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      Mechanisms of parental distress during and after the first COVID-19 lockdown phase: A two-wave longitudinal study

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          Abstract

          Background

          In these unpredictable times of the global coronavirus disease 2019 (COVID-19) pandemic, parents worldwide are affected by the stress and strain caused by the physical distancing protocols that have been put in place.

          Objective

          In a two‐wave longitudinal survey, we investigated the levels of parental stress and symptoms of anxiety and depression in a sample of parents at two time points; during the implementation of the strictest physical distancing protocols following the onset of the COVID-19 pandemic (T1, N = 2,868) and three months after the discontinuation of the protocols (T2, N = 1,489). Further, we investigated the relationships between parental stress and anxiety and depression relative to relationship quality and anger toward their children at the two aforementioned time points, including subgroups based on age, parental role, cultural background, relationship status, education level, number of children, employment status and pre-existing psychiatric diagnosis.

          Methods and findings

          Parents were asked to fill out a set of validated questionnaires on the two measurement points. Parental stress significantly decreased from T1 to T2, indicating that the cumulative stress that parents experienced during the implementation of the distancing protocols declined when the protocols were phased out. The decrease of perceived parental stress was accompanied by a significant decrease in the symptoms of both depression and anxiety among the participating parents. Symptoms meeting the clinical cut-offs for depression (23.0%) and generalized anxiety disorder (23.3%) were reported among participating parents at T1, compared to 16.8% and 13.8% at T2, respectively. The reduction in depression and anger toward their child(ren) from T1 to T2 was associated with a reduction of parental stress. Relationship quality and anger toward their child(ren) at T1 further predicted a change in the level of parental stress from T1 to T2.

          Conclusions

          The study underlines the negative psychological impacts of the implementation of the distancing protocols on parents’ health and well-being. Uncovering the nature of how these constructs are associated with parents and families facing a social crisis such as the ongoing pandemic may contribute to the design of relevant interventions to reduce parental distress and strengthen parental coping and resilience.

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          Most cited references61

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          A brief measure for assessing generalized anxiety disorder: the GAD-7.

          Generalized anxiety disorder (GAD) is one of the most common mental disorders; however, there is no brief clinical measure for assessing GAD. The objective of this study was to develop a brief self-report scale to identify probable cases of GAD and evaluate its reliability and validity. A criterion-standard study was performed in 15 primary care clinics in the United States from November 2004 through June 2005. Of a total of 2740 adult patients completing a study questionnaire, 965 patients had a telephone interview with a mental health professional within 1 week. For criterion and construct validity, GAD self-report scale diagnoses were compared with independent diagnoses made by mental health professionals; functional status measures; disability days; and health care use. A 7-item anxiety scale (GAD-7) had good reliability, as well as criterion, construct, factorial, and procedural validity. A cut point was identified that optimized sensitivity (89%) and specificity (82%). Increasing scores on the scale were strongly associated with multiple domains of functional impairment (all 6 Medical Outcomes Study Short-Form General Health Survey scales and disability days). Although GAD and depression symptoms frequently co-occurred, factor analysis confirmed them as distinct dimensions. Moreover, GAD and depression symptoms had differing but independent effects on functional impairment and disability. There was good agreement between self-report and interviewer-administered versions of the scale. The GAD-7 is a valid and efficient tool for screening for GAD and assessing its severity in clinical practice and research.
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            The PHQ-9: validity of a brief depression severity measure.

