Publication date: Jul 01, 2025

The COVID-19 pandemic significantly disrupted daily life, and the transition to post-pandemic living presented additional psychological challenges. Previous research shows that individuals with obsessive-compulsive traits and pre-existing mental health histories were vulnerable to adjustment difficulties, which appear to be mediated by depression, anxiety, and stress. This study examined the relationship between post-pandemic adjustment and mental health variables in a population-based cohort during the final lifting of COVID-19 restrictions, tracking outcomes over six months to assess causality. The study was pre-registered on the Open Science Framework (https://osf. io/v4c28). A cohort of 343 UK adults was assessed online at baseline, three, and six months. Self-report measures included the Obsessive-Compulsive Inventory-Revised (OCI-R), Compulsive Personality Assessment Scale (CPAS), Depression, Anxiety, and Stress Scale-21 (DASS-21), Post-Pandemic Adjustment Scale (PPAS) and COVID-19 Safety Behaviour Scale. Cognitive flexibility was assessed using the Wisconsin Card Sorting Test (CST: at baseline) and the Intradimensional-Extradimensional Set-Shifting Task (IDED: at 3 months). Approximately 28 % of participants were identified as poor adjusters. Mediation analysis revealed that obsessive-compulsive symptoms, compulsive personality traits, and a history of mental health disorders predicted post-pandemic adjustment difficulties indirectly via depression, anxiety, and COVID-19 safety behaviours. While we found no evidence that adjustment was linked to cognitive flexibility on the WCST, exploratory analyses showed that poorer adjustment was linked to reversal learning issues on the IDED task. This study replicated our prior findings, identifying obsessive-compulsive symptoms and traits, mental health histories, and cognitive inflexibility as key risk factors for poor post-pandemic adjustment. Moreover, depression, anxiety, and stress mediated these difficulties, suggesting potential markers for identifying at-risk individuals and guiding interventions for future public health crises.

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