key: cord-0273712-d57mqj2h
authors: Daimer, S.; Mihatsch, L.; Neufeld, S. A.; Murray, G. K.; Knolle, F.
title: The relationship of COVID-19 related stress and media consumption with schizotypy, depression and anxiety
date: 2021-11-28
journal: nan
DOI: 10.1101/2021.11.26.21266896
sha: 26f76cfe541578f2c89473a543c919d0505e4843
doc_id: 273712
cord_uid: d57mqj2h

Studies report a strong impact of the COVID-19 pandemic and related stressors on the mental wellbeing of general population. In this paper, we investigated whether COVID-19 related concerns and social adversity affected schizotypal traits, anxiety and depression using structural equational modelling. In mediation analyses, we furthermore explored whether these associations were mediated by healthy (sleep and physical exercise) or unhealthy behaviours (drug and alcohol consumption, excessive media use). We assessed schizotypy, depression and anxiety as well as, healthy and unhealthy behaviours and a wide range of sociodemographic scores using online surveys from residents of Germany and the United Kingdom over one year during the COVID-19 pandemic. Four independent samples were collected (April/ May 2020: N=781, September/ October 2020: N=498, January/ February 2021: N=544, May 2021: N= 486). The results revealed that COVID-19 related life concerns were significantly associated with schizotypy in the autumn 2020 and spring 2021 surveys, and with anxiety and depressive symptoms in all surveys; and social adversity significantly affected the expression of schizotypal traits in all but the spring 2020 survey, and depressive and anxiety symptoms in all samples. Importantly, we found that excessive media consumption (>4h per day) fully mediated the relationship of COVID-19 related life concerns and schizotypal traits in the winter 2021 survey. Furthermore, several of the surveys showed that excessive media consumption was associated with increased depressive and anxiety-related symptoms in people burdened by COVID-19 related life. The ongoing uncertainties of the pandemic and the restrictions on social life have a strong impact on mental well-being and especially the expression of schizotypal traits. The negative impact is further boosted by excessive media consumption, which is especially critical for people with high schizotypal traits.

Starting in Wuhan, China, the novel highly infectious severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) spread rapidly around the world in the first months of 2020 and was declared as a pandemic by the WHO om 13 th March 2020. At the time of writing, more than 258 million people worldwide contracted the illness and more than 5.2 million died with or from COVID-19 (Daly & Robinson, 2021; JHU, 2021) . Even after successful vaccination programmes were implemented in many countries (ECDE, 2021) , the uncertainties and restrictions still impacted many areas of daily life. In many countries measures such as "lockdown" or "social distancing" introduced by governments early on (Cohen & Kupferschmidt, 2020) are now procedures regularly and flexibly applied to combat the pandemic. Many educational institutions, childcare facilities, bars and restaurants have been closed over long periods during the past 1.5 years; and cultural or sporting events still being cancelled or highly restricted. Governments in different countries differed in their approach to tackling the pandemic (Plümper & Neumayer, 2020) . For example, at the start of the pandemic the United Kingdom (UK) imposed a nationwide lockdown a few days after Germany, which may have led to higher case and mortality rates. However, the UK started vaccinating earlier and faster than Germany, which allowed earlier relaxations of restrictions (Balmford et al., 2020; Pritchard et al., 2021) . Due to delays in vaccine purchases, significantly less vaccines were available in EU countries, which contributed to fewer vaccinations compared to the UK (Sasse, 2021). Figure 1 shows the number of cases, deaths and vaccinations per day averaged over the week until June 2021. substances if access to their primary substances become limited, or relapse, if they had already recovered from the addiction (Chiappini et al., 2020) .

