Psychological mechanisms of the development of suicidal ideation: Longitudinal cohort study.

INTRODUCTION: This study aimed to investigate the mechanisms of the development of suicidal ideation and its moderating and protective factors. Drawing on the Interpersonal-psychological theory of suicide, we proposed that disruptions to belongingness, in conjunction with tolerance of health risk, may influence the development of suicidal ideation above and beyond psychosocial changes such as disruptions to finances and work. METHODS: The study involved a longitudinal investigation of an Australian representative sample reporting suicidal ideation fortnightly for 12 weeks between March and June 2020. RESULTS: The results indicated that participants who reported higher levels of belongingness, mastery, and intolerance of health risk were less likely to experience suicidal ideation and had lower severity of suicidal ideation. Mastery significantly strengthened the negative link between belongingness and the incidence of suicidal ideation, while agreeableness significantly strengthened the negative link between belongingness and the severity of suicidal ideation over time. CONCLUSION: The findings suggest that supporting effective social connectedness during times of isolation and promoting self-efficacy, mastery, and regulation of risk tolerance, may be crucial for suicide prevention and therapeutic intervention.

Testing a syndemics perspective on the effects of multiple adversities on depression and anxiety symptoms in a representative population sample.

PURPOSE: Considerable empirical evidence indicates that stressful life experiences may have a negative impact on mental health. However, it is unclear how multiple adverse experiences may intersect to influence symptoms of depression and anxiety. Using a syndemics approach to identify potential synergistic effects between major stressors, we aimed to quantify the roles of multiple recent adverse life experiences on depression and anxiety symptoms. METHODS: A population-representative sample of 1090 Australian adults (53% women, Mage 47 years) completed a cross-sectional survey in 2022 that assessed mental health and retrospective reports of nine specific stressful life experiences in the past year. RESULTS: The most common adverse life experiences in the past year were financial problems (64%), loneliness (63%), or a major health problem (51%). In multivariate logistic regression analyses, financial problems, personal health problems, health problems in a close contact, relationship problems and loneliness were significantly associated with both depression and anxiety symptoms (p < 0.05). There was just one synergistic interaction and one buffering interaction of combined adversities on anxiety, and no synergistic interactions of adverse experiences on depression. The perceived impact of combined adversities was associated with both depression (b = 0.59, p < 0.001) and anxiety (b = 0.48, p < 0.001). CONCLUSION: Adversity was strongly associated with depression and anxiety. Inconsistent with a syndemics framework, there were very few synergistic relationships between different types of adversities, suggesting that different adverse experiences may independently influence mental health. The findings indicate important opportunities for early intervention to prevent depression and anxiety during difficult times.

Autistic traits are associated with differences in the perception of genuineness and approachability in emotional facial expressions, independently of alexithymia.

People with autism and higher levels of autistic traits often have difficulty interpreting facial emotion. Research has commonly investigated the association between autistic traits and expression labeling ability. Here, we investigated the association between two relatively understudied abilities, namely, judging whether expressions reflect genuine emotion, and using expressions to make social approach judgements, in a nonclinical sample of undergraduates at an Australian university (N = 149; data collected during 2018). Autistic traits were associated with more difficulty discriminating genuineness and less typical social approach judgements. Importantly, we also investigated whether these associations could be explained by the co-occurring personality trait alexithymia, which describes a difficulty interpreting one's own emotions. Alexithymia is hypothesized to be the source of many emotional difficulties experienced by autistic people and often accounts for expression labeling difficulties associated with autism and autistic traits. In contrast, the current results provided no evidence that alexithymia is associated with differences in genuineness discrimination and social approach judgements. Rather, differences varied as a function of individual differences in specific domains of autistic traits. More autistic-like social skills and communication predicted greater difficulty in genuineness discrimination, and more autistic-like social skills and attention to details and patterns predicted differences in approach judgements. These findings suggest that difficulties in these areas are likely to be better understood as features of the autism phenotype than of alexithymia. Finally, results highlight the importance of considering the authenticity of emotional expressions, with associations between differences in approach judgements being more pronounced for genuine emotional expressions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Cognitive reappraisal moderates the protective effect of body satisfaction on mental health and wellbeing in adults: A prospective study during COVID-19 lockdown.

