolescents perceived school anxiety as stressful as COVID-19. To conclude this study supports the use of the internet as a way to help young people with mental health challenges. It also suggests that the internet is a way to help young people from ethnic minorities, who otherwise might be hard to reach, during challenging times. This study also shows that supportive family units can be important during times of stress for young people and that school anxiety is a major issue for young people in today’s society even outside of the pandemic.

Adolescent Experiences of the COVID-19 Pandemic and School Closures and Implications for Mental Health, Peer Relationships and Learning: A Qualitative Study in South-West England

The COVID-19 ‘lockdown’ and multiple school closures disrupted the daily lives and routines of the entire UK population. However, adolescents were likely particularly impacted by such measures due to this time being key for social and educational development. This qualitative study explored young people’s experiences of lockdowns and school closures. Fifteen secondary schools within south-west England were initially contacted and three schools participated in recruitment efforts. From December 2020 to March 2021, 25 students aged 14–15 participated in a combination of individual interviews (n = 5) and focus groups (n = 3). Findings revealed diverse experiences of the pandemic and highlighted the complexity of experiences according to individual student contexts. Three main themes were identified: (1) Learning environments; (2) Connection to peers; (3) Transition, adaptation and coping. These findings highlight the value young people place on face-to-face social contact with close friends, and the sense of structure provided by school, with implications for future home-based learning. Further in-depth qualitative research is needed to continue to understand the varied experiences during the course of the pandemic, particularly longer-term impacts on mental health and learning.

Facilitators and barriers to social distancing for young people during the COVID-19 pandemic

BACKGROUND

Social (or physical) distancing is an important transmission-prevention behaviour that has been endorsed to minimize COVID-19 transmission. This qualitative study explores the facilitators of and barriers to social distancing for young people during the COVID-19 pandemic, with recognition that young people represent a unique demographic group, with differing psychosocial needs and experiences to other age cohorts.

METHODS

Qualitative data was collected as part of a larger Qualtrics survey between July 28th 2020 and August 24th 2020. Eligible participants were young people living on the Island of Ireland, aged 16-25 years. The survey design was underpinned by the Capability, Opportunity, and Motivation model of behaviour change (COM-B). Semi-inductive thematic analysis was used to analyse comments collected via three free-text survey items. The COM-B model provided a thematic framework to organise subthemes extracted.

RESULTS

A total of N = 477 young people completed the survey, of which N = 347 provided comments for at least one of three free-text survey items. The majority of respondents lived in Northern Ireland (96%), the average age was 21 years, and most respondents were female (73%) and were students (81%). Key barriers identified included lack of environmental support for social distancing (lack of physical Opportunity to social distance), observing other people not social distancing (lack of social Opportunities supporting social distancing), and missing physical interaction from others (relating to the dissuading influence of automatic Motivational factors i.e. the influence of loneliness). Key facilitators included presence of clear and consistent environmental cues and availability of space to support social distancing (increasing physical Opportunity to social distance), increasing awareness and perceived consequences of risk of transmission (enhancing reflective Motivational factors i.e. perceived benefits (versus costs) of social distancing), and increasing opportunities to observe others' adhering to guidelines (increasing social Opportunities supporting social distancing).

CONCLUSIONS

These findings suggest that the actions and endorsement of peers and the physical design of environments have a key role in influencing social distancing behaviour among young people living in NI. The COM-B factors identified in this study can inform the development of tailored interventions using models such as the Behaviour Change Wheel. The findings of this study suggest that intervention functions based on peer modelling and physical environmental restructuring and enablement should be priortitised, however it is imperative that interventions are co-designed with young people to foster collaboration and empowerment.

The impact of the initial and second national COVID-19 lockdowns on mental health in young people with and without pre-existing depressive symptoms

BACKGROUND

The evidence on mental health during COVID-19 evolved fast, but still little is known about the long-lasting impact of the sequential lockdowns. We examine changes in young people's mental health from before to during the initial and second more prolonged lockdown, and whether women and those with pre-existing depressive symptoms were disproportionally impacted.

METHODS

Participants reported on mental health indicators in an ongoing 18-year data collection in the Danish National Birth Cohort and in a COVID-19 survey, including 8 data points: 7 in the initial lockdown, and 1 year post. Changes in quality of life (QoL), mental well-being, and loneliness were estimated with random effect linear regressions on longitudinal data (N = 32,985), and linear regressions on repeated cross-sections (N = 28,579).

