Forced Social Isolation and Lockdown during the COVID-19 Pandemic: Depression, Anxiety, and Trauma-distress in a Greek sample

Forced Social Isolation and Lockdown during the COVID-19 Pandemic: Depression, Anxiety, and Trauma-distress in a Greek sample | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Forced Social Isolation and Lockdown during the COVID-19 Pandemic: Depression, Anxiety, and Trauma-distress in a Greek sample ATHANASIA LIOZIDOU, VASILIKI VARELA, DIMITRIOS VLASTOS, ERASMIA GIOGKARAKI, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1909518/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose The COVID-19 outbreak escalated into a global pandemic, forcing governments around the world to impose measures affecting all aspects of life. Like other countries, Greece adopted social restriction, lockdowns, and quarantines to reduce transmission from person-to-person. This cross-sectional study investigated the impact of social restriction measures on mental health in a Greek adult sample. Method An online questionnaire collected data during the second national lockdown (February to May 2021). A total of 650 participants ( M age: 33.13, 71.5% female) comprised the final sample. Results 21.3% of respondents reported moderate-to-extremely severe anxiety, 33% moderate-to-extremely severe depression, 31.8% moderate-to-severe stress, and 38% clinically significant trauma-related distress. Hierarchical linear regression analyses revealed that the strongest contributors to adverse mental health outcomes were being female, younger age, experiencing increases in verbal arguments at home, being separated from family and close friends, and being unable to afford enough or healthy food. Lastly, participants moved away from social support and into more individual strength and resilience-based coping strategies to cope with challenges. Conclusion These findings suggest that in addition to the detrimental effects on physical health, COVID-19 also imposed a heavy psychological burden on the population via forced social isolation, which, by design, increased not only physical distancing but also psychological distancing between people. COVID-19 Quarantine Depression Anxiety Stress Trauma Coping Greece Figures Figure 1 Figure 2 Figure 3 Introduction More than two years since the declaration of the coronavirus disease (COVID-19) as a pandemic by the World Health Organization (WHO), managing the virus spread remains an international public health priority. The COVID‐19 pandemic, characterized by its rapid transmission between individuals and the capacity of even asymptomatic cases to spread the disease leading to potentially overwhelmed health systems, forced many countries to adopt non-pharmacological interventions (NPIs) in the form of restrictions and spread management strategies, such as physical self- and social isolation [ 1 – 4 ]. However, these same restriction measures might have inadvertently caused significant mid‐, to long‐term impacts on people’s mental health [ 5 – 10 ]. Although the magnitude of the impact is still under debate, ranging in recent meta-analyses from modest [ 8 ] to substantial [ 11 ], there is no doubt that rates of depression, stress, anxiety, and trauma-related distress have increased as a direct result of the pandemic. After the confirmation of the first few cases in Greece, unprecedented measures of social constraints to inhibit its spread were rapidly implemented by the government and were gradually expanded to lead to strict social distancing constraints and lockdown (i.e., stay-at-home restrictions), enforced on March 23rd, 2020 [ 12 ]. Compliance to lockdown measures was characterized by news outlets as high, meeting little opposition from the public and leading to a smaller number of loss of life in the country, at least compared to the mortality rates of neighboring Italy or other Mediterranean countries, such as France or Spain [ 13 – 15 ]. It is worth noting, that the COVID-19 pandemic hit Greece just as the country was stepping out of years of economic crisis, with the fiscal hardship that accompanied harsh austerity policies leading to worse mental health, as documented by a 36% increase in suicide rates [ 16 ] and the 1-month prevalence of major depression rising from 3.3% at the beginning of the financial crisis in 2008 to 12.3% in 2013 [ 17 – 19 ]. The full impact of the pandemic and subsequent restrictions on the Greek population is still unknown, although few studies indicate adverse effects on mental health [ 14 , 20 , 21 ]. The present study, therefore, examined the impact of COVID-19 pandemic and subsequent forced social restrictions on mental health. In particular, we examined the contribution of demographic and social characteristics, restrictive measures and social isolation extend on psychological health of a Greek sample. Method Participants A snowball sampling technique was used, with the study simultaneously advertised on several social media outlets and online mailing lists. The final sample after data validation consisted of 650 participants (465 female, 71.5%), with a mean age of 33.13 years ( SD = 12.2; range = 18–77) and 16.6 years of education ( SD = 4.2). Full demographics are shown in Table 1 . Most participants (89.8%) were actively employed (i.e., full-time, part-time, or student). Of those employed, 67.5% were working from home at the time of completing the questionnaire. No difference was reported by participants in their perceived physical health before and after the pandemic, χ 2 (1) = .62, p = .804. Half of participants reported following moderate restrictions (57.5%), 17.7% severe restrictions, and only 4% did not obey the restrictions. Table 1 Summary Sociodemographic characteristics of study participants (n = 651). M or N SD or % Age (years), M , SD 33.13 12.17 Education (years), M , SD 16.6 4.2 Gender, N , % Male 85 28.5 Female 465 71.5 Employment status, N , % Employed 584 88.8 Unemployed 66 10.1 Relationship status, N , % Single 421 65 Partnered 227 34.9 Living arrangements, N , % Lives with Children 18 years 127 19.5 Lives with parents 213 32.8 History of Psychiatric conditions N , % Yes 88 13.5 Measures The Epidemic–Pandemic Impacts Inventory (EPII) [ 22 ] () was utilized to assess participants’ degree of direct exposure to COVID-19 and the COVID-19 pandemic impact on specific life domains. Following the methodology of other studies on similar topics [ 5 , 23 ], only 29 items off the original inventory’s 91 were used. The level of isolation experienced during the pandemic was assessed through a question about compliance with quarantine restrictions. There were four options to choose from, each describing measures implemented by governments of different countries, as follows: “1) Level 0: I was not following any specific restrictions; 2) Level 1: I was following mild restrictions (e.g., not gathering with ten or more people, not traveling outside my city or state); 3) Level 2: I was following moderate restrictions (e.g., not leaving home except for working, care of another family member, exercise, or getting fresh air); 4) Level 3: I was following severe restrictions (e.g., not leaving home at all, or only leaving to buy food or medicine).” The Depression, Anxiety and Stress Scale (DASS-21) [ 24 , 25 ] and the Generalized Anxiety Disorder-7 (GAD-7) [ 26 ] questionnaire were used to assess symptom severity/frequency. The 8-item Child-Revised Impact of Events Scale (CRIES-8) [ 27 ] was used to measure respondents’ trauma-related distress. Finally, the Brief Coping Orientations to Problems Experienced Inventory (Brief COPE) [ 28 – 30 ] was utilized to tap into participants’ use of coping styles (problem-focused, emotion-focused, and avoidant coping style). Half of the items were used in this study, one from each scale, as has been done elsewhere, to reduce completion times [ 6 ]. Procedure The survey was developed by an international group of psychologists, originally in English and later translated into Greek. The Lab of Cognitive Neuroscience and Clinical Neuropsychology of the Scientific College of Greece was responsible for the data collection. The study received IRB approval from both host institutions (Autonomous University of Madrid Ethical Committee, Spain, CEI-106-206 & The Scientific College of Greece Human Research Ethics Committee). All aspects of the study complied to the Declaration of Helsinki. The survey, hosted by the online platform SurveyMonkey, was promoted by professional emailing lists and advertised on social media (WhatsApp, Twitter, Facebook, and Instagram). Data collection was performed between February 3rd to June 1st, 2021. This period covers the “second COVID wave” in Greece and the longest period of enforced measures, during which restrictions were imposed on travelling between cities and between city boroughs, social distancing, and quarantine at home. Data Analysis Once data were collected, they were exported from the survey platform to the statistical program IBM SPSS version 23. Data were initially checked for violations of test assumptions, and descriptive statistics were calculated for all outcome variables. A correlation matrix was created to show the bivariate relationships between demographic and outcome variables. The main statistical analyses involved four hierarchical stepwise multiple linear regressions with depression (DASS-21), anxiety (GAD-7), stress (DASS-21), and trauma-related distress (CRIES-8) as the outcome variables. In each regression, Step 1 included the demographic predictors (gender, age, employment and relationship status, lives with children < 5, children 6–17, children < 18), Step 2 included the COVID-19 exposure variables (the EPII items), and Step 3 included the level of quarantine experienced. In follow-up chi-squares and correlations, bivariate associations between coping (Brief COPE) and these outcome variables were assessed. Results Trauma-related Distress The average participant score in the CRIES-8 was 13.76 ( SD = 10.5), with only a small number of people (12.6%) reporting no trauma-related distress at all. 38% of participants reported clinically significant distress, denoted by a total score of > 17 in CRIES-8. In the correlation matrix (Table 2 ), higher trauma-related distress was moderately associated with depression ( r = .46, p < .001), stress ( r = .53, p < .001), and anxiety ( r = .51, p < .001) levels. Step 1 of the Hierarchical linear regression analysis (Table 3 ) was statistically significant, F (8,638) = 3.641, p < .001, r 2 = .03. The only significant variable that contributed to the prediction of trauma-related distress in this step was gender (being female was associated with higher CRIES-8 scores, Fig. 3). In Step 2, the model remained significant, F (28,618) = 3.471, p < .001, r 2 = .10, F change = 3.298, p < .001, r 2 change = .09. Specifically, apart from gender, EPII items “ Increase in verbal arguments or conflict with other adult(s) in home ” and “ Separated from family or close friends ” were positively associated with trauma-related distress. The full model (Step 3) was statistically significant, F (29,617) = 3.350, p < .001, r 2 = .09. However, the addition of the last predictor (level of quarantine) did not add to predictive power, F change = .113, p = .737, r 2 change = .00. Therefore, the level at which one was following the restrictions was not a significant predictor of trauma-related distress. Overall, in order of magnitude of contribution to the final model, the predictors that were significant in the final model were EPII item “ Increase in verbal arguments or conflict with other adult(s) in home ” ( β = .22, p < .001), gender ( β = .13, p < .001), and EPII item “ Separated from family or close friends” ( β = .13, p < .001). Table 2 Correlation matrix among demographic variables and health outcomes. M SD 1 2 3 4 5 6 7 8 1. Age 33.14 12.2 -- 2. Education 16.57 4.2 .36 ** -- 3. CRIES-8 13.76 10.5 − .05 − .03 -- 4. DASS Stress 15.10 11.7 − .18 ** − .06 .53 ** -- 5. DASS Depression 10.53 10.7 − .14 ** − .10 ** .46 ** .71 ** -- 6. GAD 7 5.93 5.6 − .15 ** − .07 .51 ** .83 ** .74 ** -- 7. COPE Problem-focused 10.73 2.82 .00 .04 .29** .19** .08 .15** -- 8. COPE Emotion-focused 14.19 3.21 − .03 − .01 .35** .30** .23** .25** .62** -- 9. COPE Avoidant 6.71 2.14 − .06 − .01 .52** .52** .51** .50** .28** .34** * Correlation is significant at the 0.05 level (2−tailed). ** Correlation is significant at the 0.01 level (2-tailed). Depression, Stress, and Anxiety Rates of both depression and stress (Fig. 2 ) were low-to-mild. In the DASS- Depression scale, participants scored an average of 10.53 ( SD = 10.7). 14.9% of the sample reported moderate symptoms of depression, while 18% reported either severe or extremely severe symptomatology (Fig. 2 ). There was a statistically significant, weak association between marital status and depression severity ( χ 2 (4) = 10.51, p = .033, Cramer’s V = .13). A significant, weak association was also observed between employment status and depression severity ( χ 2 (4) = 12.95, p = .012, Cramer’s V = .14). Singles reported more intense depression symptoms than partnered/married participants, and unemployed participants reported higher rates in all severity bands of the depression scale. Females reported higher depression rates ( M = 11.42, SD = 10.9) than males ( M = 8.30, SD = 9.6), t (384) = -3.59, p < .001, one-tailed (Fig. 3). Strong positive correlations were found between depression symptoms and anxiety ( r = .74, p < .001) and depression and stress ( r = .71, p < .001) levels. Depression severity also negatively correlated with age ( r = − .14, p < .001), with lower depression scores observed in older participants. A three-step hierarchical linear regression analysis was conducted to evaluate the prediction of depression symptomatology (DASS Depression total score) from demographic variables (Step 1: F (8,638) = 6.303, p < .001, r 2 = .07), variables relating to COVID-19 exposure (Step 2: F (28,618) = 6.648, p < .001, r 2 = .23, F change = 6.362, p < .001, r 2 change = .16), and the level of quarantine experienced (Step 3). The full results can be viewed in Table 3 . The full model (Step 3) was statistically significant, F (29,617) = 6.453, p < .001, r 2 = .23. Once again, the addition of last factor (level of quarantine) did not add to predictive power, F change = .994, p = .319, r 2 change = .001. Therefore, the level to which one was following the restrictions was not a significant predictor of depression. The variables that were significant in order of magnitude of contribution to the final model were EPII item “ Being separated from family or close friends ” ( β = .23, p < .001), marital status ( β = − .12, p = .004), EPII items “ Increase in verbal arguments or conflict with other adult(s) in home ” ( β = .19, p < .001), and “ Unable to get enough food or healthy food ” ( β = .1, p = .003), employment status ( β = .11, p = .005), EPII item “ Laid off from job or had to close own business ” ( β = − .08 p = .037), and gender ( β = .08, p = .033). In DASS- Stress , participants reported mild-low levels of stress, as mentioned above, M = 15.10, SD = 11.68 on average. 11.8% of the sample reported moderate symptoms of stress, while almost 20% reported either severe or extremely severe symptomatology (Fig. 2 ). Higher stress rates were reported by females ( M = 16.31, SD = 11.6) than males ( M = 12.06, SD = 11.3), t (648) = -4.234, p < .001, one-tailed (Fig. 3). A weak negative correlation was observed between stress levels and age ( r = − .18, p < .001), a moderate positive correlation between stress and trauma-related distress (CRIES-8), r = .53, p < .001, and two strong positive correlations between stress and depression ( r = .71, p < .001) and anxiety ( r = .83, p < .001). Step 1 of the Hierarchical linear regression (Table 3 ) was statistically significant, F (8,638) = 5.00, p < .001, r 2 = .06, as was Step 2, F (28,618) = 9.099, p < .001, r 2 = .23, F change = 10.164, p < .001, r 2 change = .23. The full model (Step 3) was also statistically significant, F (29,617) = 8.858, p < .001, r 2 = .002, F change = 1.797, p = .18, r 2 change = .002, again, with no significant contribution of level of quarantine on predictive power. Overall, and in order of magnitude of contribution to the final model, the predictors that were significant in the final model were EPII items “ Increase in verbal arguments or conflict with other adult(s) in home ” ( β = .35, p < .001), “ Separated from family or close friends ” ( β = .21, p < .001), “ Unable to get enough food or healthy food ” ( β = .12, p < .001), age ( β = − .10, p = .019), EPII item “ Laid off from job or had to close own business” ( β = − .1, p = .009), and gender ( β = .09, p = .010). On average across the sample, low-mild levels of anxiety severity were observed, M = 5.93, SD = 5.6 (Fig. 2 ). 