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. 2022 Jul 4:11:e75893.
doi: 10.7554/eLife.75893.

Investigating the relationship of COVID-19 related stress and media consumption with schizotypy, depression, and anxiety in cross-sectional surveys repeated throughout the pandemic in Germany and the UK

Sarah Daimer  1 , Lorenz L Mihatsch  2   3 , Sharon A S Neufeld  4 , Graham K Murray  4   5 , Franziska Knolle  1   4
Affiliations

Investigating the relationship of COVID-19 related stress and media consumption with schizotypy, depression, and anxiety in cross-sectional surveys repeated throughout the pandemic in Germany and the UK

Sarah Daimer et al. Elife. .

Abstract

Background: Studies report a strong impact of the COVID-19 pandemic and related stressors on the mental well-being of the general population. In this paper, we investigated whether COVID-19 related concerns and social adversity affected schizotypal traits, anxiety, and depression using structural equational modelling. In mediation analyses, we furthermore explored whether these associations were mediated by healthy (sleep and physical exercise) or unhealthy behaviours (drug and alcohol consumption, excessive media use).

Methods: We assessed schizotypy, depression, and anxiety as well as healthy and unhealthy behaviours and a wide range of sociodemographic scores using online surveys from residents of Germany and the United Kingdom over 1 year during the COVID-19 pandemic. Four independent samples were collected (April/May 2020: N=781, September/October 2020: N=498, January/February 2021: N=544, May 2021: N=486). The degree of schizotypy was measured using the Schizotypal Personality Questionnaire (SPQ), anxiety, and depression symptoms were surveyed with the Symptom Checklist (SCL-27), and healthy and unhealthy behaviours were assessed with the Coronavirus Health Impact Survey (CRISIS). Structural equation models were used to consider the influence of COVID-19 related concerns and social adversity on depressive and anxiety-related symptoms and schizotypal traits in relation to certain healthy (sleep and exercise) and unhealthy behaviours (alcohol and drug consumption, excessive media use).

Results: The results revealed that COVID-19 related life concerns were significantly associated with schizotypy in the September/October 2020 and May 2021 surveys, with anxiety in the September/October 2020, January/February 2021, and May 2021 surveys, and with depressive symptoms in all surveys. Social adversity significantly affected the expression of schizotypal traits and depressive and anxiety symptoms in all four surveys. Importantly, we found that excessive media consumption (>4 hr per day) fully mediated the relationship between COVID-19 related life concerns and schizotypal traits in the January/February 2021 survey. Furthermore, several of the surveys showed that excessive media consumption was associated with increased depressive and anxiety-related symptoms in people burdened by COVID-19 related life.

Conclusions: The ongoing uncertainties of the pandemic and the restrictions on social life have a strong impact on mental well-being and especially the expression of schizotypal traits. The negative impact is further boosted by excessive media consumption, which is especially critical for people with high schizotypal traits.

Funding: FK received funding from the European Union's Horizon 2020 (Grant number 754,462). SN received funding from the Cundill Centre for Child and Youth Depression at the Centre for Addiction and Mental Health, Toronto, Canada and the Wellcome Trust Institutional Strategic Support Fund from the University of Cambridge.

Keywords: COVID-19; Schizotypy; epidemiology; global health; human; media consumption; medicine; mental health.

Plain language summary

The 2020 COVID-19 pandemic, and the measures different governments took to contain it, harmed many people’s mental well-being. The restrictions, combined with pandemic-related uncertainty, caused many individuals to experience increased stress, depression, and anxiety. Many people turned to unhealthy behaviours to cope, including consuming more alcohol or drugs, using media excessively, developing poor sleeping habits, or reducing the amount of exercise they did. Stress, drugs, poor sleep, and uncertainty can increase an individual’s risk of developing psychotic symptoms, including delusions, hallucinations, or difficulty thinking clearly. These symptoms may be temporary or part of a more lasting condition, like schizophrenia. The risk of developing these symptoms increases in people with ‘schizotypal traits’, such as a lack of close relationships, paranoia, or unusual or implausible beliefs. These individuals may be especially vulnerable to the harmful mental health effects of the pandemic. Daimer et al. demonstrated that people who were more worried about their life stability or financial situation during the 2020 COVID-19 pandemic had worse mental well-being than those who felt secure. In the experiments, volunteers completed a series of online mental health questionnaires at four different time points during the pandemic. People who reported feeling lonely, having negative thoughts, or experiencing fewer positive social interactions had more symptoms of mental illness. People who experienced more life disruptions also reported more anxiety or depression symptoms and more schizotypal traits. Daily consumption of at least four hours of digital media exacerbated negative mental health symptoms, and people with more pandemic-related life concerns also spent more time on digital media Daimer et al. suggest that increased media consumption among people with pandemic-related hardships may have increased mental health symptoms and schizotypal traits in these individuals. The survey results suggest that maintaining a healthy lifestyle, including meaningful relationships, is essential to staying mentally healthy during extreme situations like a global pandemic. Protective interventions – such as strengthening social support networks, providing mental health education, or increasing mental healthcare provisions – are essential to prevent poor mental health outcomes during future crises.

