Worry and mental health in the Covid-19 pandemic: vulnerability factors in the general Norwegian population
Open accessAbstract
Background: There is an urgent need for knowledge about the mental health consequences of the ongoing pandemic. The aim of this study was to identify vulnerability factors for psychological distress and reduced life satisfaction in the general population. Furthermore, we aimed to assess the role of COVID-related worries for psychological distress and life satisfaction. Methods: A presumed representative sample for the Norwegian population (n = 1041, response rate = 39.9%) responded to a web-survey in May 2020. The participants were asked about potential vulnerability factors including increased risk for severe illness from COVID-19 (underlying illness, older age), socioeconomic disadvantage (living alone, unemployment, economic problems), and pre-existing mental health vulnerability (recent exposure to violence, previous mental health challenges). Additional measures included COVID-related worry, psychological distress, and life satisfaction. Results: More than one out of four reported current psychological distress over the threshold for clinically significant symptoms. Socioeconomic disadvantages, including living alone and pre-existing economic challenges, and pre-existing mental health vulnerabilities, including recent exposure to violence and previous mental health problems, were associated with a higher level of psychological distress and a lower level of life satisfaction. A higher level of COVID-related worry was significantly associated with a higher level of psychological distress, and a lower level of life satisfaction, even when adjusting for all the vulnerability factors. Conclusion: This study identified several vulnerability factors for mental health problems in the pandemic. Individuals recently exposed to violence and individuals with pre-existing mental health problems are at particular risk. Worrying about the consequences of the pandemic contributes negatively to current mental health. However, worry cannot explain the excess distress in vulnerable groups. Future research should focus on how COVID-related strains contribute to mental health problems for vulnerable groups.
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- Findingown data
Recent exposure to violence within the last month was associated with higher psychological distress in the sample.
“Linear regression analyses showed that living alone, pre-existing economic challenges, being exposed to violence within the last month, previous mental health problems, and female sex, were significantly associated with a higher level of psychological distress.”
Quote in the paperSubstantial claim - Findingown data
Age above 65 years was associated with higher life satisfaction in the sample.
“Age higher than 65 years was associated with a higher level of life satisfaction.”
Quote in the paperNot a substantial claim - Findingown data
Higher COVID-related worry was uniquely associated with higher psychological distress after adjusting for vulnerability factors.
“A higher level of COVID-related worry was uniquely associated with a higher level of psychological distress.”
Quote in the paperSubstantial claim - Findingown data
In the Norwegian web-survey sample, 25.7% (268 of 1041) reported current psychological distress above the threshold for clinically significant symptoms.
“More than one out of four reported current psychological distress over the threshold for clinically significant symptoms.”
- Also stated in: § Results · plain
“25.7% (268 participants) reported current psychological distress over the threshold for clinically significant symptoms.”
Quote in the paperNot a substantial claim - Also stated in: § Results · plain
- Findingown data
Increased risk for severe illness from COVID-19 was not associated with higher psychological distress.
“Contrary to our expectations, we found no evidence for an association between increased risk for severe illness from COVID-19, and a higher level of psychological distress.”
Quote in the paperSubstantial claim
- Findingown data
Previous mental health problems were associated with higher psychological distress in the sample.
“Linear regression analyses showed that living alone, pre-existing economic challenges, being exposed to violence within the last month, previous mental health problems, and female sex, were significantly associated with a higher level of psychological distress.”
Quote in the paperSubstantial claim - Findingown data
Underlying illness was independently associated with lower life satisfaction when mutually adjusted.
“When mutually adjusted (model 1, Table 5), all the same factors and underlying illness were independently associated with a lower level of life satisfaction.”
Quote in the paperSubstantial claim - Findingown data
Female sex was associated with higher psychological distress in the sample.
“Linear regression analyses showed that living alone, pre-existing economic challenges, being exposed to violence within the last month, previous mental health problems, and female sex, were significantly associated with a higher level of psychological distress.”
