Obsessive-compulsive symptoms and information seeking during the Covid-19 pandemic

Abstract

Increased mental-health symptoms as a reaction to stressful life events, such as the Covid-19 pandemic, are common. Critically, successful adaptation helps to reduce such symptoms to baseline, preventing long-term psychiatric disorders. It is thus important to understand whether and which psychiatric symptoms show transient elevations, and which persist long-term and become chronically heightened. At particular risk for the latter trajectory are symptom dimensions directly affected by the pandemic, such as obsessive-compulsive (OC) symptoms. In this longitudinal large-scale study (N = 406), we assessed how OC, anxiety and depression symptoms changed throughout the first pandemic wave in a sample of the general UK public. We further examined how these symptoms affected pandemic-related information seeking and adherence to governmental guidelines. We show that scores in all psychiatric domains were initially elevated, but showed distinct longitudinal change patterns. Depression scores decreased, and anxiety plateaued during the first pandemic wave, while OC symptoms further increased, even after the ease of Covid-19 restrictions. These OC symptoms were directly linked to Covid-related information seeking, which gave rise to higher adherence to government guidelines. This increase of OC symptoms in this non-clinical sample shows that the domain is disproportionately affected by the pandemic. We discuss the long-term impact of the Covid-19 pandemic on public mental health, which calls for continued close observation of symptom development.

Fig. 1. Longitudinal data collection of mental health symptoms.

The first data collection took place from the 24th of April to the 7th of May. Shown is the log-average of daily new confirmed Covid-19 cases, using the rolling 7-day average in the UK from the 1st of February 2020 to the 1st of September 2020. Lockdown was formally enforced on the 26th of March. The ease of lockdown commenced on the 10th of May when people were encouraged to visit parks again and engage in unlimited outdoor exercise. On the 4th of July pubs and restaurants were among the last businesses to come out of lockdown. The second data collection took place from the 15th of July until the 15th of August, after the lockdown restrictions had been lifted. The pandemic curve has been plotted on the basis of data maintained by Our World in Data.

Fig. 2. Average OC symptoms sub- and total scores of the Padua Inventory Washington State University Revision (PI-WSUR) at T1 and T2 in comparison to previous studies.

Current study summary statistics are highlighted by surrounding squares (NT1 = 406; NT2 = 296). These are put in context with two pre-pandemic patient samples reported by Burns et al. (N = 15) displayed as pink triangles and unpublished patient data by Hauser et al. (N = 31), displayed as yellow triangles. A pre-pandemic non-patient sample reported by Burns et al. (N = 5010) is shown as pink dots and data from a previously collected young UK public sample reported by Vaghi et al. (N = 1606) as brown dot. The elevated scores in our sample do not imply that these participants suffer from a clinically relevant disorder, but show that symptoms are elevated across multiple subscales (including some that do not entail Covid-related items, e.g. the CHCK-score) and increased from T1 to T2. OTAHSO Obsessional Thoughts about Harm to Self or Others, OITHSO Obsessional Impulses about Harm to Self or Others, CHCK Checking Compulsions, COWC Contamination Obsessions and Washing Compulsions, DRGRC Dressing and Grooming Compulsions. Data points are means, and error bars represent standard errors.

Fig. 3. Changes of psychiatric symptoms during the first Covid-19 pandemic wave.

Top-panels show the distributions of OC symptoms (A) as measured by PI-WSUR, anxiety (B) and depression scores (C) of the Hospital Anxiety and Depression Scale (HADS) at time point 1 (T1; N = 406) and time point 2 (T2; N = 296). Dashed lines denote the means of each time point. The bottom panels show boxplots for each of the psychiatric symptoms. Boxplots visualize an increase in OC symptom scores from T1 to T2 (A), stable levels of anxiety scores (B) and a decrease in depression scores (C). Connected thin lines show individual scores for T1 and T2 (N = 296). Paired t-test (two-tailed): *p < 0.05, ***p < 0.001. n.s. non-significant.

Fig. 4. Regression analysis showing the association between Covid-19 related information seekingand psychiatric scores (OC symptoms, anxiety, and depression).

(A, B) Regression models estimated separately for each psychiatric dimension (left panels) showed that OC symptoms and anxiety were associated with increased information seeking at time point T1 (N = 406; A) and time point T2 (N = 296; B). When combining all three psychiatric scores in one model (right panels) only OC symptoms remained associated with information seeking at both time points. Error bars represent standard errors and **p < 0.01, ***p < 0.001.

Fig. 5. Mediation model assessing the relationship between OC symptoms and information seeking at T1 and guideline adherence at T2.

The effect of OC symptoms on guideline adherence was mediated by information seeking. Displayed are standardized regression coefficients. The mediation analysis was performed on data from participants who completed the study at both time points (N = 296) *p < 0.05, ***p < 0.001. n.s. non-significant.