Discussion

According to our data, about 30% of the European population (aged 50+ years) report experiencing a mental health problem (i.e. depressed mood, anxiety symptoms, or sleep problems) during the COVID-19 pandemic. Moreover, about two thirds (64%–73%) of those experiencing depressed mood or anxiety symptoms report that these conditions have worsened since the outbreak of the pandemic. The corresponding figure for worsened sleep problems was 35%. These results suggest that the pandemic has led to deteriorating mental health in the European population of older adults. Similarly, our results suggest that the pandemic may have brought about considerable declines in social well-being. Among participants reporting loneliness, about 40% felt more lonely since the outbreak than previously. Most importantly, our results reveal significant associations between loneliness and mental health problems during the pandemic. Having adjusted for COVID-19 mortality, our results suggest that these associations are not accounted for by people having lost one or more close family members, confidants, friends or other kinds of close relationships due to COVID-19 infection. In other words, the patterns in our results appear to be features of the pandemic in general rather than a consequence of COVID-19 mortality.

Before going into the results further, it is necessary to keep the following limitations in mind when interpreting them: First, interviews were conducted in the period June-August 2020, when infection numbers across Europe were relatively low and there were relatively fewer government restrictions than previously and later on. Most countries have seen increases in infection rates at the beginning of the winter season 2020, and it is possible that performing the interviews during this time would produce different and possibly even stronger and more alarming results. Thus, the results we present may be regarded as conservative estimates. Second, data were self-reported, and there is a risk of self-report bias and issues pertaining to common-methods variance. Third, we used single-item questions to assess symptoms of mental health problems and loneliness rather than validated scales or medical diagnoses (which were not included in the SHARE COVID-19 survey). Finally, the cross-sectional design precludes us from making causal inferences. The use of retrospective variables (i.e. ‘Has that been more so, less so, or about the same as before the outbreak of Corona?’) may have partly compensated for this, as they inquire about change over time. It is also important to note that the relationship between loneliness and mental health problems is likely bi-directional (Santini et al., Reference Santini, Jose, York Cornwell, Koyanagi, Nielsen, Hinrichsen, Meilstrup, Madsen and Koushede2020). In other words, these factors may be reinforcing each other over time in a downward spiral unless buffered by protective factors or interrupted through intervention.

While a multitude of factors may have affected population mental health, such as the virus itself as well as other consequences of the pandemic (e.g. economic recession, financial insecurity, heavy exposure of the pandemic in the media), the social consequences of the pandemic cannot be disregarded. The risk of infection, social distancing measures, government restrictions and quarantines have resulted in unfavorable social conditions that in turn may have had negative implications for mental health. In line with recent research (Manca et al., Reference Manca, De Marco and Venneri2020), the current study shows strong links between loneliness and mental health problems during the pandemic. This is particularly so among those that reported any amount of both loneliness and mental health problems (about 12%–16%). Among such individuals, worsened loneliness during the pandemic was associated with an extremely high risk for worsened depressed mood, anxiety symptoms, and sleep problems (OR = 6.26, 10.11). In conclusion, our data suggest an escalation in loneliness across Europe since the outbreak of the pandemic, which is associated with a dramatic increase in odds for deteriorating mental health problems. There is an urgent need for research to address the mental health implications of intensified loneliness experienced during the pandemic, as well as how loneliness and the consequences of it may be mitigated under pandemic conditions. The social ramifications of the pandemic must also be considered and prioritised accordingly in health policy, planning and prevention strategies.