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Analysis of Co-SPACE (Supporting Parents, Adolescents and Children During Epidemics) data

This project will use data from a longitudinal cohort study (ALSPAC) to explore the relationship between child bereavement and later mental health. Specifically, it will investigate whether modifiable parental factors moderate the relationship between children who experience bereavement before the age of 11 and their mental health outcomes at 18 years old.

This scoping review aims to investigate for the treatment and targeted prevention of anxiety in young people aged 14-24 years: 1) In which ways, and which contexts does exposure therapy work and why? 2) In which ways, and which contexts does exposure NOT work and why? 3) What are some clinician and client barriers to using exposure therapy?

Co-SPACE (Supporting Parents, Adolescents and Children During Epidemics)

The COVID-19 pandemic is likely to have pervasive and enduring consequences for the mental health and wellbeing of children and adolescents. Indeed, there is evidence that child and adolescent mental health problems and service use have increased since the onset of the COVID-19 pandemic (e.g. Glynn, Poggi Davis, Luby, Bara, & Sandman, 2021; Yeasmin, et al., 2020; and Leeb, et al., 2020). When assessing the wellbeing needs of children, for example in research and for service provision, parent reports may be relied on in order to provide clear insight into the wellbeing of the child and to ensure adequate care or support is provided. To the authors’ knowledge, to date there is no validated parent report measure which captures pandemic related anxieties in children and adolescents. The Pandemic Anxiety Scale (PAS) is 7-item measure which is easy to use and a cost effective method to identify concerns related to specific aspects or contextual factors of epidemics which provoke anxiety. The PAS specifically captures insight into respondent’s worries about the disease itself, such as catching or transmitting the disease, and the long-term outcomes associated with the public health response, such as future economic uncertainty. The PAS has previously been validated as a self-report measure in the context of COVID-19 in non-clinical adult populations in the UK between March 30 and April 29 2020 (McElroy, et al., 2020) and between June 29 and August 9, 2020 (Kubb & Foran, 2020). It has, however, not been validated when used as a parent report of child and adolescent pandemic specific anxiety. The present study aims to validate the standard and modified parent-report PAS through a series of exploratory and confirmatory factor analyses.

Co-SPYCE (Covid-19: Supporting Parents and Young Children during Epidemics)