11% of participants reported moderate anxiety levels, while 10.3% reported severe symptoms. There was a statistically significant, weak association between age and anxiety severity, χ 2 (15) = 35.85, p = .002, Cramer’s V = .23. Higher anxiety rates were reported by females ( M = 6.56, SD = 5.728) than males ( M = 4.35, SD = 4.8), t (398) = -4.997, p < .001, one-tailed (Fig. 3). Anxiety symptomatology was positively and moderately correlated with trauma-related distress ( r = .51, p < .001), strongly with stress ( r = .83, p < .001), and strongly with depression ( r = .74, p < .001) (Table 2 ). Step 1 of the Hierarchical linear regression (Table 3 ) was statistically significant, F (8,638) = 5.595, p < .001, r 2 = .07, as was Step 2, F (28,618) = 7.168, p < .001, r 2 = .24, F change = 7.352, p < .001, r 2 change = .18, and the full model (Step 3), F (29,617) = 6.921, p < .001, r 2 = .25. However, the addition of level of quarantine again did not add to predictive power, F change = .243, p = .62, r 2 change = .00. In order of contribution, the significant predictors in the final model were EPII items “ Increase in verbal arguments or conflict with other adult(s) in home ” ( β = .28, p = < .001), “ Separated from family or close friends ” ( β = .23, p < .001), gender ( β = .11, p = .002), age (β = − .1, p = .027), and EPII item “ Unable to get enough food or healthy food ” ( β = .08, p = .030). Table 3 Results of Multiple Regression Analyses by outcome (standardized betas from Step 3). Predictor variable CRIES-8 DASS Depression DASS Stress GAD-7 β p β p β p β p Step 1 Age − .059 .210 − .080 .086 − .101 .019 − .098 .027 Gender .174 .000 .129 .001 .090 .010 .110 .002 Education (years) − .022 .603 − .056 .177 .004 .909 − .019 .622 Relationship status .042 .363 − .084 .068 − .033 .426 − .017 .688 Employment status − .026 .501 .148 .000 − .003 .939 .053 .159 Lives with Children 18 .003 .943 -0.59 .129 − .032 .355 − .027 .460 Step 2 Currently have symptoms of this disease but have not been tested .022 .629 − .052 .227 .051 .213 − .027 .531 Tested and currently have this disease .021 .719 − .014 .794 .031 .544 .029 .582 Had symptoms of this disease but never tested .001 .989 .028 .508 − .040 .330 − .006 .893 Tested positive for this disease but no longer have it − .047 .437 − .026 .653 − .064 .250 − .060 .293 Got medical treatment due to severe symptoms of this disease − .016 .727 .053 .205 .066 .101 .057 .169 Hospital stay due to this disease − .026 .541 − .001 .980 − .017 .651 − .012 .760 Death of close friend or family member from this disease .015 .699 − .015 .676 − .045 .201 − .026 .476 Laid off from job or had to close own business − .027 .511 − .081 .037 − .097 .009 − .069 .071 Reduced work hours or furloughed .024 .567 .044 .262 .012 .747 .021 .591 Had to continue to work even though in close contact with people who might be infected .046 .250 .039 .294 .005 .899 .021 .573 Provided direct care to people with the disease − .018 .637 − .052 .151 − .039 .265 − .042 .242 Increase in workload or work responsibilities .009 .823 − .006 .878 − .013 .721 .009 .818 Hard time doing job well because of needing to take care of people in the home .034 .391 .067 .071 .052 .145 .046 .213 Hard time making the transition to working from home .005 .904 − .032 .389 .012 .736 .028 .447 Unable to get enough food or healthy food .024 .543 .110 .003 .118 .001 .081 .030 Unable to pay important bills like rent or utilities .001 .988 .023 .560 − .028 .451 .005 .894 Had a child in home who could not go to school .002 .970 .073 .163 .073 .144 .056 .275 Increase in verbal arguments or conflict with other adult(s) in home .224 .000 .191 .000 .353 .000 .279 .000 Separated from family or close friends .135 .001 .226 .000 .208 .000 .226 .000 Events/celebrations canceled or restricted .014 .730 − .029 .437 .004 .920 .004 .906 Step 3 Compliance with restrictions .013 .749 − .037 .319 − .048 .181 − .018 .622 Coping styles Most participants reported using acceptance, reframing, planning, active coping, and self-distraction. Significant gender differences were found with regard to self-distraction ( x 2 (3) = 26.867, p < .001, Cramer’s V = .203), active coping ( x 2 (3) = 14.45, p = .002, Cramer’s V = .15), use of emotional support ( x 2 (3) = 23.252 p < .001, Cramer’s V = .189), behavioral disengagement ( x 2 (3) = 20.493, p < .001, Cramer’s V = .178), venting ( x 2 (3) = 10.799, p = .013, Cramer’s V = .129), use of instrumental support ( x 2 (3) = 19.169, p < .001, Cramer’s V = .172) and positive reframing ( x 2 (3) = 11.362, p = .010, Cramer’s V = .132) (Table 4 ). A greater proportion of women than men used self-distraction (80.9 versus 65.4%), active coping (86.9 versus 78.9%), use of emotional support from others (79.4 versus 63.2%), behavioral disengagement (38 versus 20%), venting (69.2 versus 59.5%), instrumental support (77.6 versus 66.5), and positive reframing (94.6 versus 88.1%) as coping styles. There was no difference between males and females in use of substances, denial, self-blame, use of humor, acceptance or turning to religion as a coping mechanism. Use of a problem-focused coping style was weakly related to trauma-related distress ( r = .29, p < .001). Emotion-focused coping was also weakly related to trauma-related distress ( r = .35, p < .001) and stress ( r = .30, p < .001), while avoidant coping was moderately associated with trauma-related distress ( r = .52, p < .001), stress ( r = .52, p < .001), depression ( r = .51, p < .001), and anxiety ( r = .50, p < .001) (Table 2 , for the full correlation matrix). Table 4 Proportions of Males and Females endorsing use of each coping style of the Brief Cope inventory. Brief COPE “I’ve been …” % M % F Whole sample … accepting the reality of the fact that it has happened ( acceptance ) 94,6 95,7 80,4 … trying to see it in a different light, more positive ( positive reframing) 88,1 94,6* 70,5 … trying to come up with a strategy about what to do ( planning ) 86,5 86,7 60,6 … concentrating my efforts doing something about the situation ( active coping ) 78,9 86,9* 59 … turning to work/other activities to take my mind off things ( self-distraction ) 65,4 80,9* 52,9 … criticizing myself ( self-blame ) 72,4 78,9 49,7 … making jokes about it ( humour ) 72,4 75,7 44,3 … getting emotional support from others ( emotional support from others ) 63,2 79,4* 42,5 … getting help and advice from other people ( instrumental support) 66,5 77,6* 40,4 … saying things to let my unpleasant feelings escape ( venting ) 59,5 69,2* 30,9 … trying to find comfort in my religion or spiritual beliefs ( religion ) 38,9 43,4 22 … giving up trying to deal with it ( behavioral disengagement ) 20 38* 9,7 … using alcohol or other drugs to make myself feel better ( substance ) 23,8 25,4 8,8 … refusing to believe that it has happened ( denial ) 20,5 27,1 7,7 Note: * gender difference significant at p < 0.01. Discussion The present study explored the mental health impact of the profound lifestyle changes imposed by the COVID19- pandemic in a Greek sample during the second pandemic wave. Overall, considerable psychological burden was reported, with the proportion of the sample with moderate-to-severe depression being 33%, anxiety 21.3%, and stress 31.8. Moreover, almost 40% reported clinically significant trauma-related distress. The rates found here are comparable to those found in other countries under restrictions measures. For example, in a meta-analysis of 17 studies looking at psychological impact of the first wave of pandemic restrictions in Spring 2020, Salari et al. [ 9 ] reported a pooled prevalence of 29.6% for stress, 31.9% anxiety, and 33.7% depression. Despite the fact that the present study was cross-sectional, with no indicators of pre-pandemic mental health rates, the findings show the need for immediate implementation of social policy interventions designed to support the population in the post-pandemic era. Longitudinal studies are also emerging documenting a deterioration in mental health during the first quarantine [ 7 ]. For all outcomes, the strongest predictors of depression, anxiety, stress, and trauma distress were pandemic-related life changes. Experiencing conflict in the home, being separated from close family and friends, being unable to buy enough/healthy food, and being laid off from work, or having to close down one’s business were stronger predictors of mental health than level of quarantine (which did not affect any outcome) or most demographics. Increases in verbal arguments with other adults at home emerged as the strongest predictor for all outcomes. Known contributors to family violence, such as financial hardship and social isolation, that have been identified in the past have certainly contributed to increasing rates of family/relationship violence observed in many countries during and after lockdowns, including Greece [ 31 – 35 ]. The same pandemic-related contributors to decreased mental health were reported in similar studies in other countries. For example, in a study by Yuksel et al. [ 23 ], data from 59 countries on mental health outcomes during the first pandemic wave showed that conflicts between adults in the home were consistently related to poor sleep health, while Alzueta et al. [ 5 ] also found domestic arguments to be the strongest predictor of depression and anxiety, over and above demographic characteristics or level of restrictions imposed. In the current study, the level to which someone was complying with government-imposed restrictions made no difference to any mental health outcome. This finding has been observed in other studies as well [ 5 ] and is quite paradoxical, since it would be expected that those who did not follow restrictions or followed them just a bit (about 25% of the sample) would fare better. Pandemic impact was likely more diffuse and global, rather than relating to more specific day-to-day practices (e.g., social distancing, use of protective equipment, etc.). Apart from quarantine-related factors, certain population characteristics increased the risk of mental health vulnerability. Being female, of younger age, or unemployed were all associated with higher rates of depression, stress, and anxiety, as has been documented elsewhere during the pandemic [ 3 , 6 , 7 ], but also more generally, as consistent epidemiological markers of mental health inequalities [ 7 , 36 – 38 ]. The female predominance in most psychiatric disorders is a complex phenomenon, explained by interacting biological (neurotransmitter, neuroendocrine, genetic factors and circadian rhythm) and psychosocial forces, such as women’s lower social and financial status, higher rates of lifelong victimisation and other adverse life events (see for discussions 40–43,55). In addition, marital status was a predictor of depression, with singles being more vulnerable to the detrimental effects of the pandemic, a finding corroborated by other studies [ 5 , 39 , 43 , 44 ]. Several studies have documented how age, marital and employment status may separately and together act as stress-buffering or stress-exacerbating factors. The job losses and financial uncertainty suffered by the younger age groups (who are also more likely to be single/live alone) during the COVID-19 pandemic, would make them disproportionately affected [ 45 – 47 ]. Lastly, we looked at the way participants used specific coping strategies during the pandemic. Most respondents reported engaging in acceptance, positive reframing, planning, active coping, and self-distraction through work or other activities. These strategies are all based on individual strengths and resilience and do not rely on social network support. Receiving emotional or instrumental support from others appeared further down the list as a coping strategy, being endorsed by 42.5% and 40.4% of participants, respectively. This is not surprising and shows how the lockdown, by design, increased not only physical distancing but also psychological distancing between people. Gender differences emerged, in that women reported using reframing, active coping, self-distraction, venting, behavioral disengagement, and social support more than men, findings that have been reported elsewhere as well [ 6 , 48 ], possibly offering some protection against mental health problems. Reframing and acceptance, for example, both positive emotion-focused coping strategies, have been recognised as protective factors for mental health [ 49 – 53 ]. Other strategies, such as venting, behavioural disengagement, self-distraction, use of instrumental support have been associated with higher stress, anxiety and depression levels, and can be less useful in potential psycho-traumatic situations [ 53 , 54 ]. The present study adds to an international body of research exploring the tremendous impact that this contemporary pandemic had to the psychological aspects of peoples’ lives and in particular of the population of a Mediterranean country. However, while the study offers a glimpse into the mental health impact of pandemic-related restrictions on Greek people, it has several methodological limitations. First, the study design was cross-sectional, and hence only associations, and no causal inferences, can be drawn. Second, online sampling, while the only outlet during pandemic restrictions, carries its own biases, excluding those with reduced or no internet accessibility. Additionally, the self-report instruments used here, in the absence of independent clinical verification, might exacerbate or minimize reported symptomatology, and hence lack objectivity. Finally, it is important point out that most adverse consequences emerged from the imposition of restrictions on liberty, which in the future, if essential, should be kept short, with a clear rationale provided. From the emerging literature, it is shown that self-imposed isolation is related to less psychological distress [see 11 for a review], so future measures might rely on persuasion more than imposition. The findings of the present study illustrate the urgent need for mental health support services in the post-pandemic era, especially in populations of people with multiple vulnerabilities, such as historical financial hardship, female gender, younger age, and unemployment. Declarations Funding Acknowledgement: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Declaration of Conflicting Interest: The Authors declare that there is no conflict of interest. References Chan JF, Yuan S, Kok KH, To KK, Chu H, Yang J, Xing F, Liu J, Yip CC, Poon RW, Tsoi HW (2020) A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. The lancet 15;395(10223):514–23. Reicher S, Drury J (2020) Pandemic fatigue? How adherence to covid-19 regulations has been misrepresented and why it matters. Bmj 372. Solomou I, Constantinidou F (2020) Prevalence and predictors of anxiety and depression symptoms during the COVID-19 pandemic and compliance with precautionary measures: age and sex matter. International journal of environmental research and public health 17(14):4924. Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, Ho RC (2020a) Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. International Journal of Environmental Research and Public Health17(5):1729. Alzueta E, Perrin P, Baker FC, Caffarra S, Ramos-Usuga D, Yuksel D, Arango‐Lasprilla JC (2021) How the COVID‐19 pandemic has changed our lives: A study of psychological correlates across 59 countries. Journal of clinical psychology 77(3):556–570. Kolakowsky-Hayner SA, Goldin Y, Kingsley K, Alzueta E, Arango-Lasprilla JC, Perrin PB, Baker FC, Ramos-Usuga D, Constantinidou F (2021) Psychosocial impacts of the COVID-19 quarantine: a study of gender differences in 59 countries. Medicina 57(8):789. Pierce M, Hope H, Ford T, Hatch S, Hotopf M, John A, Kontopantelis E, Webb R, Wessely S, McManus S, Abel KM (2020) Mental health before and during the COVID-19 pandemic: a longitudinal probability sample survey of the UK population. The Lancet Psychiatry 7(10):883–892. Prati G, Mancini AD (2021) The psychological impact of COVID-19 pandemic lockdowns: a review and meta-analysis of longitudinal studies and natural experiments. Psychological medicine 51(2):201–211. Salari N, Hosseinian-Far A, Jalali R, Vaisi-Raygani A, Rasoulpoor S, Mohammadi M, Rasoulpoor S, Khaledi-Paveh B (2020) Prevalence of stress, anxiety, depression among the general population during the COVID-19 pandemic: a systematic review and meta-analysis. Globalization and health 16(1):1–11. Wu T, Jia X, Shi H, Niu J, Yin X, Xie J, Wang X (2021) Prevalence of mental health problems during the COVID-19 pandemic: A systematic review and meta-analysis. Journal of affective disorders 281:91–98. Brooks JT, Beezhold DH, Noti JD, Coyle JP, Derk RC, Blachere FM, Lindsley WG (2021) Maximizing fit for cloth and medical procedure masks to improve performance and reduce SARS-CoV-2 transmission and exposure, 2021. Morbidity and Mortality Weekly Report 70(7): 254. CovidTrackingMapGR. CoVid19.gov.gr (in Greek). 29 May 2021. Retrieved 8 July 2022. https://covid19.gov.gr/covid-map/ . Delinasios GJ, Fragkou PC, Gkirmpa AM, Tsangaris G, Hoffman RM, Anagnostopoulos AK (2021) The experience of Greece as a model to contain COVID-19 infection spread. In vivo 35(2):1285–1294. Fountoulakis KN, Apostolidou MK, Atsiova MB, Filippidou AK, Florou AK, Gousiou DS, Katsara AR, Mantzari SN, Padouva-Markoulaki M, Papatriantafyllou EI, Sacharidi PI (2021) Self-reported changes in anxiety, depression and suicidality during the COVID-19 lockdown in Greece. Journal of affective disorders 279:624–629. Skapinakis P, Bellos S, Oikonomou A, Dimitriadis G, Gkikas P, Perdikari E, Mavreas V (2020) Depression and its relationship with coping strategies and illness perceptions during the COVID-19 lockdown in Greece: a cross-sectional survey of the population. Depression research and treatment Vol. 2020. Branas CC, Kastanaki AE, Michalodimitrakis M, Tzougas J, Kranioti EF, Theodorakis PN, Carr BG, Wiebe DJ (2015) The impact of economic austerity and prosperity events on suicide in Greece: a 30-year interrupted time-series analysis. BMJ open 5(1):e005619. Economou M, Angelopoulos E, Peppou LE, Souliotis K, Tzavara C, Kontoangelos K, Madianos M, Stefanis C (2016) Enduring financial crisis in Greece: prevalence and correlates of major depression and suicidality. Social psychiatry and psychiatric epidemiology 51(7):1015–1024. Economou M, Madianos M, Peppou LE, Patelakis A, Stefanis CN (2013) Major depression in the era of economic crisis: a replication of a crosssectional study across Greece. J Affect Disord 145:308–314. Madianos M, Economou M, Alexiou T, Stefanis C (2011) Depression and economic hardship across Greece in 2008 and 2009: two cross-sectional surveys nationwide. Soc Psychiatry Psychiatr Epidemiol 46:943–952. Kaparounaki CK, Patsali ME, Mousa DP, Papadopoulou EV, Papadopoulou KK, Fountoulakis KN (2020) University students’ mental health amidst the COVID-19 quarantine in Greece. Psychiatry research 290:113111. Parlapani E, Holeva V, Voitsidis P, Blekas A, Gliatas I, Porfyri GN, Golemis A, Papadopoulou K, Dimitriadou A, Chatzigeorgiou AF, Bairachtari V (2020) Psychological and behavioral responses to the COVID-19 pandemic in Greece. Frontiers in psychiatry 821. Yuksel B, Ozgor F (2020) Effect of the COVID-19 pandemic on female sexual behavior. International Journal of Gynecology & Obstetrics 150(1):98–102. Grasso DJ, Briggs-Gowan MJ, Ford JD, Carter AS (2020) The epidemic–pandemic impacts inventory (EPII). University of Connecticut School of Medicine. National Institute of Health (NIH) Disaster Research Response (DR2) Repository of COVID-19 Research Tools. Retrieved from https://dr2.nlm.nih.gov . Lovibond PF, Lovibond SH (1995) The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour research and therapy 33(3):335–343. Lyrakos GN, Arvaniti C, Smyrnioti M, Kostopanagiotou G (2011) Translation and validation study of the depression anxiety stress scale in the Greek general population and in a psychiatric patient's sample. European Psychiatry 26(S2):1731–1731. Spitzer RL, Kroenke K, Williams JB, Löwe B (2006) A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of internal medicine 166(10):1092–1097. Perrin S, Meiser-Stedman R, Smith P (2005) The Children's Revised Impact of Event Scale (CRIES): Validity as a screening instrument for PTSD. Behavioural and Cognitive Psychotherapy 33(4):487–498. Carver CS, Scheier MF, Weintraub JK. (1989). Assessing coping strategies: a theoretically based approach. Journal of personality and social psychology 56(2):267. Carver CS (1997) You want to measure coping but your protocol’too long: Consider the brief cope. International journal of behavioral medicine 4(1):92–100. Kapsou M, Panayiotou G, Kokkinos CM, Demetriou AG (2010) Dimensionality of coping: An empirical contribution to the construct validation of the Brief-COPE with a Greek-speaking sample. Journal of health psychology 15(2):215–229. Boserup B, McKenney M, Elkbuli A (2020). Alarming trends in US domestic violence during the COVID-19 pandemic. The American journal of emergency medicine 38(12):2753–2755. Ertan D, El-Hage W, Thierrée S, Javelot H, Hingray C (2020) COVID-19: urgency for distancing from domestic violence. European journal of psychotraumatology 11(1):1800245. Kourti A, Stavridou A, Panagouli E, Psaltopoulou T, Spiliopoulou C, Tsolia M, Sergentanis TN, Tsitsika A (2021) Domestic violence during the COVID-19 pandemic: a systematic review. Trauma, violence, & abuse 15248380211038690. Peterman A, Potts A, O'Donnell M, Thompson K, Shah N, Oertelt-Prigione S, Van Gelder N (2020). Pandemics and violence against women and children (Vol. 528). Washington, DC: Center for Global Development. Usher K, Bhullar N, Durkin J, Gyamfi N, Jackson D (2020) Family violence and COVID-19: Increased vulnerability and reduced options for support. International journal of mental health nursing 10.1111/inm.12735 . Boyd A, Van de Velde S, Vilagut G, De Graaf R, Florescu S, Alonso J, Kovess-Masfety V, EU-WMH Investigators (2015) Gender differences in mental disorders and suicidality in Europe: results from a large cross-sectional population-based study. Journal of affective disorders 173:245–254. Hasin DS, Fenton MC, Weissman MM (2011) Epidemiology of depressive disorders. In Tsuang, M. T., Tohen, M., & Zahner, G. E. (Eds.). Textbook in psychiatric epidemiology. New York: Wiley-Liss. (Ed. 3) 289–309. Seedat S, Scott KM, Angermeyer MC, Berglund P, Bromet EJ, Brugha TS, Demyttenaere K, De Girolamo G, Haro JM, Jin R, Karam EG (2009) Cross-national associations between gender and mental disorders in the World Health Organization World Mental Health Surveys. Archives of general psychiatry 66(7):785–795. Afifi M (2007) Gender differences in mental health. Singapore medical journal 48(5):385. Eaton NR, Keyes KM, Krueger RF, Balsis S, Skodol AE, Markon KE, Grant BF, Hasin DS (2012) An invariant dimensional liability model of gender differences in mental disorder prevalence: Evidence from a national sample. Journal of Abnormal Psychology 121(1):282–288. Kessler RC (2003) Epidemiology of women and depression. Journal of affective disorders 74(1):5–13. Leigh E, Yule W, Smith P (2016) Measurement issues: Measurement of posttraumatic stress disorder in children and young people–lessons from research and practice. Child and Adolescent Mental Health 21(2):124–135. Riecher-Rössler A (2017) Sex and gender differences in mental disorders. The Lancet Psychiatry 4(1):8–9. Andrade L, Caraveo-Anduaga JJ, Berglund P, Bijl RV, Graaf RD, Vollebergh W, Dragomirecka E, Kohn R, Keller M, Kessler RC, Kawakami N (2003) The epidemiology of major depressive episodes: Results from the International Consortium of Psychiatric Epidemiology (ICPE) Surveys. International Journal of Methods in Psychiatric Research 12(1):3–21. Xiong J, Lipsitz O, Nasri F, Lui LM, Gill H, Phan L, Chen-Li D, Iacobucci M, Ho R, Majeed A, McIntyre R (2020). Impact of COVID-19 pandemic on mental health in the general population: A systematic review. Journal of affective disorders 277:55–64. Gill PK, Du C, Khan F, Karimi N, Sabharwal K, Agarwal M (2022) The psychological effects of COVID-19 spread in young Canadian adults. International Journal of Social Psychiatry 68(1):216–222 Holingue C, Kalb LG, Riehm KE, Bennett D, Kapteyn A, Veldhuis CB, Johnson RM, Fallin MD, Kreuter F, Stuart EA, Thrul J (2020) Mental distress in the United States at the beginning of the COVID-19 pandemic. American journal of public health 110(11):1628–1634. Perry BL, Aronson B, Pescosolido BA (2021) Pandemic precarity: COVID-19 is exposing and exacerbating inequalities in the American heartland. Proceedings of the National Academy of Science 118(8):e2020685118. Liu N, Zhang F, Wei C, Jia Y, Shang Z, Sun L, Wu L, Sun Z, Zhou Y, Wang Y, Liu W (2020) Prevalence and predictors of PTSS during COVID-19 outbreak in China hardest-hit areas: Gender differences matter. Psychiatry research 287:112921. Bai Z, Luo S, Zhang L, Wu S, Chi I (2020) Acceptance and commitment therapy (ACT) to reduce depression: A systematic review and meta-analysis. Journal of Affective Disorders 260:728–737 Coto-Lesmes R, Fernández-Rodríguez C, González-Fernández S (2020) Acceptance and Commitment Therapy in group format for anxiety and depression. A systematic review. Journal of affective disorders 263:107–120. Folkman S, Lazarus RS (1988) The relationship between coping and emotion: Implications for theory and research. Social science & medicine 26(3):309–317. Horwitz AG, Czyz EK, Berona J, King CA (2018) Prospective associations of coping styles with depression and suicide risk among psychiatric emergency patients. Behavior therapy 49(2):225–236. Stanisławski K (2019) The coping circumplex model: an integrative model of the structure of coping with stress. Frontiers in psychology 10:694. Gurvich C, Thomas N, Thomas EH, Hudaib AR, Sood L, Fabiatos K, Sutton K, Isaacs A, Arunogiri S, Sharp G, Kulkarni J (2021) Coping styles and mental health in response to societal changes during the COVID-19 pandemic. International Journal of Social Psychiatry 67(5):540–549. Afifi TO, Cox BJ, Enns MW (2006) Mental health profiles among married, never-married, and separated/ divorced mothers in a nationally representative sample. Social Psychiatry and Psychiatric Epidemiology 41(2):122–129. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-1909518","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":126639048,"identity":"9373f05a-99ac-4b1e-9bd1-94e4149458e6","order_by":0,"name":"ATHANASIA LIOZIDOU","email":"","orcid":"","institution":"Scientific College Greece","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"ATHANASIA","middleName":"","lastName":"LIOZIDOU","suffix":""},{"id":126639047,"identity":"12e86170-7334-45a0-9a1e-66c001db85b4","order_by":1,"name":"VASILIKI 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14:29:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-1909518/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-1909518/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":24996708,"identity":"eeecdcc1-c922-4a83-b2fd-ad3d4d987cba","added_by":"auto","created_at":"2022-08-09 17:16:35","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":36780,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eThe distribution of Depression, Stress and Anxiety ratings\u003c/em\u003e.\u0026nbsp;\u003c/p\u003e","description":"","filename":"Fig1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-1909518/v1/2d21e77b9e736c8eea1cd7ea.jpg"},{"id":24996706,"identity":"63b23eb0-0803-42ec-940b-28762a17b309","added_by":"auto","created_at":"2022-08-09 17:16:35","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":37290,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eMean difference of mental health outcomes by Gender (asterisk denote significant at p\u0026lt;0.001).\u003cspan class=\"ql-cursor\"\u003e\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Fig2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-1909518/v1/94b47f62d4caa5d06090a0bf.jpg"},{"id":24997647,"identity":"0ab965a6-98d9-42bd-afe9-6e1788cf2da4","added_by":"auto","created_at":"2022-08-09 17:21:35","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":4493,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version.\u003c/p\u003e","description":"","filename":"Fig3.png","url":"https://assets-eu.researchsquare.com/files/rs-1909518/v1/a66dc96523df5bc62f3484db.png"},{"id":26516478,"identity":"2c6b9801-10c9-488f-944d-5bd38e4baeb1","added_by":"auto","created_at":"2022-09-15 16:44:25","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":361651,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1909518/v1/1375c376-f7b1-4c50-8d92-ce76b497ee73.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eForced Social Isolation and Lockdown during the COVID-19 Pandemic: Depression, Anxiety, and Trauma-distress in a Greek sample\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMore than two years since the declaration of the coronavirus disease (COVID-19) as a pandemic by the World Health Organization (WHO), managing the virus spread remains an international public health priority. The COVID‐19 pandemic, characterized by its rapid transmission between individuals and the capacity of even asymptomatic cases to spread the disease leading to potentially overwhelmed health systems, forced many countries to adopt non-pharmacological interventions (NPIs) in the form of restrictions and spread management strategies, such as physical self- and social isolation [\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e]. However, these same restriction measures might have inadvertently caused significant mid‐, to long‐term impacts on people\u0026rsquo;s mental health [\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e]. Although the magnitude of the impact is still under debate, ranging in recent meta-analyses from modest [\u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e] to substantial [\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e], there is no doubt that rates of depression, stress, anxiety, and trauma-related distress have increased as a direct result of the pandemic.\u003c/p\u003e\n\u003cp\u003eAfter the confirmation of the first few cases in Greece, unprecedented measures of social constraints to inhibit its spread were rapidly implemented by the government and were gradually expanded to lead to strict social distancing constraints and lockdown (i.e., stay-at-home restrictions), enforced on March 23rd, 2020 [\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e]. Compliance to lockdown measures was characterized by news outlets as high, meeting little opposition from the public and leading to a smaller number of loss of life in the country, at least compared to the mortality rates of neighboring Italy or other Mediterranean countries, such as France or Spain [\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e]. It is worth noting, that the COVID-19 pandemic hit Greece just as the country was stepping out of years of economic crisis, with the fiscal hardship that accompanied harsh austerity policies leading to worse mental health, as documented by a 36% increase in suicide rates [\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e] and the 1-month prevalence of major depression rising from 3.3% at the beginning of the financial crisis in 2008 to 12.3% in 2013 [\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e]. The full impact of the pandemic and subsequent restrictions on the Greek population is still unknown, although few studies indicate adverse effects on mental health [\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e]. The present study, therefore, examined the impact of COVID-19 pandemic and subsequent forced social restrictions on mental health. In particular, we examined the contribution of demographic and social characteristics, restrictive measures and social isolation extend on psychological health of a Greek sample.