{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T12:59:01Z","timestamp":1790773141809,"version":"4.1.0"},"reference-count":49,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2021,12,1]],"date-time":"2021-12-01T00:00:00Z","timestamp":1638316800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>(1) Background: Little is known about how the COVID-19 pandemic has impacted social support and loneliness over time and how this may predict subsequent mental health problems. This study aims to determine longitudinal trajectories of social support and loneliness in the French general population during the first year of the COVID-19 pandemic and study whether variations in these trajectories are associated with symptoms of depression and anxiety; (2) Methods: Analyses were based on data from 681 French participants in the international COVID-19 Mental Health Study (COMET) study, collected at four periods of time between May 2020 and April 2021. Group-based trajectory modelling (GBTM) was used to determine social support and loneliness trajectories. Associations between the identified trajectories and symptoms of depression and anxiety, measured with the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder scale (GAD-7), were tested through multivariate linear regression models; (3) Results: Social support trajectories revealed four stable groups: \u2018poor\u2019 (17.0%), \u2018moderate\u2019 (42.4%), \u2018strong\u2019 (35.4%) and \u2018very strong\u2019 (5.1%). Loneliness trajectories also identified four groups: \u2018low stable\u2019 (17.8%), \u2018low rising\u2019 (40.2%), \u2018moderate stable\u2019 (37.6%) and \u2018high rising\u2019 (5.0%). Elevated symptoms of depression were associated with poor social support as well as all identified loneliness trajectories, while high levels of anxiety were associated with moderate stable and high rising loneliness trajectories; (4) Conclusions: High and increasing levels of loneliness are associated with increased symptoms of depression and anxiety during the pandemic. Interventions to address loneliness are essential to prevent common mental health problems during the pandemic and afterwards.<\/jats:p>","DOI":"10.3390\/ijerph182312677","type":"journal-article","created":{"date-parts":[[2021,12,2]],"date-time":"2021-12-02T02:40:02Z","timestamp":1638412802000},"page":"12677","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":39,"title":["Impact of Longitudinal Social Support and Loneliness Trajectories on Mental Health during the COVID-19 Pandemic in France"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1162-468X","authenticated-orcid":false,"given":"Sandy","family":"Laham","sequence":"first","affiliation":[{"name":"Social Epidemiology Research Team, Institut Pierre Louis d\u2019\u00c9pid\u00e9miologie et de Sant\u00e9 Publique, Sorbonne Universit\u00e9, INSERM U1136, 75012 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leticia","family":"Bertuzzi","sequence":"additional","affiliation":[{"name":"Social Epidemiology Research Team, Institut Pierre Louis d\u2019\u00c9pid\u00e9miologie et de Sant\u00e9 Publique, Sorbonne Universit\u00e9, INSERM U1136, 75012 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9872-3690","authenticated-orcid":false,"given":"S\u00e9verine","family":"Deguen","sequence":"additional","affiliation":[{"name":"Social Epidemiology Research Team, Institut Pierre Louis d\u2019\u00c9pid\u00e9miologie et de Sant\u00e9 Publique, Sorbonne Universit\u00e9, INSERM U1136, 75012 Paris, France"},{"name":"Department of Environmental and Occupational Health, EHESP School of Public Health, 35043 Rennes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irwin","family":"Hecker","sequence":"additional","affiliation":[{"name":"Social Epidemiology Research Team, Institut Pierre Louis d\u2019\u00c9pid\u00e9miologie et de Sant\u00e9 Publique, Sorbonne Universit\u00e9, INSERM U1136, 75012 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Melchior","sequence":"additional","affiliation":[{"name":"Social Epidemiology Research Team, Institut Pierre Louis d\u2019\u00c9pid\u00e9miologie et de Sant\u00e9 Publique, Sorbonne Universit\u00e9, INSERM U1136, 75012 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8093-8530","authenticated-orcid":false,"given":"Martina","family":"Patan\u00e8","sequence":"additional","affiliation":[{"name":"World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Institute, Vrije Universiteit, 1081 HV Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2861-7294","authenticated-orcid":false,"given":"Irene","family":"Pinucci","sequence":"additional","affiliation":[{"name":"World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Institute, Vrije Universiteit, 1081 HV Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5430-9810","authenticated-orcid":false,"given":"Marit","family":"Sijbrandij","sequence":"additional","affiliation":[{"name":"World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Institute, Vrije Universiteit, 1081 HV Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5324-1372","authenticated-orcid":false,"given":"Judith","family":"van der Waerden","sequence":"additional","affiliation":[{"name":"Social Epidemiology Research Team, Institut Pierre Louis d\u2019\u00c9pid\u00e9miologie et de Sant\u00e9 Publique, Sorbonne Universit\u00e9, INSERM U1136, 75012 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,12,1]]},"reference":[{"key":"ref_1","unstructured":"(2021, July 31). Coronavirus: Chiffres Cl\u00e9s et Evolution de la COVID-19 en France et dans le Monde. Available online: https:\/\/www.santepubliquefrance.fr\/dossiers\/coronavirus-covid-19\/coronavirus-chiffres-cles-et-evolution-de-la-covid-19-en-france-et-dans-le-monde."