FINDINGS

Interim deterioration in mental well-being and loneliness was observed during the initial lockdown, and only in those without pre-existing depressive symptoms. During the second lockdown, a modest deterioration was again observed for mental well-being and loneliness. QoL likewise only declined among those without pre-existing symptoms, where women showed a greater decline than men. QoL did not normalise during the initial lockdown and remained at lower levels during the second lockdown. These findings were not replicated in the repeated cross-sections.

INTERPRETATION

Except for an interim decrease in mental health, and only in those without pre-existing depressive symptoms, this study's findings do not suggest a substantial detrimental impact of the lockdowns.

“I Think Friendship Over This Lockdown Like Saved My Life”—Student Experiences of Maintaining Friendships During COVID-19 Lockdown: An Interpretative Phenomenological Study

COVID-19 lockdown presented a novel opportunity to study the experiences of people attempting to maintain friendships in the context of worldwide, government-enforced physical distancing and lockdown. Here we report on an experiential, idiographic qualitative project with a purposive sample of Scottish students. Data was collected via one-to-one on-line interviews with nine student participants (N = 9). Data was transcribed and analyzed using Interpretative Phenomenological Analysis (IPA). Analysis highlighted three group-level experiential themes (GETs) and associated subthemes. Participants’ shared experiences of maintaining friendships were reflected in a dynamic process by which (1) ‘changes to communication’ were associated with experiences of (2) ‘effort and balance’ across friendships. Participants reported becoming particularly aware of the psychological processes involved in maintaining friendships, in turn, this was associated with (3) ‘reflection and growth.’ These experiential findings resonate well with several longstanding classic theories; however, they also speak to the particularities of the context in which the study was conducted. They suggest the need for a pandemic psychology that moves beyond the typical focus on the direct impacts of infectious disease to address the wider psychosocial impacts with equal vigor.

Understanding Barriers and Facilitators to Compliance with UK Social Distancing Guidelines During the COVID-19 Pandemic: A Qualitative Interview Study

When followed, there is evidence that social distancing measures play a major role in reducing the transmission of viruses such as COVID-19. However, not all individuals follow the guidance. We explored barriers and facilitators to compliance with UK social distancing guidelines during the COVID-19 pandemic through semi-structured interviews with 116 adults. Data were analysed using reflexive thematic analysis and themes mapped to the Capability, Opportunity and Motivation Model of Behaviour (COM-B). Barriers to compliance included inconsistent rules, caring responsibilities, fatigue, unintended consequences of control measures, and the need for emotional support. Facilitators were informational support and social responsibility. Six themes were both a barrier and a facilitator: lived environment, beliefs about consequences of non-compliance, influence of others, practical support, and trust in government. Reflective motivation, psychological capability, and social opportunity were important drivers for compliance. Measures that enable social support alongside strategies to maintain motivation to comply, provide clear guidance and optimise social cohesion should be promoted.

Problemas emocionais e comportamentais em adolescentes no contexto da COVID-19: um estudo de método misto

Resumo Objetivo: estimar a prevalência de problemas emocionais e comportamentais em adolescentes no contexto da pandemia de COVID-19 e explorar a percepção dos adolescentes sobre os problemas emocionais e comportamentais identificados. Método: estudo de método misto de desenho explanatório sequencial. Participaram 479 adolescentes de 15 a 18 anos de uma capital do Centro-Oeste brasileiro. Resultados: dos 479 participantes, a média de idade foi de 16,03 anos (DP=1,01). A prevalência de problemas emocionais e comportamentais foi de 61,17% e houve diferença em relação ao sexo (ORb=2,93; p<0,01). As maiores prevalências foram relativas aos problemas de relacionamentos com os pares (54,49%) e aos sintomas emocionais (52,40%). Os adolescentes perceberam o aumento de solidão, ansiedade, tristeza, distanciamento dos amigos e dificuldades de socialização durante a pandemia. Conclusão: a maioria dos adolescentes foi classificada com problemas emocionais e comportamentais, sendo que as meninas apresentaram maior chance de manifestá-los em comparação aos meninos. Os depoimentos dos adolescentes reforçam os resultados quantitativos. Dessa forma, nota-se a necessidade de implementar ações de promoção e restabelecimento da saúde mental dos adolescentes, de modo a mitigar o impacto socioemocional da pandemia de COVID-19 junto a essa população.