Quote in the paperSubstantial claim - Findingown data
Higher COVID-related worry was uniquely associated with lower life satisfaction after adjusting for vulnerability factors.
“The results showed that a higher level of COVID-related worry was uniquely associated with a lower level of life satisfaction.”
Quote in the paperSubstantial claim - Findingown data
Pre-existing economic challenges were associated with lower life satisfaction in the sample.
“Linear regression analyses showed that living alone, pre-existing economic challenges, being exposed to violence within the last month and previous mental health problems, were associated with lower levels of reported life satisfaction.”
Quote in the paperSubstantial claim - Findingown data
Previous mental health problems were associated with lower life satisfaction in the sample.
“Linear regression analyses showed that living alone, pre-existing economic challenges, being exposed to violence within the last month and previous mental health problems, were associated with lower levels of reported life satisfaction.”
Quote in the paperSubstantial claim - Findingown data
Recent exposure to violence within the last month was associated with lower life satisfaction in the sample.
“Linear regression analyses showed that living alone, pre-existing economic challenges, being exposed to violence within the last month and previous mental health problems, were associated with lower levels of reported life satisfaction.”
Quote in the paperSubstantial claim - Findingown data
Living alone was associated with higher psychological distress in the sample.
“Linear regression analyses showed that living alone, pre-existing economic challenges, being exposed to violence within the last month, previous mental health problems, and female sex, were significantly associated with a higher level of psychological distress.”
Quote in the paperSubstantial claim - Findingown data
Age above 65 years was associated with lower psychological distress in the sample.
“Conversely, age higher than 65 years was negatively associated with psychological distress.”
Quote in the paperSubstantial claim - Findingown data
Living alone was associated with lower life satisfaction in the sample.
“Linear regression analyses showed that living alone, pre-existing economic challenges, being exposed to violence within the last month and previous mental health problems, were associated with lower levels of reported life satisfaction.”
Quote in the paperSubstantial claim - Findingown data
Pre-existing economic challenges were associated with higher psychological distress in the sample.
“Linear regression analyses showed that living alone, pre-existing economic challenges, being exposed to violence within the last month, previous mental health problems, and female sex, were significantly associated with a higher level of psychological distress.”
Quote in the paperSubstantial claim - Findingown data
Adding COVID-related worry as a predictor did not substantially attenuate the associations between vulnerability factors and psychological distress.
“Adding COVID-related worry as a predictor in the multivariate regression analysis (model 2, Table 4) did not substantially attenuate the associations between the suggested vulnerability factors and psychological distress.”
Quote in the paperSubstantial claim - Findingown data
Adding worry did not considerably attenuate the associations between the other independent variables and life satisfaction.
“Adding worry as a predictor did not considerably attenuate the associations between the other independent variables and life satisfaction.”
Quote in the paperSubstantial claim - Findingown data
After adding worry, all vulnerability factors except female sex remained significantly associated with higher psychological distress.
“All the same factors, except female sex, were still significantly associated with distress.”
Quote in the paperSubstantial claim - Study design and conductown data
Responders and non-responders did not differ in sex or education.
“Our study participants did not differ from non-responders in sex or education (Table 1), but the sample was highly skewed toward older age, with a mean age of 54.1 in responders and 43.3 in non-responders.”
Quote in the paperNot a substantial claim - Interpretationown data
COVID-related worry does not explain the higher psychological distress or lower life satisfaction among vulnerable groups.
“However, worry cannot explain the excess distress in vulnerable groups.”
- Also stated in: § Discussion · hedged
“However, the present results do not suggest that COVID-related worry can explain the excess distress in vulnerable groups.”
Quote in the paperSubstantial claim - Also stated in: § Discussion · hedged
- Interpretationown data
COVID-related worry partly explains why women report more psychological distress during the pandemic.
“COVID-related worry seems to partly explain why women report more distress in the pandemic.”
Quote in the paperSubstantial claim - Interpretationown data
The pandemic can lead to increased psychological distress in the population even when infection rates are low and countermeasures are moderate.
