{"http:\/\/dx.doi.org\/10.14288\/1.0438384":{"http:\/\/vivoweb.org\/ontology\/core#departmentOrSchool":[{"value":"Arts and Social Sciences, Irving K. Barber Faculty of (Okanagan)","type":"literal","lang":"en"},{"value":"Non UBC","type":"literal","lang":"en"},{"value":"Psychology, Department of (Okanagan)","type":"literal","lang":"en"}],"http:\/\/www.europeana.eu\/schemas\/edm\/dataProvider":[{"value":"DSpace","type":"literal","lang":"en"}],"https:\/\/open.library.ubc.ca\/terms#identifierCitation":[{"value":"Psych 4 (4): 934-951 (2022)","type":"literal","lang":"en"}],"http:\/\/purl.org\/dc\/terms\/creator":[{"value":"Yunus, Fakir Md.","type":"literal","lang":"en"},{"value":"Livet, Audrey","type":"literal","lang":"en"},{"value":"Mahmoud, Aram","type":"literal","lang":"en"},{"value":"Moore, Mackenzie","type":"literal","lang":"en"},{"value":"Murphy, Clayton B.","type":"literal","lang":"en"},{"value":"Nogueira-Arjona, Raquel","type":"literal","lang":"en"},{"value":"Thompson, Kara","type":"literal","lang":"en"},{"value":"Keough, Matthew T.","type":"literal","lang":"en"},{"value":"Krank, Marvin","type":"literal","lang":"en"},{"value":"Conrod, Patricia J.","type":"literal","lang":"en"},{"value":"Stewart, Sherry H.","type":"literal","lang":"en"}],"http:\/\/purl.org\/dc\/terms\/issued":[{"value":"2024-01-03T20:51:51Z","type":"literal","lang":"en"},{"value":"2022-11-30","type":"literal","lang":"en"}],"http:\/\/purl.org\/dc\/terms\/description":[{"value":"We investigated whether anxiety sensitivity (AS) is associated with increased distress and adherence to public health guidelines during the COVID-19 pandemic among undergraduates, and whether increased distress mediates the relationship between AS and increased adherence. An online cross-sectional survey was conducted with 1318 first- and second-year undergraduates (mean age of 19.2 years; 79.5% females) from five Canadian universities. Relevant subscales of the Substance Use Risk Profile Scale (SURPS) and the Big Five Inventory-10 (BFI-10) were used to assess AS and neuroticism. Three measures tapped distress: the Patient Health Questionnaire-9 (PHQ-9) for depressive symptoms, the Generalized Anxiety Disorder-7 (GAD-7) for anxiety symptoms, and the Brief COVID-19 Stress Scales (CSS-B) for COVID-19-specific distress. The COVID-19 Adherence scale (CAD) assessed adherence to COVID-19 containment measures. AS was significantly independently associated with higher general distress (both anxiety and depressive symptoms) and higher COVID-19-specific distress, after controlling age, sex, study site, and neuroticism. Moreover, AS indirectly predicted greater adherence to COVID-19 preventive measures through higher COVID-19-specific distress. Interventions targeting higher AS might be helpful for decreasing both general and COVID-19-specific distress, whereas interventions targeting lower AS might be helpful for increasing adherence to public health containment strategies, in undergraduates.","type":"literal","lang":"en"}],"http:\/\/www.europeana.eu\/schemas\/edm\/aggregatedCHO":[{"value":"https:\/\/circle.library.ubc.ca\/rest\/handle\/2429\/87055?expand=metadata","type":"literal","lang":"en"}],"http:\/\/www.w3.org\/2009\/08\/skos-reference\/skos.html#note":[{"value":"Citation: Yunus, F.M.; Livet, A.;Mahmoud, A.; Moore, M.; Murphy,C.B.; Nogueira-Arjona, R.;Thompson, K.; Keough, M.T.; Krank,M.D.; Conrod, P.J.; et al. Is AnxietySensitivity Associated withCOVID-19 Related Distress andAdherence among Emerging Adults?Psych 2022, 4, 934\u2013951. https:\/\/doi.org\/10.3390\/psych4040069Academic Editor: Mosad ZineldinReceived: 30 October 2022Accepted: 28 November 2022Published: 30 November 2022Publisher\u2019s Note: MDPI stays neutralwith regard to jurisdictional claims inpublished maps and institutional affil-iations.Copyright: \u00a9 2022 by the authors.Licensee MDPI, Basel, Switzerland.This article is an open access articledistributed under the terms andconditions of the Creative CommonsAttribution (CC BY) license (https:\/\/creativecommons.org\/licenses\/by\/4.0\/).ArticleIs Anxiety Sensitivity Associated with COVID-19 RelatedDistress and Adherence among Emerging Adults?Fakir Md. Yunus 1 , Audrey Livet 2 , Aram Mahmoud 2, Mackenzie Moore 1 , Clayton B. Murphy 1 ,Raquel Nogueira-Arjona 1,3 , Kara Thompson 4, Matthew T. Keough 5, Marvin D. Krank 6, Patricia J. Conrod 2and Sherry H. Stewart 1,7,*1 Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS B3H 4R2, Canada2 Department of Psychiatry and Addictology, Universit\u00e9 de Montr\u00e9al, Montr\u00e9al, QC H3T 1J4, Canada3 School of Psychology, University of Sussex, Brighton BN1 9RH, UK4 Department of Psychology, St. Francis Xavier University, Antigonish, NS B2G 2W5, Canada5 Department of Psychology, York University, Toronto, ON M3J 1P3, Canada6 Department of Psychology, University of British Columbia, Kelowna, BC V1V 1V7, Canada7 Department of Psychiatry, Dalhousie University, Halifax, NS B3H 2E2, Canada* Correspondence: sstewart@dal.caAbstract: We investigated whether anxiety sensitivity (AS) is associated with increased distress andadherence to public health guidelines during the COVID-19 pandemic among undergraduates, andwhether increased distress mediates the relationship between AS and increased adherence. An onlinecross-sectional survey was conducted with 1318 first- and second-year undergraduates (mean ageof 19.2 years; 79.5% females) from five Canadian universities. Relevant subscales of the SubstanceUse Risk Profile Scale (SURPS) and the Big Five Inventory-10 (BFI-10) were used to assess AS andneuroticism. Three measures tapped distress: the Patient Health Questionnaire-9 (PHQ-9) for de-pressive symptoms, the Generalized Anxiety Disorder-7 (GAD-7) for anxiety symptoms, and theBrief COVID-19 Stress Scales (CSS-B) for COVID-19-specific distress. The COVID-19 Adherencescale (CAD) assessed adherence to COVID-19 containment measures. AS was significantly indepen-dently associated with higher general distress (both anxiety and depressive symptoms) and higherCOVID-19-specific distress, after controlling age, sex, study site, and neuroticism. Moreover, ASindirectly predicted greater adherence to COVID-19 preventive measures through higher COVID-19-specific distress. Interventions targeting higher AS might be helpful for decreasing both general andCOVID-19-specific distress, whereas interventions targeting lower AS might be helpful for increasingadherence to public health containment strategies, in undergraduates.Keywords: personality traits; undergraduate students; COVID-19 pandemic; distress; adherence1. IntroductionCOVID-19 is an infectious respiratory virus which first emerged in Wuhan, China inDecember 2019 [1]. It spread rapidly across the globe and as of August 2022, more than591 million cases had been confirmed and more than 6.4 million deaths reported [2]. TheCOVID-19 pandemic has had a significant impact on the economy, as it led to the lossof many jobs, and it will likely result in long-lasting economic damage domestically andglobally [3].Although the COVID-19 pandemic has had adverse impacts across populations, it hashad specific negative impacts on university students. Numerous aspects of student life weredisrupted or ceased entirely during early phases of the pandemic, and these disruptionswere relatively long-lasting. Most universities across the country moved their classes online,which many students believe had a negative impact on the quality of their education.These changes raised