Psychological distress, wellbeing and resilience: modelling adolescent mental health profiles during the COVID-19 pandemic

There has been concern about adolescent mental health during the pandemic. The current study examined adolescent mental health during the initial phase of the COVID-19 pandemic in the UK. Using indicator of psychological distress, wellbeing and resilience, latent profile analysis was used to identify homogeneous mental health groups among young people aged 13-24 (N = 1971). Multinomial logistic regression was then used to examine which sociodemographic and psychosocial variables predicted latent class membership. Four classes were found. The largest class (Class 1, 37.2%) was characterised by moderate symptomology and moderate wellbeing. Class 2 (34.2%) was characterised by low symptomology and high wellbeing, while Class 3 (25.4%) was characterised by moderate symptomology and high wellbeing. Finally, Class 4 was the smallest (3.2%) and was characterised by high symptomology and low wellbeing. Compared to the low symptomology, high wellbeing class, all other classes were associated with less social engagement with friends, poorer family functioning, greater somatic symptoms, and a less positive model of self. A number of unique associations between the classes and predictor variables were identified. Although around two-thirds of adolescents reported moderate-to-high symptomology, most of these individuals also reported concurrent moderate-to-high levels of wellbeing, reflecting resilience. Furthermore, these findings demonstrate how a more comprehensive picture of mental health can be gained through adopting a dual-continua conceptualisation of mental health that incorporates both pathology and well-being. In this way, at-risk youth can be identified and interventions and resources targeted appropriately.

The network structure of psychopathological and resilient responses to the pandemic: A multicountry general population study of depression and anxiety

Commonly identified patterns of psychological distress in response to adverse events are characterized by resilience (i.e., little to no distress), delayed (i.e., distress that increases over time), recovery (i.e., distress followed by a gradual decrease over time), and sustained (i.e., distress remaining stable over time). This study aimed to examine these response patterns during the COVID-19 pandemic. Anxiety and depressive symptom data collected across four European countries over the first year of the pandemic were analyzed (N = 3,594). Participants were first categorized into groups based on the four described patterns. Network connectivity and symptom clustering were then estimated for each group and compared. Two thirds (63.6%) of the sample displayed a resilience pattern. The sustained distress network (16.3%) showed higher connectivity than the recovery network (10.0%) group, p = .031; however, the resilient network showed higher connectivity than the delayed network (10.1%) group, p = .016. Regarding symptom clustering, more clusters emerged in the recovery network (i.e., three) than the sustained network (i.e., two). These results replicate findings that resilience was the most common mental health pattern over the first pandemic year. Moreover, they suggest that high network connectivity may be indicative of a stable mental health response over time, whereas fewer clusters may be indicative of a sustained distress pattern. Although exploratory, the network perspective provides a useful tool for examining the complexity of psychological responses to adverse events and, if replicated, could be useful in identifying indicators of protection against or vulnerability to future psychological distress.

A network approach to understanding social distancing behaviour during the first UK lockdown of the COVID-19 pandemic

OBJECTIVE

Given the highly infectious nature of COVID-19, social distancing practices are key in stemming the spread of the virus. We aimed to assess the complex interplay among psychological factors, socio-demographic characteristics and social distancing behaviours within the framework of the widely used Capability, Opportunity, Motivation-Behaviour (COM-B) model.

DESIGN

The present research employed network psychometrics on data collected during the first UK lockdown in April 2020 as part of the COVID-19 Psychological Research Consortium (C19PRC) Study. Using a network approach, we examined the predictions of psychological and demographic variables onto social distancing practices at two levels of analysis: macro and micro.

RESULTS

Our findings revealed several factors that influenced social distancing behaviour during the first UK lockdown. The COM-B model was successful in predicting particular aspects of social-distancing via the influence of psychological capability and motivation at the macro-and micro-levels, respectively. Notably, demographic variables, such as education, income, and age, were directly and uniquely predictive of certain social distancing behaviours.

CONCLUSION

Our findings reveal psychological factors that are key predictors of social distancing behaviour and also illustrate how demographic variables directly influence such behaviour. Our research has implications for the design of empirically-driven interventions to promote adherence to social distancing practices in this and future pandemics.

Supplemental data for this article is available online at.

Symptoms and levels of ICD-11 Prolonged Grief Disorder in a representative community sample of UK adults

BACKGROUND

Prolonged Grief Disorder (PGD) is a new disorder included in ICD-11 (WHO, 2018). There is a growing body of literature surrounding the prevalence and correlates of ICD-11 PGD symptoms as assessed using various measures. This study was the first to assess levels of ICD-11 PGD symptoms as measured by the International Prolonged Grief Disorder Scale (IPGDS), a self-report scale directly aligned with the ICD-11 definition of PGD, among the United Kingdom adult general population, and identify correlates.

METHOD

Participants included 2025 adults who participated in Wave 5 of the COVID-19 Psychological Research Consortium Study (C19PRC-UK). Prevalence rates of PGD were estimated based on two commonly used algorithms defined as 'strict' and 'moderate'. Sociodemographic, loss-related, and mental health correlates (i.e., anxiety, depression, mental health treatment seeking, loneliness) of strict and moderate PGD were then examined using multinomial logistic regressions.

