Cited by 585COVID-19 and Mental HealthCommunication and COVID-19 ImpactMaternal Mental Health During Pregnancy and Postpartum

Lockdown, quarantine measures, and social distancing: Associations with depression, anxiety and distress at the beginning of the COVID-19 pandemic among adults from Germany

Open access
Benke, Christoph, Autenrieth, Lara K., Asselmann, Eva, Pané-Farré, Christiane A.·2020·Psychiatry Research

Abstract

The COVID-19 pandemic is suggested to have a negative impact on mental health. To prevent the spread of Sars-CoV-2, governments worldwide have implemented different forms of public health measures ranging from physical distancing recommendations to stay-at-home orders, which have disrupted individuals’ everyday life tremendously. However, evidence on the associations of the COVID-19 pandemic and public health measures with mental health are limited so far. In this study, we investigated the role of sociodemographic and COVID-19 related factors for immediate mental health consequences in a nationwide community sample of adults from Germany (N = 4335). Specifically, we examined the effects of different forms and levels of restriction resulting from public health measures (e.g. quarantine, stay-at-home order) on anxiety and depression symptomatology, health anxiety, loneliness, the occurrence of fearful spells, psychosocial distress and life-satisfaction. We found that higher restrictions due to lockdown measures, a greater reduction of social contacts and greater perceived changes in life were associated with higher mental health impairments. Importantly, a subjectively assumed but not an officially announced stay-at-home order was associated with poorer mental health. Our findings underscore the importance of adequate risk communication and targeted mental health recommendations especially for vulnerable groups during these challenging times.

Integrity signals

Registry

Crossref · 10.1016/j.psychres.2020.113462

Cites

36 of 36 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 30 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    In the present sample, 13.1% reported a fearful spell in the past four weeks.

    “In the present sample, 31.1% exceeded the cutoff score for a potential depression, 21.2% exceeded the cutoff score for a potential anxiety disorder diagnosis and 13.1% of the sample reported having had a fearful spell during the past 4 weeks.”
    Quote in the paperNot a substantial claim
  • Findingown data

    In the sample, being quarantined by a local health authority was not associated with any psychological outcome.

    “However, being quarantined by a local health authority was not associated with any psychological outcome.”
    Quote in the paperNot a substantial claim
  • Findingown data

    In the same sample, a subjectively perceived stay-at-home order was unrelated to health anxiety.

    “Perceived stay-at-home orders were unrelated to health anxiety.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Belonging to a risk group for severe COVID-19 was associated with negative mental health consequences of the public containment measures.

    “Consistent with previous studies from countries around the world (see Luo et al., 2020; Vindegaard and Eriksen Benros, 2020 for a review), we found that belonging to a risk group for a severe course of COVID-19, a current or past treatment due to mental health problems, being unemployed or non-working, a lower educational level and younger age were associated with negative mental health”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Luo et al., 2020

      Not checked in the free run.

    • cites Vindegaard and Eriksen Benros, 2020 source

      Not checked in the free run.

  • Findingown data

    In the same sample, an officially announced stay-at-home order was not associated with any psychological outcome measure.

    “There was no association of officially announced stay-at-home orders with psychological outcome measures (see Table 1).”
    Quote in the paperSubstantial claim
  • May combine two claims. 14
  • Classified as probably not a substantial claim. 5
  • The quote only partly states this claim. 1
  • May combine two claims.

    Findingown data

    In the sample, having contact to loved ones in an officially announced COVID-19 risk group was associated with higher health anxiety and lower loneliness.

    “Having contact to loved ones that belong to an officially announced COVID-19 risk group was associated with higher health anxiety and lower loneliness.”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The mean life-satisfaction score in the sample was 6.42 (SD = 2.31).

    “The mean score of life-satisfaction was 6.42 (SD = 2.31).”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Findingown data

    In the same sample, a greater reduction of social contacts was associated with higher anxiety and depressive symptoms, fearful spells, psychosocial distress, and lower life-satisfaction.

    “A stronger reduction of social contacts, higher distress due to restrictions of social contacts, stronger perceived changes in life due to the public health measures and a more negative appraisal of these perceived changes were positively associated with higher anxiety and depressive symptomatology, fearful spells, psychosocial distress and lower life-satisfaction.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Findingown data

    In the sample, belonging to an officially announced COVID-19 risk group was associated with higher anxiety and depressive symptomatology, health anxiety, fearful spells, higher psychosocial distress, and lower life-satisfaction.

    “Belonging to an officially announced COVID-19 risk group was associated with higher anxiety and depressive symptomatology, health anxiety, fearful spells, higher psychosocial distress, and lower life-satisfaction.”
    Quote in the paperSubstantial claim
  • May combine two claims. The quote only partly states this claim.

