A series of standardised self-report measures were included in the survey. Many were included in full, whereas some were included in part. The survey also included newly created questions pertaining to COVID-19 exposures, worries, and symptoms. Furthermore, we included a series of questions related to social and traditional media engagements around COVID-19 news. This study was devised in early March and therefore there were no standardised measures available covering the COVID-19 pandemic. To ensure our questions were robust and reliable several academics reviewed them in full and suggested modifications based on the extant knowledge of COVID-19 at the time. This knowledge was based on reliable and trusted sources such as Public Health England, the National Health Service, and the World Health Organisation. These modifications were incorporated in full for the final survey. Further details are below:
Participants provided information regarding their gender, age, marital status, ethnicity, religious status, personal income, and their highest level of educational attainment. Female participants were asked to specify if they were currently pregnant. Participants were also asked to provide information related to education and employment and to indicate whether they themselves or their family members were working in one of the government assigned key worker roles. If they indicated that a family member was a key worker, they were also asked to indicate if they lived as part of the same household.
Participants were asked several questions based on their residential status. Specifically, their place of residence, residence type (‘house’, ‘room in a shared house’, ‘apartment/flat’, ‘student halls’, ‘residential home’ or ‘other), urban vs rural (‘isolated dwelling’, ‘hamlet’, ‘village’, ‘small town’, ‘large town’, ‘city’), and number of bedrooms in place of residence. They were also asked to best describe their housing situation (‘owned outright’, ‘owned with mortgage’, shared ownership’, rented’, ‘living rent free’ or ‘other’). Finally, participants were also asked to specify the number of adults over 18 years and children under 18 years present in their place of residence, and whether they currently owned any pets (and were asked to specify what type or types of pets they had).
Previous Physical or Mental Health Conditions
The survey queried whether participants had ever suffered from a physical or mental health related concern. Specifically, asthma, heart disease, cancer, diabetes, shortness of breath, post-traumatic stress disorder, major depressive disorder, phobia, social phobia, obsessive compulsive disorder, generalised anxiety disorder, psychotic disorders, eating disorders, health anxiety or another kind of chronic condition not specified.
COVID-19 Living Status
Participants were asked to indicate their current living status in relation to COVID-19 at the time of completing the baseline survey (‘I am living as normal’, ‘I am not self-isolating but have cut down my usual activities as a precaution’, ‘I am not self-isolating but have been told to work from home’, ‘I am self-isolating as I do not want to get ill, but I am not high risk, ‘I am self-isolating as I do not want to get ill, but I am regarded as high risk’, ‘I am self-isolating as I do not want others to get ill’, ‘I have been told to self-isolate due to possible symptoms of COVID-19′, ‘I have been told to self-isolate due to a diagnosis of COVID-19′, or ‘I have been ordered by the government or local authority to self-isolate/stay home’.
COVID-19 Related Experiences
Participants were presented with a series of questions in relation to symptom expression, testing, diagnosis (for themselves or loved ones) and exposure to COVID-19 related deaths. Specifically, they were asked (at the time of survey completion) did they know someone who currently has or had in the past been quarantined for COVID-19 due to exposure and whether any of these people have been close family members or friends. Likewise, they were asked to indicate did they know someone who currently has or had in the past been diagnosed with COVID-19 and whether any of these people have been close family members or friends. Participants were also asked to indicate if they were a carer for someone who had been diagnosed with COVID-19.
Participants were also asked whether they themselves were currently in quarantine or had been in quarantine in the past due to COVID-19, whether they had self-isolated in order to avoid infection and whether they were regarded as ‘high risk’. Participants were also asked if they had self-isolated due to government advice and whether they had self-isolated because they had symptoms. Participants were also asked whether they themselves have been tested for COVID-19 and whether they had been diagnosed with COVID-19. Two questions pertained to whether participants had received a flu vaccination in the past year and whether they had had the flu in the past year. Participants were also asked about exposure to COVID-19 related deaths, specifically whether they had experienced the death of a close friend or family member and whether they had been exposed to COVID-19 related deaths due to their occupational role. Finally, participants were asked to indicate whether they experienced any of the following symptoms (‘fever’, ‘cough’, ‘sore throat’, ‘headache’, ‘cold symptoms’ or ‘no symptoms’) at the time of survey completion.
A number of questions queried participants’ media consumption in related to COVID-19. Specifically, they were asked how often they were watching, reading, and hearing reports or updates about COVID-19 on social media, on traditional media and on a dedicated app that has been set up to provide COVID-19 updates. The possible response categories in relation to each type of media consumption were, (1) less than once a day, (2) 1–5 times a day, (3) 6–10 times a day, (4) 11–20 times a day, (5) 20–50 times a day. and (6) more than 50 times a day.
COVID-19 Related Concerns
Participants were asked to indicate how worried they were about several COVID-19 related concerns. Specifically, worries around quarantine/self-isolation, being infected with the virus by others, infecting others with the virus, stigmatisation due to exposure, job security, the financial implications of the outbreak, food shortages, the government’s ability to manage the outbreak, the healthcare systems ability to care for COVID-19 patients, border closures and the impact of school/university closures on children and young adults. Each of these responses were rated on a Likert scale, ranging from 1 (‘Not at all’) to 5 (‘Extremely’). Finally, participants were asked to indicate if they thought school, university or border closures were necessary.
