Increase in Mental Disorders During the COVID-19 Pandemic - Role of Occupational & Financial Strains

Abstract

Background Numerous studies reported an increase in mental disorders during the COVID-19 pandemic, but the specific causes for this increase are unclear. We therefore investigate whether pandemic-related occupational and financial changes (e.g., reduced working hours, working from home, financial losses) were associated with increased symptoms of depression and anxiety compared with the situation before the pandemic. Methods We analyzed data from the German National Cohort Study (NAKO). Between May and November 2020, 161,849 participants answered questions on their mental state and social circumstances. Responses were compared with data from the baseline survey before the pandemic (2014-2019). Linear fixed-effects models were used to determine whether individual changes in the symptoms of depression (PHQ-9) or anxiety (GAD-7) were associated with occupational/financial changes (controlling for covariates). Results A pronounced increase in symptoms was observed among those who became unemployed during the pandemic (+ 1.16 points on the depression scale, 95% confidence interval [0.91; 1.41], range 0-27). Increases were also seen for reduced working hours without short-term working allowance, increased working hours, working from home, insecurity regarding employment, and financial strain. The deterioration in mental health was largely statistically explained by the occupational and financial changes investigated in the model. Conclusions Depressive symptoms and anxiety disorders increased in the study population during the first year of the COVID-19 pandemic and occupational and financial difficulties were an essential contributory factor. These strains should be taken into account both in the care of individual patients and in the planning of targeted prevention measures. Results suggest that welfare state benefits such as short-time allowance in times of crises may reduce mental load in affected populations.

Time trends of mental health indicators in Germany’s adult population before and during the COVID-19 pandemic

“…While many studies with longer observation periods reported a decline back to or almost back to pre-pandemic levels in the summer months of 2020 (30, 32, 100), symptoms of depression were sometimes found to remain elevated for longer than symptoms of anxiety (32, 101). Also contradicting our results, a large population-based cohort study in Germany found an increase in individual-level PHQ-9 mean scores during the first wave of the pandemic (53) and in population-level means and proportions of positive PHQ-9 screens from 7.1 % to 9.5 % between April and November 2020 (38). Likewise, a longitudinal study based on representative household panel data found an increase in proportions of positive PHQ-2 screens from April to June 2020 (13.8 %) compared to the year 2019 (9.6 %) (37).…”

“…In Germany, higher income individuals have, for example, been reported as showing greater declines in life satisfaction during the pandemic (49, 112). Discussed reasons include more working from home in this group (113), which has been shown to be linked to mental health declines in the pandemic (38). Moreover, this group may have experienced a more substantial change in lifestyle more generally (48), perhaps with concomitant greater expectations for the constant availability of resources (62).…”

“…However, a complex set of risk factors is likely to be at play in all education groups. Occupational and financial difficulties were identified as particularly crucial for an increase in depressive and anxiety symptoms in Germany (38). Importantly, the established social gradient in the risk of depressive symptoms remains unchanged until the end of the observation period in our study, with twice the percentage of positive screens in the low as in the high level of education group in spring/summer 2022.…”

“…According to this assumption, distributions of PHQ-based measures are commonly described by means of sum scores (e.g. 38, 49, 65, 104). Furthermore, information based on self-report can be subject to recall-bias and social desirability (118).…”

“…Importantly, two thirds of the reviewed studies are based on data collected during the first wave and the summer plateau of 2020, when COVID-19 incidence was comparatively low in Germany (35). The few studies that address the later course of the pandemic find an elevated frequency of depressive symptoms in the first months of 2021 (36,37) or of depressive and anxiety symptoms into later 2020 (37,38) compared to pre-pandemic data and an increase in mental distress (39) but a decrease in depressive and anxiety symptoms (37) in the second wave compared to the first wave. Further results from representative surveys spanning the whole pandemic period and allowing for comparisons to pre-pandemic baseline data are needed in order to adequately assess the mental health impact of the pandemic in the general population in Germany.…”