How the COVID‐19 pandemic has changed our lives: A study of psychological correlates across 59 countries

How the COVID‐19 pandemic has changed our lives: A study of psychological correlates across 59 countries. Elisabet Alzueta  Paul Perrin  Fiona C. Baker  Sendy Caffarra  Daniela Ramos‐Usuga  Dilara Yuksel  Juan Carlos Arango‐Lasprilla. Journal of Clinical Psychology, October 31 2020. https://doi.org/10.1002/jclp.23082

Rolf Degen's take: https://twitter.com/DegenRolf/status/1324384844302999554

Abstract

Objective: This study examined the impact of the COVID‐19 pandemic and subsequent social restrictions or quarantines on the mental health of the global adult population.

Method: A sample of 6,882 individuals (Mage = 42.30; 78.8% female) from 59 countries completed an online survey asking about several pandemic‐related changes in life and psychological status.

Results: Of these participants, 25.4% and 19.5% reported moderate‐to‐severe depression (DASS‐21) and anxiety symptoms (GAD‐7), respectively. Demographic characteristics (e.g. higher‐income country), COVID‐19 exposure (e.g., having had unconfirmed COVID‐19 symptoms), government‐imposed quarantine level, and COVID‐19‐based life changes (e.g., having a hard time transitioning to working from home; increase in verbal arguments or conflict with other adult in home) explained 17.9% of the variance in depression and 21.5% in anxiety symptoms.

Conclusions: In addition to posing a high risk to physical health, the COVID‐19 pandemic has robustly affected global mental health, so it is essential to ensure that mental health services reach individuals showing pandemic‐related depression and anxiety symptoms.

4 DISCUSSION

This study examined the effects of the COVID‐19 pandemic on the mental health of adults in the general population of five global regions, as well as the demographic risk factors that may have made depression and anxiety symptoms more likely. This is one of the first studies to provide a global perspective on the pandemic's effects on mental health. While the majority of the sample had low or mild levels of depression and anxiety symptoms during the pandemic, a significant proportion of respondents reported moderate to severe symptoms of depression (25.4%) and anxiety (19.5%). These prevalence rates help generalize to a much larger global population the high rates of mental health issues found in previous studies of specific global regions or countries (Solomou & Constantinidou, 2020). COVID‐19‐related life changes were the strongest predictors of higher depression and anxiety symptoms over and above effects of demographics, quarantine level, and COVID‐19 exposure. Myriad consequences of the pandemic, including challenges paying bills, inability to access food, conflict in the home, and separation from loved ones were linked with poorer mental health.

In line with the current results, emerging studies have consistently reported a high prevalence of depression and anxiety symptoms in populations around the world during the COVID‐19 pandemic (Ahmed et al., 2020; Gao et al., 2020; Li et al., 2020; Mazza et al., 2020; Moghanibashi‐Mansourieh, 2020, Solomou & Constantinidou, 2020; Ueda et al., 2020; Wang, Wang, et al., 2020). While most of these cross‐sectional studies—including the current study—can only show levels of and not change in depression and anxiety symptoms in the populations studied during the pandemic, a cross‐sectional study in China (Ahmed et al., 2020) comparing the psychological impact during the outbreak with an epidemiological study conducted before the pandemic (Huang et al., 2019) concluded that the rates of anxiety, depression, and alcohol consumption were higher, and mental well‐being was lower, among Chinese people during the COVID‐19 outbreak than before. In addition, a longitudinal study comparing pre‐ and during‐pandemic levels of depression, anxiety, and well‐being in two UK population cohorts reported a significant decrease in well‐being and a higher probability of anxiety disorders during the pandemic (24% in vs. the previous 13%; Kwong et al., 2020). Altogether, evidence so far points to the pandemic's negative effect on mental health.

Certain populations may be more vulnerable to the impact of the COVID‐19 pandemic on mental health. In line with previous studies (Kwong et al., 2020; Mazza et al., 2020; Moghanibashi‐Mansourieh, 2020; Solomou & Constantinidou; 2020; Stanton et al., 2020; Wang, Wang, et al., 2020), the current study found a higher prevalence of depression and anxiety symptoms among women or people with a nonbinary/transgender relative to men. These findings also are consistent with the literature showing a strong association between woman gender and a higher prevalence of anxiety and depression in the general population in nonpandemic times (Baxter et al., 2014; Kessler, 2003), suggesting gender‐role influences on coping with or reporting of mental health symptoms (Mrazek, and Haggerty, 1994; Sandanger et al., 2004). This somewhat consistent finding is complex, and researchers and theorists have postulated many explanations for it, ranging from social norms for the gender‐role based experience of emotion, to personality traits, to hormones (Albert, 2015). Whatever the source of these effects, the current findings suggest that women and nonbinary‐trans individuals may be at greater risk for mental health symptoms during the pandemic.

The current study found other demographic factors, such as younger age, not being partnered, and living in a high‐income country to be associated with higher levels of depression and anxiety symptoms during the pandemic. In terms of age, others researchers have reported that younger adults may be more vulnerable to the effects of the COVID‐19 pandemic (Moghanibashi‐Mansourieh, 2020; Qiu et al., 2020; Stanton et al., 2020), which could be a consequence of greater exposure to media, how they are affected by financial crisis, and managing workload responsibilities (Ahmed et al., 2020; Liu et al., 2020). Also, studies about previous outbreaks have attributed the greater vulnerability of young people to a less effective use of coping strategies than older adults (Yeung & Fung, 2007). The current finding that being not partnered was associated with more depression and anxiety symptoms supports findings in the general population that being separated or divorced are risk factors for some psychological disorders (Afifi et al., 2006; Andrade et al., 2003).

