key: cord-0976317-589aufwm authors: Taylor, S.; Rachor, G. S.; Asmundson, G. J. G. title: Who Develops Pandemic Fatigue? date: 2022-01-25 journal: nan DOI: 10.1101/2022.01.24.22269786 sha: 06e8b183313fc08b3a60451e6e00ebd2f925d2bb doc_id: 976317 cord_uid: 589aufwm According to the World Health Organization, pandemic fatigue poses a serious threat for managing COVID-19. The cardinal feature of pandemic fatigue is a progressive decline in adherence to social distancing (SDIS) guidelines, which is associated with pandemic-related emotional burnout. Little is known about the nature of pandemic fatigue; for example, it is unclear who is most likely to develop pandemic fatigue. We sought to evaluate this issue based on data from 5,812 American and Canadian adults recruited during the second year of the COVID-19 pandemic. Past-year decline in adherence to SDIS had a categorical latent structure according to Latent Class Analysis, consisting of an SDIS adherent group (Class 1: 92% of the sample) and a group reporting a progressive decline in adherence to SDIS (i.e., pandemic fatigue; Class 2: 8% of the sample). Class 2, compared to Class 1, was associated with greater pandemic-related burnout, pessimism, and apathy about the COVID-19 pandemic. They also tended to be younger, perceived themselves to be more affluent, tended to have greater levels of narcissism, entitlement, and gregariousness, and were more likely to report having been previously infected with SARSCOV2, which they regarded as an exaggerated threat. People in Class 2 also self-reported higher levels of pandemic-related stress, anxiety, and depression, and described making active efforts at coping with SDIS restrictions that they perceived as unnecessary and stressful. People in Class 1 generally reported that they engaged in SDIS for the benefit of themselves and their community, although 35% of this class also feared they would be publicly shamed if they did not comply with SDIS guidelines. The findings suggest that pandemic fatigue affects a substantial minority of people and even many SDIS-adherent people experience emotionally adverse effects (i.e., fear of being shamed). Implications for the future of SDIS are discussed. According to the World Health Organization (WHO), pandemic fatigue during the 42 current COVID-19 crisis is a global problem that "poses a serious threat to efforts to control the 43 spread of the virus" (p. 6) (1). The cardinal feature of pandemic fatigue is a progressive decline 44 in adherence to government guidelines for social distancing (SDIS), arising in the weeks or 45 months in which SDIS and other pandemic-mitigation restrictions are in place. The decline in 46 adherence is hypothesized to be associated with pandemic-related burnout (1), which involves 47 7 occurs in COVID-19 (18), which can reinforce beliefs that the COVID-19 threat is exaggerated, 107 thereby amplifying non-adherence. Accordingly, we assessed whether respondents believed 108 that they had acquired COVID-19. Belief that one had been infected, rather than objective 109 evidence of infection, is important because beliefs drive behaviors. Anxiety, depression, 110 stressors, and coping strategies were also assessed, as stressors and distress are thought to 111 exacerbate non-adherence to SDIS (1). People who are especially distressed may be most likely 112 to violate SDIS guidelines in pursuit of socially rewarding activities, such as attending social 113 gatherings. To investigate the relationship between pandemic fatigue and personality, broad 114 and narrow personality traits were assessed. Broad traits consisted of the Big 5 (i.e., 115 agreeableness, conscientiousness, negative emotionality, extraversion, and openness to 116 experience) (19). Adherence to SDIS requires that people put the well-being of the community 117 ahead of personal self-interests. Accordingly, people who score highly on personality traits such 118 as narcissism or self-entitlement might be most likely to be non-adherent to SDIS, particularly 119 when SDIS guidelines are personally inconvenient (e.g., refraining from socializing). 120 Narcissism and psychological entitlement are related but distinguishable constructs. 