Younger people are more vulnerable to stress, anxiety and depression during COVID-19 pandemic: a global cross-sectional survey
Open accessAbstract
The COVID-19 pandemic has had far-ranging consequences for general physical and mental health. Country-specific research reveals a general reduction in mental and physical well-being, due to measures undertaken to stop the spread of COVID-19 disease. However, research is yet to examine the impact of the pandemic on global psychological distress and its effects upon vulnerable groups. Exploration of the factors that potentially mediate the relationship between stress and mental health during this period is needed, to assist in undertaking concrete measures to mitigate psychological distress and support vulnerable groups. Therefore, this study examined the impact of the COVID-19 pandemic on psychological distress globally, and identified factors that may exacerbate decline in mental health. N = 1653 participants (mean age 42.90 ± 13.63 years; 30.3% males) from 63 countries responded to the survey. Depression and anxiety were assessed using the Patient Health Questionnaire and State Trait Anxiety Inventory, respectively. Other measures included the Perceived Stress Scale, the Pittsburgh Sleep Quality Index, 3-item UCLA Loneliness Scale and the Brief Resilient Coping Scale. Globally, consistently high levels of stress, anxiety, depression and poor sleep were observed regardless of number of COVID-19 cases. Over 70% of the respondents had greater than moderate levels of stress, with 59% meeting the criteria for clinically significant anxiety and 39% reporting moderate depressive symptoms. People with a prior mental health diagnosis experienced greater psychological distress. Poor sleep, lower levels of resilience, younger age and loneliness significantly mediated the links between stress and depression, and stress and anxiety. Age-based differences revealed that younger age-groups were more vulnerable to stress, depression and anxiety symptoms. Results show that these vulnerable individuals need more support. Age-specific interventions for modifiable factors that mediate the psychological distress need to urgently deployed to address the global mental health pandemic.
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- Findingown data
The relationship between stress and anxiety remained significant after accounting for all mediators (β = 1.57, t(1493) = 43.16, p < .001), indicating partial mediation.
“The relationship between stress and anxiety remained significant even after accounting for all mediators (β = 1.57, t (1493) = 43.16, p < .001), indicating partial mediation.”
Quote in the paperNot a substantial claim - Findingown data
Participants from South Africa reported a significantly higher proportion of at least moderate depression compared to the other countries.
“Subsequent post-hoc testing revealed that participants from South Africa reported a significantly higher proportion of at least moderate levels of depression compared to the other countries.”
Quote in the paperNot a substantial claim - Findingown data
Loneliness significantly mediated the relationship between stress and depression, accounting for 5% of the variance.
“Significant mediation effects were observed (Fig. 1 ), where poor sleep quality accounted for 10% of the variance in the relationship between stress and depression, followed by loneliness (by 5%) and resilient coping (by 2%).”
Quote in the paperNot a substantial claim - Findingown data
Poor sleep quality significantly mediated the relationship between stress and anxiety, predicting 11% change.
“Poor sleep quality was the largest mediator, predicting 11% change in the relationship between stress and anxiety, followed by isolation (by 4%) and age (by 3%).”
Quote in the paperNot a substantial claim - Findingown data
Higher resilient coping was associated with lower anxiety symptoms (r = −0.11, p < .001).
“Higher resilient coping was associated with lower symptoms of anxiety (r = −0.11, p < .001) and depression (r = −0.33, p < .001).”
Quote in the paperNot a substantial claim
- Findingown data
Higher loneliness was positively associated with anxiety.
“In addition, poor sleep quality, higher levels of loneliness shared positive relationships with anxiety and depression.”
Quote in the paperNot a substantial claim - Findingown data
Within younger adults, financial distress was associated with poorer anxiety outcomes.
“Within younger adults, loneliness and financial distress were associated with poorer depression and anxiety outcomes, respectively.”
Quote in the paperNot a substantial claim - Findingown data
Older adults had the lowest ratings on depression, stress and anxiety measures.
“Younger adults fared the worst with regards to depression, stress and anxiety symptoms. In comparison, older adults had the lowest ratings on these measures.”
Quote in the paperSubstantial claim - Findingnone given
Resilience was an inverse contributor to the relationship between stress and depression.
“Additionally, resilience was an inverse contributor to the relationship between stress and depression.”