Besides substance use, many people may also "escape" from the current situation through excessive media consumption, or use media excessively in search for information regarding the current situation. The media plays a particular role in how individuals cope with disasters (Taylor, 2019) , which also applies to the COVID-19 pandemic. On the one hand, the media provides essential information about the virus, recent developments, and protective measures; further, social media is necessary to stay in contact with others and may also be useful to distract oneself from boredom due to a lack of alternatives (Bendau et al., 2021) . On the other hand, the media may produce rumours or misinformation (Tasnim et al., 2020) , or perpetuate the sense of constant threat, which may lead to increased anxiety (Garfin et al., 2020; Satici et al., 2020) . Interestingly, the WHO recently started using the term "infodemic" in the context of the present crisis as "a tsunami of misinformation, hate, scapegoating and scare-mongering (which) has been unleashed" (WHO, 2020) . A large body of literature suggests that excessive media consumption (>3h daily) is associated with poorer mental health (e.g. Bendau et al., 2020; Gao et al., 2020; Neophytou et al., 2021; Ni et al., 2020; Su et al., 2021; Valdez et al., 2020; Zendle, 2020) ).

In the context of the COVID-19 pandemic, most general-population studies focus on the increase of symptoms from common mental disorders, i.e.: depression and anxiety. The present study extends this work by also addressing the development of schizotypal traits. Our previous studies indicated an increase in schizotypic traits during the pandemic (Daimer et al.,

The pandemic could pose an increased risk for people with pronounced schizotypal traits. For example, paranoia related to the risk of a contagious virus may result in individuals experiencing higher levels of psychological stress, depressive feelings, and anxiety (Preti et al., 2020) . Fekih-Romdhane and colleagues showed that people scoring high on schizotypy were more likely to think they had COVID-19 symptoms than people with low schizotypy and they also experienced more pronounced fear of illness (Fekih-Romdhane et al., 2021) . Furthermore, a comparison between individuals with low and high schizotypy during the pandemic showed that those with low schizotypy had a variety of strategies to adaptively cope with the fear of COVID-19 (e.g. positive reframing, planning, religion, self-distraction, and behavioural disengagement), yet those with high schizotypy had fewer such strategies (Fekih-Romdhane et al., 2021) . Those with high schizotypy were more likely to use maladaptive strategies such as venting or self-blame, which were less effective in reducing COVID-19 related anxiety (Fekih-Romdhane et al., 2021) .

Due to greater levels of introversion and mistrust of others, individuals with high schizotypal traits have fewer and poorer social contacts compared to others, are less integrated into communities, and are more likely to be lonely (Kozloff et al., 2020; Le et al., 2019) . When contact with others is regarded as an additional potential risk to one's health, schizotypal individuals may further reduce their social contacts, which may take longer to be restored in the aftermath of the pandemic (Preti et al., 2020) . Additionally, individuals with high schizotypal traits may be particularly likely to succumb to media misinformation, for example, due to their low agreeableness (Kwapil et al., 2018) and disposition towards believing conspiracist ideation (Barron et al., 2014) . A recent study found that people with pronounced schizotypy were more likely to share false political information (Buchanan & Kempley, 2021) . Buchanan and Kempley argued that such individuals are less likely to question the truth of information than those low in schizotypy. This suggests that people scoring high on schizotypy are more likely to become victims of misinformation in the media. Misinformation due to excessive media consumption following mental health deterioration has been frequently reported during this pandemic (e.g. (De Coninck et al., 2021; Su et al., 2021; Tasnim et al., 2020; Zhao & Zhou, 2020; Zhong et al., psychosis in the presence of a biological predisposition to schizophrenia (Debbané & Barrantes-Vidal, 2015) . The psychological stress caused by the prospect of being infected by the COVID-19 virus, as well as the social restraining measures to mitigate the virus' spread, could potentially trigger the development of a full-blown psychosis in people with high schizotypy (Carter et al., 1995; Chapman et al., 1994; Grant & Hennig, 2020) . Valdes-Florido and colleagues (2020) reported cases of psychosis triggered by the fear of infection, compulsory homeconfinement or concerns about the economic consequence of the lockdown. Hu et al. (2020) reported a 25% increase in incidence of schizophrenia in January 2020 compared to previous years in China. The authors attribute this to the psychosocial stress and social distancing measures caused by COVID-19 (Hu et al., 2020) . These medium and long-term effects of COVID-19 as an adverse life event could disproportionately affect people at risk of psychosis over the next few years (Beards et al., 2013; E. Brown et al., 2020) .

In this paper we therefore aim to investigate whether pandemic-related stressors, namely 'COVID-19 related social adversity' and 'COVID-19 related life concerns', have an effect on mental health, and whether these effects are mediated by healthy and unhealthy behaviours.

