Association of Non-Pharmaceutical Interventions to Reduce the Spread of SARS-CoV-2 With Anxiety and Depressive Symptoms: A Multi-National Study of 43 Countries.

Kira E Riehm,Carly P Lupton-Smith,Ting-Hsuan Chang,Luke R Aldridge,Rachel Presskreischer,Elena Badillo Goicoechea,Frauke Kreuter,Esther Kim,Frances M Wang,Sarah Larocca,Elizabeth A Stuart

doi:10.3389/ijph.2022.1604430

Abstract

Objectives: To examine the association of non-pharmaceutical interventions (NPIs) with anxiety and depressive symptoms among adults and determine if these associations varied by gender and age. Methods: We combined survey data from 16,177,184 adults from 43 countries who participated in the daily COVID-19 Trends and Impact Survey via Facebook with time-varying NPI data from the Oxford COVID-19 Government Response Tracker between 24 April 2020 and 20 December 2020. Using logistic regression models, we examined the association of [1] overall NPI stringency and [2] seven individual NPIs (school closures, workplace closures, cancellation of public events, restrictions on the size of gatherings, stay-at-home requirements, restrictions on internal movement, and international travel controls) with anxiety and depressive symptoms. Results: More stringent implementation of NPIs was associated with a higher odds of anxiety and depressive symptoms, albeit with very small effect sizes. Individual NPIs had heterogeneous associations with anxiety and depressive symptoms by gender and age. Conclusion: Governments worldwide should be prepared to address the possible mental health consequences of stringent NPI implementation with both universal and targeted interventions for vulnerable groups.

Highlights

The Coronavirus Disease 2019 (COVID-19) pandemic has had a devastating impact on health and well-being around the world
Interactions between each non-pharmaceutical interventions (NPIs) and gender for associations with anxiety and depressive symptoms were statistically significant for every NPI except for workplace closures
Associations of school closures, cancellation of public events, restrictions on the size of gatherings, and restrictions on internal movement with anxiety and depressive symptoms were stronger among females, whereas associations of stay-at-home requirements and international travel controls with anxiety and depressive symptoms were stronger among males

Summary

Introduction

The Coronavirus Disease 2019 (COVID-19) pandemic has had a devastating impact on health and well-being around the world. To limit the spread of disease and mitigate the burden on health systems, non-pharmaceutical interventions (NPIs) have been rapidly adopted worldwide and include a range of restrictions, such as stay-at home orders, workplace closures, and social venue closures [1, Non-Pharmaceutical Interventions and Mental Health. Some researchers have called for explicit consideration of the potential negative consequences of NPIs, including anxiety and depressive symptoms, high unemployment, deaths due to causes other than COVID-19 infection, and widening health inequities [7, 8]. With regards to mental health, some NPIs, most prominently stay-at-home orders, have been widely speculated to contribute to anxiety and depressive symptoms by restricting access to social support networks and inducing isolation [9, 10]. Females have been vulnerable to adverse changes in mental health during the COVID-19 pandemic [11], which may be due to factors such as increased childcare responsibilities and disproportionate job loss as a result of school and workplace closures [12, 13]. NPIs may have more severe implications for mental health among young adults, who are overrepresented in the service industry and more susceptible to job loss or wage cuts in response to restrictions [12]

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