Quote in the paperNot a substantial claim - Findingown data
Older individuals reported higher resilient coping compared to other age groups (p < .05).
“Older individuals reported higher resilient coping (p < .05) compared to the other age groups but slightly poorer sleep quality (p < .05) compared to the youngest age group.”
Quote in the paperNot a substantial claim - Findingown data
Poor sleep quality significantly mediated the relationship between stress and depression, accounting for 10% of the variance.
“Significant mediation effects were observed (Fig. 1 ), where poor sleep quality accounted for 10% of the variance in the relationship between stress and depression, followed by loneliness (by 5%) and resilient coping (by 2%).”
Quote in the paperNot a substantial claim - Findingown data
Poor sleep quality was positively associated with depression.
“In addition, poor sleep quality, higher levels of loneliness shared positive relationships with anxiety and depression.”
Quote in the paperNot a substantial claim - Findingown data
In individuals under 55 years, increased weekly exercise was associated with lower depressive symptoms.
“For example, in individuals under 55 years, increased levels of weekly exercise were associated with lower endorsement of depressive symptoms.”
Quote in the paperNot a substantial claim - Findingown data
Previous diagnosis of a mental health condition had a low but significant correlation with anxiety symptoms (r = 0.15, p < .001).
“Previous diagnosis of a mental health condition had a low, but significant, correlation with depression (r = 0.26, p < .001) and anxiety (r = 0.15, p < .001) symptoms.”
Quote in the paperNot a substantial claim - Findingown data
In individuals aged 55 years and above, poor sleep quality contributed to changes in depression symptoms.
“Poor sleep quality contributed to changes in depression symptoms in individuals aged 55 years and above.”
Quote in the paperNot a substantial claim - Findingreasoning
Older adults demonstrated more resilience than other age groups.
“Older adults demonstrated more resilience than other age-groups, which may be a key factor in protection against psychological distress.”
Quote in the paperSubstantial claim - Findingown data
Poor sleep quality was positively associated with anxiety.
“In addition, poor sleep quality, higher levels of loneliness shared positive relationships with anxiety and depression.”
Quote in the paperNot a substantial claim - Findingown data
73% of participants reported poor sleep quality.
“Poor sleep quality was also common, reported by 73% of the participants.”
Quote in the paperNot a substantial claim - Findingown data
Within younger adults, loneliness was associated with poorer depression outcomes.
“Within younger adults, loneliness and financial distress were associated with poorer depression and anxiety outcomes, respectively.”
Quote in the paperNot a substantial claim - Findingown data
No significant group differences were observed for anxiety and depression across groups based on number of COVID-19 cases.
“No significant group differences were observed for anxiety and depression across the groups.”
Quote in the paperNot a substantial claim - Findingown data
In individuals aged 35-54 years, higher resilience was inversely related to anxiety.
“Higher resilience was inversely related to anxiety in individuals aged 35–54 years.”
Quote in the paperNot a substantial claim - Findingown data
Higher perceived stress was strongly associated with anxiety symptoms (r = 0.72, p < .001).
“Higher levels of perceived stress were strongly associated with both depression (r = 0.72, p < .001) and anxiety (r = 0.72, p < .001) symptoms”
Quote in the paperNot a substantial claim - Findingown data
In all age groups, perceived stress was the largest predictor of changes in depression symptoms.
“In all age-groups, perceived stress emerged as the largest predictor of changes in depression symptoms.”
Quote in the paperNot a substantial claim - Findingown data
In individuals aged 55 years or above, poor sleep quality was a significant predictor of anxiety.
“Poor sleep quality was a significant predictor of anxiety in individuals aged 55 years or above.”
Quote in the paperNot a substantial claim - Findingown data
35% of respondents had moderate or higher depression.
“Moderate or higher levels of depression was noted for 35% of respondents.”
Quote in the paperNot a substantial claim - Findingown data
59% of participants had clinically probable state anxiety.
“Clinically probable levels of anxiety were noted for state anxiety in 59% of the participants.”
Quote in the paperNot a substantial claim - Findingown data
Higher loneliness was positively associated with depression.
“In addition, poor sleep quality, higher levels of loneliness shared positive relationships with anxiety and depression.”
Quote in the paperNot a substantial claim - Findingown data
Perceived stress was the strongest predictor of anxiety symptoms in each age group.
