# Global and risk-group stratified well-being and mental health during the COVID-19 pandemic in adults: Results from the international COH-FIT Study

Marco Solmi, Trevor Thompson, Andrés Estradé, Agorastos Agorastos, Joaquim Radua, Samuele Cortese, Elena Dragioti, Davy Vancampfort, Lau Caspar Thygesen, Harald Aschauer, et al.

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Marco Solmi, Trevor Thompson, Andrés Estradé, Agorastos Agorastos, Joaquim Radua, et al. Global and risk-group stratified well-being and mental health during the COVID-19 pandemic in adults: Results from the international COH-FIT Study. Psychiatry Research, 2024, 342, pp.115972. 10.1016/j.psychres.2024.115972. hal-04906737

HAL Id: hal-04906737

https://uca.hal.science/hal-04906737v1

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# Global and risk-group stratified well-being and mental health during the COVID-19 pandemic in adults: Results from the international COH-FIT Study

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Marco Solmi<sup>a,b,c,d,e,f,1</sup>, Trevor Thompson<sup>g,1</sup>, Andrés Estradé<sup>d,i,1</sup>, Agorastos Agorastos<sup>j</sup>, Joaquim Radua<sup>d,k,1</sup>, Samuele Cortese<sup>h</sup>, Elena Dragioti<sup>m,n</sup>, Davy Vancampfort<sup>o</sup>, Lau Caspar Thygesen<sup>p</sup>, Harald Aschauer<sup>q</sup>, Monika Schlögelhofer<sup>q</sup>, Elena Aschauer<sup>q</sup>, Andres Schneeberger<sup>r</sup>, Christian G. Huber<sup>s</sup>, Gregor Hasler<sup>t</sup>, Philippe Conus<sup>u</sup>, Kim Q. Do Cuénod<sup>u</sup>, Roland von Känel<sup>v</sup>, Gonzalo Arrondo<sup>l,w</sup>, Paolo Fusar-Poli<sup>d,x,y</sup>, Philip Gorwood<sup>z,aa</sup>, Pierre-Michel Llorca<sup>ab</sup>, Marie-Odile Krebs<sup>aa,ac</sup>, Elisabetta Scanferla<sup>z</sup>, Taishiro Kishimoto<sup>ad</sup>, Golam Rabbani<sup>ae</sup>, Karolina Skonieczna-Żydecka<sup>af</sup>, Paolo Brambilla<sup>ag,ah</sup>, Angela Favaro<sup>ai</sup>, Akihiro Takamiya<sup>ad</sup>, Leonardo Zoccante<sup>aj</sup>, Marco Colizzi<sup>ak</sup>, Julie Bourgin<sup>al</sup>, Karol Kamiński<sup>am</sup>, Maryam Moghadasin<sup>an</sup>, Soraya Seedat<sup>ao</sup>, Evan Matthews<sup>ap</sup>, John Wells<sup>ap</sup>, Emilia Vassilopoulou<sup>aq</sup>, Ary Gadelha<sup>ar</sup>, Kuan-Pin Su<sup>as,at</sup>, Jun Soo Kwon<sup>au</sup>, Minah Kim<sup>av</sup>, Tae Young Lee<sup>aw</sup>, Oleg Papsuev<sup>a,b,c</sup>, Denisa Manková<sup>ay</sup>, Andrea Boscutti<sup>az</sup>, Cristiano Gerunda<sup>ai</sup>, Diego Saccon<sup>ba</sup>, Elena Righi<sup>bb</sup>, Francesco Monaco<sup>bc,bd</sup>, Giovanni Croatto<sup>be</sup>, Guido Cereda<sup>ag</sup>, Jacopo Demurtas<sup>bf</sup>, Natascia Brondino<sup>y</sup>, Nicola Veronese<sup>bg</sup>, Paolo Enrico<sup>ag</sup>, Pierluigi Politi<sup>y</sup>, Valentina Ciappolino<sup>bh</sup>, Andrea Pfennig<sup>bi</sup>, Andreas Bechdolf<sup>bj</sup>, Andreas Meyer-Lindenberg<sup>bk</sup>, Kai G. Kahl<sup>bl</sup>, Katharina Domschke<sup>bm</sup>, Michael Bauer<sup>bi</sup>, Nikolaos Koutsouleris<sup>bn</sup>, Sibylle Winter<sup>f</sup>, Stefan Borgwardt<sup>bo</sup>, Istvan Bitter<sup>bp</sup>, Judit Balazs<sup>bq,br</sup>, Pál Czobor<sup>bp</sup>, Zsolt Unoka<sup>bp</sup>, Dimitris Mavridis<sup>bs</sup>, Konstantinos Tsamakis<sup>bt</sup>, Vasilios P. Bozikas<sup>j</sup>, Chavit Tunvirachaisakul<sup>bu</sup>, Michael Maes<sup>bu</sup>, Teerayuth Rungnirundorn<sup>bu</sup>, Thitiporn Supasitthumrong<sup>bu</sup>, Ariful Haque<sup>ae</sup>, Andre R. Brunoni<sup>bv,bw</sup>, Carlos Gustavo Costardi<sup>ar</sup>, Felipe Barreto Schuch<sup>bx,by,bz</sup>, Guilherme Polanczyk<sup>bv</sup>, Jhoanne Merlyn Luiz<sup>ca</sup>, Lais Fonseca<sup>ar</sup>, Luana V. Aparicio<sup>bv</sup>, Samira S. Valvassori<sup>ca</sup>, Merete Nordentoft<sup>cb</sup>, Per Vendsborg<sup>cc</sup>, Sofie Have Hoffmann<sup>p</sup>, Jihed Sehli<sup>cd</sup>, Norman Sartorius<sup>ce</sup>, Sabina Heuss<sup>cf</sup>, Daniel Guinart<sup>cg,ch,ci</sup>, Jane Hamilton<sup>cj</sup>, John Kane<sup>ck</sup>, Jose Rubio<sup>ck</sup>, Michael Sand<sup>cm</sup>, Ai Koyanagi<sup>cn</sup>, Aleix Solanes<sup>k</sup>, Alvaro Andreu-Bernabeu<sup>co</sup>, Antonia San José Cáceres<sup>co</sup>, Celso Arango<sup>co</sup>, Covadonga M. Díaz-Caneja<sup>co</sup>, Diego Hidalgo-Mazzei<sup>cp</sup>, Eduard Vieta<sup>cp</sup>, Javier Gonzalez-Peñas<sup>co</sup>, Lydia Fortea<sup>k</sup>, Mara Parellada<sup>co</sup>, Miquel A. Fullana<sup>k</sup>, Norma Verdolini<sup>cp,cq</sup>, Eva Andrlíková<sup>ay</sup>, Karolina Janků<sup>ay</sup>, Mark J. Millan<sup>cr</sup>, Mihaela Honciuc<sup>ab</sup>, Anna Moniuszko-Malinowska<sup>cs</sup>, Igor Łoniewski<sup>af,ct</sup>, Jerzy Samochowiec<sup>cu</sup>, Łukasz Kiszkiel<sup>cv</sup>, Maria Marlicz<sup>af</sup>, Paweł Sowa<sup>am</sup>, Wojciech Marlicz<sup>cw,cx</sup>, Georgina Spies<sup>ao</sup>, Brendon Stubbs<sup>cy</sup>, Joseph Firth<sup>cz</sup>, Sarah Sullivan<sup>da</sup>, Asli Enez Darcin<sup>db</sup>, Hatice Aksu<sup>dc</sup>, Nesrin Dilbaz<sup>dd</sup>, Onur Noyan<sup>dd</sup>, Momoko Kitazawa<sup>ad</sup>, Shunya Kurokawa<sup>ad</sup>, Yuki Tazawa<sup>ad</sup>, Alejandro Anselmi<sup>de</sup>, Cecilia Cracco<sup>de</sup>,

