Changes In Relationship Quality Research Articles

Parent-child relationship quality and older parents’ cognitive trajectories

This study assesses the bidirectional link between parent-child relationship quality and older parents’ cognitive trajectories over time, with particular attention to potential variations by parents’ gender. Methods: Using a longitudinal, nationally representative sample of parents aged 50 and older from the Health and Retirement Study 2006–2016, the analysis examines three dimensions of the relationship quality between parents and children—contact, support, and strain—in relation to parents’ cognitive function. Parallel latent growth curve models (LGCMs) estimate how baseline relationship quality relates to subsequent change in parents’ cognition and how parents’ baseline cognitive function relates to subsequent change in relationship quality over time. Results: Higher initial levels of relationship strain with children predicts a faster cognitive decline for older parents. Neither initial contact frequency nor initial relationship support is associated with subsequent change in a parent’s cognition, however, good cognitive function predicts a more rapid increase or a slower decline in contact frequency and relationship support over time. No gender difference was found. Conclusion: The results highlight the importance of the “linked lives” of aging parents and their children as well as the potential for bidirectional associations between cognition and family relationships.

Patterns and predictors of change in relationship status among Black mothers over 16 weeks postpartum.

The transition to parenthood has long been viewed as a period of change in new parents' romantic relationships. However, this research has largely focused on changes in relationship quality, generally overlooking changes in relationship status (e.g., ending or entering a relationship during this period). To address this gap, we explored patterns and predictors of relationship dissolution and relationship formation during the early postpartum period among a sample of first-time Black mothers. A community sample of mothers living with low incomes (N = 212; 10% married; 85% enrolled in Medicaid) reported on their relationship status and other characteristics at 1, 8, and 16 weeks postpartum. Among mothers who were in a relationship at 1 week postpartum (N = 126), 20% of these relationships ended by Week 8 or 16. Mothers whose relationships ended reported lower relationship functioning at Week 1 than mothers whose relationships remained intact. Among mothers who were single at 1 week postpartum (N = 86), over 50% subsequently reported being in a relationship at Week 8 or 16. Mothers who started relationships reported lower overall social support at Week 1 relative to mothers who remained single. Together, these findings indicate that changes in relationship status during the early postpartum period were common and provide initial insights into factors characterizing mothers who experienced relationship transitions. Future work would benefit from considering changes in relationship status as well as other relational changes during the transition to parenthood to reflect a wider range of experiences among new parents. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Evaluation of Siblings’ Perceived Relationship Outcomes with Their Parents in an Open Trial of the SIBS Intervention for Children with Chronic Disorders

The SIBS intervention aims to prevent mental health problems for siblings of children with chronic disorders and has shown promising results. The mechanisms behind these changes have not been examined. Parent-child relationship quality is a predictor of mental health in siblings. Our first objective was to investigate whether sibling-perceived relationship quality between siblings and parents changes over time after participating in SIBS. Second, as the intervention requires participation of only one parent, we examined with a dual scale (anxiety and avoidance attachment style) whether relationship quality was associated with which parent participated. Third, as SIBS aims to promote parents‘ communication skills, we examined whether sibling-perceived communication quality with parents predicted relationship quality over time. The sample comprised 99 siblings (M = 11.5 years, SD = 2.0; range 8–16; 54% girls, 46% boys) of children with chronic disorders and one parent per sibling (63% mothers). We administered the questionnaires at pre-intervention, at three- and 6-months post-intervention. We applied growth curve models for relationship quality over time with communication quality as a predictor, controlling for parent gender. We found significant improvement in sibling-perceived relationship quality with the participating and the non-participating parent on the relationship anxiety scale over time, with small to medium effect sizes. Higher communication quality significantly predicted improvement of relationship quality in all four relationship outcomes. We conclude that change in relationship quality may be part of the positive outcomes of the SIBS intervention and is mainly explained by communication enhancement. Controlled trials of the SIBS intervention are indicated.

Relationship Status and Quality Are Associated With Perceived Benefits of Caregiving for People With Heart Failure.