121 Entitlement refers to a stable and pervasive sense that one deserves more compared to other 122 people (34). Narcissism is a broader construct involving self-absorption, grandiosity, arrogance, 123 and a sense of entitlement (53). Thus, entitlement can be a component of narcissism but high 124 levels of entitlement can also occur in the absence of narcissism; that is, a person can feel 125 entitled to special treatment without necessarily having an inflated sense of self-worth. A sense 126 of relative deprivation is one way in a person might feel entitled without necessarily being 127 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 sample consisted of 5,812 adults (age ≥18 years) from the U.S. (n=2,964) and 132 Canada (n=2,848) who were recruited as part of the COVID Stress Study (20, 21), which is a 133 broad investigation into the psychology of COVID-19. The mean age of the sample was 49 years 134 (SD=17 years, range 18-92 years). About half the sample (52%) were employed full-or part-135 time, most (78%) had completed full or partial college, and 57% were female. Most (64%) were 136 White, with the remainder being Asian (13%), African American/Black (11%), Latino/Hispanic 137 (4%), or other (7%). A total of 4% of the sample reported that they were healthcare workers 138 and 7% stated that they had been diagnosed with COVID-19 by a healthcare worker. A third 139 (32%) of respondents reported that they had been partially or fully vaccinated against the novel 140 coronavirus at the time of the study, and 38% reported that they had a preexisting (pre-COVID-141 19) general medical condition. A total of 23% of respondents reported that they had a recent 142 (past year) history of a mental health problems, predominantly mood or anxiety symptoms, and 143 71% believed that COVID-19 had harmed their mental health. 144 The respondent's perceived socioeconomic status, in relation to people in one's 146 country, was assessed by a 10-point item from the MacArthur Scale of Subjective Social Status, 147 which has been shown to have good reliability and validity (22). Higher scores corresponded to 148 greater perceived socioeconomic status. Political conservatism was assessed with a face-valid 149 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. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. Past-year changes in adherence to SDIS were assessed by the 10-item face-valid SDIS 163 Scale, developed for the purpose of the present study. The items, listed in Table 2 , assessed 164 respondent's reports of whether their adherence to SDIS had increased, remained unchanged, 165 or decreased over the past year. For people who adhered to SDIS, their reasons for adherence 166 were assessed by an 8-item face-valid scale in which respondents rated their strength of 167 agreement with each item. The items appear in Table 3 . 168 169 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. Scales developed in our previous research (25) were administered to assess the 179 following: (a) current disregard for SDIS (as distinct from past-year changes in SDIS), (b) belief 180 that the dangerousness of COVID-19 is exaggerated, (c) belief that one has robust personal 181 health against infection, and (d) belief in COVID-19 related conspiracy theories. Items on these 182 measures were rated on a 5-point scale (0=strongly disagree, 4=strongly agree). These face-183 valid scales have good levels of reliability and validity (25) (see Table 1 ). 184 COVID-19 related stressors were assessed using a 22-item face-valid scale based on our 185 previous research (21) in which respondents rated the frequency (1=never, 5=often) of various 186 stressors experienced during COVID-19 (e.g., difficulty working from home, isolation, crowding 187 at home, difficulty caring for loved ones). Despite covering a range of different, commonly 188 occurring stressors during COVID-19 (21), the 22-item scale had excellent reliability (see Table 189 1). Coping with COVID-19-related stress was assessed with a 38-item, face valid scale (21) that 190 assessed the frequency of use (1=never, 5=very often) of a range of different coping strategies 191 (e.g., exercising, reading novels, talking with a trusted friend). The reliability of the scale was 192 excellent (see Table 1 ). 193 preference for natural immunity. The scale has good levels of reliability and validity (26, 27) 199 (see Table 1 ). Current non-adherence for wearing facemasks was assessed by a 3-item face-200 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 January 25, 2022. ; https://doi.org/10.1101/2022.01.24.22269786 doi: medRxiv preprint valid scale in which respondents were asked to rate the frequency in which they intentionally 201 refrained from wearing a mask in public places (e.g., in stores or on public transit). Items were 202 rated on a 1-6 scale (0=never, 6=more than once a day). 