“Similar to depression outcomes, perceived stress was the strongest predictor of anxiety symptoms in each age group.”
Quote in the paperNot a substantial claim - Findingown data
In younger adults, poor sleep quality and loneliness were related to anxiety symptoms.
“However, in younger adults, both poor sleep quality and loneliness were related to anxiety symptoms.”
Quote in the paperNot a substantial claim - Findingown data
Resilient coping significantly mediated the relationship between stress and depression, accounting for 2% of the variance.
“Significant mediation effects were observed (Fig. 1 ), where poor sleep quality accounted for 10% of the variance in the relationship between stress and depression, followed by loneliness (by 5%) and resilient coping (by 2%).”
Quote in the paperNot a substantial claim - Findingown data
There was a significant difference between the top five countries for anxiety, depression and stress (all p < .001).
“There was a significant difference between the groups for anxiety, depression and stress (all p < .001).”
Quote in the paperNot a substantial claim - Findingown data
Higher resilient coping was associated with lower depression symptoms (r = −0.33, p < .001).
“Higher resilient coping was associated with lower symptoms of anxiety (r = −0.11, p < .001) and depression (r = −0.33, p < .001).”
Quote in the paperNot a substantial claim - Findingown data
Younger adults had higher depression symptoms compared to other age groups.
“Younger adults fared the worst with regards to depression, stress and anxiety symptoms. In comparison, older adults had the lowest ratings on these measures.”
Quote in the paperSubstantial claim - Findingown data
Higher perceived stress was strongly associated with depression symptoms (r = 0.72, p < .001).
“Higher levels of perceived stress were strongly associated with both depression (r = 0.72, p < .001) and anxiety (r = 0.72, p < .001) symptoms”
Quote in the paperNot a substantial claim - Findingown data
Younger age significantly mediated the relationship between stress and anxiety, accounting for 3% change.
“Poor sleep quality was the largest mediator, predicting 11% change in the relationship between stress and anxiety, followed by isolation (by 4%) and age (by 3%).”
Quote in the paperNot a substantial claim - Findingown data
In individuals aged 35-54 years, greater exercise minutes and good sleep quality were associated with lower depression scores.
“Similar to the younger age-group, in individuals aged 35–54 years, greater exercise minutes and good sleep quality was associated with lower scores on depression measure.”
Quote in the paperNot a substantial claim - Findingown data
Younger people reported significantly higher anxiety scores compared to other age groups, with moderate to large effect size.
“In particular, moderate to large effect sizes were noted for both anxiety (p < .001) and stress (p < .001), with younger people reporting significantly higher scores on both measures compared to the other age groups (Fig. 3 ).”
Quote in the paperSubstantial claim - Findingown data
In the 18-34 age group, more exercise minutes per week were related to lower depression symptoms.
“In the 18–34 age group, more exercise minutes (per week) were related to lower depression symptoms.”
Quote in the paperNot a substantial claim - Findingown data
In the 18-34 age group, poor sleep quality and increased financial distress predicted changes in depression symptoms.
“Poor sleep quality and increased distress due to financial circumstances also predicted changes in depression symptoms.”
Quote in the paperNot a substantial claim - Findingown data
Poor sleep and perceived stress were common contributing factors for both depression and anxiety across all age groups.
“While poor sleep and perceived stress were common contributing factors for both depression and anxiety across all age groups, there were some factors that were specifically related to these outcomes within each age category.”
Quote in the paperNot a substantial claim - Findingown data
Loneliness (isolation) significantly mediated the relationship between stress and anxiety, accounting for 4% change.
“Poor sleep quality was the largest mediator, predicting 11% change in the relationship between stress and anxiety, followed by isolation (by 4%) and age (by 3%).”
Quote in the paperNot a substantial claim - Findingown data
77% of respondents reported at least moderate perceived stress.
“High rates of perceived stress were observed in the sample, with 77% of the respondents reporting at least moderate levels of stress (Table 1).”
Quote in the paperNot a substantial claim - Findingown data
There was a small effect for stress, with respondents from countries with higher numbers of cases reporting more stress (p > .01, Partial η2 = 0.008).
“However, small effect size was noted for stress, as respondents from countries with higher number of cases reported more stress (p > .01, Partial η 2 = 0.008).”
