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      Time trends in mental health indicators in Germany's adult population before and during the COVID-19 pandemic

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          Abstract

          Background

          Times of crisis such as the COVID-19 pandemic are expected to compromise mental health. Despite a large number of studies, evidence on the development of mental health in general populations during the pandemic is inconclusive. One reason may be that representative data spanning the whole pandemic and allowing for comparisons to pre-pandemic data are scarce.

          Methods

          We analyzed representative data from telephone surveys of Germany's adults. Three mental health indicators were observed in ~1,000 and later up to 3,000 randomly sampled participants monthly until June 2022: symptoms of depression (observed since April 2019, PHQ-2), symptoms of anxiety (GAD-2), and self-rated mental health (latter two observed since March 2021). We produced time series graphs including estimated three-month moving means and proportions of positive screens (PHQ/GAD-2 score ≥ 3) and reports of very good/excellent mental health, as well as smoothing curves. We also compared time periods between years. Analyses were stratified by sex, age, and level of education.

          Results

          While mean depressive symptom scores declined from the first wave of the pandemic to summer 2020, they increased from October 2020 and remained consistently elevated throughout 2021 with another increase between 2021 and 2022. Correspondingly, the proportion of positive screens first decreased from 11.1% in spring/summer 2019 to 9.3% in the same period in 2020 and then rose to 13.1% in 2021 and to 16.9% in 2022. While depressive symptoms increased in all subgroups at different times, developments among women (earlier increase), the youngest (notable increase in 2021) and eldest adults, as well as the high level of education group (both latter groups: early, continuous increases) stand out. However, the social gradient in symptom levels between education groups remained unchanged. Symptoms of anxiety also increased while self-rated mental health decreased between 2021 and 2022.

          Conclusion

          Elevated symptom levels and reduced self-rated mental health at the end of our observation period in June 2022 call for further continuous mental health surveillance. Mental healthcare needs of the population should be monitored closely. Findings should serve to inform policymakers and clinicians of ongoing dynamics to guide health promotion, prevention, and care.

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          Most cited references120

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          The psychological impact of quarantine and how to reduce it: rapid review of the evidence

          Summary The December, 2019 coronavirus disease outbreak has seen many countries ask people who have potentially come into contact with the infection to isolate themselves at home or in a dedicated quarantine facility. Decisions on how to apply quarantine should be based on the best available evidence. We did a Review of the psychological impact of quarantine using three electronic databases. Of 3166 papers found, 24 are included in this Review. Most reviewed studies reported negative psychological effects including post-traumatic stress symptoms, confusion, and anger. Stressors included longer quarantine duration, infection fears, frustration, boredom, inadequate supplies, inadequate information, financial loss, and stigma. Some researchers have suggested long-lasting effects. In situations where quarantine is deemed necessary, officials should quarantine individuals for no longer than required, provide clear rationale for quarantine and information about protocols, and ensure sufficient supplies are provided. Appeals to altruism by reminding the public about the benefits of quarantine to wider society can be favourable.
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            Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science

            Summary The coronavirus disease 2019 (COVID-19) pandemic is having a profound effect on all aspects of society, including mental health and physical health. We explore the psychological, social, and neuroscientific effects of COVID-19 and set out the immediate priorities and longer-term strategies for mental health science research. These priorities were informed by surveys of the public and an expert panel convened by the UK Academy of Medical Sciences and the mental health research charity, MQ: Transforming Mental Health, in the first weeks of the pandemic in the UK in March, 2020. We urge UK research funding agencies to work with researchers, people with lived experience, and others to establish a high level coordination group to ensure that these research priorities are addressed, and to allow new ones to be identified over time. The need to maintain high-quality research standards is imperative. International collaboration and a global perspective will be beneficial. An immediate priority is collecting high-quality data on the mental health effects of the COVID-19 pandemic across the whole population and vulnerable groups, and on brain function, cognition, and mental health of patients with COVID-19. There is an urgent need for research to address how mental health consequences for vulnerable groups can be mitigated under pandemic conditions, and on the impact of repeated media consumption and health messaging around COVID-19. Discovery, evaluation, and refinement of mechanistically driven interventions to address the psychological, social, and neuroscientific aspects of the pandemic are required. Rising to this challenge will require integration across disciplines and sectors, and should be done together with people with lived experience. New funding will be required to meet these priorities, and it can be efficiently leveraged by the UK's world-leading infrastructure. This Position Paper provides a strategy that may be both adapted for, and integrated with, research efforts in other countries.
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              COVID-19 pandemic and mental health consequences: systematic review of the current evidence

              Highlights • COVID-19 patients displayed high levels of PTSS and increased levels of depression. • Patients with preexisting psychiatric disorders reported worsening of psychiatric symptoms. • Higher levels of psychiatric symptoms were found among health care workers. • A decrease in psychological well-being was observed in the general public. • However, well conducted large-scale studies are highly needed.
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                Author and article information

                Contributors
                Journal
                Front Public Health
                Front Public Health
                Front. Public Health
                Frontiers in Public Health
                Frontiers Media S.A.
                2296-2565
                23 February 2023
                2023
                23 February 2023
                : 11
                : 1065938
                Affiliations
                [1] 1Department of Epidemiology and Health Monitoring, Robert Koch Institute , Berlin, Germany
                [2] 2Institute of Medical Sociology and Rehabilitation Science, Charité-Universitätsmedizin , Berlin, Germany
                Author notes

                Edited by: Wulf Rössler, Charité Universitätsmedizin Berlin, Germany

                Reviewed by: Rachel Dale, Danube University Krems, Austria; Hong Cai, University of Macau, China; Tengteng Fan, Peking University, China

                *Correspondence: Elvira Mauz ✉ MauzE@ 123456rki.de

                This article was submitted to Public Mental Health, a section of the journal Frontiers in Public Health

                †These authors have contributed equally to this work and share first authorship

                Article
                10.3389/fpubh.2023.1065938
                9995751
                36908429
                bdde4179-9e0b-4db5-9490-230978154c01
                Copyright © 2023 Mauz, Walther, Junker, Kersjes, Damerow, Eicher, Hölling, Müters, Peitz, Schnitzer and Thom.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 10 October 2022
                : 26 January 2023
                Page count
                Figures: 4, Tables: 6, Equations: 0, References: 135, Pages: 23, Words: 18501
                Funding
                Funded by: Bundesministerium für Gesundheit, doi 10.13039/501100003107;
                Funded by: Deutsche Forschungsgemeinschaft, doi 10.13039/501100001659;
                The “MHS–Establishment of a National Mental Health Surveillance at Robert Koch-Institute” project is funded by the Federal Ministry of Health (Grant Number: ZMI5-2519FSB402). CK collaboration on social inequalities in mental health during the pandemic was funded by the German Research Foundation (Project Number: 458531028).
                Categories
                Public Health
                Original Research

                mental health surveillance,depressive symptoms,anxiety symptoms,covid-19 pandemic,time trends,general population,germany

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