concerns about students\u2019 opportunities for academic success andabout possible adverse impacts on their future careers due to reduced human connectionPsych 2022, 4, 934\u2013951. https:\/\/doi.org\/10.3390\/psych4040069 https:\/\/www.mdpi.com\/journal\/psychPsych 2022, 4 935and support [4,5]. The large majority of undergraduates are in a developmental phasereferred to as \u201cemerging adulthood\u201d (age range 18\u201325 years), in which social relationshipsand interactions are crucial [6]. A large aspect of student life normally involves socialgatherings, which had to cease to limit spread of the virus [7]. Indeed, the COVID-19pandemic has had significant negative effects in increasing social isolation and loneliness,both of which are highly correlated with psychological distress [8]. Public health viralcontainment strategies such as social distancing and lockdowns resulted in a markedlydifferent university experience from previous years.Concerningly, the prevalence of anxiety and depression has doubled during theCOVID-19 pandemic compared to prior to the pandemic [9]. In addition to a rise inthe prevalence of anxiety and depressive disorders during COVID-19, the pandemic hasincreased students\u2019 levels of general distress (i.e., distress not specifically focused on pan-demic circumstances) including both anxiety and depressive symptoms. Anxiety symptomsinclude excessive and persistent worry over a number of topics, such as one\u2019s finances,health, family, employment, and other daily life concerns [10\u201313], difficulties controllingthe worry, and anticipating the worst [10,14]. Depressive symptoms include low mood anda loss of interest in or pleasure from previously rewarding or pleasurable activities [15].In addition to increases in general distress (both anxiety and depressive symptoms)during the pandemic, many students have been experiencing distress specifically focusedon COVID-19 and the associated pandemic circumstances [16]. This COVID-19-specificdistress can include fears of becoming infected oneself, fears of a family member or friendbecoming infected, or fears of loss of a loved one [17\u201319]. Apart from elevated generaldistress, COVID-19-specific distress is directly linked with reduced life satisfaction andincreased suicidal ideation [20,21].However, not all individuals have reacted with general or COVID-19-specific distressto the pandemic. It is, therefore, important to identify individual difference factors thatmay play a role in susceptibility to increased general and\/or COVID-19-specific distress todevelop and implement targeted prevention and treatment strategies. There is substantialtheory to suggest that anxiety sensitivity (AS) may be one important individual differencefactor in predicting increased distress in response to the COVID-19 pandemic [22]. ASentails a fear of arousal related sensations because of beliefs that such sensations mayhave negative outcomes like physical illness, loss of control, or social censure [23,24].Moreover, as an anxiety-amplifying factor [25], higher levels of AS may place peopleat increased risk of experiencing anxiety symptoms, even in pre-pandemic times. Thisincreased risk is likely to be more pronounced during the COVID-19 pandemic given themany uncertainties surrounding the pandemic (e.g., uncertainties surrounding the highlycontagious nature of the COVID-19 respiratory virus and\/or its severity of symptoms ifinfected) and uncertainties around its associated containment strategies (e.g., uncertaintiessurrounding the availability of resources for testing and treatment, and frequently changingpublic health advice regarding effective containment strategies) [26\u201328]. AS has also beenassociated with an increased risk for depression in pre-pandemic times, possibly due to itsassociation with a ruminative or negative response style [29]. Particularly in the contextof restrictive social distancing measures where normal social rewards are disrupted, highAS individuals may be a group at particular risk for experiencing more severe depressivesymptoms [30]. Finally, those higher in AS may be more susceptible to increased COVID-19-specific distress due to their heightened anxiety surrounding bodily arousal sensations suchas shortness of breath [31] given COVID-19 is a highly contagious respiratory illness [31,32].Indeed, emerging research provides support for a relationship between AS and ele-vated distress during the COVID-19 pandemic. Several studies have reported that higherAS is directly linked with higher levels of emotional distress\u2014both anxiety and depressivesymptoms\u2014associated with the various potentially stressful disruptions caused by the COVID-19 pandemic, including social distancing, financial constraints, and uncertainty [33\u201337]. AShas also been linked with higher levels of COVID-19-specific distress. For example, aCanadian study found a positive association between AS and increased anxiety and worryPsych 2022, 4 936specifically about the COVID-19 pandemic [38]. However, these studies assessed membersof the general public of all ages [38\u201340]. Further research is warranted to assess the relation-ship between AS and distress during the pandemic in emerging adults (ages 18\u201325)\u2014theadult demographic most vulnerable to distress during the pandemic [41]. In addition,the extant literature on the relations of AS to distress during the pandemic has failed tocompare the pattern of associations of AS (and of the related yet conceptually distincthigher-order trait of neuroticism) with COVID-19-specific distress and general distress.Such a comparison would aid in identifying, if any, the particular association between ASand COVID-19-specific distress, which could aid in the development of pandemic-specificpersonality targeted programs for improving student mental health.Studies to date on the links of AS to COVID-19 distress have also not firmly establishedthe specific utility of AS relative to related, but higher-order, traits. It has been proposedthat there is a hierarchical structure to personality traits, with broader dimensions havinginfluence over more narrowly defined traits [42]. An example of this is the broader, higher-order trait of neuroticism influencing the more specific and lower order trait of AS [42].Neuroticism can be defined as a general tendency to experience negative emotions acrosssituations [42], whereas AS involves the more specific tendency to experience anxiety inresponse to arousal sensations [24]. AS is significantly positively correlated with broadermeasures of trait neuroticism [43]; therefore, it is important that neuroticism is controlledwhen determining if the proposed relationships of personality to general and COVID-19-specific distress are unique to AS.In addition to pandemic-related distress, another important public health issue duringthe pandemic has been the degree to which people are adhering to public health measuresdesigned to contain viral spread. During earlier phases of the pandemic such measuresincluded social distancing and stay-at-home advisories. Again, just as there have beenmarked individual differences in pandemic-related distress, there are similarly markedindividual differences in adherence. Additionally, again, personality may be useful inidentifying those who may be more (or less) adherent to these public health recommen-dations. AS is a variable that could theoretically be related to adherence to public healthCOVID-19 containment