Quote in the paperNot a substantial claim - Findingown data
In individuals aged 55 years and above, having dependents was related to higher depression symptoms.
“In particular, having dependents was related to higher depression symptoms.”
Quote in the paperNot a substantial claim - Findingown data
In individuals aged 55 years and above, better adjustment to lockdown regulations was related to lower depression symptoms.
“In contrast, better adjustment to lockdown regulations was related to lower depression symptoms.”
Quote in the paperNot a substantial claim - Premisecitation
Disrupted routines during the pandemic resulted in significant changes in sleep.
“Indeed, disrupted routines during the pandemic has resulted in significant changes in sleep.(Blume et al., 2020; Wright et al., 2020)”
Quote in the paperNot a substantial claim0 of 2 sources checked - Premisecitation
Digital therapeutics, including evidence-based self-help tools, are showing promising effectiveness at improving sleep and mental health outcomes.
“These tools are showing promising effectiveness at improving sleep and mental health outcomes.(Low et al., 2020)”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Low et al., 2020 source
Not checked in the free run.
- Study design and conductreasoning
Due to the cross-sectional nature of the study, the direction of the relationship between stress and mental health cannot be determined.
“Due to the cross-sectional nature of this study, we cannot determine the direction of the relationship between stress and mental health.”
Quote in the paperNot a substantial claim - Premisecitation
During COVID-19, people across the globe experienced heightened anxiety and stress due to financial distress, social distancing, quarantining, and stay-at-home orders.
“Apart from the physical toll of the disease itself, people across the globe are experiencing heightened anxiety and stress due to financial distress, social distancing, quarantining and stay-at-home orders.(Li et al., 2020; McGinty et al., 2020; Pierce et al., 2020; Hetkamp et al., 2020)”
Quote in the paperNot a substantial claim0 of 3 sources checked - Premisecitation
Early evidence from the UK, US, Korea and Australia indicates that younger people have had the greatest increase in rates of psychological distress during the pandemic.
“Early evidence from the UK, US, Korea and Australia indicates that younger people have had the greatest increase in rates of psychological distress during the pandemic.(McGinty et al., 2020; Pierce et al., 2020; Rossell et al., 2020; Jung et al., 2020)”
Quote in the paperSubstantial claim0 of 3 sources checked - Study design and conductcitation
The study might not be representative because half of people aged 75 and over and many with mental illness are not regular internet users.
“It is also important to note that half of people aged 75 and over, and many with mental illness (who represent a key COVID-19 risk group), are not regular internet users,(Hargittai et al., 2019) so this study might not be a representative sample in terms of tapping into a wider group of non-social media users.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Hargittai et al., 2019 source
Not checked in the free run.
- Premisecitation
Sleep disturbances increase the risk of depression and anxiety.
“Sleep disturbances also increase the risk of depression and anxiety.(Harvey, 2011)”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Harvey, 2011 source
Not checked in the free run.
- Premisecitation
Loneliness, particularly social isolation, is associated with a larger cortisol awakening response.
“Loneliness, particularly social isolation, is associated with a larger cortisol awakening response,(Grant et al., 2009) potentially explaining the mediating role of loneliness in the links between stress and depression.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Grant et al., 2009 source
Not checked in the free run.
- Not yet classified. 1
- Classified as probably not a substantial claim. 18
- May combine two claims. 12
Not yet classified.
FindingThere were significant group differences across age groups for all mental health measures.
“With regards to difference in psychological distress across different age-groups, results revealed significant group differences for all measures (Table 2).”
Quote in the paperNot yet classifiedProbably not a substantial claim: may not pass S3 (load-bearing).
Findingown dataPrevious diagnosis of a mental health condition had a low but significant correlation with depression symptoms (r = 0.26, p < .001).
“Previous diagnosis of a mental health condition had a low, but significant, correlation with depression (r = 0.26, p < .001) and anxiety (r = 0.15, p < .001) symptoms.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataThe relationship between stress and depression remained significant after controlling for mediators (β = 0.61, t(1493) = 39.86, p < .001), indicating partial mediation.
“After controlling for the mediators, the relationship between stress and depression still remained significant (β = 0.61, t (1493) = 39.86, p < .001), indicating partial mediation.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingown dataOlder individuals reported slightly poorer sleep quality compared to the youngest age group (p < .05).
