A 16-Month Longitudinal Investigation of Risk and Protective Factors for Mental Health Outcomes Throughout Three National Lockdowns and a Mass Vaccination Campaign: Evidence from a Weighted Israeli Sample During COVID-19

BackgroundThe COVID-19 pandemic is an ongoing global crisis, with a multitude of factors that affect mental health worldwide. Here, we explore potential predictors for the emergence and maintenance of depression, anxiety, and posttraumatic stress symptoms (PTSS) in the general population in Israel. MethodsAcross the span of 16 months, 2,478 people completed a repeated self-report survey which inquired psychiatric symptoms and pandemic related stress factors (PRSF). PRSF were divided into four clusters of environmental stressors: financial, health-related, fatigue and sense of protection by authorities. We applied mixed-effects linear models to assess how each stressor contributes to depression, anxiety and PTSS at each time point, alongside a longitudinal exploration among participants who completed at least two consecutive surveys (n=400). ResultsFatigue was the strongest predictor for depression, anxiety and PTSS at all time points (standardized {beta} between 0.28-0.60, p<.0001), and predicted deterioration overtime ({beta} between 0.22-0.36, p<.0001). Financial concerns associated with depression and anxiety at all time points ({beta} between 0.13- 0.26, p<.01), and with their deterioration overtime ({beta} between 0.16-0.18, p<.0001), while health related concerns were uniquely associated with anxiety and PTSS at all time points ({beta} between 0.14-0.29, p<.01) and their deterioration ({beta} between 0.11-0.16, p<.001), but not with depression. Improvement in sense of protection overtime associated with decrease in depression and anxiety ({beta} between -0.09 to -0.16, p<.01). ConclusionsOur findings accentuate the multitude of risk factors for psychiatric morbidity during COVID-19, and the dynamics in their association with different aspects of psychopathology at various time points.

Association among income loss, financial strain and depressive symptoms during COVID-19: evidence from two longitudinal studies

BackgroundThe COVID-19 pandemic has major ramifications for global health and the economy, with growing concerns about economic recession and implications for mental health. Here we investigated the associations between COVID-19 pandemic-related income loss with financial strain and mental health trajectories over a 1-month course. MethodsTwo independent studies were conducted in the U.S and in Israel at the beginning of the outbreak (March-April 2020, T1; N = 4 171) and at a 1-month follow-up (T2; N = 1 559). Mixed-effects models were applied to assess associations among COVID-19-related income loss, financial strain, and pandemic-related worries about health, with anxiety and depression, controlling for multiple covariates including pre-COVID-19 income. FindingsIn both studies, income loss and financial strain were associated with greater depressive symptoms at T1, above and beyond T1 anxiety, worries about health, and pre-COVID-19 income. Worsening of income loss was associated with exacerbation of depression at T2 in both studies. Worsening of subjective financial strain was associated with exacerbation of depression at T2 in one study (US). InterpretationIncome loss and financial strain were uniquely associated with depressive symptoms and the exacerbation of symptoms over time, above and beyond pandemic-related anxiety. Considering the painful dilemma of lockdown versus reopening, with the tradeoff between public health and economic wellbeing, our findings provide evidence that the economic impact of COVID-19 has negative implications for mental health. FundingThis study was supported by grants from the National Institute of Mental Health, the US-Israel Binational Science Foundation, Foundation Dora and Kirsh Foundation.