We generated a separate latent model for each stressor across four samples, each collected at a different time point over a year from the start of the pandemic. We hypothesized that the separate COVID-19 stressors related to restrictions and financial concerns ("life concerns"), and inhibited social relationships ("social adversity"), would each be negatively associated with symptoms of common mental distress (i.e. depressive and anxiety-related symptoms), and schizotypal traits, at all timepoints during the pandemic. In addition, we hypothesised that this association will be mediated by healthy and unhealthy behaviours (respectively, exercise and sleep; alcohol, media, and drug consumption). Specifically, we expect that individuals who experience high levels of the above-mentioned stressors may damage their mental wellbeing through the unhealthy behaviours of substance use and excessive media consumption, and may improve their mental well-being through the healthy behaviours of adequate sleep and regular exercise.

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The COVID-19 exposure and COVID-19 related mental health questionnaire was designed as an online survey using EvaSys (https://www.evasys.de, Electric Paper Evaluationssysteme GmbH, Luneburg, Germany), see Knolle et al. (2021) for a detailed description. The questionnaires were available in German and English. For participant recruitment we used a snowball sampling strategy to reach the general public in Germany and the UK. The "Spring 2020 survey" was collected from 27/04/2020 -31/05/2020, approximately five weeks after the introduction of the nationwide lockdowns in the UK and Germany. Completion of this first survey took approximately 35 min. The three follow-up surveys took only about 15 minutes, as they did not include question on subjective change of psychological distress ("Autumn 2020 survey": 10/09/2020 -18/10/2020; "Winter 2021 survey": 10/01/2021 -07/02/2021; "Spring 2021 survey": 01/05/2021 -31/05/2021). Figure 1 shows the time point of data collection with respect to the development of cases and deaths in the UK and Germany. For the follow-up surveys, the respondents who provided their email addresses on any of the previous surveys were contacted again, and additional respondents were recruited via social media (i.e., Facebook, Twitter, WhatsApp) and recruitment platforms (www.callforparticipants.com).

Participation was voluntary, and participants did not receive any compensation.

Ethical approval was obtained from the Ethical Commission Board of the Technical University Munich (250/20 S). All participants provided informed consent.

As described in Knolle et al. (2021) in detail, the self-reported survey assessed the following domains: demographic information (age, gender (not biological sex), education and parental education, living conditions), the Coronavirus Health Impact Survey (CRISIS, http://www.crisissurvey.org/), which assessed COVID-19 exposure (infection status, symptoms, contact), subjective mental and physical health, and healthy and unhealthy behaviour (i.e., weekly amount of sleep and exercise, consumption of alcohol, drugs, and media), and general mental health status using the Symptom Check List (SCL) (Hardt et al., 2011; Hardt & Gerbershagen, 2001; Kuhl et al., 2010) . The SCL's 27 items assess symptoms of anxiety, . CC-BY-NC 4.0 International license It is made available under a perpetuity.

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The copyright holder for this this version posted November 28, 2021. ; https://doi.org/10.1101 https://doi.org/10. /2021 depression, mistrust, and somatisation. Finally, we assessed schizotypy using the of the Schizotypy Personality Questionnaire (SPQ, dichotomous version (Raine, 1991) ).

Statistical analysis and visualisations were computed using R and R Studio (R Core Team, 2016; Rstudio, 2020) . We used Wilcoxon rank sum tests or Chi-square test of independence to explore differences between the countries (UK, Germany) and four surveys (April/ May 2020, September/ October 2020, January/ February 2021, May 2021) on demographics and the COVID-19 exposure variables.

To further explore the differences between the countries and time points in CRISIS variables we conducted robust ANOVAS (Mair & Wilcox, 2020) with country (UK, Germany) and survey (April/ May 2020, September/ October 2020, January/ February 2021, May 2021) as a betweensubjects factor.

In order to assess the relationships between possible influences of health-damaging behaviour on depressive and anxiety-related symptoms as well as high schizotypy, we created structural equation models (SEM) using the Lavaan package in R (Rosseel, 2012) . The visualisations of the models were carried out using Onyx (Brandmaier, 2021) . See Figure 2 for an overview of the hypothesized models.