BACKGROUND: Body satisfaction is associated with mental health and well-being in adults. However, prospective studies are needed to better understand its protective effects, and in whom these are most beneficial. This study investigated body satisfaction as a predictor of depressive symptoms, generalised anxiety, and well-being in a representative Australian sample collected during the initial COVID-19 lockdown. Two emotion regulation strategies - cognitive reappraisal and expressive suppression - were also tested as moderating variables. METHODS: The sample comprised 684 adults aged 19 to 87 years who completed three primary waves of data spanning two months [Wave 3 (W3), W4 and W7] from the Australian National COVID-19 Mental Health, Behaviour and Risk Communication Survey. RESULTS: Hierarchical multiple regression models controlling for demographic and COVID-19 risk factors, as well as W3 for each outcome variable, indicated that W3 body satisfaction predicted greater W7 well-being, and fewer W7 depressive symptoms and greater W7 well-being in participants reporting low levels of W4 cognitive reappraisal. No moderation for W4 expressive suppression was observed, nor predictive relationships between W3 body satisfaction and W7 anxiety. LIMITATIONS: The two-month follow-up period precludes conclusions relating to the longer-term protective effects of body satisfaction within and beyond the pandemic context. Examination of focal relationships in clinical samples, and inclusion of broader indices of body image, emotion regulation and mental health, is needed in future studies. CONCLUSIONS: Findings suggest body satisfaction warrants attention in community well-being promotion in adults, and may be particularly beneficial for those lack adaptive emotion regulation strategies.

COVID-19 infection associated with poorer mental health in a representative population sample.

OBJECTIVE: There is limited evidence of the direct effects of COVID-19 infection on mental health, and whether these are influenced by vaccination or physical health symptoms. We aimed to investigate the relationships of COVID-19 infection, current symptom presentation, and vaccination status with mental health symptoms in adults. STUDY DESIGN AND SETTING: A cross-sectional sample of the Australian adult population that was representative by age, gender, and location was recruited through market research panels (N = 1407, 51.3% female, mean age 47.9 years). Hierarchical regression analyses were used to examine the associations of COVID-19 infection history and current COVID-19 symptoms with symptoms of depression (Patient Health Questionnaire-9), generalized anxiety (Generalized Anxiety Disorder-7) and social anxiety (Mini-Social Phobia Inventory). RESULTS: COVID-19 infection was associated with significantly higher depression and anxiety symptoms, but only in those who were not fully vaccinated. Current experience of COVID-related symptoms was associated with significantly higher depression and anxiety symptoms, and attenuated the direct effect of infection on mental health outcomes to non-significance. CONCLUSION: COVID-19 infection may be associated with increased mental health symptoms. However, the effects of infection on mental health were primarily evident in those who were not fully vaccinated and were explained by greater physical health problems associated with COVID-19 infection. The findings reinforce the efficacy of vaccination for reducing physical and mental health symptoms following infection.

Four best-practice recommendations for improving the conceptualization and operationalization of motivational intensity: Reply to Kaczmarek and Harmon-Jones.