"Benefit finding" is a strengths-based strategy for coping with medical illness that may be particularly useful for caregivers of people with heart failure given the highly fluctuating disease course. The aim of this study was to investigate benefit finding's association with the caregiver-care recipient relationship, depression, and burden at baseline and longitudinally. This is a longitudinal observational study of caregivers' benefit finding, relationship quality, depression, and burden. Correlation and multiple regression analyses identify baseline associations and predictors of 12-month change in benefit finding. At baseline (n = 100; median, 60 years [interquartile range, 46-69]; 81% female, 70% partner/spouse), increased benefit finding correlated with higher relationship quality (r = 0.53; 95% confidence interval [CI], 0.38-0.67), lower depression (r = -0.33; 95% CI, -0.49 to -0.14), and lower burden (r = -0.31; 95% CI, -0.47 to -0.11). Twelve-month change in benefit finding was predicted by change in relationship quality (ß = 7.12; 95% CI, 0.62-13.61) but not depression or burden. Relationship quality and benefit finding changed together over time. Interventions strengthening the caregiver-care recipient bond may be especially impactful for heart failure caregivers.

Change in maternal relationship quality and maternal and child distress

BackgroundMaternal relationship quality is associated with mental health; maternal mental health could affect child mental health. The COVID-19 pandemic adversely affected both relationship quality and mental health. PurposeTo examine if maternal distress mediates the association between pandemic-related changes in maternal relationship quality and child distress. MethodsA sample of 194 mother-child dyads were from the Alberta Pregnancy Outcomes and Nutrition (APrON) cohort participated. Mothers reported pandemic-related changes in relationship quality (partner, child, friends/family) and mental health (anxiety, depressive symptoms). Children (7-10 yrs) self-reported mental health (anxiety, depressive symptoms). Covariates were maternal sociodemograhics, child age and gender, number of children in the home, time between pandemic start and assessments, and pandemic change in household income. Mediation was tested using the SPSS PROCESS macro. ResultsAn indirect effect of maternal relationship quality on child anxiety via maternal depressive symptoms was detected, .95CI upper boundary <-.025. Decreases in partner relationship quality, b = -.45, SE = .23, p = .001, and relationship quality with friends or family outside the household, b = -.46, SE = .27, p = .001, were associated with higher maternal anxiety, which in turn, predicted higher child depressive symptoms, p’s<.014. ConclusionsPandemic-related decreases in maternal relationship quality were associated with maternal distress, which in turn was associated with child distress. LimitationsWe focused on mothers only and obtained retrospective recall reports on changes in relationship quality during the pandemic.

Key predictors of psychological distress and wellbeing in Australian frontline healthcare workers during COVID-19 (Omicron wave).

The COVID-19 pandemic has led to significant challenges for frontline healthcare workers' (FHW), raising many mental health and wellbeing concerns for this cohort. To facilitate identification of risk and protective factors to inform treatment and interventions, this study investigated key predictors of psychological distress and subjective wellbeing in FHWs. During the Omicron wave of the COVID-19 pandemic (January 2022), Victorian (Australia) doctors, nurses, allied health and non-medical staff from Emergency Departments, Intensive Care units, Aged Care, Hospital In The Home, and COVID Wards completed a cross-sectional survey consisting of the Kessler 6 item (Psychological Distress), Personal Wellbeing Index (Subjective Wellbeing), Coronavirus Health Impact Survey tool (COVID-19 related factors) and occupational factors. Multivariable linear regressions were used to evaluate unadjusted and adjusted associations. Relative weight analysis was used to compare and identify key predictors. Out of 167 participants, 18.1% screened positive for a probable mental illness and a further 15.3% screened positive for low wellbeing. Key risk factors for greater psychological distress included COVID infection worries, relationship stress and younger age. For both psychological distress and lower wellbeing, health status and supervisor support were key protective factors, while infection risks were key risk factors. Only positive changes in relationship quality was protective of lower wellbeing. This study highlights the significance of social determinants and individual level factors alongside work related factors, in influencing FHWs' mental health and wellbeing during public health crises, such as the COVID-19 pandemic. Findings suggest that future interventions and supports should take a more holistic approach that considers work, social and individual level factors when supporting FHWs' mental health and wellbeing.