<footnote>* Corresponding author at: Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité University Medical Center, Campus Virchow, Augustenburger Platz 1, D-13353, Berlin, Germany.</footnote>

<footnote>E-mail address: christoph.correll@charite.de (C.U. Correll).</footnote>
AnaInés Machado<sup>de</sup>, Natalia Estrade<sup>de</sup>, Diego De Leo<sup>df</sup>, Jackie Curtis<sup>dg</sup>, Michael Berk<sup>dh</sup>,
Andre F. Carvalho<sup>dh</sup>, Philip Ward<sup>di</sup>, Scott Teasdale<sup>di</sup>, Simon Rosenbaum<sup>di</sup>, Wolfgang Marx<sup>dh</sup>,
Adrian Vasile Horodnic<sup>dj</sup>, Liviu Oprea<sup>dj</sup>, Ovidiu Alexinschi<sup>dk</sup>, Petru Ifteni<sup>dl</sup>, Serban Turliuc<sup>dj</sup>,
Tudor Ciuhodaru<sup>dm</sup>, Alexandra Bolos<sup>dj</sup>, Valentin Matei<sup>dn</sup>, Dorien H. Nieman<sup>do</sup>, Iris Sommer<sup>dp</sup>,
Jim van Os<sup>dq</sup>, Therese van Amelsvoort<sup>dr</sup>, Ching-Fang Sun<sup>at,ds</sup>, Ta-wei Guu<sup>at,bt,dt</sup>, Can Jiao<sup>du</sup>,
Jieting Zhang<sup>du</sup>, Jialin Fan<sup>du</sup>, Liye Zou<sup>du</sup>, Xin Yu<sup>dv</sup>, Xinli Chi<sup>du</sup>, Philippe de Tinary<sup>dw,dx</sup>,
Ruud van Winkel<sup>dy</sup>, Bernardo Ng<sup>dz</sup>, Edilberto Peña de León<sup>dz</sup>, Ramon Arellano<sup>dz</sup>,
Raquel Roman<sup>dz</sup>, Thelma Sanchez<sup>dz</sup>, Larisa Movina<sup>ax</sup>, Pedro Morgado<sup>ea,eb</sup>, Sofia Brissos<sup>ec</sup>,
Oleg Aizberg<sup>ed</sup>, Anna Mosina<sup>ee</sup>, Damir Krinitski<sup>ef</sup>, James Mugisha<sup>eg</sup>,
Dena Sadeghi-Bahmani<sup>eh,ei</sup>, Farshad Sheybani<sup>ej</sup>, Masoud Sadeghi<sup>ek</sup>, Samira Hadi<sup>el</sup>,
Serge Brand<sup>ei,em,en,eo,ep,eq</sup>, Antonia Errazuriz<sup>er</sup>, Nicolas Crossley<sup>er</sup>, Dragana Ignjatovic Ristic<sup>es</sup>,
Carlos López-Jaramillo<sup>et</sup>, Dimitris Efthymiou<sup>eu</sup>, Praveenlal Kuttichira<sup>ev</sup>,
Roy Abraham Kallivayalil<sup>ew</sup>, Afzal Javed<sup>ex</sup>, Muhammad Iqbal Afridi<sup>ey,ez</sup>, Bawo James<sup>fa</sup>,
Omonefe Joy Seb-Akahomen<sup>fb</sup>, Jess Fiedorowicz<sup>a,b,c</sup>, Jeff Daskalakis<sup>r</sup>, Lakshmi N. Yatham<sup>fc</sup>,
Lin Yang<sup>fd,fe</sup>, Tarek Okasha<sup>ff</sup>, Aïcha Dahdouh<sup>fg</sup>, Jari Tiihonen<sup>l,fh</sup>, Jae Il Shin<sup>fi</sup>, Jinhee Lee<sup>fj</sup>,
Ahmed Mhalla<sup>fk</sup>, Lotfi Gaha<sup>fk</sup>, Takoua Brahim<sup>fk</sup>, Kuanysh Altynbekov<sup>fl</sup>, Nikolay Negay<sup>fl</sup>,
Saltanat Nurmagambetova<sup>fl</sup>, Yasser Abu Jamei<sup>fm</sup>, Mark Weiser<sup>fn</sup>, Christoph U. Correll<sup>f,cg,ck,cl,*</sup>

<footnote><sup>a</sup> University of Ottawa, Department of Psychiatry, Ontario, Canada</footnote>

<footnote><sup>b</sup> The Ottawa Hospital, Department of Mental Health, Ontario, Canada</footnote>

<footnote><sup>c</sup> Ottawa Hospital Research Institute (OHRI) Neurosciences Program, Ottawa Ontario</footnote>

<footnote><sup>d</sup> Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK</footnote>

<footnote><sup>e</sup> Centre for Innovation in Mental Health-Developmental Lab, School of Psychology, University of Southampton, and NHS Trust, Southampton, United Kingdom</footnote>

<footnote><sup>f</sup> Charité Universitätsmedizin Berlin, Department of Child and Adolescent Psychiatry, Berlin, Germany</footnote>

<footnote><sup>g</sup> Centre for Chronic Illness and Ageing, University of Greenwich, London, UK</footnote>

<footnote><sup>h</sup> University of Southampton, Centre for Innovation in Mental Health, Southampton, UK</footnote>

<footnote><sup>i</sup> Universidad Católica, Department of Psychology, Montevideo, Uruguay</footnote>

<footnote><sup>j</sup> Aristotle University of Thessaloniki, II. Dept. of Psychiatry, Division of Neurosciences, Medical School, Faculty of Health Sciences, Greece</footnote>

<footnote><sup>k</sup> Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Imaging of Mood- and Anxiety-Related Disorders (IMARD), University of Barcelona, CIBERSAM, Instituto de Salud Carlos III, Barcelona, Spain</footnote>

<footnote><sup>l</sup> Karolinska Institutet, Centre for Psychiatric Research and Education, Department of Clinical Neuroscience, Stockholm, Sweden</footnote>

<footnote><sup>m</sup> Linköping University, Pain and Rehabilitation Centre and Department of Health, Medicine and Caring Sciences, Linköping, Sweden</footnote>

<footnote><sup>n</sup> University of Ioannina, Research Laboratory Psychology of Patients, Families & Health Professionals, Department of Nursing, School of Health Sciences, Ioannina, Greece</footnote>

<footnote><sup>o</sup> Katholieke Universiteit Leuven (KU Leuven), Department of Rehabilitation Sciences, Leuven, Belgium</footnote>