Replies to the comments made by Kaczmarek and Harmon-Jones (see record 2024-44184-002) on the current authors original article (see record 2021-21096-001). Kaczmarek and Harmon-Jones (2023) provide a commentary on our original empirical piece, does motivational intensity exist distinct from valence and arousal? (Campbell et al., 2021). In this response, we articulate the motivation behind our work, including the major issues with the conceptualization and operationalization of motivational intensity in prior literature. For example, while motivational intensity was proposed to replace valence as the determinant of cognitive scope more than a decade and a half ago, in both this original work and ongoing work since then, motivational intensity has been operationalized in a variety of questionable ways, including via participants' ratings of valence, rather than motivational intensity. That is, in multiple studies, differences in cognitive processes measured in two conditions have been attributed to motivational intensity which was not explicitly measured, while the conditions do demonstrably differ in the valence participants experienced. We explain exactly what we found in Campbell et al. (2021) and our subsequent follow-up work (Campbell et al., 2023), and what aspects of our interpretation converge versus diverge with the views offered in Kaczmarek and Harmon-Jones' commentary. We also identify four important recommendations for best-practice research going forward. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

AI Hyperrealism: Why AI Faces Are Perceived as More Real Than Human Ones.

Recent evidence shows that AI-generated faces are now indistinguishable from human faces. However, algorithms are trained disproportionately on White faces, and thus White AI faces may appear especially realistic. In Experiment 1 (N = 124 adults), alongside our reanalysis of previously published data, we showed that White AI faces are judged as human more often than actual human faces-a phenomenon we term AI hyperrealism. Paradoxically, people who made the most errors in this task were the most confident (a Dunning-Kruger effect). In Experiment 2 (N = 610 adults), we used face-space theory and participant qualitative reports to identify key facial attributes that distinguish AI from human faces but were misinterpreted by participants, leading to AI hyperrealism. However, the attributes permitted high accuracy using machine learning. These findings illustrate how psychological theory can inform understanding of AI outputs and provide direction for debiasing AI algorithms, thereby promoting the ethical use of AI.

Estimating statistical power for ERP studies using the auditory N1, Tb, and P2 components.

The N1, Tb, and P2 components of the event-related potential (ERP) are thought to reflect the sequential processing of auditory stimuli in the human brain. Despite their extensive use in biological, cognitive, and clinical neuroscience, there are no guidelines for how to appropriately power ERP studies using these components. In the present study, we investigated how the number of trials, number of participants, effect magnitude, and study design influenced statistical power. Using Monte Carlo simulations of ERP data from a passive listening task, we determined the probability of finding a statistically significant effect in 58,900 experiments repeated 1,000 times each. We found that as the number of trials, number of participants, and effect magnitude increased, so did statistical power. We also found that increasing the number of trials had a bigger effect on statistical power for within-subject designs than for between-subject designs, and that within-subject designs required a smaller number of trials and participants to provide the same level of statistical power for a given effect magnitude than between-subject designs. These results show that it is important to carefully consider these factors when designing ERP studies, rather than relying on tradition or anecdotal evidence. To improve the robustness and reproducibility of ERP research, we have built an online statistical power calculator (https://bradleynjack.shinyapps.io/ErpPowerCalculator), which we hope will allow researchers to estimate the statistical power of previous studies, as well as help them design appropriately-powered studies in the future.

Do emotion intensity, variability, differentiation, co-occurrence, and positive-negative ratios make unique contributions to predicting longitudinal change in psychological distress and well-being?

A burgeoning array of affective indices are proposed to capture features of affect that contribute to mental health and well-being. However, because indices are often investigated separately, it is unclear what-if any-unique role they have. The present study addresses this question in a high-stress naturalistic context by prospectively testing the relative contributions of eight affective indices to psychological outcomes during the first acute lockdown phase of the COVID-19 pandemic. Across six fortnightly waves of data collection, participants (N = 613, aged 19 to 87 years) reported how much they experienced five positive and five negative emotions in response to images showing the health and social impacts of the pandemic. We used these ratings to calculate participant-level indices of intensity, variability, and differentiation for positive and negative emotions separately, and positive-negative co-occurrence and ratios. Psychosocial outcome measures were general psychological distress, loneliness, work, and social impairment specifically due to the pandemic, well-being, and coping. On average, psychosocial functioning improved across the lockdown period, and, for most affective indices, bivariate relationships with psychosocial functioning supported existing theory and empirical work. However, multiple regression analyses suggested that the contributions of the individual indices were rarely unique, with most of the change in psychosocial functioning over time being explained by affect intensity and variability. These findings highlight that affective indices should be studied in concert to build a comprehensive and integrated understanding of their role in mental health and well-being. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The Factors Associated With Telehealth Use and Avoidance During the COVID-19 Pandemic: Longitudinal Survey.

