Factors Associated With Psychological Disturbances During the COVID-19 Pandemic: Multicountry Online Study

Abstract

Background: Accumulating evidence suggests that the COVID-19 pandemic has negatively impacted the mental health of individuals. However, the susceptibility of individuals to be impacted by the pandemic is variable, suggesting potential influences of specific factors related to participants' demographics, attitudes, and practices.

Objective: We aimed to identify the factors associated with psychological symptoms related to the effects of the first wave of the pandemic in a multicountry cohort of internet users.

Methods: This study anonymously screened 13,332 internet users worldwide for acute psychological symptoms related to the COVID-19 pandemic from March 29 to April 14, 2020, during the first wave of the pandemic amidst strict lockdown conditions. A total of 12,817 responses were considered valid. Moreover, 1077 participants from Europe were screened a second time from May 15 to May 30, 2020, to ascertain the presence of psychological effects after the ease down of restrictions.

Results: Female gender, pre-existing psychiatric conditions, and prior exposure to trauma were identified as notable factors associated with increased psychological symptoms during the first wave of COVID-19 (P<.001). The same factors, in addition to being related to someone who died due to COVID-19 and using social media more than usual, were associated with persistence of psychological disturbances in the limited second assessment of European participants after the restrictions had relatively eased (P<.001). Optimism, ability to share concerns with family and friends like usual, positive prediction about COVID-19, and daily exercise were related to fewer psychological symptoms in both assessments (P<.001).

Conclusions: This study highlights the significant impact of the COVID-19 pandemic at the worldwide level on the mental health of internet users and elucidates prominent associations with their demographics, history of psychiatric disease risk factors, household conditions, certain personality traits, and attitudes toward COVID-19.

Keywords: COVID-19; depression; general psychological disturbance; global; mental health; pandemic; posttraumatic stress disorder.

Figure 1

Geodemographic representation of global mental health burden. The three maps present mean scores from the World Health Organization (WHO) Self-Reporting Questionnaire-20 (SRQ), Impact of Event Scale (IES), and Beck Depression Inventory II (BDI). The means were calculated separately for each of the countries and for each WHO region. The total number of responders is 12,817. First panel: mean scores for the SRQ, indicating general psychological disturbance; Second panel: mean scores for the IES, indicating risk for posttraumatic stress disorder (PTSD); Third panel: mean scores for the BDI, indicating risk for depression. All mean scores were calculated separately for the featured countries and WHO regions.

Figure 2

Risk and resilience factors for general psychological disturbance (Self-Reporting Questionnaire-20 [SRQ]), risk for posttraumatic stress disorder (PTSD) (Impact of Event Scale [IES]), and depression (Beck Depression Inventory II [BDI]). These foster plots show the mean estimates and the 95% CIs for adjusted coefficients significantly affecting SRQ, IES, and BDI scores generated through multiple regression models. Only factors that survived Bonferroni correction for multiple comparisons (P<.017) are listed. Factors associated with an increase in scores are shown in red, while those associated with a decrease in scores are in blue.

Figure 3

Violin plots indicating the effects of selected factors on general psychological disturbance (Self-Reporting Questionnaire-20 [SRQ]), risk for posttraumatic stress disorder (PTSD) (Impact of Event Scale [IES]), and depression (Beck Depression Inventory II [BDI]). These plots provide a relation between the participant scores on the SRQ, IES, and BDI and participant characteristics (previous history of a psychiatric condition, past exposure to trauma, prediction about COVID-19 resolution, level of optimism, gender, and daily physical activity/sports) adjusted for confounding variables through multiple regression models. Boxplots display the distribution of the selected factors with the visualization of five summary statistics (minimum, maximum, median, first quartile, and third quartile), and all outliers individually. Violin plots added behind the boxplots visualize the probability density of selected factors. Parallel to the x-axis, dashed lines present cutoffs for the scales used. For the BDI, Ext is “extreme,” 40+ points, extreme depression; Sev is “severe,” 31-40 points, severe depression; Mod is “moderate,” 21-30 points, moderate depression; Brd is “borderline,” 17-20 points, borderline clinical depression; Mld is “mild,” 11-16 points, mild mood disturbance; and Nrm is “normal,” 1-10 points, considered normal. For the SRQ, Con is “concern,” 8-20 points, clinical concern for general psychological disturbance and Nrm is “normal,” 0-7 points. For the IES, Sev is “severe,” 37+ points, symptoms high enough to suppress the immune system; PTSD is “posttraumatic stress disorder,” 34-36 points; Con is “clinical concern for possible PTSD,” 24-33 points; and Nrm is “Normal,” 0-23 points.

Figure 4

Factors associated with general psychological disturbance in the second assessment. These foster plots show the mean estimates and the 95% CIs for adjusted coefficients affecting the Self-Reporting Questionnaire-20 (SRQ) generated through multiple regression. Panel A shows fixed factors for SRQ scores during the second assessment. Panel B indicates interaction terms included in our regression model, indicating a significant difference between the fixed effects and SRQ scores during the first phase of the data collection and the second assessment. Factors increasing the SRQ score are shown in red, and factors decreasing the SRQ score are shown in blue.