Mental health inequalities, challenges and support needs during COVID-19: a qualitative study of 14-to-25-year-olds in London.

OBJECTIVES: The impact of the COVID-19 pandemic on adolescent's mental health and relationships has received growing attention, yet the challenges and support needs of adolescents living in existing deprivation are not well understood. The current qualitative study, part of a broader project cocreating mental health and life-skill workshops with young people, documents adolescents' lived experience and support needs 4 years on from the COVID-19 pandemic. DESIGN: 20 semi-structured interviews and 6 focus groups were transcribed and thematically analysed in NVivo V.12 to inform codesigned workshops to support adolescents' needs. SETTING: Islington borough in North London, United Kingdom. PARTICIPANTS: 20 adolescents aged 14-25 years (mean=18.3; 60% female, 60% white) from Islington with a history of difficulties (eg, mental health, deprivation, court order) were referred by Islington local authority teams to our study. RESULTS: Thematic analyses revealed eight themes on adolescents' COVID-19 experiences and five associated suggestions on 'support needs': health challenges and support; relationships and support; routines and support; educational challenges and learning support; inequality and support; distrust; loss of opportunities and grief. CONCLUSIONS: In our qualitative study, adolescents spoke of positive reflections, challenges, and need for support 4 years on from the COVID-19 pandemic. Many adolescents shared their lived experiences for the first time with someone else and wished they would have the space and time to acknowledge this period of loss. Adolescents living with existing inequality and deprivation before the pandemic have reported sustained and exacerbated impacts during the pandemic, hence coproduced support for adolescents should be a priority.

Impact of the COVID-19 pandemic on young people from black and mixed ethnic groups' mental health in West London: a qualitative study.

OBJECTIVES: The COVID-19 pandemic has disproportionately impacted vulnerable groups' physical and mental health, especially young people and minority ethnic groups, yet little is known about the crux of their experiences and what support they would like. To address this gap, this qualitative study aims to uncover the effect of the COVID-19 outbreak on young people with ethnic minority backgrounds' mental health, how this changed since the end of lockdown and what support they need to cope with these issues. DESIGN: The study utilised semi-structured interviews to conduct a phenomenological analysis. SETTING: Community centre in West London, England. PARTICIPANTS: Ten 15 min in-person semistructured interviews were conducted with young people aged 12-17 years old from black and mixed ethnic groups who regularly attend the community centre. RESULTS: Through Interpretative Phenomenological Analysis, results indicated that the participants' mental health was negatively impacted by the COVID-19 pandemic, with feelings of loneliness being the most common experience. However, positive effects were concurrently observed including improved well-being and better coping strategies post lockdown, which is a testament to the young people's resilience. That said, it is clear that young people from minority ethnic backgrounds lacked support during the COVID-19 pandemic and would now need psychological, practical and relational assistance to cope with these challenges. CONCLUSIONS: While future studies would benefit from a larger ethnically diverse sample, this is a start. Study findings have the potential to inform future government policies around mental health support and access for young people from ethnic minority groups, notably prioritising support for grassroots initiatives during times of crisis.

Nutrition, Sleep, and Exercise as Healthy Behaviors in Schizotypy: A Scoping Review.

This scoping review identifies the role of nutrition, sleep, and exercise as healthy behaviors in non-clinical individuals with schizotypy throughout the lifespan. METHODS: We systematically reviewed the existing literature on these topics through databases including: PsycINFO, Scopus, APA PsycNet, ScienceDirect, Wiley Online Library, and SpringerLink. RESULTS: Of the 59 studies found, a total of 29 studies met the inclusion criteria on the review topic. Included studies reflect varying study designs (cross-sectional, multiple time-point, intervention, randomized-placebo controlled trials), assessment of schizotypy and associated healthy behaviors, focus on various samples and lifespan (e.g., undergraduates, adolescents, at-risk individuals), and stem from different countries. CONCLUSION: While a moderate number of studies address the role of nutrition, sleep, and physical exercise in relation to schizotypy, studies intersecting these topics are limited. Of the limited studies that do exist, the majority are correlational with the beginnings of causal support from intervention studies. As such, more research is needed on the topics of nutrition, sleep, and exercise in relation to schizotypy. Specifically, future research should focus on providing a more holistic understanding of schizotypal traits and its subtypes, and which specific or combination of behaviors may reduce levels of schizotypy.