},{"key":"ref_2","unstructured":"De D\u00e9claration, M. (2021, May 15). Emmanuel Macron, Pr\u00e9sident de la R\u00e9publique, sur la Mobilisation Face \u00e0 L\u2019\u00e9pid\u00e9mie de COVID-19, la Guerre Sanitaire Contre le Coronavirus et sur les Nouvelles Mesures Adopt\u00e9es Report du 2e Tour des Municipales, Suspension des R\u00e9formes. Available online: https:\/\/www.vie-publique.fr\/discours\/273933-emmanuel-macron-16-mars-2020-coronavirus-confinement-municipales."},{"key":"ref_3","unstructured":"(2021, May 15). Covid-19: Un 2e Confinement National \u00e0 Compter du 29 Octobre Minuit. Available online: https:\/\/www.vie-publique.fr\/en-bref\/276947-covid-19-un-2e-confinement-national-compter-du-29-octobre-minuit."},{"key":"ref_4","unstructured":"De D\u00e9claration, M. (2021, May 15). Jean Castex, Premier Ministre, sur les Nouvelles Mesures de Lutte Contre L\u2019\u00e9pid\u00e9mie de Covid-19 (Restrictions Etendues \u00e0 L\u2019ensemble du Territoire, Fermeture des Ecoles Pour 3 Semaines), \u00e0 l\u2019Assembl\u00e9e Nationale le 1er Avril. Available online: https:\/\/www.vie-publique.fr\/discours\/279306-jean-castex-01042021-extension-mesures-anti-covid-fermeture-ecoles."},{"key":"ref_5","unstructured":"(2021, May 15). Loi du 9 Juillet 2020 Organisant la Sortie de L\u2019\u00e9tat D\u2019urgence Sanitaire. Available online: https:\/\/www.vie-publique.fr\/loi\/274501-loi-9-juillet-2020-organisant-la-sortie-de-letat-durgence-sanitaire."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1016\/S0140-6736(20)30460-8","article-title":"The psychological impact of quarantine and how to reduce it: Rapid review of the evidence","volume":"395","author":"Brooks","year":"2020","journal-title":"Lancet"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1056\/NEJMp2008017","article-title":"Mental Health and the Covid-19 Pandemic","volume":"383","author":"Pfefferbaum","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"113599","DOI":"10.1016\/j.psychres.2020.113599","article-title":"Prevalence of symptoms of depression, anxiety, insomnia, posttraumatic stress disorder, and psychological distress among populations affected by the COVID-19 pandemic: A systematic review and meta-analysis","volume":"295","author":"Noorishad","year":"2021","journal-title":"Psychiatry Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1007\/s00406-020-01196-x","article-title":"Mental health effects of infection containment strategies: Quarantine and isolation\u2014a systematic review and meta-analysis","volume":"271","author":"Henssler","year":"2021","journal-title":"Eur. Arch. Psychiatry Clin. Neurosci."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"113190","DOI":"10.1016\/j.psychres.2020.113190","article-title":"The psychological and mental impact of coronavirus disease 2019 (COVID-19) on medical staff and general public\u2014A systematic review and meta-analysis","volume":"291","author":"Luo","year":"2020","journal-title":"Psychiatry Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1186\/s12992-020-00589-w","article-title":"Prevalence of stress, anxiety, depression among the general population during the COVID-19 pandemic: A systematic review and meta-analysis","volume":"16","author":"Salari","year":"2020","journal-title":"Glob. Health"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Wang, Y., Kala, M.P., and Jafar, T.H. (2020). Factors associated with psychological distress during the coronavirus disease 2019 (COVID-19) pandemic on the predominantly general population: A systematic review and meta-analysis. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0244630"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/j.jad.2020.08.001","article-title":"Impact of COVID-19 pandemic on mental health in the general population: A systematic review","volume":"277","author":"Xiong","year":"2020","journal-title":"J. Affect. Disord."},{"key":"ref_14","unstructured":"(2021, May 31). CoviPrev: Une Enqu\u00eate Pour Suivre L\u2019\u00e9volution des Comportements et de la Sant\u00e9 Mentale Pendant L\u2019\u00e9pid\u00e9mie de COVID-19. Available online: https:\/\/www.santepubliquefrance.fr\/etudes-et-enquetes\/coviprev-une-enqu\u00eate-pour-suivre-l\u2019\u00e9volution-des-comportements-et-de-la-sante-mentale-pendant-l-epidemie-de-covid-19."