Does COVID-19 psychological fatigue exist? Results of three online cross-sectional studies conducted in Spain from April 2020 to March 2021

Abstract

Background: A previously published meta-analysis found that about one-third of the general population experienced some mental health problem during the early phase of the COVID-19 pandemic, potentially leading to a late mental health crisis. We aimed to describe the acute, short-term, and long-term effects of the COVID-19 pandemic on mental health.

Methods: A one-year online survey (S) was conducted in Spain (April 2020 - March 2021). We recruited 18 180 subjects using a virtual respondent-driven snowball sampling method (S1 April 2020, n = 6108; S2 October-November 2020, n = 6418; S3 March 2021, n = 5654). Participants completed the Spanish Depression, Anxiety, and Stress Scale (DASS-21).

Results: Overall, our results suggest a progressive increase in the prevalence of anxiety and stress throughout the pandemic waves and relative stability of depression. Women had a greater probability of having depression, anxiety, or stress than men in each survey (P < 0.001). The youngest group (aged 18-24) reported a higher probability (P < 0.05) of having depression, anxiety, or stress than the older groups in S1 and S2. Middle-aged people (25-59) had a greater probability of being a case in the DASS-21 scales than the oldest group (60+), except for depression in men (P = 0.179). In S3, the trend changed: the youngest group showed a decrease in depression and stress while the oldest group showed a dramatic increase (anxiety: men = 664.5%, women = 273.52%; stress: men = 786%, women = 431.37%).

Conclusions: It is plausible to conclude that COVID-19 psychological fatigue exists, especially in middle-aged and older adults. Strategies to assist people who have fewer coping skills should be implemented in the near future.

Figure 1

Evolution of the COVID-19 pandemic and the state of emergency in Spain from February 2020 to May 2021. Source: COVID-19 Data Repository by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (link: https://github.com/CSSEGISandData/COVID-19). Note: There are two corrections in the timeline due to the Spanish government’s adjustments of the overall data (05-21-2020 & 01-30-2021).

Figure 2

Depression, Anxiety, and Stress Scales, scale mean scores on each survey. Panel A. Women. Panel B. Men. DASS-21 scales mean scores and (SD) separately for women and men. In each survey, women scored significantly higher than men (P < 0.001).

Figure 3

Kernel density charts of scores on the Depression, Anxiety, and Stress Scales in each survey. Panel A. DASS Depression scale scores. DASS – Depression, Anxiety, and Stress Scales; S – Survey. Kruskal-Wallis χ² = 426.39, df = 2, P < 2.2^-16- Pairwise comparison (Wilcoxon rank sum test with continuity correction): S1 ≠ S2 ≠ S3, P < 0.001. Panel B. DASS Anxiety scale scores. DASS – Depression, Anxiety, and Stress Scales; S – Survey. Kruskal-Wallis χ² = 1434.8, df = 2, P < 2.2^-16. Pairwise comparison (Wilcoxon rank sum test with continuity correction): S1 ≠ S2 ≠ S3, P < 0.001. Panel C. DASS Stress scale scores. DASS – Depression, Anxiety, and Stress Scales, S – Survey. Kruskal-Wallis χ² = 1202.1, df = 2, P < 2.2^-16. Pairwise comparison (Wilcoxon rank sum test with continuity correction): S1 ≠ S2 and S1 ≠ S3, P < 0.001. S2 = S3. Estimation of the probable density of DASS-21 scale scores and graphical representation of their distribution in each survey.