Reflections, resilience and recovery: a qualitative study of Covid-19's impact on an international adult population's mental health and priorities for support.

The impact of the coronavirus 2019 (Covid-19) pandemic on different countries and populations is well documented in quantitative studies, with some studies showing stable mental health symptoms and others showing fluctuating symptoms. However, the reasons behind why some symptoms are stable and others change are under-explored, which in turn makes identifying the types of support needed by participants themselves challenging. To address these gaps, this study thematically analysed 925 qualitative responses from five open-ended responses collected in the UCL-Penn Global COVID Study between 17 April and 31 July 2021 (Wave 3). Three key themes that comprised 13 codes were reported by participants across countries and ages regarding the impact of Covid-19 on their health, both mental and physical, and livelihoods. These include: (1) Outlook on self/life, (2) Self-improvement, and (3) Loved ones (friends and family). In terms of support, while 2.91% did not require additional support, 91% wanted support beyond financial support. Other unexpected new themes were also discussed regarding vulnerable populations suffering disproportionately. The pandemic has brought into sharp focus various changes in people's mental health, physical health and relationships. Greater policy considerations should be given to supporting citizens' continued access to mental health when considering pandemic recovery.

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

The 2019 coronavirus (Covid-19) pandemic has impacted people's mental wellbeing. Studies to date have examined the prevalence of mental health symptoms (anxiety and depression), yet fewer longitudinal studies have compared across background factors and other psychological variables to identify vulnerable subgroups in the general population. This study tests to what extent higher levels of schizotypal traits and paranoia are associated with mental health variables 6- and 12-months since April 2020. Over 2300 adult volunteers (18-89 years, female = 74.9%) with access to the study link online were recruited from the UK, the 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, N1 = 1599; 17 October to 31 January 2021, N2 = 774; and 17 April to 31 July 2021, N3 = 586) were mapped using network analysis and compared across time and background variables (sex, age, income, country). 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 (time 3). Individuals with higher levels of schizotypal traits/paranoia reported poorer mental health outcomes than individuals in the low-trait groups. Schizotypal traits and paranoia are associated with poor mental health outcomes through self-perceived feelings of loneliness, suggesting that increasing social/community cohesion may improve individuals' mental wellbeing in the long run.

Self-perceived loneliness and depression during the Covid-19 pandemic: a two-wave replication study.

The global Covid-19 pandemic has forced countries to impose strict lockdown restrictions and mandatory stay-at-home orders with varying impacts on individual's health. Combining a data-driven machine learning paradigm and a statistical approach, our previous paper documented a U-shaped pattern in levels of self-perceived loneliness in both the UK and Greek populations during the first lockdown (17 April to 17 July 2020). The current paper aimed to test the robustness of these results by focusing on data from the first and second lockdown waves in the UK. We tested a) the impact of the chosen model on the identification of the most time-sensitive variable in the period spent in lockdown. Two new machine learning models - namely, support vector regressor (SVR) and multiple linear regressor (MLR) were adopted to identify the most time-sensitive variable in the UK dataset from Wave 1 (n = 435). In the second part of the study, we tested b) whether the pattern of self-perceived loneliness found in the first UK national lockdown was generalisable to the second wave of the UK lockdown (17 October 2020 to 31 January 2021). To do so, data from Wave 2 of the UK lockdown (n = 263) was used to conduct a graphical inspection of the week-by-week distribution of self-perceived loneliness scores. In both SVR and MLR models, depressive symptoms resulted to be the most time-sensitive variable during the lockdown period. Statistical analysis of depressive symptoms by week of lockdown resulted in a U-shaped pattern between weeks 3 and 7 of Wave 1 of the UK national lockdown. Furthermore, although the sample size by week in Wave 2 was too small to have a meaningful statistical insight, a graphical U-shaped distribution between weeks 3 and 9 of lockdown was observed. Consistent with past studies, these preliminary results suggest that self-perceived loneliness and depressive symptoms may be two of the most relevant symptoms to address when imposing lockdown restrictions.