    Findingown data

    In the same sample, greater distress due to restrictions of social contacts was associated with higher anxiety and depressive symptoms, fearful spells, psychosocial distress, lower life-satisfaction, and higher health anxiety.

    “A stronger reduction of social contacts, higher distress due to restrictions of social contacts, stronger perceived changes in life due to the public health measures and a more negative appraisal of these perceived changes were positively associated with higher anxiety and depressive symptomatology, fearful spells, psychosocial distress and lower life-satisfaction.”
    • Also stated in: § COVID-19-related variables · plain
      “There was no association (expect for social distancing related distress) of theses predictors with health anxiety.”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Findingown data

    In a nationwide German community sample of 4335 adults, a higher level of restriction due to public health measures was associated with greater loneliness, greater psychosocial distress, and lower life-satisfaction.

    “A higher level of restriction due to public health measures was associated with higher loneliness, higher psychosocial distress, and lower life-satisfaction.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Findingown data

    In the same sample, stronger perceived changes in life due to public health measures were associated with higher anxiety and depressive symptoms, fearful spells, psychosocial distress, and lower life-satisfaction.

    “A stronger reduction of social contacts, higher distress due to restrictions of social contacts, stronger perceived changes in life due to the public health measures and a more negative appraisal of these perceived changes were positively associated with higher anxiety and depressive symptomatology, fearful spells, psychosocial distress and lower life-satisfaction.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Findingown data

    In the sample, being in self-quarantine was associated with higher health anxiety and with fearful spells.

    “Being in self-quarantine was associated with higher health anxiety and with fearful spells.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Findingown data

    In the same sample, a subjectively perceived stay-at-home order was associated with higher anxiety and depressive symptoms, fearful spells, greater psychosocial distress, greater loneliness, and lower life-satisfaction.

    “However, perceived stay-at-home orders were associated with higher anxiety and depressive symptoms, fearful spells, higher psychosocial distress, higher loneliness, and lower life-satisfaction (see Table 1).”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Findingown data

    In the same sample, reduction of social contacts, perceived changes in life, and negative appraisal of those changes were not associated with health anxiety, whereas distress due to restrictions of social contacts was associated with health anxiety.

    “There was no association (expect for social distancing related distress) of theses predictors with health anxiety.”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Findingown data

    About one in four respondents reported living in a German federal state where the government had imposed a stay-at-home order, while objective data indicated that the government had not announced such an order.

    “However, about one in four respondents reported to live in a German federal state in which government has imposed a prohibition to leave the apartment without sound reasons (stay-at-home order), while objective data indicated that the respective government had not announced such stay-home-order.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Interpretationreasoning

    Convenience sampling led to underrepresentation of older respondents and men, which limits generalization of the results to the general population of Germany and other countries.

    “However, as a result of our recruitment method (i.e., convenience sampling methods) older respondents and men were relatively underrepresented in the current sample which limits the generalization of the present results to the general population of Germany and other countries.”
    Quote in the paperSubstantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Recent studies found that insufficient information or misinformation about COVID-19 was associated with poorer mental health and well-being.

    “For example, recent studies found that insufficient information (González-Sanguino et al., 2020) or misinformation (‘fake news’) on COVID-19 (Wang et al., 2020) was associated with poorer mental health and well-being (Ko et al., 2020; Chao et al., 2020; Gao et al., 2020).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites González-Sanguino et al., 2020 source

      Not checked in the free run.

    • cites Wang et al., 2020 source

      Not checked in the free run.

    • cites Ko et al., 2020

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Lockdown measures have been associated with increased psychological distress and loneliness.

    “For example, lockdown measures have been associated with increased psychological distress and loneliness (Tull et al., 2020).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Tull et al., 2020 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Externalizing symptoms might also be affected by public health measures and restrictions.

    “Moreover, we only assessed internalizing symptoms like depressive or anxiety symptoms, while externalizing symptoms (e.g., anger, aggression, alcohol abuse) might also be affected by public health measures and restrictions (Brooks et al., 2020).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Brooks et al., 2020 source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    The study relied exclusively on self-report data, which might have been subject to memory and recall biases.

    “Our study exclusively relied on self-report data which might have been subject to memory and recall-biases.”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Interpretationcitation

    Greater loneliness and higher psychosocial distress might facilitate or moderate potential negative mental health consequences.

    “Although the level of restriction due to lockdown measures was not associated with an immediate increase in psychopathological symptoms, more loneliness and higher psychosocial distress might be relevant factors that facilitate or moderate potential negative consequences for mental health.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Unfavorable feelings may not relate to immediate mental health impairments but may increase the future risk of developing psychopathological symptoms and mental disorders.
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Loneliness has been linked to increased risk for several mental disorders and somatic diseases in general.