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Conflict of interest statement

SD, LM, SN, GM, FK No competing interests declared

Figures

Figure 1.
Figure 1.. Progression of COVID-19 cases, deaths, and vaccine rate (first dose) in comparison between Germany and the UK from January 2020 to June 2021.
Germany: 1. State-wise lockdown (LD) on 16 March 2020; UK: 1. National LD on 23 March 2020. Numbers of vaccinations averaged over the week. Data (cases and deaths) taken from the 2019 Novel CoronaVirus CoViD (2019-nCoV) data repository by Johns Hopkins University Center for Systems Science and Engineering (JHU CSSE). Data for UK vaccination rate taken from GOV.UK Coronavirus in the UK (https://coronavirus.data.gov.uk/details/vaccinations) and for the German vaccination rate from Impfdashboard (https://impfdashboard.de/daten). The grey bars mark the time sections of data collection in the present study.
Figure 2.
Figure 2.. Overview of the complete theoretical model for the influence of ‘social adversity’ and ‘COVID-19 related life concerns’ directly on mental health scores and indirectly via healthy and harmful behaviour variables.
The same model was calculated separately for the two exogeneous variables (‘predictors’, left large box) for all four time points. The bold arrows indicate the direct pathways to the three endogenous variables (‘outcomes’). The dashed arrows indicate the indirect pathways from predictor to outcomes via the five mediators (box in the middle). Co19_concerns: COVID-19 related life concerns; Soc_adversity: social adversity; financial_I: financial impact due to the crisis; Restrictions: Perception of the restrictions as stressful; Life_Stability: Concerns about life stability due to the crisis; Change_socR: stressful social relationship changes; Neg_Thoughts: Negative Thoughts during COVID 19; ANX: anxiety symptoms; DEP: depressive Symptoms, SPQ: total sum scores of SPQ.
Figure 3.
Figure 3.. Boxplot of (A) Schizotypal Personality Questionnaire (SPQ), (B) anxiety scores (SCL-27) and (C) depression scores (SCL-27) separately for four time point samples.
The colored dots represent the means of the distributions, the boxplot the median (middle line in the box), the lower and upper quartiles (edges of the box), the area where 95% of the distribution lies (vertical lines), and the outliers (black dots). The respective sample sizes are April-May sample N = 781, September – October sample N = 498, January – February sample N = 544, May sample N = 486.
Figure 4.
Figure 4.. Structural equation model showing a mediator model of the impact of ‘COVID-19 related life concerns’ on depressive and anxiety-related symptoms and Schizotypal traits, via the mediator excessive media use.
The exogeneous latent variable (‘predictor’) had an elevating effect on the endogenous variable (‘outcome’) and the mediator. Black estimates: April/May 2020 survey, purple estimates: September/October 2020 survey, blue estimates: January/February 2021 survey, green estimates: May 2021 survey. Solid, bold lines indicate direct effects; dashed lines indicate indirect effects. Effects are only shown where p<0.05 (see Table 4). Other possible mediators were included in the model, but are not depicted for simplicity, as indirect effects were non-significant (Table 4). ANX: anxiety symptoms; DEP: depressive Symptoms, SPQ: total sum scores of Schizotypal Personality Questionnaire; TP: time point; Co19_concerns: COVID-19 related life concerns.
Figure 5.
Figure 5.. Structural equation model showing a mediator model of the impact of ‘social adversity’ on depressive and anxiety-related symptoms and schizotypal traits and via the mediator excessive media use.
The exogeneous latent variable (‘predictor’) had an elevating effect on the endogenous variable (‘outcome’) and the mediator. We only present significant pathways (p<0.05). Black estimates: April/May 2020 survey, purple estimates: September/October 2020 survey, blue estimates: January/February 2021, green estimates: May 2021 survey. Solid, bold lines indicate direct effects; dashed lines indicate indirect effects. Other possible mediators were included in the model, but are not depicted for simplicity, as indirect effects were non-significant (Table 5). ANX: anxiety symptoms; DEP: depressive Symptoms, SPQ: total sum scores of Schizotypal Personality Questionnaire; TP: time point; Soc_adversity: social adversity.
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