“Thus, the present study adds to the literature by showing that the pandemic can lead to increased psychological distress in the population, even in a situation with low infection rates and moderate countermeasures.”
Quote in the paperSubstantial claim - Premisecitation
COVID-related worry is associated with psychological distress during the pandemic.
“Several studies have shown that COVID-related worry is associated with psychological distress in the pandemic [7–9].”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [7] El-Gabalawy R, Sommer JL. "“We Are at Risk Too”: The Disparate Mental Health Impacts of the Pandemic on Younger Generations: Nous Sommes Aussi à Risque: Les Effets Disparates de la Pandémie Sur la Santé Mentale des Générations Plus Jeunes." The Canadian Journal of Psychiatry. 2021. https://doi.org/10.1177/0706743721989162. source
Not checked in the free run.
- cites [8] Elmer T, Mepham K, Stadtfeld C. Students under lockdown: Comparisons of students’ social networks and mental health before and during the COVID-19 crisis in Switzerland. PLoS ONE. 2020;15(7). https://doi.org/10.1371/journal.pone.0236337. source
Not checked in the free run.
- cites [9] Kampfen F, Kohler IV, Ciancio A, Bruine de Bruin W, Maurer J, Kohler H-P Predictors of mental health during the Covid-19 pandemic in the US: Role of economic concerns, health worries and social distancing. PLoS ONE 2020;15(11): e0241895. https://doi.org/10.1371/journal.pone.0241895. source
Not checked in the free run.
- Premisecitation
A cut-off value of >2 on the HSCL has the best combination of specificity, sensitivity, and predictive values for clinically significant symptoms.
“Based on previous research we used a cut-off value of > 2, which has achieved the best combination of specificity, sensitivity, and predictive values for clinically significant symptoms [19].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [19] Strand BH, Dalgard OS, Tambs K, Rognerud M. Measuring the mental health status of the Norwegian population: a comparison of the instruments SCL-25, SCL-10, SCL-5 and MHI-5 (SF-36). Nordic J Psychiatr. 2003;57(2):113–8. https://doi.org/10.1080/08039480310000932. source
Not checked in the free run.
- Premisecitation
Previous studies from Turkey, Spain, and Italy reported that chronic disease was associated with higher levels of psychological distress.
“This contrasts with previous studies from Turkey conducted in April 2020 [24], from Spain conducted in March 2020 [25] and from Italy conducted in March 2020 [26], which all reported that chronic disease was associated with higher levels of psychological distress.”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [24] Özdin S, Bayrak ÖŞ. Levels and predictors of anxiety, depression and health anxiety during COVID-19 pandemic in Turkish society: the importance of gender. Int J Soc Psychiatry. 2020;66(5):504–11. source
Not checked in the free run.
- cites [25] Ozamiz-Etxebarria N, Idoiaga Mondragon N, Dosil Santamaría M, Picaza GM. Psychological symptoms during the two stages of lockdown in response to the COVID-19 outbreak: an investigation in a sample of citizens in northern Spain. Front Psychol. 2020;11:1491. https://doi.org/10.3389/fpsyg.2020.01491. source
Not checked in the free run.
- cites [26] Mazza C, Ricci E, Biondi S, Colasanti M, Ferracuti S, Napoli C, et al. A nationwide survey of psychological distress among italian people during the COVID-19 pandemic: immediate psychological responses and associated factors. Int J Environ Res Public Health. 2020;17(9):3165. https://doi.org/10.3390/ijerph17093165. source
Not checked in the free run.
- Study design and conductown data
Cronbach's alpha for the 5-item HSCL was 0.91 in the present study.
“Cronbach’s Alpha for the 5-item HSCL was 0.91 in the present study.”
Quote in the paperNot a substantial claim - Study design and conductnone given
The study could not compare violence exposure to previous levels.
“Although this study could not compare violence exposure to previous levels, our results underscore the importance of targeting this group for prevention purposes.”
Quote in the paperNot a substantial claim - Premisecitation
Population data from 2019 show that 14% scored above the clinical threshold.