\u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003e\u003cem\u003eParticipants\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA snowball sampling technique was used, with the study simultaneously advertised on several social media outlets and online mailing lists. The final sample after data validation consisted of 650 participants (465 female, 71.5%), with a mean age of 33.13 years (\u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;12.2; range\u0026thinsp;=\u0026thinsp;18\u0026ndash;77) and 16.6 years of education (\u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;4.2). Full demographics are shown in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. Most participants (89.8%) were actively employed (i.e., full-time, part-time, or student). Of those employed, 67.5% were working from home at the time of completing the questionnaire. No difference was reported by participants in their perceived physical health before and after the pandemic, \u003cem\u003e\u0026chi;\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e(1)\u0026thinsp;=\u0026thinsp;.62, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.804. Half of participants reported following moderate restrictions (57.5%), 17.7% severe restrictions, and only 4% did not obey the restrictions.\u003c/p\u003e\n\u003ctable border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cp\u003eTable 1\u003c/p\u003e\n \u003cp\u003eSummary Sociodemographic characteristics of study participants (n = 651).\u003c/p\u003e\n \u003c/caption\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"291\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"66\"\u003e\n \u003cp\u003e\u003cem\u003eM or N\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"78\"\u003e\n \u003cp\u003e\u003cem\u003eSD or %\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"291\"\u003e\n \u003cp\u003eAge (years), \u003cem\u003eM\u003c/em\u003e, \u003cem\u003eSD\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"66\"\u003e\n \u003cp\u003e33.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"78\"\u003e\n \u003cp\u003e12.17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"291\"\u003e\n \u003cp\u003eEducation (years), \u003cem\u003eM\u003c/em\u003e, \u003cem\u003eSD\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"66\"\u003e\n \u003cp\u003e16.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"78\"\u003e\n \u003cp\u003e4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"291\"\u003e\n \u003cp\u003eGender, \u003cem\u003eN\u003c/em\u003e, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"66\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"78\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"291\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Male\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"66\"\u003e\n \u003cp\u003e85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"78\"\u003e\n \u003cp\u003e28.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"291\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"66\"\u003e\n \u003cp\u003e465\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"78\"\u003e\n \u003cp\u003e71.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"291\"\u003e\n \u003cp\u003eEmployment status, \u003cem\u003eN\u003c/em\u003e, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"66\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"78\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"291\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Employed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"66\"\u003e\n \u003cp\u003e584\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"78\"\u003e\n \u003cp\u003e88.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"291\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Unemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"66\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"78\"\u003e\n \u003cp\u003e10.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"291\"\u003e\n \u003cp\u003eRelationship status, \u003cem\u003eN\u003c/em\u003e, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"66\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"78\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"291\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Single\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"66\"\u003e\n \u003cp\u003e421\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"78\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"291\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Partnered\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"66\"\u003e\n \u003cp\u003e227\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"78\"\u003e\n \u003cp\u003e34.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"291\"\u003e\n \u003cp\u003eLiving arrangements, \u003cem\u003eN\u003c/em\u003e, %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"66\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"78\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"291\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Lives with Children \u0026lt;5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"66\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"78\"\u003e\n \u003cp\u003e7.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"291\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Lives with Children 6-18 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"66\"\u003e\n \u003cp\u003e136\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"78\"\u003e\n \u003cp\u003e20.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"291\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Lives with Children \u0026gt;18 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"66\"\u003e\n \u003cp\u003e127\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"78\"\u003e\n \u003cp\u003e19.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"291\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Lives with parents\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"66\"\u003e\n \u003cp\u003e213\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"78\"\u003e\n \u003cp\u003e32.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"291\"\u003e\n \u003cp\u003eHistory of Psychiatric conditions \u003cem\u003eN\u003c/em\u003e, %\u003cem\u003eYes\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"66\"\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"78\"\u003e\n \u003cp\u003e13.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eMeasures\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe \u003cem\u003eEpidemic\u0026ndash;Pandemic Impacts Inventory\u003c/em\u003e (EPII) [\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e] () was utilized to assess participants\u0026rsquo; degree of direct exposure to COVID-19 and the COVID-19 pandemic impact on specific life domains. Following the methodology of other studies on similar topics [\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e], only 29 items off the original inventory\u0026rsquo;s 91 were used.\u003c/p\u003e\n\u003cp\u003eThe level of isolation experienced during the pandemic was assessed through a question about compliance with quarantine restrictions. There were four options to choose from, each describing measures implemented by governments of different countries, as follows: \u003cem\u003e\u0026ldquo;1) Level 0: I was not following any specific restrictions; 2) Level 1: I was following mild restrictions (e.g., not gathering with ten or more people, not traveling outside my city or state); 3) Level 2: I was following moderate restrictions (e.g., not leaving home except for working, care of another family member, exercise, or getting fresh air); 4) Level 3: I was following severe restrictions (e.g., not leaving home at all, or only leaving to buy food or medicine).\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe \u003cem\u003eDepression, Anxiety and Stress Scale\u003c/em\u003e (DASS-21) [\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e] and the \u003cem\u003eGeneralized Anxiety Disorder-7\u003c/em\u003e (GAD-7) [\u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e] questionnaire were used to assess symptom severity/frequency. The 8-item \u003cem\u003eChild-Revised Impact of Events Scale (CRIES-8)\u003c/em\u003e [\u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e] was used to measure respondents\u0026rsquo; trauma-related distress. Finally, the \u003cem\u003eBrief Coping Orientations to Problems Experienced Inventory\u003c/em\u003e (Brief COPE) [\u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e30\u003c/span\u003e] was utilized to tap into participants\u0026rsquo; use of coping styles (problem-focused, emotion-focused, and avoidant coping style). Half of the items were used in this study, one from each scale, as has been done elsewhere, to reduce completion times [\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eProcedure\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe survey was developed by an international group of psychologists, originally in English and later translated into Greek. The Lab of Cognitive Neuroscience and Clinical Neuropsychology of the Scientific College of Greece was responsible for the data collection. The study received IRB approval from both host institutions (Autonomous University of Madrid Ethical Committee, Spain, CEI-106-206 \u0026amp; The Scientific College of Greece Human Research Ethics Committee). All aspects of the study complied to the Declaration of Helsinki. The survey, hosted by the online platform SurveyMonkey, was promoted by professional emailing lists and advertised on social media (WhatsApp, Twitter, Facebook, and Instagram). Data collection was performed between February 3rd to June 1st, 2021. This period covers the \u0026ldquo;second COVID wave\u0026rdquo; in Greece and the longest period of enforced measures, during which restrictions were imposed on travelling between cities and between city boroughs, social distancing, and quarantine at home.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eData Analysis\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eOnce data were collected, they were exported from the survey platform to the statistical program IBM SPSS version 23. Data were initially checked for violations of test assumptions, and descriptive statistics were calculated for all outcome variables. A correlation matrix was created to show the bivariate relationships between demographic and outcome variables. The main statistical analyses involved four hierarchical stepwise multiple linear regressions with depression (DASS-21), anxiety (GAD-7), stress (DASS-21), and trauma-related distress (CRIES-8) as the outcome variables. In each regression, Step 1 included the demographic predictors (gender, age, employment and relationship status, lives with children\u0026thinsp;\u0026lt;\u0026thinsp;5, children 6\u0026ndash;17, children\u0026thinsp;\u0026lt;\u0026thinsp;18), Step 2 included the COVID-19 exposure variables (the EPII items), and Step 3 included the level of quarantine experienced. In follow-up chi-squares and correlations, bivariate associations between coping (Brief COPE) and these outcome variables were assessed.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv class=\"Section2\" id=\"Sec2\"\u003e\n \u003ch2\u003eTrauma-related Distress\u003c/h2\u003e\n \u003cp\u003eThe average participant score in the CRIES-8 was 13.76 (\u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;10.5), with only a small number of people (12.6%) reporting no trauma-related distress at all. 38% of participants reported clinically significant distress, denoted by a total score of \u0026gt;\u0026thinsp;17 in CRIES-8. In the correlation matrix (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e), higher trauma-related distress was moderately associated with depression (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.46, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001), stress (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.53, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001), and anxiety (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.51, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001) levels. Step 1 of the Hierarchical linear regression analysis (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e) was statistically significant, \u003cem\u003eF\u003c/em\u003e(8,638)\u0026thinsp;=\u0026thinsp;3.641, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001, \u003cem\u003er\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.03. The only significant variable that contributed to the prediction of trauma-related distress in this step was gender (being female was associated with higher CRIES-8 scores, Fig.\u0026nbsp;3). In Step 2, the model remained significant, \u003cem\u003eF\u003c/em\u003e(28,618)\u0026thinsp;=\u0026thinsp;3.471, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001, \u003cem\u003er\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.10, \u003cem\u003eF\u003c/em\u003e\u003csub\u003echange\u003c/sub\u003e = 3.298, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001, \u003cem\u003er\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003csub\u003e\u003cem\u003echange\u003c/em\u003e\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;.09. Specifically, apart from gender, EPII items \u0026ldquo;\u003cem\u003eIncrease in verbal arguments or conflict with other adult(s) in home\u003c/em\u003e\u0026rdquo; and \u0026ldquo;\u003cem\u003eSeparated from family or close friends\u003c/em\u003e\u0026rdquo; were positively associated with trauma-related distress. The full model (Step 3) was statistically significant, \u003cem\u003eF\u003c/em\u003e(29,617)\u0026thinsp;=\u0026thinsp;3.350, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001, \u003cem\u003er\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.09. However, the addition of the last predictor (level of quarantine) did not add to predictive power, \u003cem\u003eF\u003c/em\u003e\u003csub\u003echange\u003c/sub\u003e = .113, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.737, \u003cem\u003er\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003csub\u003e\u003cem\u003echange\u003c/em\u003e\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;.00. Therefore, the level at which one was following the restrictions was not a significant predictor of trauma-related distress. Overall, in order of magnitude of contribution to the final model, the predictors that were significant in the final model were EPII item \u0026ldquo;\u003cem\u003eIncrease in verbal arguments or conflict with other adult(s) in home\u003c/em\u003e\u0026rdquo; (\u003cem\u003e\u0026beta;\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.22, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001), gender (\u003cem\u003e\u0026beta;\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.13, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001), and EPII item \u0026ldquo;\u003cem\u003eSeparated from family or close friends\u0026rdquo;\u003c/em\u003e (\u003cem\u003e\u0026beta;\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.13, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable border=\"1\" id=\"Tab2\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eCorrelation matrix among demographic variables and health outcomes.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eM\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eSD\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1. Age\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e33.