strategies. Moreover, it is possible that this relation may be ineither direction (i.e., increased or decreased adherence). On the one hand, AS may moti-vate increased adherence behaviour as a way of reducing heightened pandemic-relateddistress. For example, if a higher AS individual is fearful of contamination by COVID-19,handwashing may provide temporary reduction of their associated anxiety, making futurehandwashing more likely through the process of negative reinforcement. In fact, elevatedanxiety was shown to motivate increased preventive behaviours including washing hands,disinfecting doorknobs, and avoiding social situations during the H1N1 pandemic [44].High AS individuals, on the other hand, may show decreased adherence during a publichealth emergency if their heightened levels of distress motivate unhealthy avoidance-basedcoping. Several past studies have suggested that AS is linked with avoidance of healthybehaviours and engagement in unhealthy coping (e.g., drinking to cope with anxiety [45])due to the fear of somatic sensations characteristic of high AS [46,47]. Moreover, certainforms of maladaptive coping in high AS students like increased coping drinking and druguse may indirectly lead to disregard for social distancing in young adults [40,45].It is also possible that AS may contribute to increased or decreased adherence topublic health containment strategies by way of its association with specific forms of distressduring the pandemic. With respect to anxiety symptoms, several studies have foundhigher likelihood of adherence to COVID-19 quarantine guidelines among people withelevated anxiety given they are more apprehensive about the future [48,49]. It has alsobeen suggested that it may be fears of contracting COVID-19 (i.e., COVID-19-specificdistress) that may explain the links of anxiety with increased adherence to COVID-19containment guidelines [48]. With respect to general depression, people are less likely toadhere to recommended COVID-19 containment protocols if they are experiencing elevateddepression since they have a lack of confidence in the future and a low sense of control [50]Psych 2022, 4 937which may make adherence efforts appear futile. Although previous studies have examinedpersonality traits\u2019 associations with COVID-19 adherence [51\u201353], ours is the first study toexamine potential mediators of this association where relations of AS to pandemic-specificdistress and\/or anxiety may mediate increased adherence and where, in contrast, relationsof AS to depression may mediate decreased adherence.We investigated whether the trait of AS is associated with distress (both general andCOVID-19-specific) and adherence in emerging adult undergraduate students. Understand-ing which students are most susceptible to pandemic related distress and non-adherenceduring the COVID-19 pandemic will allow for the development\/evaluation of targetedpersonality-tailored prevention strategies for mitigating these maladaptive reactions invulnerable students. We hypothesized that (H1) Higher AS would predict increased generaldistress (both anxiety and depression) and increased COVID-19-specific distress above-and-beyond other relevant predictors including neuroticism, sex, age, and study site. (H2)Higher AS would be associated with greater adherence to public health strategies throughgreater COVID-19-specific distress (an indirect effect), consistent with the suggestions of anearlier study [48], rather than through general anxiety or depression.2. Materials and Methods2.1. Study Design and PopulationWe carried out an online cross-sectional survey at five universities in four Canadianprovinces (British Columbia, Ontario, Quebec, and Nova Scotia) in the winter of 2021 asa part of the \u2018UniVenture\u2019 study [54]. \u2018UniVenture\u2019 is a research partnership that aimsto adapt, test, and begin sharing an effective, sustainable, targeted wellness program totackle the timely social issue of heavy drinking and other substance misuse on Canadiancampuses [16,55]. A total of 1318 Emerging adults aged 18 to 25 years (mean \u00b1 SEMage = 19.2 \u00b1 0.03 years; 79.5% female), who were studying at the first- or second-year un-dergraduate level at one of the five participating Canadian universities, were enrolled intothe study. Individual sites had sample sizes ranging from n = 127 to n = 395, respectively.2.2. Data Collection Tools and TechniquesWe used the REDCap (Research Electronic Data Capture) survey tool to collect the dataonline using the Dalhousie University REDCap server (https:\/\/redcap.its.dal.ca\/ (accessedon 24 June 2021)). REDCap is a well-accepted and secure web-based software platformthat helps ensure participant privacy and confidentiality as well as allowing for automaticbranching logic [56]. A total of five separate projects were created in REDCap\u2014one foreach study site\u2014and each site administered their own project. De-identified data were latermerged across sites. Various strategies were adopted at each site to reach out to the targetpopulation such as direct survey email invitations sent by respective university studentaffairs units and sharing posts to university student-relevant social media groups. Thecontents of all recruitment materials covered a broad array of topics such as student\u2019smental health symptoms, personality, substance use, risky behaviour and injury, andCOVID-19 experiences among emerging adults transitioning to the university environment(in their first or second year of studies).A closed-ended structured questionnaire of about 45 min duration was developed andbeta-tested prior to survey launch. Given the survey length, participants were permitted topartially respond to the survey and return to complete it at another time. Both French andEnglish versions of the questionnaire were used since the primary language of one studysite was French. Each participant provided an online signature to indicate their informedconsent before participating. We provided participants with CAD$15 worth of online giftcards (all sites) or 1 academic credit point (at the three sites using the SONA system to allowstudents to participate for partial course credit) as compensation for their time. Participantswere required to provide their institutional email addresses or to otherwise verify theirstudent identity, to participate. Compensation was provided by email. Data were storedseparately from email addresses to preserve participant confidentiality.Psych 2022, 4 9382.3. Measures2.3.1. Substance Use Risk Profile Scale (SURPS)The Substance Use Risk Profile Scale (SURPS; [43]) is a 23-item questionnaire that isused to assess the four-factor model of personality vulnerability to substance misuse. Forthe purposes of this study, we used the 5-item AS subscale as the predictor variable in ourhypothesis tests. Participants identified to what extent they agreed with each of the items(e.g., \u201cIts frightening to feel dizzy or faint\u201d, \u201cIt scares me when I\u2019m unable to focus on atask.