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

Abstract

BackgroundTimes 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.MethodsWe analyzed representative data from telephone surveys of Germany’s adults: “German Health Update (GEDA)” and “COVID-19 vaccination rate monitoring in Germany (COVIMO)”. Three indicators of mental health were observed in approximately 1,000 and later 3,000 randomly sampled participants monthly until June 2022: symptoms of depression (observed since April 2019 using the PHQ-2), symptoms of anxiety (observed since March 2021 using the GAD-2) and self-rated mental health (observed since March 2021 using a single item). We produced time series graphs including estimated three-month moving means and proportions of individuals with a positive screen (PHQ/GAD-2 score ≥ 3) and of those reporting 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.ResultsWhile 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, the youngest and eldest adults, and the high level of education group stand out. Furthermore, symptoms of anxiety increased while self-rated mental health decreased between 2021 and 2022.ConclusionsElevated 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.