The COVID-19 pandemic and related social restrictions brought about numerous changes to family life, with many children and parents schooling and working from home, having limited external contact, and experiencing reduced access to support (Young Minds, 2020). Data from the Co-SPACE study shows that periods of social restriction owing to the COVID-19 pandemic have been associated with increased mental health problems among both parents and children (Creswell et al., 2021; Shum et al., 2021a). According to parent/carer-report using the Strengths and Difficulties questionnaire (SDQ; Goodman, 1997), children exhibited elevated externalizing (conduct and attentional) and emotional difficulties during periods of peak restrictions (Creswell et al., 2021). Such effects seemed to vary by child age and gender, with primary-aged children exhibiting elevated overall symptoms relative to secondary-aged children; girls exhibiting higher emotional difficulties than boys; and boys exhibiting more externalizing symptoms than girls. Similarly, parents reported increased depression, stress, and anxiety (assessed via the Depression Anxiety and Stress Scale 21 items (DASS-21); Lovibond and Lovibond, 1995) – as well as feeling less able to meet the needs of their child and their work (Shum et al., 2021b; Skripkauskaite et al., 2022; Shum et al., 2022). Parent mental health also appeared to vary with child age such that parents with younger children experienced greater mental health difficulties overall (Skripkauskaite et al., 2022). Previous analyses have reported that parent depression, anxiety, and stress are related to later child internalizing and externalizing difficulties, and vice versa (Lengua et al., 2022; Robertson et al., 2021; Rizeq et al., 2021; Davidson et al., 2020; Russell et al., 2022). The fluctuating nature of parent and child mental health during the pandemic provides a valuable opportunity to examine their longitudinal associations. Moreover, during periods of peak restriction, most children and parents would have had less external contact and spent more time together (e.g., Pearcey et al., 2022), which may increase the likelihood of poor mental health in the parent or child impacting the mental health of the other. Additionally, experiences of increased environmental and socioeconomic adversity have been linked to greater mental health symptoms across the dyad (Luningham et al., 2022; Rizeq et al., 2021), entailing that relationships between parent DASS and child SDQ might vary with changes in restriction level. The proposed analysis will use Cross-Lagged Panel Modelling (CLPM) to assess the dynamics of parent and child mental health symptoms over time. Specifically, the CLPM will assess relationships between total DASS-21 score (reflecting the summed total of parent depression, anxiety, and stress ratings) and child externalizing (conduct problems and attention/hyperactivity subscales of the SDQ) and child internalizing difficulties (emotional symptoms subscale of SDQ; see Measured Variables for more detail). Based on changes in the level of social restrictions and previous Co-SPACE data, four time periods covering the first year of the pandemic will be selected to include the ‘peaks’ and ‘troughs’ of restrictions and parent and child mental health (Skripkauskaite et al., 2022; Burgess et al., 2022). Time periods will be defined as: Time 1 (T1) = May 2020 (during the first national lockdown when restrictions were high; Time 2 (T2) = September 2020 (when restrictions had loosened, and schools has re-opened); Time 3 (T3) = January 2021 (during the second national lockdown when restrictions had tightened again); Time 4 (T4) = May 2021 (all restrictions had been lifted). (See Unit of Analysis) This analysis will offer insight into bidirectional relationships between parent and child mental health during periods of restriction during the COVID-19 pandemic. This might help us infer where support might best be allocated to mitigate the impact of poor mental health within family units.

The current study is a secondary analysis using collected data from a randomised controlled trial - Supporting Parents and Kids Through Lockdown Experiences (SPARKLE; Kostyrka-Allchorne et al., 2021). This study aims to conduct exploratory non-hypotheses driven analyses to assess whether the effects of a digital parenting intervention (Parent Positive) on child conduct and emotional difficulties are predicted and/or moderated by baseline characteristics.

Additional file 1. SPIRIT Checklist for Trials

Additional file 2. FMWOfferDoc_17417979. Original funder approval (MRC).

Additional file 3. NIHR204435 Intend to Fund letter. Original funder approval (NIHR).

Additional file 1: Supplement 1. SPIRIT Checklist.

Supplemental Material, sj-pdf-3-ccp-10.1177_13591045221088708 for ‘It opened my eyes’: Parents’ experiences of their child receiving an anxiety disorder diagnosis by Emily Davey, Cathy Creswell, Ray Percy and Tessa Reardon in Clinical Child Psychology and Psychiatry

Additional file 2: Supplement 2. Schedule of enrolment, intervention, and assessment.

Supplemental Material, sj-pdf-1-ccp-10.1177_13591045221088708 for ‘It opened my eyes’: Parents’ experiences of their child receiving an anxiety disorder diagnosis by Emily Davey, Cathy Creswell, Ray Percy and Tessa Reardon in Clinical Child Psychology and Psychiatry

Additional file 4. Original ethics approval.

Additional file 3: Supplement 3. Progression criteria assessed by the Programme Steering Committee prior to progressing to Phase 2.

Supplemental Material, sj-pdf-2-ccp-10.1177_13591045221088708 for ‘It opened my eyes’: Parents’ experiences of their child receiving an anxiety disorder diagnosis by Emily Davey, Cathy Creswell, Ray Percy and Tessa Reardon in Clinical Child Psychology and Psychiatry

Additional file 1. SPIRIT 2013 Checklist: Recommended items to address in a clinical trial protocol and related documents*.

Additional file 2. Schedule of enrolment, intervention and assessment.

Additional file 3. Indicative interview topic guides.