“Older individuals reported higher resilient coping (p < .05) compared to the other age groups but slightly poorer sleep quality (p < .05) compared to the youngest age group.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataYounger people reported significantly higher stress scores compared to other age groups, with moderate to large effect size.
“In particular, moderate to large effect sizes were noted for both anxiety (p < .001) and stress (p < .001), with younger people reporting significantly higher scores on both measures compared to the other age groups (Fig. 3 ).”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataWeekly exercise minutes, adjusting to lockdown, and distress due to financial changes were not significant predictors of anxiety in any age group.
“Notably, factors like weekly exercise minutes, adjusting to lockdown and distress due to financial changes were not significant predictors of anxiety in any age group.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown data20% of respondents reported significant distress related to their financial situation, which was associated with both psychological distress and poorer sleep.
“Further, 20% of respondents reported significant distress related to their financial situation, which was associated with both psychological distress and poorer sleep.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown dataOf 2555 people who opened the survey, 902 did not complete all mental health outcome measures, leaving 1653 in the final analysis.
“A total of 2555 individuals from 63 countries opened the survey. Of these, 902 participants did not complete all of the mental health outcome measures. Therefore, 1653 participants were included in the final analysis.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationResilience and perception of social support can be protective against psychiatric disorders.
“In contrast, resilience and perception of social support can be protective against psychiatric disorders.(Serafini et al., 2020)”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Serafini et al., 2020 source
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Study design and conductcitationSelection bias may have occurred because individuals suffering from mild anxiety and stress may be more likely to opt into an online survey mentioning salient symptoms.
“It is also possible that there was a selection bias in that individuals suffering and feeling frustrated with mild anxiety and stress may be more likely to notice an online survey mentioning salient symptoms and opt-in to participate.(Keusch, 2015)”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Keusch, 2015
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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductnone givenThe study was approved by the Monash University Human Research Ethics Committee and conducted in accordance with the Declaration of Helsinki.
“The study was approved by the Monash University Human Research Ethics Committee and conducted in accordance with the Declaration of Helsinki.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationPsychological resilience is linked to better mental health outcomes during the pandemic.
“Psychological resilience – a construct representing ability to withstand set-backs and adapt positively in the face of adversity(Luthar and Cicchetti, 2000) – is linked to better mental health outcomes during the pandemic.(Killgore et al., 2020b)”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites Luthar and Cicchetti, 2000 source
Not checked in the free run.
- cites Killgore et al., 2020b
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Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationIndividuals who have experienced childhood trauma are at increased risk of depression and suicide.
“Individuals who have experienced childhood trauma, who are at increased risk of depression and suicide,(Pompili et al., 2014) and those impacted by domestic violence or at risk of abuse during the pandemic,(Bradbury-Jones and Isham, 2020) may need additional support.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Pompili et al., 2014 source
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PremisecitationOlder adults may also be at risk of poor mental health outcomes due to isolation and anxieties about infection risk, particularly those with comorbid health conditions or cognitive impairment.
“On the other hand, older adults may also be at risk of poor mental health outcomes as a result of isolation and anxieties about infection risk, particularly those with comorbid health conditions or cognitive impairment.(World Health Organization, 2020)”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites World Health Organization, 2020
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PremisecitationPoor sleep has a well-known bidirectional relationship with depression and anxiety.
“For instance, poor sleep has a well-known bidirectional relationship with depression and anxiety.(Bartlett and Jackson, 2016)”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Bartlett and Jackson, 2016
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationImproving sleep can result in positive outcomes for both depression and anxiety even when the conditions are not directly treated.
“For instance, improving sleep can result in positive outcomes for both depression and anxiety even when the conditions are not directly treated.(Cunningham and Shapiro, 2018)”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Cunningham and Shapiro, 2018
Not checked in the free run.
May combine two claims.
Study design and conductown dataThe levels of depression detected were at most mild-moderate across all groups, so findings should be interpreted cautiously.
“The levels of depression detected in this study were at most mild-moderate across all groups, therefore the findings need to be interpreted cautiously and not overstated.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationPoor sleep can degrade neurocognitive functioning, impacting mood and emotion regulation.