Child externalising and internalising behaviour and parental wellbeing during the Covid-19 pandemic.

In this study we surveyed families' experiences with parental depression, stress, relationship conflict and child behavioural issues during 6 months of the coronavirus (Covid-19) pandemic through the Covid-19: Global Social Trust and Mental Health Study. The current analyses used data collected from online surveys completed by adults in 66 countries from 17 April 2020 to 13 July 2020 (Wave I), followed by surveys 6 months later at Wave II (17 October 2020-31 January 2021). Analyses were limited to 175 adult parents who reported living with at least one child under 18 years old at Wave I. Parents reported on children's level of externalising and internalising behaviour at Wave I. At Wave II, parents completed self-reported measures of stress, depression and inter-partner conflict. Child externalising behaviour at Wave I significantly predicted higher levels of parental stress at Wave II, controlling for covariates. Child internalising behaviour at Wave I did not predict parental stress or depression, controlling for covariates. Neither child externalising nor internalising behaviour predicted parental relationship conflict. The overall findings demonstrate that child behaviour likely influenced parental stress during the Covid-19 pandemic. Findings suggest that mental health interventions for children and parents may improve the family system during times of disaster.

The effects of cumulative stressful educational events on the mental health of doctoral students during the Covid-19 pandemic.

High rates of psychological distress including anxiety and depression are common in the doctoral community and the learning environment has a role to play. With the coronavirus disease (Covid-19) pandemic taking a toll on mental health it is necessary to explore the risk and protective factors for this population. Using data from the Covid-19: Global Study of Social Trust and Mental Health, the present study examined the relationship between Covid-19-related stressful educational experiences and doctoral students' mental health problems. Moreover, it assessed the role of attentional ability and coping skills in promoting good mental health. One hundred and fifty-five doctoral students completed an online survey where micro-, meso- and macro-level educational stressors were measured. The Patient Health Questionnaire and the Generalized Anxiety Disorder Questionnaire were used to measure depression and anxiety symptoms, respectively. We also measured coping skills using a 13-item scale and attentional ability using a questionnaire. The results of multiple linear regression analyses showed that specific stressful educational experiences were unrelated but cumulative stressful educational experiences were related to increased depression symptoms (but not anxiety symptoms) in fully adjusted models. Additionally, higher coping skills and attentional ability were related to fewer depression and anxiety symptoms. Finally, no associations between demographics and other covariates and mental health problems were found. The experience of multiple educational stressful events in their learning environment due to Covid-19 is a key risk factor for increased mental illness in the doctoral community. This could be explained by the uncertainty that the Covid-19 pandemic has caused to the students.

Is it good to be bad? An evolutionary analysis of the adaptive potential of psychopathic traits.

Although psychopathy is widely conceptualised as a mental disorder, some researchers question the maladaptive nature of psychopathy, and argue that it might be advantageous from an evolutionary point of view. According to this view, psychopathy can be seen as an evolutionary adaptative strategy that relies on deception and manipulation to gain short-term reproductive benefits. Psychopathy is also identified as a fast life strategy in response to early life stress and an adaptation to harsh environments. This paper investigates the evidence that psychopathic traits are adaptive, while also addressing the limitations of current evolutionary models of psychopathy based on frequency-dependent selection and life history theory. We review recent studies on the fitness correlates of psychopathy and find that psychopathic traits present potential adaptive trade-offs between fertility and mortality, and offspring quantity and quality. On a proximate level, individual differences in stress reactivity and environmental risk factors in early development predispose to psychopathy through gene-environment interactions. We propose that environmental, developmental, social and cultural factors can mediate the relationship between psychopathic traits and fitness and therefore should be considered to make accurate predictions on the adaptive potential of psychopathy. We end by outlining gaps in the literature and making recommendations for future evolutionary research on psychopathy.