RESULTS

It was found that 2.4% (n = 43) of participants met probable caseness for PGD using the strict criteria while 7.9% (n = 140) met probable caseness for PGD using the moderate criteria. Multinomial logistic regression analysis results showed, as predicted, that income, time since bereavement, death of a child, religiosity, and depression were associated with both moderate and strict PGD. Correlates of moderate PGD included country of residence, urbanicity, younger age of bereaved, and loneliness.

CONCLUSIONS

This study highlights that some symptoms of PGD are commonly reported in the general population, although relatively few meet the criteria for clinical significance. The routine assessment for PGD following a bereavement is discussed and the development of appropriate interventions are recommended.

The development and initial validation of self-report measures of ICD-11 depressive episode and generalized anxiety disorder: The International Depression Questionnaire (IDQ) and the International Anxiety Questionnaire (IAQ)

BACKGROUND

The new International Classification of Diseases came into effect in 2022 (ICD-11; World Health Organization, 2022) and included updated descriptions and diagnostic rules for "Depressive Episode" and "Generalized Anxiety Disorder." No self-report measures align with these disorders so this study reports the development and initial validation of the "International Depression Questionnaire" (IDQ) and "International Anxiety Questionnaire" (IAQ).

METHODS

Items were developed that aligned to the ICD-11 descriptions and their performance was assessed using data from a community sample (N = 2058) that was representative of the United Kingdom adult population.

RESULTS

Item response theory models indicated that the two scales were unidimensional, and the items performed well in terms of difficulty and discrimination. Estimates of internal reliability were high. Based on ICD-11 derived diagnostic algorithms, 7.4% met requirements for ICD-11 Depressive Episode and 7.1% for Generalized Anxiety Disorder.

CONCLUSIONS

The IDQ and the IAQ are short, easy to use, self-report measures aligned to the new and updated ICD-11 diagnostic descriptions. This study provides initial evidence that the scales produce scores that are reliable and valid.

Refuting the myth of a 'tsunami' of mental ill-health in populations affected by COVID-19: evidence that response to the pandemic is heterogeneous, not homogeneous

BACKGROUND

The current study argues that population prevalence estimates for mental health disorders, or changes in mean scores over time, may not adequately reflect the heterogeneity in mental health response to the COVID-19 pandemic within the population.

METHODS

The COVID-19 Psychological Research Consortium (C19PRC) Study is a longitudinal, nationally representative, online survey of UK adults. The current study analysed data from its first three waves of data collection: Wave 1 (March 2020, N = 2025), Wave 2 (April 2020, N = 1406) and Wave 3 (July 2020, N = 1166). Anxiety-depression was measured using the Patient Health Questionnaire Anxiety and Depression Scale (a composite measure of the PHQ-9 and GAD-7) and COVID-19-related posttraumatic stress disorder (PTSD) with the International Trauma Questionnaire. Changes in mental health outcomes were modelled across the three waves. Latent class growth analysis was used to identify subgroups of individuals with different trajectories of change in anxiety-depression and COVID-19 PTSD. Latent class membership was regressed on baseline characteristics.

RESULTS

Overall prevalence of anxiety-depression remained stable, while COVID-19 PTSD reduced between Waves 2 and 3. Heterogeneity in mental health response was found, and hypothesised classes reflecting (i) stability, (ii) improvement and (iii) deterioration in mental health were identified. Psychological factors were most likely to differentiate the improving, deteriorating and high-stable classes from the low-stable mental health trajectories.

CONCLUSIONS

A low-stable profile characterised by little-to-no psychological distress ('resilient' class) was the most common trajectory for both anxiety-depression and COVID-19 PTSD. Monitoring these trajectories is necessary moving forward, in particular for the ~30% of individuals with increasing anxiety-depression levels.

Refuting the myth of a 'tsunami' of mental ill-health in populations affected by COVID-19: evidence that response to the pandemic is heterogeneous, not homogeneous

BACKGROUND

The current study argues that population prevalence estimates for mental health disorders, or changes in mean scores over time, may not adequately reflect the heterogeneity in mental health response to the COVID-19 pandemic within the population.

METHODS

The COVID-19 Psychological Research Consortium (C19PRC) Study is a longitudinal, nationally representative, online survey of UK adults. The current study analysed data from its first three waves of data collection: Wave 1 (March 2020, N = 2025), Wave 2 (April 2020, N = 1406) and Wave 3 (July 2020, N = 1166). Anxiety-depression was measured using the Patient Health Questionnaire Anxiety and Depression Scale (a composite measure of the PHQ-9 and GAD-7) and COVID-19-related posttraumatic stress disorder (PTSD) with the International Trauma Questionnaire. Changes in mental health outcomes were modelled across the three waves. Latent class growth analysis was used to identify subgroups of individuals with different trajectories of change in anxiety-depression and COVID-19 PTSD. Latent class membership was regressed on baseline characteristics.

