Psychiatry Research
Volume 293, November 2020, 113462
Lockdown, quarantine measures, and social distancing: Associations with depression, anxiety and distress at the beginning of the COVID-19 pandemic among adults from Germany
Author links open overlay panelChristophBenkeaChristiane A.Pané-Farréa
https://doi.org/10.1016/j.psychres.2020.113462
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Highlights
•
sociodemographic and COVID-19 related predictors were related to immediate mental health consequences in Germany.

•
greater reduction of social contacts and perceived changes in everyday life were related to psychopathological symptoms.

•
Subjectively perceived, but not officially announced stay-at-home orders are associated with mental health impairments.

•
results do not support that public health measures per se are associated with mental health problems.


Abstract
The COVID-19 pandemic is suggested to have a negative impact on mental health. To prevent the spread of Sars-CoV-2, governments worldwide have implemented different forms of public health measures ranging from physical distancing recommendations to stay-at-home orders, which have disrupted individuals’ everyday life tremendously. However, evidence on the associations of the COVID-19 pandemic and public health measures with mental health are limited so far. In this study, we investigated the role of sociodemographic and COVID-19 related factors for immediate mental health consequences in a nationwide community sample of adults from Germany (N = 4335). Specifically, we examined the effects of different forms and levels of restriction resulting from public health measures (e.g. quarantine, stay-at-home order) on anxiety and depression symptomatology, health anxiety, loneliness, the occurrence of fearful spells, psychosocial distress and life-satisfaction. We found that higher restrictions due to lockdown measures, a greater reduction of social contacts and greater perceived changes in life were associated with higher mental health impairments. Importantly, a subjectively assumed but not an officially announced stay-at-home order was associated with poorer mental health. Our findings underscore the importance of adequate risk communication and targeted mental health recommendations especially for vulnerable groups during these challenging times.

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Keywords
Public health measuresLonelinessPanic attackLife-satisfaction
1. Introduction
The coronavirus disease (COVID-19) has recently evolved into a global crisis affecting the physical and mental health of people worldwide. Due to the rapid dissemination of the Sars-COV-2 virus and its potential deleterious effects for physical health, governments worldwide have imposed different forms and levels of public health measures ranging from physical distancing recommendations to stay-at-home orders to contain an uncontrolled spreading of the Sars-CoV-2 virus. Although being effective in preventing a further dissemination of the coronavirus (Nussbaumer-Streit et al., 2020), these measures may have changed peoples’ everyday life significantly and may have led to an immediate disruption of self-regulated behavior and a reduction of social connections (e.g. loss of reinforcer and social support, perceived controllability) which may lead to specific mental health problems, especially in vulnerable people (Lewinsohn and Atwood, 1969; Brooks et al., 2020; Holmes et al., 2020). Moreover, people are faced with the risk of a potentially life-threatening COVID-19 infection, which may trigger feelings of uncertainty, fear, anxiety and even result into social isolation (Asmundson and Taylor, 2020; Mertens et al., 2020).

A few previous studies from different countries worldwide investigated the role of sociodemographic and COVID-19 related factors for mental health (González-Sanguino et al., 2020; Losada-Baltar et al., 2020; Pierce et al., 2020; Tull et al., 2020; Wang et al., 2020; see Luo et al., 2020; Vindegaard and Eriksen Benros, 2020 for a review). Their findings suggest that especially women, younger people, as well as individuals with a mental disorder, chronic somatic disease, and predisposing factors for a potentially severe course of COVID-19 are at risk for mental health problems during these challenging times. However, studies on the effects of different forms and levels of restrictions resulting from public health measures (e.g., stay-at-home orders, being quarantined or reduction of social contacts) on mental health are scarce. Studies from previous epidemics and the current COVID-19 pandemic investigated the role of quarantine and related measures for mental health. Some of these studies revealed that quarantine was associated with elevated mental health problems (Wang et al., 2020; Liu et al., 2012; Wu et al., 2009; Bai et al., 2004). However, these findings were not entirely conclusive, given that other research did not find such associations (Wang et al., 2011; Zhu et al., 2020; Wang et al., 2020; Zhang et al., 2020). Consequently, to adequately inform the public health care system and enable adequate measures to protect from or mitigate adverse mental health effects, the consequences and relevant factors influencing the psychological response to the pandemic and public health measures need to be characterized.

In Germany, daily infection rates rapidly increased early in March 2020. At that time, each federal state started to implement public health measures (e.g., closure of schools and kindergartens) to prevent a further spread of COVID-19. Although various measures were implemented all over Germany, some measures (e.g. stay-home orders) and the associated degree of restriction for individuals’ personal and social life differed between German federal states. The present study was conducted four weeks after all German federal states had implemented public health measures (e.g., minimum distance of 1.5 m to other persons, closure of non-essential shops, such as bookstores, warehouses; see Steinmetz et al., 2020). At the time of the study, the highest rate of COVID-19 related death per day in Germany was recorded since the outbreak of COVID-19 in Germany. The present study was aimed at identifying potential predictors for immediate mental health consequences to the COVID-19 pandemic and related public health measures in Germany.
https://doi.org/10.1016/j.psychres.2020.113462
Get rights and content
Highlights
•
sociodemographic and COVID-19 related predictors were related to immediate mental health consequences in Germany.

•
greater reduction of social contacts and perceived changes in everyday life were related to psychopathological symptoms.

•
Subjectively perceived, but not officially announced stay-at-home orders are associated with mental health impairments.

•
results do not support that public health measures per se are associated with mental health problems.


Abstract
The COVID-19 pandemic is suggested to have a negative impact on mental health. To prevent the spread of Sars-CoV-2, governments worldwide have implemented different forms of public health measures ranging from physical distancing recommendations to stay-at-home orders, which have disrupted individuals’ everyday life tremendously. However, evidence on the associations of the COVID-19 pandemic and public health measures with mental health are limited so far. In this study, we investigated the role of sociodemographic and COVID-19 related factors for immediate mental health consequences in a nationwide community sample of adults from Germany (N = 4335). Specifically, we examined the effects of different forms and levels of restriction resulting from public health measures (e.g. quarantine, stay-at-home order) on anxiety and depression symptomatology, health anxiety, loneliness, the occurrence of fearful spells, psychosocial distress and life-satisfaction. We found that higher restrictions due to lockdown measures, a greater reduction of social contacts and greater perceived changes in life were associated with higher mental health impairments. Importantly, a subjectively assumed but not an officially announced stay-at-home order was associated with poorer mental health. Our findings underscore the importance of adequate risk communication and targeted mental health recommendations especially for vulnerable groups during these challenging times.