Changes in socioeconomic resources and mental health after the second COVID-19 wave (2020-2021): a longitudinal study in Switzerland

Abstract

Background: During the 2020/2021 winter, the labour market was under the impact of the COVID-19 pandemic. Changes in socioeconomic resources during this period could have influenced individual mental health. This association may have been mitigated or exacerbated by subjective risk perceptions, such as perceived risk of getting infected with SARS-CoV-2 or perception of the national economic situation. Therefore, we aimed to determine if changes in financial resources and employment situation during and after the second COVID-19 wave were prospectively associated with depression, anxiety and stress, and whether perceptions of the national economic situation and of the risk of getting infected modified this association.

Methods: One thousand seven hundred fifty nine participants from a nation-wide population-based eCohort in Switzerland were followed between November 2020 and September 2021. Financial resources and employment status were assessed twice (Nov2020-Mar2021, May-Jul 2021). Mental health was assessed after the second measurement of financial resources and employment status, using the Depression, Anxiety and Stress Scale (DASS-21). We modelled DASS-21 scores with linear regression, adjusting for demographics, health status, social relationships and changes in workload, and tested interactions with subjective risk perceptions.

Results: We observed scores above thresholds for normal levels for 16% (95%CI = 15-18) of participants for depression, 8% (95%CI = 7-10) for anxiety, and 10% (95%CI = 9-12) for stress. Compared to continuously comfortable or sufficient financial resources, continuously precarious or insufficient resources were associated with worse scores for all outcomes. Increased financial resources were associated with higher anxiety. In the working-age group, shifting from full to part-time employment was associated with higher stress and anxiety. Perceiving the Swiss economic situation as worrisome was associated with higher anxiety in participants who lost financial resources or had continuously precarious or insufficient resources.

Conclusion: This study confirms the association of economic stressors and mental health during the COVID-19 pandemic and highlights the exacerbating role of subjective risk perception on this association.

Keywords: Anxiety; COVID-19; Depressive symptoms; Financial resources; Socioeconomic condition; Stress.

Fig. 1

Changes in financial resources, risk and economic perception, and mental health outcomes: univariable regression. Note: a positive coefficient (effect on score) means a higher DASS-21 score (more symptoms) Q1: first questionnaire on financial resources and employment situation; November 2020 – March 2021. Q2: second questionnaire on financial resources and employment situation; May – July 2021. Financial resources categories are compared to the reference category of “comfortable or sufficient resources at both Q1 and Q2”

Fig. 2

Changes in financial resources, perceived risk of infection and economic perceptions, and mental health outcomes: multivariable regression. Note: a positive coefficient (effect on score) means a higher DASS-21 score (more symptoms) Q1: first questionnaire on financial resources and employment situation; November 2020 – March 2021. Q2: second questionnaire on financial resources and employment situation; May – July 2021. Model estimates are adjusted for sex, age, number of chronic health conditions, positive COVID-19 test before Q2, vaccination status, size of household (living alone vs living with other persons), median loneliness score, employment status, changes in workload and language. Financial resources categories are compared to the reference category of “comfortable or sufficient resources at both Q1 and Q2”

Fig. 3

Changes in employment situation and mental health outcomes among working-age participants: univariable regression. Note: a positive coefficient (effect on score) means a higher DASS-21 score (more symptoms) Q1: first questionnaire on financial resources and employment situation; November 2020 – March 2021. Q2: second questionnaire on financial resources and employment situation; May – July 2021. Change in employment situation is compared to a reference category of “full- or part-time employed at both Q1 and Q2”

Fig. 4

Changes in employment situation and mental health outcomes among working-age participants: multivariable regression. Note: a positive coefficient (effect on score) means a higher DASS-21 score (more symptoms). Q1: first questionnaire on financial resources and employment situation; November 2020 – March 2021. Q2: second questionnaire on financial resources and employment situation; May – July 2021. Model estimates are adjusted for sex, age, number of chronic health conditions, positive COVID-19 test before Q2, vaccination status, size of household (living alone vs living with other persons), median loneliness score, changes in financial resources, changes in workload and language. Change in employment situation is compared to a reference category of “full- or part-time employed at both Q1 and Q2”

Fig. 5

Predicted DASS-21 anxiety scores: marginal effect of financial resources and perceived Swiss economic situation. Note: Higher-Higher = participants had sufficient or comfortable resources at both measurements (Q1 and Q2); Lower-Lower = participants had precarious or insufficient resources at both measurements (Q1 and Q2); Higher-Lower = participants had sufficient or comfortable resources at Q1 and precarious or insufficient at Q2; Lower-Higher = participants had precarious or insufficient at Q1 and sufficient or comfortable at Q2