key: cord-262198-3slh8aha authors: Rossell, S.; Neill, E.; Phillipou, A.; Tan, E.; Toh, W. L.; Van Rheenen, T.; Meyer, D. title: An overview of current mental health in the general population of Australia during the COVID-19 pandemic: Results from the COLLATE project date: 2020-07-18 journal: nan DOI: 10.1101/2020.07.16.20155887 sha: doc_id: 262198 cord_uid: 3slh8aha The novel coronavirus disease (COVID-19) poses significant mental health challenges globally; however, to date, there is limited community level data. This study reports on the first wave of data from the COLLATE project (COvid-19 and you: mentaL heaLth in AusTralia now survEy), an ongoing study aimed at understanding the impact of the COVID-19 pandemic on the mental health and well-being of Australians. This paper addresses prevailing primary concerns related to the COVID-19 pandemic, current levels of negative emotions and risk factors predicting these negative emotions. On April 1st to 4th 2020, 5158 adult members of the Australian general public completed an online survey. Participants ranked their top ten current primary concerns about COVID-19, and completed standardized measures to ascertain levels of negative emotions (specifically, depression, anxiety and stress). Socio-demographic information was also collected and used in the assessment of risk factors. The top three primary concerns were all related to the health and well-being of family and loved ones. As expected, levels of negative emotion were exceptionally high. Modelling of predictors of negative emotions established several risk factors related to demographic variables, personal vulnerabilities, financial stresses, and social distancing experiences; particularly being young, being female, or having a mental illness diagnosis. The data provides important characterization of the current mental health of Australians during the COVID-19 pandemic. Critically, it appears that specific groups in the Australian community may need special attention to ensure their mental health is protected during these difficult times. The data further suggests the need for immediate action to combat high levels of psychological distress, along with the exacerbation of mental health conditions, in relation to the COVID-19 pandemic in Australia. These results may provide some direction for international researchers hoping to characterize similar issues in other countries. The novel coronavirus disease emerged in China in late 2019 and has spread rapidly across the globe. It is a contagious viral infection presenting with respiratory, neurological, gastrointestinal, and cardiac symptoms that range in severity from non-symptomatic through to causing death (Mao et al., 2020) . The first case in Australia reported symptoms on January 13th 2020 -nCoV National Incident Room Surveillance Team, 2020 . This was followed by an exponential increase in infections, and unfortunately, deaths (the first Australian death occurred on February 24th). Since COVID-19 was declared a pandemic by the World Health Organization (WHO) on March 11th 2020 (WHO, 2020) , the world has been engulfed in an unprecedented global crisis characterized by threatened or actual healthcare system collapse, job losses, and a failing global economy. In Australia, the crisis has been compounded by the implementation of government-regulated restrictions to contain the virus affecting social liberties. In light of this, COVID-19 poses a significant mental health challenge to the Australian population, both now and in the long term. However, at the time of conducting this project there was no community level data in relation to the mental health implications of the COVID-19 pandemic in Australia, and only one published study from another Western country. In that study of 1310 adults in Spain, heightened negative emotions were associated with being female, being younger, and having negative self-perceptions (Losada-Baltar et al., 2020) . Four studies on the psychological impacts of COVID-19 have also emerged from China. One study analyzed Weibo (Chinese social media platform) posts from 17,865 active users using online ecological recognition based on machine-learning predictive models . The results showed that negative emotions increased (e.g., anxiety, depression and indignation), while positive emotions (e.g., happiness) and life satisfaction decreased over a two-week period from January 13th to January 26th 2020. Two other studies compared the psychological status of medical and non-medical (administration) health workers, illustrating increased insomnia, fear, anxiety, depression, somatization, and obsessive-All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted July 18, 2020 . . https://doi.org/10.1101 /2020 compulsive symptoms in medical health workers (Lu et al., 2020 , Zhang et al., 2020 . Living in rural areas, being female, and being in contact with COVID-19-positive patients were reported as risk factors for negative emotions. Finally, Wang et al. , using an online survey and snowball sampling in the general population between