Emotional and behavioral problems in adolescents in the context of COVID-19: a mixed method study

Abstract Objective: to estimate the prevalence of emotional and behavioral problems in adolescents in the context of the COVID-19 pandemic e to explore adolescents’ perception of emotional and behavioral problems identified. Method: mixed-method explanatory sequential design. Participants were 479 adolescents aged 15 to 18 from a Brazilian Central-West region capital. Results: with a total of 479 participants, mean age was 16.03 years (SD=1.01). The prevalence of emotional and behavioral problems was 61.17%, and there was a difference between the sexes (ORb=2.93; p<0.01). The highest prevalence was related to peer relationship problems (54.49%) and emotional symptoms (52.40%). Adolescents noticed an increase in loneliness, anxiety, sadness, distancing from friends and difficulties in socializing during the pandemic. Conclusion: most of the investigated adolescents were classified as having emotional and behavioral problems, and girls were more likely to have them than boys. The adolescents’ statements reinforce the quantitative findings. In this way, there is a need to implement actions to promote and restore the adolescents’ mental health, in order to mitigate the COVID-19 pandemic socio-emotional impact on this population.

Problemas emocionales y de comportamiento en adolescentes en el contexto de COVID-19: un estudio de método mixto

Resumen Objetivo: estimar la prevalencia de problemas emocionales y de comportamiento en adolescentes en el contexto de la pandemia de COVID-19 e explorar la percepción de los adolescentes acerca de los problemas emocionales y de comportamiento identificados. Método: un estudio de método mixto de diseño explicativo secuencial. Participaron 479 adolescentes de 15 a 18 años de una capital de la región Centro-Oeste brasileña. Resultados: de los 479 participantes, la media de las edades fue los 16,03 años (DP=1,01). La prevalencia de PEC fue del 61,17% y había una diferencia en cuanto al sexo (ORb=2,93; p<0,01). Las mayores prevalencias se relacionaron con los problemas de relación entre pares (54,49%) y con los síntomas emocionales (52,40%). Los adolescentes notaron un aumento de soledad, ansiedad, tristeza, alejamiento de amigos y dificultades de socialización durante la pandemia. Conclusión: se clasificó la mayoría de los adolescentes investigados con problemas emocionales y de comportamiento, y las chicas presentaron una mayor probabilidad de manifestarlos en comparación con los chicos. Las declaraciones de los adolescentes refuerzan los resultados cuantitativos. Así, se señala la necesidad de implementar acciones para promover y restaurar la salud mental de los adolescentes, para mitigar los impactos socioemocionales de la pandemia de COVID-19 en esa población.

How has the COVID-19 pandemic affected eczema self-management and help seeking? A qualitative interview study with young people and parents/carers of children with eczema

Background

Eczema can have a considerable impact on quality of life. Treatments can improve this, but management is complex. Barriers to eczema self‐management may be impacted upon by environmental context, such as the COVID‐19 pandemic.

Objectives

To explore experiences of eczema, self‐management, and accessing healthcare and advice during the COVID‐19 pandemic among young people with eczema and parents/carers of children with eczema.

Methods

Qualitative semi‐structured interviews were carried out with 36 participants recruited from general practices as part of randomised controlled trials of online eczema resources.

Results

Changes to everyday life—Periods of staying at home due to the pandemic alter the burden of eczema, with reports of an improved routine and application of topical treatments for many, but difficulties with handwashing for others. Parents/carers reported improved eczema control due to closures of educational settings. Young people reported higher stress that may have triggered eczema flare‐ups. Changes to access to advice and treatment—There was a reluctance to seek medical appointments in a non‐emergency situation. Participants reported a lack of trust in the outcome of telephone consultations because health professionals were unable to see or feel the skin. Delays or difficulties when obtaining appointments and treatments caused frustration. Access to an online eczema resource was reported to have extra value in the context of the pandemic.

Conclusion

Changes to lifestyle and access to healthcare during the pandemic have affected eczema and self‐management. Healthcare settings may want to consider providing extra reassurance around remote consultations.