RESULTS

Overall prevalence of anxiety-depression remained stable, while COVID-19 PTSD reduced between Waves 2 and 3. Heterogeneity in mental health response was found, and hypothesised classes reflecting (i) stability, (ii) improvement and (iii) deterioration in mental health were identified. Psychological factors were most likely to differentiate the improving, deteriorating and high-stable classes from the low-stable mental health trajectories.

CONCLUSIONS

A low-stable profile characterised by little-to-no psychological distress ('resilient' class) was the most common trajectory for both anxiety-depression and COVID-19 PTSD. Monitoring these trajectories is necessary moving forward, in particular for the ~30% of individuals with increasing anxiety-depression levels.

Predicting resilience during the COVID-19 Pandemic in the United Kingdom: Cross-sectional and longitudinal results

Although the COVID-19 pandemic has impacted the psychological wellbeing of some people, there is evidence that many have been much less affected. The Ecological Model of Resilience (EMR) may explain why some individuals are not resilient whilst others are. In this study we test the EMR in a comparison of UK survey data collected from the COVID-19 Psychological Research Consortium (C19PRC) longitudinal study of a representative sample of the United Kingdom (UK) adult population and data from an Italian arm of the study. We first compare data from the third wave of the UK arm of the study, collected in July/August 2020, with data from an equivalent sample and stage of the pandemic in Italy in July 2020. Next, using UK longitudinal data collected from C19PRC Waves 1, 3 and 5, collected between March 2020 and April 2021 we identify the proportion of people who were resilient. Finally, we examine which factors, drawn from the EMR, predict resilient and non-resilient outcomes. We find that the 72% of the UK sample was resilient, in line with the Italian study. In the cross-sectional logistic regression model, age and self-esteem were significantly associated with resilience whilst death anxiety thoughts, neuroticism, loneliness, and Post Traumatic Stress Disorder (PTSD) symptoms related to COVID-19 were significantly associated with Non-Resilient outcomes. In the longitudinal UK analysis, at Wave 5, 80% of the sample was Resilient. Service use, belonging to wider neighbourhood, self-rated health, self-esteem, openness, and externally generated death anxiety were associated with Resilient outcomes. In contrast, PTSD symptoms and loneliness were associated with Non-Resilient outcomes. The EMR effectively explained the results. There were some variables which are amenable to intervention which could increase resilience in the face of similar future challenges.

Tracking the psychological and socio-economic impact of the COVID-19 pandemic in the UK: A methodological report from Wave 5 of the COVID-19 Psychological Research Consortium (C19PRC) Study

OBJECTIVES

The COVID-19 Psychological Research Consortium (C19PRC) Study was established in March 2020 to monitor the psychological and socio-economic impact of the pandemic in the UK and other countries. This paper describes the protocol for Wave 5 (March-April 2021).

METHODS

The survey assessed: COVID-19 related experiences; experiences of common mental health disorders; psychological characteristics; and social and political attitudes. Adults who participated in any previous wave (N = 4949) were re-invited to participate. Weights were calculated using a survey raking algorithm to ensure the longitudinal panel was nationally representative in terms of gender, age, and household income, amongst other factors.

RESULTS

Overall, 2520 adults participated. A total of 2377 adults who participated in the previous survey wave (November-December 2020) were re-interviewed at Wave 5 (61.5% retention rate). Attrition between these two waves was predicted by younger age, lower household income, children living in the household, and treatment for mental health difficulties. Of the adults recruited into the C19PRC study at baseline, 57.4% (N = 1162) participated in Wave 5. The raking procedure re-balanced the longitudinal panel to within 1.5% of population estimates for selected socio-demographic characteristics.

CONCLUSION

This paper outlines the growing strength of the publicly available C19PRC Study data for COVID-19-related interdisciplinary research.

An 18-month follow-up of the Covid-19 psychology research consortium study panel: Survey design and fieldwork procedures for Wave 6

OBJECTIVES

Established in March 2020, the C19PRC Study monitors the psychological and socio-economic impact of the pandemic in the UK and other countries. This paper describes the protocol for Wave 6 (August-September 2021).

METHODS

The survey assessed: COVID-19 related experiences; experiences of common mental health disorders; psychological characteristics; and social and political attitudes. Adult participants from any previous wave (N = 3170) were re-invited, and sample replenishment procedures helped manage attrition. Weights were calculated using a survey raking algorithm to ensure the on-going original panel (from baseline) was nationally representative in terms of gender, age, and household income, amongst other factors.

RESULTS

1643 adults were re-interviewed at Wave 6 (51.8% retention rate). Non-participation was higher younger adults, those born outside UK, and adults living in cities. Of the adults recruited at baseline, 54.3% (N = 1100) participated in Wave 6. New respondent (N = 415) entered the panel at this wave, resulting in cross-sectional sample for Wave 6 of 2058 adults. The raking procedure re-balanced the longitudinal panel to within 1.3% of population estimates for selected socio-demographic characteristics.

CONCLUSIONS

This paper outlines the growing strength of the publicly available C19PRC Study data for COVID-19-related interdisciplinary research.

