Abstract - The present study found evidence that essential workers and their families are at an increased risk for anxiety, stress and sleep disruption. 120 female adolescents and 55 of their parents completed surveys measuring anxiety and sleep quality during the COVID-19 pandemic. The two samples, although drawn from the same community, were not linked. All adolescents attend an all-girls academy in suburban New York. T-tests and regression analyses suggest that essential workers and their families are at elevated risk for mental illness. KEY WORDS - Anxiety - Mental Health - COVID-19 - Frontline Workers - Sleep Quality INTRODUCTION - Due to the current pandemic, the stress levels of many people throughout the world have grown. Numerous studies show that one’s anxiety ofGeneralized Anxiety Disorder and Sleep Quality during the COVID-19 Outbreak in Adolescents & Parents: A Web-Based Cross-Sectional Survey Kaylin Spinelli ten becomes heightened during disease outbreaks (Tausczik et al. 2012). Every individual copes with stress and anxiety differently, and they are brought on in different people at different times. Some cope with anxiety and stress by sleeping more, while others find it difficult to fall asleep at all during stressful or anxious times. The COVID-19 pandemic has increased anxiety in more people than have most other diseases, in large part because people have been confined to their homes for extended periods of time (Pfefferbaum and North 2020). Teens typically are developmentally prone to high anxiety levels (Henker et al. 2002). At their age, it is natural to worry about peer acceptance and academic performance (Henker et al. 2002). Gupta et al. (2020) found that during the lockdown phase of the pandemic, many individuals began to reduce their hours of nighttime sleep in favor of taking more midday naps. This pattern slowly undermined 33 • NYCSEA Vol. 2 ISBN 979-8-89238-262-5 JSEA-Social Economics & Applied Science | NYCSEA - Vol. 2 peoples’ mental health (Gupta et al. 2020). A study of healthcare workers in Sudan found heightened anxiety during the COVID-19 pandemic (Elamin 2020). This raises the question of, the extent to which the heightened anxiety levels of healthcare workers might affect their families. The present study examines not only the anxiety levels and sleep quality of individuals who self-identify as essential workers but also persons who self-identify as the child of an essential worker. Did these two groups report significantly higher COVID-19 related anxiety or more significantly disrupted sleep? Our study is a cross-sectional, web-based survey testing generalized anxiety disorder and sleep quality during the COVID-19 pandemic in adolescents and their parents. A similar study of adult workers - frontline and non-frontline - was conducted in China in March 2020 at the height of the pandemic. We intentionally followed similar research protocols to better compare our February 2021 results in New York with the February 2020 data collected by Chinese scholars. Huang & Zhao (2020) found that younger people and essential workers were at highest risk of mental illness due to the COVID-19 outbreak. The present research tests whether the mid-pandemic anxiety levels and sleep quality of essential workers and their children differed from that of their peers using the Generalized Anxiety Disorder Survey (GAD-7) and the Pittsburgh Sleep Quality Index questionnaire (PSQI). The aim of my study is twofold. It seeks to (1) gain a better understanding of the effects of a global pandemic on adolescents and their parents and, (2) to uncover the impact essential workers have on the anxiety levels and sleep quality of their families during a pandemic. HYPOTHESES It is hypothesized that: 1. Essential workers and their family members will be at higher risk for anxiety. 2. Essential workers and adolescent family members will suffer from poorer sleep quality. 3. Adolescents will report greater anxiety levels (higher GAD-7 scores) compared to adults. 4. Adolescents will report poorer sleep quality compared to adults (as per PSQI). METHOD Procedure The sample for this study was not random. We recruited 120 female adolescents from an all-girls Catholic academy 34 • NYCSEA Vol. 2 ISBN 979-8-89238-262-5 JSEA-Social Economics & Applied Science | NYCSEA - Vol. 2 in a suburb of New York City and 55 of their parents. However, the students and their parents were not linked. We sought to survey adults and teens from the same community, not necessarily test for specific parental influence on individual girls. The participants were told that the project involved sleep quality and anxiety levels during the COVID-19 pandemic. The sample was reasonably representative of the racial/ethnic makeup of the school. The school, although “increasingly diverse,” is more Euro-American in makeup than the surrounding county (see Table 1). After informed consent was received from the subjects and one custodial parent/guardian, each subject completed the survey electronically via Google Forms. Students were identified by their school-issued ID numbers, and parents were identified by the last four digits of their phone number and their birth month. Although all responses were kept anonymous, researchers needed a way to identify people in case respondents requested that their information be removed from the study at a later date. Each subject completed demographic information, questions about parents/guardians’ schooling and profession or their own schooling and profession if adults were the participant. Then subjects took the Generalized Anxiety Disorder-7 (GAD-7) survey, and the Pittsburgh Sleep Quality Index (PSQ) questionnaire. The GAD-7 is proven to be one of the most effective methods of measuring anxiety (Spitzer et al. 2006). Once participants’ results were checked for completeness, parents could be classified as essential workers. Thus, two measures of “essential