Internalising and Externalising Symptoms Before and During the Initial COVID-19 Lockdown in the UK and Turkey: A Cross-cultural Examination

Background: The COVID-19 pandemic has had a profound effect on the mental health and wellbeing of children and young people. Culture can inuence emotional and behavioural responses to the pandemic and its consequences, but research is primarily focused on single country experiences. The study examined differences in caregiver worry of infection and experience with the connement during the initial lockdown and their impact on children’s internalising and externalising symptoms across two culturally different countries which were severely affected by the pandemic: UK and Turkey. Method: Participants were 1849 caregivers with children between 5 and 12 years old in the UK (n= 995) and Turkey (n = 854) who completed a 20 -min electronic survey on child and family wellbeing distributed via social networks during the initial phase of the COVID-19 lockdown (July and August 2020). Findings: Worry of infection was higher amongst caregivers in the Turkish sample and it independently predicted change in children’s internalising symptoms in the Turkish sample only. Caregivers in the Turkish sample reported more diculty with family coexistence during the lockdown, but regressions analysis showed that diculty with coexistence independently predicted change in children’s externalising and internalising symptoms before and during the lockdown in both samples. The study revealed cross-cultural differences in the predictors of change in children’s internalising and externalising symptoms before and during the initial national COVID-19 lockdown. 17% of the variance in the UK and Turkish sample, respectively, even after controlling for the effects of sociodemographic and infection risk, caregiver mental health and parenting stress. Higher parenting-related stress was a signicant predictor only in the UK sample. In the fourth step, more family coexistence diculty predicted more change in internalising symptoms across both samples even after controlling for sociodemographic variables, child and caregiver mental health, and parenting stress. Higher worry of infection was a signicant predictor only in the Turkish sample, even after controlling for the effects of perceived infection risk. The nal model explained 23% and 11% of the variance in the UK and Turkish sample, respectively. Feinberg et al., 2021). The children in the UK sample were overall slightly more impacted as their externalising mean score was somewhat higher, and more caregivers in the UK than in Turkey reported change across all externalising symptoms. Previous research on the prevalence of childhood mental health problems across countries in Europe found that behaviour problems were less likely to be reported in Turkey (Husky et al., 2018; Kovess-Masfety, 2016). Hence, the differences may reect genuine prevalence rates. Nevertheless, the range of the percentage of parents reporting change in how much children were irritable, argumentative, and angry was reecting approximately one in two caregivers across both samples. This nding shows that the behaviours that were a major cause of concern for caregivers during the lockdown across both cultures were the same and suggest that culture did not inuence the type of challenging behaviour caregivers had to grapple with during the lockdown. Although, frustration as an emotional response to the lockdown has been reported often in western and non-western samples (Fernandez Ruiz, 2021; Tiwari et al., 2021) the proportion of caregivers who reported frustration in the UK sample was double the proportion of Turkish caregivers. The difference could reect differences in the conceptual understanding of the term ‘frustration’, but further research is required to verify this assumption.


