Jo Carlowe Hello, welcome to the Papers Podcast series for the Association for Child and Adolescent Mental Health, or ACAMH for short. I’m Jo Carlowe, a Freelance Journalist with a specialism in Psychology. In this series, we speak to authors of papers published in one of ACAMH’s three journals. These are the Journal of Child Psychology and Psychiatry, commonly known as JCPP, the Child and Adolescent Mental Health, known as CAMH, and JCPP Advances. Today, I’m interviewing Dr. Simona Skripkauskaite, a Postdoctoral Researcher at the University of Oxford. She works for Oxford’s Co-SPACE study, which stands for COVID-19 Supporting Parents, Adolescents and Children During Pandemics. Simona leads the project on learning from the trajectories of mental health challenges for children, young people and parents over the course of the COVID-19 pandemic and she is the first author of the paper, “Changes in UK Parental Mental Health Symptoms Over 10 Months of the COVID-19 Pandemic,” recently published in JCPP Advances. This paper will be the focus of today’s podcast. If you’re a fan of our Papers Podcast series, please subscribe on your preferred streaming platform, let us know how we did, with a rating or review, and do share with friends and colleagues. Simona, welcome, thank you for joining me. Can you start with an introduction about who you are and what you do? Dr. Simona Skripkauskaite Excellent, thank you so much for having me. I am Dr. Simona Skripkauskaite. I’m a Psychologist, Developmental Psychologist that my research interests really falling in the area of atypical development and, to date, sort of, ranging from attention and autism to longitudinal patterns or pathways between parental and child mental health and behaviour and particularly, sort of, context of the COVID pandemic. So, currently, I’m a Postdoctoral Researcher working across the departments of Psychiatry and Experimental Psychology at the University of Oxford, where I mostly work with the Co-SPACE study, the OxWell Student study, and the project aiming to compare somewhat longer-term effects of the COVID pandemic on children and families in UK and Japan. Jo Carlowe Great, thank you very much. So, we’re looking today at your paper, “Changes in UK Parental Mental Health Symptoms Over 10 Months of the COVID-19 Pandemic,” recently published in JCPP Advances. Simona, can you set the scene for us, why was it important to focus on parental mental health, in the context of the pandemic? Dr. Simona Skripkauskaite Well, I know that nowadays it gives people heebie-jeebies to talk about the, sort of, COVID effects and how bad the experience went. But I think many of us will remember that those first ten months of the COVID pandemic, so, sort of, March/April to January 2021, has been a particularly hard, intense and unprecedented time. And the, sort of, global threats, the health, social restrictions, number of lockdowns, the economic consequences associated with COVID-19 pandemic, and research has shown that mental health symptoms, in the general population, has varied in line with the, sort of, restrictions and spread of the disease. Living with children, being younger, having pre-existing mental health diagnosis, living without a partner or having lower educational attainment were repeatedly indicated as associated with greater increases in mental health difficulties, in the general population, at the start of the pandemic. However, when we look at parents, many of those parents did have those vulnerability qualities, as well as extra challenges, due to being parents. So, things like combining work from home and homeschooling their children, caring for children with special educational needs and neurodevelopmental conditions, as well as just addressing the different child development needs at different ages and different experiences and different things they have been missing out on. Given that it’s likely that parental mental health effects would cascade down and affect the wider family system, we believe it was very important to understand how and whether different vulnerably factors have affected the parent and carer population. Jo Carlowe And also, can you give us a quick overview of the paper, so what did you look at? Dr. Simona Skripkauskaite So, we examined monthly study data from two linked UK-based, longitudinal studies, so that’s the Co-SPACE study, previously mentioned. That stands for COVID-19 Supporting Parents, Adolescents and Children during the Epidemics, and Co-SPYCE, which is our sister study, run by University of Southampton and University of Reading at the time, which stands for Supporting Parents and Young Children during Epidemics. So, the main aim was to investigate how parent and carers self-reported stress, anxiety and depression symptoms changed among those samples over the 10 months in the pandemic, from April 2020 to January 2021, a time which included two national lockdowns that involved most children having to stay at home from school. And we also set out to investigate how these over-time trends in parental mental health were moderated by personal and family characteristics. So, beyond looking at averages of trends, we also wanted to examine cumulative effects of vulnerability by exploring whether there were distinct trajectories associated with changes in anxiety, stress and depression in parents and, again, how different personal circumstances might have predicted