Mental Health Variables
Prior trauma exposure was assessed using the Life Events Checklist for DSM-5 (LEC-5; Weathers et al. 2013a). The LEC-5 contains 17 items measuring trauma exposure and therefore the measure is used to assess whether an individual has been exposed a PTSD ‘Criterion A’ traumatic event. In the current study we added an additional event of ‘Coronavirus’. Participants were asked if any of the 18 stressful life events, as measured by the LEC-5 (plus our single addition), ever happened to them. The possible response categories were ‘yes’ or ‘no’. Participants were asked to keep their answers to the trauma screen in mind and indicate which event they felt was the worst. The possible options were, ‘Natural disaster’; ‘Fire or explosion’; ‘Transportation accident’; ‘Serious accident at work, home, or during recreational activity’; ‘Exposure to toxic substance’; ‘Physical assault’; ‘Assault with a weapon’; ‘Sexual assault,’; ‘Other unwanted or uncomfortable sexual experience’; ‘Combat or exposure to a war zone’; ‘Captivity’; ‘Life threatening illness (not COVID-19)’; ‘witnessing severe human suffering’; ‘Sudden violent death’; ‘Sudden accidental death’; ‘Serious injury, harm, or death you caused to someone else’; ‘Coronavirus’; ‘Other’; ‘None’. Previous research has highlighted excellent psychometric properties of the LEC-5 (Gray et al. 2004).
COVID-19 Related Post-Traumatic Stress Disorder (PTSD)
PTSD was assessed with the PTSD Checklist for DSM-5 (PCL-5; Weathers et al. 2013b). The PTSD checklist contains 20 items reflect the DSM-5 symptom criteria for PTSD. In this study, participants were asked to think about their responses in regard to their COVID-19 related experiences. These 20 items are organised into one of four clusters each reflecting a different aspect of PTSD symptomatology. These clusters are ‘intrusions’, ‘avoidance’, ‘negative alterations in cognition and mood’ and ‘alterations in arousal and reactivity’. Each item of the PCL-5 is rated on a five-point Likert scale (‘0 = Not at all’ to ‘4 = Extremely’), and asks participants to indicate how much each symptom bothered them over the past month. A participant must rate a given item (or symptom) as ‘2 = Moderately’ or higher in order to constitute as valid endorsement of a symptom. In order to meet the criteria for a diagnosis of PTSD, there must first of all be trauma exposure, followed by valid symptom endorsement across each of the PTSD symptom clusters. According to the DSM-5, this requires valid endorsement (a score of 2 or higher) of at least, one ‘intrusions’ item, one ‘avoidance’ item, two ‘negative alterations in cognition and mood’ items and finally, two ‘alterations in arousal and reactivity’ items (American Psychiatric Association [APA] 2013). Additionally, previous empirical research suggests that a total score on the PCL-5 of between 34 is indicative of ‘probable PTSD’ (Murphy et al. 2017). In line with the research outlined above, if a respondent had a score of 34 or above on the PCL-5 they were classified as reporting ‘probable PTSD’. A wealth of previous literature has demonstrated the excellent psychometric properties of the PCL-5 across various populations (Blevins et al. 2015; Bovin et al. 2015; Weathers et al. 2013b; Wortmann et al. 2016).
Generalised Anxiety Disorder
The Generalised Anxiety Disorder scale (GAD-7; Spitzer et al. 2006) is a seven-item scale (GAD-7) used to measure symptoms of generalised anxiety disorder. The scores across all seven items are summed to yield a total score, with higher scores indicating higher levels of severity (range 0–21). The scale asks participants to reflect on the past two weeks in answering each of the seven items, with each item ranging from 0 (not at all) to 3 (nearly every day). Furthermore, across both adult and adolescent samples, scores on the GAD-7 have also been used to define severity of anxiety-based symptoms (Spitzer et al. 2006). A score of 0–4 is considered none/normal levels of anxiety, 5–9 is considered mild, 10–14 is moderate and 15–21 is severe (Spitzer et al. 2006). In adult samples scores of 10 or more may be of particular clinical concern, as they are likely to meet the diagnostic criteria for an anxiety disorder. Using the threshold score of 10, the GAD-7 has a sensitivity of 89% and a specificity of 82% for GAD (Spitzer et al. 2006). Therefore, in the context of this study scores of 10 or above were considered indicative of those meeting the criteria for GAD. Previous literature has demonstrated the excellent psychometric properties of the GAD-7 across various clinical and non-clinical populations (Kertz et al. 2013; Lee and Kim 2019; Rutter and Brown 2017; Spitzer et al. 2006).