203 COVID-19-related burnout, apathy, blame, and pessimism were assessed using scales 204 developed for the present study. All had good reliability (see Table 1 ). These measures were 205 based on the short form of the Burnout Measure (28), which is a psychometrically sound 206 measure of burnout. In the COVID-19-related burnout scale, respondents were presented with 207 12 adjective statements (e.g., irritable, frustrated, emotionally exhausted) and were asked, 208 "When you think about COVID-19, how often do you feel the following?" Statements were 209 rated on a 5-point scale (1=never, 5=always). COVID-19-related apathy was measured by 7 210 statements, each rated on a 5-point scale (e.g., "Regardless of what we do, almost everyone 211 will get COVID-19"; 1=strongly disagree, 5=strongly agree). The same rating scale was used in 212 the COVID-19-related blame and pessimism scales. Blame was assessed by 8 items (e.g., 213 "People in my community are to blame for the spread of COVID-19"). COVID-19-related 214 pessimism was assessed in a similar manner with 16 items (e.g., "There is nothing I can do to 215 keep myself safe from COVID-19"). General anxiety and depression over the past week were 216 assessed, respectively, by the GAD-7 (29) and PHQ-9 (30). Both scales have good psychometric 217 properties (29, 30) (see Table 1 ). 218 A broad assessment of personality traits was conducted using the Ten Item Personality 219 Inventory (TIPI) (19). The TIPI is a 10-item measure of the Big 5 personality dimensions of 220 extraversion, agreeableness, conscientiousness, negative emotionality, and openness to 221 experience. Despite being a very brief measure, the TIPI has performed well on various indices 222 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 January 25, 2022. ; https://doi.org/10.1101/2022.01.24.22269786 doi: medRxiv preprint of reliability and validity (19, 31, 32). In the present study, the TIPI scales had acceptable-to-223 good levels of reliability (see Table 1 ). 224 Narcissism was measured using the 7-item scale from the Short Dark Tetrad (33), in 225 which respondents rated their strength of agreement on a 5-point scale (e.g., "I have some 226 exceptional qualities"; 1=strongly disagree, 5=strongly agree). This scale has good reliability and 227 validity (33) (see Table 1 ). Psychological entitlement was assessed using a 12-item version of 228 the Psychological Entitlement Scale (34), in which participants rated, on a 7-point scale, the 229 extent to which the respondent believed that he or she was entitled to special treatment in 230 various aspects of life (e.g., "I honestly feel I'm just more deserving than others"; 1=strongly 231 disagree, 7=strongly agree). Although entitlement is related to narcissism (r=0.44 in the present 232 study), the two constructs are distinguishable in that entitlement entails beliefs in deserving 233 special treatment without necessarily entailing, as in narcissism, an inflated sense of self-worth. 234 The scale has good reliability and validity (34) (see Table 1 ). 235 Sociability was assessed using the Sociability Scale (35), in which respondents rated their 236 agreement on five statements (e.g., "I find people more stimulating than anything else"; 237 1=strongly disagree, 5=strongly agree). The scale has sound psychometric properties (35) (see 238 Table 1 ). The tendency to feel lonely was measured using the Loneliness Scale (36) in which 239 items assessing loneliness (e.g., "How often do you feel left out?") are rated on a 3-point scale 240 (1=hardly ever, 3=often). The scale has good psychometric properties (36) (see Table 1 ). 241 Distrust in government for managing the COVID-19 pandemic was assessed using a 14-242 item face-valid measure developed for the purpose of the present study. For each item, 243 participants rated their agreement on a 5-point scale for statements such as "My government 244 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 January 25, 2022. ; https://doi.org/10.1101/2022.01.24.22269786 doi: medRxiv preprint has allowed its citizens to be financially ruined by the pandemic" (1=strongly disagree, 245 5=strongly agree). The reliability of the scale was excellent (see Table 1 ). 