The Association Between Perceived Relationship Quality and Psychological Symptoms in Refugees

Introduction: Relationship quality plays an important role in mental health, but little is known about its importance among resettled refugees. We investigated the association between perceived relationship quality and psychological symptoms among refugees resettled in Australia. Methods: Participants were 738 adult refugees (principal applicants, 83.5% male, M = 43.2 years, SD = 12.3) and their partners who participated in the Building a New Life in Australia (BNLA) study across 5 years from 2013 to 2017. Participants were assessed for psychological distress, posttraumatic stress symptoms (PTSS), and perceived relationship quality, using the Kessler scale (K6), the Posttraumatic Stress Disorder-8 (PTSD-8), and the Dyadic Adjustment Scale-4 (DAS-4), respectively. Results: Multiple regression analyses found that, among principal applicants, perceived relationship quality predicted psychological distress (p = .0006) at post-arrival, and changes in perceived relationship quality predicted changes in PTSS (p = .0003) across a one-year interval. When partners were analyzed, results were broadly consistent with those of the principal applicants, except that changes in relationship quality did predict changes in psychological distress, but not changes in PTSS. Discussion: Relationship quality appeared to be associated with psychological distress, but improvements in relationship quality may have particular utility for reductions in posttraumatic stress disorder (PTSD) symptoms. These results highlight the importance of relationship quality as a key correlate of refugee mental health.

For better or worse: Economic strain, furlough, and relationship quality during the Covid‐19 lockdown

AbstractObjectiveThis study evaluates the role of objective and subjective measures of economic uncertainty, as well as furlough schemes, on changes in couples' relationships during the first lockdown in the UK.BackgroundMost theories of relationship quality argue that economic uncertainty strains intimate relationships, leading to a deterioration in relationship quality. Few studies capture such an intense period of economic uncertainty, and the role of government policy to mitigate the impact of the economic crisis.MethodThe study employs the UK Household Longitudinal Covid‐19 surveys conducted in April–June 2020. Using multinomial logit regression models (N = 5792), we examine how self‐reported change in relationship quality is associated with socioeconomic status, subjective financial uncertainty, and change in employment situation, especially for those furloughed through the UK government's Employment Protection Scheme.ResultsThe study finds that 8% of individuals reported a decline in their couple relationship quality, but 19% reported improvements. Those with higher education and household earnings were more likely to experience improvements in relationship quality. Reduced work hours or job loss was not associated with changes in relationship, although expecting a worse future financial situation was. Furlough was strongly associated with improvements in relationships, and furloughed men were slightly more likely to report an improvement in their relationships than women.Conclusion and ImplicationsAlthough prior research has found that economic uncertainty is detrimental to relationships, employment protection schemes seem to have mitigated some of the worst effects on families.

COVID-19 Phobia, Dyadic Coping, and Subjective Change in Relationship Quality due to the Pandemic: A Dyadic Approach

The present study investigated, in a dyadic approach, whether phobic symptoms experienced due to the COVID-19 pandemic correlated with conflicts with romantic partners and subjective change in the quality of romantic relationships during the pandemic. Although previous studies investigated stress and partner’s responsiveness as predictors of romantic satisfaction during the pandemic, the present study investigated the phobia as a particular emotional consequence of pandemic-related stress for romantic couples.&nbsp;One hundred fifteen marital couples (230 individuals) participated in the study. Both spouses from each marital couple assessed their COVID-19 phobia, marital disagreements during the pandemic, perceived dyadic coping of their partner and subjective change in relationship quality compared to the quality before the outbreak of the pandemic. We observed that COVID-19 phobia predicted higher marital disagreements in husbands and wives and that the wives’ COVID-19 phobia predicted higher perceived marital disagreements among the husbands. Perceived partner's supportive behavior buffered the actor effects of COVID-19 phobia in men and women. Additionally, higher husband's COVID-19 phobia predicted subjective positive change in relationship quality during the pandemic when the wife's supportiveness was perceived as lower.

Transitions and transformations in sibling relationships: Characteristics of Turkish and US young adults’ sibling-related turning-point memories

This study investigated the narrative characteristics of Turkish and U.S. young adults’ sibling-related turning-point memories across gender, age orders, and cultures. We conducted face-to-face semi-structured interviews with 45 Turkish and 27 U.S. college students who had only one sibling. Participants were asked two main narrative questions: whether they have a close and personal relationship with their sibling and there is a turning point in their sibling relationships. Participants’ answers to these questions were coded on a number of narrative dimensions which are thematic categories, presence of personal relationship, direction of change in relationship quality, narrative style, transformativeness, and emotional valence. Three themes emerged in turning-point memories: developmental events, transitions, and growth; negative life events and challenges; and change in context. Results revealed no significant differences in turning-point memories between females and males, and between Turkish and U.S. populations. The findings indicated the unique role of siblings in the context of significant relationships regardless of gender and culture.