<footnote><sup>p</sup> National Institute of Public Health, University of Southern Denmark, Denmark</footnote>

<footnote><sup>q</sup> BioPsyC - Biopsychosocial Corporation, Non-profit association for Research Funding Ltd., Vienna, Austria</footnote>

<footnote><sup>r</sup> University of California San Diego, California, USA</footnote>

<footnote><sup>s</sup> University of Basel, Universitäre Psychiatrie kliniken Basel (UPK), Basel, Switzerland</footnote>

<footnote><sup>t</sup> University of Fribourg, Fribourg Network of Mental Health (RFSM), Fribourg, Switzerland</footnote>

<footnote><sup>u</sup> University of Lausanne, Department of Psychiatry, Lausanne, Switzerland</footnote>

<footnote><sup>v</sup> University of Zurich, University Hospital Zurich, Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, Switzerland</footnote>

<footnote><sup>w</sup> University of Navarra, Mind-Brain Group, Institute for Culture and Society (ICS), Pamplona, Spain</footnote>

<footnote><sup>x</sup> OASIS service, South London and Maudsley NHS Foundation Trust, London, UK</footnote>

<footnote><sup>y</sup> University of Pavia, Department of Brain and Behavioral Sciences, Pavia, Italy</footnote>

<footnote><sup>z</sup> Université Paris Cité, CMME, GHU Paris Psychiatrie et Neurosciences, Paris, France</footnote>

<footnote><sup>aa</sup> Institute de Psychiatrie et Neuroscience de Paris, INSERM U1266, F-75014, Paris, France</footnote>

<footnote><sup>ab</sup> Université Clermont Auvergne, CHU Clermont-Ferrand, Service de Psychiatrie B, Clermont-Ferrand, France</footnote>

<footnote><sup>ac</sup> Université de Paris, PEPIT, GHU Paris Psychiatrie et Neuroscience, Paris, France</footnote>

<footnote><sup>ad</sup> Keio University School of Medicine, Department of Neuropsychiatry, Tokyo, Japan</footnote>

<footnote><sup>ae</sup> The National Foundation of Mental Health of Bangladesh, Bangladesh</footnote>

<footnote><sup>af</sup> Pomeranian Medical University in Szczecin, Department of Biochemical Sciences, Szczecin, Poland</footnote>

<footnote><sup>ag</sup> University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy</footnote>

<footnote><sup>ah</sup> Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Neurosciences and Mental Health, Milan, Italy</footnote>

<footnote><sup>ai</sup> University of Padua, Neurosciences Department, Padua, Italy</footnote>

<footnote><sup>aj</sup> UOC Infanzia, Adolescenza, Famiglia e Consultori - Districts 1 & 2 AULSS 9 Scaligera, Verona, Italy</footnote>

<footnote><sup>ak</sup> University of Udine, Department of Medicine (DAME), Unit of Psychiatry, Italy</footnote>

<footnote><sup>al</sup> Service de Psychiatrie de l'enfant et de l'adolescent, GHNE, 91440 Bures Sur Yvette, France</footnote>

<footnote><sup>am</sup> Medical University of Bialystok, Department of Population Medicine and Lifestyle Diseases Prevention, Bialystok, Poland</footnote>

<footnote><sup>an</sup> Kharazmi University, Department of Clinical Psychology, Faculty of Psychology and Education, Tehran, Iran</footnote>

<footnote><sup>ao</sup> South African Medical Research Council Unit on the Genomics of Brain Disorders, Stellenbosch University, Department of Psychiatry, Faculty of Medicine and Health Sciences, South Africa</footnote>

<footnote><sup>ap</sup> South East Technological University, School of Health Science, Waterford, Ireland</footnote>

<footnote><sup>aq</sup> University of Nicosia, Department of Life and Health Sciences, Nicosia, Cyprus</footnote>

<footnote><sup>ar</sup> Universidade Federal de São Paulo, Department of Psychiatry, São Paulo, Brazil</footnote>

<footnote><sup>as</sup> An-Nan Hospital, China Medical University, Department of Psychiatry, Tainan, Taiwan</footnote>

<footnote><sup>at</sup> China Medical University Hospital, Mind-Body Interface Research Center, Taichung, Taiwan</footnote>

<footnote><sup>au</sup> Seoul National University College of Medicine, Department of Psychiatry, Seoul, Republic of Korea</footnote>

<footnote><sup>av</sup> Seoul National University Hospital, Department of Neuropsychiatry, Seoul, Republic of Korea</footnote>

<footnote><sup>aw</sup> Pusan National University Yangsan Hospital, Department of Psychiatry, Yangsan, Republic of Korea</footnote>

<footnote><sup>ax</sup> Moscow Research Institute of Psychiatry, Moscow, Russia</footnote>
ay National Institute of Mental Health, Klecany, Czech Republic

az UTHealth Houston, Department of Psychiatry, 1941 East Rd, Houston, TX 77054, USA

bb AULSS4 Veneto Orientale, Addictions Department, Italy

bb University of Modena and Reggio Emilia, Department of Biomedical, Metabolic and Neural Sciences, Modena, Italy

bc ASL Salerno, Department of Mental Health, Salerno, Italy

bd European Biomedical Research Institute of Salerno (EBRIS), Salerno, Italy

be University of Padova, Padova, Italy

bf University of Modena and Reggio Emilia, Clinical and Experimental Medicine PhD Program, Modena, Italy

bg University of Palermo, Department of Internal Medicine, Geriatrics Section, Palermo, Italy

bh Unit of Psychiatry, Azienda Ospedaliero-Universitaria Ss. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy

bi Technische Universität Dresden, University Hospital Carl Gustav Carus, Department of Psychiatry and Psychotherapy, Dresden, Germany

bi Charité Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Berlin, Germany

bk Heidelberg University, Central Institute of Mental Health, Medical Faculty Mannheim, Germany

bH Hannover Medical School, Department of Psychiatry, Social Psychiatry and Psychotherapy, Germany

bm University of Freiburg, Department of Psychiatry and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine, Freiburg, Germany

bn Ludwig-Maximilians-University of Munich, Munich, Germany

bO Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany

bS Semmelweis University, Department of Psychiatry and Psychotherapy, Budapest, Hungary

bI Eotvos Lorand University, Institute of Psychology, Budapest, Hungary

bJ Bjørknes University College, Oslo, Norway

bU University of Ioannina, Department of Primary Education, Ioannina, Greece

bK King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK

bu Chulalongkorn University, Department of Psychiatry, Thailand

bV Faculdade de Medicina da Universidade de São Paulo, Departments of Internal Medicine and Psychiatry, São Paulo, Brazil

bW Instituto de Psiquiatria do Hospital das Clínicas da FMUSP, R. Dr. Ovídio Pires de Campos, 785 - Cerqueira César, São Paulo - SP, 05403-903, Brazil

bx Universidade Federal de Santa Maria, Department of Sports Methods and Techniques, Santa Maria, RS, Brazil

by Faculty of Health Sciences, Universidad Autónoma de Chile, Providencia, Chile

bz Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

cU Universidade do Extremo Sul Catarinense, Translational Psychiatry Laboratory, Graduate Program in Health Sciences, Criciúma, SC, Brazil