            While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity. The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as "0" (not at all) to "3" (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients. As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score > or =10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples. In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.
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              The psychological impact of quarantine and how to reduce it: rapid review of the evidence

              Summary The December, 2019 coronavirus disease outbreak has seen many countries ask people who have potentially come into contact with the infection to isolate themselves at home or in a dedicated quarantine facility. Decisions on how to apply quarantine should be based on the best available evidence. We did a Review of the psychological impact of quarantine using three electronic databases. Of 3166 papers found, 24 are included in this Review. Most reviewed studies reported negative psychological effects including post-traumatic stress symptoms, confusion, and anger. Stressors included longer quarantine duration, infection fears, frustration, boredom, inadequate supplies, inadequate information, financial loss, and stigma. Some researchers have suggested long-lasting effects. In situations where quarantine is deemed necessary, officials should quarantine individuals for no longer than required, provide clear rationale for quarantine and information about protocols, and ensure sufficient supplies are provided. Appeals to altruism by reminding the public about the benefits of quarantine to wider society can be favourable.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Formal analysisRole: MethodologyRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: MethodologyRole: SoftwareRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: InvestigationRole: MethodologyRole: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                24 June 2021
                2021
                24 June 2021
                : 16
                : 6
                : e0253087
                Affiliations
                [1 ] Oslo Metropolitan University, Oslo, Norway
                [2 ] Department of Psychology, University of Oslo, Oslo, Norway
                [3 ] Modum Bad Psychiatric Hospital, Vikersund, Norway
                China Agricultural University, CHINA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                https://orcid.org/0000-0001-7486-2859
                https://orcid.org/0000-0002-8335-2217
                https://orcid.org/0000-0001-7190-4187
                Article
                PONE-D-21-00346
                10.1371/journal.pone.0253087
                8224894
                34166429
                978ed0ce-aff0-44dd-b041-606bb44745d6
                © 2021 Johnson et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 6 January 2021
                : 27 May 2021
                Page count
                Figures: 0, Tables: 5, Pages: 17
                Funding
                The authors received no specific funding for this work.
                Categories
                Research Article
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Psychological Stress
                Biology and Life Sciences
                Psychology
                Psychological Stress
                Social Sciences
                Psychology
                Psychological Stress
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Mood Disorders
                Depression
                Medicine and Health Sciences
                Epidemiology
                Pandemics
                Medicine and Health Sciences
                Medical Conditions
                Infectious Diseases
                Viral Diseases
                Covid 19
                Biology and Life Sciences
                Psychology
                Emotions
                Anxiety
                Social Sciences
                Psychology
                Emotions
                Anxiety
                Medicine and Health Sciences
                Mental Health and Psychiatry
                People and Places
                Population Groupings
                Age Groups
                Children
                People and Places
                Population Groupings
                Families
                Children
                People and Places
                Geographical Locations
                Europe
                Norway
                Custom metadata
                The ethical approval granted by the Regional Committees for Medical and Health Research Ethics in Norway (REK and NSD) and in accordance to the information given to the participants in the informed consent form regarding the use of data, does not allow the authors to submit the data to a public repository. In line with the ethics approval, the data are to be kept at a secure server only accessible by the authors of this study. The data are stored at the TSD-system, which is part of the long-term storage facility at the University of Oslo. TSD uses regular back-up thus the data is well secured. Data will be stored at least five years in accordance to the ethical approval granted by the Regional Committees for Medical and Health Research Ethics in Norway. Access to the data can be granted following ethical approval of suggested project plan for the use of data from NSD and REK. The data will then be anonymized and further stored at the TSD-system. Such requests are to be sent to Associate Professor, Miriam S. Johnson, Department of Behavioral Sciences, Oslo Metropolitan University, email: mirsin@ 123456oslomet.no , Associate Professor, Sverre Urnes Johnson, Department of Psychology, University of Oslo, Email: s.u.johnson@ 123456psykologi.uio.no , or to psychologist Omid V. Ebrahimi, Email: omid.ebrahimi@ 123456psykologi.uio.no . Although the authors cannot make their study’s data publicly available at the time of publication, all authors commit to make the data underlying the findings described in this study fully available without restriction to those who request the data, in compliance with the PLOS Data Availability policy. For data sets involving personally identifiable information or other sensitive data, data sharing is contingent on the data being handled appropriately by the data requester and in accordance with all applicable local requirements.
                COVID-19

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