Perceived manageability of debt and mental health during the COVID-19 pandemic: A UK population analysis

Objectives

This study examined the association between perceived manageability of debt and risk of depression, anxiety, and mental health help-seeking among a nationally representative sample of adults living in the United Kingdom (UK).

Methods

Data was derived from the COVID-19 Psychological Research Consortium (C19PRC) Study Wave 6 (August/September 2021) which examined the psychological, social, and economic effects of the COVID-19 pandemic on the UK adult population. Bivariate and logistic regression analyses were conducted to determine the association between different levels of perceived debt manageability (i.e., “easily manageable”, “some problems”, “quite serious problems”, “very serious problems”, “cannot manage at all”) and mental health related outcomes.

Results

Almost a quarter of the sample (24%, n = 494) reported debt management problems, and debt manageability associated with higher levels of anxiety, depression, and mental health help-seeking. After adjusting for demographic variables (e.g. income, receipt of benefits), logistic regression analysis demonstrated a dose-response association between increasing levels of debt manageability problems and mental health outcomes. Specifically, adjusted odds ratios for anxiety ranged from 2.28 (‘some problems’) to 11.18 (‘very serious problems’), for depression ranged from 2.80 (‘some problems’) to 16.21 (‘cannot manage at all’), and for mental health help-seeking ranged from 1.69 (‘some problems’) to 3.18 (‘quite serious problems’, ‘very serious problems’).

Conclusion

This study highlights that debt manageability problems represent a robust predictor of depression, anxiety, and mental-health help seeking.

Left-wing support of authoritarian submission to protect against societal threat

New Zealand’s Prime Minister, Jacinda Ardern, adopted a “go hard, go early” approach to eliminate COVID-19. Although Ardern and her Labour party are considered left-leaning, the policies implemented during the pandemic (e.g., police roadblocks) have the hallmarks of Right-Wing Authoritarianism (RWA). RWA is characterized by three attitudinal clusters (authoritarian aggression, submission, and conventionalism). The uniqueness of the clusters, and whether they react to environmental change, has been debated. Here, in the context of the pandemic, we investigate the relationship between political orientation and RWA. Specifically, we measured political orientation, support for New Zealand’s major political parties, and RWA among 1,430 adult community members. A multivariate Bayesian model demonstrated that, in the middle of a pandemic, both left-leaning and right-leaning individuals endorsed items tapping authoritarian submission. In contrast to authoritarian submission, and demonstrating the multidimensional nature of RWA, we observed the typical relationships between political orientation and authoritarian aggression and conventionalism was observed.

Modelling the complexity of pandemic-related lifestyle quality change and mental health: an analysis of a nationally representative UK general population sample

PURPOSE

The COVID-19 pandemic has affected the way many individuals go about their daily lives. This study attempted to model the complexity of change in lifestyle quality as a result of the COVID-19 pandemic and its context within the UK adult population.

METHODS

Data from the COVID-19 Psychological Research Consortium Study (Wave 3, July 2020; N = 1166) were utilised. A measure of COVID-19-related lifestyle change captured how individuals' lifestyle quality had been altered as a consequence of the pandemic. Exploratory factor analysis and latent profile analysis were used to identify distinct lifestyle quality change subgroups, while multinomial logistic regression analysis was employed to describe class membership.

RESULTS

Five lifestyle dimensions, reflecting partner relationships, health, family and friend relations, personal and social activities, and work life, were identified by the EFA, and seven classes characterised by distinct patterns of change across these dimensions emerged from the LPA: (1) better overall (3.3%), (2) worse except partner relations (6.0%), (3) worse overall (2.5%), (4) better relationships (9.5%), (5) better except partner relations (4.3%), (6) no different (67.9%), and (7) worse partner relations only (6.5%). Predictor variables differentiated membership of classes. Notably, classes 3 and 7 were associated with poorer mental health (COVID-19 related PTSD and suicidal ideation).

CONCLUSIONS

Four months into the pandemic, most individuals' lifestyle quality remained largely unaffected by the crisis. Concerningly however, a substantial minority (15%) experienced worsened lifestyles compared to before the pandemic. In particular, a pronounced deterioration in partner relations seemed to constitute the more severe pandemic-related lifestyle change.

Testing both affordability-availability and psychological-coping mechanisms underlying changes in alcohol use during the COVID-19 pandemic