cb University of Copenhagen, Copenhagen, Denmark

cc Pomeranian Medical University in Szczecin, Department of Psychiatry, Szczecin, Poland

cd Le Jolimont Psychiatry and Psychotherapy, Fribourg, Switzerland

ce Association for the Improvement of Mental Health Programmes (AMH), Switzerland

cH FHNW University of Applied Sciences and Arts Northwestern Switzerland, Switzerland

cS Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, USA

cI Institut de Salut Mental, Parc de Salut Mar, Barcelona, Spain

cI Hospital del Mar Research Institute, CIBERSAM, Barcelona, Spain

cI University of Texas Health Science Center Houston, McGovern Medical School, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, USA

cK The Zucker Hillside Hospital, Northwell Health, New York, USA

cI The Feinstein Institute for Medical Research, Center for Psychiatric Neuroscience, Manhasset, NY, USA

cm S2 Consulting LLC

cn Parc Sanitari Sant Joan de Deu, Barcelona, Spain

cP Hospital General Universitario Gregorio Marañón, Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health (IPS MARAÑÓN), IISGM, CIBERSAM, Universidad Complutense, Madrid, Spain

cP University of Barcelona, Hospital Clínic, IDIBAPS, CIBERSAM, Barcelona, Spain

cL Local Health Unit 1, Department of Mental Health, Mental Health Center of Perugia, Italy

cG Glasgow University, Institute of Neuroscience and Psychology, College of Medicine, Vet and Life Science, Glasgow, UK

cM Medical University of Bialystok, Department of Infectious Diseases and Neuroinfections, Poland

cS Sanprobi Sp. z o.o. Sp. k, Poland

cU Pomeranian Medical University in Szczecin, Department of Psychiatry, Szczecin, Poland

cU University of Bialystok, Institute of Sociology, Society and Cognition Unit, Bialystok, Poland

cW Pomeranian Medical University in Szczecin, Department of Gastroenterology, Szczecin, Poland

cX The Centre for Digestive Diseases Endoklinika, Szczecin, Poland

cK King's College London, London, UK

cU University of Manchester, Division of Psychology and Mental Health, Manchester, UK

da Bristol Medical School, University of Bristol, Bristol, United Kingdom

db Istanbul Topkapı University, Istanbul, Turkey

dc Adnan Menderes University Department of Child and Adolescent Psychiatry, Aydın, Turkey

dK Uskudar University, Department of Psychiatry and Psychology, Istanbul, Turkey

de Department of Psychology, Universidad Católica del Uruguay, Avenida 8 de Octubre 2738, Montevideo, Montevideo 11600, Uruguay

dI Griffith University, South East Queensland, Australia

dM Mindgardens Neuroscience Network, Sydney, Australia

dh Deakin University School of Medicine, Victoria, Australia

dI UNSW Sydney, School of Psychiatry, Sydney, Australia

dU University of Medicine and Pharmacy Grigore T. Popa, Faculty of Medicine, Iasi, Romania

dk Institute of Psychiatry "Socola", Iasi, Romania

dI Transilvania University of Brasov, Faculty of Medicine, Brasov, Romania

dm Emergency Hospital "Nicolaes Oblu", Iasi, Romania

dP Psychiatry Department, University of Medicine and Pharmacy "Carol Davila" Bucharest, "Prof. Dr. Alexandru Obregia" Psychiatric Hospital, Bucharest, Romania

do Amsterdam University Medical Centers (location AMC), Department of Psychiatry, Amsterdam, the Netherlands

dP University Medical Center Groningen, Groningen, the Netherlands

dq Utrecht University Medical Centre, Department of Psychiatry, Utrecht, the Netherlands

dM Maastricht University, Department of Psychiatry and Neuropsychology, Maastricht, the Netherlands

ds Department of Psychiatry and Behavioral Medicine, Carilion Clinic Virginia Tech Carilion School of Medicine, Roanoke, VA, USA

dt China Medical University Beigang Hospital, Division of Psychiatry, Department of Internal Medicine, Taiwan

dI Shenzhen University, School of Psychology, Shenzhen, China

dv Peking University Institute of Mental Health, Department of Public Mental Health, Pekin, China

dw UCLouvain, Institute of Neuroscience and Cliniques Universitaires Saint-Luc, Department of Adult Psychiatry, Brussels, Belgium

dx Cliniques Universitaires Saint-Luc, Department of Adult Psychiatry, Brussels, Belgium

dy Katholieke Universiteit Leuven (KU Leuven), Department of Neurosciences, Leuven, Belgium
dz Asociación Psiquiátrica Mexicana, Mexico

ea University of Minho, Life and Health Sciences Research Institute (ICVS), School of Medicine, Braga, Portugal

eb ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal

ec Lisbon's Psychiatric Hospital Centre, Department of Psychiatry, Portugal

ed Belarusian Medical Academy of Postgraduate Education, Belarus

ee Clienia AG, Wetzikon Psychiatric Centre, Switzerland

el Integrated Psychiatry Winterthur (IPW), Switzerland

es Kyambogo University, Department of Sociology and Social Administration, Kampala, Uganda

eh Stanford University, Department of Psychology, California, USA

el Universität Psychiatrie kliniken Basel (UPK), Center of Affective, Stress and Sleep Disorders (ZASS), Basel, Switzerland

eI Department of Psychiatry and Clinical Psychology, Mashhad University of Medical Sciences, Mashhad, Iran

ek Kermanshah University of Medical Sciences, Medical Biology Research Center, Kermanshah, Iran

el Kharazmi University, Tehran, Iran

em University of Basel, Department of Sport, Exercise, and Health, Division of Sport Science and Psychosocial Health, Basel, Switzerland

en Kermanshah University of Medical Sciences, Substance Abuse Prevention Research Center, Kermanshah, Iran

eo Kermanshah University of Medical Sciences, Sleep Disorders Research Center, Kermanshah, Iran

ep Tehran University of Medical Sciences, School of Medicine, Tehran, Iran

eq Center for Disaster Psychiatry and Disaster Psychology, Psychiatric Clinics of the University of Basel, Basel, Switzerland

et Pontificia Universidad Católica de Chile, Department of Psychiatry, School of Medicine, Santiago, Chile

es University of Kragujevac, Department of Psychiatry, Faculty of Medical Sciences, Kragujevac, Serbia

eu University of Antioquia, Department of Psychiatry, Medellín, Colombia

eu Nous Therapy Center, Thessaloniki, Greece

ev Jubilee Mission Medical College & Research Institute, Thrissur, India

ew Pushpagiri Institute of Medical Sciences, Department of Psychiatry, Thiruvalla, Kerala, India

ex Chairman, Pakistan Psychiatric Research Centre-Fountain House, Lahore, Pakistan

ey Distinguished National Professor, Jinnah Sindh Medical University, Karachi, Pakistan

ez Adjunct Professor of Psychiatry, Baylor College of Medicine, Texas, USA

fa Tees Esk & Wear Valleys NHS Foundation Trust, UK

fb Irrua Specialist Teaching Hospital, Department of Psychiatry, Edo State, Nigeria

fc University of British Columbia, Vancouver, Canada

fd Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, Canada

fe Departments of Oncology and Community Health Sciences, University of Calgary, Calgary, Canada

ff Okasha Institute of Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt

fg Oran 1 University, Department of Psychiatry-Addictology, Oran, Algeria

fh University of Eastern Finland, Department of Forensic Psychiatry, Niuvanniemi Hospital, Kuopio, Finland

fl Yonsei University College of Medicine, Department of Pediatrics, Seoul, South Korea

fj Yonsei University, Wonju College of Medicine, Department of Psychiatry, Wonju, South Korea

fl University of Monastir, Faculty of Medicine of Monastir, Research Unit "Vulnerability to Mental Disorders" LR05ES10, Monastir, Tunisia

fl Republican Scientific and Practical Center of Mental Health, Almaty, Kazakhstan

fm Gaza Community Mental Health Programme, Gaza, Palestine

fn Sheba Medical Center, Israel

ARTICLE INFO

Keywords:

Covid-19

Pandemic

Survey

WHO-5

P-factor

Well-being

Mental health

Psychiatry

Psychopathology

A B S T R A C T

International studies measuring wellbeing/multidimensional mental health before/ during the COVID-19 pandemic, including representative samples for >2 years, identifying risk groups and coping strategies are lacking. COH-FIT is an online, international, anonymous survey measuring changes in well-being (WHO-5) and a composite psychopathology P-score, and their associations with COVID-19 deaths/restrictions, 12 a-priori defined risk individual/cumulative factors, and coping strategies during COVID-19 pandemic (26/04/2020-26/06/2022) in 30 languages (representative, weighted non-representative, adults). T-test, $\chi^2$, penalized cubic splines, linear regression, correlation analyses were conducted. Analyzing 121,066/142,364 initiated surveys, WHO-5/P-score worsened intra-pandemic by 11.1±21.1/13.2±17.9 points (effect size d=0.50/0.60) (comparable results in representative/weighted non-probability samples). Persons with WHO-5 scores indicative of depression screening (<50, 13% to 32%) and major depression (<29, 3% to 12%) significantly increased. WHO-5 worsened from those with mental disorders, female sex, COVID-19-related loss, low-income country location, physical disorders, healthcare worker occupations, large city location, COVID-19 infection, unemployment, first-generation immigration, to age=18-29 with a cumulative effect. Similar findings emerged for P-score. Changes were significantly but minimally related to COVID-19 deaths, returning to near-pre-pandemic values after >2 years. The most subjectively effective coping strategies were exercise and walking, internet use, social contacts. Identified risk groups, coping strategies and outcome trajectories can inform global public health strategies.

1. Introduction

Until June-7-2023 >767,750,000 persons have been infected with COVID-19, and >6,941,000 died (World Health Organization, 2020). The pandemic also worsened mental health of the general population (Clift et al., 2022), as measured in cohort studies and surveys in individual countries. Several non-COVID-19-related cohort studies had a

pre-pandemic mental health assessment (Ahrens et al., 2021), but most did not, retrospectively assessing pre-pandemic mental health (Huang et al., 2022). Also, to avoid in-person visits, both cohort studies and surveys assessed mental health with questionnaires (Lu et al., 2022). Many surveys have reported alarming rates of anxiety, depression, and post-traumatic symptoms during COVID-19 (Dragioti et al., 2022). However, most studies were affected by methodological limitations limiting the impact, representativeness, and generalizability of findings (e.g., assessing one intra-pandemic time-point only). Also, studies were set in at most two countries, used questionnaires in one language only

<footnote n="1">¹ Joint first authors.</footnote>
(neglecting linguistic/ethnic minorities), focused on one or few mental health domains, in non-representative samples, or in specific population subgroups, collecting few candidate risk/mitigating factors for mental health, without concurrently assessing physical health outcomes (Dragioti et al., 2022). Such limitations impede a comprehensive understanding of the health impact COVID-19. For instance, previous reports from individual countries showed that general population mental health is closely related with COVID-19 infection (Abel et al., 2021) and restrictions (Fancourt et al., 2021), but such associations at the global level remain unclear. Moreover, no study has assessed whether risk factors for poor mental health identified in individual countries, like younger and older age (Patel et al., 2022), female sex (Patel et al., 2022), or pre-existing physical and mental disorders (Dragioti et al., 2022), replicate globally.

The Collaborative Outcomes study on Health and Functioning during Infection Times (COH-FIT, www.coh-fit.com) (Solmi et al., 2022a, b) is an international survey study, conducted in 30 languages in representative/weighted non-representative samples. COH-FIT has been measuring well-being and the psychopathology factor (P-score), a composite mental health measure (Solmi et al., 2022a), in the general population across all continents since April-26-2020, including a retrospectively recalled pre-pandemic assessment, comprehensive multidimensional factors relevant for well-being and mental health. Here, we report globally in adults, findings of the two co-primary COH-FIT outcomes, well-being and the P-score, hypothesizing reduced well-being and increased psychopathology globally, with increased impairment in vulnerable subgroups and related to death rates and stringency measures over time, and with cumulative effects across multiple risk factors. We also assessed subjectively most effective coping strategies for dealing with the impact of the pandemic.

## 2. Methods

COH-FIT was approved by institutional ethics committees in study investigators' countries (published protocol (Solmi et al., 2022a, b)). COH-FIT translations and the P-score have been validated (Solmi et al., 2022a). For detailed methods and data dictionary with items' text and response values, see supplementary material. Below, we report methods and results following A Consensus-Based Checklist for Reporting of Survey Studies (CROSS) (Sharma et al., 2021) (eChecklist).

### 2.1. Outcomes

The two co-primary outcomes were intra- vs. pre-pandemic changes in the WHO-5 well-being score (Topp et al., 2015), and the “P-score”, a 5-dimensional measure composed of anxiety, depression, post-traumatic symptoms, psychotic symptoms, and psychophysiologic parameters (stress, sleep problems, and concentration problems). Participants rated symptoms “during the last two weeks”, and “during the last two weeks of their regular life” before the pandemic (visual analogue scale, 0-100 range WHO-5=0-100, P-score=0-100, higher scores better and worse status, respectively). Additionally, we calculated the proportion of subjects with WHO-5 <50 (indication for testing for depression), and <29 (indicative of major depression) (Topp et al., 2015), pre- and intra-pandemic.

We examined possible recall bias for WHO-5 and P-score performing polynomial regression analyses using linear or quadratic relationships.

Additionally, respondents rated how important (“very”, “some-what”, “not”) the following coping strategies were for dealing effectively with the pandemic: exercise or walking, internet use, direct social contact, hobby, information about the COVID-19 pandemic, media, social media, work, studying/learning, pet, physical intimacy, prescribed medications, religion/meditation/spirituality, gaming, substance use, or other strategies.

### 2.2. At-risk groups

Based on previous literature (Dragioti et al., 2022; Salazar de Pablo et al., 2020) we *a priori* identified 12 risk factors for poor well-being/mental health, namely having had COVID-19 infection, age ≤30, female sex, being unemployed, healthcare worker employment, having a mental disorder, having a physical disorder, first-generation immigrant status, large city location, low-income country location, obesity, and having lost someone due to COVID-19.