Introduction
The outbreak of COVID-19 saw a worldwide implementation of erce social distancing measures including national lockdown and self-isolation. The United Kingdom (UK) and Turkey were amongst the most seriously affected countries worldwide (Worldometer Statistics, 2020). The COVID-19 lockdown has had an unprecedented impact on the psychological wellbeing of children and young people in both countries (Adıbelli & Sümen, 2020;Creswell et al., 2021;Panchal et al., 2021). Because different countries reacted differently to the lockdown, cross-country generalisations about its impact should be avoided and more research on country-speci c factors that may have in uenced its effect is required to fully understand it (Fernandez Ruiz, 2021;Maaravi et al., 2021;San et al., 2021). Cultural factors can shape emotional and behavioural reactions to the consequences of the pandemic (Burkova et al., 2021). Western European cultures are known to promote individualist values of independence and self-reliance whereas the collectivist values of interdependence, compliance, and inhibition dominate in non-Western European cultures (Green et al., 2005). Children are in uenced by families which are nested within wider sociocultural systems of in uence (Prime et al., 2020). The cross-cultural examination of emotional reactions to the lockdown within the family context can help understand better child wellbeing and family life during the lockdown and reveal determinants of child and family wellbeing that are context speci c. Compared with the UK culture, which is more individualistic, the Turkish culture is relatively collectivist (Hofstede et al., 2005). The two countries offer a natural experiment to examine cultural variability in caregiver response to the COVID-19 pandemic and coping with the lockdown and their impact on child psychological adjustment during and before the lockdown.
Worry of COVID-19 infection was a pandemic related challenge which while it encouraged adoption of preventive measures in some countries (Harper et al., 2020;Yıldırım et al., 2021), it was also found to be associated with psychological distress (Fitzpatrick et al., 2020;Kayis et al., 2021;Satici et al., 2020a).
Previous research demonstrated that intolerance of uncertainty interferes with how humans appreciate the impact of an imminent threat including illness related threat (Taha et al., 2014). Threatening conditions induce worry which may lead to psychological stress (Nabi & Myrick, 2019;Witte & Allen, 2000). Additionally, there is a tendency for collectivism to be associated with less tolerance to uncertainty (Hofstede et al., 2005). Therefore, it is plausible that Turkish caregivers are at a higher risk of worry of infection compared to caregivers in less collectivist contexts. Findings from two surveys carried out in Turkey link worry of COVID-19 with worry of uncertainty (Satici et al., 2020b;Pak et al., 2021). Additionally, a large survey of 15-25-year-olds found that worry of infection was higher in Turkey compared to migrant and non-migrant Austrians (Akkaya-Kalayci et al., 2020). However, to our best of our knowledge we are not aware of studies which have compared worry of infection in caregivers and its impact on children's emotions and behaviour across cultures.
Families in several European countries (Italy, Spain, and Belgium;Orgilés et al., 2020;Stassart et al., 2021) and the UK (Morgül et al., 2020) struggled to cope with the co-existence imposed by the con nement. In the UK, the families who struggled most were more likely to report that their children's behaviour and emotional state had changed for the worse since the lockdown had started (Morgül et al., 2020). Currently, we do not have research on how caregivers in collectivist contexts coped with the prolonged coexistence that was brough upon them and whether they differed in their response from caregivers in individualist societies.

The present study
To understand better cultural in uences on the impact of the COVID-19 pandemic and the lockdown on children's psychological outcomes we compared caregiver worry of infection and family co-existence di culty between UK and Turkey and examined their effect on children's emotional states and behaviour.

Participants and Procedures
Participant characteristics are presented in Table 1. A total of 1849 caregivers between 18 to 61 years old participated in the present study of which 995 were living in the UK (M age = 39.16 years, SD = 5.62) and 854 in Turkey (M age = 38.25 years, SD = 4.73). In the UK sample, caregivers were mostly of White ethnic background (91.9%), and in the Turkish sample of Turkish ethnic background (90.4%). Across both samples most caregivers were married (n UK =738, 74.2%; n TR =811, 95.0%), in employment (n UK =724, 72.8%; n TR =496, 58.1%), and had at least a university degree (n UK =760, 76.4%; n TR =665, 77.9%). Children were (n boysUK = 546, 54.9%; n boysTR = 423, 49.5%) between 5 to 12 years old (M ageUK = 7.48 years; SD =2.05; M ageTR = 7.86 years, SD=2.24). In the Turkish sample, most children were attending independent schools (49.1%) whereas in the UK sample the majority was attending state schools (89.5%). Using snow-ball sampling, caregivers in the UK and Turkey were invited to complete a 20 -min electronic survey on child and family wellbeing distributed via social networks (e.g., Facebook, Instagram), e-mail, and messaging groups (e.g., Whatsapp) between the 14th of July 2020 and the 14th of August 2020. Survey development details can be found in Morgül et. al, (2020). The study was approved by the University of Roehampton Research Ethics Committee (PSYC 20/ 367).

