Lower-Income Predicts Increased Smartphone Use and Problematic Behaviors Among Schoolchildren During COVID-19 Related School Modification: A Longitudinal Study.

BACKGROUND: As the coronavirus disease 2019 (COVID-19) has continued for a couple of years, the long-term effects of the pandemic and the subsequent school curriculum modification on the mental health of children and parents need to be investigated. To clarify the changes that can occur during one school year and to predict the risk factors for vulnerable groups, this study identified parameters relative to children's screen time, their problematic behavior, and parental depression. METHODS: A total of 186 participants were analyzed who were parents of elementary schoolchildren in South Korea. These parents were required to complete a web-based questionnaire twice. The questionnaires were conducted in June 2020 and September 2021. Participants' general demographics including family income, children's screen time, sleep patterns, problematic behavior, and parental depression were assessed via the parental questionnaire that included various measurement tools. RESULTS: Children's body mass index (BMI) increased significantly in 2021 (18.94 ± 3.75 vs. 18.14 ± 3.30, P < 0.001). Smartphone frequency of use per week (5.35 vs. 4.54, P < 0.001) and screen time per day (3.52 vs. 3.16, P < 0.001) significantly increased during the period of the COVID-19 pandemic. The television screen time (2.88 vs. 3.26, P < 0.001), frequency of viewing (3.77 vs. 4.77, P < 0.001), and children's problematic behaviors significantly decreased (9.15 vs. 11.85, P < 0.001). A lower income household was a key predictor of increased smartphone frequency (B = 1.840, 95% confidence interval [CI], 0.923-2.757, P < 0.001) and smartphone screen time (B = 1.992, 95% CI, 1.458-2.525, P < 0.001). The results showed that the lower income household (B = 5.624, 95% CI, 2.927-8.320, P < 0.001) and a child's psychiatric treatment history (B = 7.579, 95% CI, 5.666-9.492, P < 0.001) was the most significant predictor of problematic behaviors of children and parental depression (B = 3.476, 95% CI, 1.628-5.325, P < 0.001; B = 3.138, 95% CI, 1.827-4.450, P < 0.001). CONCLUSION: This study suggested that children's smartphone screen time and BMI increased during COVID-19 because of the school curriculum modification following school closures in South Korea. The increased children's problematic behaviors and parental depression were predicted by lower-income households and the previous psychiatric history of children. These results indicate that multiple social support systems to the vulnerable group are needed during the ongoing pandemic and that a modified school setting is required.

The Psychometric Properties of the French-Canadian Stress and Anxiety to Viral Epidemics-6 Scale for Measuring the Viral Anxiety of the General Population During the COVID-19 Pandemic.

Objective: This study examined the psychometric properties of the French-Canadian version of the Stress and Anxiety to Viral Epidemics-6 items (SAVE-6) scale for assessing the anxiety response to the viral epidemic among the general population in Quebec, Canada. Methods: A total of 590 participants responded to a confidential online survey between September 28 and October 18, 2020. Confirmatory Factor Analysis (CFA) was conducted to explore the factor structure of the scale. Psychometric properties were assessed using the Item Response Theory (IRT) approach. To explore the convergent validity, a Pearson correlation analysis between the SAVE-6 scale and the depression (Patient Health Questionnaire-2, PHQ-2) or anxiety subscale (Generalized Anxiety Disorder-2, GAD-2) of the Patient Health Questionnaire-4 items scale was conducted. Findings: The French-Canadian version of the SAVE-6 scale was clustered into a single factor. The CFA of the SAVE-6 scale showed a good model fit (CFI = 0.985, TLI = 0.976, RMSEA = 0.051, RSMR = 0.048), and the multi-group CFA revealed that the SAVE-6 scale can measure anxiety response in the same way across gender or the presence of elevated depressive and anxiety symptoms. It showed good internal consistency (Cronbach's alpha = 0.76, McDonald's Omega = 0.77) and significant correlation with the PHQ-2 score and GAD-2 score. The IRT model suggested the efficiency in discrimination among individuals in this latent trait. Conclusion: The French-Canadian version of the SAVE-6 scale is a valid and reliable rating scale, which can measure the general population's anxiety response to the viral epidemic.