246 Data were collected from March 24 to May 4, 2021, at which time social distancing 248 restrictions were implemented throughout the U.S. and Canada. The sample was obtained 249 using an internet-based self-report survey delivered in English by Qualtrics, a commercial 250 survey sampling and administration company. Qualtrics solicited the present sample, for which 251 no data have yet been reported on or published, as part of our ongoing research program (20, 252 21, 37). Qualtrics maintains a pool of potential participants who have agreed to be contacted in 253 order to respond to surveys. Qualtrics selected and contacted participants to meet sampling 254 quotas to approximate general population demographics, based on age, gender, ethnicity, 255 socioeconomic status, and geographic region within each country. The demographic 256 composition of the sample approximated census-derived data of U.S. and Canadian adults (i.e., 257 excluding children and adolescents), where, for example, the mean age averaged across 258 countries is 50 years and 67% white. The sample departed from census data in that females 259 were over-represented (57%) as compared to census data (51%). However, gender was not 260 substantively associated with any of the variables in this study; that is, effect sizes for gender 261 were smaller than what is conventionally regarded as "small" effect sizes (see below). 262 All respondents provided informed consent prior to completing the survey. The research 263 described in this article was approved by the Research Ethics Board of the University of Regina 264 (REB# 2020-043). Filters were used to eliminate data from careless responders. Embedded in 265 the assessment battery were four attention-check items (e.g., "This is an attention check, 266 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 January 25, 2022. ; https://doi.org/10.1101/2022.01.24.22269786 doi: medRxiv preprint please select Strongly Agree"; "For our research, it is really important that you paid attention 267 while responding to our survey. How attentive were you when responding?": "Very Inattentive" 268 to "Very Attentive"). Participants were included only if they provided correct responses to three 269 or more of the four attention checks (e.g., "Strongly agree" or "Very attentive"), indicating that 270 they were sufficiently attentive. In addition, at the end of the assessment battery, participants 271 were asked to indicate whether, in their honest opinion, their data should be used. Those who 272 responded "no" were excluded from data analysis, regardless of their score on the attention-273 check items. 274 Exploratory factor analysis using robust Maximum-Likelihood and Parallel Analysis were 276 used to determine the number of factors of the SDIS scale. This was followed by Latent Class 277 Analyses, also using robust Maximum-Likelihood, to determine whether the factor was 278 dimensional or categorical in nature. Analyses were conducted using SPSS 27.0 and Mplus (38). 279 In the Latent Class Analyses, models consisting of increasing numbers of classes were evaluated 280 (e.g., 1 vs 2 classes, 2 vs 3 classes) until the best-fitting model was identified, as determined by 281 four goodness-of-fit indices: Akaike Information Criterion, Bayesian Information Criterion, 282 sample-size adjusted Bayesian Information Criterion, and the Bootstrap Likelihood Ratio Test. 283 For the first three fit indices, the best-fitting model has the lowest value on these indices. For 284 the Bootstrap Likelihood Ratio Test, the best fitting model is a model consisting of N classes, 285 which has a significantly better (p<0.01) fit than a model consisting of N−1 classes, and is not 286 significantly different from a model consisting of N+1 classes. The resulting number of classes 287 were then compared on a range of affective and other variables. 288 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 January 25, 2022. ; https://doi.org/10.1101/2022.01.24.22269786 doi: medRxiv preprint Given the number of analyses reported in this article, the α level was set at 0.01 instead 289 of 0.05. This adjustment corrects for inflated Type I error without unduly inflating Type II error 290 with a more stringent correction, such as a Bonferroni correction. Given the large sample size, 291 substantively trivial effect sizes would be statistically significant (e. g., for r=0.05, p<.001) . Table 2 , indicating that all loadings were salient (>0.30). 