\u201d) on a four-point Likert scale ranging from 1 (\u201cstrongly disagree\u201d) to 4 (\u201cstronglyagree\u201d). Participants\u2019 total AS scores were calculated which involved summing acrossitems. The SUPRS has been validated (concurrent, discriminant, and incremental validity)in several languages and countries [57\u201359]. In the present sample, the Cronbach\u2019s alphafor the AS scale was 0.67. Given the short length of the scale (i.e., less than 10 items),Cronbach\u2019s alpha > 0.60 is considered an acceptable level of internal consistency [60,61].2.3.2. Big Five Inventory-10 (BFI-10)The Big Five Inventory-10 (BFI-10) is a 10-item scale that was used as a brief measure ofthe Big Five personality traits [62]. For this study, only the two-item Neuroticism scale wasused as a control measure in our hypothesis tests. Participants responded to what extentthey agreed with each of the items (i.e., \u201cI see myself as someone who . . . . . . is relaxed; . . .handles stress well (reverse-scored item); . . . gets nervous easily.\u201d) on a five-point Likertscale (\u201cstrongly disagree\u201d to \u201cstrongly agree\u201d). Participants\u2019 mean scores were calculatedfor the neuroticism subscale. This subscale has established self-peer convergent validityand acceptable internal consistency (Cronbach\u2019s alpha = 0.65 in the current sample) for ashort scale [60].2.3.3. Generalized Anxiety Disorder Scale (GAD-7)The Generalized Anxiety Disorder (GAD-7) scale [63] is a 7-item scale which was usedto assess severity of anxiety symptoms during the COVID-19 pandemic [63]. The GAD-7served as one of our two general distress outcome measures in the test of H1 and as amediator variable in the test of H2. It contains items such as \u201cFeeling nervous, anxious, oron edge\u201d which are answered on a scale from zero for \u201cNot at all\u201d to three for \u201cNearly everyday\u201d, in the past month (30 days). The GAD-7 score is calculated by summing the scoresacross the seven items for a possible total score ranging from 0\u201321. The GAD-7 possessesexcellent internal consistency [Cronbach\u2019s alpha = 0.92 in the validation sample [63] andCronbach\u2019s alpha = 0.90 in the present sample)]. The GAD-7 has also been shown to possessgood convergent and discriminant validity [64] and it has been validated with universitystudents in a number of countries and languages [65\u201367].2.3.4. Patient Health Questionnaire (PHQ-9)The Patient Health Questionnaire (PHQ-9) is a 9-item questionnaire which was used toassess severity of depressive symptoms during the COVID-19 pandemic [68]. The PHQ-9served as one of our two general distress outcome measures in the test of H1 and as amediator variable in the test of H2. The scale contains items such as \u201cLittle interest orpleasure in doing things\u201d which are answered on a scale from zero for \u201cNot at all\u201d to threefor \u201cNearly every day\u201d, in the past month (30 days). The PHQ-9 total score is calculated bysumming the scores across the nine items for a possible total score ranging from 0\u201327. ThePHQ-9 has been shown to possess excellent internal reliability (\u03b1 > 0.80; Cronbach\u2019s alpha= 0.88 in the present sample) as well as good construct and criterion-related validity as ameasure of depressive symptom severity [68].2.3.5. COVID Stress Scales-Brief (CSS-B)The COVID Stress Scales (CSS) were developed several months into the COVID-19pandemic to assess distress responses specific to the COVID-19 pandemic [69]. The originalfull scale has a total of 36 items; however, for the purposes of UniVenture, a brief 18-itemPsych 2022, 4 939version was developed [16] where higher scores indicate higher COVID-19 specific distress.Sample items from the CSS-B are \u201cI am worried about catching the virus\u201d, and \u201cI hadtrouble sleeping because I was worried about the virus.\u201d Items are responded to on a scaleranging from 1 (Not at all) to 5 (Extremely). The CSS-B shows excellent structural validityin university students [16] and strong internal consistency (Cronbach\u2019s alpha = 0.90 inthe present sample). We used the total score (items summed across the 18 items) since itprovides a useful measure of overall COVID-19-specific distress and given evidence of ahierarchical structure for the CSS-B where the total score represents the overall COVID-19-specific distress construct [16]. The CSS-B total served as one of our outcome measures inthe test of H1 and as a mediator variable in the test of H2.2.3.6. COVID-19 Adherence Scale (CAD)Adherence to the public health restrictions in place at the time of the study weremeasured with the 6-item COVID-19 Adherence Scale (CAD) [70]. The items in the CADare as follows: \u201cSince returning to campus this semester\/term (i.e., since starting classes),have you (1) Gone out to a restaurant, bar, club, or other places where people gather? (2)Gone to the grocery store or pharmacy? (3) Gone to a friend, neighbour, or relative\u2019s house(that is not your own)? (4) Had more than 10 friends, neighbours, or relatives over to yourhouse? (5) Gone to a family gathering where there were more than 10 people such as areunion, wedding, funeral, or birthday party? (6) Gone to a gathering of friends where therewere more than 10 people such as a party, wedding, or concert?\u201d Each item was answeredwith a \u201cyes\/no\u201d response option and we counted the number of positively endorsed items.For ease of interpretation, we then recoded the non-adherence measure into an adherencemeasure through reverse coding (i.e., 0 was coded as 6 and 6 was coded as 0, etc.). Weused a total score (possible range of 0\u20136) as our outcome measure in the test of H2. Greaterscores indicate higher levels of adherence to the COVID-19 containment measures. Whilethe CAD is an unvalidated author-compiled measure, its items show similarity to itemson validated COVID-19 non-adherence measures [40,71] and its items were significantlyintercorrelated in the current sample (i.e., Cronbach\u2019s alpha = 0.67 which is acceptable for ashort scale), suggesting face and construct validity, respectively.2.4. Statistical AnalysisSPSS version 27 (Chicago IL) and Jamovi (version 2.0) were used to run the descriptiveand inferential statistics. Participants\u2019 demographics characteristics were tabulated inmeans and percentages by study site. We coded the five study sites numerically as sites1 through 5 to maintain the confidentiality of the various participating sites. We builtmultilevel models (MLM) for linear mixed model regression to test our hypotheses. Weidentified two levels for MLM: the individual level response and the mean of the individualresponse by site. MLM was carried out if the random variable (study site) explainedmore than 1% of the variation across sites (i.e., Intra-Cluster Correlation [ICC] > 1%; [72]).Four models were tested for each outcome variable after adjusting for age, biological sex,and neuroticism as fixed effect variables and study site as a random effect variable. Model0 was the null (unconditional) model where only the random effect of the dependentvariable was estimated. Model I involved level one individual data, model II involvedthe individual means by site, and model III involved a combination of models I and II.Proportional Change in Variance (PCV) and Akaike\u2019s Information Criterion (AIC) werecalculated to understand the change in the proportion of variance in the outcome accountedfor by the predictor(s) across the different models and to identify better models wherelower values represented closer model fit, respectively. Furthermore, we ran generalizedmediation analysis to test the indirect effect of SURPS AS on CAD via CSS-B, GAD-7, andPHQ-9, as well as the remaining direct effect of SURPS AS on CAD, after adjusting age, sex,and study site effects. Significance levels were set a priori at p < 0.05.Psych 2022, 4 