BACKGROUND: Social distancing requirements due to the COVID-19 pandemic saw a rapid increase in the delivery of telehealth consultations as an alternative to face-to-face health care services. OBJECTIVE: The aims of this study were to assess the use and acceptability of telehealth during the early stages of the pandemic and identify factors associated with telehealth avoidance during this period. METHODS: Data were obtained from waves 4 and 7 of a longitudinal survey designed to assess the impact of the COVID-19 pandemic on the health and behavior of a representative sample of Australian adults. Participants reported on their use or avoidance of telehealth during the assessment period, as well as the mode of telehealth used and acceptability. RESULTS: Approximately 30% of participants reported using telehealth during the assessment periods, with the most common telehealth modality being the telephone. Acceptance of telehealth was generally high and was higher among those who used telehealth compared with those who did not. Approximately 18% of participants reported avoiding health care due to telehealth. Across assessment waves, avoidance was associated with younger age, speaking a language other than or in addition to English, having a current medical diagnosis, and lower levels of telehealth acceptability. CONCLUSIONS: While most participants in this study were accepting of telehealth services, there remain barriers to use, especially among those from particular sociodemographic groups. At a population level, avoidance of health services in nearly one in five adults may have considerable long-term impacts on morbidity and potentially mortality. Targeted efforts to promote engagement with telehealth services are critical if these adverse outcomes are to be avoided, particularly during periods when access to face-to-face services may be limited.

A three-dimensional model of emotional display rules: Model invariance, external validity, and gender differences.

In this foundational study, we test display rules for a set of 24 theoretically derived emotions to discover the key emotional dimensions underlying this important construct. Participants (Sample 1 [exploratory factor analysis, EFA] N = 339, 18-77 years; Sample 2 [confirmatory factor analysis, CFA] N = 477, 20-81 years) rated how important it was to control expressions of each emotion for them personally (self-rules). Sample 1 also gave ratings for other people (men-rules and women-rules). EFA revealed a three-dimensional (3D) structure, comprising emotions that have harmonious/affiliative (e.g., happiness, sympathy), vulnerable (e.g., sadness, shame), and disharmonious/dominant (e.g., anger, contempt) social implications. CFA confirmed the 3D model fit the data well, and demonstrated invariance between the two samples; men and women; different stages of the adult life span; and the three rule-types. The model also demonstrated good internal consistency and external validity via associations with individual differences in emotion regulation, emotion beliefs, and social anxiety. We then used the model to investigate theorized gender differences in display rules. Men's and women's self-rules did not differ, aligning with several previous studies. However, significant within-gender differences emerged across the three rule-types: Men believed it was more important for them and other men to control their expressivity than for women to, while women believed it was more important for them personally to control their expressivity than for everyone else to, including other women. Overall, our findings establish a novel model that highlights the social motivations underlying emotional display rules, paving the way for new understanding across contexts, cultural groups, and individuals. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Why the other-race effect matters: Poor recognition of other-race faces impacts everyday social interactions.

What happens to everyday social interactions when other-race recognition fails? Here, we provide the first formal investigation of this question. We gave East Asian international students (N = 89) a questionnaire concerning their experiences of the other-race effect (ORE) in Australia, and a laboratory test of their objective other-race face recognition deficit using the Cambridge Face Memory Test (CFMT). As a 'perpetrator' of the ORE, participants reported that their problems telling apart Caucasian people contributed significantly to difficulties socializing with them. Moreover, the severity of this problem correlated with their ORE on the CFMT. As a 'victim' of the ORE, participants reported that Caucasians' problems telling them apart also contributed to difficulties socializing. Further, 81% of participants had been confused with other Asians by a Caucasian authority figure (e.g., university tutor, workplace boss), resulting in varying levels of upset/difficulty. When compared to previously established contributors to international students' high rates of social isolation, ORE-related problems were perceived as equally important as the language barrier and only moderately less important than cultural differences. We conclude that the real-world impact of the ORE extends beyond previously identified specialized settings (eyewitness testimony, security), to common everyday situations experienced by all humans.