“Poor sleep can degrade neurocognitive functioning, impacting mood and emotion regulation.(Konjarski et al., 2018; Palmer and Alfano, 2017)”
Quote in the paperNot a substantial claim0 of 2 sources checkedProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationFactors such as previous psychiatric diagnosis, isolation, financial distress, hopelessness, loneliness and uncertainty due to COVID-19 outbreaks can increase the risk of psychiatric conditions and suicide.
“Factors such as a previous psychiatric diagnosis, isolation, financial distress, hopelessness, loneliness and uncertainty due to COVID-19 outbreaks can also increase the risk of psychiatric conditions and suicide.(Killgore et al., 2020a; Serafini et al., 2020; Xin et al., 2020; Serafini et al., 2012)”
Quote in the paperNot a substantial claim0 of 3 sources checkedProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationReduced sleep quantity and quality during the pandemic is related to poor mental health outcomes.
“Consequently, reduced sleep quantity and quality during the pandemic is related to poor mental health outcomes.(Ernstsen and Havnen, 2020; Janati Idrissi et al., 2020)”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites Ernstsen and Havnen, 2020
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- cites Janati Idrissi et al., 2020 source
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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationSleep and resilience are modifiable factors, with resilience associated with more daily exercise and perceived social support.
“It appears that both sleep and resilience are modifiable factors, with the latter associated with more daily exercise and perceived social support.(Killgore et al., 2020b)”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Killgore et al., 2020b
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Study design and conductcitationThe study included respondents from more than 60 countries, which addresses underrepresentation in recent research.
“The strength of this study is that it included respondents from more than 60 countries. It has been noted that several countries and communities have been underrepresented in recent research,(Holmes et al., 2020) and the current study was able to overcome this issue by surveying participants from a range of different countries.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Holmes et al., 2020 source
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PremisecitationThe figures in this study are comparable to other national surveys during this period and are well above pre-pandemic prevalence figures.
“However, these figures are comparable to other national surveys during this period,(Fisher et al., 2020; Gao et al., 2020; Wang et al., 2020) and are well above pre-pandemic prevalence figures.(McGinty et al., 2020)”
Quote in the paperNot a substantial claim0 of 3 sources checkedMay combine two claims.
Study design and conductown dataThe sample was highly educated and majority employed, so it may not be representative of a broader demographic.
“The sample was also highly educated, and the majority of respondents were employed, thus it may not be representative of a broader demographic.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationEmploying stress reduction strategies such as mindfulness can have positive outcomes for mental health.
“Similarly, employing stress reduction strategies, such as mindfulness, can have positive outcomes for mental health.(Gu et al., 2015)”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Gu et al., 2015
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PremisecitationReports from China suggest that depression and anxiety are associated with higher levels of insomnia in adolescents and young adults during the pandemic.
“In particular, reports from China suggest that depression and anxiety are associated with higher levels of insomnia in adolescents and young adult during the pandemic.(Zhou et al., 2020)”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Zhou et al., 2020 source
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PremisecitationSleep and affective brain functioning are linked.
“Previous studies have shown that sleep and affective brain functioning are linked.(Palmer and Alfano, 2017)”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Palmer and Alfano, 2017 source
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PremisecitationCountry-specific data has revealed high levels of stress, depression and anxiety symptoms, increased loneliness and suicidal ideation during the pandemic.
“Country specific data has revealed high levels of stress, depression and anxiety symptoms, increased loneliness and suicidal ideation.(Killgore et al., 2020a; Reger et al., 2020; Zhang et al., 2020; Rossell et al., 2020; Serafini et al., 2020)”
Quote in the paperNot a substantial claim0 of 3 sources checked
The paper relies on this without support.
Participants' self-reported responses accurately reflect their true mental health and sleep status.
“A global online survey was disseminated between April 9 and May 25, 2020 through social media channels, targeting adults over 18 years of age.”
The paper relies on this without support.
The number of COVID-19 cases in a country as of May 25, 2020 accurately reflects the pandemic burden experienced by respondents in that country.
“Participants were divided into three groups based on number of COVID-19 cases in their country (based on the data available on May 25th 2020).”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The prevalence of depressive and anxiety symptoms in this sample is lower than that reported in early pandemic studies on young adult populations.
“this is a lower prevalence when compared to those reported by research carried out on young adult populations at the early stages of the pandemic when social isolation was imposed to limit the spread of the virus (Faisal et al., 2022; Liu et al., 2020; Varma et al., 2021).”
