A Multinational Study on the Protective and Risk Factors Associated with Mental Health Parameters in the General Population During the COVID-19 Pandemic: A Study in the Asia-Europe-North America Cohort

Background: The novel Coronavirus-2019 (COVID-19) was declared a pandemic by the World Health Association (WHO) in March 2020, impacting the lifestyles, economy, physical and mental health of individuals globally. Little is known about the relationship between the impact of COVID-19 and one’s mental health status, and thus research needs to be conducted to identify the factors involved and develop tailored evidence-based strategies in response to reduce the adverse psychological impact. Methods: From February to June 2020, we conducted an online Global Mental Health survey which recruited participants via a respondent-driven sampling country in 8 countries (China, Pakistan, Philippines, Iran, Poland, Spain, USA and Vietnam). The online survey collected information on demographic characteristics, physical symptoms and health service utilisation, contact history, knowledge and concerns regarding COVID-19, precautionary measures taken and additional health information variables among the countries involved. The psychological impact was measured by the Impact of Event Scale-Revised (IES-R) questionnaire and the mental health status was measured by the Depression, Anxiety and Stress Scale (DASS-21). Results: There were 5555 participants involved in the study, 31.4% male and 68.6% female, with an age range of 12-to above 50 years of age. There were significant differences in the mean IES-R and DASS-21 scores between the 8 countries (F(7, 55477) = 71.605, η2=0.085, p<0.001). China had the highest IES-R score (mean=32.98, SD=15.42). Poland and Pakistan were found to be the two countries with the highest levels of anxiety, depression and stress;conversely, Vietnam had the lowest scores in stress (mean = 3.80, SD = 5.81), anxiety (mean = 2.10, SD = 4.91) and depression (mean = 2.28, SD = 5.43). Female gender, age older than 50 years, crowded home environment, unemployment and student status were significant associated with adverse mental health (p<0.05). However, higher education background, greater level of satisfaction with health information, staying with family members, spending less than 2 hours a day monitoring health information, taking suitable precautionary measures, use of face masks and less time spent at home were found to be protective factors for mental health (p<0.05). Interpretation: During the height of the COVID-19 pandemic, the mental health of the global population was significantly affected as shown empirically by the results of our study, and each country faced their own set of unique challenges in their response to COVID-19. Our findings have identified protective and risk factors associated with mental health that can help us to develop targeted psychological interventions for those who are more vulnerable during this pandemic.Funding Statement: This study has the following funding sources: Huaibei Normal University, China, Ministry of Science and Higher Education in Poland under the 2019-2022 program, Regional Initiative of Excellence", project number 012 / RID / 2018/19, National University of Singapore iHeathtech Other Operating Expenses (R-722-000-004-731) and Vingroup Innovation Foundation (VINIF) COVID research grant (VINIF.2020.Covid19.DA07) in Vietnam.Declaration of Interests: None declared.Ethics Approval Statement: The study was approved by the Institutional Review Boards from each country, China (Huaibei Normal University of China, HBU-IRB2020-001/002), Philippines (University of Philippines Manila Research Ethics Board, UPMREB 2020-198-01), Poland (SWPS University, WKEB62/04/2020), Spain (Complutense University of Madrid of Spain, Pr_2019_20_027), Vietnam (Hanoi Medical University, QD 75/QD-YHDP&YHDP) and the US (East Carolina University, UMCIRB 20-000838). Approval was also obtained from the relevant Iranian and Pakistani committees. All respondents provided informed consent. The collected data were anonymous and treated as confidential.