Covid-19’s impact on Loneliness and Mental Health: A Study of Schizotypal Traits and Paranoia

The Covid pandemic lockdown has affected us differently, with some people being impacted more than others. Extensive research has indicated that lockdowns – which broadly include isolation measures, such as, in the UK, being required to stay at home unless for essential reasons – have disproportionately impacted individuals with higher levels of paranoia. Paranoia can be described as ’a pervasive and unwarranted mistrust and suspiciousness of others’ (APA). This same paranoia is correlated with mental health disorders and schizophrenia spectrum disorders (Bebbington P. et al, 2013; Wong K & Raine, 2018). Schizotypy is a ‘type of personality organization defined by milder forms of positive symptoms of schizophrenia’ (APA). Higher distrust in government Covid-19 policies and endorsement of pandemic-related conspiracy theories may make lockdowns more impactful on those with greater paranoia. (Freeman D. et al, 2022; Ipsos M, 2020).

Specifically, government physical distancing and lockdown restrictions have, with the vast majority, increased loneliness, exacerbating the mental health issues of patients with psychosis (Lim M. et al, 2018). In addition, loneliness, exacerbated by the Covid-19 pandemic, was strongly associated with individuals showing greater depression and worries about the pandemic (Killgore W.et al, 2020; Van Tilburg T.et al, 2020). Thus, it is essential to understand the impact of loneliness during the Covid-19 pandemic on schizotypal traits, paranoia, and mental health in young people over 18, a key aim of Wong et al (2022), using data from the UCL-Penn Global Covid Study (Wong K & Raine, 2020). What are the advantages of looking at a variety of variables simultaneously in an interrelated network?

In this paper, Wong and colleagues measured the extent to which higher rates of paranoia correlate with mental health issues and loneliness during different pandemic stages.

The Pandemic has disproportionately affected individuals with higher paranoia, mental health disorders, and schizophrenia, exacerbated by loneliness during the pandemic.

Other Research

This was particularly important to study since very little knowledge exists concerning the interrelation of a wide variety of mental health variables during the pandemic.

Studies addressing a similar issue are limited – only four studies have been identified at the time of writing that investigated schizotypal personality traits, where paranoia is a key symptom, in relation to mental health during the pandemic. These studies indicate that more research is needed to understand specific target variables for intervention and changes in relative associations over time. This is particularly relevant to this field since sparse comorbid relationships are apparent in mental health research.

Therefore, the Wong et al (2022) study conducted a three-timepoint network analysis to fill these gaps. A particularly useful statistical technique being used here is a network analysis (NA), which help us understand how a variety of mental health variables are correlated with each other and other factors such as schizotypal traits, stress, and insomnia simultaneously. NA estimates a network structure where nodes represent variables and edges represent partial correlations between each variable. Collectively, the study can use network comparison techniques across variables and time points to identify influential variables for intervention. Additionally, a 12-month follow-up, with interval assessment after 6 months, allows for a cross-lagged panel network analysis to examine longitudinal relationships between variables to understand whether network relationships and structures change or are stable across time.

Study procedure

The research was conducted to provide answers to the following hypotheses:

1. Schizotypal traits and paranoia will be positively associated with poorer mental health symptoms across three-time points, while mean levels of these traits and mental health variables will differ.
2. The overall network structures will vary based on gender, age, country, income level, and time point.
3. The network structure will differ for individuals with high versus low levels of paranoid and schizotypal traits, with stronger associations in those with higher symptom levels.

Through online advertising and various platforms, the study enlisted over 2,300 volunteers aged 18 years and above to a 30-minute survey available in English and seven other languages.

Listed below are the various ways in which measures were determined:

• Schizotypal personality traits and paranoia: SPQ
• Paranoia: SMS
• Externalising problems (Aggression): RPQ
• Internalising problems: PHQ (Depression) and GAD (Anxiety)
• Feelings of loneliness: LQ
• Sleep quality: Consensus sleep diary and the Karolinska Sleepiness Scale
• Covid 19 related stressors: Participants selected from a list of 27 potential stressors related to the Covid-19 pandemic that they thought caused them stress in the past 14 days.
• Demographic variables: survey

Study finds that easing lockdown rules reduced self-perceived loneliness, reducing negative associations between paranoia/schizotypal traits and mental health.

Results

There are three key findings from the paper:

1. Findings suggest that decreases in self-perceived loneliness may have taken place due to the improved environmental conditions derived from the easing of lockdown rules.
2. Decreases in loneliness may have reduced the degree to which paranoia and schizotypal traits are negatively associated with mental health symptoms.
3. The study found that interpersonal and disorganised features were uniquely associated with loneliness and depression.

The study provided a holistic and concise review of the relationship between paranoia and schizotypal traits by looking at the changes in factors related to the pandemic, such as anxiety, depression, loneliness, aggression, poor sleep, and, more broadly, Covid-19 related stress.

Likewise, utilising a three-time network framework enabled the study to identify changes in schizotypal traits as the pandemic progressed. For example, the study identified, across interval periods of 6 months, a reduction in schizotypal traits and aggression but a rise in poor sleep for the same participants. Moreover, via this framework, the study was able to show a significant overall reduction in levels of Covid 19-related stress, paranoia, loneliness, and schizotypal traits in participants, concomitantly with the ease of lockdown measures.

