Risk of stress/depression and functional impairment in Denmark immediately following a COVID-19 shutdown

  1. Lars H. Andersen
  2. Peter Fallesen
  3. Tim A. Bruckner

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Abstract

Background

Existing estimates of the impact of the COVID-19 burden on mental wellbeing come from countries with high mortality rates. This study therefore aimed to investigate the impact of the first COVID-19 lockdown (March–April 2020) on risk for stress/depression and functional impairment in a representative sample of adult individuals in Denmark, which had lower infection rates, and whether the impact of lockdown was heterogeneous across living situation.

Methods

Using a representative, randomly drawn sample from the complete Danish adult population interviewed in March 2 to April 13, 2020 ( n  = 2836) and again in July 2020 ( n  = 1526, 54% retention rate), we study how the imposed lockdown announced March 11 following the onset of the first Danish wave of COVID-19 infections affected mental wellbeing. We use the World Health Organization Five Well-being Index (WHO-5) and the Work and Social Adjustment Scale (WSAS) to capture risk for stress/depression (WHO-5 < 50) and functional impairment (WSAS > 10). Using covariate adjusted ordinary least squares linear probability models and exploiting variation in the timing of responses occurring just before and just after the introduction of lockdown, we compare respondents before lockdown to respondents that answered during lockdown, as well as to answers in re-interviews in July.

Results

In our fully controlled models, we find reduced depressive symptoms among adults immediately after the shutdown, concentrated in adults with children living at home (−.089, p  < .01 (from pre lockdown baseline .273)). Measures of functional impairment also declined immediately after the March shutdown among adults with children living at home (−.066, p  < .05 (from pre lockdown baseline .150)). Impairment intensified for the entire sample between March and July (+.199, p  < .001 (from pre lockdown baseline .248)), but depressive symptoms remained at lower rate in July (−.033, p  < .05 (from pre lockdown baseline .332).

Conclusions

Findings in Denmark indicate that living with children at home may have, in the short term, buffered the potential mental health sequelae of the COVID-19 shutdown.

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  1. Version published to 10.1186/s12889-021-11020-3
  2. ScreenIT

    SciScore for 10.1101/2020.12.15.20248251: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations involve the fact that the March comparisons of mental wellbeing before and after the lockdown examine serial cross-sections rather than a panel. We, however, controlled for compositional changes of the panel in our analyses. The WHO-5 also asks about 14-day recall of depressive symptoms, which may have biased pre-vs. post March 11 responses towards the null. We, however, controlled for this circumstance using a weighted analysis as a robustness check; findings, moreover, rejected the null, which precludes a type II error. Lastly, we cannot rule out the possibility of seasonal confounding in that late-March coincided with Spring and better temperature than in early March. This seasonal confounding, however, cannot explain the distinct nature of the subgroup responses in which depressive symptoms and functional impairment fall in late-March only among adults with children but not among adults living alone. Our findings diverge from previous population-based reports in the UK, the US and France. This circumstance could arise for several reasons. First, Denmark underwent a much less severe COVID-19 pandemic in Spring 2020 than did these countries, as measured by overall cases or deaths per population. Danes, therefore, may not have had to contend as heavily with the associated fear and anxiety of COVID-19-related morbidity as did other countries. Second, Denmark’s strong social safety net largely protects adults and families against large financial “shocks” that appea...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We found bar graphs of continuous data. We recommend replacing bar graphs with more informative graphics, as many different datasets can lead to the same bar graph. The actual data may suggest different conclusions from the summary statistics. For more information, please see Weissgerber et al (2015).

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2020.12.15.20248251v1 on medRxiv