Relationship between screen time among children and lower economic status during elementary school closures due to the coronavirus disease 2019 pandemic.

BACKGROUND: This study aimed to examine whether the extended use of a variety of digital screen devices was associated with lower economic status and other environmental factors among Korean elementary school children and their caregivers during school closures precipitated by the coronavirus disease 2019 (COVID-19) pandemic. METHODS: A total of 217 caregivers of children 7-12 years of age from Suwon, Korea, were recruited and asked to respond to a self-administered questionnaire in June 2020. The questionnaire addressed demographic information and children's use of digital media, in addition to their caregivers. The t-test was used for continuous variables, and the Kruskal-Wallis test was used for variables measured on an interval scale. A multiple regression analyses were performed to examine the effects of significant correlative factors on screen time in children as predictors. RESULTS: Children with lower household incomes demonstrated a higher frequency and longer duration of smartphone and tablet personal computer use compared to those from higher income households. Children of households in which incomes decreased after COVID-19 used smartphones and tablet PCs more often and for longer durations. Children from households that experienced decreased income(s) after COVID-19 used personal computers more often and for a longer duration, and children from low-income families engaged in longer screen time on smartphones. A change in primary caregiver(s) may have increased children's screen time on smartphones. CONCLUSION: Lower household income was associated with longer screen time among children, and poor mental health among caregivers during school closures precipitated the COVID-19 pandemic.

Schoolteachers' Resilience Does but Self-Efficacy Does Not Mediate the Influence of Stress and Anxiety Due to the COVID-19 Pandemic on Depression and Subjective Well-Being.

Objectives: In the current coronavirus disease (COVID-19) pandemic, schoolteachers experience stress from addressing students or performing school tasks that may result in burnout. This study aimed to observe whether teachers' stress and anxiety due to the pandemic can influence their depression or psychological well-being and examine whether their resilience or self-efficacy mediates this association. Methods: During March 4-15, 2021, 400 teachers participated and responded voluntarily to an online survey that included the Stress and Anxiety to Viral Epidemics-9 items (SAVE-9), the Teacher-Efficacy Scale, the Brief Resilience Scale (BRS), the WHO-5 Well-Being Index, and the Patients Health Questionnaire-9 items. Results: High psychological well-being of teachers in COVID-19 pandemic era was expected by a low SAVE-9 score (aOR = 0.95; 95% CI, 0.91-0.99), a high level of self-efficacy (aOR = 1.03; 95% CI, 1.01-1.06), and a high BRS score (aOR = 1.18; 95% CI, 1.10-1.27). Moreover, teachers' resilience mediated the effects of stress and anxiety from the COVID-19 pandemic on their subjective well-being or depression. Conclusions: Schoolteachers' subjective well-being and depression were influenced by high levels of stress and anxiety of the viral epidemic, and their resilience mediated this relationship in this COVID-19 pandemic era.

The Psychometric Properties of the Stress and Anxiety to Viral Epidemics-6 Items: A Test in the U.S. General Population.

Objectives: Many individuals around the world are suffering from psychological distress due to the COVID-19 outbreak. The aim of this study is to explore the validity and reliability of the English version of Stress and Anxiety to Viral Epidemics-6 (SAVE-6), which measures the anxiety response of the general population to the viral epidemic. Methods: A cross-sectional web-based study with self-reporting measures was conducted. A total of 314 United States residents were recruited via online platform in exchange for payment. The participants were asked to an anonymous questionnaire, collecting information on demographics, psychiatric history, SAVE-6, Patient Health Questionnaire-4 (PHQ-4), and the Coronavirus Anxiety Scale. Results: The result from confirmatory factor analysis (CFA) demonstrated that a single-factor model [ χ ( 9 ) 2 = 11.53, p = 0.24] yielded excellent fit for all of indices [χ2/df ratio = 1.28; CFI = 1.00; TLI = 1.00; SRMR = 0.02; RMSEA = 0.03 (0.00, 0.07; 90% CI)] and yielded strong internal consistency reliability (Cronbach's α = 0.88). The results from multigroup CFAs showed that there were no gender differences [ Δ χ ( 6 ) 2 = 3.20, p = 0.78, ns] and no race differences [ Δ χ ( 6 ) 2 = 3.60, p = 0.73, ns] between the models, along with excellent model fits. Conclusions: The results of this study support the reliability and validity of SAVE-6 with strong psychometric properties for the English version of the U.S. population.