I'm alone but not lonely. U-shaped pattern of self-perceived loneliness during the COVID-19 pandemic in the UK and Greece.

OBJECTIVES: In the past months, many countries have adopted varying degrees of lockdown restrictions to control the spread of the COVID-19 virus. According to the existing literature, some consequences of lockdown restrictions on people's lives are beginning to emerge yet the evolution of such consequences in relation to the time spent in lockdown is understudied. To inform policies involving lockdown restrictions, this study adopted a data-driven Machine Learning approach to uncover the short-term time-related effects of lockdown on people's physical and mental health. STUDY DESIGN: An online questionnaire was launched on 17 April 2020, distributed through convenience sampling and was self-completed by 2,276 people from 66 different countries. METHODS: Focusing on the UK sample (N = 325), 12 aggregated variables representing the participant's living environment, physical and mental health were used to train a RandomForest model to estimate the week of survey completion. RESULTS: Using an index of importance, Self-Perceived Loneliness was identified as the most influential variable for estimating the time spent in lockdown. A significant U-shaped curve emerged for loneliness levels, with lower scores reported by participants who took part in the study during the 6th lockdown week (p = 0.009). The same pattern was replicated in the Greek sample (N = 137) for week 4 (p = 0.012) and 6 (p = 0.009) of lockdown. CONCLUSIONS: From the trained Machine Learning model and the subsequent statistical analysis, Self-Perceived Loneliness varied across time in lockdown in the UK and Greek populations, with lower symptoms reported during the 4th and 6th lockdown weeks. This supports the dissociation between social support and loneliness, and suggests that social support strategies could be effective even in times of social isolation.

Internalizing and externalizing problems across childhood and psychotic-like experiences in young-adulthood: The role of developmental period.

BACKGROUND: Psychopathology in childhood and adolescence, commonly indexed by co-occurring internalizing and externalizing problem behaviors, has been found to predict psychotic-like experiences (PLEs) in adults. However, studies to date have rarely examined internalizing and externalizing problem behaviors simultaneously or identified in which developmental period do these problem behaviors predict PLEs in adults. This study tests to what extent internalizing and externalizing problem behaviors in childhood (4-9 years) or adolescence (11-16 years) predict PLEs in young-adulthood (18 years). METHODS: Parent-rated child internalizing and externalizing problems on the Strengths and Difficulties Questionnaire at ages 4, 6, 8, 9, 11, 13, and 16 years from the Avon Longitudinal Study of Parents and Children (N = 4717) were modelled using two-piece latent growth curve modelling to predict clinician-rated PLEs at age 18 years, controlling for confounders (gender, ethnicity, socio-economic status, parental education and stressful life events) assessed prior to baseline at age 4 years. RESULTS: Controlling for confounders, an increase in childhood internalizing problems from 4 to 9 years and externalizing problems at baseline (at 4 years) predicted PLEs at 18 years, explaining 9.5% of the variance in adult PLEs. These associations were independent to controls for any changes in adolescent internalizing and externalizing problems from 11 to 16 years. CONCLUSIONS: High baseline levels of externalizing problems and increasing internalizing problems throughout childhood can predict PLEs at 18 years. Externalizing problems around the transition to primary school and internalizing problems throughout childhood may be particularly helpful in informing risk of PLEs in young-adulthood.

The Schizotypal Personality Questionnaire for Children (SPQ-C): Factor Structure, Child Abuse, and Family History of Schizotypy.