307 The SDIS scale, representing the sum of the 10 SDIS items, had a high internal consistency 308 (Table 1 ). The total score was used as the input variable for the Latent Class Analyses. The 309 results, shown in Table 4 , indicated that the best fitting model consisted of two classes; Class 1 310 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. Table 5 shows the comparisons between classes on a range of personality, affective, and 319 COVID-19-related variables. Statistical power to detect small effect sizes at α=0.01 was 0.95 for 320 these analyses. Accordingly, the study was sufficiently powered to detect even small 321 differences between classes. To facilitate the interpretation of the results, a Discriminant 322 Function Analysis was conducted to determine which variables best distinguished the two 323 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 January 25, 2022. ; https://doi.org/10.1101/2022.01.24.22269786 doi: medRxiv preprint 21 classes. Input variables for this analysis were those having small, medium, or large effects in 324 Table 5 shows that people in Class 2, compared to Class 1, reported a greater 327 current disregard for SDIS. In other words, for Class 2 there was a progressive past-year 328 deterioration in SDIS as well as a current low level of adherence. 329 People in Class 2, compared to those in Class 1, tended to be younger and perceived 330 themselves as being more affluent (Table 5 ). There were more Americans in Class 2 (77%) than 331 in Class 1 (49%); that is, more Americans than Canadians tended to be non-adherent to SDIS. 332 People in Class 2 were more likely to believe that the COVID-19 threat was a hoax or 333 exaggerated, even though these individuals were more likely to have reportedly contracted the 334 SARSCOV2 virus. The latter finding is consistent with reports that SARSCOV2 often produces 335 mild illness, particularly among young and healthy individuals (18). People in Class 2 reported 336 greater stressors related to COVID-19 and also reported greater efforts at attempting to cope 337 with those stressors. 338 339 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. Pandemic fatigue: Reinvigorating the public to prevent COVID-19 The psychology of pandemics: Lessons learned for the future The Canadian politicians who travelled over the holidays during a 457 coronavirus pandemic The psychology of pandemics: Preparing for the next global outbreak of 460 infectious disease Change in reported adherence to 462 nonpharmaceutical interventions during the COVID-19 pandemic A worldwide 465 assessment of changes in adherence to COVID-19 protective behaviours and 466 hypothesized pandemic fatigue A historical assessment of 468 nonpharmaceutical disease containment strategies employed by selected U.S. 469 communities during the second wave of the 1918-1920 influenza pandemic. Ann Arbor, 470 MI: Defense Threat Reduction Agency Don't open!" is drastic command Quebec couple hit with curfew-violation fine after wife walks husband 474 on a leash Protesters gather in downtown Vancouver for rally against COVID-19 Factors associated with 482 adherence to self-isolation and lockdown measures in the UK: A cross-sectional survey Pandemic fatigue: The effects of the COVID-19 crisis on public trust 485 and compliance with regulations in Israel Mask 487 use, risk-mitigation behaviours and pandemic fatigue during the COVID-19 pandemic in 488 five cities in Australia, the UK and USA: A cross-sectional survey How does age affect personal and social reactions to COVID-19: 491 Results from the national Understanding America Study 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 COVID-19 mitigation 494 behaviors by age group-United States Non-compliance 497 with COVID-19-related public health measures among young adults in Switzerland: 498 Insights from a longitudinal cohort study A very brief measure of the Big-Five personality 507 domains Development 509 and initial validation of the COVID Stress Scales Covid stress 512 syndrome: Concept, structure, and correlates 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 The MacArthur Scale of Subjective Social Status Test theory: A unified approach Thanks coefficient alpha, we'll take it from here Worry, avoidance, and 520 coping during the COVID-19 pandemic: A comprehensive network analysis Understanding the dimensions of anti-vaccination attitudes: The 523 vaccination attitudes examination (VAX) scale A 526 proactive approach for managing COVID-19: The importance of understanding the 527 motivational roots of vaccination hesitancy for SARS-CoV2 A brief measure for assessing generalized 532 anxiety disorder: The GAD-7 The PHQ-9: Validity of a brief depression severity 534 measure 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 Testing 539 the latent factor structure and construct validity of the Ten-Item Personality