Correlated Change in Sense of Purpose and Romantic Relationship Quality.

Sense of purpose, or feeling that that one has personally meaningful goals and directions guiding them through life, consistently predicts a variety of desirable well-being, health, and social outcomes. However, work has been limited with respect to evaluating it as a predictor and promoter of romantic relationships, or how purpose may develop in these contexts. For instance, healthy romantic relationships could also help individuals develop and maintain a higher sense of purpose. With cross-sectional evidence finding positive associations between sense of purpose and romantic relationship commitment and satisfaction, the current study expanded on past work by using longitudinal data with three months between two measurement occasions (Time 1: N = 2243; Time 2: N = 1284) to evaluate whether sense of purpose predicted relationship status over time and how changes in relationship quality and sense of purpose were associated. Results showed that greater sense of purpose predicted maintaining a romantic relationship, but did not predict later romantic relationship quality, while higher romantic relationship quality predicted an increase in sense of purpose. Findings are discussed regarding why people with a higher sense of purpose may be more likely to stay in relationships as well as the role that positive romantic relationships may play in helping maintain a higher sense of purpose.

Relationship Quality Change Among Partnered Older Adults During the COVID-19 Pandemic.

The coronavirus disease 2019 (COVID-19) pandemic dramatically changed social life, but we know less about whether partnered relationships changed during this time. Because high-quality intimate relationships are key to many older Americans' well-being, we explore whether, how, and for whom the pandemic changed relationship quality among partnered older Americans. Nationally representative data from 1,642 partnered adults aged 50 and older come from the 2020 National Social Life, Health, and Aging Project COVID-19 Study. Multinomial logistic regression analyses estimate the likelihood of reporting improved, unchanged, or worsened relationship quality since the pandemic began across sociodemographic groups. Two thirds of respondents reported that relationship quality stayed the same during the pandemic, 22.8% reported their relationship quality got better, and 10.5% reported their relationship quality got worse. Although women and the oldest old were less likely to report improved relationship quality, Black respondents were more likely to do so, even after controlling for explanatory variables. Resilience describes many partnered older adults' experiences during the first year of the pandemic, suggesting that they were able to protect their partnerships during this public health crisis.

Trajectories of relationship quality and conflict in low‐income parents receiving home visitation services

AbstractObjectiveThe purpose of this study was to examine changes in relationship quality and couple conflict in low‐income parents.BackgroundWhen welcoming a new child, couples often report increased conflict and a decline in relationship quality. However, some scholars maintain couples can transition to parenthood with few negative effects. Low‐income, unmarried, and experienced parents remain understudied.MethodUtilizing data from a broader parent education project, the study employed dyadic latent growth curve analysis to examine changes over time in relationship quality and conflict. Participants were 216 low‐income couples receiving home visitation services who reported on relationship quality and conflict at three time points. Differences between first‐time and multiparous parents and among married, cohabiting, and non‐residential opposite‐sex couples were examined.ResultsTrajectories of relationship quality and conflict were stable over time. Compared to married and cohabiting couples, non‐residential couples reported lower initial relationship quality. When comparing cohabiting and non‐residential couples, couples with higher expectations of marriage had higher initial relationship quality and lower initial conflict.ConclusionSome couples navigate the transition to parenthood without negative relationship effects, especially those with higher initial quality, lower initial conflict, and greater expectations of marriage. Implications Policy and practice supporting relationship stability in low‐income couples should incorporate a strengths‐based approach.