“Whereas population data from 2019 show that 14% scored above the clinical threshold [20].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [20] Norway S. Utdanning-statistikk-SSB.[Education-statistics-SSB]. 2019.
Not checked in the free run.
- Interpretationreasoning
Individuals at increased risk for severe illness from COVID-19 would likely experience a higher level of perceived threat when the pandemic is not under control.
“Likely, individuals living with increased risk for severe illness due to COVID-19 would experience a higher level of perceived threat in a situation where the pandemic is currently not under control.”
Quote in the paperSubstantial claim
- May combine two claims. 15
- Classified as probably not a substantial claim. 16
- The quote only partly states this claim. 1
May combine two claims.
Interpretationown dataRecent exposure to violence and previous mental health problems are particular risk factors for mental health problems during the pandemic.
“Individuals recently exposed to violence and individuals with pre-existing mental health problems are at particular risk.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing), S4 (based).
Study design and conductnone givenSystematic response rate biases are more likely to affect levels of vulnerability factors, worries, distress, and life satisfaction than estimates of their associations.
“It should also be mentioned that systematic response rate biases are more likely to affect levels of vulnerability factors, COVID-related worries, psychological distress, and life satisfaction than estimates of their associations.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductreasoningSelf-selection bias cannot be excluded.
“Although we cannot exclude a self-selection bias, we could assess the representability by comparing demographic characteristics between responders and non-responders.”
Quote in the paperNot a substantial claimMay combine two claims.
Study design and conductown dataThe sample was skewed toward older age; responders had a mean age of 54.1 years compared with 43.3 years in non-responders.
“Our study participants did not differ from non-responders in sex or education (Table 1), but the sample was highly skewed toward older age, with a mean age of 54.1 in responders and 43.3 in non-responders.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim. May combine two claims.
Study design and conductreasoningThe study is cross-sectional and only shows a snapshot of COVID-related worries, life satisfaction, and psychological distress at a particular time and place.
“Additionally, it is important to emphasise that the present study is cross-sectional and only shows a snapshot of COVID-related worries, life satisfaction, and psychological distress at a particular time and place.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataAnalyses weighted for sex, age, education, and area of residence produced results very similar to the unweighted analyses.
“We performed the same analyses, weighted on sex, age, education, and area of residence, and these showed very similar results.”
Quote in the paperNot a substantial claimMay combine two claims.
Study design and conductown dataA one-factor confirmatory factor analysis of six COVID-related worry items showed acceptable fit and appropriate factor loadings.
“The CFA for COVID-related worries showed an acceptable fit and all factor loadings were appropriate when six COVID-related worries were included in the one-factor model.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationSimilar findings have been reported in studies from Ireland, the UK, and Denmark.
“Similar findings have been reported in studies from Ireland [5], the UK [21], and Denmark [22].”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites [5] Hyland P, Shevlin M, McBride O, Murphy J, Karatzias T, Bentall RP, et al. Anxiety and depression in the Republic of Ireland during the COVID-19 pandemic. Acta Psychiatr Scand. 2020;142(3):249–56. https://doi.org/10.1111/acps.13219. source
Not checked in the free run.
- cites [21] Shevlin M, McBride O, Murphy J, Miller JG, Hartman TK, Levita L et al. Anxiety, depression, traumatic stress and COVID-19-related anxiety in the UK general population during the COVID-19 pandemic. BJPsych Open. 2020;6(6):E125. https://doi.org/10.1192/bjo.2020.109. source
Not checked in the free run.
- cites [22] Sønderskov KM, Dinesen PT, Santini ZI, Østergaard SD. The depressive state of Denmark during the COVID-19 pandemic. Acta Neuropsychiatr. 2020;32(4):226–8. source
Not checked in the free run.
Classified as probably not a substantial claim.
Study design and conductnone givenSampling and weighting were performed based on official statistics from Statistics Norway.
“Sampling and weighting were performed based on official statics from Statistics, Norway.”
Quote in the paperSubstantial claimMay combine two claims.
