Association between prolonged stress caused by COVID-19 pandemic and earthquakes and quality of life, anxiety, depression, psychoactive substances, and problematic alcohol use in adult Croatian population

Abstract

Background: The prolonged stress experience caused by the COVID-19 pandemic and two earthquakes led to increased alcohol and psychoactive substance use (PSU) accompanied by a decrease in mental wellbeing and quality of life (QoL) in the Croatian population. Our aim was to determine the relationship between alcohol and PSU and mental health outcomes including anxiety and depression, and QoL.

Methods: A cross-sectional online survey conducted from September 30 to October 27, 2021, included 1,118 Croatian adults (220 men and 898 women; mean age, 35.1 ± 12.3 years) recruited through non-probabilistic convenience sampling. The survey consisted of a self-reported questionnaire on PSU, the CAGE Alcohol Questionnaire, the Hospital Anxiety Depression Scale, and the World Health Organization Quality of Life (WHOQoL)-BREF. Structural equation modeling was used to evaluate the association between PSU, problematic alcohol use (PAU), mental health outcomes, and QoL.

Results: The model demonstrated a good fit and indicated that PSU increase, PAU, and anxiety and depression symptoms significantly explained all QoL domains (p < 0.001 for all). Both PSU increase and PAU during prolonged stress were directly associated with decreased QoL. These relationships were also indirectly mediated through increased anxiety and depression symptoms.

Conclusion: These results showed the need to direct public health interventions and treatment interventions during and after long-term stress (pandemics and earthquakes) to reduce the negative impact on substance use and QoL by reducing depression and anxiety, which ultimately may contribute to better wellbeing and rapid recovery of individuals affected by prolonged stress.

Keywords: alcohol drinking; mental health; prolonged stress; quality of life; substance abuse.

Figure 1

Structural equation modeling: tested model of psychoactive substance use increase and problematic alcohol use in predicting QoL domains through anxiety and depression symptoms. HADS-A, Hospital Anxiety Depression Scale—Anxiety; HADS-D, Hospital Anxiety Depression Scale—Depression; QoL, quality of life. Indicators for latent variables, as well as errors and residuals, were omitted from the figure due to clarity. Black arrows represent regression paths that are significant at p < 0.05, while gray arrows represent tested but non-significant regression paths. *p < 0.05, ** p < 0.01.