Setting
The general population in Norway, USA, UK and Australia were invited in April/May 2020 to participate in a self-administered survey that was distributed via different social media, such as Facebook, Instagram and Twitter. Each participating country had a landing site for the survey at the involved universities. These were Oslo Metropolitan University, Norway; University of Michigan, USA; University of Salford, UK; and University of Queensland, Australia. AØG from Oslo Metropolitan University initiated the overall project, but each of the universities had a project lead. The survey was translated from Norwegian to English by the researchers according to the language and cultural context where the survey was to be used.
Participants
To be included in the study, participants were required to be 18 years or older; to understand the language in which the survey was presented (Norwegian or English); and to be living in one of the relevant countries at the time of the survey (Norway, USA, UK or Australia).
Measures
Sociodemographic characteristics
Sociodemographic variables included age group (18-29 years, 30-39 years, 40-49 years, 50-59 years, 60-69 years, 70 years and above), gender (male, female, other/not stated), living area (rural/farming area, small town, medium sized city, large city), highest completed education level (elementary school, high school, associated/technical degree, bachelor’s degree, master’s/doctoral degree), cohabitation (living with spouse or partner), and employment status (having full-time or part-time employment versus not having employment).
Worry
Three aspects of worry were measured. The participants were asked: (i) to what extent are you worried about your own situation, (ii) to what extent are you worried about your immediate family, and (iii) to what extent are you worried about the future? All items had the following response options: (1) not at all, (2) slightly worried, (3) worried, (4) very worried, and (5) overwhelmed. The items were constructed for this study.
Loneliness
Loneliness was measured with the Loneliness Scale [17] which consists of six statements, all of which rated from 0 (totally disagree) to 4 (totally agree). This scale was designed to measure two different aspects of loneliness, “emotional loneliness” and “social loneliness”. Previous factor-analytic studies have found the six statements to load on two different factors, and that they therefore should be treated as constituting two different scales reflecting the two different aspects of loneliness [17, 18]. Internal consistencies (Cronbach’s α) in this study were 0.66 and 0.86 for the emotional loneliness and social loneliness scales, respectively.
Mental health
General Health Questionnaire 12 (GHQ-12) is widely used as a self-report measure of mental health [19, 20]. A large number of studies in the general adult, clinical, work and student population have provided support for its validity across samples and contexts [20-24]. Six items of the GHQ-12 are phrased positively (e.g. ‘able to enjoy day-to-day activities’), while six items are phrased as a negative experience (e.g. ‘felt constantly under strain’). For each item, the person indicates the degree to which the item content has been experienced during the two preceding weeks, using four response categories (‘less than usual’, ‘as usual’, ‘more than usual’ or ‘much more than usual’). Items are scored between 0 and 3, and positively formulated items are recoded prior to analysis. As a result, the GHQ-12 scale score range is 0-36, with higher scores indicating poorer mental health (more psychological distress).
COVID-19 infection
Participants were asked two questions relating to COVID-19 infection: (i) Have you been infected by COVID-19; and (ii) Has someone in your immediate family been infected by COVID-19? Both questions were answered with yes, no or don’t know. In view of the small number of participants who reported COVID-19 infection, we compared those who had been personally infected with COVID-19 (n = 52, 1.4%) with those reporting that someone in the immediate family had been infected (n = 373, 9.8%). Between these groups, the difference regarding social loneliness (M = 4.9 versus M = 3.9, p < 0.05) was the only difference reaching statistical significance. Therefore, we grouped those individuals personally infected with individuals who had a family member infected and with those reporting both, into one category (n = 504, 13.2 %). The rest of the participants (n = 3306, 86.8 %) constituted the comparison group (those indicating not known infection or no infection, either personally or within the family). For the remainder of this article, we will label those participants with infection personally or within the immediate family as ‘with infection’, while the rest of the participants will be labelled ‘without infection’ in the family.
Statistical analysis
The overall sample, and each of the national subsamples, were described with frequencies and percentages for categorical variables and means and standard deviations for continuous variables. Overall differences in proportions between groups were analyzed with the Chi-Square test. Differences in worry, loneliness and mental health between those with and without infection were analyzed with independent t-tests for the whole sample and for each of the four countries. A series of linear regression analysis was used to assess associations between sociodemographic variables and a range of outcomes: worry for oneself, worry for family members, worry about the future, emotional loneliness, social loneliness, and mental health. In each of the regression analyses, included independent variables were age group, gender, education level, employment and living with spouse or partner. Statistical significance was set at p < 0.05. Missing values were managed with casewise deletion, resulting in n varying between analyses.
Ethics
The data in this cross-sectional cross-national study were collected anonymously. The study was quality assured and approved by Oslo Metropolitan University and by the Regional committee for medical and health research ethics (REK; project reference 132066) in Norway. In the USA, it was reviewed by the University of Michigan Institutional Review Board for Health Sciences and Behavioral Sciences (IRB HSBS) and designated as exempt (HUM00180296). Similarly, it was reviewed by the University Health Research Ethics (HSR1920-080) in the UK and the University of Queensland Human Research Ethics Office (HSR1920-080; 2020000956) in Australia.