Major Depressive Disorder
The Patient Health Questionnaire (PHQ-9; Kroenke et al. 2001), was used to measure symptoms of major depressive disorder. The PHQ-9 asks participants to reflect on the past two weeks in their response to nine items, which are based upon the DSM-IV diagnostic criteria (APA 2000) used to assess MDD symptomatology, namely, sleep, fatigue, concentration, low self-esteem, anhedonia, etc. However, it also is in line with the current DSM-5 criteria (APA 2013; Burdzovic and Brunborg 2017). Each item of the PHQ-9 is scored on a 4-point Likert scale, ranging from 0 to 3. The response categories were, not at all (0), several days (1), more than half the days (2) and nearly every day (3). Each item is summed to yield a total score, with a possible range of 0–27, with higher scores reflecting greater levels of MDD. Furthermore, scores on the PHQ-9 have also been used to define severity of MDD symptoms. In adults, a score of 0–4 none or mild, 5–9 is considered minimal, 10–14 is considered moderate, 15–19 is moderately severe, and ≥ 20 is severe. Furthermore, in adult samples scores of ≥ 10 or more may be of particular clinical concern, as they are likely to meet the diagnostic criteria for an MDD. Using the threshold score of ≥ 10, the PHQ-9 has a sensitivity of 88% and a specificity of 88% for MDD (Kroenke et al. 2001; Levis et al. 2019; Manea et al. 2012). Therefore, in the context of this study scores of 10 or above are considered as meeting the criteria for MDD. The PHQ-9 has been strongly supported for its applicability as a short screening tool (Burdzovic and Brunborg 2017) across various clinical and non-clinical contexts and support the psychometric validity of the scale (Allgaier et al. 2012; Burdzovic and Brunborg 2017; Lee et al. 2007; Levis et al. 2019; Titov et al. 2011; Umegaki and Todo 2017).
Participants were asked to rate what the quality of their sleep in general. The response categories were ‘very good’, ‘fairly good’, ‘fairly bad’ or ‘very bad’. Further participants were asked how they would rate their sleep quality as a result of the coronavirus (COVID-19) situation during the past month. Again, the response categories were ‘very good’, ‘fairly good’, ‘fairly bad’ or ‘very bad’.
Other Risk or Protective Psychological Factors
The Difficulties in Emotion Regulation Scale—Short Form (DERS-SF; Kaufman et al. 2016) was used to measure deficits in emotional regulation. The DERS-SF was developed from the original 36-item scale (DERS, Gratz and Roemer 2004). The DERS-SF contains 18 items rated on a 5-point Likert scale, ranging from 1 to 5. Items 1, 4 and 6 are reverse coded. The response categories were, ‘almost never’ (1), ‘sometimes’ (2), ‘about half of the time’ (3), ‘most of the time’ (4), and ‘almost always’ (5). The measure yields a total score as well as scores on six sub-scales. Each subscale reflects a different aspect of emotional dysregulation. These are (1) ‘non-acceptance’, (2) ‘difficulties with goal directed behaviour’, (3) ‘impulse control’, (4) ‘lack of emotional awareness’, (5) ‘lack of clarity’ and (6) ‘limited access to emotional regulation strategies’. Higher scores indicate higher levels of dysregulation. In comparison to the original 36-item form, DERS-SF has been shown to have excellent psychometric properties, with internal reliability values for both the DERS-SF total scale and six subscales ranging from 0.78 to 0.91 in the original validation study (Kaufman et al. 2016). Additionally, Kaufman et al. (2016) indicated correlations between the DERS and DERS-SF ranged from 0.90 to 0.97 and indicated that the DERS and the DERS-SF shared 81–94% of their variance.
The UCLA Three-Item Loneliness Scale (Hughes et al. 2004) was used to measure subjective feelings of loneliness among the sample. The UCLA 3 item Loneliness Scale contains three questions derived from the full-scale UCLA Loneliness Scale (Version 3; Russell 1996). Each item measures one of three key dimensions of loneliness, (1) social connectedness, (2) relational connectedness and (3) self-perceived connectedness. The response categories are (1) ‘Hardly ever’, (2) ‘Some of the time’ and (3) ‘Often’. Higher scores across these items reflect higher levels of loneliness. The excellent psychometric properties of the both the long and short forms of the UCLA Loneliness scale are well documented (Hughes et al. 2004; Russell 1996). Additionally, participants were asked to indicate how often they felt lonely, using the same response categories as above. This was a bespoke question.
The Perceived Social Support Questionnaire-Brief Form (Kliem et al. 2015) was used to assess participants perceived level of social support. The measure contains 6 items which are rated on a 5-point Likert scale ranging from 1 (‘not true at all’) to 5 (‘very true’). Higher scores reflect higher levels of perceived social support. Previous research supports the psychometric validity of the scale across a range of diverse populations (Kliem et al. 2015; Lin et al. 2019).
Meaning in Life
The Meaning in Life Questionnaire (MLQ; Steger et al. 2006) was used to measure the presence of and pursuit for meaning in life. The MLQ contains 10 items which correspond to one of two dimensions of meaning in life (1) ‘presence of meaning’ (which refers to the extent to which participants feel that their lives have meaning), and (2) ‘the pursuit of meaning’ (this refers to the extent to which participants try to find meaning and understanding in their lives; Steger et al. 2006). Each item is rated on a 7-point Likert scale ranging from 1 (‘Absolutely True’) to 7 (‘Absolutely Untrue’).