9403. ResultsA total of 2441 participants started the online survey, of which 2060 completed thesurvey, with a survey drop-out rate of 15.6%. After the data cleaning, a total of 1318participants\u2019 data were analyzed. Table 1 presents the Mean (\u00b1SEM) of the study populationon key study variables. The mean AS level (13.43) in the current sample was found to beslightly higher than that of an earlier study among undergraduate drinkers (12.2) usingthe SURPS [43] which may have been due to the COVID-19 pandemic [22]. Controllingfor age, sex, and study site, we found that AS, neuroticism, general anxiety, generaldepression, and COVID-19-specific distress were positively correlated with each other withAS showing stronger relationships than neuroticism with COVID-19-specific distress, andneuroticism showing stronger relationships than AS with general distress (anxiety anddepression) (Table 2). COVID-19 adherence was positively correlated with neuroticism,general depression, and COVID-19 specific distress (Table 2).Table 1. Mean (\u00b1SEM) of the study population by key study variables.Variables Mean (\u00b1SEM)Age 19.27 (0.04)Anxiety sensitivity 13.43 (0.07)Neuroticism 3.37 (0.02)COVID-19-specific distress 11.80 (0.25)General distress\u2014Anxiety 9.87 (0.15)General distress\u2014Depression 11.05 (0.17)COVID-19 adherence 2.46 (0.04)Sex N (%)Male 270 (20.5)Female 1046 (79.4)Table 2. Correlations between independent and dependent variables.(1) (2) (3) (4) (5) (6)(1) Anxiety sensitivity \u2014(2) Neuroticism 0.44 ** \u2014(3) COVID-19 specific distress 0.29 ** 0.12 ** \u2014(4) General distress\u2014anxiety 0.37 ** 0.51 ** 0.30 ** \u2014(5) General distress\u2014depression 0.27 ** 0.35 ** 0.26 ** 0.72 ** \u2014(6) COVID-19 adherence 0.04 0.07 * 0.19 *** 0.05 0.06 * \u2014Controlling for \u2018Age\u2019, \u2018Sex\u2019, and \u2018Study Site\u2019 * p < 0.05, ** p < 0.001.Table 3 shows hypothesis testing of the relationship of AS with general distress inseparate analyses for anxiety and depressive symptoms. The null models (model 0) forboth anxiety and depressive symptoms revealed that less than 1% variation in each ofthese outcome variables was attributable to study site; therefore, MLMs were not necessary.Model I suggested a sex effect, with females scoring significantly higher in both anxiety[\u03b2 = 0.97 (0.29; 1.65)] and depressive symptoms [\u03b2 = 1.61 (0.77; 2.45)] compared to males.While controlling neuroticism, sex, age and study site, AS was associated with higher levelsof general distress, as hypothesized, both for anxiety [\u03b2 = 0.35 (0.24; 0.45)] and depressivesymptoms [\u03b2 = 0.32 (0.19; 0.45)]; however, neuroticism showed stronger effects than AS onboth measures of general distress: \u03b2 = 2.43 (2.14; 2.73) for anxiety symptoms and \u03b2 = 1.84(1.47; 2.20) for depressive symptoms.Psych 2022, 4 941Table 3. Factors associated with General Distress: Anxiety (GAD-7) and Depression (PHQ-9).General Distress\u2014Anxiety(GAD-7) #General Distress\u2014Depression(PHQ-9) ##Model 0 a Model I b Model 0 a Model I bCharacteristics \u03b2 (95% CI) \u03b2 (95% CI) \u03b2 (95% CI) \u03b2 (95% CI)Individual levelAge 0.09 (\u22120.10; 0.30) 0.13 (\u22120.12; 0.38)SexMale Ref RefFemale 0.97 (0.29; 1.65) * 1.61 (0.77; 2.45) **Anxietysensitive 0.35 (0.24; 0.45) ** 0.32 (0.19; 0.45) **Neuroticism 2.43 (2.14; 2.73) ** 1.84 (1.47; 2.20) **Measure ofvariationVariance (SD) 0.03 (0.17) 0.29 (0.54) 0.21 (0.46) 0.28 (0.53)ICC (%) 0.00 1.31 0.52 0.81PCV (%) Ref \u2212866.66 Ref \u221233.33Model fitstatisticsAIC 8352 7596.37 8658.87 8129.31a Model 0 (Null model) was fitted without determinant variables. b Model I is the final model adjusted for bothindividual-level and individual-level mean by site variables. * p < 0.05; ** p < 0.001 # Dependent variable: Generaldistress\u2014anxiety measured by the General Anxiety Disorder scale (GAD-7); Fixed effect variables: age and sex;Random effect variable: study site. ## Dependent variable: General distress\u2014depression measured by the PatientHealth Questionnaire (PHQ-9); Fixed effect variables: age and sex; Random effect variable: study site.Table 4 presents the MLM regression for COVID-19-specific distress with study siteas the random effect variable and AS as a fixed effect variable, after adjusting for age,biological sex, study site, and neuroticism. In the null model (Model 0), study site explained6.87% of the variance in COVID-19-specific distress which justified the MLM. Model IIIrevealed the best fitting model since AIC (9125.82) was the lowest compared to othermodels. Adjusted results indicated that AS was significantly associated with increasedCOVID-19 specific distress [\u03b2 = 0.91 (0.72; 1.11)], as hypothesized. However, neuroticismwas not significantly related to COVID-19-specific distress when controlling AS [\u03b2 = \u22120.05(\u22120.59; 0.48)]. Furthermore, after including AS and the covariates, ICC values showedthat variation across study sites explained a relatively small proportion of the variance inCOVID-19-specific distress (1.5% according to the ICC value for Model III as comparedto 6.87% in Model 0 [the null model]). As shown by the PCV, individual- and individualmean-level factors at the site level together accounted for 81.39% of the variance in estimatesof COVID-19-specific distress across study sites.Table 5 displays the results of the parallel mediation analysis model to explain thehypothesized link of AS to COVID-19 adherence where anxiety symptoms, depressivesymptoms, and COVID-19-specific distress served as simultaneous potential mediators in asingle model. With respect to anxiety and depressive symptoms, while AS was significantlypositively linked with each potential general distress mediator (path |a|), we did notfind a unique effect of either general distress indicator to COVID-19 adherence (path |b|),nor did we find a significant indirect effect (paths |ab|) of AS to COVID-19 adherencethrough either potential general distress mediator. With respect to COVID-19-specificdistress as a potential mediator, we found that AS was significantly positively linked withCOVID-19-specific distress (path |a|) and that COVID-19-specific distress was significantlypositively linked with COVID-19 adherence (path |b|). Moreover, a significant indirecteffect (path |ab|) was found for the positive relation of AS to COVID-19 adherence throughCOVID-19-specific distress. This is consistent with the possibility that AS significantlyPsych 2022, 4 942increased COVID-19-specific distress, which subsequently significantly increased COVID-19 adherence. Moreover, the direct effect (path |c|) of AS to COVID-19 adherence was notsignificant suggesting full mediation through increased COVID-19-specific distress.Table 4. Factors associated with COVID-19-Specific Distress.Model 0 a Model I b Model II c Model III dCharacteristics \u03b2 (95% CI) \u03b2 (95% CI) \u03b2 (95% CI) \u03b2 (95% CI)Individual levelAge 0.34 (\u22120.03; 0.73) 0.52 (0.13; 0.91) * 0.37 (0.19; \u22120.11)SexMale Ref Ref RefFemale 1.19 (\u22120.05; 2.43) 2.34 (1.11; 3.56) ** 1.21 (\u22120.03; 2.45)Anxiety sensitivity 0.91 (0.72; 1.11) ** - 0.91 (0.72; 1.11) **Neuroticism \u22120.05 (\u22120.59; 0.48) - \u22120.05 (\u22120.59; 0.48)Individual level(mean by site)Anxiety sensitivity(mean by site) 8.00 (4.67; 11.33) * 7.29 (3.31; 11.26)Neuroticism(mean by site) 24.84 (10.02; 39.67) 27.06 (9.23; 44.89)Measure of variationVariance (SD) 6.18 (2.49) 5.28 (2.30) 0.68 (0.82) 1.15 (1.07)ICC (%) 6.87 6.61 0.82 1.5PCV (%) Ref 14.56 8.89 81.39Model fit statisticsAIC 9590.86 9131.93 9544.38 9125.82a Model 0 (Null model) was fitted without determinant variables. b Model I is adjusted for individual-levelvariables only. c Model II is adjusted for Individual-level mean by site variables only. d Model III is the finalmodel adjusted for both individual-level and individual-level mean by site variables. * p < 0.05; ** p < 0.001Dependent variable: COVID-19-specific distress (CSS-B); Fixed effect variables: age and sex; Random effectvariable: study site.Table 5. Mediation of AS to COVID-19 adherence link through general distress (anxiety and depres-sive symptoms) and COVID-19-specific distress.Indirect Effect[\u03b2 (95% CI)]Direct Effect[\u03b2 (95% CI)]Predictor MediatorPath |a|(Effect of ASon Mediator)Path|b|(Unique Effect ofthe Mediator onCOVID-19Adherence)Path |ab|(Indirect Effect)Path |c|(Effect of AS toCOVID-19Adherence)AnxietySensitivityCOVID-19-specific distress 0.99 (0.81; 1.16) * 0.02 (\u22120.03; \u22120.01) * 0.02 (\u22120.03; \u22120.01) *0.01 (\u22120.02; 0.05)Anxietysymptoms 0.81 (0.70; 0.91) * 0.01 (\u22120.01; 0.02) 0.01 (\u22120.01; 0.02)Depressive symptoms 0.70 (0.58; 0.82) * 0.00 (\u22120.02; 0.01) 0.00 (\u22120.01; 0.01)Dependent variable: COVID-19 adherence * p < 0.001.4. DiscussionWe investigated the relationship of AS to three indices of distress during the COVID-19pandemic and whether they play mediating roles in explaining the hypothesized positivelink between AS and adherence to COVID-19 public health measures. We found that ASwas significantly positively associated with greater levels of both general (anxiety anddepression) and COVID-19-specific distress during the pandemic, after controlling age, sex,Psych 2022, 4 943study site, and neuroticism. We also found that AS indirectly predicted greater COVID-19adherence as mediated through greater COVID-19-specific distress after adjusting for age,sex, and study site and general distress mediators.We improved upon the extant literature in several ways: controlling for the effectsof the higher-order trait of neuroticism when examining links of AS to indices of distressduring the pandemic, examining these issues in emerging adult undergraduates wheredistress during the pandemic is particularly prevalent, and examining both general (anxietyand depressive symptoms) and COVID-19-specific distress as outcomes in a single study.We found that AS is a strong positive predictor of concurrent anxiety symptoms, depressivesymptoms, and COVID-19-specific distress, even after controlling for neuroticism andbiological sex. Neuroticism and female sex showed independent effects in predicting higheranxiety and depressive symptoms, but not COVID-19-specific distress. These independentpositive relationships between neuroticism and indicators of general distress, in the formof anxiety and depressive symptoms, have been supported by several earlier pre-pandemicstudies [73,74]. Others have studied the relation of AS to each form of distress (generalanxiety, general distress, COVID-19-specific distress) during the pandemic [33\u201337] but weare the first to establish that AS predicts concurrent levels of each form of distress duringthe COVID-19 pandemic when controlling the related trait of neuroticism.The associations between AS and increased general anxiety and depression are consis-tent with prior pre-pandemic research as well as research conducted during the COVID-19pandemic. For instance, AS is significantly linked with both post-traumatic stress disorderand generalized anxiety disorder in non-pandemic times [75]. In pre-pandemic research, AShas been shown to be a vulnerability factor for the development of anxiety disorders [75].This may be due to the strong associations those high in AS tend to make between physicalarousal sensations and catastrophic consequences like physical illness [76]. Misconstruingharmless physical sensations as signs of serious illness\u2014namely the highly infectiousrespiratory disease of COVID-19\u2014may have contributed to high AS students\u2019 increasedanxiety symptoms during the pandemic [77]. Other studies found relationships betweenAS and general depression\u2014particularly those studies assessing lower-order facets of AS.AS cognitive concerns (a lower order facet of AS involving fear of cognitive dyscontroland a fear of mental incapacitation when experiencing anxiety) have been shown to beassociated with increased depression symptom severity in clinically depressed individu-als [30,78,79] and with depressed mood in non-clinical samples [80]. Our findings extendthis prior research linking AS with indices of general distress\u2014both anxiety and depressivesymptoms\u2014to the context of the COVID-19 pandemic.We also found that students higher in AS suffer from COVID-19-specific distress to agreater extent than other students. The construct of COVID-19-specific distress includesworries around contracting the virus, post-traumatic stress disorder symptoms like diffi-culties sleeping and concentrating, worries around the health of the self and loved ones,concerns about the potential of reduced access to supplies during the pandemic, COVID-related xenophobia, and reassurance seeking behaviours with respect to the pandemic [69].Our findings are consistent with other studies showing a link of AS to COVID-19-specificdistress [38,81] and extend those prior findings from community samples to universitystudents. Similarly, a prior study found that AS was related to greater COVID-19 relatedworries; their findings suggested it was the physical concerns dimension of AS in particular(i.e., beliefs that physical arousal sensations like difficulties breathing are signs of seriousillness) that predicted greater COVID-19-specific distress [39]. They speculated that thosewith elevated AS physical concerns may be more likely to misinterpret harmless bodilysensations as signs of COVID-19 infection.Similar to AS, we found that neuroticism was significantly linked with increasedgeneral distress in the form of both anxiety and depressive symptoms. This is not justdue to measurement overlap as the BFI-10 neuroticism scale taps a personality trait thatinvolves susceptibility to negative emotions whereas the PHQ-9 and GAD-7 tap anxiety anddepressive symptoms that include negative emotions but also other symptoms of distressPsych 2022, 4 944(e.g., difficulties concentrating, appetite changes, sleeping difficulties for the PHQ-9). Ourresults are in line with earlier evidence regarding the relationship between neuroticism andboth anxiety and depressive symptoms. For example, neuroticism has been associated withincreased anxiety symptoms among adolescents and heightens risk for the development ofan anxiety disorder [82,83]. Furthermore, other studies support the claim that individualshigh in neuroticism are more prone than others to emotional distress including states ofboth anxiety and sadness [84\u201387]. Although the relationship between neuroticism andgeneral distress (anxiety and depression) is well established, the present findings extendthis result to the context of the COVID-19 pandemic and show such relations even aftercontrolling for the influence of the lower-order trait of AS [88].However, only AS and not neuroticism was associated with COVID-19-specific distressin our multivariate models, showing a unique link of AS with worries and concerns specificto the pandemic. Why neuroticism is linked with