Inventory Screening for dark personalities: The Short Dark Tetrad (SD4) Psychological entitlement: 545 Interpersonal consequences and validation of a self-report measure Shyness and sociability A short scale for measuring loneliness in 550 large surveys: Results from two population-based studies Negative attitudes about facemasks during the COVID-19 553 pandemic: The dual importance of perceived ineffectiveness and psychological 554 reactance Mplus users guide Statistical power analyses for the behavioral sciences Call them COVIDiots: Exploring the effects of aggressive 559 communication style and psychological distance in the communication of COVID-19 Is shame necessary? New uses for an old tool Clinician's guide to PTSD Development of reliable and valid short forms of the Marlowe-Crowne Farmer R, Sundberg ND. Boredom proneness-The development and correlates of a 566 new scale Does a narcissism epidemic exist in modern Western 569 societies? Comparing narcissism and self-esteem in East and West Germany Overcoming pandemic fatigue: How to 572 reenergize organizations for the long run 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 What doctors wish patients knew about pandemic fatigue NavIgating pandemic fatigue as a working parent Great Barrington declaration Fauci attacks herd immunity declaration embraced by White House as "total 585 nonsense Revealed: The inside story 589 of the UK's Covid-19 crisis. The Guardian Entitlement is about "others", narcissism is not: Relations to 593 sociotropic and autonomous interpersonal styles The authors thank Michelle M. Paluszek and Caeleigh A. Landry for their assistance in this study. 447 448 449 450 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 January 25, 2022. ; https://doi.org/10.1101/2022.01.24.22269786 doi: medRxiv preprint Pandemic fatigue is an important problem for managing (1) and likely to be a 345 salient obstacle in mitigating future pandemics. The present study, conducted during the 346 second year of the COVID-19 pandemic, found that past-year decline in adherence to SDIS had 347 a categorical latent structure, consisting of an SDIS adherent group (Class 1: 92% of the sample) 348 and a group reporting a progressive decline in adherence to SDIS (Class 2: 8% of the sample). 349Class 2 had features indicative of pandemic fatigue; specifically, in addition to reporting a 350 decline in adherence to SDIS, this group had various features consistent with pandemic-related 351 burnout. Compared to Class 1, Class 2 had greater levels of emotional burnout, pessimism, 352 apathy, and cynical or negative beliefs about the COVID-19 pandemic (e.g., believing COVID-19 353 to be a hoax). The present study confirmed previous findings that pandemic fatigue is 354 associated with the perception that lockdown is unnecessary and ineffective (11), younger age 355 (12-15), greater perceived personal affluence (16), and lower trust in government (16). People 356 in Class 2, compared to Class 1, tended to be more narcissistic, entitled, and gregarious, and 357were more likely to report having been infected with SARSCOV2, which they regarded as an 358 exaggerated threat. In other words, pandemic fatigue was associated with heightened self-359interest to the expense of community needs. 360People in Class 2 also reported higher levels of pandemic-related stress, anxiety, and 361 depression, and described making active efforts at coping with SDIS restrictions that they 362 perceived as unnecessary and stressful. People in Class 1 generally reported that they engaged 363 in SDIS for the benefit of themselves and their community, although 35% also feared they 364 would be publicly shamed if they did not comply with SDIS guidelines. The findings suggest that 365 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 present study had various strengths and limitations. In terms of strengths, the 383 sample size was large, robust statistical methods were used, and the assessment period was 384 timely, given that pandemic-related restrictions had been in place for over a year. Regarding 385 limitations, the assessment of SDIS was retrospective, based on self-report, and the 386 generalizability of the results across different demographic and geographic groups remains to 387 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 January 25, 2022. ; https://doi.org/10.1101/2022.01.24.22269786 doi: medRxiv preprint 28 be investigated. Retrospective and prospective assessments each have their strengths and 388 limitations, and ideally both would be conducted; but, this was not possible for logistic reasons. 