Mental health trajectories of individuals and families following the COVID-19 pandemic: Study protocol of a longitudinal investigation and prevention program

Abstract

Introduction: Many adults, adolescents and children are suffering from persistent stress symptoms in the face of the COVID-19 pandemic. This study aims to characterize long-term trajectories of mental health and to reduce the transition to manifest mental disorders by means of a stepped care program for indicated prevention.

Methods and analysis: Using a prospective-longitudinal design, we will assess the mental strain of the pandemic using the Patient Health Questionnaire, Strength and Difficulties Questionnaire and Spence Child Anxiety Scale. Hair samples will be collected to assess cortisol as a biological stress marker of the previous months. Additionally, we will implement a stepped-care program with online- and face-to-face-interventions for adults, adolescents, and children. After that we will assess long-term trajectories of mental health at 6, 12, and 24 months follow-up. The primary outcome will be psychological distress (depression, anxiety and somatoform symptoms). Data will be analyzed with general linear model and machine learning. This study will contribute to the understanding of the impact of the COVID-19 pandemic on mental health. The evaluation of the stepped-care program and longitudinal investigation will inform clinicians and mental health stakeholders on populations at risk, disease trajectories and the sufficiency of indicated prevention to ameliorate the mental strain of the pandemic.

Ethics and dissemination: The study is performed according to the Declaration of Helsinki and was approved by the Ethics Committee of the Department of Psychology at the Humboldt Universität zu Berlin (no. 2020-35).

Trial registration number: DRKS00023220.

Keywords: COVID-19; Cortisol; Family transmission; Prediction; Stepped-care.

Fig. 1

The red line shows the assumed increase in psychological strain based on the increase in COVID-19 cases against distinct phases of the pandemic: an acute phase with mostly rising numbers, a post-acute phase of decreasing numbers and relaxation of restrictions and an intermediate phase of stability followed by a prolonged phase of stress and a second acute phase with rising numbers. The increase has been reported in preliminary studies, while a decrease will occur much later (Zielsek & Gouzoulis-Mayfrank, 2020). Note. Numbers based on John Hopkins University, CDC, WHO; worldometers.info; A – 22nd March: Strict limitations to leave the house, social distancing rules (green dotted line); B – 20th April: First relaxation of restrictions, first implementation of mandatory face masks; C – End of June: Several federal states allow regular service in kindergartens and schools; D – 14th October: New restrictions for regions with more than 50 new infections per 100.000 inhabitants; E – 28th October: Federal State and States of Germany decide on “part-lockdown”; F – 10th January: Federal State and States of Germany decide on “lockdown”;

Fig. 2

Procedure shows sample and subsamples in circles, assessment time points as blue bars and intervention steps as yellow bars. ^a Children participate in self-assessment if > 10 years old. ^bChildren may participate while the intervention is targeted at adults.