general distress but does not inciteCOVID-19-specific distress remains unclear. This distinction was observed because weincluded both measures of general distress and COVID-19-specific distress in a single studyand because we included neuroticism as a covariate in all our models. We are the first,to our knowledge, to examine the link of neuroticism to COVID-19-specific distress. OneCanadian study reported that neuroticism negatively correlated with the mental health ofadults during the COVID-19 pandemic [89] but they did not examine COVID-19-specificdistress, in particular. Another study carried out in Italy concluded that neuroticism playsa major role in COVID-19 pandemic coping behaviours because the feeling of being boredis positively linked with higher neuroticism [90]. A likely reason for our not finding arelationship between neuroticism and COVID-19-specific distress could be because unlikethese other studies [90,91], our study controlled for AS. Therefore, our results are suggestingthat prior findings of neuroticism being linked to pandemic-related distress may be betteraccounted for by the more specific trait of AS. Additionally, AS might be a better constructthan neuroticism for predicting concurrent COVID-19-specific distress since the signs andsymptoms of COVID-19 are widespread in daily life (e.g., coughing, upset stomach) andAS may intensify these signs and symptoms to the point where people may see them ascatastrophic, resulting in more overall symptoms and related functional impairment [92].Our results also suggest that AS is indirectly associated with more adherence toCOVID-19 public health preventive measures by way of its association with greater COVID-19-specific distress. It is possible that those individuals characterized by higher AS aredisproportionately more likely to experience distress relating to the pandemic, motivat-ing these individuals to adhere more strongly to public health guidelines as a way oftemporarily alleviating their pandemic-specific distress. This is corroborated by previousfindings where those characterized by higher AS levels engaged in more preventive be-haviours during a previous pandemic [44]. We add to this prior work in two importantways: generalizing the findings from the H1N1 to the COVID-19 pandemic and identifyinga mechanism to explain the AS-to-increased adherence link (i.e., via greater pandemic-specific distress) [44]. Interestingly, we did not find a significant mediation effect of eithergeneral anxiety or general depression in explaining the link of AS to increased adherenceto COVID-19 public health measures in our simultaneous mediator model, even though ASwas positively associated with both general anxiety and general depression. A likely reasonfor this is that COVID-19-specific distress has a unique impact on COVID-19 adherencebehaviour since specific worries and concerns about the pandemic (e.g., worries aboutcontracting the virus) are theoretically more likely than general (unfocused) distress tomotivate behaviours like adherence to public health measures to contain viral spread. Thispossibility could be studied further in future longitudinal research and may be helpful infuture intervention efforts.Our study shows how students in the emerging adult phase of development areresponding to the pandemic and to the public health containment strategies put in place intheir communities and universities to prevent the spread of the virus. The possible reasonfor site differences on COVID-19-specific stress and COVID-19 adherence are likely to bePsych 2022, 4 945related to different infection rates and associated pandemic restrictions across sites, bothat the provincial and university level as discussed in other papers from the UniVenturedataset [16,55]. For instance, Thibault et al. (2022) reported on these site effects for COVID-19-specific distress in this same sample, showing that the mean scores of COVID-19-specificdistress were highest at sites where COVID-19 infection rates were highest and COVID-19-related public health restrictions were strongest during the time of data collection(i.e., between February and April 2021) [16,93]. Interestingly, our null models indicatedthat there were small and non-significant site differences for general distress, with siteexplaining only 0.8% (in the case of depressive symptoms) and 1.31% (in the case of anxietysymptoms) of the variance in general distress scores. In contrast, site explained a significant6.87% of the variance in the case of COVID-19-specific distress. The results suggestedthat more attention should be given to interventions for managing students\u2019 COVID-19-specific distress in provinces where COVID-19 infection rates are higher, and provincial anduniversity-based restrictions are stricter. Our results also indicate that those students withhigher levels of AS are more vulnerable than other students to experiencing both generaldistress (i.e., anxiety and depression symptoms) and COVID-19-specific distress. Thus, ourresults are consistent with prior calls for the need for personality-specific interventionstargeted towards higher AS individuals during pandemic times that would help themmanage their increased susceptibility to distress [38].An earlier Canadian study advised adopting personality-appropriate mental healthservices during the COVID-19 pandemic [89]. Our results suggest that targeting AS, asopposed to the higher-order trait of neuroticism, may be most helpful for reducing bothgeneral and COVID-19-specific distress in university students. A personality-targetedintervention called PreVenture might be helpful in this regard given it has an arm whichtargets higher AS individuals. PreVenture is an evidence-based program which trialshave shown to reduce alcohol misuse, risky motives for drinking, emotional distress,and behavioural problems, and to prevent multiple medical service usage among bothadolescents and adults [94\u201398]. It is also important to note that even though high ASindividuals are indirectly showing increased adherence behaviours, it is at the cost ofincreased distress about the pandemic. Prolonged distress during the pandemic maymanifest in maladaptive behaviours, including increased drinking [40]. By reducing theheightened general distress being experienced by high AS students, adherence can bemaintained while promoting general mental well-being. However, it is important to beaware that reducing COVID-19-specific distress may result in reduced COVID-19 adherence.Public health needs to find a balance of instituting sufficient worry and concern about thepandemic in emerging adults that they will be sufficiently adherent to slow viral spread,but not incur so much distress in vulnerable individuals like high AS individuals that theyare suffering psychologically and turning to other maladaptive behaviours like copingdrinking. Such suffering may have longer term physical and mental health costs for boththe individual and society.Our study also suggests that lower AS students might be experiencing abnormallylow levels of COVID-19-specific distress, which could result in decreased adherence topublic health containment measures, placing them and the community at risk of COVID-19infection. Findings may thus aid in the development and evaluation of interventionswhich can be targeted to individual differences in personality for tackling both distressand non-adherence.Several possible limitations of the current study should be acknowledged and consid-ered