389 Research suggests that behavioral and self-report measures of SDIS produce broadly similar 390 results (6). 391Participants were asked to report on their socially undesirable behaviors (i.e., non-392 adherence to SDIS) and the question arises as to whether the results were affected by a social 393 desirability bias; that is, the tendency to give socially desirable answers to the assessment 394 battery. It might be argued that Class 2 simply represents a group of people who are more 395 willing to admit to socially undesirable attitudes or acts, such as non-adherence to SDIS. This 396 explanation is unlikely for two reasons. First, responding was anonymous. Second, our previous 397 COVID-19 research found that social desirability was unrelated to a range of behavioral, Whether the results of the present study generalize to more protracted, highly 407 restrictive SDIS programs, such as stay-at-home mandates imposed over extended periods of 408 time, remains to be investigated. Under such conditions, the structure of pandemic fatigue, as 409 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 January 25, 2022. ; https://doi.org/10.1101/2022.01.24.22269786 doi: medRxiv preprint 29 identified in the present study, may be altered. Non-adherence (as in Class 2) is likely to be 410 found under conditions of more severe lockdowns, unless there are efforts to offset the 411 problem. Pandemic fatigue may also start to appear in people who have been generally 412 adherent (as in Class 1). Future research is also needed to investigate potentially relevant 413 variables that were not examined in the present study. For example, boredom proneness is a 414 trait characterized by the tendency to readily become bored in a wide range of situations (44). 415This trait was associated with non-adherence to SDIS early in the COVID-19 pandemic and may 416 play a role in pandemic fatigue (45). 417Finally, additional research is needed to identify strategies for easing the mental health 418 burden imposed by SDIS. Several studies have found that SDIS harms mental health, with 419 protracted SDIS being correlated with substantial increases in anxiety, depression, substance 420 abuse, and other psychological problems (2). Humans are inherently social creatures, and SDIS 421 involves thwarting this natural urge to socialize. Moreover, research suggests that narcissism (a 422 feature of Class 2 in the present study) is becoming more prevalent in Western societies, likely 423 due to a range of sociocultural factors (46). This raises concerns about the future of pandemic 424 mitigation methods such as SDIS, which require people to work for the collective good rather 425 than focusing on individuals needs or desires. 426The WHO described a number of methods intended to reinvigorate people to follow 427 SDIS guidelines (see refs. 1 and 47-49) . The efficacy of such methods remains to be established. 428Encouraging or "nudging" people to follow the guidelines may have greater impact on people 429 who are already amendable to following SDIS guidelines (i.e., Class 1). For people who are 430 narcissistic and distressed, and who see the pandemic restrictions as unnecessary, nudges may 431 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. advocates that only the elderly and medically compromised should be subject to stay-at-home 436 orders during COVID-19 (50). This proposal has been widely criticized as discriminatory and 437 likely to result in greater morbidity and mortality than existing SDIS measures (51, 52). During 438 COVID-19, communities experimented with alternatives such as short-term "circuit breaker" 439 lockdowns, in which lockdown and sometimes curfews were imposed for short periods (e.g., 440two weeks) to attempt to disrupt the spread of infection. The tolerability and efficacy of this 441 and other alternative methods of SDIS that may have less of an impact on mental health remain 442 to be investigated. 443 444 445 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 January 25, 2022. ; https://doi.org/10.1101/2022.01.24.22269786 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 January 25, 2022. ; https://doi.org/10.1101/2022.01.24.22269786 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 January 25, 2022. ; https://doi.org/10.1101/2022.01.24.22269786 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 January 25, 2022. ; https://doi.org/10.1101/2022.01.24.22269786 doi: medRxiv preprint