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2. Education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.36\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3. CRIES-8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4. DASS Stress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.18\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.53\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5. DASS Depression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.14\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.10\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.46\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.71\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6. GAD 7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.15\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.51\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.83\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.74\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7. COPE Problem-focused\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.29**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.19**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.15**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8. COPE Emotion-focused\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.35**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.30**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.23**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.25**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.62**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9. COPE Avoidant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.52**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.52**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.51**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.50**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.28**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.34**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"11\"\u003e* Correlation is significant at the 0.05 level (2\u0026minus;tailed).\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"11\"\u003e** Correlation is significant at the 0.01 level (2-tailed).\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec3\"\u003e\n \u003ch2\u003eDepression, Stress, and Anxiety\u003c/h2\u003e\n \u003cp\u003eRates of both depression and stress (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e) were low-to-mild. In the DASS-\u003cem\u003eDepression\u003c/em\u003e scale, participants scored an average of 10.53 (\u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;10.7). 14.9% of the sample reported moderate symptoms of depression, while 18% reported either severe or extremely severe symptomatology (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). There was a statistically significant, weak association between marital status and depression severity (\u003cem\u003e\u0026chi;\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e(4)\u0026thinsp;=\u0026thinsp;10.51, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.033, \u003cem\u003eCramer\u0026rsquo;s V\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.13). A significant, weak association was also observed between employment status and depression severity (\u003cem\u003e\u0026chi;\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e(4)\u0026thinsp;=\u0026thinsp;12.95, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.012, \u003cem\u003eCramer\u0026rsquo;s V\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.14). Singles reported more intense depression symptoms than partnered/married participants, and unemployed participants reported higher rates in all severity bands of the depression scale. Females reported higher depression rates (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;11.42, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;10.9) than males (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;8.30, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;9.6), \u003cem\u003et\u003c/em\u003e(384) = -3.59, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001, one-tailed (Fig.\u0026nbsp;3). Strong positive correlations were found between depression symptoms and anxiety (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.74, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001) and depression and stress (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.71, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001) levels. Depression severity also negatively correlated with age (\u003cem\u003er\u0026thinsp;=\u0026thinsp;\u0026minus;\u003c/em\u003e\u0026thinsp;.14, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001), with lower depression scores observed in older participants.\u003c/p\u003e\n \u003cp\u003eA three-step hierarchical linear regression analysis was conducted to evaluate the prediction of depression symptomatology (DASS Depression total score) from demographic variables (Step 1: \u003cem\u003eF\u003c/em\u003e(8,638)\u0026thinsp;=\u0026thinsp;6.303, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001, \u003cem\u003er\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.07), variables relating to COVID-19 exposure (Step 2: \u003cem\u003eF\u003c/em\u003e(28,618)\u0026thinsp;=\u0026thinsp;6.648, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001, \u003cem\u003er\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.23, \u003cem\u003eF\u003c/em\u003e\u003csub\u003echange\u003c/sub\u003e = 6.362, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001, \u003cem\u003er\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003csub\u003e\u003cem\u003echange\u003c/em\u003e\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;.16), and the level of quarantine experienced (Step 3). The full results can be viewed in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e. The full model (Step 3) was statistically significant, \u003cem\u003eF\u003c/em\u003e(29,617)\u0026thinsp;=\u0026thinsp;6.453, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001, \u003cem\u003er\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.23. Once again, the addition of last factor (level of quarantine) did not add to predictive power, \u003cem\u003eF\u003c/em\u003e\u003csub\u003echange\u003c/sub\u003e = .994, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.319, \u003cem\u003er\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003csub\u003e\u003cem\u003echange\u003c/em\u003e\u003c/sub\u003e\u0026thinsp;\u003cem\u003e=\u003c/em\u003e\u0026thinsp;.001. Therefore, the level to which one was following the restrictions was not a significant predictor of depression. The variables that were significant in order of magnitude of contribution to the final model were EPII item \u0026ldquo;\u003cem\u003eBeing separated from family or close friends\u003c/em\u003e\u0026rdquo; (\u003cem\u003e\u0026beta;\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.23, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001), marital status (\u003cem\u003e\u0026beta;\u003c/em\u003e = \u0026minus;\u0026thinsp;.12, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.004), EPII items \u0026ldquo;\u003cem\u003eIncrease in verbal arguments or conflict with other adult(s) in home\u003c/em\u003e\u0026rdquo; (\u003cem\u003e\u0026beta;\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.19, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001), and \u0026ldquo;\u003cem\u003eUnable to get enough food or healthy food\u003c/em\u003e\u0026rdquo; (\u003cem\u003e\u0026beta;\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.1, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.003), employment status (\u003cem\u003e\u0026beta;\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.11, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.005), EPII item \u0026ldquo;\u003cem\u003eLaid off from job or had to close own business\u003c/em\u003e\u0026rdquo; (\u003cem\u003e\u0026beta;\u003c/em\u003e = \u0026minus;\u0026thinsp;.08 \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.037), and gender (\u003cem\u003e\u0026beta;\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.08, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.033).\u003c/p\u003e\n \u003cp\u003eIn DASS-\u003cem\u003eStress\u003c/em\u003e, participants reported mild-low levels of stress, as mentioned above, \u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;15.10, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;11.68 on average. 11.8% of the sample reported moderate symptoms of stress, while almost 20% reported either severe or extremely severe symptomatology (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). Higher stress rates were reported by females (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;16.31, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;11.6) than males (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;12.06, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;11.3), \u003cem\u003et\u003c/em\u003e(648) = -4.234, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001, one-tailed (Fig.\u0026nbsp;3). A weak negative correlation was observed between stress levels and age (\u003cem\u003er\u0026thinsp;=\u0026thinsp;\u0026minus;\u003c/em\u003e\u0026thinsp;.18, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001), a moderate positive correlation between stress and trauma-related distress (CRIES-8), \u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.53, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001, and two strong positive correlations between stress and depression (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.71, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001) and anxiety (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.83, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001). Step 1 of the Hierarchical linear regression (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e) was statistically significant, \u003cem\u003eF\u003c/em\u003e(8,638)\u0026thinsp;=\u0026thinsp;5.00, \u003cem\u003ep\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;.001, \u003cem\u003er\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.06, as was Step 2, \u003cem\u003eF\u003c/em\u003e(28,618)\u0026thinsp;=\u0026thinsp;9.099, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001, \u003cem\u003er\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.23, \u003cem\u003eF\u003c/em\u003e\u003csub\u003echange\u003c/sub\u003e = 10.164, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001, \u003cem\u003er\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003csub\u003e\u003cem\u003echange\u003c/em\u003e\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;.23. The full model (Step 3) was also statistically significant, \u003cem\u003eF\u003c/em\u003e(29,617)\u0026thinsp;=\u0026thinsp;8.858, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001, \u003cem\u003er\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.002, \u003cem\u003eF\u003c/em\u003e\u003csub\u003echange\u003c/sub\u003e = 1.797, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.18, \u003cem\u003er\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003csub\u003e\u003cem\u003echange\u003c/em\u003e\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;.002, again, with no significant contribution of level of quarantine on predictive power. Overall, and in order of magnitude of contribution to the final model, the predictors that were significant in the final model were EPII items \u0026ldquo;\u003cem\u003eIncrease in verbal arguments or conflict with other adult(s) in home\u003c/em\u003e\u0026rdquo; (\u003cem\u003e\u0026beta;\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.35, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001), \u0026ldquo;\u003cem\u003eSeparated from family or close friends\u003c/em\u003e\u0026rdquo; (\u003cem\u003e\u0026beta;\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.21, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001), \u0026ldquo;\u003cem\u003eUnable to get enough food or healthy food\u003c/em\u003e\u0026rdquo; (\u003cem\u003e\u0026beta;\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.12, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001), age (\u003cem\u003e\u0026beta;\u003c/em\u003e = \u0026minus;\u0026thinsp;.10, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.019), EPII item \u0026ldquo;\u003cem\u003eLaid off from job or had to close own business\u0026rdquo;\u003c/em\u003e (\u003cem\u003e\u0026beta;\u003c/em\u003e = \u0026minus;\u0026thinsp;.1, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.009), and gender (\u003cem\u003e\u0026beta;\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.09, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.010).\u003c/p\u003e\n \u003cp\u003eOn average across the sample, low-mild levels of anxiety severity were observed, \u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;5.93, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;5.6 (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). 11% of participants reported moderate anxiety levels, while 10.3% reported severe symptoms. There was a statistically significant, weak association between age and anxiety severity, \u003cem\u003e\u0026chi;\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e(15)\u0026thinsp;=\u0026thinsp;35.85, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.002, \u003cem\u003eCramer\u0026rsquo;s V\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.23. Higher anxiety rates were reported by females (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;6.56, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;5.728) than males (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;4.35, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;4.8), \u003cem\u003et\u003c/em\u003e(398) = -4.997, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001, one-tailed (Fig.\u0026nbsp;3). Anxiety symptomatology was positively and moderately correlated with trauma-related distress (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.51, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001), strongly with stress (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.83, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001), and strongly with depression (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.74, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001) (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003eStep 1 of the Hierarchical linear regression (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e) was statistically significant, \u003cem\u003eF\u003c/em\u003e(8,638)\u0026thinsp;=\u0026thinsp;5.595, \u003cem\u003ep\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;.001, \u003cem\u003er\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.07, as was Step 2, \u003cem\u003eF\u003c/em\u003e(28,618)\u0026thinsp;=\u0026thinsp;7.168, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001, \u003cem\u003er\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.24, \u003cem\u003eF\u003c/em\u003e\u003csub\u003echange\u003c/sub\u003e = 7.352, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001, \u003cem\u003er\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003csub\u003e\u003cem\u003echange\u003c/em\u003e\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;.18, and the full model (Step 3), \u003cem\u003eF\u003c/em\u003e(29,617)\u0026thinsp;=\u0026thinsp;6.921, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001, \u003cem\u003er\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.25. However, the addition of level of quarantine again did not add to predictive power, \u003cem\u003eF\u003c/em\u003e\u003csub\u003echange\u003c/sub\u003e = .243, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.62, \u003cem\u003er\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003csub\u003e\u003cem\u003echange\u003c/em\u003e\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;.00. In order of contribution, the significant predictors in the final model were EPII items \u0026ldquo;\u003cem\u003eIncrease in verbal arguments or conflict with other adult(s) in home\u003c/em\u003e\u0026rdquo; (\u003cem\u003e\u0026beta;\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.28, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026lt;\u0026thinsp;.001), \u0026ldquo;\u003cem\u003eSeparated from family or close friends\u003c/em\u003e\u0026rdquo; (\u003cem\u003e\u0026beta;\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.23, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001), gender (\u003cem\u003e\u0026beta;\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.11, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.002), age \u003cem\u003e(\u0026beta;\u003c/em\u003e = \u0026minus;\u0026thinsp;.1, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.027), and EPII item \u0026ldquo;\u003cem\u003eUnable to get enough food or healthy food\u003c/em\u003e\u0026rdquo; (\u003cem\u003e\u0026beta;\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.08, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.030).