Interpretationown dataBoth individuals with and without vulnerabilities can worry enough about the pandemic to experience psychological distress and reduced quality of life.
“Thus, both individuals with and without vulnerabilities can worry about the pandemic so much that it brings about psychological distress and decrease their quality of life.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationPrior studies have identified female sex, younger age, and chronic or psychiatric illnesses as risk factors for mental distress during the COVID-19 pandemic.
“In a recent review, Xiong et al. [6] reported that among the risk factors associated with mental distress during the COVID-19 pandemic were female sex, younger age (≤40 years), and chronic/psychiatric illnesses.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [6] Xiong J, Lipsitz O, Nasri F, Lui LM, Gill H, Phan L, et al. Impact of COVID-19 pandemic on mental health in the general population: a systematic review. J Affect Disord. 2020;277:55–64. https://doi.org/10.1016/j.jad.2020.08.001. source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationA recent review showed high prevalence rates for stress, anxiety, and depression in the general population, with more than a third of respondents scoring above the threshold for anxiety and depression.
“A recent review showed high prevalence rates for stress, anxiety, and depression in the general population, across studies more than a third of the respondents scored above the threshold for anxiety and depression [1].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [1] Salari N, Hosseinian-Far A, Jalali R, Vaisi-Raygani A, Rasoulpoor S, Mohammadi M, et al. Prevalence of stress, anxiety, depression among the general population during the COVID-19 pandemic: a systematic review and meta-analysis. Glob Health. 2020;16(1):1–11. source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationWorry is initially an adaptive response to a threatening situation, but when excessive or difficult to control it can lead to psychological distress.
“Worry refers to problem-focused thoughts about the future, and these types of thoughts can motivate us to search for goals or solutions [10] and are initially an adaptive response to a threatening situation like the current pandemic. However, when worry becomes excessive or difficult to control, these thoughts can be experienced as negative, and lead to psychological distress [11].”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [10] Sweeny K, Dooley MD. The surprising upsides of worry. Soc Personal Psychol Compass. 2017;11(4):e12311. https://doi.org/10.1111/spc3.12311. source
Not checked in the free run.
- cites [11] Muris P, Roelofs J, Rassin E, Franken I, Mayer B. Mediating effects of rumination and worry on the links between neuroticism, anxiety and depression. Personal Individ Differ. 2005;39(6):1105–11. https://doi.org/10.1016/j.paid.2005.04.005. source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationPrevious studies outside a pandemic context have found that older adults tend to worry less than younger adults.
“It should be mentioned that the tendency for older adults to worry less than younger adults have also been found in previous studies conducted outside a pandemic context [28, 29].”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [28] Basevitz P, Pushkar D, Chaikelson J, Conway M, Dalton C. Age-related differences in worry and related processes. Int J Aging Hum Dev. 2008;66(4):283–305. https://doi.org/10.2190/AG.66.4.b. source
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- cites [29] Gonçalves DC, Byrne GJ. Who worries most? Worry prevalence and patterns across the lifespan. Int J Geriatr Psychiatr. 2013;28(1):41–9. https://doi.org/10.1002/gps.3788. source
Not checked in the free run.
May combine two claims.
PremisecitationThe 5-item HSCL has shown good psychometric properties and correlates highly (r = 0.92) with the HSCL-25 in a general population sample.
“This abbreviated version of the HSCL has shown good psychometric properties and has previously been found to correlate highly (r = 0.92) with the HSCL-25 in a general population sample [18].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [18] Tambs K, Moum T. How well can a few questionnaire items indicate anxiety and depression? Acta Psychiatr Scand. 1993;87(5):364–7. https://doi.org/10.1111/j.1600-0447.1993.tb03388.x. source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing). The quote only partly states this claim.
Study design and conductown dataThe survey had a response rate of 39.9% (1041 of 2612).
“In total, 39.9% (N = 1041) completed the survey”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationA diary study reported that older and younger participants experienced comparable stress, but younger participants expressed more worry.