Application of Stress and Anxiety to Viral Epidemics-6 Items (SAVE-6) to Public Workers for Measuring Their Anxiety Response During the COVID-19 Pandemic.

Objective: This study aimed to compare the adaptability of the adapted version of Stress and Anxiety to Viral Epidemics-9 (SAVE-9) for public workers and the SAVE-6 scale and to validate them among public workers who are on the frontline of the coronavirus disease 2019 pandemic. Methods: A total of 300 public workers responded to the anonymous online survey during April 1-12, 2021. Principal component analysis was conducted with varimax rotation to explore the factor structure of this scale. Confirmatory factor analysis was also used to explore construct validity. Spearman correlation analysis of the scale with the Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9) was performed to explore the convergent validity. The cut-off score in accordance with the mild degree of generalized anxiety symptoms (GAD-7 score of 5) was defined using the receiver operating characteristic (ROC) analysis. Findings: The single-structure model of each scale (the adapted version of SAVE-9 and SAVE-6) was adopted based on the results of the parallel analysis. Because SAVE-6 showed good construct validity, but the adapted version of SAVE-9 did not, we adopted to apply the SAVE-6 scale to assess the anxiety response of public workers in response to the viral epidemic. SAVE-6 showed good internal consistency (Cronbach's alpha = 0.817; McDonald's Omega = 0.818) and good convergent validity with GAD-7 (rho = 0.417, p < 0.001) and PHQ-9 (rho = 0.317, p < 0.001) scale scores. The appropriate cut-off score for SAVE-6 was determined to be ≥ 16. Conclusion: The SAVE-6 scale, as compared to the public workers' version of SAVE-9, is a reliable and valid rating scale to assess the work-related stress and anxiety of public workers due to the viral epidemic.

The Schoolteachers' Version of the Stress and Anxiety to Viral Epidemics-9 (SAVE-9) Scale for Assessing Stress and Anxiety During the COVID-19 Pandemic.

This study aimed to validate the schoolteachers' version of the Stress and Anxiety to Viral Epidemics-9 (SAVE-9) scale. This scale assessed the work-related stress and anxiety response of schoolteachers to the COVID-19 pandemic. A total of 400 schoolteachers participated in an online survey between March 4 and 15, 2021. The survey questionnaire included the schoolteachers' version of the SAVE-9, Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorders-7 (GAD-7) scales. A scree test and parallel analysis suggested a single-factor structure model for the schoolteachers' version of the SAVE-9 scale (real-data eigenvalue = 68.89, 95th percentile of the random eigenvalues = 27.56). The SAVE-9 scale showed good internal consistency (Cronbach's alpha = 0.853) and good convergent validity with GAD-7 (rho = 0.545, p < 0.001) and PHQ-9 (rho = 0.434, p < 0.001) scale scores. This, schoolteachers' version of the SAVE-9 scale is a reliable and valid rating scale that can be applied to teachers in a pandemic situation.