Our three endogenous manifest variables ("outcomes") were schizotypy trait, symptoms of depression, and symptoms of anxiety. Schizotypal trait was defined as the total sum score of all SPQ items. For anxiety and depressive symptoms, specific items of the SCL-27 were summed and divided by the number of items. For depression, we used all SCL-27 items assessing dysthymic and depressive symptoms; and for anxiety we used all items describing agoraphobic and social phobic symptoms.

For the exogeneous latent variables ("predictors"), we generated two variables. The first is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint

The copyright holder for this this version posted November 28, 2021. ; https://doi.org/10.1101 https://doi.org/10. /2021 your daily life been for you ' and ' to what degree are you concerned about the stability of your living situation'. The exogeneous variables were scaled so that we fixed the variance of all factor loadings within one exogeneous latent variable to 1. This allowed comparing estimates between different models using these exogeneous latent variables quantitively. The second exogeneous latent variable, 'social adversity', reflects loneliness and whether change in the quality of social relationships was perceived as stressful. The variables that loaded best on the factor 'social adversity' were the CRISIS items 'has the quality of the relationships between you and members of your family/social contacts changed/ how stressful have these changes in contacts been for you', 'how lonely were you' and 'to what extent did you have negative thoughts, thoughts about unpleasant experiences or things that make you feel bad'. The two measurement models for the two exogeneous latent variables (predictors) had excellent fit, see Supplementary Table 2. The mediators drug use and excessive media use were recoded into dichotomous variables from categorical responses, due to sparse endorsement of some categories. Both were expressed with a positive value for at least one occasion of marijuana, opiate or tranquilliser use in the last four weeks, or, for at least four hours of daily consumption of any of social media, digital media, or video game (None at all, Under 1 hour, 1-3 hours, 4-6 hours, More than 6 hours), respectively. Alcohol consumption was used as a continuous variable (Not at all, Rarely, Once a month, Several times a month, Once a week, Several times a week, Once a day, More than once a day). Hours of sleep per night (<6 hours, 6-8 hours, 8-10 hours, >10 hours) during the week and frequency of 30-min exercise (sporting activities) per week were analysed with the original categories from the CRISIS measure.

For each of the four survey time points, two separate models were conducted, one to assess how 'social adversity' predicted mental health scores, and the second to assess how 'COVID-19 related life concerns' predicted mental health scores. Mental health scores were our three endogenous variables, SPQ traits, depressive symptoms and anxiety symptoms. Covariances between the outcome variables were included in the model, including covariances between mediators led to a non-converging model. As we hypothesised that these relationships are mediated by healthy and unhealthy behaviours, we included drug consumption, excessive media use, alcohol consumption, hours of sleep per night during the week, and exercise per week as mediation variables to explain the relationship between each exogeneous latent . CC-BY-NC 4.0 International license It is made available under a perpetuity.

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The copyright holder for this this version posted November 28, 2021. ; https://doi.org/10.1101/2021.11.26.21266896 doi: medRxiv preprint variable ('COVID-19 related life concerns', 'social adversity') and all the endogenous variables (SPQ, depression, anxiety) . In order to facilitate comparison across the four surveys collected at different time points throughout the pandemic, we included as confounders in each model those variables which were associated with differences across the timepoints at p<.01 (Table   1) . We did not control for suspected COVID-19 infection, as the infection rate was <1% in each of the four samples. We also included age and sex as these are known confounders of many of the paths in our proposed model. As each survey consisted of different participants, each model was based on cross-sectional data. Therefore, the direction of the associations may be ambiguous and the variables may influence each other. Nonetheless, here we examine the influence of distressing conditions, which have occurred in particular because of the COVID-19 pandemic, on mental health, and the mediation of these relationships by healthy and unhealthy behaviours. Alternative models are presented in the supplements. We fitted mediation models that included the direct effect of the exogeneous latent variable on the endogenous variable (pathway c) as well as the indirect effects via the mediation variables (pathway a+b), which included the effect of the exogeneous variable to the mediator (pathway a) and the mediator to the endogenous variable (pathway b). The total effect is calculated as the product of paths a and b plus the direct effect c. Figure 2 shows an overview of the theoretical models. Note that the models were calculated separately for the two exogeneous latent variables and the samples at the different timepoints.