Measures
Caregiver worry of infection and family coexistence di culty: A total infection worry score was calculated by adding all four items (range: 4 -20). Internal reliability of the total infection worry scores for each sample was good (Cronbach's α = .87 UK ; .91 TR ). Caregivers indicated how di cult co-existence was on a 5-point rating scale (1=very easy -5=very di cult). Caregivers answered four questions about worry of getting infected (e.g., Have you ever worried about being infected with COVID-19 during the recent coronavirus outbreak period?) using a ve-point rating scale (1 = never thought about it -5 = worried about it all the time).
Change in the child emotional state (internalising symptoms) and behaviour (externalising symptoms) before and during the lockdown: Caregivers indicate how much they thought their children's emotional state and behaviour changed during the lockdown by rating 23 emotional and behavioural symptom items on a ve-point scale (1 = much less compared to before quarantine; 2 = somewhat less compared to before quarantine; 3 = stayed the same; 4 = somewhat more compared to before quarantine; 5 = much more compared to before quarantine) (Morgül et al., 2020).
We used exploratory (EFA) and con rmatory factor analyses (CFA) in line with Worthington and Whittaker (2006) to create a total internalising and externalising score, to assess children's total emotional and behaviour change. Each sample was randomly divided into two equal sub-samples. For each sample, we tested the factor structure on the rst sub-sample using EFA and then replicated the structure in the second sub-sample using CFA (n EFA_UK = 507, n EFA_TR = 438; n CFA_UK = 488, n CFA_TR = 416). EFA was conducted using a principal axis factoring analysis on the rst sub-sample to investigate the underlying factor structure of the 23 items. In both countries, the Kaiser-Meyer-Olkin (KMO UK = .93; KMO TR = .93) measure of sampling adequacy was above the commonly recommended value of .60 and the Bartlett's test of sphericity was signi cant suggesting that the sample were appropriate for the factor analysis (Henson and Roberts, 2006). Preliminary correlation analysis showed that majority of the correlation coe cients of the items My child has no appetite, My child eats a lot, and My child is quiet were lower than the suggested minimum level of .30 (Table 2a & Table 2b) (Tabachnick & Fidell, 2007). Therefore, these three items were not used further in the analysis. The remaining 20 items were subjected to oblique promax rotation, since the factors were assumed to be correlated (Costello & Osborne, 2005). The items having factor loadings greater than .32 were retained in the factor structure (Tabachnick & Fidell, 2007;Worthington & Whittaker, 2006). Item communalities were above the accepted value of .40 (range: .45 to .85) (Osborne et al., 2008). The number of retained factors was based the Kaiser's criterion (eigenvalues > 1.0) and inspection of the Cattell's scree test (Tabachnick & Fidell, 2007). The EFA revealed 11 items with high loadings across both factors (range: .52 -.98) and samples explaining 69.2% and 68.6% of the total variance, in the UK and Turkey, respectively (Table 3). The high factor loadings, communalities, and sample size corroborate the robustness of the EFA (Osborne & Costello, 2004).
CFA was conducted on the second sub-sample to identify the t between our model based on the EFA results and the data of our second sub-sample. Various indices were used as standard measures of t in CFA including the root mean squared error approximation (RMSEA), minimum discrepancy per degree of freedom (CMIN/DF), goodness-of-t index (GFI), adjusted goodness-of-t index (AGFI), normed t index (NFI), the Tucker-Lewis Index (TLI) and comparative t index (CFI). In general, threshold values of RMSEA less than .05 suggest "good" t (Browne & Cudeck, 1992), values between .05 and .10 suggest "acceptable" t (Browne & Cudeck, 1992;MacCallum et al., 1996), and values larger than .10 suggest "bad" t (Browne & Cudeck, 1992). CMIN/DF < 3 indicates an "acceptable" t between hypothetical model and sample data (Kline, 2015) and CMIN/DF<5 indicating a "reasonable" t (Marsh & Hocevar, 1985). GFI, AGFI, NFI, TLI and CFI > .9 indicate "good" levels of t between data and model with more liberal criteria of .85 < GFI, NFI < .9 and .8 < AGFI < .9 indicating an acceptable model (Bentler, 1990;Cole, 1987;Marsh et al., 1988). In the CFA, a two-factor model based on data from 11 items showed an acceptable model t in both countries ( According to broadband dimensions of internalising and externalising di culties in children and young people (Achenbach et al., 2016), items loaded in Factor 1 re ected externalising symptoms and items in Factor 2 re ected internalising symptoms (Table 2). Therefore, they were summed up to create a total change score in internalising (Cronbach's α =.88 UK ; .90 TR ) and externalising symptoms (Cronbach's α =.92 UK ; .89 TR ) before and during the lockdown. To examine the proportion of children whose emotions and behaviours changed, a categorical variable was created based on the child's score (no change score = 1-3; change = score 4 -5).

