Mental Health Burden of the COVID-19 Outbreak in Germany: Predictors of Mental Health Impairment

Abstract

Introduction: COVID-19 is causing an enormous psychological burden for most people. This study aims to assess individual changes in mental health and health status before and after the COVID-19 outbreak, and to explore potential predictors of change.

Methods: A cross-sectional study in Germany (n = 15 037) were conducted. Demographics, depression and anxiety symptoms (PHQ-2, GAD-2), distress (DT), and health status (EQ-5D-3L) were assessed. Additionally, all instruments used were adapted to measure the participants' mental health and health status before the COVID-19 outbreak. COVID-19-related fear, trust in governmental actions to face COVID-19, and the subjective level of information about COVID-19 were examined.

Results: Overall, the participants showed a significant increase in depression and anxiety symptoms, and distress, while health status deteriorated since the COVID-19 outbreak. Impairment in mental health was predicted by COVID-19-related fear. Pre-existing mental illness predicted an increase in depression symptoms and a deterioration in health status. Trust in governmental actions and the subjective level of information predicted less increase in psychological burden.

Conclusions: Our data revealed that there have been changes in mental health and health status at an individual level since the outbreak of COVID-19. In order to maintain mental health, the observed predictors should be addressed.

Keywords: COVID-19; anxiety; changes in mental health; depression; mental health; predictors of change.

Figure 1.

Alterations in mental health between before and after the COVID-19 outbreak. Mean values and standard errors (SE) +/−1 as error bars from before (pre) and after (post) the COVID-19 outbreak of PHQ-2 = Patient Health Questionnaire-2, M_{PHQ-2 pre} = 0.91 versus M_{PHQ-2 post} = 1.14 (panel a); GAD-2 = Generalized Anxiety Disorder Scale-2, M_{GAD-2 pre} = 1.06 versus M_{GAD-2 post} = 1.52 (panel b); DT = Distress Thermometer, M_{DT pre} = 3.91 vs. M_{DT post} = 4.94 (panel c); EQ-5D-3L = European Quality of Life 5 Dimensions 3 Level, M_{EQ-5D-3L pre} = 82.32 versus M_{EQ-5D-3L post} = 80.27 (panel d).