All models were estimated using maximum likelihood estimation combined with bootstrapped errors. To examine the quality of the model fit, we consulted the Comparative-Fit-Index (CFI; (Bentler, 1990) ) for the relative model fit and the root mean squared error (RMSEA; (Steiger, 1990) ) for the absolute model fit. An adequate fit is assumed for RMSEA of less than .06 and a CFI of greater than .90 (Beauducel & Wittmann, 2005; Browne & Cudeck, 1992) . is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint

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The copyright holder for this this version posted November 28, 2021. ; https://doi.org/10. 1101 Sample descriptions for all four surveys are presented in Table 1 . The first survey (April/May 2020) was completed by 781 participants (UK N=239; Germany N=542), after excluding three participants who did not provide consent. The second survey (September/October 2020) was completed by 498 participants (Germany, N=383; UK N=115), after excluding three responders under the age of 18, a prerequisite for taking part in the study. In the third survey (January/ February 2021), 544 participants were included after the exclusion of one person who did not give consent to the participation and four further participants under the age of 18 (Germany N=448; UK N=96). A total of 486 (Germany N=416; UK N=70) people participated in the last survey, in May 2021, after two were excluded due to lack of consent and two for being under the age of 18.

Since participation at one timepoint was not required for taking part in another one, we regard all four samples as independent. 26 participants took part in all four surveys. The samples did not differ significantly in terms of age (X 2 =2.85, p=.416) and gender (X 2 = 6.76, p =.343).

However, in the second, third, and fourth survey, significantly more participants came from Germany (X 2 = 55.31, p <.001). In addition, the distributions of educational level (X 2 = 125.74, p <.001) and living area (X 2 = 52.74, p <.001) differed significantly between the time points (Table   1 ). is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint

The copyright holder for this this version posted November 28, 2021. ; https://doi.org/10.1101/2021.11.26.21266896 doi: medRxiv preprint indicated significant high correlations between SPQ and anxiety (r=0.57-r=0.68) and between SPQ and depression (r=0.53 -r=0.58) in all four surveys (Supplementary table 1 is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint

The copyright holder for this this version posted November 28, 2021. ; https://doi.org/10. 1101 The results for this model are presented in Table 4 , and for the mediator media in Investigating the endogenous variable SPQ (Figure 4 , is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint

The copyright holder for this this version posted November 28, 2021. ; https://doi.org/10.1101/2021.11.26.21266896 doi: medRxiv preprint excessively and have higher SPQ. Media consumption explained a quarter of the total effects of COVID-19 stress on SPQ In addition, there was a trend towards a significant mediation with sleep in the winter 2021 survey.

Investigating anxiety (Figure 4, Table 4 ), we found in the last three surveys that COVID-19 related concerns were associated with increased anxiety, with the strongest effect at the May 2021 survey (c=0.20) and the weakest effect in winter 2021 (c=0.14). Significant total effects were measurable at these time points. A significant indirect effect with the mediator excessive media consumption was seen in winter 2021: 12.5% of the effects of COVID-19 related concerns on anxiety symptoms occurred through excessive media consumption.

In all four surveys, increased stress from the COVID-19 pandemic was significantly related to greater depressive symptoms ( Figure 4 is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint

The copyright holder for this this version posted November 28, 2021. ; https://doi.org/10.1101/2021.11.26.21266896 doi: medRxiv preprint Table 4 ). Other possible mediators were included in the model, but are not depicted for simplicity, as indirect effects were nonsignificant (Table 4) . is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint

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The copyright holder for this this version posted November 28, 2021. ; https://doi.org/10.1101 https://doi.org/10. /2021 (Table 5) . is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint

The copyright holder for this this version posted November 28, 2021. ; https://doi.org/10.1101 https://doi.org/10. /2021 Exploring the effect of 'social adversity' on schizotypy ( Figure 5 , Table 5 ), we found that in all four surveys, social adversity was associated with higher levels of schizotypal traits, with this association being most pronounced in the May 2021 survey (c=0.33). Significant total effects were shown in all four surveys. The mediation with excessive media consumption revealed a statistically significant indirect effect in the winter 2021 survey: 11.5% of the effects of social adversity during the pandemic on schizotypy were mediated by excessive media consumption.