who ended up in those different trajectories. Jo Carlowe Do you want to say anything more about the methodology used for the study? Dr. Simona Skripkauskaite We ultimately conducted two types of analysis on a sample of over 5,000 parents and carers that took part in either of those studies, at least twice during the period examined. We used the variable centred approach, specifically mixed-effect modelling, the growth curve analysis to define and predict average patterns in anxiety, stress and depression to see how that coincided the different contextual factors. And then we used a person-centred approach for a secondary analysis, where we used latent growth modelling to explore the heterogeneity in mental health and identifying the number and existence of different trajectories where, for example, it might be stable for some people, for other people, mental health difficulties might be increasing or decreasing by that time because we all have individual experiences. Jo Carlowe And what did you find? Can you highlight some of the key findings from the paper? Dr. Simona Skripkauskaite So I’d say, in short, our main findings probably are that changes in parental stress and depression, but not anxiety, reflected the pattern of COVID restrictions, although most parents reported consistently low mental health symptoms, across the different symptomologies. Some personal and family characteristics were associated with higher symptoms overall, others exacerbated when restrictions were highest and some were associated with lack of recovery when restrictions eased, so there’s a differential effect of the different individual circumstances. Yet parents who reported multiple risk factors were the most likely to be in that small group of people showing consistently high or increasing mental health difficulties throughout the pandemic. Jo Carlowe I want to look at the different trajectories that you found associated with changes in parental anxiety, stress and depression over the pandemic, can you talk us through those? Dr. Simona Skripkauskaite We found three different distinct trajectories for changes in anxiety symptoms and five different trajectories for changes in stress and depression. The good news is that around three-quarters of parents reported consistently low anxiety, stress or depression, yet substantial minorities. So, that’s around three to 18% of parents and carers, reported consistently high or increasing symptoms of anxiety, stress and depression, while the rest, sort of, followed different individual patterns. Jo Carlowe Was that surprising that so many were actually coping okay? Dr. Simona Skripkauskaite In a way, I guess, because there’s a lot of discussion of how it’s been bad for everybody, but I think that’s where it’s important to look at who exactly falls into different groups. And even the group that has been okay, it’s still worth remembering that there was variation and increases and decreases in mental health symptoms, throughout the time, but it’s much less so in comparison to the most vulnerable groups. Jo Carlowe Okay, so let’s look at those different groups. The paper clearly describes how personal circumstances and pre-existing inequalities shaped how parents were affected by the pandemic. Simona, what types of circumstances and inequalities put parents most at risk and, conversely, what circumstances were protective? Dr. Simona Skripkauskaite So, it – quite a few different effects came out there. So, when looked at independently, different personal circumstances and pre-existing inequalities moderated whether, how and when parental mental health symptoms changed. So, generally, parents of secondary-school-aged children, aged at the time, sort of, 11 to 17 years old, and that means that all the children in the household were in that age group, or those working out of home, did not, sort of, exhibit immediate increases in mental health symptoms when the restrictions were in place. In comparison to, for example, younger children, however, showed greater continuous increase in mental health symptoms over time without the pattern of recovery, when the restrictions had decreased. Whilst being a younger parent or having a child with special education needs predicted greater overall mental health symptoms, on average, that were further exacerbated during the pandemic, but similarly to the average pattern, increased or decreased in line with the restrictions. While those who reported having secondary level or below education themselves or being a single adult in a household also reported overall greater symptoms. And although their increase was similar to that of the average pattern, again, there was no recovery when the restrictions eased. So that’s when we look at all of them, sort of, separately, however, obviously, people come from a variety of circumstances and for many people, those factors overlap. So, actually, when we look at the cumulative effects of, sort of, person-centred approach, what we see is that the small group of high and increasing symptoms were most likely to be the parents who were younger than average, were a single adult in a household, had pre-existing mental health diagnosis and had more than one or more children with special education needs, putting those people particularly at risk. Jo Carlowe And how did that manifest in terms of was it increased depression or anxiety, what…? Dr. Simona Skripkauskaite It’s