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Protective and Risk Factors for Mental Distress and Its Impact on Health

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Protective and Risk Factors for Mental Distress and Its Impact on Health International Journal of Environmental Research and Public Health Article Protective and Risk Factors for Mental Distress and Its Impact on Health-Protective Behaviors during the SARS-CoV-2 Pandemic between March 2020 and March 2021 in Germany Donya Gilan 1,2,*, Markus Müssig 1,3 , Omar Hahad 1,4 , Angela M. Kunzler 1,2, Simon Samstag 1, Nikolaus Röthke 2, Johannes Thrul 5, Frauke Kreuter 6,7, Michael Bosnjak 8, Philipp Sprengholz 9, Cornelia Betsch 9 , Daniel Wollschläger 10 , Oliver Tüscher 1,2 and Klaus Lieb 1,2 1 Leibniz Institute for Resilience Research (LIR), 55131 Mainz, Germany; [email protected] (M.M.); [email protected] (O.H.); [email protected] (A.M.K.); [email protected] (S.S.); [email protected] (O.T.); [email protected] (K.L.) 2 Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; [email protected] 3 Department of Personality Psychology and Psychological Assessment, Johannes Gutenberg University Mainz, 55122 Mainz, Germany 4 Department of Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany 5 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; [email protected] 6 Ludwig Maximilians University of Munich, 80539 Munich, Germany; [email protected] 7 Citation: Gilan, D.; Müssig, M.; University of Maryland, College Park, MD 20742, USA 8 Leibniz Institute for Psychology (ZPID), 54296 Trier, Germany; [email protected] Hahad, O.; Kunzler, A.M.; Samstag, 9 Center for Empirical Research in Economics and Behavioural Sciences, University of Erfurt, S.; Röthke, N.; Thrul, J.; Kreuter, F.; 99089 Erfurt, Germany; [email protected] (P.S.); [email protected] (C.B.) Bosnjak, M.; Sprengholz, P.; et al. 10 Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Protective and Risk Factors for Johannes Gutenberg University Mainz, 55131 Mainz, Germany; [email protected] Mental Distress and Its Impact on * Correspondence: [email protected] Health-Protective Behaviors during the SARS-CoV-2 Pandemic between Abstract: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is posing a March 2020 and March 2021 in global public health burden. These consequences have been shown to increase the risk of mental Germany. Int. J. Environ. Res. Public distress, but the underlying protective and risk factors for mental distress and trends over different Health 2021, 18, 9167. https:// waves of the pandemic are largely unknown. Furthermore, it is largely unknown how mental distress doi.org/10.3390/ijerph18179167 is associated with individual protective behavior. Three quota samples, weighted to represent the Academic Editor: Paul B. Tchounwou population forming the German COVID-19 Snapshot Monitoring study (24 March and 26 May 2020, and 9 March 2021 with >900 subjects each), were used to describe the course of mental distress Received: 12 July 2021 and resilience, to identify risk and protective factors during the pandemic, and to investigate their Accepted: 26 August 2021 associations with individual protective behaviors. Mental distress increased slightly during the Published: 31 August 2021 pandemic. Usage of cognitive reappraisal strategies, maintenance of a daily structure, and usage of alternative social interactions decreased. Self-reported resilience, cognitive reappraisal strategies, Publisher’s Note: MDPI stays neutral and maintaining a daily structure were the most important protective factors in all three samples. with regard to jurisdictional claims in Adherence to individual protective behaviors (e.g., physical distancing) was negatively associated published maps and institutional affil- with mental distress and positively associated with frequency of information intake, maintenance iations. of a daily structure, and cognitive reappraisal. Maintaining a daily structure, training of cognitive reappraisal strategies, and information provision may be targets to prevent mental distress while assuring a high degree of individual protective behaviors during the COVID-19 pandemic. Effects of the respective interventions have to be confirmed in further studies. Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. Keywords: resilience; protective factors; pandemic; SARS-CoV-2; mental distress; protective behavior This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). Int. J. Environ. Res. Public Health 2021, 18, 9167. https://doi.org/10.3390/ijerph18179167 https://www.mdpi.com/journal/ijerph Int. J. Environ. Res. Public Health 2021, 18, 9167 2 of 12 1. Introduction The virus SARS-CoV-2, causing COVID-19, a disease first described in China in late 2019, has led to a worldwide pandemic with currently over 173 million confirmed cases and over 3.7 million deaths (8 June 2021; [1]). To control the spread of the disease, many countries have put restrictions in place that heavily impacted their economies as well as everyday life. These restrictions combined with the pandemic itself have led to increased mental distress caused by, among other things, fear of job loss, fear of losing loved ones, financial problems, social isolation, closed educational institutions, and restricted access to healthcare services [2–6]. A key question in the current pandemic that remains under- researched from a resilience perspective is: which individual characteristics contribute to this mental distress and which may prevent it, that is, may foster resilience as the maintenance or fast recovery of mental health during or after stressful life events [7]? Compared with the global situation with steadily rising SARS-CoV-2 cases and more cases per capita in many countries, the impact of the SARS-CoV-2 pandemic has been less pronounced in Germany than, for example, in Italy, Spain, Brazil, or the United States [1]. Nevertheless, in our previous study that assessed mental distress in three representative cross-sectional samples of the German population between 24 March and 21 April 2020, during the first wave of the pandemic, we found increased levels of mental distress (i.e., symptoms of depression, anxiety, loneliness, and hopelessness) compared with pre-pandemic data [8]. This is in line with a large number of systematic reviews and meta-analyses that have been published on the mental distress caused by the SARS-CoV-2 pandemic so far (e.g., [4–6,9,10]). For example, Kunzler and colleagues [9] compared mental distress during the SARS-CoV-2 pandemic in the general population (50 international studies) with pre-pandemic data and found evidence for an increase in symptoms of anxiety (d = 0.40) and depression (d = 0.67), but not in other mental health outcomes (e.g., stress). Similarly, Prati and Mancini [10] focused on the psychological impact of lockdown on the general population and reported small effects on depression (g = 0.15) and anxiety (g = 0.17), while there was no evidence for an impact on other mental health outcomes. Although the evidence base on the mental health impact of the COVID-19 pandemic has improved in the past few months, with an increasing number of longitudinal studies (e.g., comparing pre-pandemic data on mental health outcomes with data collected during the pandemic; [11,12]), the majority of existing studies suffer from methodological weaknesses such as non-representative samples, cross-sectional designs with a single data collection, and the use of non-validated questionnaires. Additionally, most previous studies focused on acute effects on mental distress, while data on the long-term consequences of the pandemic with its different waves and associated consequences are lacking. Factors contributing to or mitigating mental distress from SARS-CoV-2 have also been researched in some existing studies. Reported risk factors for mental distress in response to SARS-CoV-2 include female gender [9,11,12], working as a healthcare pro- fessional [8,13], previous diagnoses of mental illness [9,14], symptoms of a pre-existing physical condition [15], younger age [11,12], relatives who are infected with COVID- 19 [15,16], concerns about getting infected [9], being under lockdown or quarantine [17], and loneliness [15,17,18]. Protective factors for mental distress, on the other side, have been studied less comprehensively, and some of these protective factors include higher age [9], socioeconomic stability [9,12], education [9], spiritual well-being [15], sociability [19], and social support [17]. Apart from these mostly sociodemographic factors, only a few studies have evaluated the use of psychological coping strategies during the pandemic. For example, Veer et al. [20] identified a positive appraisal style as a protective coping style, while Shamblaw, Rumas, and Best [21] found that avoidance-oriented coping styles were associated with higher depression and anxiety ratings. Nevertheless, little is known about protective coping behaviors in light of the pandemic. Moreover, there is limited evidence on associations between psychological factors and individual health-protective behaviors during the pandemic such as wearing masks in Int. J. Environ. Res. Public Health 2021, 18, 9167 3 of 12 Int. J. Environ. Res. Public Health 2021, 18, x 3 of 12 public spaces, hand-hygiene,
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