Anxiety and depression during the first wave of COVID-19 in Germany – results of repeated cross-sectional surveys

© The Author(s), 2021. Published by Cambridge University Press. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0), which permits unrestricted reuse, distribution and reproduction, provided the original article is properly cited. Anxiety and depression during the first wave of COVID-19 in Germany – results of repeated cross-sectional surveys

Numerous studies have reported elevated psychological distress during the coronavirus disease 2019  pandemic in Germany (Bäuerle et al., 2020;Benke, Autenrieth, Asselmann, & Pané-Farré, 2020;Jungmann & Witthöft, 2020) and other countries worldwide (Prati & Mancini, 2021). However, longitudinal or repeated cross-sectional studies investigating the role of lockdown restrictions on mental health are rare although such studies promise to be highly useful to identify persons at risk to develop increased anxiety and depression (Daly, Sutin, & Robinson, 2020;Debowska, Horeczy, Boduszek, & Dolinski, 2020). This study aimed at examining whether symptoms of depression and anxiety were increased during v. before the first COVID-19 lockdown in Germany, whether symptoms remained elevated after lockdown restrictions were eased, and whether the observed effects were predicted by sociodemographic variables.
Stage (contrast coded: early v. mid-and late stage; midv. late stage) and sociodemographic variables served as predictors in the first step of hierarchical multiple regressions for anxiety and depression, respectively. In a second step, interactions of the contrast-coded variables of stage with sociodemographic variables were entered into the regression.
Overall and in line with our previous findings (Bäuerle et al., 2020;Benke et al., 2020;Jungmann & Witthöft, 2020), women v. men, younger v. older individuals, individuals with lower v. higher educational level, individuals who were unemployed v. employed, and with v. without a previous history of mental disorders experienced higher anxiety and depressive symptoms during the first COVID-19 wave (see Table 1). Moreover, living without v. with children was associated with more depression but not anxiety.
Anxiety and depression during v. before lockdown: Anxiety and depression were significantly higher during the lockdown than before. However, these symptom differences were greater in younger v. older individuals, in less v. more educated individuals and in individuals without v. with a previous history of mental disorders (see Table 1). Moreover, the symptom difference in anxiety (with higher anxiety during the lockdown v. before) was greater in men v. women and unemployed v. employed individuals.
Anxiety and depression during peak of v. easing of lockdown restrictions Overall, depression and anxiety decreased during easing compared to peak of lockdown restrictions (see Table 1). However, anxiety was increased during the easing v. peak of restrictions in younger v. older individuals, in men v. women, in students/ individuals in training v. employed individuals and in individuals without v. with children (see Table 1). Depression during easing v. peak of lockdown measures was higher in men v. women. The symptom difference in depression (with lower symptoms during easing v. peak of lockdown measures) was greater in individuals with v. without a history of mental disorders. The results suggest that implementation of lockdown restrictions is associated with increased levels of depression and anxiety that even persist during ease of lockdown in specific groups. Men and individuals without a history of mental disorders were particularly affected by lockdown restrictions. The results are consistent with previous longitudinal studies from the UK, which demonstrated that younger individuals experienced higher levels of distress due to lockdown measures (Daly et al., 2020;Pierce et al., 2020). This study identifies vulnerable groups (Bäuerle et al., 2020;Benke et al., 2020;Jungmann & Witthöft, 2020), which might need tailored support to avoid exacerbation or the development of manifest psychological disorders. Longitudinal studies based on representative community samples are needed to replicate our findings.
Financial support. This research received no specific grant from any funding agency, commercial or not-for-profit sectors. Fig. 1. Course of new cases of COVID-19 and restrictions due to lockdown measures (e.g. prohibition to meet with others in public places, closure of non-essential shops, or prohibition to leave the apartment without reason) during the first wave of the pandemic in Germany. The time points and durations of the three surveys are shaded in grey.