Covariates
Sociodemographic Information and Perceived COVID-19 Infection Risk: The rst part of the survey included children's and families' sociodemographic characteristics (e.g., participant age, marital status, education level, ethnicity and child age, gender, school type, and questions about housing conditions (e.g., outdoor access, number of rooms and number of people living-in at home during quarantine). Finally, caregivers indicated their COVID-19 risk status on a single multiple-choice question of four options (1= low risk: I do not know anyone who belongs to a risk group or There are friends/family being at-risk group, but not living with them; 2 = high risk: I belong to an at -risk group or People belonging to an at -risk group live with me).
Child Behavioural and Emotional Di culties: Caregivers completed the 25-item Strengths and Di culties Questionnaire (SDQ) (Goodman, 2001). It comprises ve subscales (emotional symptoms, conduct problems, hyperactivity, peer problems, and pro-social behaviour) of ve items each rated on three-point scale (0 = not true -2 = certainly true). A total di culty score (range: 0-40) is generated by adding all the subscales, except for the pro-social behaviour scale. Internal reliability of the total scores for each sample was good (Cronbach's α =.87 UK; .78 TR ).
Caregiver Mental Health: Caregivers completed the 21-item Depression, Anxiety, and Stress Scale (DASS-21; Lovibond & Lovibond, 1995). It includes three 7item subscales to measure the emotional states of depression, anxiety, and stress, respectively, on a 4-point scale (0 = did not apply to me at all -3 = applied to me very much, or most of the time). The scores on each subscale range from 0 to 21. Total score was calculated by adding the scores on the items per subscale (i.e., depression, anxiety, and stress). High levels of internal consistency reliability were detected in both samples (Cronbach's α =.94 UK ; .94 TR ).

Translation of Instruments
The Turkish versions of the SDQ and DASS-21 are publicly available at https://www.sdqinfo.org/py/sdqinfo/b0.py and https://toad.halileksi.net/olcek/depresyon-anksiyete-stres-21-olcegi, respectively. The remaining instruments were translated into Turkish from the original language (English) by the rst author who is a native Turkish speaker and uent in English, and they were checked for accuracy in meaning and cultural sensitivity by a translator who is a native English speaker and uent in Turkish. Discrepancies were discussed and resolved by joint agreement of both translators.