From Social connections combat loneliness and promote wellbeing among college students coming out of the COVID-19 pandemic (2025) · cites this paper as Varma et al., 2021
The Methods and Results describe an early-pandemic survey conducted largely during lockdown. The Results report substantial depression and anxiety prevalence for the full adult sample, and the age-group analysis finds higher symptom scores among younger adults. This was not a study of young adults alone, however, and the prevalence figures cited in the Results are not specific to that age group. (LLM, conf=0.85)
Experimental — accuracy not yet measured
Statistics recomputed
Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.
- Consistentt(1493) = 39.86reported p < .001 · recomputed p < .001
“t (1493) = 39.86, p < .001”
- Consistentt(1493) = 43.16reported p < .001 · recomputed p < .001
“t (1493) = 43.16, p < .001”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Abstract reports 39% moderate depressive symptoms vs discussion says 35%
MajorThe abstract states that 39% of respondents had moderate depressive symptoms, but the Results/Discussion sections elsewhere report 35% for depression. These are conflicting prevalence values for the same sample and outcome.
“Globally, consistently high levels of stress, anxiety, depression and poor sleep were observed regardless of number of COVID-19 cases. Over 70% of the respondents had greater than moderate levels of stress, with 59% meeting the criteria for clinically significant anxiety and 39% reporting moderate depressive”
“High rates of perceived stress were observed in the sample, with 77% of the respondents reporting at least moderate levels of stress (Table 1). Moderate or higher levels of depression was noted for 35% of respondents.”
Country post-hoc findings are described in opposite ways
MajorThe results report a significant post-hoc difference involving South Africa, whereas the discussion says post-hoc testing found no significant differences between countries.
“Subsequent post-hoc testing revealed that participants from South Africa reported a significantly higher proportion of at least moderate levels of depression compared to the other countries.”
“However, post-hoc testing did not reveal any significant differences across the countries.”
Depression prevalence differs between abstract and results
MajorThe abstract says 39% reported moderate depressive symptoms, but the results say only 35% had moderate or higher depression. The latter category includes the former, so it cannot have a lower prevalence.
“39% reporting moderate depressive symptoms.”
“Moderate or higher levels of depression was noted for 35% of respondents.”
Financial distress is both associated and unassociated with younger adults' anxiety
MajorThe discussion associates financial distress with worse anxiety among younger adults. The results instead state that financial distress was not a significant anxiety predictor in any age group.
“Within younger adults, loneliness and financial distress were associated with poorer depression and anxiety outcomes, respectively.”
“Notably, factors like weekly exercise minutes, adjusting to lockdown and distress due to financial changes were not significant predictors of anxiety in any age group.”
Cites
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- Authors
- Varma, P., Junge, M., Meaklim, H., & Jackson, M. L.
- Affiliations
- Monash University (AU)
- Corresponding author
- Jackson, Melinda L.
- Venue
- Progress in Neuro-Psychopharmacology and Biological Psychiatry
- Publisher
- Elsevier BV
- Published
- 2021-07
- Volume
- 109
- Pages
- 110236
- ISSN
- 0278-5846 (ISSN-L)
- PMC
- PMC7834119
- OpenAlex
- W3116683217
- Cited by
- 719
- References
- 46
- Citations by year
- 2026: 46 · 2025: 81 · 2024: 127 · 2023: 180 · 2022: 191 · 2021: 93
- FWCI
- 46.29
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Progress in Neuro-Psychopharmacology and Biological Psychiatry (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- COVID-19 pandemic, psychological distress, depression, anxiety, perceived stress, young adults, age differences, sleep quality, loneliness, resilience, vulnerable populations, mediation
- MeSH terms
- COVID-19, Adaptation, Psychological, Adolescent, Adult, Age Factors, Aged, Aged, 80 and over, Anxiety, Cross-Sectional Studies, Depression, Female, Humans, Sleep Initiation and Maintenance Disorders, Loneliness, Male, Mental Health, Middle Aged, Neuropsychological Tests, Surveys and Questionnaires, Stress, Psychological, Resilience, Psychological, Young Adult, Pandemics
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-09-28.
Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-09-28.
Statistics and arithmetic are recomputed, not judged.
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