There is a relative dearth of research on features of schizotypal personality in children, in part due to lack of instrumentation. This study tests 5 competing models of the factor structure of the self-report Schizotypal Personality Questionnaire for Children (SPQ-C) and examines its relationship with a family history of schizotypal personality disorder (SPD), child abuse, and stability over time. Hypotheses were tested on 454 11- to 12-year-old schoolchildren and their caregivers. Confirmatory factor analyses supported a 3-factor structure of the SPQ-C (cognitive-perceptual, interpersonal, and disorganized). Test-retest stability was relatively robust over 3 months (r = .67), 6 months (r = .64), and 12 months (r = .55), with acceptable internal reliabilities (r = .84 to .91). Regarding construct validity, children with a biological family history of SPD had higher scores on all 3 factors (d =.51). Abused children had higher schizotypy scores (d = .55). A genetic × environment interaction was observed, with schizotypy highest in those with both a family history of schizotypy and also child abuse. Findings are the first in the child schizotypy field to document a gene × environment interaction and the independence of child abuse from confounding genetic influences. Results support the utility of the SPQ-C in future family and clinical studies of schizotypal personality and provide an avenue for much-needed and neglected research into the early antecedents of child schizotypal personality.

Applying network analysis to investigate the links between dimensional schizotypy and cognitive and affective empathy.

BACKGROUND: Although impairment in empathy has been reported in schizophrenia spectrum disorders, little is known about the relationship between empathy and schizotypal traits. This study examines this relationship by applying network analysis to a large sample collected at 18-months follow-up in a longitudinal dataset. METHODS: One thousand four hundred and eighty-six college students were recruited and completed a set of self-reported questionnaires on empathy, schizotypy, depression, anxiety and stress. Networks were constructed by taking the subscale scores of these measures as nodes and partial correlations between each pair of nodes as edges. Network Comparison Tests were performed to investigate the differences between individuals with high and low schizotypy. RESULTS: Cognitive and affective empathy were strongly connected with negative schizotypy in the network. Physical and social anhedonia showed high centrality measured by strength, closeness and betweenness while anxiety and stress showed high expected influence. Predictability ranged from 22.4% (personal distress) to 79.9% (anxiety) with an average of 54.4%. Compared with the low schizotypy group, the high schizotypy group showed higher global strength (S = 0.813, p < 0.05) and significant differences in network structure (M = 0.531, p < 0.001) and strength of edges connecting empathy with schizotypy (adjusted ps < 0.05). LIMITATIONS: Only self-rating scales were used, and disorganized schizotypy was not included. CONCLUSIONS: Our findings suggest that the cognitive and affective components of empathy and dimensions of schizotypy are closely related in the general population and their network interactions may play an important role in individuals with high schizotypy.

Peer Problems and Low Self-esteem Mediate the Suspicious and Non-suspicious Schizotypy-Reactive Aggression Relationship in Children and Adolescents.

The relationship between schizophrenia and violence has been well-established. Yet very little prior research exists on the factors that might explain the nature of this relationship and even fewer studies seek to clarify the etiology of aggressive behavior in adolescents with specific features of schizotypal personality that might help improve the specificity of intervention. The current study tested whether one dimension of schizotypy alone (i.e., the 'suspicious' feature) or the other 8 dimensions (i.e., the 'non-suspicious' features) were particularly associated with aggressive behaviors (reactive and proactive aggression), and if peer problems and low self-esteem mediated these relationships. A serial multiple mediation model testing the hypothesized flow from suspicious and non-suspicious schizotypy to peer problems to low self-esteem and to increased aggression was tested in Hong Kong schoolchildren aged 8- to 14-years (N = 1412; Mage = 11.47, SD = 1.67 years, female = 47.6%). Increased suspicious and non-suspicious schizotypal features were found to be independently associated with increased reactive aggression, but not proactive aggression. Children with high levels of suspicious schizotypy and non-suspicious schizotypy were more likely to have poor peer problems and low self-esteem concurrently, which in turn was associated with reactive aggression only. This explanatory model suggests that future longitudinal intervention studies that enhance self-esteem in schizotypal adolescents may potentially reduce co-morbid reactive aggressive behaviors too.

The Schizotypal Personality Questionnaire - Child (SPQ-C): Psychometric properties and relations to behavioral problems with multi-informant ratings.

