The trajectories of anxiety and depression during the COVID-19 pandemic and the protective role of psychological flexibility: A four-wave longitudinal study

Giulia Landi; Kenneth I Pakenham; Elisabetta Crocetti; Eliana Tossani; Silvana Grandi

doi:10.1016/j.jad.2022.03.067

The trajectories of anxiety and depression during the COVID-19 pandemic and the protective role of psychological flexibility: A four-wave longitudinal study

J Affect Disord. 2022 Jun 15:307:69-78. doi: 10.1016/j.jad.2022.03.067. Epub 2022 Apr 1.

Authors

Giulia Landi¹, Kenneth I Pakenham², Elisabetta Crocetti³, Eliana Tossani⁴, Silvana Grandi⁴

Affiliations

¹ Department of Psychology, University of Bologna, Viale Berti Pichat 5, 40127 Bologna, Italy; Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Viale Europa 115, 47023 Cesena, Italy. Electronic address: giulia.landi7@unibo.it.
² School of Psychology, The University of Queensland, Brisbane, QLD 4072, Australia.
³ Department of Psychology, University of Bologna, Viale Berti Pichat 5, 40127 Bologna, Italy.
⁴ Department of Psychology, University of Bologna, Viale Berti Pichat 5, 40127 Bologna, Italy; Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Viale Europa 115, 47023 Cesena, Italy.

Abstract

Background: Published reports on the adverse mental health impacts of the initial phase of the COVID-19 pandemic suggest an emerging global mental health crisis. However, the trajectories of these mental health impacts over multiple COVID-19 peaks and corresponding lockdowns are unknown. This study explored the trajectories of anxiety and depression over two consecutive lockdowns during the first nine months of the pandemic in Europe (April 2020-January 2021) and examined whether they varied as a function of different psychological flexibility and inflexibility profiles.

Methods: A total of 569 Italians completed online surveys at four assessment points. Trajectories of anxiety and depression were examined with latent growth modeling and according to different psychological flexibility and inflexibility profiles.

Results: Anxiety increased linearly throughout the study period, whereas depression displayed a quadratic trajectory evidencing a decrease with the easing of the first lockdown followed by an increase during the second lockdown. Furthermore, two profiles were identified that displayed different anxiety and depression trajectories. Compared to the psychologically flexible profile, the psychologically inflexible profile reported significantly higher anxiety and depression which remained higher across the study period.

Limitations: A reliance on self-report measures and convenience sampling constitute key study limitations.

Conclusions: Results suggest that high psychological inflexibility is a risk factor for prolonged elevated anxiety and depression during the COVID-19 pandemic, whereas high psychological flexibility is a protective factor. Psychological flexibility and inflexibility should be targeted by preventive public health interventions that harness evidence-based strategies shown to effectively target these factors.

Keywords: Anxiety; COVID-19 pandemic; Depression; Longitudinal study; Psychological flexibility; Psychological inflexibility.

MeSH terms

Anxiety / epidemiology
COVID-19* / epidemiology
COVID-19* / prevention & control
Communicable Disease Control
Depression / epidemiology
Humans
Longitudinal Studies
Pandemics / prevention & control
SARS-CoV-2