January 31st and February 2nd 2020, reported that ~50% of the 1210 respondents rated the psychological impact of COVID-19 as moderate-to-severe, with 33% reporting moderate-to-severe anxiety. Student status, being female and poor self-rated health were reported as risk factors for negative emotions. In Australia, several health and economic measures had been implemented by March 31st 2020, in an attempt to control the spread of COVID-19 and stave off economic recession (e.g. $130b towards keeping Australians employed). While a recent funding announcement of $1.1b to boost digital mental health services is welcome, if we are to adequately manage this COVID-19 mental health crisis, there is a time-critical need to empirically characterize the current psychological impacts of the pandemic on the Australian population. This is particularly relevant given the Australian Government's current implementation of 'social distancing', a key transmissionprevention measure that describes the maintenance of minimum physical space between oneself and those outside of one's home. Social distancing restrictions, which limit one's out-of-home movements unless absolutely essential, have been found to increase social isolation and loneliness (Zhang et al., 2020) , alcohol abuse (Wu et al., 2008) , and domestic violence (Galea et al., 2020) . This could translate to widespread fear, anxiety, and depression in general society, particularly exacerbated in persons with existing mental health conditions who have an increased susceptibility to the adverse impacts of stress (Duan and Zhu, 2020) . Here we report on the first wave of data collected from the COLLATE project (COvid-19 and you: mentaL heaLth in AusTralia now survEy), an ongoing study aimed at understanding the impact of the COVID-19 pandemic on the mental health and wellbeing of Australians. The COLLATE project All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted July 18, 2020 . . https://doi.org/10.1101 /2020 (described below) focuses on identifying the current concerns, emotional experiences and risk factors for adverse COVID-19-related mental health outcomes in people currently living in Australia. In our initial analysis of wave 1 data, we focused on characterizing the primary concerns of respondents related to the current COVID-19 pandemic as of April 1st to 4th 2020. Levels of negative emotion (depression, anxiety, and stress) were examined and compared with existing Australian population norms; and were modelled as an outcome to identify possible risks factors related to demographic variables, personal vulnerabilities, financial stresses, and social distancing experiences. This study received ethics approval from Swinburne University Human Ethics Review Committee (approval number: 20202917-4107) and complied with the Declaration of Helsinki. On April 1st 2020, adult members of the Australian general public (aged 18+) were invited to participate in an anonymous ~15-20mins online survey, completed at their convenience (i.e. the inclusion criteria to participate were being aged 18+ years and currently residing in Australia). Participants were informed that 16 surveys would be issued over the course of the project. These would be active for 72 hours per month, from 9am on the 1st to 8:59am on the 4th (Australian Eastern Standard Time), occurring monthly for the first year and then annually for the subsequent four years . Participants were informed that they could complete as many or as few surveys as they wanted, with surveys from the same respondent being linked by a personalized pseudonym (thus a subsample would provide us with longitudinal data, with the remaining data cross-sectional snapshots over the 16 surveys). All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted July 18, 2020. . https://doi.org/10. 1101 /2020 After online consent, participants completed the survey which covered three broad topics: a) current were provided. As noted, the data described here relate to survey round 1: April 2020, and only the measures addressing our aims for this manuscript are described below. Invitations to complete the survey were placed on digital university and community noticeboards and social media (e.g. Facebook, LinkedIn, Instagram, and Twitter) as well as participant registries held within the Centre for Mental Health at Swinburne University, which included participants with identified mental health conditions. Exponential non-discriminative snowball sampling was used, with all participants asked to pass the invitation onto their networks. Primary concerns: Participants were asked to identify and rank their top 10 current concerns (out of 23) relating to the COVID-19 pandemic, with 1 being their greatest concern (see Table 2 for the full list of concerns). Negative emotions: The Depression Anxiety Stress Scale (DASS-21) was used. It is a 21-item selfreport measure yielding three subscalesdepression, anxiety, and stresseach containing seven All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted July 18, 2020. . https://doi.org/10.1101/2020.07.16.20155887 