Two theoretical perspectives have been proffered to explain changes in alcohol use during the pandemic: the ‘affordability-availability’ mechanism (i.e., drinking decreases due to changes in physical availability and/or reduced disposable income) and the ‘psychological-coping’ mechanism (i.e., drinking increases as adults attempt to cope with pandemic-related distress). We tested these alternative perspectives via longitudinal analyses of the COVID-19 Psychological Consortium (C19PRC) Study data (spanning three timepoints during March to July 2020). Respondents provided data on psychological measures (e.g., anxiety, depression, posttraumatic stress, paranoia, extraversion, neuroticism, death anxiety, COVID-19 anxiety, intolerance of uncertainty, resilience), changes in socio-economic circumstances (e.g., income loss, reduced working hours), drinking motives, solitary drinking, and ‘at-risk’ drinking (assessed using a modified version of the AUDIT-C). Structural equation modelling was used to determine (i) whether ‘at-risk’ drinking during the pandemic differed from that recalled before the pandemic, (ii) dimensions of drinking motives and the psychosocial correlates of these dimensions, (iii) if increased alcohol consumption was predicted by drinking motives, solitary drinking, and socio-economic changes. The proportion of adults who recalled engaging in ‘at-risk’ drinking decreased significantly from 35.9% pre-pandemic to 32.0% during the pandemic. Drinking to cope was uniquely predicted by experiences of anxiety and/or depression and low resilience levels. Income loss or reduced working hours were not associated with coping, social enhancement, or conformity drinking motives, nor changes in drinking during lockdown. In the earliest stage of the pandemic, psychological-coping mechanisms may have been a stronger driver to changes in adults’ alcohol use than ‘affordability-availability’ alone.

Measurement invariance of the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder scale (GAD-7) across four European countries during the COVID-19 pandemic

BACKGROUND

The Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder scale (GAD-7) are self-report measures of major depressive disorder and generalised anxiety disorder. The primary aim of this study was to test for differential item functioning (DIF) on the PHQ-9 and GAD-7 items based on age, sex (males and females), and country.

METHOD

Data from nationally representative surveys in UK, Ireland, Spain, and Italy (combined N = 6,054) were used to fit confirmatory factor analytic and multiple-indictor multiple-causes models.

RESULTS

Spain and Italy had higher latent variable means than the UK and Ireland for both anxiety and depression, but there was no evidence for differential items functioning.

CONCLUSIONS

The PHQ-9 and GAD-7 scores were found to be unidimensional, reliable, and largely free of DIF in data from four large nationally representative samples of the general population in the UK, Ireland, Italy and Spain.

Design, content, and fieldwork procedures of the COVID-19 Psychological Research Consortium (C19PRC) Study - Wave 4

OBJECTIVES

This paper outlines fieldwork procedures for Wave 4 of the COVID-19 Psychological Research Consortium (C19PRC) Study in the UK during November-December 2020.

METHODS

Respondents provided data on socio-political attitudes, beliefs, and behaviours, and mental health disorders (anxiety, depression, and posttraumatic stress). In Phase 1, adults (N = 2878) were reinvited to participate. At Phase 2, new recruitment: (i) replenished the longitudinal strand to account for attrition; and (ii) oversampled from the devolved UK nations to facilitate robust between-country analyses for core study outcomes. Weights were calculated using a survey raking algorithm to ensure the longitudinal panel was representative of the baseline sample characteristics.

RESULTS

In Phase 1, 1796 adults were successfully recontacted and provided full interviews at Wave 4 (62.4% retention rate). In Phase 2, 292 new respondents were recruited to replenish the panel, as well as 1779 adults from Wales, Scotland, and Northern Ireland, who were representative of the socio-political composition of the adult populations in these nations. The raking procedure successfully re-balanced the longitudinal panel to within 1% of population estimates for selected socio-demographic characteristics.

CONCLUSION

The C19PRC Study offers a unique opportunity to facilitate and stimulate interdisciplinary research addressing important public health questions relating to the COVID-19 pandemic.

Sharing data to better understand one of the world's most significant shared experiences: data resource profile of the longitudinal COVID-19 psychological research consortium (C19PRC) study

This paper serves to alert IJPDS readers to the availability of a major new longitudinal survey data resource, the COVID-19 Psychological Research Consortium (C19PRC) Study, which is being released for secondary use via the Open Science Framework. The C19PRC Study is a rich and detailed dataset that provides a convenient and valuable foundation from which to study the social, political, and health status of European adults during an unprecedented time of change as a direct result of the COVID-19 pandemic and Brexit. Here, we provide an overview of the C19PRC Study design, with the purpose of stimulating interest about the study among social scientists and maximising use of this resource.

Detecting and describing stability and change in COVID-19 vaccine receptibility in the United Kingdom and Ireland

COVID-19 continues to pose a threat to global public health. Multiple safe and effective vaccines against COVID-19 are available with one-third of the global population now vaccinated. Achieving a sufficient level of vaccine coverage to suppress COVID-19 requires, in part, sufficient acceptance among the public. However, relatively high rates of hesitance and resistance to COVID-19 vaccination persists, threating public health efforts to achieve vaccine-induced population protection. In this study, we examined longitudinal changes in COVID-19 vaccine acceptance, hesitance, and resistance in two nations (the United Kingdom and the Republic of Ireland) during the first nine months of the pandemic, and identified individual and psychological factors associated with consistent non-acceptance of COVID-19 vaccination. Using nationally representative, longitudinal data from the United Kingdom (UK; N = 2025) and Ireland (N = 1041), we found that (1) COVID-19 vaccine acceptance declined in the UK and remained unchanged in Ireland following the emergence of approved vaccines; (2) multiple subgroups existed reflecting people who were consistently willing to be vaccinated ('Accepters': 68% in the UK and 61% in Ireland), consistently unwilling to be vaccinated ('Deniers': 12% in the UK and 16% in Ireland), and who fluctuated over time ('Moveable Middle': 20% in the UK and 23% in Ireland); and (3) the 'deniers' and 'moveable middle' were distinguishable from the 'accepters' on a range of individual (e.g., younger, low income, living alone) and psychological (e.g., distrust of scientists and doctors, conspiracy mindedness) factors. The use of two high-income, Western European nations limits the generalizability of these findings. Nevertheless, understanding how receptibility to COVID-19 vaccination changes as the pandemic unfolds, and the factors that distinguish and characterise those that are hesitant and resistant to vaccination is helpful for public health efforts to achieve vaccine-induced population protection against COVID-19.