“In a diary study, from March/April 2020, Klaiber, Wen, DeLongis, and Sin [27] reported that older and younger participants experienced comparable levels of stress, but younger participants expressed more worry.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [27] Klaiber P, Wen JH, DeLongis A, Sin NL. The ups and downs of daily life during COVID-19: age differences in affect, stress, and positive events. J Gerontol. 2020;76(2):e30–e37. source
Not checked in the free run.
May combine two claims.
PremisecitationNorway was not hit particularly hard by the pandemic compared to other countries, with relatively low fatalities and sufficient hospital intensive care capacity.
“Norway was not hit particularly hard by the pandemic compared to other countries as indicated by a relatively low number of fatalities [23] and sufficient hospital intensive care capacity to handle the comparably modest number of covid-19 patients.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [23] Worldometer database. Available at https://www.worldometers.info/coronavirus/. Accessed 9 Nov 2020.
Not checked in the free run.
May combine two claims.
Study design and conductnone givenThe web-survey panel was constructed to represent the Norwegian general population in miniature, and recruitment was by probability sampling rather than self-recruitment.
“The panel was constructed to represent the Norwegian general population in miniature. Recruitment to the panel was done by probability sampling, not self-recruitment.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationOne study from Norway reported two- to threefold increases in anxiety and depression symptoms compared to pre-pandemic levels.
“One study from Norway reported two to threefold increases in anxiety and depression symptoms, compared to pre-pandemic levels [2].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [2] Ebrahimi OV, Hoffart A, Johnson SU. Physical distancing and mental health during the COVID-19 pandemic: Factors associated with psychological symptoms and adherence to pandemic mitigation strategies. Clinical Psychological Science. 2021. in press. Preprint available at: https://doi.org/10.31234/osf.io/kjzsp. source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationSeveral studies have shown that life satisfaction increases with older age in adulthood.
“Furthermore, several studies have also shown that life satisfaction increases with older age in adulthood [30].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [30] Baird BM, Lucas RE, Donnellan MB. Life satisfaction across the lifespan: findings from two nationally representative panel studies. Soc Indic Res. 2010;99(2):183–203. https://doi.org/10.1007/s11205-010-9584-9. source
Not checked in the free run.
May combine two claims.
PremisecitationCOVID-related worry and psychological distress vary across different places and phases of the pandemic, with higher fear and worry in highly affected areas.
“COVID-related worry and psychological distress in the population are likely to vary across different places and different phases of the pandemic. Indeed, one study reported significant regional differences across the US, with a higher level of fear and worry in highly affected areas [12].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [12] Fitzpatrick KM, Harris C, Drawve G. Fear of COVID-19 and the mental health consequences in America. Psychological Trauma: Theory, Research, Practice, and Policy. 2020;12(1):17–S21. https://doi.org/10.1037/tra000092412. source
Not checked in the free run.
May combine two claims.
PremisecitationOlder adults are more experienced in coping with problems and may be more capable of regulating their emotions.
“Indeed, older adults are more experienced in coping with problems and it has been suggested that older adults are more capable of regulating their emotions [31].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [31] Mather M, Carstensen LL. Aging and motivated cognition: the positivity effect in attention and memory. Trends Cogn Sci. 2005;9(10):496–502. https://doi.org/10.1016/j.tics.2005.08.005. source
Not checked in the free run.
Classified as probably not a substantial claim. May combine two claims.
Study design and conductnone givenThe panel is considered representative of the Norwegian internet population, which constitutes about 97% of the total Norwegian population.
“The panel is considered representative of the Norwegian ‘internet population’ (everyone who has access to the internet), which constitutes about 97% of the total Norwegian population.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenThe questionnaire was briefly piloted before data collection.
“The questionnaire was briefly piloted before the data collection.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationPrevious studies have shown that previous or pre-existing mental health problems are a vulnerability factor during the pandemic.
“Previous studies have also shown that previous or pre-existing mental health problems are a vulnerability factor during the pandemic (for a review see Xiong et al. 2020)”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Xiong et al. 2020 source
Not checked in the free run.