in the interpretation of the results. First, due to the cross-sectional nature of the studydesign, we are unable to establish causal relationships between AS and general anxiety,general depression, and COVID-19-specific stress or between COVID-19-specific distressand COVID-19 adherence. Longitudinal studies are needed in future to test temporality.Second, although the study captures variation in COVID-19-specific distress and adherenceamong undergraduate students from across Canada (covering from east to west coastuniversities), generalizability of the results cannot be ensured since the study sample wasPsych 2022, 4 946not representative of Canadian undergraduates (e.g., preponderance of females, all first-and second-year students). Nonetheless, females are overrepresented in the Canadianundergraduate population [99] and first- and second-year university students may havebeen experiencing the most pandemic-related disruptions to their usual university expe-rience [100]. Additionally, sampling bias is less likely to occur since the study advertisedbroader aspects of the survey topics in the recruitment materials including, but not limitedto, substance use, mental health, COVID-19 stress, academic engagement and achievement,and personality among emerging adults transitioning to the university environment (intheir first or second year of studies).Future research may consider using a multidimensional AS scale like the ASI-3 [31] ifthere are additional waves of COVID-19 or during predicted future pandemics since our useof the SURPS to measure AS did not allow us to examine links of specific AS components(physical, social, and cognitive concerns) to the distress outcomes or to adherence [101]. Itis a future direction to know which dimension(s) of AS is (are) most predictive of generaland COVID-19-specific distress during this or future pandemics in university students tofurther refine our knowledge on which students are most in need of intervention and whichaspects of AS we most need to target in intervention. Future research could also examinewhich components of COVID-19-specific distress most motivate increased adherence. Forexample, fear of contracting COVID-19 oneself might be more motivating of adherencethan some other components. It remains to be determined the optimal level of COVID-19-specific distress that is needed to motivate effective adherence yet not tip into pathologicaloutcomes like suicidality and reduced life satisfaction that are established outcomes ofCOVID-19-specific distress [20,21]. Furthermore, future studies may wish to include alonger measure of neuroticism than the brief two-item neuroticism scale from the BFI-10(e.g., Neuroticism Scale) [102]. Nonetheless, the BFI neuroticism scale used in the presentstudy did have adequate internal consistency for a short scale which was similar to theinternal consistency of the SURPS AS measure in the present study. Moreover, its briefformat allowed us to measure neuroticism without overly burdening our participants withan excessively long battery. We also acknowledge the CAD measure was an unvalidated,author-compiled measure of adherence (albeit with face and construct validity in the presentsample); therefore, future research may want to replicate using a validated adherence scale.However, it is important to note that exact replication may not be possible as public healthrecommendations have changed over the course of the pandemic and thus measures ofadherence have had to quickly evolve over time.5. ConclusionsAS was associated with higher general distress (both anxiety and depressive symp-toms) and COVID-19-specific distress among Canadian emerging adult undergraduateseven after controlling the effects of age, sex, study site, and neuroticism. Our resultsfurther suggest that higher COVID-19-specific distress has a distinct mediating effect inexplaining the link of AS to higher COVID-19 adherence, that general distress (both anxietyand depressive symptoms) does not have. Our results may help pave the way to thedevelopment\/evaluation of personality-targeted interventions for reducing general andpandemic-specific distress that are being experienced more intensely by higher AS univer-sity students, while helping them maintain appropriate levels of adherence to public healthmeasures for viral containment. Our results may also stimulate the future development ofpersonality-targeted interventions for lower AS students to help improve their adherenceto such public health containment measures.Author Contributions: Conceptualization and methodology, S.H.S., M.D.K., K.T., M.T.K., R.N.-A.,A.L. and P.J.C.; formal analysis, F.M.Y., A.L., A.M. and S.H.S.; writing\u2014original draft preparation,F.M.Y., A.L., A.M., M.M., C.B.M. and S.H.S.; writing\u2014review and editing, S.H.S., M.D.K., K.T., M.T.K.,R.N.-A., A.L. and P.J.C. All authors have read and agreed to the published version of the manuscript.Psych 2022, 4 947Funding: The study received funding from a Social Sciences and Humanities Research Council(SSHRC) Partnership Grant [Grant#: 895-2019-1021; PI Stewart], and a Canadian Institutes of HealthResearch (CIHR) COVID Mental Health Grant [Award# 202010PJK; PI Stewart]. FMY\u2019s work onthe project was supported through the Mitacs Accelerate Post-Doctoral Fellowship program incollaboration with Injury Free Nova Scotia. PJC is supported through a CIHR Tier 1 Canada ResearchChair in Preventative Mental Health and Addiction. SHS is funded through a CIHR Tier 1 CanadaResearch Chair in Addictions and Mental Health.Institutional Review Board Statement: We received ethical approval from research ethics boards atDalhousie University (REB# 2019-4925), Universit\u00e9 de Montr\u00e9al (Ref# CERSES-20-012-P), St. FrancisXavier University (Ref# 24051), York University (Ref# e2020-076), and the University of BritishColumbia-Okanagan Campus (Ref# H19-02708).Informed Consent Statement: Informed consent was obtained from all subjects involved in the study.Data Availability Statement: Data is contained within the article. Deidentified data is available fromthe corresponding author upon reasonable request and pending appropriate ethical approval.Acknowledgments: We acknowledge the support from the UniVenture Consortium that includesresearchers and project staff from the five university data collection sites and academic outcomepartners at University of Victoria. Specifically, we would like to share our sincere thanks to KarenStewart-Kirk, Laura Lambe, Stephanie Cooper, Marion Audet, Nora Fripp, Naama Kronstein, VanessaMorris, Philippe P\u00e9trin-Pomerleau, Cassidy Wallis, Katherine Rose, Ramin Rostampour, PaweenaSukhawathanakil, and Allyson Hadwin. We are thankful to our UniVenture partners (StudentAffairs Units from the five respective sites, Nova Scotia Health Authority-Research Methods Unit(NSHA-RMU), SPOR Support Units (each region), the Canadian Research Initiative in SubstanceMisuse (CRISM), the Canadian Centre on Substance Use and Addiction (CCSA), the Mental HealthCommission of Canada (MHCC), and Injury Free Nova Scotia (IFNS) for their continued support ofthe project.Conflicts of Interest: The authors have no conflict of interest to disclose.References1. World Health Organization. Coronavirus Disease (COVID-19). Available online: https:\/\/www.who.int\/health-topics\/coronavirus#tab=tab_1 (accessed on 10 November 2021).2. World Health Organization. Coronavirus Disease (COVID-19). 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