The finding that living in a high‐income country during the pandemic is a risk factor for depression and anxiety might seem counterintuitive, though it is in line with studies showing that citizens of these countries report more stress relative to those in low‐to‐middle income countries (Br et al., 2011). A related (and likely overlapping) finding was that countries belonging to the Latin America and Caribbean cluster showed a lower prevalence of mental health symptoms compared to countries belonging to North America, Europe and Central Asia, and Sub‐Saharan Africa clusters. Comparing psychological symptoms across different cultures and countries presents complex challenges (Van Bavel et al., 2020), and therefore these findings should be interpreted with caution. However, differences found in symptoms across global regions might in part be explained by the timing of data collection. The COVID‐19 pandemic outbreak has evolved rapidly and asynchronously across countries. At the time of data collection, the outbreak was more severe in North America, Europe, and Central Asia in comparison to the Latin America and Caribbean region (see report from World Health Organization, 2020). Prevalence studies during the pandemic have shown the severity of psychological symptoms are especially high in areas most affected by COVID‐19 (Moghanibashi‐Mansourieh, 2020; Solomou & Constantinidou, 2020). Therefore, lower levels of depression and anxiety reported in global regions might be explained by a possible lower perception of COVID‐19 severity or threat.

The main finding of this study is that even though certain demographic characteristics and COVID‐19 exposure were associated with increased symptoms of depression and anxiety, the effects that COVID‐19 had on a person's life were generally the most robust predictors of negative psychological effects. The most notable effects included the impact that the COVID‐19 pandemic had on economic stability (i.e., being unable to get enough food or healthy food, being unable to pay important bills like rent or utilities), work (i.e., having a hard time doing one's job well because of needing to take care of people in the home, having a hard time making the transition to working from home), and social aspects (i.e., being separated from family or close friends, having an increase in verbal arguments or conflict with other adults in home). Somewhat surprisingly, level of quarantine or social restrictions issued by governments at the time of data collection was not a notable predictor of depression and anxiety symptoms. Thus, depression and anxiety in the current sample were not directly accounted for by governmental restrictions but rather likely the consequences of these restrictions and the pandemic as a whole on participants’ lives. Studies from prior epidemics have shown that social isolation during a quarantine period is commonly associated with anxiety and depression symptoms (DiGiovanni et al., 2004; Hawryluck et al., 2004). Also, comparing data from a quarantined population versus no‐quarantined population during the COVID‐19 outbreak in China (n = 1593), a study reported a higher prevalence of depression (22.4% vs 11.9%) and anxiety (12.9% vs 6.7%) in the quarantined group (Lei et al., 2020).

The specific unique effects found within the regression provide evidence that COVID‐19‐related life changes, especially in home and work spheres, were associated with increased depression and anxiety symptoms. Changes in family structure and roles can cause psychological distress, ultimately affecting the relational environment at home (Prime et al., 2020). In this sense, caregivers who must adapt their work routines to care for others at home are at a higher risk of burden. In addition, results from the present study show that verbal arguments or conflicts with others at home during the confinement were very strongly associated with depression and anxiety symptoms. A previously problematic family environment combined with financial strain and social isolation—both well‐known domestic abuse risk factors (Usher et al., 2020)—might lead to escalating conflicts and violence at home during confinement. Indeed, there has been an unprecedented wave of intimate partner violence during the COVID‐19 pandemic (Campbell 2020). Economic insecurity, increase exposure to possible abusive relationships, as well as limited access to support in the community, among others, have been related to intimate partner violence during the COVID‐19 pandemic (Peterman et al. 2020). Therefore, providing accessible mental health support to vulnerable families while confined is critical.

Findings presented here need to be interpreted in the context of several study limitations. First, the ongoing COVID‐19 pandemic is a volatile phenomenon affecting countries in different ways. This cross‐sectional study represents the effects of the pandemic on an adult population in several global regions during a specific period of time (April–May 2020), and therefore, different countries and even different regions within a country were experiencing different scenarios in relation to the pandemic. However, it is important to note that many of the countries were experiencing a prominent peak in the COVID‐19 pandemic, and all participants’ countries were under some kind of social isolation measures at the time of data collection. Also, with the cross‐sectional design, it is not possible to conclude directionality of the relationships found, and people with poor mental health also could have reported worse life changes based on depression‐ or anxiety‐driven viewpoints. In addition, even while much effort was made to achieve a generalizable global sample, the representation of countries in different global regions or of specific demographic characteristics was not equal. Therefore, comparisons between global regions, and generalizability to the entire global population, must be viewed with caution. Certain global regions (e.g., North America, Europe) had a much higher representation than other regions (e.g., Asia, Africa) due to limitations in the snowball data collection approach and languages used. Due to the high representation of women in the sample, a finding commonly observed in other psychological studies (Plomecka et al., 2020; Solomou & Constantinidou, 2020), generalizations to men also should be made with an appropriate degree of caution.