Ragnhild Bang Nes of PROMENTA's Intervention and Gap Bridging group talked to postdoc Stella Tsotsi about her recent publication on “Flattening the quality of life curve? A prospective person-centered study from Norway amid COVID-19” in the journal Quality of Life Research.
A person-centered approach
Over the past two years, the popular and scientific press have published numerous papers, commentaries and opinion pieces on how the COVID-19 pandemic affects mental health. The vast majority of evidence, however, has focused on mental ill-health and the period after the outbreak, without considering pre-pandemic measures or positive indicators of mental health. "After all, stressors and challenges often produce mixed reactions and positive outcomes such as groundswells of prosocial behavior and solidarity", says Bang Nes. "If you pause for a minute - do you think your quality of life overall has changed from before the pandemic? And, if yes, was it a positive or a negative change?"
To answer these questions at the population level, Bang Nes and her colleagues at the Norwegian Institute of Public Health and Promenta used available data from the Norwegian County Public Health Surveys, collected before the start of the pandemic (September 2019-February 2020) and follow-up data from the same 8 000 participants at 3 and 9 months after the outbreak. The team used a “person-centered” statistical approach, which allows for more observations of heterogenous reactions to the pandemic than comparable methods.
This method, explains Bang Nes, examines five different subgroups with different types of quality of life and changes in and between the groups at these three points in time. Additionally, this method allowed the team to identify risk and protective influences.
What constitutes quality of life?
An important aspect of this work was the inclusive measurement of quality of life. Instead of focusing on one dimension of quality of life, a range of questions were included, tapping into areas of life satisfaction, meaning in life, and positive and negative emotions. This allowed for a more holistic assessment of quality of life.
One size does not fit all
Participants in this study were classified into five different groups based on how they fared on the different components of quality of life that were measured - "Flourishing", "Content", "Content-Symptomatic", "Languishing" and "Troubled". While mean quality of life levels deteriorated during the pandemic, the study found substantial stability in the quality of life groups. The greatest stability was found for those who fared exceptionally well, categorized into the "flourishing" or "content" groups. Still, the proportion of flourishing individuals dropped from 40 to 24 percent while the proportion of the struggling group also saw a modest decrease. This means that the study indicates an overall levelling of the quality of life distribution - at a population level, people’s quality of life became more similar.
Social circumstances can be protective or detrimental
A clear finding of the study was that social circumstances before the outbreak, including social support, general trust in others and feelings of belongingness to the local community predicted the quality of life groups both prior to and during the pandemic. Overall, the study underscores the importance of income, health and social integration to quality of life and resilience to stressors, of which the pandemic is an example.
Important implications
The study yields useful information with respect to theories on adaptation and core factors that support or challenge quality of life when faced with stressors. This information is relevant also beyond the Covid-19 pandemic. Favorable social, financial and health-related circumstances give significantly lower odds of belonging to a high-risk group both outside of and within the context of the pandemic, and effective policies to promote wellbeing, resilience and mental health in the population ought to strengthen these factors.
Read the full article here: https://doi.org/10.1007/s11136-022-03113-2