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable border=\"1\" id=\"Tab3\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eResults of Multiple Regression Analyses by outcome (standardized betas from Step 3).\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePredictor variable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eCRIES-8\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eDASS\u003c/p\u003e\n \u003cp\u003eDepression\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eDASS\u003c/p\u003e\n \u003cp\u003eStress\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eGAD-7\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026beta;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026beta;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026beta;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026beta;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eStep 1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.059\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.210\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.080\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.086\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.098\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.027\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.174\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e.090\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEducation (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.603\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.056\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.177\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.909\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.622\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRelationship status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.042\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.363\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.084\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.068\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.033\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.426\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.688\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmployment status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.026\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.501\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.148\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.939\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.053\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.159\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLives with Children\u0026thinsp;\u0026lt;\u0026thinsp;5yrs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.059\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.805\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.031\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.444\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.652\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLives with Children 6-17yrs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.038\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.338\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.059\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.137\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.047\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.304\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.063\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.185\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLives with Children\u0026thinsp;\u0026gt;\u0026thinsp;18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.943\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.032\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.355\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.027\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.460\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eStep 2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"9\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCurrently have symptoms of this disease but have not been tested\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.629\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.052\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.227\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e.051\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.213\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.027\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.531\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTested and currently have this disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.719\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.794\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e.031\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.544\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.029\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.582\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHad symptoms of this disease but never tested\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.989\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.028\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.508\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.040\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.330\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.893\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTested positive for this disease but no longer have it\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.047\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.437\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.026\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.653\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.064\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.250\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.060\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.293\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGot medical treatment due to severe symptoms of this disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.727\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.053\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.205\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e.066\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.057\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.169\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHospital stay due to this disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.026\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.541\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.980\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.651\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.760\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDeath of close friend or family member from this disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.699\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.676\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.201\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.026\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.476\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLaid off from job or had to close own business\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.027\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.511\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.081\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.037\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.097\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.069\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.071\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReduced work hours or furloughed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.567\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.044\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.262\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e.012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.747\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.591\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHad to continue to work even though in close contact with people who might be infected\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.046\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.250\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.039\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.294\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.899\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.573\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProvided direct care to people with the disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.637\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.052\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.151\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.039\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.265\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.042\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.242\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIncrease in workload or work responsibilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.823\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.878\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.721\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.818\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHard time doing job well because of needing to take care of people in the home\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.034\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.391\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.067\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.071\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e.052\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.046\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.213\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHard time making the transition to working from home\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.904\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.032\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.389\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e.012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.736\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.028\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.447\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnable to get enough food or healthy food\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.543\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e.118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.081\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.030\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnable to pay important bills like rent or utilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.988\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.560\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.028\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.451\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.894\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHad a child in home who could not go to school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.970\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.073\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.163\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e.073\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.144\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.056\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.275\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIncrease in verbal arguments or conflict with other adult(s) in home\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.224\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.191\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e.353\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.279\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSeparated from family or close friends\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.135\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.226\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e.208\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.226\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEvents/celebrations canceled or restricted\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.730\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.029\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.437\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.920\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.906\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eStep 3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCompliance with restrictions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.749\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.037\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.319\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.048\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.181\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.622\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec4\"\u003e\n \u003ch2\u003eCoping styles\u003c/h2\u003e\n \u003cp\u003eMost participants reported using acceptance, reframing, planning, active coping, and self-distraction. Significant gender differences were found with regard to self-distraction (\u003cem\u003ex\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e(3)\u0026thinsp;=\u0026thinsp;26.867, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001, \u003cem\u003eCramer\u0026rsquo;s V\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.203), active coping (\u003cem\u003ex\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e(3)\u0026thinsp;=\u0026thinsp;14.45, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.002, \u003cem\u003eCramer\u0026rsquo;s V\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.15), use of emotional support (\u003cem\u003ex\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e(3)\u0026thinsp;=\u0026thinsp;23.252 \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001, \u003cem\u003eCramer\u0026rsquo;s V\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.189), behavioral disengagement (\u003cem\u003ex\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e(3)\u0026thinsp;=\u0026thinsp;20.493, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001, \u003cem\u003eCramer\u0026rsquo;s V\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.178), venting (\u003cem\u003ex\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e(3)\u0026thinsp;=\u0026thinsp;10.799, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.013, \u003cem\u003eCramer\u0026rsquo;s V\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.129), use of instrumental support (\u003cem\u003ex\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e(3)\u0026thinsp;=\u0026thinsp;19.169, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001, \u003cem\u003eCramer\u0026rsquo;s V\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.172) and positive reframing (\u003cem\u003ex\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e(3)\u0026thinsp;=\u0026thinsp;11.362, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.010, \u003cem\u003eCramer\u0026rsquo;s V\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.132) (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e). A greater proportion of women than men used self-distraction (80.9 versus 65.4%), active coping (86.9 versus 78.9%), use of emotional support from others (79.4 versus 63.2%), behavioral disengagement (38 versus 20%), venting (69.2 versus 59.5%), instrumental support (77.6 versus 66.5), and positive reframing (94.6 versus 88.1%) as coping styles. There was no difference between males and females in use of substances, denial, self-blame, use of humor, acceptance or turning to religion as a coping mechanism. Use of a problem-focused coping style was weakly related to trauma-related distress (\u003cem\u003er\u0026thinsp;=\u003c/em\u003e\u0026thinsp;.29, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001). Emotion-focused coping was also weakly related to trauma-related distress (\u003cem\u003er\u0026thinsp;=\u003c/em\u003e\u0026thinsp;.35, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001) and stress (\u003cem\u003er\u0026thinsp;=\u003c/em\u003e\u0026thinsp;.30, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001), while avoidant coping was moderately associated with trauma-related distress (\u003cem\u003er\u0026thinsp;=\u003c/em\u003e\u0026thinsp;.52, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001), stress (\u003cem\u003er\u0026thinsp;=\u003c/em\u003e\u0026thinsp;.52, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001), depression (\u003cem\u003er\u0026thinsp;=\u003c/em\u003e\u0026thinsp;.51, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001), and anxiety (\u003cem\u003er\u0026thinsp;=\u003c/em\u003e\u0026thinsp;.50, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001) (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e, for the full correlation matrix).