doi: medRxiv preprint items (Lovibond and Lovibond, 1995) . Individual items are scored on a four-point Likert scale (0 to 3). DASS-21 raw scores were doubled to render them comparable to full-length DASS scores (42 items). Risk factors: Measurement of risk factors were divided into four categories: Demographics including: age, gender, education, living situation, geographical location/state, whether born in Australia, ethnicity, and religion; Personal vulnerabilities including: being someone at increased mortality risk (e.g. immune-compromised, >60years), having lived experience of mental illness, being a carer of someone with a mental illness or special needs, and being a healthcare professional or 'essential' worker; Financial stresses: fortnightly take-home pay, cash savings, mortgage repayments/rent, self-employment, job loss, and occupation; Social distancing experiences: perceived positives of the situation, perception of government restrictions on mental health, perception of social distancing measures duration, and working from home. Data were analyzed in SPSS v26.0. For all analyses, weights were used to adjust for imbalances in the sample based on the Australian Bureau of Statistics (ABS) population data for age, gender and geographical location/state (ABS, 2016) . In all, there were 12 categories for age (18-19; 20-24; 25-29; 30-34; 35-39; 40-44; 45-49; 50-54; 55-59; 60-64; 65-70; 70+) , two categories for gender (male; female) and four categories for state (Victoria; New South Wales; Queensland; Australian Capital Territory + Northern Territory + Western Australia + South Australia + Tasmania). By March 31st 2020 23:59 Australian Eastern Standard Time (AEST) there were 4,707 confirmed cases of COVID-19 in Australia, with 18 deaths. The majority of confirmed cases were in the states of New South Wales (n=2,182), Queensland (n=743) and Victoria (n=917), with the other states and territories reporting a total of 865 cases together. Given confirmed case numbers, we stratified by state by examining these three states independently from the other states and territories, which were combined. All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted July 18, 2020. . https://doi.org/10.1101/2020.07.16.20155887 doi: medRxiv preprint Primary concerns: To characterize the top ten primary concerns, the number of respondents endorsing each concern was obtained and mean rankings were computed for the ten most commonly selected options. Rankings of zero were assigned to options not endorsed by a participant, and rankings of 1 to 10 were computed for endorsed concerns, with 10 for the option of greatest concern. In this case, the weights developed used the joint distributions of the three weighting variables ensuring that the sum of weights assigned was 5545 (i.e. the total number of respondents to this question who also provided age, gender and geographical location/state data). Negative emotions: Depression, anxiety, and stress subscales and total DASS scores were compared to Australian population norms (Lovibond and Lovibond, 1995) using t-tests. Additionally, the percentage of participants (weighted and non-weighted) were calculated across the four defined severity levels (normal, mild, moderate, severe/extremely severe) for the three negative emotions. Respondents who failed to complete more than 10% of the DASS items were removed from the analysis. Remaining missing items were imputed using the EM algorithm as Little's MCAR test showed items were missing completely at random. For this analysis, the sum of weights and sample size were equal to 5158. Risk factors: Using a transformed (SQRT) total DASS, the relationships between negative emotions and the four domains (demographics, personal vulnerabilities, financial stresses and social distancing experiences) were explored using general linear model analyses. 8014 participants started the survey, with n=5545 respondents (~30% attrition) completing the primary concerns ranking question and providing demographic data. For the negative emotion analyses n=5158 respondents completed the DASS. Demographic data is displayed in Table 1 . The sample was biased in favour of females aged 25-45 living in the state of Victoria, making the use of post-stratification weighting essential in subsequent analyses. All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted July 18, 2020. . https://doi.org/10.1101/2020.07.16.20155887 doi: medRxiv preprint Primary concerns: The primary concern data, with the percentage of respondents rating their top 10 concerns, is presented in Table 2 . Mean rankings were ordered from 1 to 23 in declining order of importance (mean and standard deviations calculated for the rankings of each concern). All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted July 18, 2020. . https://doi.org/10.1101/2020.07.16.20155887 doi: medRxiv preprint "Implications for health and wellbeing of family loved ones" was the most commonly endorsed concern, however, it ranked 3rd in terms of mean rankings. "Loved one dying of coronavirus" and "Loved