Drastic Reductions in Mental Well-Being Observed Globally During the COVID-19 Pandemic: Results From the ASAP Survey

Jan Wilke¹, Karsten Hollander^{2

3}, Lisa Mohr¹, Pascal Edouard^{4

5}, Chiara Fossati⁶, Marcela González-Gross^{7

8}, Celso Sánchez Ramírez⁹, Fernando Laiño¹⁰, Benedict Tan¹¹, Julian David Pillay¹², Fabio Pigozzi⁶, David Jimenez-Pavon^{8

13}, Matteo C Sattler¹⁴, Johannes Jaunig¹⁴, Mandy Zhang¹¹, Mireille van Poppel¹⁴, Christoph Heidt¹⁵, Steffen Willwacher^{16

17}, Lutz Vogt¹, Evert Verhagen¹⁸, Luiz Hespanhol^{18

19}, Adam S Tenforde³

Affiliations

¹ Department of Sports Medicine, Goethe University Frankfurt, Frankfurt, Germany.
² Faculty of Medicine, Medical School Hamburg, Hamburg, Germany.
³ Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Harvard Medical School, Charlestown, MA, United States.
⁴ Inter-University Laboratory of Human Movement Science (LIBM EA 7424), University of Lyon, University Jean Monnet, Saint Etienne, France.
⁵ Department of Clinical and Exercise Physiology, Sports Medicine Unity, Faculty of Medicine, University Hospital of Saint-Etienne, Saint-Etienne, France.
⁶ Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy.
⁷ ImFine Research Group, Department of Health and Human Performance, Universidad Politécnica de Madrid, Madrid, Spain.
⁸ Exercise is Medicine Spain, Madrid, Spain.
⁹ School of Physical Activity Sciences, University of Santiago de Chile, Santiago, Chile.
¹⁰ Fundación Instituto Superior de Ciencias de la Salud, Buenos Aires, Argentina.
¹¹ Department of Sport and Exercise Medicine, Changi General Hospital, Singapore, Singapore.
¹² Department of Basic Medical Sciences, Durban University of Technology, Durban, South Africa.
¹³ MOVE-IT Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cádiz, Cádiz, Spain.
¹⁴ Institute of Human Movement Science, Sport and Health, University of Graz, Graz, Austria.
¹⁵ Department of Orthopedics, University Children's Hospital Basel, University of Basel, Basel, Switzerland.
¹⁶ School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia.
¹⁷ Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany.
¹⁸ Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam UMC, University Medical Centers-Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
¹⁹ Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, Brazil.

PMID: 33842492
PMCID: PMC8032868
DOI: 10.3389/fmed.2021.578959

Drastic Reductions in Mental Well-Being Observed Globally During the COVID-19 Pandemic: Results From the ASAP Survey

Jan Wilke et al. Front Med (Lausanne). 2021.

. 2021 Mar 26:8:578959.

doi: 10.3389/fmed.2021.578959. eCollection 2021.

Authors

Affiliations

¹ Department of Sports Medicine, Goethe University Frankfurt, Frankfurt, Germany.
² Faculty of Medicine, Medical School Hamburg, Hamburg, Germany.
³ Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Harvard Medical School, Charlestown, MA, United States.
⁴ Inter-University Laboratory of Human Movement Science (LIBM EA 7424), University of Lyon, University Jean Monnet, Saint Etienne, France.
⁵ Department of Clinical and Exercise Physiology, Sports Medicine Unity, Faculty of Medicine, University Hospital of Saint-Etienne, Saint-Etienne, France.
⁶ Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy.
⁷ ImFine Research Group, Department of Health and Human Performance, Universidad Politécnica de Madrid, Madrid, Spain.
⁸ Exercise is Medicine Spain, Madrid, Spain.
⁹ School of Physical Activity Sciences, University of Santiago de Chile, Santiago, Chile.
¹⁰ Fundación Instituto Superior de Ciencias de la Salud, Buenos Aires, Argentina.
¹¹ Department of Sport and Exercise Medicine, Changi General Hospital, Singapore, Singapore.
¹² Department of Basic Medical Sciences, Durban University of Technology, Durban, South Africa.
¹³ MOVE-IT Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cádiz, Cádiz, Spain.
¹⁴ Institute of Human Movement Science, Sport and Health, University of Graz, Graz, Austria.
¹⁵ Department of Orthopedics, University Children's Hospital Basel, University of Basel, Basel, Switzerland.
¹⁶ School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia.
¹⁷ Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany.
¹⁸ Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam UMC, University Medical Centers-Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
¹⁹ Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, Brazil.

PMID: 33842492
PMCID: PMC8032868
DOI: 10.3389/fmed.2021.578959

Abstract

Most countries affected by the COVID-19 pandemic have repeatedly restricted public life to control the contagion. However, the health impact of confinement measures is hitherto unclear. We performed a multinational survey investigating changes in mental and physical well-being (MWB/PWB) during the first wave of the pandemic. A total of 14,975 individuals from 14 countries provided valid responses. Compared to pre-restrictions, MWB, as measured by the WHO-5 questionnaire, decreased considerably during restrictions (68.1 ± 16.9 to 51.9 ± 21.0 points). Whereas 14.2% of the participants met the cutoff for depression screening pre-restrictions, this share tripled to 45.2% during restrictions. Factors associated with clinically relevant decreases in MWB were female sex (odds ratio/OR = 1.20, 95% CI: 1.11-1.29), high physical activity levels pre-restrictions (OR = 1.29, 95% CI 1.16-1.42), decreased vigorous physical activity during restrictions (OR = 1.14, 95% CI: 1.05-1.23), and working (partially) outside the home vs. working remotely (OR = 1.29, 95% CI: 1.16-1.44/OR = 1.35, 95% CI: 1.23-1.47). Reductions, although smaller, were also seen for PWB. Scores in the SF-36 bodily pain subscale decreased from 85.8 ± 18.7% pre-restrictions to 81.3 ± 21.9% during restrictions. Clinically relevant decrements of PWB were associated with female sex (OR = 1.62, 95% CI: 1.50-1.75), high levels of public life restrictions (OR = 1.26, 95% CI: 1.18-1.36), and young age (OR = 1.10, 95% CI: 1.03-1.19). Study findings suggest lockdowns instituted during the COVID-19 pandemic may have had substantial adverse public health effects. The development of interventions mitigating losses in MWB and PWB is, thus, paramount when preparing for forthcoming waves of COVID-19 or future public life restrictions.

Keywords: SF-36; WHO-5; coronavirus; lockdowns; pain; psychological health.

Copyright © 2021 Wilke, Hollander, Mohr, Edouard, Fossati, González-Gross, Sánchez Ramírez, Laiño, Tan, Pillay, Pigozzi, Jimenez-Pavon, Sattler, Jaunig, Zhang, van Poppel, Heidt, Willwacher, Vogt, Verhagen, Hespanhol and Tenforde.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

**Figure 1**
Mental well-being (mean WHO-5 sum score) pre- and during public life restrictions in all included countries. The red line indicates the cutoff score for depression screening (50%).

**Figure 2**
Prevalence [%] of musculoskeletal pain pre- and during public life restrictions stratified by body locations.

See this image and copyright information in PMC

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Drastic Reductions in Mental Well-Being Observed Globally During the COVID-19 Pandemic: Results From the ASAP Survey

Affiliations

Drastic Reductions in Mental Well-Being Observed Globally During the COVID-19 Pandemic: Results From the ASAP Survey

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources

Other Literature Sources

Miscellaneous