worker” were used - the respondent’s and New York States’. From there we were able to test how the jobs of parents might affect the anxiety levels and the sleep quality of their children. Participants Table 1- High School Ethnicity Statistics Ethnicity High School Population** Nassau County+ United States+ Sample % for adolescents Sample % for parents White 74% 58.5% 60.1% 70.2% 64.3% Black 10% 13.1% 13.4% 12.9% 14.3% Asian 11% 10.9% 5.9% 5.6% 3.6% Hispanic 4% 17.5% 18.5% 11.3% 17.9% Other - 2.6% 4.3% 1.6% 0% * Totals may not equal 100 due to those who reported themselves as multiracial. **2018-19 data provided by Sacred Heart Academy Annual 2019 Report to NYSED + 2019 U.S. Census Estimate 35 • NYCSEA Vol. 2 ISBN 979-8-89238-262-5 JSEA-Social Economics & Applied Science | NYCSEA - Vol. 2 Tables 2-4: High School Sample Gender & Age Statistics Table 2: Age categories Sample % for parents 35 or younger 0% 36-40 7.1% 41-45 12.5% 46-50 33.9% 51-55 35.7% 56-60 10.7% 61 or older 0% Table 3: Gender* Sample % for adolescents Sample % for parents Male 0% 38% Female 100% 62% * The high school population studied was drawn from an all-girls academy. Table 4: Age High school population Sample % for adolescents 13 1.0% 0% 14 25.7% 16.1% 15 22.8% 25.8% 16 31.7% 27.4% 17 13.9% 25.8% 18 4.9% 4.8% This sample consists of 120 high school students from an increasingly diverse Catholic all-girls high school and 55 of their parents. ● The adolescents and parents were not linked. ● Details of the sample can be seen in Tables 1 through 4. Instruments Title Author(s) / Date Purpose / Sample Questions Generalized Anxiety Disorder 7-Item (GAD-7) Scale Spitzer, et al. (2006) Over the last 2 weeks, how often have you been bothered by the following problems? (Likert scale of 0 to 3) #1 Feeling nervous, anxious, or on edge. #2 Not being able to stop or control worrying. #3 Worrying too much about different things. Pittsburgh Sleep Quality Index (PSQI) Buysse, et al. (2010) #1 During the past month, what time have you usually gone to bed at night? #2 During the past month, how long (in minutes) has it usually taken you to fall asleep each night? #3 During the past month, what time have you usually gotten up in the morning? 36 • NYCSEA Vol. 2 ISBN 979-8-89238-262-5 JSEA-Social Economics & Applied Science | NYCSEA - Vol. 2 Variables1 Independent (x) Dependent (y) Covariates Essential worker - vs. - Nonessential worker GAD-7 score Age, race/ethnicity, SES, previous mental health condition Child of essential worker - vs. - Child of nonessential worker PSQI sleep hours subscore RESULTS Teens reported a significantly higher prevalence of anxiety symptoms (GAD-7) than older people. Additionally, adults reported achieving significantly more sleep, measured in hours. Table 5: T-tests - Means & Standard Deviations GAD-7 hrs/sleep Teens 10.18a (1.35) 6.45a (1.07) Adults 9.41b (1.23) 6.90b (1.28) *Means with differing superscripts differ at the 95% confidence level. Occupationally, workers self-identifying as essential workers and teens who self-identified themselves as the children of essential workers were significantly more likely to report poor sleep quality (all p’s < .05), and report higher anxiety levels (p’s < .05). Table 6: T-tests - Means & Standard Deviations GAD-7 hrs/sleep TeensFWparent 10.53a (1.22) 6.12a (0.92) TeensN-FWparent 9.78b (1.36) 6.74b (1.30) AdultFW 9.89a (1.12) 6.70a (1.07) AdultN-FW 8.91b (1.19) 7.09b (0.89) *Means with differing superscripts differ at the 95% confidence level. A series of multiple regressions demonstrated that age group (teen vs. adult) and occupational status were predictive of both generalized anxiety (GAD-7) and poor sleep quality (PSQ); all p’s .05); occupational status and the subsequent perceived risk was the only direct predictor of both anxiety and poor sleep (both p’s<.05). As hypothesized, essential workers and their family members were proven to be at higher risk for anxiety, essential workers and their adolescent family members were found to have poorer sleep quality. The adolescents proved to have greater anxiety levels (higher GAD-7 scores) and poorer sleep quality (as per PSQI) compared to adults. These findings can also be found in Tables 5 and 6. DISCUSSION Our study identified a significant behavioral health burden on the American public nine months into the COVID-19 outbreak. 1) Younger people and 2) essential workers and their adolescent family members appear to be at elevated risk for mental illness, and may be in need of behavioral intervention. Ongoing surveillance of the psychological consequences of disease outbreaks must become a standard part of preparedness protocols in the United States and worldwide. Our results were in line with those of the study conducted in China back in March of 2020. One of the limitations of this study is that thus far we have only examined self-reported essential workers status. These results were also entirely quantitative in nature. To extend this research, it might be wise to include a qualitative study involving focus groups of a subsample of our survey respondents. Discussion would revolve around the reasons behind their anxiety - specific triggers, prefered coping strategies, etc. This would create a more comprehensive mixed-method study that could answer more questions. Another limitation of this study is the sample size. Our sample of parents remains smaller than that of our adolescent participants. Mid-pandemic, recruiting parents to take even an online survey is difficult because we lack any in-person connections to the parents. 38 • NYCSEA Vol. 2 ISBN 979-8-89238-262-5 JSEA-Social Economics & Applied Science | NYCSEA - Vol. 2 Standard mother-daughter, father-daughter, and parent-teacher events at school have been cancelled or moved to virtual platforms. In sum, this study has generally supported my hypotheses, but also brings to light new questions worthy of study in further research.