### 2.3. COVID-19 deaths and restrictions

Time- and region-specific COVID-19 daily deaths, and stringency index were extracted from Johns Hopkins University repository (http://coronavirus.jhu.edu/data), and University of Oxford stringency metric (0-100) (https://covidtracker.bsg.ox.ac.uk/) (eMethods).

### 2.4. Data analysis

The missing item data were imputed using multivariate chained equations, using predictive mean matching (van Buuren and Groothuis-Oudshoorn, 2011) to impute missing continuous values, and logistic regression for categorical variables (eMethods). Two iterations of outlier screening were undertaken, using a relatively high threshold of $|z|=5.0$, and winsoring them to the next highest non-outlying value. Details on survey weighting are available in eMethods. WHO-5 and P-score values and proportion of WHO-5 <50 and <29 pre- vs during pandemic were compared with paired t-test and $\chi^2$ test. Changes in the co-primary outcomes were compared in subjects with vs. without each risk factor for poor well-being/high P-score during the pandemic, using independent t-tests. Both weighted t-tests, using calibration weights, and unweighted t-tests with the original unweighted data were conducted. All tests of primary outcomes were evaluated for significance using an alpha threshold of $\alpha=.01$.

We also explored a cumulative effect of multiple risk factors on outcomes by testing a linear regression model between number of concomitant risk factors and co-primary outcomes. As the trajectory of intra-pandemic changes in WHO-5 and P-score could not be realistically predicted *a priori*, we conducted exploratory modelling of the course of outcomes using penalised cubic splines, plotting them together with COVID-19 deaths and restrictions. To quantify the association of outcomes with COVID-19 deaths, stringency, stringency/death ratio, and time, we conducted correlation and smoothed regression analyses. All analyses were performed in R, except for regression analyses for cumulative risk factors and correlation analyses, which were conducted with STATA.

## 3. Results

### 3.1. Survey sample

Overall, from 142,364 initiated surveys, 121,066 adults (age=42.0 ±15.9 (range=18-100); male=35.4%, female=64%, non-binary=0.4%, transgender/intersex=0.2%) provided analyzable data between 26-Apr-2020/19-Jun-2022. (participant flow in eFig. 1).

Baseline characteristics (see Table 1, and eTable 2 comparing included/excluded samples), indicated over-representation of females, younger adults, and those with higher education vs. national population statistics (eFig. 2).

A longer interval between survey completion and pandemic start was related to both pre-pandemic well-being scores (linear $\beta$=-0.03, quadratic $\beta$=-0.03, p<.001) and P scores (linear $\beta$=-0.01, quadratic $\beta$=-0.07, p<.001), yet with a negligible effect size (see eFigs. 3 and 4/), reflecting absence of substantial recall bias/drift.
<table><caption>**Table 1**