one catching coronavirus" were the next most commonly endorsed primary concerns, and had the highest mean rankings. Legend: ^ Analyses weighted to adjust for imbalance in the sample of respondents based on Australian Bureau of Statistics (ABS)(ABS, 2016) population data for age, gender and geographical location (State). # Rankings of zero were assigned to options not endorsed by a participant and, for endorsed concerns, rankings of 1 to 10 were computed, with 10 for the option of greatest concern. ~ On 31st March 2020, Australia was at Stage 3 activity restrictions, with Australians told to stay at home except for four reasons -food and essential supplies, medical attention, exercise, and work and study if cannot do so remotely. The first COLLATE survey was launched the following day, 1st All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted July 18, 2020. . https://doi.org/10.1101/2020.07.16.20155887 doi: medRxiv preprint April 2020. Black text = Top ten concerns in rank order, Grey text = Remaining thirteen concerns in rank order. Negative emotions: Figure 1 (also see Supplementary Table 1) shows mean values for the DASS scores compared to Australian norms. In all cases, they were significantly greater than the norms (ps<·001); with people self-identifying as having a mental health diagnosis (MH DX) scoring 5-5·5-fold higher than those without such a diagnosis, who themselves scored 3 times higher than normative levels. Table 3 presents the score distributions across the four severity levels (normal, mild, moderate, severe/extremely severe); 21-35% of the population demonstrated moderate-toextremely severe depression, anxiety and stress. Legend: Norms in Australia from Lovibond & Lovibond (Lovibond and Lovibond, 1995) , MH = Mental Health All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted July 18, 2020. . https://doi.org/10.1101/2020.07.16.20155887 doi: medRxiv preprint Table 3 ). People with a higher mortality risk, lived experience of mental illness, carer responsibilities for someone with a All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted July 18, 2020 . . https://doi.org/10.1101 /2020 mental illness or special needs, as well as people in "essential" occupations, all had higher levels of negative emotions. Financial stresses -Adding finance-related variables to the model explained an additional 5·2% of the variation (Supplementary Table 4 ). Individuals with higher fortnightly incomes and cash savings demonstrated lower levels of negative emotions. Higher levels of negative emotions were experienced by people under financial stress to meet mortgage and rental payments as well as those expecting to lose their jobs. Additionally, highest negative emotions were present for the unemployed, closely followed by homemakers, volunteers, or retired people. Social distancing experiences -An additional 8·4% of the variation was explained by adding social distancing variables (Supplementary Table 5 ). Generally speaking, higher negative emotions were recorded for those who found they now had more free time. This included those who had more down-time, more time to spend communicating with family, more time to do jobs around the house and for those who identified no positive influences in the current situation. However, negative emotions were lower for those who found they now had more time for hobbies. Negative emotions were higher for those who reported that the government restrictions were adversely impacting their mental health, and for those who thought that the current restrictions might continue for more than 12 months. Finally, negative emotions were higher for those not working from home. Risk factor summary -The four domains explained 42·8% of the variance in negative emotions (summarized in Table 4 ). Important predictors for high negative emotions (i.e.  2 ≥0·010) were being young (18-24), being female, being single, living in states with lower COVID-19 cases (QLD, ACT, SA, WAS, TAS, NT), being at higher risk of mortality and having a lived experience of mental illness. The perceived negative effect of government restrictions on mental health was also highly associated with negative emotions, demonstrating the largest effect size,  2 =0·102. Having sizeable cash savings, owning one's own home and predicting a short duration of the current situation were protective factors against experiencing negative emotions. All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted July 18, 2020. . https://doi.org/10.1101/2020.07.16.20155887 doi: medRxiv preprint Legend: All selected predictors with partial effect sizes  2 ≥0.010 The first wave of data from the COLLATE project provides an important characterization of the current mental health of Australians during the COVID-19 pandemic. The top three primary concerns among the general public were all related to the health and well-being of family and loved ones, specifically loved ones catching or dying from COVID-19. As expected, levels of negative emotions (depression, anxiety and stress) were exceptionally high, approximately three