Combining Natural Language Processing with Patient-Reported Outcome Measures scores to investigate the impact of pandemic regulations on anxiety in children

Background The COVID-19 pandemic and the governmental regulations taken during the pandemic had a profound impact on the experienced anxiety of children. However, there is a gap in research that explains how and which regulations had an impact. In this study we combine quantitative and qualitative data through structural topic modelling (STM) and sentimental analysis. Methods Children and adolescents (N = 3,821, aged 8–18 years old) completed an open-ended question; “ How are the corona-regulations for you? ", and the PROMIS Anxiety questionnaire, bi-annually from April 2020 until March 2023 (7 measurement occasions). This yielded 6,672 open-ended responses, with anxiety classified as (sub)clinical for PROMIS T-scores > 50.6. We applied STM to the open-ended responses to identify relevant topics, using dichotomized Anxiety as covariate. We used sentiment analysis to assess the affective state of responses and obtain polarity scores for each response (ranging from − 1 (negative) to + 1 (positive)). We identified the topics of importance to children during the pandemic and assessed the affective state of these responses per topic in the whole sample and split by presence of (sub)clinical anxiety. Results Eight topics emerged: 1) Adaptation/Resilience, 2) Distress, 3) Adherence to social distancing, 4) Limited social and family contact 5) Restrictions in activities/boredom, 6) Future perspectives, 7) Homebound (school closures), and 8) Lack of celebratory events. Compared to their peers, children with (sub)clinical anxiety reported significantly more negative sentiment, particularly regarding adaptation/resilience (-0.19 vs. -0.10, Cohen’s D = 0.24) and distress due to lockdown (-0.06 vs. 0.02, Cohen’s D = 0.20). They also expressed stronger emotional language when discussing these topics. Conclusions We successfully identified topics relating to the governmental regulations that are associated with (sub)clinical anxiety during the COVID-19 pandemic. This study shows that children with (sub)clinical anxiety scores experienced the pandemic period more negatively, and may have more problems with coping and adapting to lockdown measures.