Investigating the effect of social adversity on anxiety ( Figure 5 , Table 5 ), structural equation models revealed that the exogeneous latent variable was associated with heightened anxiety (c=0.25 -c=0.29). All total effects were significant. The mediation with excessive media consumption revealed again a statistically significant indirect effect in the winter 2021 survey:

3.6% of the effects of social adversity during the pandemic on depressive symptoms were mediated by excessive media use. Again, there was no other statistically significant indirect effect, revealing no additional mediators.

Furthermore, SEM revealed that the exogeneous latent variable 'social adversity' had a positive association with depressive symptoms in all four surveys ( Figure 5 , Table 5 ). All total effects were significant. The mediation with excessive media consumption revealed again a statistically significant indirect effect in the winter 2021 survey, with 2% of effects explained.

In an exploratory model, we investigated the mediating effect of anxiety and depression on the association between COVID-19 related life concerns and schizotypy, and social adversity and schizotypy. The model fit is presented in Supplementary Table 5. We found that the association between COVID-19 related life concerns and schizotypy was fully mediated by anxiety scores only in the winter 2021 and May 2021 surveys. Anxiety also mediated the effects of social adversity and schizotypy across all four surveys (Table 6 ). Depression did not act as a mediator between COVID-19 related life concerns and schizotypy, but it did mediate effects of social adversity predicting schizotypy in winter 2021.

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The copyright holder for this this version posted November 28, 2021. ; https://doi.org/10. 1101 (Preti et al., 2020) , whereas they were more likely to feel secure when restrictions were in place, which is why effects were not seen during lockdowns.

COVID-19 related concerns, moreover, predicted an increase in media consumption, in the samples measured at the winter 2021 survey, confirming that individuals who experienced high stress related to COVID-19 may use excessive media consumption as a potential coping strategy (Bendau et al., 2021) . Media consumption was also associated with increased schizotypy and depressive and anxiety symptoms in people experiencing high levels COVID-19 related concerns in the sample measured in winter 2021, when case numbers were highest in both countries. Here we found that media consumption significantly mediated the effect of COVID-19 related life concerns on schizotypy and depressive and anxiety symptoms, potentially by increasing levels of fear and misinformation (Tasnim et al., 2020) and thus increasing these symptoms (Ni et al., 2020; Satici et al., 2020) . is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint

The copyright holder for this this version posted November 28, 2021. ; https://doi.org/10.1101 https://doi.org/10. /2021 people (Czeisler et al., 2020) . Furthermore, a positive correlation was found between COVID-19 related life concerns and alcohol consumption only in the May 2021 survey. This could be due to the calming effect of alcohol on the nervous system, hence it could be expected that consumption might increase in response to stressors (Kypri & McCambridge, 2018; Eckardt et al., 1998) . However, we did not find this effect at the three other surveys. Interestingly, general alcohol consumption declined in most of the European countries, with the exception of the UK during the pandemic.

Our first model also revealed that higher levels of COVID-19 related life concerns was associated with fewer hours of sleep at night in the winter 2021 and May 2021 surveys. Poor sleeping or poor sleeping patterns (e.g. <6h of sleep) are associated with worse mental health (Becker et al., 2018; João et al., 2018) . Franceschini and colleagues (Franceschini et al., 2020) showed that 55% of 6519 adults reported poor sleep quality during the first lockdown, which was associated with higher levels of stress during the pandemic. Consistent with these findings, we found that more hours of sleep (>6h) were associated with lower levels of depression in the spring and autumn 2020 surveys, lower anxiety levels in the spring 2020 survey and lower SPQ scores in autumn 2020. Sleep may therefore play an important role as an emotional stabilizer (Goldstein & Walker, 2014) .

We did not find a negative association between COVID related life concerns and physical activity; however, we found a positive association between physical activity and mental health scores; indicating that more physical activity is associated with higher anxiety in the autumn 2020 survey and spring 2021 survey. This is surprising and contradicts a large body of literature showing the positive effect of exercise on levels of anxiety, depression and stress (for review see (Mikkelsen et al., 2017) ). As the associations, however, were found in those surveys when general restrictions were lower, more exercise potentially means an increased risk of exposure to potentially infected individuals. A potential reason for why we did not see a general positive effect might be the sensitivity of the measure (number of times of at least 30min increased heart rate activity per week). Also, individuals may have changed their exercise habits from for example team sport to individual exercise, which may dampen the positive impact.

