Drastic Reductions in Mental Well-Being Observed Globally During the COVID-19 Pandemic: Results From the ASAP Survey

Jan Wilke; Karsten Hollander; Lisa Mohr; Pascal Edouard; Chiara Fossati; Marcela González-Gross; Celso Sánchez Ramírez; Fernando Laiño; Benedict Tan; Julian David Pillay; Fabio Pigozzi; David Jimenez-Pavon; Matteo C Sattler; Johannes Jaunig; Mandy Zhang; Mireille van Poppel; Christoph Heidt; Steffen Willwacher; Lutz Vogt; Evert Verhagen; Luiz Hespanhol; Adam S Tenforde

doi:10.3389/fmed.2021.578959

Drastic Reductions in Mental Well-Being Observed Globally During the COVID-19 Pandemic: Results From the ASAP Survey

Front Med (Lausanne). 2021 Mar 26:8:578959. doi: 10.3389/fmed.2021.578959. eCollection 2021.

Authors

Jan Wilke¹, Karsten Hollander^{2

3}, Lisa Mohr¹, Pascal Edouard^{4

5}, Chiara Fossati⁶, Marcela González-Gross^{7

8}, Celso Sánchez Ramírez⁹, Fernando Laiño¹⁰, Benedict Tan¹¹, Julian David Pillay¹², Fabio Pigozzi⁶, David Jimenez-Pavon^{8

13}, Matteo C Sattler¹⁴, Johannes Jaunig¹⁴, Mandy Zhang¹¹, Mireille van Poppel¹⁴, Christoph Heidt¹⁵, Steffen Willwacher^{16

17}, Lutz Vogt¹, Evert Verhagen¹⁸, Luiz Hespanhol^{18

19}, Adam S Tenforde³

Affiliations

¹ Department of Sports Medicine, Goethe University Frankfurt, Frankfurt, Germany.
² Faculty of Medicine, Medical School Hamburg, Hamburg, Germany.
³ Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Harvard Medical School, Charlestown, MA, United States.
⁴ Inter-University Laboratory of Human Movement Science (LIBM EA 7424), University of Lyon, University Jean Monnet, Saint Etienne, France.
⁵ Department of Clinical and Exercise Physiology, Sports Medicine Unity, Faculty of Medicine, University Hospital of Saint-Etienne, Saint-Etienne, France.
⁶ Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy.
⁷ ImFine Research Group, Department of Health and Human Performance, Universidad Politécnica de Madrid, Madrid, Spain.
⁸ Exercise is Medicine Spain, Madrid, Spain.
⁹ School of Physical Activity Sciences, University of Santiago de Chile, Santiago, Chile.
¹⁰ Fundación Instituto Superior de Ciencias de la Salud, Buenos Aires, Argentina.
¹¹ Department of Sport and Exercise Medicine, Changi General Hospital, Singapore, Singapore.
¹² Department of Basic Medical Sciences, Durban University of Technology, Durban, South Africa.
¹³ MOVE-IT Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cádiz, Cádiz, Spain.
¹⁴ Institute of Human Movement Science, Sport and Health, University of Graz, Graz, Austria.
¹⁵ Department of Orthopedics, University Children's Hospital Basel, University of Basel, Basel, Switzerland.
¹⁶ School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia.
¹⁷ Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany.
¹⁸ Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam UMC, University Medical Centers-Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
¹⁹ Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, Brazil.

Abstract

Most countries affected by the COVID-19 pandemic have repeatedly restricted public life to control the contagion. However, the health impact of confinement measures is hitherto unclear. We performed a multinational survey investigating changes in mental and physical well-being (MWB/PWB) during the first wave of the pandemic. A total of 14,975 individuals from 14 countries provided valid responses. Compared to pre-restrictions, MWB, as measured by the WHO-5 questionnaire, decreased considerably during restrictions (68.1 ± 16.9 to 51.9 ± 21.0 points). Whereas 14.2% of the participants met the cutoff for depression screening pre-restrictions, this share tripled to 45.2% during restrictions. Factors associated with clinically relevant decreases in MWB were female sex (odds ratio/OR = 1.20, 95% CI: 1.11-1.29), high physical activity levels pre-restrictions (OR = 1.29, 95% CI 1.16-1.42), decreased vigorous physical activity during restrictions (OR = 1.14, 95% CI: 1.05-1.23), and working (partially) outside the home vs. working remotely (OR = 1.29, 95% CI: 1.16-1.44/OR = 1.35, 95% CI: 1.23-1.47). Reductions, although smaller, were also seen for PWB. Scores in the SF-36 bodily pain subscale decreased from 85.8 ± 18.7% pre-restrictions to 81.3 ± 21.9% during restrictions. Clinically relevant decrements of PWB were associated with female sex (OR = 1.62, 95% CI: 1.50-1.75), high levels of public life restrictions (OR = 1.26, 95% CI: 1.18-1.36), and young age (OR = 1.10, 95% CI: 1.03-1.19). Study findings suggest lockdowns instituted during the COVID-19 pandemic may have had substantial adverse public health effects. The development of interventions mitigating losses in MWB and PWB is, thus, paramount when preparing for forthcoming waves of COVID-19 or future public life restrictions.

Keywords: SF-36; WHO-5; coronavirus; lockdowns; pain; psychological health.

Copyright © 2021 Wilke, Hollander, Mohr, Edouard, Fossati, González-Gross, Sánchez Ramírez, Laiño, Tan, Pillay, Pigozzi, Jimenez-Pavon, Sattler, Jaunig, Zhang, van Poppel, Heidt, Willwacher, Vogt, Verhagen, Hespanhol and Tenforde.