Motivational direction diverges from valence for sadness, anger, and amusement: A role for appraisals?

Recent work has cast doubt on whether the strength of motivation (strength of avoidance or approach tendencies) experienced while viewing emotion-eliciting pictures is dissociable from felt valence (negative versus positive). The present study extended this work by testing specific discrete emotions (amusement, anger, awe, desire, sadness). Previous work has proposed separate motivational direction (avoid versus approach) from valence. In Study 1, participants (N = 60) rated the motivational direction or valence they experienced while viewing 100 pictures that each evoked one of the five discrete emotions. We found significant differences between average motivational direction and valence ratings for sadness, anger, and amusement. Critically, underlying these averages, we found that while valence responses were highly consistent, there was large variability in motivational direction, with some people indicating they wanted to approach and others indicating they wanted to avoid while viewing the same picture. Individual differences in motivational direction were largest for sadness, so in Study 2 (N = 100) we tested whether they were predicted by appraisals of the situation (e.g., ratings of how welcome or useful people believed their help would be). The three appraisals tested accounted for 64% of the variance in motivational direction, after which valence made a very small unique contribution. These findings highlight that motivational direction and valence can diverge. Given the variability in individuals' motivational direction responses, future studies designed to assess the effects of motivational direction on cognitive processes need to tailor stimuli for each participant to ensure they activate the intended motivational direction. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The Psychological Benefits of an Uncertain World: Hope and Optimism in the Face of Existential Threat.

We examine how prior mental health predicts hopes and how hopes predict subsequent mental health, testing hypotheses in a longitudinal study with an Australian nation-wide adult sample regarding mental health consequences of the COVID-19 outbreak during its initial stage. Quota sampling was used to select a sample representative of the adult Australian population in terms of age groups, gender, and geographical location. Mental health measures were selected to include those with the best psychometric properties. Hypotheses were tested using generalized linear models with random intercepts, with the type of GLM determined by the nature of the dependent variable. Greater anxiety, depression, distress, and loneliness predict less hope, but impaired quality of life and stress positively predict hopes of gaining new skills. Distress and loneliness predict hopes for social connectedness and an improved society, suggesting that predictors of hope depend on what is hoped for. These findings suggest the need for more nuanced theories of hope. Greater hopes for societal improvement predict lower anxiety, depression, distress, and impaired quality of life, but greater hopes for skills and better mental health predict higher levels of these covariates. Moreover, when relevant prior psychological states are more intense, the impact of hope state declines. These findings indicate that the consequences of hope are heterogeneous, and suggest a possible explanation for the seemingly inconsistent therapeutic effectiveness of raising hope.

Effects of the COVID-19 pandemic on suicidal ideation in a representative Australian population sample-Longitudinal cohort study.

OBJECTIVE: The direct and indirect mental health impacts of the COVID-19 pandemic are considerable. However, it is unclear how suicidal ideation was affected in communities during the acute lockdown phase of the pandemic, and over the longer-term. This study provides longitudinal data on the prevalence of, and risk factors for, suicidal ideation in the Australian national population, during the pandemic. METHOD: The Australian National COVID-19 Mental Health and Risk Communication Survey assessed a nationally representative sample of Australian adults (N = 1296) fortnightly for 12 weeks from late-March to June 2020 (7 waves), and again in March 2021 (wave 8). Cox proportional hazards models examined demographic and pandemic-related risk factors for suicidal ideation over time. RESULTS: Prevalence of suicidal ideation was high but steady at ∼18% across the acute lockdown phase of the pandemic, and 16.2% in March 2021. People who had direct experience with COVID-19 (tested, diagnosed, or contact with someone who was diagnosed) had increased risk for suicidal ideation. Higher pandemic-related work and social impairment, recent adversity, loneliness, and being younger were also associated with increased risk of suicidal ideation over time. CONCLUSION: Both the direct and indirect impacts of COVID-19 were associated with increased risk for suicidal ideation over time, although prevalence did not vary over time. The high prevalence of suicidal ideation in our sample flags a critical need for accessible mental health support, and findings provide insights into the factors placing people at risk during the pandemic.