Limitations and implications

However, while the study is novel in its approach and promulgates impressive results, a few limitations exist. The sample recruited online through convenience sampling may have biased the findings towards individuals with a greater incentive towards mental health awareness and limited the generalisability of the results by excluding individuals without exposure or access to social media. Given the Covid-19 restrictions at the time, the study design can also be seen as both an adaptive and polemical measurement strategy and was in line with other covid study designs during the pandemic. Despite this, the credibility of the findings is encouraged by the literature, which assimilates pre-pandemic findings with those of the study.

Future research needed for alternative sampling methods and focus on loneliness

Future Research

Future research may want to use alternative sampling methods, given that some regional sample sizes were not large enough to be generalisable.
To help clarify the role of loneliness in the network analysis, future studies may want to look at a latent class analysis to distinguish the propensity of people to loneliness and the subsequent mental health and schizotypal correlates.

Policy implications

The findings of this study suggest that more should be done to combat loneliness, the significance of which cannot be overstated in its linkage to the increase in mental health issues among populations globally (WHO, 2005). Efforts in the UK have been commendable (Theresa May appointing a minister for loneliness), but more needs to be done to combat this invisible threat. In addition, the Covid recovery policy on loneliness needs to be given more attention, especially since, as the British Red Cross discovered, the loneliest people feel the least able to recover from the Covid-19 crisis.

Insightful research on mental health, schizophrenia, and Covid-19’s impact

Conclusion

Overall, the study by Wong et al (2022) gives a crucial insight into the relationship between factors associated with mental health and schizotypal traits/ paranoia during the pandemic. The study’s network analysis approach provides an avid and shrewd framework of analysis that mediates the comorbid relations in the field of mental health and schizophrenia that other researchers in the field may consider useful when dealing with a variety of variables. Authors highlight loneliness as a ‘key variable for intervention for governments and local communities in the Covid-19 recovery plans to improve people’s psychological and relational health’ a potentially important yet neglected target for intervention that is in line with current ‘social prescribing’ as a clinical target.

Conflicts of interest
Edouard de Bray is a voluntary research assistant in researcher’s (Keri Wong) lab – The Wong Lab.

Co-author of this is blog is Dr. Keri Wong, Associate Professor of Developmental Psychology, Psychology & Human Development, University College London

References

Primary Paper:

• Wong, K., Wang, Y., Esposito, G., & Raine, A. (2021). A three-wave network analysis of COVID-19’s impact on schizotypal traits, paranoia and mental health through loneliness. doi10.31234/osf.io/p9wrv

Other References:

• Bebbington, P., McBride, O., Steel, C., Kuipers, E., Radovanoviĉ, M., Brugha, T., . . . Freeman, D. (2013). The structure of paranoia in the general population. The British Journal of Psychiatry,202(6), 419-427. doi:10.1192/bjp.bp.112.119032
• Freeman, D., Waite, F., Rosebrock, L., Petit, A., Causier, C., East, A., . . . Lambe, S. (2022). Coronavirus conspiracy beliefs, mistrust, and compliance with government guidelines in England. Psychological Medicine, 52(2), 251-263. doi:10.1017/S0033291720001890
• Ipsos, M. O. R. I. (2020). Veracity Index 2020. Ipsos Mori, 26, 3-11. https://www.ipsos.com/sites/default/files/ct/news/documents/2021-12/Veracity%20index%202021_v2_PUBLIC.pdf
• Lim, M.H., Gleeson, J.F.M., Alvarez-Jimenez, M. et al. Loneliness in psychosis: a systematic review. Soc Psychiatry Psychiatr Epidemiol 53, 221–238 (2018). doi.10.1007/s00127-018-1482-5
• Killgore, W. D., Cloonan, S. A., Taylor, E. C., & Dailey, N. S. (2020). Loneliness: A signature mental health concern in the era of COVID-19. Psychiatry research, 290, 113117. doi.10.1016/j.psychres.2020.113117
• Van Tilburg, T. G., Steinmetz, S., Stolte, E., Van der Roest, H., & de Vries, D. H. (2021). Loneliness and mental health during the COVID-19 pandemic: A study among Dutch older adults. The Journals of Gerontology: Series B, 76(7), e249-e255. doi.10.1093/geronb/gbaa111
• World Health Organization. Department of Mental Health, Substance Abuse, World Health Organization, World Health Organization. Department of Mental Health, Substance Abuse. Mental Health, World Health Organization. Mental Health Evidence, & Research Team. (2005). Mental health atlas 2005. World Health Organization. https://books.google.co.uk/books?id=2SXuXnlz3PgC&lpg=PA6&ots=KIOmfKIarx&dq=global%20increases%20in%20mental%20health%20issues&lr&pg=PA1#v=onepage&q=global%20increases%20in%20mental%20health%20issues&f=false
• Wong, K. K., & Raine, A. (2020). Covid19: Global social trust and mental health study. Center for Open Science. doi.10.17605/OSF.IO/FE8Q7
• Wong, K.K., Raine, A. Developmental Aspects of Schizotypy and Suspiciousness: a Review. Curr Behav Neurosci Rep 5, 94–101 (2018). doi.10.1007/s40473-018-0144-y