times greater than existing population norms in those with no pre-existing mental health conditions. Of concern was the finding that those with a pre-existing mental health condition demonstrated negative emotions 5 to 5.5 times greater than population norms. When the current Australian DASS data was compared with Chinese data , two differences emerged. First, the mean total DASS score from China of 20·16 (SD 20·42) was lower than that of Australia, even for individuals not reporting a mental health condition (18-24years: 33·56 (SD 25·49) and 25years+: 22·29 (SD 16.90)). Second, more Australians were classified as having moderate-to-extremely severe negative emotions (see Table 3 ). These apparent cross-cultural differences will need to be further investigated with a specifically designed comparison study, with differences in social norms and civil liberties between the two countries being possible influences. Nonetheless, both the All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted July 18, 2020. . https://doi.org/10. 1101 /2020 Australian and Chinese data speak to the elevation of negative emotions in the general population during the COVID-19 pandemic. In our data, modelling predictors of negative emotions established several risks factors related to demographic variables, personal vulnerabilities, financial stresses, and social distancing experiences. This included young people (18-24 years) as well as those that are approaching middle-age (35-50 years) . Given that the number of young people experiencing mental health conditions has been rising over the last decade in Australia (Carlisle et al., 2019) , and internationally (Miron et al., 2019) , this current data of such high levels of negative emotions in young people (up to age 24 here) is of particular concern. Increased negative emotions in our middle-aged respondents were associated with increased childcare duties and/or financial stresses that are specific to the immediate situation. This speaks to the importance of monitoring negative emotions in both young people and the middle-aged group longitudinally, that is, in the short and long term. Being female was another significant risk factor for high levels of negative emotions (Lu et al., 2020 , Zhang et al., 2020 . While possible reasons for this remain to be determined, we speculate this could relate to juggling work and increased childcare duties, heightened risk of being in a domestic violence situation, as well as the higher risks of job loss and/or higher likelihood of being an 'essential' worker. Those under financial strain and those who were unemployed are also at increased risk of psychological distress. Thus, methods for targeting this 'financial strain' population to offer them more affordable options for mental health support will be important. Finally, those with pre-existing mental illness are of specific concern Van Rheenen et al, 2020) , and existing mental health services will likely need increased All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted July 18, 2020 . . https://doi.org/10.1101 /2020 support to meet the rising needs of these consumers. It is notable that since this survey was conducted, the Australian government has announced a significant boost in funding to support mental health ($76m over the next two years) with initiatives including dedicated websites and phone lines to support people experiencing stress and anxiety from prevailing COVID-19 related pressures, as well as a public information campaign. The current findings strongly underlie the need for such initiatives to be more targeted to specific groups. Two other findings in our data warrant discussion. First, respondents from the two states with the highest number of COVID-19 cases, New South Wales and Victoria, were found to have lower negative emotions. While this was unexpected, further examination of risk factors established there were a number of protective personal vulnerabilities and financial stresses for persons living in these two states. That is, these states encompassed a lower percentage of respondents with lived experience of a mental illness and a greater percentage of respondents with financial stability. Another important, albeit unsurprising, finding from our data was that individuals who perceived that current government restrictions were very negatively impacting their mental health also had the most pronounced negative emotions. In the context of respondents' primary concerns with the health and well-being of family members, this finding reinforces that government restrictions, such as social distancing, may be better be framed in public messaging as necessary for protecting loved ones and ourselves from contracting the virus. Such a refocusing on positive outcomes may provide individuals with a sense of agency that tempers the powerlessness of being given a legal mandate to stay home. A limitation of the study was the snowballing approach to survey recruitment; this resulted in a nonrepresentative sample of the Australian population, which included some respondents