Observers perceive the Duchenne marker as signaling only intensity for sad expressions, not genuine emotion.

The Duchenne marker-crow's feet wrinkles at the corner of the eyes-has a reputation for signaling genuine positive emotion in smiles. Here, we test whether this facial action might be better conceptualized as a marker of emotional intensity, rather than genuineness per se, and examine its perceptual outcomes beyond smiling, in sad expressions. For smiles, we found ratings of emotional intensity (how happy a face is) were unable to fully account for the effect of Duchenne status (present vs. absent) on ratings of emotion genuineness. The Duchenne marker made a unique direct contribution to the perceived genuineness of smiles, supporting its reputation for signaling genuine emotion in smiling. In contrast, across 4 experiments, we found Duchenne sad expressions were not rated as any more genuine or sincere than non-Duchenne ones. The Duchenne marker did however make sad expressions look sadder and more negative, just like it made smiles look happier and more positive. Together, these findings argue the Duchenne marker has an important role in sad as well as smiling expressions, but is interpreted differently in sad expressions (contributions to intensity only) compared with smiles (emotion genuineness independently of intensity). (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A systematic survey of face stimuli used in psychological research 2000-2020.

For decades, psychology has relied on highly standardized images to understand how people respond to faces. Many of these stimuli are rigorously generated and supported by excellent normative data; as such, they have played an important role in the development of face science. However, there is now clear evidence that testing with ambient images (i.e., naturalistic images "in the wild") and including expressions that are spontaneous can lead to new and important insights. To precisely quantify the extent to which our current knowledge base has relied on standardized and posed stimuli, we systematically surveyed the face stimuli used in 12 key journals in this field across 2000-2020 (N = 3374 articles). Although a small number of posed expression databases continue to dominate the literature, the use of spontaneous expressions seems to be increasing. However, there has been no increase in the use of ambient or dynamic stimuli over time. The vast majority of articles have used highly standardized and nonmoving pictures of faces. An emerging trend is that virtual faces are being used as stand-ins for human faces in research. Overall, the results of the present survey highlight that there has been a significant imbalance in favor of standardized face stimuli. We argue that psychology would benefit from a more balanced approach because ambient and spontaneous stimuli have much to offer. We advocate a cognitive ethological approach that involves studying face processing in natural settings as well as the lab, incorporating more stimuli from "the wild".

Cause or symptom? A longitudinal test of bidirectional relationships between emotion regulation strategies and mental health symptoms.

Previous work has generally conceptualized emotion regulation as contributing to mental health outcomes, and not vice versa. The present study challenges this assumption by using a prospective design to investigate the directionality of underlying relationships between emotion regulation and mental health in the context of a major population-level stressor. We surveyed a large nationally representative sample of adults (18-91 years, N = 704) at three 1-month intervals across the acute lockdown phase of the COVID-19 pandemic in Australia, using standardized measures of depression and anxiety symptoms. At each time point, we also measured the use of two emotion regulation strategies-cognitive reappraisal and emotional suppression-previously associated with adaptive and maladaptive mental health outcomes, respectively. We found cognitive reappraisal was unrelated to mental health symptoms. In contrast, greater emotional suppression was robustly associated with higher symptom levels for both depression and anxiety. Longitudinal analyses revealed this association reflected bidirectional relationships. Higher symptoms of depression and anxiety each predicted greater subsequent use of emotional suppression, and greater use of emotional suppression predicted higher subsequent symptoms. This bidirectionality suggests emotional suppression is both symptomatic and predictive of psychological distress. The lack of a relationship for cognitive reappraisal is discussed with respect to the pandemic context and evidence that high stress might reduce people's ability to use this strategy effectively. Given the strong emphasis on reappraisal in clinical practice, there is a critical need to understand for whom, what and when this strategy is helpful. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Associations of loneliness, belongingness and health behaviors with psychological distress and wellbeing during COVID-19.