Parenting stress in lockdown: The role of changes in Children's routines and Parents' relationship with live‐in grandparents

AbstractObjectivesThis study examined parenting stress in relation to changes in preschool‐aged children's routines and change in relationship quality between parents and live‐in grandparents caused by the lockdown.BackgroundThe Chinese city of Wuhan was the first city in the world to enforce a strict citywide lockdown to curtail the spread of Covid‐19. The 76‐day (1/23–4/8/2020) lockdown affected about 13 million of Wuhan's residents, many of whom were families with young children.MethodSurvey data were collected from 130 parents in Wuhan on parenting stress, children's routines in learning, play/exercise, screen exposure and sleep before, during and after the lockdown.ResultsThe lockdown led to a significant decrease in the amount of time that the children spent daily in playing/exercise and learning, but a significant increase in nighttime sleep and screen exposure. Hierarchical linear regression analyses showed that controlling for other variables, the following significantly predicted parenting stress: decrease in learning time, parent–grandparent relationship deterioration, and the interaction between decrease in learning time and parent–grandparent relationship improvement.ConclusionMinimizing loss of learning time and preventing parent–grandparent relationship deterioration could help reduce parenting stress during the lockdown.

Changes in Relationship Quality in the COVID-19 Pandemic: Associations with Pandemic Stressors and Couple Communication

Little is known about how positive relationship quality (PRQ) and negative relationship quality (NRQ) changed in the context of romantic relationships during the early phases of the COVID-19 pandemic. Adults in relationships (N = 359) completed self-report measures between April and August of 2020. Participants experienced early increases in both PRQ and NRQ, followed by uniform decline in PRQ but a more variable trajectory of NRQ across couples. Higher NRQ was generally associated with greater pandemic impacts and greater fear of COVID (this latter association weakened over time). Supportive COVID-related communication was associated with higher PRQ and lower NRQ.

Perceptions of Relationship Quality Before and During COVID-19 Pandemic Among Young Sexual Minority Men in Romantic Relationships.

The COVID-19 pandemic has impacted the well-being of people worldwide; however, there has been limited research examining ways in which the pandemic has created changes in relationship quality among young sexual minority men. We analyzed data from a sample of 150 young sexual minority men, aged 15–24 years. In total, 25% reported their relationship quality decreased during the pandemic, 47% reported no change, and 28% reported increased relationship quality due to COVID-19. In multinomial models, intimate partner violence, lower commitment, and spending less time with a partner due to COVID-19 were associated with decreased relationship quality during the pandemic compared to those who reported no change or increased relationship quality due to the pandemic. More efforts are needed to understand and address the impact of COVID-19 on the romantic relationships of young sexual minority men.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10508-021-02254-8.

Attachment anxiety, tracking accuracy, and biased memory of prior relationship evaluations

AbstractCurrent and recent relationship evaluations offer important information about the strength and stability of relationships. The diagnostic value of relationship evaluations should motivate people to accurately recall recent changes in relationship quality (tracking accuracy) but may also increase sensitivity to times of low relationship quality (directional bias). Such a vigilant pattern of tracking accuracy and negatively biased memories of relationship quality should be amplified for those high in attachment anxiety. The current study used repeated assessments to compare memories of relationship quality across several weeks with actual evaluations of relationship quality gathered in prior weeks (787 weekly reports, N = 113, 94% women). People high in attachment anxiety more accurately tracked the ups and downs of past relationship quality, but also remembered times of low relationship quality to be lower than actually reported. People high in attachment anxiety also experienced greater depressed moods across weeks when they remembered their relationship quality more negatively. These results have important implications for understanding inconsistencies in prior research and the links between attachment anxiety and depressed mood.

A longitudinal examination of the reciprocal relationship between borderline personality features and interpersonal relationship quality.

Interpersonal dysfunction is a core characteristic of borderline personality disorder (BPD). Cross-sectional research suggests that higher BPD features are associated with lower relationship quality. Many researchers have examined the associations between interpersonal stressors and short-term increases in emotional reactivity or impulsivity among those with high levels of BPD features. Yet, most research paradigms assume that interpersonal stressors change over time, whereas BPD features remain relatively stable; however, the stability of BPD features in the context of fluctuating interpersonal stressors has yet to be tested longitudinally. In the current study, we examined co-occurring changes in relationship quality and BPD features over time. In Study 1, 126 female, undergraduate participants completed ratings of relationship quality (i.e., conflict, criticism, closeness, satisfaction, and support) with recent interpersonal partners as well as self-reported BPD features at baseline and 1-month follow-up. In Study 2, 50 female participants from the community (n = 27 with BPD; n = 23 without any psychiatric diagnoses) completed the same measures at baseline and 1-, 3-, and 6-month follow-ups. Across both studies, when participants reported decreases in the quality of their interpersonal relationships, they endorsed increases in BPD features. Similarly, when participants endorsed worsening BPD features, their perceptions of relationship quality with all recent interaction partners (in Study 1) or more frequent interaction partners (in Study 2) decreased as well. Even in samples with a wide range of BPD features, these results suggest that the quality of interpersonal relationships and BPD features may influence each other over time. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Changes in Frequency and Patterns of Marital Sexual Activity During COVID-19: Evidence From Longitudinal Data Prior to, During and After Lockdown in Singapore