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1037\/0003-066X.59.1.20","article-title":"Loss, Trauma, and Human Resilience: Have We Underestimated the Human Capacity to Thrive After Extremely Aversive Events?","volume":"59","author":"Bonanno","year":"2004","journal-title":"Am. Psychol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1192\/bjp.bp.115.169094","article-title":"Social support and protection from depression: Systematic review of current findings in Western countries","volume":"209","author":"Honkaniemi","year":"2016","journal-title":"Br. J. Psychiatry"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1037\/0033-2909.98.2.310","article-title":"Stress, social support, and the buffering hypothesis","volume":"98","author":"Cohen","year":"1985","journal-title":"Psychol. Bull."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Kocalevent, R.-D., Berg, L., Beutel, M.E., Hinz, A., Zenger, M., H\u00e4rter, M., Nater, U., and Br\u00e4hler, E. (2018). Social support in the general population: Standardization of the Oslo social support scale (OSSS-3). BMC Psychol., 6.","DOI":"10.1186\/s40359-018-0249-9"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1893","DOI":"10.1111\/jonm.13336","article-title":"Psychological resilience, coping behaviours and social support among health care workers during the COVID-19 pandemic: A systematic review of quantitative studies","volume":"29","author":"Labrague","year":"2021","journal-title":"J. Nurs. Manag."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Fluharty, M., Bu, F., Steptoe, A., and Fancourt, D. (2020). Association of Coping Strategies with Mental Health Trajectories During the First Twenty-One Weeks of COVID-19 Lockdown [Internet]. PsyArXiv, Available online: psyarxiv.com\/hy5wb.","DOI":"10.31234\/osf.io\/hy5wb"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Zhou, Y., MacGeorge, E.L., and Myrick, J.G. (2020). Mental Health and Its Predictors during the Early Months of the COVID-19 Pandemic Experience in the United States. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17176315"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1007\/s12160-010-9210-8","article-title":"Loneliness Matters: A Theoretical and Empirical Review of Consequences and Mechanisms","volume":"40","author":"Hawkley","year":"2010","journal-title":"Ann. Behav. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1037\/0882-7974.21.1.140","article-title":"Loneliness as a specific risk factor for depressive symptoms: Cross-sectional and longitudinal analyses","volume":"21","author":"Cacioppo","year":"2006","journal-title":"Psychol. Aging"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1177\/0020764018776349","article-title":"The effect of loneliness on depression: A meta-analysis","volume":"64","author":"Erzen","year":"2018","journal-title":"Int. J. Soc. Psychiatry"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1080\/13607860500193138","article-title":"Associations between loneliness, depressive symptoms and perceived togetherness in older people","volume":"9","author":"Tiikkainen","year":"2005","journal-title":"Aging Ment. Health"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"100020","DOI":"10.1016\/j.lanepe.2020.100020","article-title":"Loneliness, worries, anxiety, and precautionary behaviours in response to the COVID-19 pandemic: A longitudinal analysis of 200,000 Western and Northern Europeans","volume":"2","author":"Varga","year":"2021","journal-title":"Lancet Reg. Health Eur."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"113117","DOI":"10.1016\/j.psychres.2020.113117","article-title":"Loneliness: A signature mental health concern in the era of COVID-19","volume":"290","author":"Killgore","year":"2020","journal-title":"Psychiatry Res."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1016\/j.bbi.2020.05.040","article-title":"Mental health consequences during the initial stage of the 2020 Coronavirus pandemic (COVID-19) in Spain","volume":"87","author":"Castellanos","year":"2020","journal-title":"Brain Behav. Immun."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"509","DOI":"10.3928\/0048-5713-20020901-06","article-title":"The PHQ-9: A New Depression Diagnostic and Severity Measure","volume":"32","author":"Kroenke","year":"2002","journal-title":"Psychiatr. Ann."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1001\/archinte.166.10.1092","article-title":"A Brief Measure for Assessing Generalized Anxiety Disorder: The GAD-7","volume":"166","author":"Spitzer","year":"2006","journal-title":"Arch. Intern. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1016\/j.yebeh.2016.02.015","article-title":"Rapid detection of generalized anxiety disorder and major depression in epilepsy: Validation of the GAD-7 as a complementary tool to the NDDI-E in a French sample","volume":"57","author":"Lagarde","year":"2016","journal-title":"Epilepsy Behav."