BACKGROUND: The aim of this study was to assess the effects of loneliness, belongingness and other modifiable factors on psychological distress and wellbeing and whether the effects of COVID-19 modulated these relationships. METHODS: The current study reported on 1217 participants aged 18 years or older who completed an online survey from 28 to 31 March 2020. Survey measures included demographic characteristics; exposure to COVID-19; impact of COVID-19 on employment, finance, and work and social adjustment; loneliness, thwarted belongingness, and health behavior changes as modifiable factors. Outcome measures were psychological distress and wellbeing. RESULTS: Linear regression models revealed that COVID-19 related work and social adjustment difficulties, financial distress, loneliness, thwarted belongingness, eating a less healthy diet poorer sleep and being female were all associated with increased psychological distress and reduced wellbeing (p < 0.05). Psychological distress was more elevated for those with high difficulties adjusting to COVID-19 and high levels of thwarted belongingness (p < 0.005). Similarly, as COVID-19 related work and social adjustment difficulties increased, wellbeing reduced. This was more pronounced in those who felt lower levels of loneliness (p < 0.0001). Other interactions between COVID-19 impacts were observed with gender and poorer diet for psychological distress and cigarette use, age and gender for wellbeing (p < 0.05). LIMITATIONS: The study was cross-sectional, preventing causal interpretation of the relationships. CONCLUSION: Modifiable factors, age and gender had significant impacts on psychological distress and wellbeing. Public health and policy approaches to improving social, economic and lifestyle factors may mitigate the negative mental health effects of the pandemic and its restrictions.

Trajectories of depression and anxiety symptoms during the COVID-19 pandemic in a representative Australian adult cohort.

OBJECTIVES: To estimate initial levels of symptoms of depression and anxiety, and their changes during the early months of the COVID-19 pandemic in Australia; to identify trajectories of symptoms of depression and anxiety; to identify factors associated with these trajectories. DESIGN, SETTING, PARTICIPANTS: Longitudinal cohort study; seven fortnightly online surveys of a representative sample of 1296 Australian adults from the beginning of COVID-19-related restrictions in late March 2020 to mid-June 2020. MAIN OUTCOME MEASURES: Symptoms of depression and anxiety, measured with the Patient Health Questionnaire (PHQ-9) depression and Generalised Anxiety Disorder (GAD-7) scales; trajectories of symptom change. RESULTS: Younger age, being female, greater COVID-19-related work and social impairment, COVID-19-related financial distress, having a neurological or mental illness diagnosis, and recent adversity were each significantly associated with higher baseline depression and anxiety scores. Growth mixture models identified three latent trajectories for depression symptoms (low throughout the study, 81% of participants; moderate throughout the study, 10%; initially severe then declining, 9%) and four for anxiety symptoms (low throughout the study, 77%; initially moderate then increasing, 10%; initially moderate then declining, 5%; initially mild then increasing before again declining, 8%). Factors statistically associated with not having a low symptom trajectory included mental disorder diagnoses, COVID-19-related financial distress and social and work impairment, and bushfire exposure. CONCLUSION: Our longitudinal data enabled identification of distinct symptom trajectories during the first three months of the COVID-19 pandemic in Australia. Early intervention to ensure that vulnerable people are clinically and socially supported during a pandemic should be a priority.