    “Especially loneliness has been associated with an increased risk for several mental disorders and somatic diseases in general (Beutel et al., 2017; Holt-Lunstad et al., 2015; Valtorta et al., 2018; Luhmann and Hawkley, 2016) and during the current pandemic (Palgi et al., 2020; González-Sanguino et al., 2020; Luchetti et al., 2020).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Beutel et al., 2017 source

      Not checked in the free run.

    • cites Holt-Lunstad et al., 2015 source

      Not checked in the free run.

    • cites Valtorta et al., 2018 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    The current findings suggest that the COVID-19 pandemic causes negative mental health consequences, especially in vulnerable groups.

    “The current findings suggest that the COVID-19 pandemic causes negative consequences for mental health especially in vulnerable groups (e.g. young adults, individuals with a mental disorder) which may need special attention and support by implementing interventions or prevention programs to mitigate long-term consequences for mental health (Holmes et al., 2020).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Holmes et al., 2020 source

      Not checked in the free run.

19 of 19
  • The paper relies on this without support.

    The cross-sectional associations observed during the study period reflect the immediate mental health consequences of the COVID-19 pandemic and public health measures, rather than pre-existing or unrelated differences.

    “The present study was aimed at identifying potential predictors for immediate mental health consequences to the COVID-19 pandemic and related public health measures in Germany.”
  • The paper relies on this without support.

    Participants' self-reported zip codes accurately identify their federal state and thus the public health measures in place.

    “Analyses including data provided by the ZPID (Restrictions by public health measures and officially announced stay-at-home orders) were limited to those participants who reported their zip codes (n = 4185).”
  • The authors state this as an assumption.

    Unfavorable feelings may not relate to immediate mental health impairments but may increase the future risk of developing psychopathological symptoms and mental disorders.

    “In line with vulnerability-stress models, it is plausible to assume that such unfavorable feelings not necessarily relate to immediate mental health impairments, but may increase the risk to develop psychopathological symptoms and mental disorders in the future.”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • The coronavirus (COVID-19) first appeared in China at the end of 2019 and evolved into a global crisis with a significant negative impact on the physical and mental health of individuals across the globe.

    “The coronavirus (COVID-19) first appeared in China at the end of 2019 and evolved into a global crisis with a significant negative impact on the physical and mental health of individuals across the globe (Benke et al., 2020; Huang and Zhao, 2020).”

    From Mindfulness-Based Stress Reduction Increases Mental Wellbeing and Emotion Regulation During the First Wave of the COVID-19 Pandemic: A Synchronous Online Intervention Study (2021) · cites this paper as Benke et al., 2020

    The Introduction describes COVID-19 as a global crisis affecting physical and mental health worldwide. It does not state that the coronavirus first appeared in China at the end of 2019, so that part of the citing sentence is not supported by this source. (LLM, conf=0.88)

    Experimental — accuracy not yet measured
  • Behavioral activation may be especially crucial during pandemic times because engagement with typical mood-boosting reinforcers dwindles to preserve social distancing and cope with quarantining.

    “Further, we argue that behavioral activation may be especially crucial during pandemic times, as engagement with typical mood-boosting reinforcers (e.g., social interaction) dwindles to preserve social distancing and cope with quarantining (Benke et al., 2020;Jin et al., 2021).”
  • There is substantial evidence to demonstrate the deterioration of mental health among people during and after the COVID-19 pandemic compared to the pre-COVID-19 period.

    “There is substantial evidence to demonstrate the deterioration of mental health among people during and after the COVID-19 pandemic compared to the pre-COVID-19 period [13–16].”

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Authors
Benke, C., Autenrieth, L. K., Asselmann, E., & Pané-Farré, C. A.
Affiliations
  • Philipps University of Marburg (DE)
  • Humboldt-Universität zu Berlin (DE)
Corresponding author
Benke, Christoph
Venue
Psychiatry Research
Publisher
Elsevier BV
Published
2020-11
Volume
293
Pages
113462
ISSN
0165-1781 (ISSN-L)
OpenAlex
W3087101165
Cited by
585
References
39
Citations by year
2026: 14 · 2025: 36 · 2024: 76 · 2023: 126 · 2022: 181 · 2021: 148 · 2020: 3
FWCI
46.04
Type
journal article
Language
en
Open access
Locations
  • Psychiatry Research (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
  • Social Sciences › Communication › Communication and COVID-19 Impact
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
Keywords
COVID-19 pandemic, lockdown measures, quarantine, stay-at-home orders, social distancing, depression, anxiety, psychosocial distress, loneliness, health anxiety, life satisfaction, risk communication, mental health outcomes, adults
MeSH terms
Betacoronavirus, COVID-19, SARS-CoV-2, Adolescent, Adult, Aged, Aged, 80 and over, Anxiety, Cross-Sectional Studies, Depression, Female, Germany, Humans, Male, Middle Aged, Pneumonia, Viral, Quarantine, Psychological Distance, Stress, Psychological, Coronavirus Infections, Young Adult, Pandemics

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