Adult mental health during the covid-19 pandemic – Results from the CORONA HEALTH App Study

Due to the dramatic rise of COVID-19 cases around the world since the beginning of 2020, federal governments applied pandemic action plans in order to limit disease spreading. In Germany, as in other countries, the pandemic action plan includes quarantine, reduction of social contact and mobility. A society in quarantine faces psychological stress with possible long-lasting consequences [1]. Social isolation, fear of contracting COVID-19 and insufficient medical care because of a capacity gap, distress about relatives’ health as well as existential fear present severe stressors during the current COVID-19 crisis [2]. As a result, the risk of a ‘comorbid pandemic of symptoms of mental disorders’ such as helplessness, sleeplessness, depressive and anxiety symptoms, is increased [2-8]. Data from Wuhan, China also show a rising rate of domestic violence [1]. Thereby, the duration of burden (i.e. trauma-exposure) is a prominent risk factor for symptoms of mental disorders such as depression [9]. Currently, due to the successful implementation of social distancing measures, the reproduction score of COVID-19 in Germany and many other countries has diminished, suggesting slower spreading of the virus. Hence, the federal government already initiates a step-by-step alleviation of the existing measures, i.e. reopening of stores, playgrounds and schools and a discussion of the practicability of normality in family life and business has started. At the same time, the COVID-19 pandemic is still active and the risk of a second wave of infection remains [10]. For society this will likely demand a months-long balance act of protection from a growing number of new infections and reduction of mental and physical stressors created by severe restrictions of daily life. The effects on mental health are, especially in the long-term mastery and recovery from the pandemic, still unknown. Hence, close monitoring of mental health in Germany over the following months is urgently needed. Importantly, such monitoring should include vulnerable groups such as people with preexisting mental illnesses [11], elderly people [12], people with low socio-economic status and employees in the health care system. Therefore, our research motivation is to monitor mental health longitudinally, to quantify need of treatment and identify risk factors for mental health disturbances during and after the pandemic restrictions of public life associated with remaining e.g. existential fears. Our findings may aid public health officials in discussing future improvements during possible future pandemic waves or other life crises. More specifically, this project aims to answer two main research questions: 1. What individual and social (risk) factors are predictive for depressive and anxiety symptoms in times of the COVID-19 pandemic? 2. In how far does the duration of present relevant individual and social (risk) factors correlates with symptoms of depression or anxiety? The focus of the present research lies on depression and anxiety based on previous findings indicating a relatively high prevalence in general as well as during pandemic or other population crises in particular. While evidence from population-based studies on depressive symptoms and risk factors is accumulating, relatively little is known about anxiety. What recent data has shown, is, that for example among older adults social isolation does increase also symptoms of anxiety [13]. Especially for medical staff anxiety plays an important role during the COVID-19 pandemic, such as anxiety of contracting COVID-19, of a lack of protection equipment and treatment capacities, of insufficient childcare or of posing a risk of infection for family members [14]. Previous research also suggests that depression is associated with behavioral changes, e.g. social withdrawal, negative self-image and loss of energy [15, 16]. Nowadays a high proportion of interpersonal communication happens via mobile devices with various effects on personal relationships [17]. During the recent social distancing measures, research on media usage indicates that the amount of social interactions performed online increased [18]. Prior research has shown that depressive symptoms correlate with various smartphone usage patterns such as the number of text messages sent or the duration of phone calls [19]. Researchers also discuss social network use as to be correlated with an increase of depressive symptoms [20]. A decrease of social interaction (measured in terms of usage duration of various social media apps on the smartphone) during non-working hours might therefore be a valid indicator for an increase of depressive symptoms. Therefore, we intend to measure average usage duration of social media channels [20]. Also other applications for social interactions will be included like messenger apps and apps offering (video-) calls and the usage duration of phone specific telephone and text messaging