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable border=\"1\" id=\"Tab4\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eProportions of Males and Females endorsing use of each coping style of the Brief Cope inventory.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eBrief COPE \u0026ldquo;I\u0026rsquo;ve been \u0026hellip;\u0026rdquo;\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e% M\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e% F\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eWhole sample\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026hellip; accepting the reality of the fact that it has happened (\u003cem\u003eacceptance\u003c/em\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e94,6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e95,7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80,4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026hellip; trying to see it in a different light, more positive (\u003cem\u003epositive reframing)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e88,1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e94,6*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026hellip; trying to come up with a strategy about what to do (\u003cem\u003eplanning\u003c/em\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e86,5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e86,7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60,6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026hellip; concentrating my efforts doing something about the situation (\u003cem\u003eactive coping\u003c/em\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e78,9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e86,9*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026hellip; turning to work/other activities to take my mind off things (\u003cem\u003eself-distraction\u003c/em\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65,4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80,9*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52,9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026hellip; criticizing myself (\u003cem\u003eself-blame\u003c/em\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72,4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e78,9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49,7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026hellip; making jokes about it (\u003cem\u003ehumour\u003c/em\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72,4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75,7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44,3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026hellip; getting emotional support from others (\u003cem\u003eemotional support from others\u003c/em\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63,2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79,4*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026hellip; getting help and advice from other people (\u003cem\u003einstrumental support)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66,5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77,6*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40,4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026hellip; saying things to let my unpleasant feelings escape (\u003cem\u003eventing\u003c/em\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e59,5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69,2*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30,9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026hellip; trying to find comfort in my religion or spiritual beliefs (\u003cem\u003ereligion\u003c/em\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38,9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43,4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026hellip; giving up trying to deal with it (\u003cem\u003ebehavioral disengagement\u003c/em\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9,7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026hellip; using alcohol or other drugs to make myself feel better (\u003cem\u003esubstance\u003c/em\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23,8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25,4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8,8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026hellip; refusing to believe that it has happened (\u003cem\u003edenial\u003c/em\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20,5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27,1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7,7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003eNote: * gender difference significant at \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.01.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study explored the mental health impact of the profound lifestyle changes imposed by the COVID19- pandemic in a Greek sample during the second pandemic wave. Overall, considerable psychological burden was reported, with the proportion of the sample with moderate-to-severe depression being 33%, anxiety 21.3%, and stress 31.8. Moreover, almost 40% reported clinically significant trauma-related distress. The rates found here are comparable to those found in other countries under restrictions measures. For example, in a meta-analysis of 17 studies looking at psychological impact of the first wave of pandemic restrictions in Spring 2020, Salari et al. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] reported a pooled prevalence of 29.6% for stress, 31.9% anxiety, and 33.7% depression. Despite the fact that the present study was cross-sectional, with no indicators of pre-pandemic mental health rates, the findings show the need for immediate implementation of social policy interventions designed to support the population in the post-pandemic era. Longitudinal studies are also emerging documenting a deterioration in mental health during the first quarantine [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFor all outcomes, the strongest predictors of depression, anxiety, stress, and trauma distress were pandemic-related life changes. Experiencing conflict in the home, being separated from close family and friends, being unable to buy enough/healthy food, and being laid off from work, or having to close down one\u0026rsquo;s business were stronger predictors of mental health than level of quarantine (which did not affect any outcome) or most demographics. Increases in verbal arguments with other adults at home emerged as the strongest predictor for all outcomes. Known contributors to family violence, such as financial hardship and social isolation, that have been identified in the past have certainly contributed to increasing rates of family/relationship violence observed in many countries during and after lockdowns, including Greece [\u003cspan additionalcitationids=\"CR32 CR33 CR34\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. The same pandemic-related contributors to decreased mental health were reported in similar studies in other countries. For example, in a study by Yuksel et al. [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], data from 59 countries on mental health outcomes during the first pandemic wave showed that conflicts between adults in the home were consistently related to poor sleep health, while Alzueta et al. [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] also found domestic arguments to be the strongest predictor of depression and anxiety, over and above demographic characteristics or level of restrictions imposed. In the current study, the level to which someone was complying with government-imposed restrictions made no difference to any mental health outcome. This finding has been observed in other studies as well [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] and is quite paradoxical, since it would be expected that those who did not follow restrictions or followed them just a bit (about 25% of the sample) would fare better. Pandemic impact was likely more diffuse and global, rather than relating to more specific day-to-day practices (e.g., social distancing, use of protective equipment, etc.).\u003c/p\u003e \u003cp\u003eApart from quarantine-related factors, certain population characteristics increased the risk of mental health vulnerability. Being female, of younger age, or unemployed were all associated with higher rates of depression, stress, and anxiety, as has been documented elsewhere during the pandemic [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], but also more generally, as consistent epidemiological markers of mental health inequalities [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan additionalcitationids=\"CR37\" citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. The female predominance in most psychiatric disorders is a complex phenomenon, explained by interacting biological (neurotransmitter, neuroendocrine, genetic factors and circadian rhythm) and psychosocial forces, such as women\u0026rsquo;s lower social and financial status, higher rates of lifelong victimisation and other adverse life events (see for discussions 40\u0026ndash;43,55). In addition, marital status was a predictor of depression, with singles being more vulnerable to the detrimental effects of the pandemic, a finding corroborated by other studies [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. Several studies have documented how age, marital and employment status may separately and together act as stress-buffering or stress-exacerbating factors. The job losses and financial uncertainty suffered by the younger age groups (who are also more likely to be single/live alone) during the COVID-19 pandemic, would make them disproportionately affected [\u003cspan additionalcitationids=\"CR46\" citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLastly, we looked at the way participants used specific coping strategies during the pandemic. Most respondents reported engaging in acceptance, positive reframing, planning, active coping, and self-distraction through work or other activities. These strategies are all based on individual strengths and resilience and do not rely on social network support. Receiving emotional or instrumental support from others appeared further down the list as a coping strategy, being endorsed by 42.5% and 40.4% of participants, respectively. This is not surprising and shows how the lockdown, by design, increased not only physical distancing but also psychological distancing between people. Gender differences emerged, in that women reported using reframing, active coping, self-distraction, venting, behavioral disengagement, and social support more than men, findings that have been reported elsewhere as well [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e], possibly offering some protection against mental health problems. Reframing and acceptance, for example, both positive emotion-focused coping strategies, have been recognised as protective factors for mental health [\u003cspan additionalcitationids=\"CR50 CR51 CR52\" citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. Other strategies, such as venting, behavioural disengagement, self-distraction, use of instrumental support have been associated with higher stress, anxiety and depression levels, and can be less useful in potential psycho-traumatic situations [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe present study adds to an international body of research exploring the tremendous impact that this contemporary pandemic had to the psychological aspects of peoples\u0026rsquo; lives and in particular of the population of a Mediterranean country. However, while the study offers a glimpse into the mental health impact of pandemic-related restrictions on Greek people, it has several methodological limitations. First, the study design was cross-sectional, and hence only associations, and no causal inferences, can be drawn. Second, online sampling, while the only outlet during pandemic restrictions, carries its own biases, excluding those with reduced or no internet accessibility. Additionally, the self-report instruments used here, in the absence of independent clinical verification, might exacerbate or minimize reported symptomatology, and hence lack objectivity.\u003c/p\u003e \u003cp\u003eFinally, it is important point out that most adverse consequences emerged from the imposition of restrictions on liberty, which in the future, if essential, should be kept short, with a clear rationale provided. From the emerging literature, it is shown that self-imposed isolation is related to less psychological distress [see 11 for a review], so future measures might rely on persuasion more than imposition. The findings of the present study illustrate the urgent need for mental health support services in the post-pandemic era, especially in populations of people with multiple vulnerabilities, such as historical financial hardship, female gender, younger age, and unemployment.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding Acknowledgement:\u003c/strong\u003e This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of Conflicting Interest:\u003c/strong\u003e The Authors declare that there is no conflict of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eChan JF, Yuan S, Kok KH, To KK, Chu H, Yang J, Xing F, Liu J, Yip CC, Poon RW, Tsoi HW (2020) A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. The lancet 15;395(10223):514\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eReicher S, Drury J (2020) Pandemic fatigue? How adherence to covid-19 regulations has been misrepresented and why it matters. Bmj 372.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSolomou I, Constantinidou F (2020) Prevalence and predictors of anxiety and depression symptoms during the COVID-19 pandemic and compliance with precautionary measures: age and sex matter. International journal of environmental research and public health 17(14):4924.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, Ho RC (2020a) Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. International Journal of Environmental Research and Public Health17(5):1729.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlzueta E, Perrin P, Baker FC, Caffarra S, Ramos-Usuga D, Yuksel D, Arango‐Lasprilla JC (2021) How the COVID‐19 pandemic has changed our lives: A study of psychological correlates across 59 countries. Journal of clinical psychology 77(3):556\u0026ndash;570.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKolakowsky-Hayner SA, Goldin Y, Kingsley K, Alzueta E, Arango-Lasprilla JC, Perrin PB, Baker FC, Ramos-Usuga D, Constantinidou F (2021) Psychosocial impacts of the COVID-19 quarantine: a study of gender differences in 59 countries. Medicina 57(8):789.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePierce M, Hope H, Ford T, Hatch S, Hotopf M, John A, Kontopantelis E, Webb R, Wessely S, McManus S, Abel KM (2020) Mental health before and during the COVID-19 pandemic: a longitudinal probability sample survey of the UK population. The Lancet Psychiatry 7(10):883\u0026ndash;892.