Basic participant characteristics for overall, representative and non-probability samples.</caption><thead><tr><th rowspan="2"></th><th colspan="2">Overall</th><th colspan="2">Representative</th><th colspan="2">Non-probability</th></tr><tr><th>N</th><th>Percent</th><th>N</th><th>Percent</th><th>N</th><th>Percent</th></tr></thead><tbody><tr><td><strong>Representative sample</strong></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>non-probability</td><td>86017</td><td>71.0</td><td>0</td><td>0</td><td>86017</td><td>100</td></tr><tr><td>representative</td><td>35049</td><td>29.0</td><td>35049</td><td>100</td><td>0</td><td>0</td></tr><tr><td><strong>Age</strong></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>18-34</td><td>46159</td><td>38.1</td><td>10216</td><td>29.1</td><td>35943</td><td>41.8</td></tr><tr><td>35-49</td><td>33947</td><td>28.0</td><td>9829</td><td>28.0</td><td>24118</td><td>28.0</td></tr><tr><td>50-64</td><td>28769</td><td>23.8</td><td>10058</td><td>28.7</td><td>18711</td><td>21.8</td></tr><tr><td>65+</td><td>12191</td><td>10.1</td><td>4946</td><td>14.1</td><td>7245</td><td>8.4</td></tr><tr><td><strong>Gender</strong></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Male</td><td>42891</td><td>35.4</td><td>17242</td><td>49.2</td><td>25649</td><td>29.8</td></tr><tr><td>Female</td><td>77487</td><td>64.0</td><td>17696</td><td>50.5</td><td>59791</td><td>69.5</td></tr><tr><td>Non-binary</td><td>462</td><td>0.4</td><td>67</td><td>0.2</td><td>395</td><td>0.5</td></tr><tr><td>Transgender or intersex</td><td>226</td><td>0.2</td><td>44</td><td>0.1</td><td>182</td><td>0.2</td></tr><tr><td><strong>Ethnicity</strong></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>White</td><td>83498</td><td>69.0</td><td>28641</td><td>81.7</td><td>54857</td><td>63.8</td></tr><tr><td>African/African-descent</td><td>3375</td><td>2.8</td><td>632</td><td>1.8</td><td>2743</td><td>3.2</td></tr><tr><td>Hispanic</td><td>3366</td><td>2.8</td><td>884</td><td>2.5</td><td>2482</td><td>2.9</td></tr><tr><td>Asian</td><td>23795</td><td>19.7</td><td>2765</td><td>7.9</td><td>21030</td><td>24.4</td></tr><tr><td>Mixed</td><td>5121</td><td>4.2</td><td>1561</td><td>4.5</td><td>3560</td><td>4.1</td></tr><tr><td>Other</td><td>1403</td><td>1.2</td><td>449</td><td>1.3</td><td>954</td><td>1.1</td></tr><tr><td>Prefer not to answer</td><td>508</td><td>0.4</td><td>117</td><td>0.3</td><td>391</td><td>0.5</td></tr><tr><td><strong>First-generation immigrant</strong></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>No</td><td>73346</td><td>92.6</td><td>26480</td><td>92.2</td><td>46866</td><td>92.8</td></tr><tr><td>Yes</td><td>5897</td><td>7.4</td><td>2253</td><td>7.8</td><td>3644</td><td>7.2</td></tr><tr><td><strong>Education</strong></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>None</td><td>671</td><td>0.6</td><td>196</td><td>0.6</td><td>475</td><td>0.6</td></tr><tr><td>Primary school</td><td>3401</td><td>2.8</td><td>2018</td><td>5.8</td><td>1383</td><td>1.6</td></tr><tr><td>High school</td><td>38726</td><td>32.0</td><td>18706</td><td>53.4</td><td>20020</td><td>23.3</td></tr><tr><td>College/university degree</td><td>68335</td><td>56.4</td><td>12986</td><td>37.1</td><td>55349</td><td>64.3</td></tr><tr><td>PhD</td><td>9933</td><td>8.2</td><td>1143</td><td>3.3</td><td>8790</td><td>10.2</td></tr><tr><td><strong>Socio-economic status</strong></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>0-24</td><td>7104</td><td>5.9</td><td>2298</td><td>6.6</td><td>4806</td><td>5.6</td></tr><tr><td>25-49</td><td>23091</td><td>19.1</td><td>7253</td><td>20.7</td><td>15838</td><td>18.4</td></tr><tr><td>50-74</td><td>71109</td><td>58.7</td><td>21148</td><td>60.3</td><td>49961</td><td>58.1</td></tr><tr><td>75-100</td><td>19762</td><td>16.3</td><td>4350</td><td>12.4</td><td>15412</td><td>17.9</td></tr><tr><td><strong>Employment</strong></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>No</td><td>46890</td><td>38.7</td><td>13909</td><td>39.7</td><td>32981</td><td>38.3</td></tr><tr><td>Yes</td><td>74176</td><td>61.3</td><td>21140</td><td>60.3</td><td>53036</td><td>61.7</td></tr><tr><td><strong>Healthcare worker</strong></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>No</td><td>56004</td><td>76.1</td><td>18864</td><td>89.4</td><td>37140</td><td>70.7</td></tr><tr><td>Yes</td><td>17606</td><td>23.9</td><td>2239</td><td>10.6</td><td>15367</td><td>29.3</td></tr><tr><td><strong>Mental health diagnosis</strong></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>No</td><td>101325</td><td>83.7</td><td>30523</td><td>87.1</td><td>70802</td><td>82.3</td></tr><tr><td>Yes</td><td>19741</td><td>16.3</td><td>4526</td><td>12.9</td><td>15215</td><td>17.7</td></tr><tr><td><strong>Physical disease diagnosis</strong></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>No</td><td>66840</td><td>55.2</td><td>20404</td><td>58.2</td><td>46436</td><td>54.0</td></tr><tr><td>Yes</td><td>54226</td><td>44.8</td><td>14645</td><td>41.8</td><td>39581</td><td>46.0</td></tr><tr><td><strong>COVID-19 infection</strong></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>No</td><td>27989</td><td>82.8</td><td>10874</td><td>77.6</td><td>17115</td><td>86.6</td></tr><tr><td>Yes</td><td>5805</td><td>17.2</td><td>3147</td><td>22.4</td><td>2658</td><td>13.4</td></tr><tr><td><strong>Urbanicity</strong></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Village/rural</td><td>21415</td><td>17.7</td><td>8459</td><td>24.1</td><td>12956</td><td>15.1</td></tr><tr><td>Small city/town (10,000-100,000 population)</td><td>30037</td><td>24.8</td><td>10199</td><td>29.1</td><td>19838</td><td>23.1</td></tr><tr><td>Medium city/town (100,000-500,000 population)</td><td>27312</td><td>22.6</td><td>7186</td><td>20.5</td><td>20126</td><td>23.4</td></tr><tr><td>Large city/town (over 500,000 population)</td><td>42302</td><td>34.9</td><td>9205</td><td>26.3</td><td>33097</td><td>38.5</td></tr><tr><td><strong>Restrictions (Oxford Stringency Index)</strong></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>0-24</td><td>4578</td><td>3.8</td><td>3446</td><td>9.8</td><td>1132</td><td>1.3</td></tr><tr><td>25-49</td><td>24754</td><td>20.4</td><td>10270</td><td>29.3</td><td>14484</td><td>16.8</td></tr><tr><td>50-74</td><td>61978</td><td>51.2</td><td>17914</td><td>51.1</td><td>44064</td><td>51.2</td></tr><tr><td>75-100</td><td>29756</td><td>24.6</td><td>3419</td><td>9.8</td><td>26337</td><td>30.6</td></tr><tr><td><strong>Country income</strong></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>High income</td><td>83214</td><td>68.7</td><td>29492</td><td>84.1</td><td>53722</td><td>62.5</td></tr><tr><td>Middle income</td><td>32517</td><td>26.9</td><td>5557</td><td>15.9</td><td>26960</td><td>31.3</td></tr><tr><td>Low income</td><td>5335</td><td>4.4</td><td>0</td><td>0</td><td>5335</td><td>6.2</td></tr><tr><td><strong>Obesity</strong></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>No (BMI &lt; 30)</td><td>98291</td><td>85.0</td><td>26998</td><td>79.1</td><td>71293</td><td>87.4</td></tr><tr><td>Yes (BMI 30+)</td><td>17371</td><td>15.0</td><td>7113</td><td>20.9</td><td>10258</td><td>12.6</td></tr><tr><td><strong>COVID-19-related loss</strong></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>No</td><td>114424</td><td>94.8</td><td>32684</td><td>93.3</td><td>81740</td><td>95.4</td></tr><tr><td>Yes</td><td>6329</td><td>5.2</td><td>2347</td><td>6.7</td><td>3982</td><td>4.6</td></tr></tbody></table>
## 3.2. Well-being

The WHO-5 score decreased by 11.1±21.1 points from pre- (71.5 ±19.3) to intra-pandemic (60.4±24.5) (paired t=183.68, p<.001, moderate effect size of d=.50). The proportion of individuals scoring <50 increased from 13% pre-pandemic to 32% intra-pandemic (McNemar's $\chi^2$=17637.38, p<.001), with the proportion scoring <29 increasing from 3% pre-pandemic to 12% intra-pandemic (McNemar's $\chi^2$=9103.50, p<.001).

A world map of WHO-5 changes shows that worsening varied across countries, but with a general pattern of global deterioration (Figs. 1A, 2A, and B, eTable 3).

Compared with those without each risk factor, larger decreases in WHO-5 score emerged for those, in descending order, with a mental disorder, females, COVID-related loss, living in low-income countries, with a physical disorder, healthcare workers, living in a large city, with prior COVID-19 infection, unemployment, and age 18-29 years old, but not for first-generation immigrants. Obesity was associated with smaller decline of WHO-5 (Fig. 3A, eTable 4). Multiple concomitant risk factors cumulatively increased WHO-5 worsening (1.95 WHO-5 score worsening for each risk factor, standard error/SE=0.070, p<0.01).

## 3.3. P-score

The P-scores increased by 13.2±17.9 points from pre-pandemic 27.5 ±19.9 to intra-pandemic 40.7±23.6 (paired t=256.23, p<.001, moderate effect size d=.60). Additionally, 63% experienced a P-score increase by ≥20%, 57% by ≥30%, 52% by ≥40%, and 47% by ≥50%.

A world map of P-score changes shows that P-score worsening varied across countries, but with a general pattern of global increase (Fig. 1B, eTable 3).

Compared with those without each risk factor, larger increases in P-score emerged for those, in descending order, with a mental disorder, living in low-income countries, females, age 18-29 years old, a physical disorder, COVID-related loss, healthcare workers, unemployment, living in a large city, first-generation immigrants, with history of COVID-19 infection, but without any difference for obesity (Fig. 3A, eTable 4). Multiple concomitant risk factors increased P-score worsening (2.03 P-score worsening for each risk factor, SE=0.06, p<0.01).