apps. Following the idea of a vulnerability-stress-model [21] it is to be assumed that an accumulation of stressors leads to an increased risk for depressive and anxiety symptoms. Discrepancies and changes in public communication varying from acute risk to a relatively mild pandemic process in Germany confront individuals with extreme emotional contrasts. These emotional contrasts have been identified as a risk factor for hypersensitive individuals, facilitating the development of a generalized anxiety disorder by an exaggeration of worries [22]. The list of stressors during a global pandemic moreover includes known aspects like loneliness and existential worries [23], maladaptive sleep and alcohol consumption patterns [24, 25] as well as possible new stressors such as home office, home schooling and fear of an infection. Working from home might for some individuals be more or less stressful than working in a regular working environment: The lack of clear borders between workspace and living room may increase working hours, small apartments shared with playing kids can easily cause distraction. On the contrary, less social responsibilities, less time to commute to work and less face-to-face confrontations at work might also be a positive experience. Home schooling as additional responsibility for parents could also be an additional stressor during these days but has not yet been investigated. Taking current findings on onerous family climate during the COVID-19 pandemic into account underpins these assumptions [22]. Also fear of contamination in combination with missing knowledge of the individual physical reaction to the infection supposedly increases the risk of psychopathological symptoms. In conclusion, the present study aims to explain variance in probability of depressive and generalized anxiety symptoms by taking a broad variety of relevant individual and social risk factors into account. Thereby, we intend to detect early warning signs which would enable preventive actions in pandemic or other population crises. 1. IASC Reference Group on Mental Health and Psychosocial Support in Emergency Settings (2020) Interim Briefing Note: Adressing Mental Health and Psychosocial Aspects of Covid-19 Outbreak. Version 1.5. (Stand: 28.03.2020) 2. Brooks, S.K., Webster, R.K., Smith, L.E. et al. (2020) The psychological impact of quarantine and how to reduce it: rapid review of the evidence. The Lancet, 395(10227):912–920. DOI: 10.1016/S0140-6736(20)30460-8 3. Yao, H., Chen, J.-H., Xu, Y.-F. (2020). Patients with mental health disorders in the COVID-19 epidemic. The Lancet Psychiatry, 7(4):e21. DOI: 10.1016/S2215-0366(20)30090-0. 4. Bao, Y., Sun, Y., Meng, S. et al. (2020). 2019-nCoV epidemic: address mental health care to empower society. The Lancet, 395(10224):e37-e38. DOI: 10.1016/S0140-6736(20)30309-3. 5. Zhou, X. (2020). Psychological crisis interventions in Sichuan Province during the 2019 novel coronavirus outbreak. Psychiatry Research, 286:112895. DOI: 10.1016/j.psychres.2020.112895 6. Carvalho, P.M.d.M., Moreira, M.M., de Oliveira, M.N.A. et al. (2020). The psychiatric impact of the novel coronavirus outbreak. Psychiatry Research, 286:112902. DOI: 10.1016/j.psychres.2020.112902 7. DiGiovanni, C., Conley, J., Chiu, D. et al. (2004). Factors influencing compliance with quarantine in Toronto during the 2003 SARS outbreak. Biosecur Bioterror, 2(4):265-272. DOI: 10.1089/bsp.2004.2.265. 8. Tracy, C.S., Rea, E., Upshur, R.E.G. (2009). Public perceptions of quarantine: community-based telephone survey following an infectious disease outbreak. BMC Public Health 9(1):470. DOI: 10.1186/1471-2458-9-470 9. Adams, J., Mrug, S., Knight, D.C. (2019). Characteristics of child physical and sexual abuse as predictors of psychopathology. Child Abuse & Neglect. 2018;86:167‐177. DOI: 10.1016/j.chiabu.2018.09.019 10. Leung, K., Wu, J.T., Liu, D. & Leung, G.M. (2020). First-wave COVID-19 transmissibility and severity in China outside Hubei after control measures, and second-wave scenario planning: a modelling impact assessment. The Lancet, 395(10233), 1382 – 1393. DOI: 10.1016/S0140-6736(20)30746-7 11. Yao, H., Chen, J.-H., & Xu, Y.-F. (2020). Patients with mental health disorders in the COVID-19 epidemic. The Lancet Psychiatry, 7(4), e21. DOI: 10.1016/S2215-0366(20)30090-0 12. Vahia, I. V., Blazer, D. G., Smith, G. S., Karp, J. F., Steffens, D. C., Forester, B. P., . . . Reynolds, C. F., III. COVID-19, Mental health and aging: A need for new knowledge to bridge science and service. The American Journal of Geriatric Psychiatry. DOI: 10.1016/j.jagp.2020.03.007 13. Santini, Z.I., Jose, P.E., Cornwell, E.Y., Nielsen, A.K.L., Hinrichsen, X., Meilstrup, C., Madsen, K.R. & Koushede, V. (2020). Social disconnectedness, perceived isolation, and symptoms of depression and anxiety among older Americans (NSHAP): A longitudinal mediation analysis, The Lancet Public Health, 5(1), e62-e70. DOI: 10.1016/S2468-2667(19)30230-0. 14. Shanafelt, T., Ripp, J.

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