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The copyright holder for this this version posted November 28, 2021. ; https://doi.org/10.1101 https://doi.org/10. /2021 In the second model, we explored investigated the association between social adversity or the lack of supportive relationships and mental health, and how those associations were mediated by healthy and unhealthy behaviour. We found that in all four surveys, social adversity predicted the expression of schizotypal traits. A study by Le et al. (2019) found that in individuals with trait schizotypy, psychosis-like symptoms were exacerbated only in those who experienced increased loneliness. Individuals high in schizotypal traits tend to have fewer social skills. Therefore an increase in loneliness during the pandemic might heighten schitzotypal traits, potentially pushing individuals with already high scores of schizotypy into a full blown psychosis (Brown et al., 2020; Chau et al., 2019; Esposito et al., 2021) . Our findings in the light of the literature show the tremendous need for enabling safe social contacts during situations which require social distancing. Furthermore, we found that social stress predicted both depressive and anxiety symptoms in all four samples. This is consistent with the social exclusion theory, which identified social exclusion as the primary source of anxiety (Leary, 1990) . Other studies during the COVID-19 pandemic have also shown that loneliness was the main risk factor for depression and anxiety (Okruszek et al., 2020; Palgi et al., 2020) . McQuaid and colleagues (2021) found that loneliness related to anxiety and depression increased in a dose-like fashion during the first half of the COVID-19 pandemic.

In addition, social adversity was associated with increased excessive media use in the winter 2021 sample and increased drug use in sample at the surveys from spring 2020, winter 2021 and May 2021. Both have been discussed as maladaptive coping mechanisms to reduce loneliness (Rokach, 2005) . Increased media consumption during the pandemic has been described as a compensation for the lack of social contacts (Cauberghe et al., 2021) . However, excessive use of social media increases the risk of misinformation (Siddiqui et al., 2020; Tasnim et al., 2020) , and as pointed out above is linked to lower mental health, especially to higher levels of anxiety and depression (Gao et al., 2020; Zhao & Zhou, 2020) . Furthermore, higher social adversity also predicted higher alcohol consumption in the spring 2020 survey. This showed that people who felt more lonely or isolated at the beginning of the pandemic also drank more alcohol, as previously found (Horigian et al., 2021) . Similar to the first model, social adversity was found to reduce sleep. Research on sleep, social adversity and mental health is inconsistent, with some studies reporting no influence of social adversity or loneliness on sleep (e.g. (Hawkley et al., 2010) ), while others show a clear negative impact of social adversity and loneliness on sleep (e.g. (Bartoszek et al., 2020; Groarke et al., 2020) ). Unhealthy behavioural . CC-BY-NC 4.0 International license It is made available under a perpetuity.

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The copyright holder for this this version posted November 28, 2021. ; https://doi.org/10. 1101 patterns might act in a negative self-reinforcing way, as it has been reported that lack of sleep leads people to participate less in social interactions and to withdraw (Simon & Walker, 2018), increasing the risk for reduced mental health, which might again negatively impact the quality of sleep. However, our cross-sectional data does not show evidence of a direct link between reduced sleep, schizotypy, depressive or anxiety symptoms. We also found no association between social adversity and physical activity. This contradicts the results of other studies that report that loneliness decreased the likelihood of physical activity (Creese et al., 2021; Hawkley et al., 2009 ). However, we again found that more exercise was associated with higher levels of anxiety at the spring 2021 survey, which could be explained as.

Excessive media consumption partially mediated the effects of social adversity on SPQ traits.

Thus, individuals who suffer more from loneliness or lack of social support have higher schizotypy in part because of their propensity for high levels of media consumption. However, we did not find mediation of the social adversity and schizotypy association via drugs, alcohol consumption, exercise, or sleep.