mostly stress and depression that we’ve seen, the, sort of – the increases in a way in line with the restrictions. In terms of anxiety, while there was a group, again a similar group, that was – sort of, had high anxiety symptoms throughout and potentially increasing anxiety symptoms throughout, there was, sort of, less variation in it. So I’d say that stress and depression is really what it’s pointing out towards mostly. Jo Carlowe And if I heard you correctly, you said for this group, there was no recovery when restrictions ended? Dr. Simona Skripkauskaite Depending on some of characteristics, then, yes. When we were looking at the combination of those characteristics, mostly we have not seen the recovery that we’ve seen in some groups where, as restrictions were released, people have recovered, and just, sort of, life coming back to normal because, potentially, it was not for this group. Jo Carlowe Is there anything else in the paper that you would like to highlight? Dr. Simona Skripkauskaite Well, I think as with any research, it’s important to remember the limitations of the study when interpreting the findings. So, it should be noted that it’s not necessarily a representative sample of UK population and it does not allow us to really draw any conclusions about immediate impact of the pandemic as the data collection really started once the first lockdown was announced. However, in combination with the previous research that shows deterioration in mental health in parents compared to pre pandemic levels, we’re really providing an extra nugget of knowledge by providing insight into month-to-month changes throughout the pandemic. So that’s important to remember, when looking at these findings. Jo Carlowe What are the implications of your findings for CAMH professionals? Dr. Simona Skripkauskaite Ultimately, these findings emphasise how different personal circumstances and pre-existing inequalities have shaped how parents and families have been affected during this unprecedented pandemic. Hopefully, for the CAMHS professionals, it really highlights the need for support and consideration for those with multiple vulnerability factors and pre-existing inequalities that might make up a small, but most disadvantaged group showing deterioration – deteriorating mental health over the pandemic. And hopefully it highlights the importance of a comprehensive image and addressing the different inequalities that might be experienced by the same people, rather than necessarily considering one factor at the time. Jo Carlowe And what about policymakers, what message do – should they take from your research? Dr. Simona Skripkauskaite Well, the fact that different pre-existing inequalities and vulnerabilities, when looked at independently, showed really clear patterns of whether, how and when parents were affected by the national emergencies, such as COVID-19 pandemic. I think it, sort of, shows the needs for support and policy that recognises these different circumstances and really takes that, sort of, knowledge into account, when making decisions so that the damage can be minimised. ‘Cause, obviously, it’s understandable that certain decisions have to be made and under circumstances as we have been in, but in any sort of future pandemic-related activities or any other national emergencies, it’s important to think about the personal circumstances of the families in how different decisions might impact that. Jo Carlowe Are you planning any follow-up research or is there anything else in the pipeline that you would like to share with us? Dr. Simona Skripkauskaite Yes, so as previously mentioned, I currently lead the study looking at long-term effect of the COVID pandemic across UK and Japan and ultimately, our aim is to unravel any of the effects we have seen in parents and children further by understanding who is and is not bouncing back longer-term. So that’s two and three years since the start of the pandemic, as well as how that differs between countries and aiming to unravel the, sort of, universal versus country-specific effects. Jo Carlowe Simona, where can our listeners go if they would like some further information? Dr. Simona Skripkauskaite For more information on the Co-SPACE study findings and any, sort of, updates on what is happening with the study, you can go to cospaceoxford.org, which is the website of our study, and you can follow up. Jo Carlowe Brilliant. Finally, what is your take-home message for our listeners? Dr. Simona Skripkauskaite As much as we want to move on and forget what’s happened and carry on, often for our own mental health needs, which is very understandable, it is important to remember that if you’re so lucky that you ended up falling in that majority of the group who potentially went relatively unscathed during the pandemic, it’s important to remember that that’s not the case for some other people, under different circumstances. And it’s important to consider the needs of those people and not forget about the potentially long lasting impact that those families might be experiencing. Jo Carlowe Simona, thank you ever so much. For details on Dr. Simona Skripkauskaite, please visit the ACAMH website, www.acamh.org, and Twitter @acamh. ACAMH is spelt A-C-A-M-H, and don’t forget to follow us on your preferred streaming platform, let us know if you enjoyed the podcast, with a rating or review, and do share with friends and colleagues.