Data Analysis
Statistical analyses were performed using the IBM SPSS 26 (Statistical Package for the Social Sciences) and AMOS 18 (Analysis of Moment Structures). Because of some item-level missing data in the PCEBQ (≤5% of values were missing across 23 items), multiple imputation was performed using the Markov Chain Monte Carlo procedure in SPSS (Graham, 2012). Imputation of missing values was only done for variables in the PCEBQ. A preliminary screening of the data revealed no issues with multicollinearity, outliers, and normality (Tabachnick & Fidell, 2007). No collinearity was detected via variance in ation factor (VIF < 5) (Becker et al., 2015). The outliers were tested, and no extreme values were identi ed, thereby no case was removed from the sample. To check for the assumptions of normality, skewness and kurtosis values were calculated for each of the variables of interest. Except for the kurtosis and skewness value of outdoor access, which is considered acceptable according to Hair et al. (2010) and Byrne (2010), none of the variables presented extreme skewness and kurtosis values falling outside the proposed threshold of ±2, suggesting a normal distribution for the variables of interest (George & Mallery, 2010).
To compare variables across samples we used one-way analysis of variance (ANOVA) and independent groups t-tests for continuous variables, and Chisquared tests for categorical variables. Differences were considered statistically signi cant at p < .05. Pearson correlations were calculated to analyse the relationship between the study variables. Hierarchical multiple regression analyses were used to identify the psychosocial predictors of immediate changes in children's externalising and internalising symptoms during the lockdown across both samples.

Between-country Differences in Participant Characteristics
Differences are presented in Table 1. Compared to the caregivers in the Turkish sample, caregivers in the UK sample were older, and more likely to have a job, be lone/never married, belong to a small household (1-2 members), and live in houses with fewer rooms. No signi cant differences were found in level of education. Compared to children in the Turkish sample, children in the UK sample were older, more likely to be boys, and attend state schools. Children in the UK sample were more likely to experience behaviour and emotional di culties than children in the Turkish sample. Additionally, caregivers in the UK sample reported more stress related to their parenting role. Caregivers in the Turkish sample were more likely to belong to a high-risk group for COVID-19 infection and worry about getting infected, but less likely to have trouble with co-existence than caregivers in the UK sample. The proportion of caregivers who were married and had a higher education in the study samples was higher than in the national population. The Turkish sample had a higher proportion of caregivers in employment and whose children attended private schools than the national population.
Nearly one in two caregivers across both samples (range: 40% -57%) reported signi cant change in children internalising behaviours. Nonetheless, there were no signi cant differences across countries in the overall level of internalising behaviour change, except for children in the UK sample being more restless, and children in the Turkish sample being more anxious than before the quarantine (Table 4). Although caregivers in UK were overall slightly more likely than caregivers in Turkey to report change in children's externalising behaviour, around one in two caregivers across both samples (range: 48% -57%) reported that their children were more argumentative, angry, and irritable than before the quarantine ( Table 4).