The authors state this as an assumption.
The survey sample is representative of the Norwegian general population.
“A presumed representative sample for the Norwegian population (n = 1041, response rate = 39.9%) responded to a web-survey in May 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?
Mental health is harmed by too much time spent thinking about the outbreak.
“Indeed, mental health has been shown to be harmed by too much time spent thinking about the outbreak [3,10].”
From At the Peak of the Second Wave of COVID-19, Did Millennials Show Different Emotional Responses from Older Adults? (2022) · cites this paper as [3]
The Discussion reports that higher COVID-related worry was significantly associated with greater psychological distress and lower life satisfaction. But the study was cross-sectional and measured worry rather than time spent thinking about the outbreak, so it does not show that spending too much time thinking caused harm. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe COVID-19 pandemic has led to increases in rates of mental health disturbances in the general population.
“Since the onset of the pandemic, an important number of studies have been interested in its psychological impacts and showed increases in rates of mental health disturbances.”
From At the Peak of the Second Wave of COVID-19, Did Millennials Show Different Emotional Responses from Older Adults? (2022) · cites this paper as [3]
The prevalence of psychological distress has increased.
“Moreover, faced with the increase in the prevalence of psychological distress [3,4], it seems useful to invest in the development of prevention tools.”
From At the Peak of the Second Wave of COVID-19, Did Millennials Show Different Emotional Responses from Older Adults? (2022) · cites this paper as [3]
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.
Discussion overlooks the reported illness-life-satisfaction association
MinorThe results report an adjusted association between underlying illness and lower life satisfaction. The discussion instead states that increased risk for severe illness was not associated with the adverse outcomes it summarizes.
“When mutually adjusted (model 1, Table 5), all the same factors and underlying illness were independently associated with a lower level of life satisfaction.”
“Taken together, our findings showed that socioeconomic disadvantage and pre-existing mental health problems, recent violence exposure, but no increased risk for severe illness, was associated with a higher level of psychological distress and a lower level of life satisfaction.”
The age cutoff changes between the measure and results
MinorThe measure defines the older-age group as 65 or above, but the results describe it as older than 65. Those definitions classify participants aged exactly 65 differently.
“age was dichotomized into ‘High’ (>/=65) or to ‘Not high’ (< 65).”
“Old age (> 65 years), underlying illness, living alone, and pre-existing mental health problems were the most frequent potential vulnerability factors.”
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References 31 · Cited by 90
Research works printed but not linked: 1
- Comrey A, Lee H. A first course in factor analysis (2nd edn.) Lawrence Earlbaum associates. Hillsdale: Publishers; 1992.
- Authors
- Blix, I., Birkeland, M. S., & Thoresen, S.
- Affiliations
- Norwegian Centre for Violence and Traumatic Stress Studies (NO)
- Corresponding author
- Blix, Ines
- Venue
- BMC Public Health
- Published
- 2021-05-17
- Volume
- 21
- Issue
- 1
- Pages
- 928-928
- ISSN
- 1471-2458 (ISSN-L)
- PMC
- PMC8127278
- OpenAlex
- W3128160363
- Semantic Scholar
- a3763d47717f484c713c2e36a93da7f27e7914a0
- Cited by
- 90
- References
- 31
- Citations by year
- 2026: 4 · 2025: 8 · 2024: 18 · 2023: 22 · 2022: 27 · 2021: 11
- FWCI
- 13.29
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Public Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- OSF Preprints (OSF Preprints) (submittedVersion)
- 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
- Health Sciences › Health Professions › General Health Professions › Employment and Welfare Studies
- Keywords
- COVID-19 pandemic, psychological distress, life satisfaction, vulnerability factors, socioeconomic deprivation, living alone, unemployment, economic hardship, violence exposure, general population mental health
- MeSH terms
- COVID-19, SARS-CoV-2, Aged, Anxiety, Humans, Mental Health, Stress, Psychological, 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 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.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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