with known mental health diagnosis. To address this, weightings were used based on ABS data (ABS, 2016) to statistically correct for any bias. However, even with statistical weighting, it is difficult to account All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted July 18, 2020. . https://doi.org/10.1101/2020.07.16.20155887 doi: medRxiv preprint for specific subgroups, for example those without access to the internet. Furthermore, despite >8000 participants starting the survey, only ~5500 had useable datasets due to considerable attrition (30%), which is albeit typical of online research. This data provides a snapshot of mental health and well-being of Australians in April 2020 in relation to COVID-19; to do so we compared current negative emotions to existing Australian norms. It is possible differences in sampling factors related to the current sample data and existing norms may explain some of the differences rather than COVID-19 itself. However, given the magnitude of our findings in terms of elevated negative emotions in the general community such sampling differences are unlikely to explain the large variance between current and norm data. We also did not assess the mental health of school-aged children and adolescents in the current survey, the majority are whom are being home-schooled and not permitted face-to-face contact with their peers in Australia at present. School-age children may thus be particularly vulnerable to stress and anxiety, and a critical avenue for future work will be to examine this group specifically. The data collected from the COLLATE project will provide a reference for healthcare professionals in terms of current mental health needs in Australia, in addition to guiding policymakers in making accurate provisions within mental health services and actionable policies. The findings are predicted to be applicable across other nations with similar healthcare systems and government management of the COVID-19 pandemic. Important findings from the data are that: a) people with existing mental health conditions have very high levels of negative emotions (as per (Duan and Zhu, 2020) ) , in addition, there are b) high levels of psychological distress in the general community, with some individuals particularly vulnerable (as per ). The fluid nature of the situation throughout this pandemic makes our continuing and longitudinal comparisons of the mental health effects of government restrictions and lock-down duration forecasts a priority for future study. All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted July 18, 2020. . https://doi.org/10. 1101 /2020 Overall, this data has made it clear that increased mental health support will be of paramount importance as the world faces the consequences of the COVID-19 pandemic. All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted July 18, 2020. (Lovibond and Lovibond, 1995) , Nwt = weighted sample size, M= mean, SD = standard deviation, Md = Median, MH = mental health, DX = diagnosis All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted July 18, 2020. . https://doi.org/10.1101/2020.07.16.20155887 doi: medRxiv preprint All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted July 18, 2020. . https://doi.org/10. 1101 /2020 -NCOV NATIONAL INCIDENT ROOM SURVEILLANCE TEAM 2020. 2019-nCoV acute respiratory disease Psychological interventions for people affected by the COVID-19 epidemic The Mental Health Consequences of COVID-19 and Physical Distancing: The Need for Prevention and Early Intervention We're staying at home". Association of self-perceptions of aging, personal and family resources and loneliness with psychological distress during the lock-down period of COVID-19 Manual for the depression anxiety stress scales. Sydney: Psychology Foundation Monograph Psychological status of medical workforce during the COVID-19 pandemic: A cross-sectional study Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease Suicide Rates Among Adolescents and Young Adults in the United States Alcohol Use in Australia during the Early Days of the COVID-19 Pandemic: Initial results from the COLLATE project Eating and exercise behaviours in eating disorders and the general population during the COVID-19 pandemic in Australia: initial results from the COLLATE project Considerations for assessing the impact of the COVID-19 pandemic on mental health in Australia. Australian and New Zealand Journal of Psychiatry Survey fundamentals: A guide to designing and implementing surveys. Madison: Board of Regents Mental health status of individuals with a mood-disorder during the COVID-19 Pandemic in Australia: Initial Results from the COLLATE Project COVID-19) Epidemic among the General Population in China WHO Director-General's opening remarks at the media briefing on COVID-19 -11 Alcohol abuse/dependence symptoms among hospital employees exposed to a SARS outbreak Mental Health and Psychosocial Problems of Medical Health Workers during the COVID-19 Epidemic in China (GNT1154651), and EJT (GNT1142424) and TVR (GNT1088785) hold Early Career NHMRC