Parental Mental Health and Children's Behaviors and Media Usage during COVID-19-Related School Closures.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is different from previous disasters in that it continues to the present and has affected all aspects of family life. During epidemics, psychosocial support is not less important than infection control. During COVID-19-related school closures, prolonged partial closures of schools could have detrimental social and health consequences for children and may increase the burden on the family. Based on a community sample in Korea, this study identified parental concerns, children's media usage, other various factors and examined whether parental stress level or depression were positively associated with problem behaviors, media exposure, and sleep problems of the primary school children during school closure under COVID-19. METHODS: Participants were 217 parents residing in Suwon, South Korea, who had primary school children and responded to a web-based questionnaire on parental concerns from school closure under COVID-19, subjective stress, depression, whether having received mental health services, and family characteristics; children's sleep patterns, problem behaviors, media usage during the online-only class period, and changes in activity level following the pandemic. RESULTS: During school closure, children gained body weight, spent less time in physical activities and more in media usage. Besides online learning content (97.2%), YouTube was highly used content (87.6%), and games followed (78.3%). Parental subjective stress index was highly associated with parental depression (Pearson correlation 0.439, P < 0.001), children's sleep problems (0.283, P < 0.001), tablet time (0.171, P = 0.012) and behavior problems (0.413, P < 0.001). Parental depression was associated with children's sleep problems (0.355, P < 0.001), TV time (0.153, P = 0.024), tablet time (0.159, P = 0.019), and behavior problems (0.524, P < 0.001). Parents who previously received mental services seemed to be more concerned about the problems their children already have getting worse because of COVID-19 than the disease itself. Children's sleep problem was associated with tablet (0.172, P = 0.011) and smartphone time (0.298, P < 0.001), but not its frequency. CONCLUSION: During COVID-19-related school closures, many parents and children had various difficulties relating to mental health. Ongoing monitoring of mental health of high-risk groups and multiple support systems may need to be expanded to cover those parents having difficulty in caring for their children.

The Stress and Anxiety to Viral Epidemics-6 Items (SAVE-6) Scale: A New Instrument for Assessing the Anxiety Response of General Population to the Viral Epidemic During the COVID-19 Pandemic.

The general population has reported experiencing anxiety due to the COVID-19 pandemic. This study explored the validity and utility of the Stress and Anxiety to Viral Epidemics-6 items (SAVE-6) scale for measuring the anxiety response of the general population to the viral epidemic. About 1,009 respondents participated in an online survey. Of these, 501 (49.7%) participants were rated as having at least a mild degree of anxiety response to the viral epidemic (SAVE-6 score ≥ 15), while 90 (8.9%) and 69 (6.8%) participants were rated as having moderate degree of depression and anxiety, respectively. The SAVE-6 scale showed a good internal consistency (Cronbach's alpha = 0.815). Parallel analysis suggested a one-factor structure for the measure. The SAVE-6 scale was found to be a reliable, valid, and useful brief measure that can be applied to the general population.

Application of the Stress and Anxiety to Viral Epidemics-6 (SAVE-6) and Coronavirus Anxiety Scale (CAS) to Measure Anxiety in Cancer Patient in Response to COVID-19.

This study investigated the usefulness of the six-item Stress and Anxiety to Viral Epidemics (SAVE-6) scale and the Coronavirus Anxiety Scale (CAS) as tools to assess anxiety related to coronavirus disease (COVID-19) in cancer patients. A total of 221 patients with cancer responded to an anonymous online questionnaire between 15 July and 15 August 2020. The functional impairment of the patients was assessed using the Work and Social Adjustment Scale (WSAS), and the SAVE-6 and CAS were also applied. Among these 221 cancer patients, 110 (49.8%) had SAVE-6 scores ≥ 15 and 21 (9.5%) had CAS scores ≥ 5. Within the study population, 104 (47.1%) and 29 (13.1%) patients had WSAS scores ≥ 11 (moderate to severe functional impairment) and ≥ 21 (severe functional impairment), respectively. The correlations between the SAVE-6 and WSAS (p < 0.001) and CAS (p < 0.001) scores were statistically significant. The cut-off for the SAVE-6 was 15 points, while that for the WSAS was 11. Our results suggested that the SAVE-6 and CAS could be used to evaluate moderate and severe degrees of functional impairment related to mental health, respectively, in cancer patients during viral epidemics.