The Schizotypal Personality Questionnaire (SPQ) is one of the most widely used screening tools for schizotypy in adults. The Schizotypal Personality Questionnaire-Child version (SPQ-C) was recently developed to assess schizotypy in children and has a similar three-factor structure to the adult SPQ (i.e., Cognitive-Perceptual, Interpersonal-Affective, and Disorganization). However, few studies to date have reported on the psychometric properties and the usefulness of the SPQ-C in Eastern populations, including Mainland China. This study presents the first psychometric assessment of the Chinese SPQ-C in Mainland China. Exploratory factor analysis and confirmatory factor analysis were used to assess the factor structure of the SPQ-C in 1668 children (M = 12.10, SD = 0.60 years) from the China Jintan Child Cohort Study. Our findings document a three-factor structure and partial measurement invariance across residential location and gender, replicating the psychometric properties of the SPQ-C in English. The Chinese SPQ-C further correlates with standard behavioral problems (i.e., Child Behavior Checklist, Youth Self-Report and Teacher Report Form), demonstrating construct validity and utility as a child psychopathology assessment tool. Our findings provide the first robust psychometric evidence for a three-factor structure of the Chinese SPQ-C in a large Mainland Chinese sample, and suggest that the SPQ-C is suitable as a screening tool for schizotypy in community children who may be at risk for behavioral problems and later psychosis.

The effect of being left home alone at age 3 years on schizotypy and antisocial behavior at ages 17 and 23 years.

OBJECTIVE: Negative home environments are associated with both schizophrenia-spectrum disorders and crime, but whether this is due to the social or cognitive sequelae of such environments is unclear. This study investigates the effect of early home environments on adult mental health. METHOD: Using data from the Mauritius Child Health Project, a multiple time-point prospective study where all children born in 1969 in two towns (Quatre Bornes and Vacaos) were recruited at age 3 years (N = 1794), a group of children left home alone at age 3 (n = 34) were compared to children cared for by siblings/relatives (n = 222), or by mothers (n = 1498) on antisocial behavior and schizotypal personality at ages 11, 17, and 23 years. RESULTS: Home alone children showed higher scores on psychotic behavior and conduct disorder at age 17, and also schizotypal personality and crime at 23 years compared to the other groups. No negative behavioral or cognitive effects were observed at age 11. Findings were not accounted for by social adversity or ethnicity and appear to be 'sleeper effects' in that they do not emerge until later adolescence and into adulthood. CONCLUSIONS: Findings appear to be the first to show the negative effects of dual-parental daytime absence on adult schizotypy and crime, a finding that cannot be accounted for by verbal and spatial cognitive impairments. Results suggest an early common psychosocial denominator to the two comorbid conditions of antisocial behavior and schizotypy.

Suspiciousness in young minds: Convergent evidence from non-clinical, clinical and community twin samples.

BACKGROUND: We validated the Social Mistrust Scale (SMS) and utilized it to examine the structure, prevalence, and heritability of social mistrust in a large sample of Chinese children and adolescents. METHODS: In Study 1, a large sample of healthy twins (N=2094) aged 8 to 14years (M=10.27years, SD=2) completed the SMS. Structural equation modeling (SEM) was conducted to assess the structure of the SMS and to estimate the heritability of social mistrust in a sub-sample of twins (n=756 pairs). In Study 2, 32 adolescents with childhood-onset schizophrenia were compared with 34 healthy controls on levels of suspiciousness and clinical symptoms to examine the associations between the SMS and the Positive and Negative Syndrome Scale (PANSS). RESULTS: We found a three-factor structure for social mistrust (home, school, and general mistrust). Social mistrust was found to be moderately - heritable (19%-40%), with mistrust at home most strongly influenced by genetic factors. Compared with 11.76% of the healthy controls, 56.25% of the adolescents with early-onset schizophrenia exhibited very high levels of social mistrust on all three subscales of the SMS. The SMS exhibited good discriminant validity in distinguishing adolescents with childhood-onset schizophrenia from healthy controls and showed associations with a broad range of symptoms assessed by the PANSS. CONCLUSIONS: Social mistrust assessed by the SMS may be heritable. The SMS demonstrates good discriminant validity with clinical diagnoses of schizophrenia. However, it seems to be correlated with multiple aspects of psychopathology in the schizophrenia group, rather than being specific to delusional ideation/paranoia.