Predictors of Perceived Change in Children's Internalising and Externalising Symptoms Before and During the Lockdown by Country
The analysis showed signi cant and consistent correlates of psychological change across both samples with the following variables (Table 5). Increased change in internalising and externalising behaviour was associated with increased levels of family co-existence di culty (Int: r UK = .40, r TR = .24; Ext: r UK = .44, r TR = .30), child emotional and behavioural di culties (Int: r UK = .41; r TR = .26; Ext: r UK = .46, r TR = .31), caregiver mental health (Int: r UK = .25; r TR = .19; Ext: r UK = .36, r TR = .23) and parenting stress (Int: r UK = .26, r TR = .12; Ext: r UK = .35, r TR = .25).
The analysis showed signi cant but weak correlates of change in chil internalising and externalising behaviour which were country speci c. In the UK sample, more change in both internalising and externalising behaviour was associated with no higher education (r Int = -.12; r Ext =.10) and ethnic minority background (r Int = .07; r Ext = .09). Additionally, externalising behaviour was associated with caregiver lone/never married (r UK = -.07) and caregiver young age (r UK = -.07). In the Turkish sample, more change in both internalising and externalising behaviour was associated with older age in children (r Int = .10), more change in internalising behaviour was associated with higher infection worry (r TR = .10), and more change in externalising behaviour with lack of outdoor access (r TR = -.07).
To identify the impact of coexistence and worry of infection on children's internalising and externalising behaviour during the lockdown two hierarchical multiple regressions were conducted for each sample. Variables were included in the regressions if they were signi cantly associated (Table 5) with either type of symptom change in either country. Because employment status, child gender, household number of rooms and members were not signi cantly associated with either type of symptom in any country, they were not included in the regressions. We entered the sociodemographic variables in the rst step, caregiver mental health and parenting stress variables in the second step, child emotional and behavioural di culties in the third step, and caregiver response to COVID-19 pandemic variables in the fourth step. Table 6 presents the results of the contribution of worry of infection and coexistence di culty to children's internalising behaviour change score before and during the lockdown across the two samples. Sociodemographic variables including infection risk (Step 1) explained a very small proportion of the variance (UK: 2.0%; TR: 2.0%) across both samples. Caregiver mental health (Step 2) explained 10% and 6% of the variance in the UK and Turkish sample, respectively, even after controlling for the effects of sociodemographic variables and infection risk. Child behavioural and emotional di culties (Step 3) explained 17% and 7% of the variance in the UK and Turkish sample, respectively, even after controlling for the effects of sociodemographic variables and infection risk, caregiver mental health and parenting stress. Higher parenting-related stress was a signi cant predictor only in the UK sample. In the fourth step, more family coexistence di culty predicted more change in internalising symptoms across both samples even after controlling for sociodemographic variables, child and caregiver mental health, and parenting stress. Higher worry of infection was a signi cant predictor only in the Turkish sample, even after controlling for the effects of perceived infection risk. The nal model explained 23% and 11% of the variance in the UK and Turkish sample, respectively. Table 7 presents the contribution of worry of infection and family coexistence in children's externalising behaviour change score across the two samples. Sociodemographic variables (Step 1) explained a small proportion (2%) of the variance in the UK sample, whereas it did not signi cantly contribute to the TR sample. In the second step, higher caregiver mental health and parenting stress signi cantly predicted more change in children's externalising symptoms across both samples and explained 16% and 8% of the variance in the UK and Turkish sample, respectively, even after controlling for the effects of sociodemographic variables. In the third step, higher child social and emotional di culties signi cantly predicted more change in children's externalising symptoms across both samples and explained 23% and 12% of the variance in the UK and Turkish sample, respectively, even after controlling for the effects of sociodemographic variables, caregiver mental health and parenting stress. In the fourth step, more family co-existence di culty predicted more change across both samples even after controlling for sociodemographic variables, child and caregiver mental health, and parenting stress. The nal model explained 29% and 16% of the variance in the UK and Turkish sample, respectively.