In exploratory analyses, we investigated the mediating effect of anxiety and depressive symptoms on the association between social adversity and schizotypal traits and COVID-19 related concerns and schizotypal traits. Depressive symptoms did not mediate the effects of COVID-19 concerns on schizotypy, but they did mediate effects of social adversity on schizotypy, but only during the winter 2021 survey. We found that the association between social adversity as well as COVID-19 related concerns and schizotypy was in both cases fully mediated by anxiety (all surveys for the former effects, only winter 2021 and May 2021 for the latter effects). This means that social adversity and COVID-19 related concerns increased anxiety in our samples which in turn impacted the level of schizotypal traits. Findings are consistent with other work reporting a positive association between schizotypy and social anxiety (Brown et al., 2008; Lewandowski et al., 2006) .

There are several limitations to our study. First, in this analysis we investigate four different samples collected at different time points within one year from the start of the COVID-19

pandemic. Although the samples are highly comparable, and we adjust for observed differences between them in our models, we cannot adjust for unmeasured confounding. Thus, we cannot definitively say that the altered associations observed throughout the pandemic are related to genuine changes in these relationships, and thus reflect the changing impact of the pandemic. is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint

The copyright holder for this this version posted November 28, 2021. ;

Second, an adequate fit is assumed for RMSEA of less than 0.06 and a CFI of greater than 0.90.

Our models fulfil these criteria for the RMSEA, but are slightly lower for the CFI, ranging between 0.78-0.86. Our models are highly complex, with each model including five mediators and three outcomes. When reducing the complexity of the models, fit based on CFI meets threshold (³0.9); however, for the sake of parsimony we present the full models.

In conclusion, we found that social adversity and COVID-19 related concerns predicted higher schizotypal traits, and symptoms of depression and anxiety. We furthermore found that excessive media consumption (more than 4h a day) partially mediated these relationships. We identified the ameliorating potential of regular sleep on mental health, but especially on schizotypy. Overall, our study shows that during the handling of extreme situations such as a global pandemic which require lockdowns and social distancing, sustained meaningful relationships and a healthy lifestyle are essential to maintain mental health. Furthermore, our findings highlight the risk of pandemic stressors heightening people's levels of schizotypy, especially through excessive media consumption. Finally, our findings show that symptoms of common mental disorders (depression and anxiety) mediated the effects of social adversity and COVID-19 related concerns on schizotypy. All together our findings underscore the need for protective measures to be in place, such as social support networks, psychoeducation, media education, and treatment for common mental disorders, to support those most vulnerable to increased schizotypy.

. CC-BY-NC 4.0 International license It is made available under a perpetuity.

is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint

The copyright holder for this this version posted November 28, 2021. ; https://doi.org/10.1101 https://doi.org/10. /2021 Ethical statement Ethical approval was obtained from the Ethical Commission Board of the Technical University Munich (250/20 S). All respondents included in the analyses provided informed consent.

. CC-BY-NC 4.0 International license It is made available under a perpetuity.

is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint

The copyright holder for this this version posted November 28, 2021. ; https://doi.org/10.1101 https://doi.org/10. /2021 Fancourt, D., Steptoe, A., & Bu, F. (2020) . Trajectories of anxiety and depressive symptoms during enforced isolation due to COVID-19 in England: a longitudinal observational study.

The Lancet Psychiatry. is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint

The copyright holder for this this version posted November 28, 2021. is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint

The copyright holder for this this version posted November 28, 2021. ; https://doi.org/10.1101 https://doi.org/10. /2021 is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint

The copyright holder for this this version posted November 28, 2021. ; https://doi.org/10.1101/2021.11.26.21266896 doi: medRxiv preprint . CC-BY-NC 4.0 International license It is made available under a perpetuity.

is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint

The copyright holder for this this version posted November 28, 2021. ; https://doi.org/10.1101 https://doi.org/10. /2021 

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We thank the participants of the study who contributed their time and further circulated the survey.Funding FK received funding from the European Union's Horizon 2020 [Grant number 754462]. SN received funding from the Cundill Centre for Child and Youth Depression at the Centre for Addiction and Mental Health, Toronto, Canada and the Wellcome Trust Institutional Strategic Support Fund from the University of Cambridge.

All authors declare no competing financial interests.

All data produced in the present study are available upon reasonable request to the authors.