key: cord-0864217-3dqlg1te authors: Pieh, Christoph; Probst, Thomas; Budimir, Sanja; Humer, Elke title: Diminished well-being persists beyond the end of the COVID-19 lockdown date: 2021-01-15 journal: Gen Hosp Psychiatry DOI: 10.1016/j.genhosppsych.2021.01.004 sha: cfe084042cd73fdba8ead83e7d7dad067893562f doc_id: 864217 cord_uid: 3dqlg1te nan The coronavirus disease 2019 (COVID-19) outbreak dramatically affects mental well-being [1] . Even if the causes for this decline in mental health during are not yet known, some explanations seem obvious. According to the OECD's Economic Outlook from June 2020, the COVID-19 pandemic has triggered the most severe recession in nearly a century [2] . Furthermore, the fear of infection and possible consequences, including death, might impact mental health symptoms [3] . Furthermore, most governments have enacted restrictions to prevent uncontrolled spreading of the virus. In Austria, the first governmental restrictions against COVID-19 became obligatory on the 16 th of March 2020 (COVID-19 lockdown) and lasted until the 30 th of April 2020. During the lockdown, leaving the house was only allowed for a few specific reasons. Although these restrictions helped to achieve the goal of attenuating the uncontrolled spread of the virus, reduced access to social contacts and other social support systems have been reported to impair mental well-being [4] . There is a need to explore whether reduced mental well-being related to the COVID-19 pandemic emerged primarily due to restrictions to prevent the uncontrolled spreading such as lockdowns, or it changes when these measures are lifted. Therefore, this longitudinal study aimed to evaluate mental health in the Austrian general population during and 6 weeks after the end of the lockdown. A representative quota sampling according to age, gender, education, and region was recruited through Qualtrics. In total, 1,005 participated in the first wave of the online survey 4 weeks after the lockdown started (detailed data is presented here [5] ). All participants were re-contacted in the second wave, 6 weeks after the end of the lockdown and N = 445 responded at the second time point (response rate 44.3%). Sociodemographic characteristics are summarized in Suppl. Table 1 . We examined differences between the two measurement points in well-being (WHO Well-being Index (WHO-5) [6] , psychological quality of life (WHO-QoL BREF [7] ), anxiety (Generalized Anxiety Disorder 7 scale (GAD-7) [8] ), and sleep quality (Insomnia Severity Index (ISI) [9] ). All data were analyzed using SPSS26 (IBM Corp, Armonk, NY, USA). To compare outcome measures during the COVID-19 lockdown in responders vs. non-responders independent t-tests were conducted. Differences between both measurement time points (during vs. after lockdown) were analyzed with paired t-tests. To analyze whether changes between the two time points differed between gender and age groups, mixed ANOVAs were calculated with time (2-levels: during and 6 weeks after the end of the lockdown) as the within-subject factor and age (6-levels: 6 age groups see Supplementary Tables) or gender (2-levels: female and male) as between-subject factors. All tests were conducted using two- (Table 1 ). Gender and age effects were observed for all outcome variables (Supplementary Tables 2-3) , with female and younger participants showing worse outcomes across both time points (p≤.036). However, the interaction effects between time and gender as well as between time and age were not significant for any outcome variables (p≥.143). The responders (n = 445) did not differ from the nonresponders (n = 560) in well-being (WHO-5), psychological quality of life (WHO-QoL BREF), and anxiety symptoms (GAD-7) during the COVID-19 lockdown. However, responders differed from nonresponders in sleep quality (ISI: 7.91 ± 5.38 vs. 8.63 ± 5.94) at the first measurement point (p = 0.046). The deterioration of mental well-being during the COVID-19 lockdown compared to pre-epidemiological data [5] remained unchanged in Austria despite the end of the lockdown. This is in line with research suggesting long-term mental health effects after large-scale disasters [10] . The generalizability of these data according to the relatively small sample size and the low response rate is limited. Even if there are no significant differences between responders and non-responders in most outcome measures, a possible bias cannot be excluded. A further limitation is that no causal conclusions are possible about changes in mental health due to the COVID-19 pandemic per se since the presented sample's mental health was not assessed before the pandemic. Three measurement points (before vs. during vs. after COVID-19 lockdown) would have been more appropriate to study changes in mental health due to lockdown measures as well as the COVID-19 pandemic. A further limitation is that mental health was assessed only by self-ratings without clinician-based assessments. In conclusion, reduced mental well-being remained despite end of COVID-19 lockdown. This study was approved by the Ethics Committee of the Danube University Krems (approval code: EK GZ 26/2018-2021) and was conducted following the Declaration of Helsinki. All participants gave electronic informed consent upon completing the questionnaires. Not applicable. The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors declare that they have no competing interests. The psychological impact of COVID-19 on the mental health in the general population The COVID-19 pandemic and mental health impacts The role of telehealth in reducing the mental health burden from COVID-19 The effect of age, gender, income, work, and physical activity on mental health during coronavirus disease (COVID-19) lockdown in Austria Teststatistische Prüfung und Normierung der deutschen Versionen des EUROHIS-QOL Lebensqualität-Index und des WHO-5 Wohlbefindens-Index Programme on mental health: WHOQOL user manual, 2012 revision. World Health Organization A brief measure for assessing generalized anxiety disorder: the GAD-7 The insomnia severity index: psychometric indicators to detect insomnia cases and evaluate treatment response The mental health consequences of COVID-19 and physical distancing: the need for prevention and early intervention Many thanks to Rachel Dale, PhD for proof-reading the paper and her valuable contribution to the manuscript. Supplementary data to this article can be found online at https://doi. org/10.1016/j.genhosppsych.2021.01.004.