Discussion
Nearly half of the parents across both samples reported that the children's internalising and externalising behaviour changed signi cantly during the lockdown. This nding is in line with international literature which showed that children's mental health and wellbeing got signi cantly worse during the lockdown (Christner et al., 2021;Feinberg et al., 2021). The children in the UK sample were overall slightly more impacted as their externalising mean score was somewhat higher, and more caregivers in the UK than in Turkey reported change across all externalising symptoms. Previous research on the prevalence of childhood mental health problems across countries in Europe found that behaviour problems were less likely to be reported in Turkey (Husky et al., 2018;Kovess-Masfety, 2016). Hence, the differences may re ect genuine prevalence rates. Nevertheless, the range of the percentage of parents reporting change in how much children were irritable, argumentative, and angry was re ecting approximately one in two caregivers across both samples. This nding shows that the behaviours that were a major cause of concern for caregivers during the lockdown across both cultures were the same and suggest that culture did not in uence the type of challenging behaviour caregivers had to grapple with during the lockdown. Although, frustration as an emotional response to the lockdown has been reported often in western and non-western samples (Fernandez Ruiz, 2021; Tiwari et al., 2021) the proportion of caregivers who reported frustration in the UK sample was double the proportion of Turkish caregivers. The difference could re ect differences in the conceptual understanding of the term 'frustration', but further research is required to verify this assumption.
Worry of COVID-19 infection was an independent predictor of children's internalising behaviour change before and during the lockdown in the Turkish sample.
To our knowledge, our study is the rst to reveal an association between worry of COVID-19 infection and change in children's outcomes during the pandemic. Previous research by Hofstede et al., (2005) has linked collectivism with less tolerance to uncertainty. Combined with the uncertainty created by the fast spread of the infection and public handling of the crisis during the initial period of the pandemic in Turkey (Pak et al., 2021;San et al., 2021) caregivers in Turkey may have experienced higher levels of worry of COVID-19 infection than in the UK. Together with research that shows that worry of COVID-19 infection is related to poor psychological wellbeing (Fitzpatrick et al., 2020;Kayis et al., 2021;Satici et al., 2020a) our ndings propose that public health strategies should aim to reduce worry and social panic in the face of imminent crisis. In line with Huang et al., (2020) collectivism on its own is enough to encourage uptake of preventive practices as high worry of COVID-19 infection may even reduce preventive behaviour.
Caregivers in the Turkish sample reported signi cantly less di culty with the con nement which can be attributed to its collectivist orientation that values interdependence and close-knit family ties (Kuşdil & Kağıtçıbaşı, 2000). Because interdependence in the family unit cultivates a sense of belongingness and purpose (Hofstede, 2001) spending time with the family during the lockdown may have not in uenced families in collectivist societies as dramatic as in individualistic societies. Additionally, because collectivism promotes a strong sense of responsibility for the community and maintenance of social order it encourages high adherence to prevention measures (Cukur et al., 2004;Germani et al., 2020;Huang et al., 2020;Maaravi et al., 2021;). The lockdown was one of the many measures that countries imposed to mitigate the spread of the virus. Families in collectivist cultures may have perceived the con nement yet another prevention strategy to adhere to and as a result were more tolerant to its impact. Finally, collectivist child socialisation goals aim to promote obedience (Louie et al., 2015) may translate to more manageable child behaviour. Indeed, the rates of externalising behaviour were lower in the Turkish sample. Nevertheless, it made a unique contribution to the prediction of change in internalising and externalising behaviour change across both the Turkish and UK sample suggesting that collectivism many not buffer the harmful effects of the con nement.
On a nal note, although it was not an aim of our study, we found that parenting stress predicted internalising di culties in the UK sample only. Parenting stress during the pandemic was associated with a range of social and emotional symptoms in a cross-sectional study of a large sample of caregivers in Turkey (Büber & Terzioğlu, 2021). However, an earlier study of Turkish pre-schoolers found weak direct and indirect effects of parenting stress on internalising symptoms (Yavuz et al., 2017). The differential impact of parenting stress could be explained by cultural differences. Collectivist culture prioritises group over individual harmony and child socialisation goals tend to promote restrain and inhibition (Chen-Bouck et al., 2019;Louie et al., 2015). Therefore, within a collectivist context, internalising behaviour as a response to the stresses of the lockdown could have been potentially perceived as adaptive and by extension acceptable insofar as it re ects social sensitivity and the dominant public emotional response. In this context, caregivers in Turkey may have not felt that they were burdened by the demands of parenting a child with internalising behaviour. However, more research is required to validate this hypothesis.

Limitations
The cross-sectional design did not allow to examine the long-term impact of the quarantine in children's internalising and externalising behaviour change. Additionally, changes in children's symptoms were based only on perceived parental report. Majority of participants were female university graduates. Additionally, half of the Turkish children were primarily attending private schools, which is not representative of the national population. Therefore, generalisation of the ndings should be approached with caution. The study did not use any measures to examine collectivism vs individualism, and tolerance of uncertainty. Replication studies should include a longitudinal design, multi-informant methods of assessing children's emotional stated and behaviour and measures that capture cultural orientation.

Declarations
Con ict of interest: the authors report not con ict of interest Acknowledgements: the authors would like to thank the families for their participation in the study Saddik, B., Hussein, A., Albanna, A., Elbarazi, I., Al-Shujairi, A., Temsah, M. H., … Halwani, R. (2021). The psychological impact of the COVID-19 pandemic on adults and children in the United Arab Emirates: a nationwide cross-sectional study. BMC psychiatry, 21(1), 1-18.  Tables   Table 1 Between-country Differences by Participant Characteristics