Delay discounting and under-valuing of recent information predict poorer adherence to social distancing measures during the COVID-19 pandemic

The COVID-19 pandemic has brought about unprecedented global changes in individual and collective behaviour. To reduce the spread of the virus, public health bodies have promoted social distancing measures while attempting to mitigate their mental health consequences. The current study aimed to identify cognitive predictors of social distancing adherence and mental health symptoms, using computational models derived from delay discounting (the preference for smaller, immediate rewards over larger, delayed rewards) and patch foraging (the ability to trade-off between exploiting a known resource and exploring an unknown one). In a representative sample of the UK population (N = 442), we find that steeper delay discounting predicted poorer adherence to social distancing measures and greater sensitivity to reward magnitude during delay discounting predicted higher levels of anxiety symptoms. Furthermore, under-valuing recently sampled information during foraging independently predicted greater violation of lockdown guidance. Our results suggest that those who show greater discounting of delayed rewards struggle to maintain social distancing. Further, those who adapt faster to new information are better equipped to change their behaviour in response to public health measures. These findings can inform interventions that seek to increase compliance with social distancing measures whilst minimising negative repercussions for mental health.

Context, design and conduct of the longitudinal COVID-19 psychological research consortium study-wave 3

OBJECTIVES

The COVID-19 Psychological Research Consortium (C19PRC) Study aims to assess the impact of the COVID-19 pandemic in the adult population in multiple countries. This paper describes the third wave of the UK survey (the 'parent' strand of the Consortium) during July-August 2020.

METHODS

Adults (N = 2025) who participated in the baseline and/or first follow-up surveys were reinvited to participate in this survey, which assessed: (1) COVID-19 related knowledge, attitudes, and behaviours; (2) the occurrence of common mental disorders; as well as the role of (3) psychological factors and (4) social and political attitudes, in influencing the public's response to the pandemic. Weights were calculated using a survey raking algorithm to ensure that the cross-sectional sample is nationally representative in terms of gender, age, and household income, and representative of the baseline sample characteristics for household composition, ethnicity, urbanicity and born/raised in UK.

RESULTS

1166 adults (57.6% of baseline participants) provided full interviews at Wave 3. The raking procedure successfully re-balanced the cross-sectional sample to within 1% of population estimates across selected socio-demographic characteristics.

CONCLUSION

This paper demonstrates the strength of the C19PRC Study data to facilitate and stimulate interdisciplinary research addressing important public health questions relating to the COVID-19 pandemic.

How does the COVID-19 pandemic impact on population mental health? A network analysis of COVID influences on depression, anxiety and traumatic stress in the UK population

BACKGROUND

The coronavirus disease 2019 (COVID-19) emergency has led to numerous attempts to assess the impact of the pandemic on population mental health. The findings indicate an increase in depression and anxiety but have been limited by the lack of specificity about which aspects of the pandemic (e.g. viral exposure or economic threats) have led to adverse mental health outcomes.

METHODS

Network analyses were conducted on data from wave 1 (N = 2025, recruited 23 March-28 March 2020) and wave 2 (N = 1406, recontacts 22 April-1 May 2020) of the COVID-19 Psychological Research Consortium Study, an online longitudinal survey of a representative sample of the UK adult population. Our models included depression (PHQ-9), generalized anxiety (GAD-7) and trauma symptoms (ITQ); and measures of COVID-specific anxiety, exposure to the virus in self and close others, as well as economic loss due to the pandemic.

RESULTS

A mixed graphical model at wave 1 identified a potential pathway from economic adversity to anxiety symptoms via COVID-specific anxiety. There was no association between viral exposure and symptoms. Ising network models using clinical cut-offs for symptom scores at each wave yielded similar findings, with the exception of a modest effect of viral exposure on trauma symptoms at wave 1 only. Anxiety and depression symptoms formed separate clusters at wave 1 but not wave 2.

CONCLUSIONS

The psychological impact of the pandemic evolved in the early phase of lockdown. COVID-related anxiety may represent the mechanism through which economic consequences of the pandemic are associated with psychiatric symptoms.

Monitoring the psychological, social, and economic impact of the COVID-19 pandemic in the population: Context, design and conduct of the longitudinal COVID-19 psychological research consortium (C19PRC) study

OBJECTIVES

The C19PRC study aims to assess the impact of the COVID-19 pandemic in the adult population of the UK, Republic of Ireland, and Spain. This paper describes the conduct of the first two waves of the UK survey (the "parent" strand of the Consortium) during March-April 2020.