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"McNeely, J., Strauss, S.M., Saitz, R., Cleland, C.M., Palamar, J.J., Rotrosen, J., and Gourevitch, M.N. (2015). A Brief Patient Self-administered Substance Use Screening Tool for Primary Care: Two-site Validation Study of the Substance Use Brief Screen (SUBS). Am. J. Med., 128.","DOI":"10.1016\/j.amjmed.2015.02.007"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1037\/1082-989X.6.1.18","article-title":"Analyzing developmental trajectories of distinct but related behaviors: A group-based method","volume":"6","author":"Nagin","year":"2001","journal-title":"Psychol. Methods"},{"key":"ref_34","first-page":"451","article-title":"The GRoLTS-Checklist: Guidelines for Reporting on Latent Trajectory Studies","volume":"24","author":"Sijbrandij","year":"2016","journal-title":"Struct. Equ. Modeling Multidiscip. J."},{"key":"ref_35","first-page":"1","article-title":"mice: Multivariate Imputation by Chained Equations in R","volume":"45","year":"2011","journal-title":"J. Stat. Soft."},{"key":"ref_36","unstructured":"(2021, May 15). RStudio|Open Source & Professional Software for Data Science Teams. Available online: https:\/\/rstudio.com\/."},{"key":"ref_37","unstructured":"(2021, May 31). Mental Well-Being and Social Support Statistics. Available online: https:\/\/ec.europa.eu\/eurostat\/statistics-explained\/index.php?title=Mental_well-being_and_social_support_statistics."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"566965","DOI":"10.3389\/fpsyg.2020.566965","article-title":"Perceived Social Support Protects Lonely People Against COVID-19 Anxiety: A Three-Wave Longitudinal Study in China","volume":"11","author":"Xu","year":"2020","journal-title":"Front. Psychol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"113521","DOI":"10.1016\/j.socscimed.2020.113521","article-title":"Loneliness during a strict lockdown: Trajectories and predictors during the COVID-19 pandemic in 38,217 United Kingdom adults","volume":"265","author":"Bu","year":"2020","journal-title":"Soc. Sci. Med."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Beutel, M.E., Klein, E.M., Br\u00e4hler, E., Reiner, I., J\u00fcnger, C., Michal, M., Wiltink, J., Wild, P.S., M\u00fcnzel, T., and Lackner, K.J. (2017). Loneliness in the general population: Prevalence, determinants and relations to mental health. BMC Psychiatry, 17.","DOI":"10.1186\/s12888-017-1262-x"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"3222","DOI":"10.3389\/fpsyg.2020.579181","article-title":"Safe but Lonely? Loneliness, Anxiety, and Depression Symptoms and COVID-19","volume":"11","author":"Okruszek","year":"2020","journal-title":"Front. Psychol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"589127","DOI":"10.3389\/fpsyt.2020.589127","article-title":"Loneliness and Social Distancing During the COVID-19 Pandemic: Risk Factors and Associations with Psychopathology","volume":"11","author":"Hoffart","year":"2020","journal-title":"Front. Psychiatry"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1207\/s15327752jpa6601_2","article-title":"UCLA Loneliness Scale (Version 3): Reliability, Validity, and Factor Structure","volume":"66","author":"Russell","year":"1996","journal-title":"J. Personal. Assess."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1177\/0164027506289723","article-title":"A 6-Item Scale for Overall, Emotional, and Social Loneliness: Confirmatory Tests on Survey Data","volume":"28","author":"Gierveld","year":"2006","journal-title":"Res. Aging"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1017\/S0959259805001723","article-title":"Measuring loneliness in later life: A comparison of differing measures","volume":"15","author":"Victor","year":"2005","journal-title":"Rev. Clin. Gerontol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1007\/s00127-017-1392-y","article-title":"A life less lonely: The state of the art in interventions to reduce loneliness in people with mental health problems","volume":"52","author":"Mann","year":"2017","journal-title":"Soc. Psychiatry Psychiatr. Epidemiol."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Williams, C.Y.K., Townson, A.T., Kapur, M., Ferreira, A.F., Nunn, R., Galante, J., Phillips, V., Gentry, S., and Usher-Smith, J.A. (2021). Interventions to reduce social isolation and loneliness during COVID-19 physical distancing measures: A rapid systematic review. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0247139"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1016\/S0005-7894(04)80028-5","article-title":"Mindfulness-based relationship enhancement","volume":"35","author":"Carson","year":"2004","journal-title":"Behav. Ther."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"100368","DOI":"10.1016\/j.invent.2021.100368","article-title":"A pilot randomized controlled trial of a group intervention via Zoom to relieve loneliness and depressive symptoms among older persons during the COVID-19 outbreak","volume":"24","author":"Shapira","year":"2021","journal-title":"Internet Interv."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/23\/12677\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:38:27Z","timestamp":1760168307000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/23\/12677"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,1]]},"references-count":49,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2021,12]]}},"alternative-id":["ijerph182312677"],"URL":"https:\/\/doi.org\/10.3390\/ijerph182312677","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12,1]]}}}