BackgroundThe literature suggests that the pandemic has affected sexual activity and sexual desire around the world, potentially due to increased levels of stress, movement restrictions under lockdown conditions, and changes in relationship quality. AimTo investigate changes in frequency and patterns of marital sexual activity and the role of potential factors underlying these changes, during and after COVID-19 lockdown. MethodsThis longitudinal study followed 409 heterosexual married female participants who completed a baseline survey in April–July 2018 and biweekly online surveys over the next 14 weeks; an online survey in May 2020 during the lockdown in Singapore; and an online survey in June 2020 after the lockdown was lifted. Participants were recruited in 2018 using street intercept and screened for inclusion and exclusion criteria. Logistic fixed-effects models were used to test for changes in frequency and patterns of marital sexual activity and assess underlying factors. Pseudo-design-based sample weights were applied. OutcomesThe 2018 in-person baseline survey collected information on demographic characteristics and ideal frequency of marital sex, while follow-up online questionnaires in May–June 2020 included items on exact dates of marital sexual activity of previous weeks; stress and fatigue levels; both spouses’ stay-at-home statuses during lockdown; and marital satisfaction. Results409 heterosexual married women were included in this study. Compared to pre-pandemic levels, the proportion of participants not having marital sex within a week remained stable while weekly sexual frequency increased, with more evenly distributed sexual activity on weekdays and weekends. Stress, fatigue, and marital satisfaction levels predicted probability of non-activity and sexual frequency. Clinical TranslationThe increase in weekly sexual frequency has implications for sexual and reproductive health, including sexual satisfaction and prevalence of infertility and low birth weight associated with waiting time to pregnancy. Strengths & LimitationsThe longitudinal nature of the dataset provides unique insights into differences in frequency of marital sexual activity during compared to before the pandemic. Unlike previous studies, detailed data on exact dates of sexual activity allow for detection of differences in sexual activity by day of the week. However, dates of sexual activity were recorded retrospectively and may contain recall errors. Data were collected only from wives and hence dates of marital sexual activities were not cross-validated with husbands. ConclusionResults point to more active and flexible marital sex lives during the pandemic, with effects that persisted after the lockdown ended.Tan PL. Changes in Frequency and Patterns of Marital Sexual Activity During COVID-19: Evidence From Longitudinal Data Prior to, During and After Lockdown in Singapore. J Sex Med 2022;19:188–200.

Family relationship quality during the COVID-19 pandemic: The value of adolescent perceptions of change

IntroductionAdolescents typically spend decreasing amounts of time with family members, but the COVID-19 pandemic changed this pattern for many youth. The objective of the current study was to better understand adolescents' perceived change in family relationship quality, and how these perceptions were related to psychosocial functioning during the COVID-19 pandemic, accounting for more traditional measures of family relationship quality. Understanding how adolescents perceived change in relationship quality with family members during the pandemic offers novel insight into adolescents’ relationships with their families and psychosocial functioning during this period. MethodA sample of Canadian adolescents (N = 605, ages 14 to 18, 53% girls), was employed to examine patterns of adolescents’ perceived change in relationship quality with parents and siblings since the start of the pandemic, accounting for relationship quality, pandemic-related characteristics, and demographic variables. ResultsFour latent profiles were identified: youth who perceived (1) low change, (2) improvement only, (3) moderate instability and (4) high instability in relationship quality. Higher perceived instability was associated with poorer functioning, with youth who reported only improvement reporting the highest overall level of functioning. ConclusionsAdolescent perceptions of change in relationship quality were heterogeneous, and contribute to psychosocial functioning over and above their general evaluations of relationship quality. In particular, youth who perceive considerable change in their relationships with siblings and parents may require additional support in response to the COVID-19 pandemic.