METHODS

A longitudinal, internet panel survey was designed to assess: (1) COVID-19 related knowledge, attitudes, and behaviors; (2) the occurrence of common mental health disorders as well as the role of (3) psychological factors and (4) social and political attitudes, in influencing the public's response to the pandemic. Quota sampling (age, sex, and household income) was used to recruit a nationally representative sample of adults.

RESULTS

Two thousand and twenty five adults were recruited at baseline, and 1406 were followed-up one-month later (69.4% retention rate). The baseline sample was representative of the UK population in relation to economic activity, ethnicity, and household composition. Attrition was predicted by key socio-demographic characteristics, and an inverse probability weighting procedure was employed to ensure the follow-up sample was representative of the baseline sample.

CONCLUSION

The C19PRC study data has strong generalizability to facilitate and stimulate interdisciplinary research on important public health questions relating to the COVID-19 pandemic.

Pandemic buying: Testing a psychological model of over-purchasing and panic buying using data from the United Kingdom and the Republic of Ireland during the early phase of the COVID-19 pandemic

The over-purchasing and hoarding of necessities is a common response to crises, especially in developed economies where there is normally an expectation of plentiful supply. This behaviour was observed internationally during the early stages of the Covid-19 pandemic. In the absence of actual scarcity, this behaviour can be described as 'panic buying' and can lead to temporary shortages. However, there have been few psychological studies of this phenomenon. Here we propose a psychological model of over-purchasing informed by animal foraging theory and make predictions about variables that predict over-purchasing by either exacerbating or mitigating the anticipation of future scarcity. These variables include additional scarcity cues (e.g. loss of income), distress (e.g. depression), psychological factors that draw attention to these cues (e.g. neuroticism) or to reassuring messages (eg. analytical reasoning) or which facilitate over-purchasing (e.g. income). We tested our model in parallel nationally representative internet surveys of the adult general population conducted in the United Kingdom (UK: N = 2025) and the Republic of Ireland (RoI: N = 1041) 52 and 31 days after the first confirmed cases of COVID-19 were detected in the UK and RoI, respectively. About three quarters of participants reported minimal over-purchasing. There was more over-purchasing in RoI vs UK and in urban vs rural areas. When over-purchasing occurred, in both countries it was observed across a wide range of product categories and was accounted for by a single latent factor. It was positively predicted by household income, the presence of children at home, psychological distress (depression, death anxiety), threat sensitivity (right wing authoritarianism) and mistrust of others (paranoia). Analytic reasoning ability had an inhibitory effect. Predictor variables accounted for 36% and 34% of the variance in over-purchasing in the UK and RoI respectively. With some caveats, the data supported our model and points to strategies to mitigate over-purchasing in future crises.

Psychological characteristics associated with COVID-19 vaccine hesitancy and resistance in Ireland and the United Kingdom

Identifying and understanding COVID-19 vaccine hesitancy within distinct populations may aid future public health messaging. Using nationally representative data from the general adult populations of Ireland (N = 1041) and the United Kingdom (UK; N = 2025), we found that vaccine hesitancy/resistance was evident for 35% and 31% of these populations respectively. Vaccine hesitant/resistant respondents in Ireland and the UK differed on a number of sociodemographic and health-related variables but were similar across a broad array of psychological constructs. In both populations, those resistant to a COVID-19 vaccine were less likely to obtain information about the pandemic from traditional and authoritative sources and had similar levels of mistrust in these sources compared to vaccine accepting respondents. Given the geographical proximity and socio-economic similarity of the populations studied, it is not possible to generalize findings to other populations, however, the methodology employed here may be useful to those wishing to understand COVID-19 vaccine hesitancy elsewhere.

Capability, opportunity, and motivation to enact hygienic practices in the early stages of the COVID-19 outbreak in the United Kingdom

OBJECTIVES

The COVID-19 pandemic is one of the greatest global health threats facing humanity in recent memory. This study aimed to explore influences on hygienic practices, a set of key transmission behaviours, in relation to the Capability, Opportunity, Motivation-Behaviour (COM-B) model of behaviour change (Michie et al., 2011).

DESIGN

Data from the first wave of a longitudinal survey study were used, launched in the early stages of the UK COVID-19 pandemic.

METHODS

Participants were 2025 adults aged 18 and older, representative of the UK population, recruited by a survey company from a panel of research participants. Participants self-reported motivation, capability, and opportunity to enact hygienic practices during the COVID-19 outbreak.

RESULTS

Using regression models, we found that all three COM-B components significantly predicted good hygienic practices, with motivation having the greatest influence on behaviour. Breaking this down further, the subscales psychological capability, social opportunity, and reflective motivation positively influenced behaviour. Reflective motivation was largely driving behaviour, with those highest in reflective motivation scoring 51% more on the measure of hygienic practices compared with those with the lowest scores.

