Centrality in the Cross-sectional Network of Depressive Symptom and Metacognitive Variables During COVID-19: Do Central Variables Predict Overall Symptom Reduction From Periods of Strict to Lifted Social Distancing Protocols?

Hypotheses (Hs) H1: In the cross-sectional depression-metacognitive network at T1, the symptoms depressed mood, little interest/pleasure, and self-blame and the metacognitive coping variables rumination/worry, threat monitoring, situational avoidance, thought suppression, and uncontrollability of thoughts will be the most central variables.

H2: Reductions of the most central variables of the cross-sectional network from T1 to T2 will be more related to overall reduction of symptoms in the same time frame than reductions of the less central variables.

Study design and participants The design is a longitudinal observational survey of the general adult Norwegian population during the COVID-19 pandemic. Eligible participants are all individuals of 18 years and above, who are living in Norway and thus experience identical distancing protocols, and who provide informed consent to participate in the study. For this study, only participants reaching the cut-off value (>= 5; Kroenke et al, 2001) for subclinical symptoms on the PHQ-9 at T1 will be included, amounting to 6 508 individuals. The strict social distancing protocols were implemented in Norway at March 12. 2020 and the first data collection in this period (T1) has already been done. It lasted seven days and was between March 31st 2020 and April 7th 2020. Thus, the strict protocols had been held constant during the two weeks prior to data collection, as well as during the data collection week. Furthermore, no new information was given by the government during this period with regard to changes of distancing protocols, keeping expectation effects constant. From June 15., the majority of the distancing protocols will be lifted in Norway, and the T2 period is defined from this date. Data are set to be collected from the sample providing data in the first collection (N = 10 084), starting one week after the lifting of the protocols, that is, from 22th of June. The collection will last until enough data has been collected, but no longer than three weeks.

Ethical approval of the study was granted by The Regional Committee for Medical and Health Research Ethics and the Norwegian Centre for Research Data (reference numbers: 125510 and 802810, respectively, for the first data collection, and , respectively for the second data collection), where the study protocol and analysis plan was approved prior to data collection. The study is conducted in accordance with the guidelines of the Strengthening the Reporting of Observational Studies in Epidemiology statement (STROBE; Von Elm et al., 2007). The pre-registered protocol for a study of loneliness based on the first (T1) data collection can be found at Clinicaltrials.gov (Identifier: NCT04365881). The study is part of The Norwegian COVID-19, Mental Health and Adherence Project (Ebrahimi, Hoffart, & Johnson, 2020).

Procedures The survey is disseminated online. At T1, it was disseminated in a systematic manner to give the adult population an equal opportunity to participate in the study. The dissemination procedure involved information about the survey through broadcasting on national, regional, and local news channels and provision of the online survey to a random selection of Norwegian adults on Facebook. The dissemination procedure is described in detail elsewhere (Ebrahimi et al., 2020).