*3.7. Were the COVID-19 Related Stresses and Gratitude Assessed by the ECQ Correlated with Indices of Mental Health and Well-Being?*

Table 5 shows correlations between the ECQ and other scales. The ECQ Personal Stress, Parenting Stress, and Older Parent Stress scales had significant (*p* < 0.001) correlations with DASS-21 Depression, Anxiety, and Stress scales completed to reflect distress during quarantine, the WEMWBS well-being scale, and the BIPQ Perception of COVID-19 and Emotional Impact of COVID-19 scales. All correlations were in the expected direction. High levels of COVID-19-related stresses assessed with the ECQ were associated with greater depression, anxiety, and stress assessed with the DASS-21; lower levels of well-being assessed with the WEMWBS; and greater negative perceptions of and emotional reactions to COVID-19 assessed with the BIPQ. The ECQ Gratitude scale had non-significant correlations with the DASS-21 Depression, Anxiety and Stress Scale when stratified by group. The ECQ Gratitude scale correlated positively and significantly with the WEMWBS for people with older aging parents and individuals with neither older aging parents nor children. There was a positive, non-significant correlation for parents of children. There were also positive and significant correlations between the ECQ Gratitude measure and the BIPQ Perception of COVID-19 for all group stratifications. The Emotional Impact of COVID-19, as measured by the BIPQ, correlated positively and significantly with the ECQ Gratitude scale for parents and people with older parents. The BIPQ Knowledge about COVID-19 had a significant correlation with the ECQ Gratitude scale for parents of children. Supplementary Tables S3 and S4 report the correlation coefficients across all measures, stratified by group.




**Table 5.** *Cont.*

Note: ECQ = Effects of COVID-19 Questionnaire. DASS-21 = Depression, Anxiety, and Stress Scale. WEMWBS = Warwick–Edinburgh Mental Well-Being Scale. BIPQ = Brief Illness Perception Questionnaire. \* *p* < 0.05. \*\* *p* < 0.001.

### **4. Discussion**

This study utilized a cross-sectional online survey-based approach to investigate stress, anxiety, depression, and psychological well-being with members of the Irish public recruited through national media and social media outlets. We investigated changes in psychological distress during the COVID-19 pandemic comparing psychological outcomes before and during the quarantine period in Ireland with a sample of individuals ranging age from 18 to 76 years. Participants were asked to retrospectively comment on their "before lockdown" experience of mood and well-being. We addressed a series of five research questions. With regard to the first question concerning mean levels and rates of depression, anxiety, and stress, we found that both mean levels of all three variables and clinical levels of symptoms increased significantly during the quarantine period. The greatest increase in case severity occurred for depression. This is in line with current research specific to the COVID-19 pandemic [10]. With regard to the second question concerning mean reports of depression, anxiety, and stress in subgroups of the sample, we found that increases in depression, anxiety and stress from pre-quarantine to quarantine were not significantly affected by having responsibility for caring for a child or older, aging parents. With regard to the third question concerning rates of stresses and things for which people felt grateful that were specifically related to the COVID-19 crisis, the most frequently identified stressors by the whole sample related to social isolation, personal and familial well-being, and loss of routines such as sleeping patterns and recreational schedules. For those caring for children, the most frequently identified stressors related to keeping their child safe, keeping their child away from crowded areas, and their child's school closing, which was in line with expected outcomes [25]. For those with older, aging parents, the most frequently identified stress was them contracting COVID-19. There was also concern over the availability of medical treatment for their parent should they need it, followed by stress that their older aging parent may become lonely during the pandemic. The most frequently identified thing that people indicated the COVID-19 crisis made them grateful for was their own personal and familial health, close relationships, and their current employment.

The fourth question concerned the psychometric properties of the ECQ. We found that the four a priori subscales had acceptable levels of internal consistency reliability, and that the structure of the ECQ was partially supported by factor analytic results. We also created severity classification bands for the ECQ based on the DASS-21, which has been used to identify high levels of psychological distress during the COVID-19 pandemic through a national survey in Italy [10]. The final question concerned the association between COVID-19-related stresses and gratitude assessed by the ECQ and indices of mental health and well-being. We found that three of the four ECQ scales had significant correlations in expected directions with depression, anxiety, stress, and each correlated as expected with mental health well-being and perceptions of COVID-19.

A limitation of the current study is the profiling of parents, children, and older aging parents. While our public sample allows for stratification into these groups to better understand relative distress,

our questionnaire was not designed to specifically investigate specific additional stressors, i.e., parents who may be managing behaviors that challenge during the quarantine period, or caregiving demands for older aging parents. It is well reported in the literature that externalizing behavior in children is among the most prevalent causes of parental stress across a number of clinical morbidities [32], and quarantine, social isolation, school closure, and reduced access to routine coping strategies may result in greater parental stress. However, such a conclusion cannot be drawn from this study [25,26]. A further limitation is the lack of male participants (16.4%), which future research could aim to recruit specifically, as this may implicate the generalizability of the findings. Lastly, the cross-sectional nature of the study, which included a retrospective component, may be subject to memory bias, and thusly participants may have reported lower scores on measures of distress prior to quarantine. Future research could prospectively conduct serial assessments. Our study is in line with the existing literature on psychological outcomes in response to both COVID-19 and what we know of the psychological impact of quarantine [11,23,27,33].
