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    Review of 'A three-wave network analysis of COVID-19's impact on schizotypal traits, paranoia and mental health through loneliness.'

    A three-wave network analysis of COVID-19's impact on schizotypal traits, paranoia and mental health through loneliness.Crossref
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    Competing interests:
    I have co-authored a paper with the second author, and have been co-applicants of a conference symposium with the first author.

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    A three-wave network analysis of COVID-19's impact on schizotypal traits, paranoia and mental health through loneliness.

     Keri Ka-Yee Wong (corresponding) ,  Yi Wang,  Gianluca Esposito (2021)
    Background The 2019 coronavirus (COVID-19) pandemic has impacted people’s mental wellbeing. Studies to date have examined the prevalence of mental health symptoms (anxiety, depression, loneliness), yet fewer longitudinal studies have compared across background factors and other psychological variables to identify vulnerable sub-groups. This study tests to what extent higher levels of psychotic-like experiences – indexed by schizotypal traits and paranoia – are associated with various mental health variables 6- and 12-months since April 2020. Methods Over 2,300 adult volunteers (18-89 years, female=74.9%) with access to the study link online were recruited from the UK, USA, Greece, and Italy. Self-reported levels of schizotypy, paranoia, anxiety, depression, aggression, loneliness, and stress from three timepoints (17 April to 13 July 2020, N 1 =1,599; 17 October to 31 January 2021, N 2 =774; and 17 April to 31 July 2021, N 3 =586) were mapped using network analysis and compared across time and background variables (sex, age, income, country). Results Schizotypal traits and paranoia were positively associated with poorer mental health through loneliness, with no effect of age, sex, income levels, countries, and timepoints. Loneliness was the most influential variable across all networks, despite overall reductions in levels of loneliness, schizotypy, paranoia, and aggression during the easing of lockdown. Individuals with higher levels of schizotypal traits/paranoia reported poorer mental health outcomes than individuals in the low-trait groups. Conclusion Schizotypal traits and paranoia are associated with poor mental health outcomes through self-perceived loneliness, suggesting that increasing social/community cohesion may improve individuals’ mental wellbeing in the long run.

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      Review text

      This is a very timely investigation on the relationship between schizotypy, paranoia, loneliness and mood disturbances during the COVID-19 pandemic. The three-wave design and large multi-site sample are unique and precious. I hope the manuscript would do justice to the amount of work that has already been put in by clarifying the following issues:

      1. The conceptuliastion of some words, such as 'mental health', 'wellbeing', and 'symptoms' seems to be blurred throughout the manuscript. For example, it is debatable whether loneliness is considered a symptom (see Abstract) just like anxiety and depression. While anxiety and depression have established cutoffs and are typically considered as sympotms within numerous clearly defined psychiatric disorders, the construct of loneliness may or may not be clinical/ symptomatic. In this paper, loneliness has been phrased as 'symptom' in Abstract, but 'problem' on p. 3, and 'feelings' on p. 4. Another example is p. 4 (last paragraph): 'four studies have investigated paranoia and schizotypal personality traits in relation to mental health during the pandemic' - it is not clear what 'mental health' is referred to here. From the abstract, my guess is that 'mental health' means anxiety, depression, and loneliness, but it wasn't made clear. Moreover, it wasn't clear why then paranoia wouldn't also be part of mental health?

      2. On a related note, while the authors set out to consider 'psychotic-like experiences' as indexed by schizotypal personal disorder and paranoia (see p. 3), the studies cited focused on mistrust and suspicion only, i.e. concepts of paranoia rather the PLE (which is broader). Freeman et al (2020) was cited (p. 4, paragraph 2) as follows: 'Psychotic-like experiences as highlighted in a large representative sample of UK adults in April 2020...'. However, while Freeman et al (2020) used a paranoia measure (R-GPTS) and a trust barometer, they did not include a PLE measure. It would be easier for readers to follow if the constructs of concern are discussed with more clarity.

      3. On p. 4 (paragraph 2), a range of variables have been suggested to be consequences of lockdown restrictions (e.g. loneliness, anxiety and PLE), but it wasn't clear how the authors think that these variables may contribute to each other. Even though network analysis is a data-driven approach, a bit more theoretical discussion of the expected directions of associations would still be helpful for interpretation of results.

      4. On p. 6 (paragraph 1), the authors specified the lockdown periods in the UK. However, this was a multi-site sample and it wasn't clear whether the same periods would be relevant to lockdown measures in other sites. If not, then it needs to be specified in the Introduction and Discussion sections so as to facilitate interpretation of results.

      5. Hypothese: what are 'social networks' in the context of hypothesis 2? [check also the expression of 'psychological networks' on p. 9 last paragraph]. Hypotheses are supposed to be tested for or against, but the way hypothesis 2 is phrased isn't testifiable. In addition, why is the 3-wave design not mentioned in the hypotheses?

      6. Since the 3-wave design is a major design element, which certainly reflects the amount of work involved in this study, it would seem fitting for more discussion on the 3-wave design and use of network analysis to be included in the Introduction section. In particular, as network analyses can be done in multiple ways, it would be helpful if the authors link the specific type of network analysis with the research question in the Introduction section. e.g. Why were the 3 time points needed? Should readers expect to see 3 separate networks? Were the strengths of edges (within each network) of interest, or the changes in edges across networks?

      7. This manuscript will benefit from thorough proof-reading and grammar check.



      2021-10-04 08:05 UTC
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