Impact of COVID-19 lockdown on mental health in Germany: longitudinal observation of different mental health trajectories and protective factors

Abstract

The COVID-19 pandemic and resulting measures can be regarded as a global stressor. Cross-sectional studies showed rather negative impacts on people's mental health, while longitudinal studies considering pre-lockdown data are still scarce. The present study investigated the impact of COVID-19 related lockdown measures in a longitudinal German sample, assessed since 2017. During lockdown, 523 participants completed additional weekly online questionnaires on e.g., mental health, COVID-19-related and general stressor exposure. Predictors for and distinct trajectories of mental health outcomes were determined, using multilevel models and latent growth mixture models, respectively. Positive pandemic appraisal, social support, and adaptive cognitive emotion regulation were positively, whereas perceived stress, daily hassles, and feeling lonely negatively related to mental health outcomes in the entire sample. Three subgroups ("recovered," 9.0%; "resilient," 82.6%; "delayed dysfunction," 8.4%) with different mental health responses to initial lockdown measures were identified. Subgroups differed in perceived stress and COVID-19-specific positive appraisal. Although most participants remained mentally healthy, as observed in the resilient group, we also observed inter-individual differences. Participants' psychological state deteriorated over time in the delayed dysfunction group, putting them at risk for mental disorder development. Consequently, health services should especially identify and allocate resources to vulnerable individuals.

Fig. 1. Timing of data acquisition relative to the development of the pandemic in Germany.

For footnotes, see the references, ^a[61], ^b[62], ^c[63], ^d[64], ^e[65], and ^f[51].

Fig. 2. Daily hassles pre- and during lockdown.

Mean scores and standard errors of the occurence of daily hassles prior to the lockdown and during weeks 1–8.

Fig. 3. Mean scores and standard errors of mental dysfunctions (GHQ-28) prior to the lockdown and during weeks 1–8.

The proposed threshold for significant distress is a total sum score of 23/24 [66].

Fig. 4. Quadratic growth mixture model (GMM) with three-class solution.

Final proportions for the latent classes based on their most likely latent class membership: “recovered” class 1 blue = 9.0% (n = 47), “resilient” class 2 green = 82.6% (n = 432), “delayed dysfunction” class 3 red = 8.4% (n = 44).

Fig. 5. Comparison of three latent classes (see Fig. 4) over the 8-week time frame.

a PHQ-4 means, b PSS-10 means, c positive appraisal sum scores (CAP), d mean loneliness scores (low values on the Loneliness Scale indicate strong feelings of loneliness), e mean of COVID-19-related events strain, f mean frequency of COVID-19-related events. PHQ-4, mean of signs of depression and anxiety; PSS-10, perceived stress; Class 1 blue, “recovered”; Class 2 green, “resilient”; Class 3 red, “delayed dysfunction”.