Anxiety, depression, and social connectedness among the general population of eight countries during the COVID-19 pandemic

Abstract

Background: The COVID-19 pandemic affected the mental health of the general population through multiple pathways. The aim of this study was to examine anxiety, depression, self-confidence, and social connectedness among the general population of eight countries during the COVID-19 pandemic, their underlying factors, and vulnerable groups.

Methods: A web-based survey was administered to persons from the general population of China, Greece, Italy, Netherlands, Russia, Sweden, the United Kingdom, and the United States. The survey included the Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9) and items on self-confidence, social connectedness, and socio-demographics. Data were analyzed with descriptive statistics, exploratory factor analysis and regression analysis.

Results: Twenty-three thousand six hundred twenty-two respondents completed the survey. Overall, 42% of the total sample had mild to severe anxiety symptoms and 43% had mild to severe depression symptoms. 14% to 38% reported suboptimal ratings in self-confidence, social participation, contact with family and friends, and feeling connected to others. In the exploratory factor analyses, in most countries, one dominant factor had a high influence on GAD-7, PHQ-9 sum scores and self-confidence with eigenvalue (% variance) above 3.2 (53.9%). One less dominant factor had a high influence on social connectedness scores with eigenvalue (% variance) ranging above 0.8 (12.8%). Being younger, female, having chronic conditions, perceived as risky to COVID-19 infection, and feeling not very well protected against COVID-19 were significantly associated with the two underlying factors.

Conclusions: Anxiety, depression, and problems with self-confidence and social connectedness were highly prevalent in the general population of eight countries during the early phase of the COVID-19 pandemic. This highlights the importance of the allocation of additional resources to implement policies to mitigate the impact of the pandemic on mental health.

Keywords: Anxiety; COVID-19; Depression; Factor analysis; Social connectedness.

Fig. 1

Symptoms of anxiety (A) and depression (B) by age groups in eight-country samples

Fig. 2

The ratio of anxiety and depression prevalence between sex according to age groups

Fig. 3

Self-confidence and social connectedness variables in the eight countries. Note to figure: level 1–5 refers to “very good” to “very bad” for contact with family and friends, “no problems” to “extreme problems” for social participation and self-confidence, and “very well” to “not” for feeling connected to others. “CN” to “US” represents “China”, “Greece”, “Italy”, “Russia”, “Sweden”, “the UK” and “the US”

Fig. 4

Problems with internal states and social connectedness variables in eight countries. Note to figure: Problems with internal states refer to worse than “mild symptoms of anxiety” and “mild symptoms of depression” (from the levels “minimal” to “extreme”) and worse than “moderate problems with confidence” (from the levels “no problems” to “extreme problem”). Problems with social connectedness refer to worse than “moderate problems with social participation” (from the levels “no problems” to “extreme problem”), “fair contact with family and friends” (from the levels “very good” to “very bad”) and feeling “moderately connected to others” (from the levels “very well” to “not”)