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePrati G, Mancini AD (2021) The psychological impact of COVID-19 pandemic lockdowns: a review and meta-analysis of longitudinal studies and natural experiments. Psychological medicine 51(2):201\u0026ndash;211.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSalari N, Hosseinian-Far A, Jalali R, Vaisi-Raygani A, Rasoulpoor S, Mohammadi M, Rasoulpoor S, Khaledi-Paveh B (2020) Prevalence of stress, anxiety, depression among the general population during the COVID-19 pandemic: a systematic review and meta-analysis. Globalization and health 16(1):1\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWu T, Jia X, Shi H, Niu J, Yin X, Xie J, Wang X (2021) Prevalence of mental health problems during the COVID-19 pandemic: A systematic review and meta-analysis. Journal of affective disorders 281:91\u0026ndash;98.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrooks JT, Beezhold DH, Noti JD, Coyle JP, Derk RC, Blachere FM, Lindsley WG (2021) Maximizing fit for cloth and medical procedure masks to improve performance and reduce SARS-CoV-2 transmission and exposure, 2021. Morbidity and Mortality Weekly Report 70(7): 254.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCovidTrackingMapGR. CoVid19.gov.gr (in Greek). 29 May 2021. Retrieved 8 July 2022. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://covid19.gov.gr/covid-map/\u003c/span\u003e\u003cspan address=\"https://covid19.gov.gr/covid-map/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDelinasios GJ, Fragkou PC, Gkirmpa AM, Tsangaris G, Hoffman RM, Anagnostopoulos AK (2021) The experience of Greece as a model to contain COVID-19 infection spread. In vivo 35(2):1285\u0026ndash;1294.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFountoulakis KN, Apostolidou MK, Atsiova MB, Filippidou AK, Florou AK, Gousiou DS, Katsara AR, Mantzari SN, Padouva-Markoulaki M, Papatriantafyllou EI, Sacharidi PI (2021) Self-reported changes in anxiety, depression and suicidality during the COVID-19 lockdown in Greece. Journal of affective disorders 279:624\u0026ndash;629.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSkapinakis P, Bellos S, Oikonomou A, Dimitriadis G, Gkikas P, Perdikari E, Mavreas V (2020) Depression and its relationship with coping strategies and illness perceptions during the COVID-19 lockdown in Greece: a cross-sectional survey of the population. Depression research and treatment Vol.\u0026nbsp;2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBranas CC, Kastanaki AE, Michalodimitrakis M, Tzougas J, Kranioti EF, Theodorakis PN, Carr BG, Wiebe DJ (2015) The impact of economic austerity and prosperity events on suicide in Greece: a 30-year interrupted time-series analysis. BMJ open 5(1):e005619.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEconomou M, Angelopoulos E, Peppou LE, Souliotis K, Tzavara C, Kontoangelos K, Madianos M, Stefanis C (2016) Enduring financial crisis in Greece: prevalence and correlates of major depression and suicidality. Social psychiatry and psychiatric epidemiology 51(7):1015\u0026ndash;1024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEconomou M, Madianos M, Peppou LE, Patelakis A, Stefanis CN (2013) Major depression in the era of economic crisis: a replication of a crosssectional study across Greece. J Affect Disord 145:308\u0026ndash;314.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMadianos M, Economou M, Alexiou T, Stefanis C (2011) Depression and economic hardship across Greece in 2008 and 2009: two cross-sectional surveys nationwide. Soc Psychiatry Psychiatr Epidemiol 46:943\u0026ndash;952.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKaparounaki CK, Patsali ME, Mousa DP, Papadopoulou EV, Papadopoulou KK, Fountoulakis KN (2020) University students\u0026rsquo; mental health amidst the COVID-19 quarantine in Greece. Psychiatry research 290:113111.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eParlapani E, Holeva V, Voitsidis P, Blekas A, Gliatas I, Porfyri GN, Golemis A, Papadopoulou K, Dimitriadou A, Chatzigeorgiou AF, Bairachtari V (2020) Psychological and behavioral responses to the COVID-19 pandemic in Greece. Frontiers in psychiatry 821.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYuksel B, Ozgor F (2020) Effect of the COVID-19 pandemic on female sexual behavior. International Journal of Gynecology \u0026amp; Obstetrics 150(1):98\u0026ndash;102.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGrasso DJ, Briggs-Gowan MJ, Ford JD, Carter AS (2020) The epidemic\u0026ndash;pandemic impacts inventory (EPII). University of Connecticut School of Medicine. National Institute of Health (NIH) Disaster Research Response (DR2) Repository of COVID-19 Research Tools. Retrieved from \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://dr2.nlm.nih.gov\u003c/span\u003e\u003cspan address=\"https://dr2.nlm.nih.gov\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLovibond PF, Lovibond SH (1995) The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour research and therapy 33(3):335\u0026ndash;343.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLyrakos GN, Arvaniti C, Smyrnioti M, Kostopanagiotou G (2011) Translation and validation study of the depression anxiety stress scale in the Greek general population and in a psychiatric patient's sample. European Psychiatry 26(S2):1731\u0026ndash;1731.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSpitzer RL, Kroenke K, Williams JB, L\u0026ouml;we B (2006) A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of internal medicine 166(10):1092\u0026ndash;1097.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePerrin S, Meiser-Stedman R, Smith P (2005) The Children's Revised Impact of Event Scale (CRIES): Validity as a screening instrument for PTSD. Behavioural and Cognitive Psychotherapy 33(4):487\u0026ndash;498.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCarver CS, Scheier MF, Weintraub JK. (1989). Assessing coping strategies: a theoretically based approach. Journal of personality and social psychology 56(2):267.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCarver CS (1997) You want to measure coping but your protocol\u0026rsquo;too long: Consider the brief cope. International journal of behavioral medicine 4(1):92\u0026ndash;100.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKapsou M, Panayiotou G, Kokkinos CM, Demetriou AG (2010) Dimensionality of coping: An empirical contribution to the construct validation of the Brief-COPE with a Greek-speaking sample. Journal of health psychology 15(2):215\u0026ndash;229.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBoserup B, McKenney M, Elkbuli A (2020). Alarming trends in US domestic violence during the COVID-19 pandemic. The American journal of emergency medicine 38(12):2753\u0026ndash;2755.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eErtan D, El-Hage W, Thierr\u0026eacute;e S, Javelot H, Hingray C (2020) COVID-19: urgency for distancing from domestic violence. European journal of psychotraumatology 11(1):1800245.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKourti A, Stavridou A, Panagouli E, Psaltopoulou T, Spiliopoulou C, Tsolia M, Sergentanis TN, Tsitsika A (2021) Domestic violence during the COVID-19 pandemic: a systematic review. Trauma, violence, \u0026amp; abuse 15248380211038690.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePeterman A, Potts A, O'Donnell M, Thompson K, Shah N, Oertelt-Prigione S, Van Gelder N (2020). Pandemics and violence against women and children (Vol.\u0026nbsp;528). Washington, DC: Center for Global Development.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUsher K, Bhullar N, Durkin J, Gyamfi N, Jackson D (2020) Family violence and COVID-19: Increased vulnerability and reduced options for support. International journal of mental health nursing \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/inm.12735\u003c/span\u003e\u003cspan address=\"10.1111/inm.12735\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBoyd A, Van de Velde S, Vilagut G, De Graaf R, Florescu S, Alonso J, Kovess-Masfety V, EU-WMH Investigators (2015) Gender differences in mental disorders and suicidality in Europe: results from a large cross-sectional population-based study. Journal of affective disorders 173:245\u0026ndash;254.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHasin DS, Fenton MC, Weissman MM (2011) Epidemiology of depressive disorders. In Tsuang, M. T., Tohen, M., \u0026amp; Zahner, G. E. (Eds.). Textbook in psychiatric epidemiology. New York: Wiley-Liss. (Ed. 3) 289\u0026ndash;309.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSeedat S, Scott KM, Angermeyer MC, Berglund P, Bromet EJ, Brugha TS, Demyttenaere K, De Girolamo G, Haro JM, Jin R, Karam EG (2009) Cross-national associations between gender and mental disorders in the World Health Organization World Mental Health Surveys. Archives of general psychiatry 66(7):785\u0026ndash;795.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAfifi M (2007) Gender differences in mental health. Singapore medical journal 48(5):385.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEaton NR, Keyes KM, Krueger RF, Balsis S, Skodol AE, Markon KE, Grant BF, Hasin DS (2012) An invariant dimensional liability model of gender differences in mental disorder prevalence: Evidence from a national sample. Journal of Abnormal Psychology 121(1):282\u0026ndash;288.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKessler RC (2003) Epidemiology of women and depression. Journal of affective disorders 74(1):5\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeigh E, Yule W, Smith P (2016) Measurement issues: Measurement of posttraumatic stress disorder in children and young people\u0026ndash;lessons from research and practice. Child and Adolescent Mental Health 21(2):124\u0026ndash;135.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRiecher-R\u0026ouml;ssler A (2017) Sex and gender differences in mental disorders. The Lancet Psychiatry 4(1):8\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAndrade L, Caraveo-Anduaga JJ, Berglund P, Bijl RV, Graaf RD, Vollebergh W, Dragomirecka E, Kohn R, Keller M, Kessler RC, Kawakami N (2003) The epidemiology of major depressive episodes: Results from the International Consortium of Psychiatric Epidemiology (ICPE) Surveys. International Journal of Methods in Psychiatric Research 12(1):3\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXiong J, Lipsitz O, Nasri F, Lui LM, Gill H, Phan L, Chen-Li D, Iacobucci M, Ho R, Majeed A, McIntyre R (2020). Impact of COVID-19 pandemic on mental health in the general population: A systematic review. Journal of affective disorders 277:55\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGill PK, Du C, Khan F, Karimi N, Sabharwal K, Agarwal M (2022) The psychological effects of COVID-19 spread in young Canadian adults. International Journal of Social Psychiatry 68(1):216\u0026ndash;222\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHolingue C, Kalb LG, Riehm KE, Bennett D, Kapteyn A, Veldhuis CB, Johnson RM, Fallin MD, Kreuter F, Stuart EA, Thrul J (2020) Mental distress in the United States at the beginning of the COVID-19 pandemic. American journal of public health 110(11):1628\u0026ndash;1634.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePerry BL, Aronson B, Pescosolido BA (2021) Pandemic precarity: COVID-19 is exposing and exacerbating inequalities in the American heartland. Proceedings of the National Academy of Science 118(8):e2020685118.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu N, Zhang F, Wei C, Jia Y, Shang Z, Sun L, Wu L, Sun Z, Zhou Y, Wang Y, Liu W (2020) Prevalence and predictors of PTSS during COVID-19 outbreak in China hardest-hit areas: Gender differences matter. Psychiatry research 287:112921.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBai Z, Luo S, Zhang L, Wu S, Chi I (2020) Acceptance and commitment therapy (ACT) to reduce depression: A systematic review and meta-analysis. Journal of Affective Disorders 260:728\u0026ndash;737\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCoto-Lesmes R, Fern\u0026aacute;ndez-Rodr\u0026iacute;guez C, Gonz\u0026aacute;lez-Fern\u0026aacute;ndez S (2020) Acceptance and Commitment Therapy in group format for anxiety and depression. A systematic review. Journal of affective disorders 263:107\u0026ndash;120.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFolkman S, Lazarus RS (1988) The relationship between coping and emotion: Implications for theory and research. Social science \u0026amp; medicine 26(3):309\u0026ndash;317.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHorwitz AG, Czyz EK, Berona J, King CA (2018) Prospective associations of coping styles with depression and suicide risk among psychiatric emergency patients. Behavior therapy 49(2):225\u0026ndash;236.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStanisławski K (2019) The coping circumplex model: an integrative model of the structure of coping with stress. Frontiers in psychology 10:694.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGurvich C, Thomas N, Thomas EH, Hudaib AR, Sood L, Fabiatos K, Sutton K, Isaacs A, Arunogiri S, Sharp G, Kulkarni J (2021) Coping styles and mental health in response to societal changes during the COVID-19 pandemic. International Journal of Social Psychiatry 67(5):540\u0026ndash;549.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAfifi TO, Cox BJ, Enns MW (2006) Mental health profiles among married, never-married, and separated/ divorced mothers in a nationally representative sample. Social Psychiatry and Psychiatric Epidemiology 41(2):122\u0026ndash;129.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"COVID-19 Quarantine, Depression, Anxiety, Stress, Trauma, Coping, Greece","lastPublishedDoi":"10.21203/rs.3.rs-1909518/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1909518/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eThe COVID-19 outbreak escalated into a global pandemic, forcing governments around the world to impose measures affecting all aspects of life. Like other countries, Greece adopted social restriction, lockdowns, and quarantines to reduce transmission from person-to-person. This cross-sectional study investigated the impact of social restriction measures on mental health in a Greek adult sample.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eAn online questionnaire collected data during the second national lockdown (February to May 2021). A total of 650 participants (\u003cem\u003eM\u003c/em\u003e age: 33.13, 71.5% female) comprised the final sample.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003e21.3% of respondents reported moderate-to-extremely severe anxiety, 33% moderate-to-extremely severe depression, 31.8% moderate-to-severe stress, and 38% clinically significant trauma-related distress. Hierarchical linear regression analyses revealed that the strongest contributors to adverse mental health outcomes were being female, younger age, experiencing increases in verbal arguments at home, being separated from family and close friends, and being unable to afford enough or healthy food. Lastly, participants moved away from social support and into more individual strength and resilience-based coping strategies to cope with challenges.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThese findings suggest that in addition to the detrimental effects on physical health, COVID-19 also imposed a heavy psychological burden on the population via forced social isolation, which, by design, increased not only physical distancing but also psychological distancing between people.\u003c/p\u003e","manuscriptTitle":"Forced Social Isolation and Lockdown during the COVID-19 Pandemic: Depression, Anxiety, and Trauma-distress in a Greek sample","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-08-09 17:16:33","doi":"10.21203/rs.3.rs-1909518/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"65e64e18-ca2a-483d-902c-3a50e817f0ed","owner":[],"postedDate":"August 9th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2022-09-15T16:44:14+00:00","versionOfRecord":[],"versionCreatedAt":"2022-08-09 17:16:33","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-1909518","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1909518","identity":"rs-1909518","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}