CONCLUSIONS

Our findings have clear implications for the design of behaviour change interventions to promote hygienic practices. Interventions should focus on increasing and maintaining motivation to act and include elements that promote and maintain social support and knowledge of COVID-19 transmission. Groups in particular need of targeting for interventions to increase hygienic practices are males and those living in cities and suburbs.

COVID-19-related anxiety predicts somatic symptoms in the UK population

This study aimed to estimate the association between anxiety associated with COVID-19 and somatic symptoms, using data from a large, representative sample (N = 2,025) of the UK adult population. Results showed that moderate to high levels of anxiety associated with COVID-19 were significantly associated with general somatic symptoms and in particular with gastrointestinal and fatigue symptoms. This pattern of associations remained significant after controlling for generalized anxiety disorder (GAD), pre-existing health problems, age, gender, and income. This is the first evidence that anxiety associated with COVID-19 makes a unique contribution to somatization, above and beyond the effect of GAD.

Anxiety, depression, traumatic stress and COVID-19-related anxiety in the UK general population during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic has created an unprecedented global crisis, necessitating drastic changes to living conditions, social life, personal freedom and economic activity. No study has yet examined the presence of psychiatric symptoms in the UK population under similar conditions.

AIMS

We investigated the prevalence of COVID-19-related anxiety, generalised anxiety, depression and trauma symptoms in the UK population during an early phase of the pandemic, and estimated associations with variables likely to influence these symptoms.

METHOD

Between 23 and 28 March 2020, a quota sample of 2025 UK adults aged 18 years and older, stratified by age, gender and household income, was recruited by online survey company Qualtrics. Participants completed standardised measures of depression, generalised anxiety and trauma symptoms relating to the pandemic. Bivariate and multivariate associations were calculated for demographic and health-related variables.

RESULTS

Higher levels of anxiety, depression and trauma symptoms were reported compared with previous population studies, but not dramatically so. Anxiety or depression and trauma symptoms were predicted by young age, presence of children in the home, and high estimates of personal risk. Anxiety and depression were also predicted by low income, loss of income and pre-existing health conditions in self and others. Specific anxiety about COVID-19 was greater in older participants.

CONCLUSIONS

This study showed a modest increase in the prevalence of mental health problems in the early stages of the pandemic, and these problems were predicted by several specific COVID-related variables. Further similar surveys, particularly of those with children at home, are required as the pandemic progresses.

Evaluation of the ability of neurobiological, neurodevelopmental and socio-economic variables to predict cognitive outcome in premature infants

BACKGROUND

When developed in the 1990s, the Neurobiologic Risk Score (NBRS) and Neurodevelopmental Risk Exam (NRE) correlated well with developmental outcomes in premature infants. Given recent advances in neonatology, we assessed their present ability to predict cognitive outcome, alone and combined with socio-economic factors.

METHODS

One hundred and twenty-nine neonates <32 weeks gestational age were assessed at 6, 12 and/or 24 months corrected age with the Cognitive Adaptive Test/Clinical Linguistic and Auditory Milestone Scale (CAT/CLAMS). Indices of socio-economic status included maternal education and marital status.

RESULTS

At 24 months corrected age (n= 67), the NBRS (r=-0.5), maternal education (r= 0.46) and marital status (r= 0.37) correlated with the CAT/CLAMS. These correlations increased when NBRS and maternal education were combined (r= 0.63) and when specific NBRS components (intraventricular haemorrhage, periventricular leukomalacia, seizures) and maternal education were combined (r= 0.66).

CONCLUSIONS

In the contemporary neonatal intensive care unit, measures used to predict cognitive outcome should incorporate both neurobiological risk factors and socio-economic variables.

The impact of maternal malaria on newborns

BACKGROUND

Each year, malaria threatens 125 million pregnancies, and gestational malaria is responsible for up to 200,000 infant deaths in sub-Saharan Africa. With advancing knowledge of malaria in pregnancy and its impact on newborns, improved preventive and therapeutic interventions are possible.

METHODS

We reviewed and, by consensus, evaluated published literature relevant to malaria and newborns. Important findings are summarised.

RESULTS

Pregnant women are more likely than others to be inoculated with and infected by malaria parasites. Poor outcomes are particularly common in primigravid women and their offspring. The placenta is affected through cellular adhesion, cytokine production and mononuclear cell infiltrates. As a result, newborns may have low birthweight owing to intrauterine growth retardation or prematurity. Recent evidence suggests that a subset of these infants is also at higher risk of malaria infections later in life. Preventive strategies to improve maternal and fetal outcomes include intermittent preventive treatment and insecticide-treated bed nets. Asymptomatic malaria infection is not uncommon in newborns, and symptomatic disease occurs. Fever and death are possible during the early days of life, and presentation with a sepsis-like illness can occur during the 1st 2 months of life. Malaria-affected infants face higher than usual risks of infantile anaemia, subsequent malaria infection and death during the 1st year of life.

CONCLUSIONS

Malaria is common during pregnancy and can have serious consequences for neonatal health. Neonatal morbidity and mortality can be significantly reduced by proper implementation of insecticide-treated nets and intermittent preventive treatment.