Increase in Mental Disorders During the COVID-19 Pandemic-The Role of Occupational and Financial Strains

Nico Dragano, Marvin Reuter, Annette Peters, Miriam Engels, Börge Schmidt, Karin H Greiser, Barbara Bohn, Steffi Riedel-Heller, André Karch, Rafael Mikolajczyk, Gérard Krause, Olga Lang, Leo Panreck, Marcella Rietschel, Hermann Brenner, Beate Fischer, Claus-Werner Franzke, Sylvia Gastell, Bernd Holloczek, Karl-Heinz JöckelRudolf Kaaks, Thomas Keil, Alexander Kluttig, Oliver Kuß, Nicole Legath, Michael Leitzmann, Wolfgang Lieb, Claudia Meinke-Franze, Karin B Michels, Nadia Obi, Tobias Pischon, Insa Feinkohl, Susanne Rospleszcz, Tamara Schikowski, Matthias B Schulze, Andreas Stang, Henry Völzke, Stefan N Willich, Kerstin Wirkner, Hajo Zeeb, Wolfgang Ahrens, Klaus Berger

Research output: Contribution to journalArticleAcademicpeer-review


BACKGROUND: Numerous studies have reported an increase in mental disorders during the COVID-19 pandemic, but the exact reasons for this development are not well understood. In this study we investigate whether pandemic-related occupational and financial changes (e.g., reduced working hours, working from home, financial losses) were associated with increased symptoms of depression and anxiety compared with the situation before the pandemic.

METHODS: We analyzed data from the German National Cohort (NAKO) Study. Between May and November 2020, 161 849 study participants answered questions on their mental state and social circumstances. Their responses were compared with data from the baseline survey before the pandemic (2014-2019). Linear fixed-effects models were used to determine whether individual changes in the severity of symptoms of depression (PHQ-9) or anxiety (GAD-7) were associated with occupational/ financial changes (controlling for various covariates).

RESULTS: The prevalence of moderate or severe symptoms of depression and anxiety increased by 2.4% and 1.5%, respectively, during the COVID-19 pandemic compared with the preceding years. The mean severity of the symptoms rose slightly. A pronounced increase in symptoms was observed among those who became unemployed during the pandemic (+ 1.16 points on the depression scale, 95% confidence interval [0.91; 1.41], range 0-27). Increases were also seen for reduced working hours with no short-time allowance, increased working hours, working from home, insecurity regarding employment, and financial strain. The deterioration in mental health was largely statistically explained by the occupational and financial changes investigated in the model.

CONCLUSION: Depressive symptoms and anxiety disorders increased slightly in the study population during the first year of the COVID-19 pandemic. Occupational and financial difficulties were an essential contributory factor. These strains should be taken into account both in the care of individual patients and in the planning of targeted prevention measures.

Original languageEnglish
Pages (from-to)179-187
Number of pages9
JournalDeutsches Arzteblatt International
Issue number11
Publication statusPublished - 2022


  • Anxiety/epidemiology
  • COVID-19/epidemiology
  • Depression/diagnosis
  • Humans
  • Mental Disorders/epidemiology
  • Pandemics
  • SARS-CoV-2


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