Relating mental health, health-related quality of life and well-being in the aftermath of the COVID-19 pandemic: A cross-sectional comparison in 14 European countries in early 2023

Abstract

Objectives: To understand country-level differences in the population's health and well-being in Europe in the aftermath of the COVID-19 pandemic, while also investigating the internal relationships among health and well-being outcomes.

Study design: Cross-sectional study.

Methods: We collected representative panel-based samples of 1000 adult respondents per country across 14 Western European countries in early 2023. The survey used standardised instruments to assess health and well-being, including EQ-5D-5L, GHQ-12, PHQ-9, general satisfaction, the Brief Resilience Scale and the ULS-6 (Loneliness) Scale. Summary statistics of the aggregate scores for each country were calculated and ranked. Multidimensional unfolding was used to visualize the rank relationships across countries and the indices, whereby a closer distance between a country and an index indicated a higher/better rank. Additionally, two key objective country-level indices (GDP growth rate and excess mortality rates) were integrated into the analysis.

Results: Austria was found to report better status on most of the indices, while Sweden and the UK ranked consistently worse than the other countries. The loneliness, EQ-VAS and satisfaction scores were plotted further from the mental well-being scores and EQ-5D utility scores. Countries that did well in controlling excess mortality and maintaining economic growth tended to exhibit lower performance in self-reported well-being.

Conclusion: This study presents the variability in health and well-being across 14 West-European countries. Discrepancies between countries in self-reported outcomes reveal the complex interrelationship among different aspects of well-being. The study also highlights the complexities and challenges in optimising policies to maximize the overall well-being of society.

Keywords: COVID-19; Europe; Health; Mental health; Quality of life; Well-being.