Longitudinal development of depression and anxiety during COVID-19 pandemic in Germany: Findings from a population-based probability sample survey

Abstract

The stress response to the COVID-19 pandemic might differ between early and later stages. Longitudinal data on the development of population mental health during COVID-19 pandemic is scarce. We have investigated mental health trajectories and predictors for change in a probability sample of the general population in Germany at the beginning and after 6 months of the pandemic. We conducted a longitudinal survey in a population-based probability sample of German adults. The current study analyzed data from a first assessment in May 2020 (T1; N = 1,412) and a second in November 2020 (T2; N = 743). Mental health was assessed in terms of anxiety and depression using the Patient Health Questionnaire-4 (PHQ-4). Mental health outcomes at T1 were compared with PHQ-4 norm data. Trajectories over time were investigated based on outcome classifications of PHQ-4 scores. Predictors of mental health outcomes and change were identified using multiple regression analysis. In spring 2020, participants showed significantly higher PHQ-4 scores as compared to the norm data, however, overall anxiety and depression remained low also 6 months later. 6.6% of respondents showed a mental health deterioration in autumn 2020, entering subclinical and clinical ranges, outweighing the proportion of people with improved outcomes. Sociodemographic variables associated with mental distress at T1 were mainly not predictive for change at T2. Even under prolonged pandemic-related stress, mental health remained mainly stable in the general population. Further development of the considerable subgroup experiencing deterioration of depression and anxiety should be monitored, in order to tailor prevention and intervention efforts.

Stress and Depressive and Anxiety Symptoms in the General Population and in SARS-CoV-2-Infected Patients—Findings from a Population-Based Three-Wave Study

“…The results show that symptoms of depression and anxiety (measured with PHQ-4) increased during the first year of the pandemic in the general population and in individuals who were infected with SARS-CoV-2 early in the pandemic. However, this increase remained relatively small, compared with PHQ-4 norm data [7]. Although depression and anxiety seemed on average a little higher in people after SARS-CoV-2 infection compared to persons who did not report an infection, these differences were not significant.…”

“…We used data collected as part of a population-based longitudinal study with three times of measurement, examining differences between the mental health of people with a SARS-CoV-2 infection in Stuttgart, a large city in southern Germany, and a sample that was representative of the general population in that city [7].…”

“…Meanwhile, early studies showed that the prevalence of elevated depressive symptoms increased during the pandemic in the general population [4][5][6][7], such as a study of US adults reporting increases from 27.8% in 2020 to 32.8% in 2021 in the general population [8]. However, only a few studies focused on depressive symptoms in people with SARS-CoV-2 infections during the further course of the pandemic and people without an infection followed prospectively over the same time.…”

Differential associations between SARS-CoV-2 infection, perceived burden of the pandemic and mental health in the German population-based cohort for digital health research

“…A growing body of literature has therefore aimed to investigate the exact and differentiated impact of the COVID-19 pandemic on mental health. Soon after the pandemics begin in Germany in March 2020 an increase of self-reported psychosocial distress was observed in population-based studies compared to pre-pandemic levels (Giel et al, 2022). Meta-analyses pooling data from international studies reported anxiety and depression levels having the strongest increase during the pandemic (Vindegaar & Benros, 2022; Prati & Mancini, 2021; Robinson et al, 2022).…”