## 3.4. Coping strategies

The coping strategies most frequently rated as "very important" were

<figure><img src="image_5.png" /><figcaption>**Fig. 1.** Global change in WHO-5 well-being score (1A) and the composite psychopathology P-score (1B) in the general population during COVID-19 pandemic in COH-FIT. Legend Fig. 1.: COH-FIT, Collaborative Outcomes study on Health and Functioning during Infection Times, WHO, World Health Organization; larger negative and positive values indicate worsening of WHO-5, and P-score, respectively.</figcaption></figure>
<figure><img src="image_6.png" /><figcaption>Fig. 2. Proportion of subjects with a WHO-5 well-being score < 50 (2A) and <29 (2B) in the general population during COVID-19 pandemic in COH-FIT.</figcaption></figure>

exercise or walking=56.0%, internet use=55.3%, direct social con-
tacts=52.7%, followed by hobby=48.8%, COVID-19 pandemic
information=44%, media use=43.9%, social media use/remote inter-
actions=39.4%, work=37.5%, studying/learning=31.6%, spending
time with a pet=31.4%, physical intimacy=27.4%, prescribed medi-
cations=26.7%, religion/meditation/spirituality=20.9%, gaming=18
.0%, other strategies=12.9%, and substance use=7.8% (Fig. 3B, eTable
5).

3.5. *Change trajectories in well-being, P-score, COVID-19 deaths and restrictions in the overall sample, and across risk factors*

The smoothed trajectories of changes in well-being suggested a
worsening of WHO-5 until May-June 2021, when well-being returned to
early intra-pandemic levels (Fig. 4A and eFig. 17).

P-score peak worsening overall preceded WHO-5 oscillations by 1-2 months (Fig. 4B).

The course of well-being and P-score, together with the course with
COVID-19 deaths and restrictions during the pandemic across risk fac-
tors, are visualized in eFigs. 5–16.

Exploratory correlation analyses showed that in the whole sample
and across risk factors, both co-primary outcomes were significantly
associated with COVID-19 deaths, restrictions stringency, and with

stringency/death ratio, yet with very small effect sizes (eTable 6).

WHO-5 and P-score worsening returned towards near-pre-pandemic
values over time (F=116.20, p<0.001, F=83.38, p<0.001).

4. Discussion

This transcontinental study shows that during the COVID-19 pandemic well-being and mental health worsened in the general population, with a medium effect size, heterogeneously across one or multiple risk factors, countries, and time. COVID-19-related deaths, restriction stringency, and their ratio were significantly yet only minimally associated with worsening of well-being and psychopathology. Most effective coping strategies were identified. Well-being and composite psychopathology returned to near-pre-pandemic values after >2 years of the pandemic.

Results of COH-FIT confirm, though transcontinentally, findings
from a systematic review that pooled 177 European studies, reporting a
significant negative impact of COVID-19 on mental health, followed by a
trending towards pre-pandemic levels over time (Ahmed et al., 2023).
Also, COH-FIT results should be interpreted in comparison with findings
of a well-conducted recent meta-analysis of cohort studies, which
concluded that no/minimal mental health changes occurred during
COVID-19 (Sun et al., 2023). Despite the methodological rigor of that
<figure><img src="image_7.png" /></figure>

<figure><img src="image_8.png" /><figcaption>**Fig. 3.** Forest plot of changes in well-being and P-score (3A) across risk factors in adults during versus before COVID-19 pandemic, and coping strategies (3B). Legend Fig. 3A.: Risk factors are ordered by WHO-5 score difference between groups with and without risk factor; **, p value <0.05</figcaption></figure>

meta-analysis, the included cohort studies had several limitations. First, 97% of response came from high/upper-middle-income countries. In COH-FIT, 31% of responses came from low/middle-income countries, which had the largest worsening. Second, only 23% of the studies recruited representative samples. In COH-FIT, 29% were representative samples, and results did not differ between representative and weighted non-probability samples. Third, only 31% of included cohorts followed up with ≥75% participants, with selective retaining of persons that were doing well enough no to drop from the study. COH-FIT kept collecting responses longitudinally at the population level, and the retrospective assessment of pre-pandemic well-being and mental health did not show an upward or downward (idealization or contamination) drift. Fourth,

the outcomes included general mental health, depressive, and anxiety symptoms, taken individually, and only one study included WHO-5. COH-FIT also measured a psychopathology P-score, integrating five different domains into one validated score (Solmi et al., 2022a), and used WHO-5 in the whole population. Fifth, regarding subgroup analyses, those were largely underpowered, with only 2-3 studies in several subgroup analyses, very wide confidence intervals, and, low power. COH-FIT was adequately powered to detect changes in outcomes and cross largely represented risk groups. Sixth, follow-up was limited to 2020 in 96.3% of the 134 cohorts, with only five studies measuring outcomes in 2021, limiting generalizability of findings beyond the very early stages of the pandemic. COH-FIT collected data for >2 years.
<figure><img src="image_9.png" /><figcaption>**Fig. 4.** Trajectory of change in WHO-5 well-being score (A) and composite psychopathology P-score (B), stringency and daily death rate.</figcaption></figure>

Despite the differences above, COH-FIT converges with the systematic review in concluding that on average, after >2 years of the pandemic, adverse effects on well-being and mental health seem to have largely disappeared in the general population.

However, worsening of both well-being and mental health were consistently larger in people with mental disorders, females, COVID-19-related loss, living in low-income countries, and those with physical

disorders. That mental illness emerged as a top vulnerability factor indicates an urgent need for primary and secondary mental illness prevention. Access to mental healthcare for those with preexisting mental disorders has been disrupted, despite legislative efforts facilitating telemedicine (Kinoshita et al., 2022), with subsequent risk of poor clinical outcomes (Sánchez-Guarnido et al., 2021). Several factors can explain the poor well-being and mental health in females, including
pre-pandemic higher prevalence of mental disorder (GBD 2019 Mental Disorders Collaborators, 2022), poor access to care, and disproportion-
ately excessive burden of family functioning disruption affecting women
more than men, including home schooling (Racine et al., 2021).
COVID-19-related loss is a traumatic event, whose reliving has been
continuously triggered since COVID-19 outbreak. Regarding
low-income countries, poorer pre- and intra-pandemic individual and
healthcare system resources, lower government financial support for the
population, excessive implementation of restrictions potentially
affecting human rights might have worsened well-being, and mental
health (Aksunger et al., 2023). For those with physical conditions, access
to care deteriorated for non-COVID-19 diseases (Topriceanu et al.,
2021), generating poor objective health status and anxiety regarding
uncertain care.

Age 18-29, being a healthcare worker and living in large cities
worsened both co-primary outcomes, yet with different magnitude. In
young adults, whose academic, professional, and social routine was
seriously disrupted (Patel et al., 2022), a larger effect on mental health
rather than well-being emerged, suggesting that the P-score may be
more change-sensitive to monitor mental health in this age group.
Conversely, healthcare workers and large cities were risk factors asso-
ciated with larger worsening in well-being. Healthcare workers have
been exposed to unprecedented traumatic events, including death of
patients and coworkers, risk for their life, fear of infecting others, long
working hours, lack of personal protective equipment, and increased
media attention, challenging well-being (Dragioti et al., 2022). Ongoing
negative effects on mental health (Dragioti et al., 2022), might have
been mitigated by the protective factor of lived altruism. Regarding
larger cities, reasons for WHO-5 worsening include higher population
density facilitating virus spread and more enforced lock-
downs/restrictions, urbanicity's association with poorer mental health
(Luo et al., 2021), worse housing conditions with less access to green
areas, and higher cost of living, increasing job/financial insecurities.
Better access to mental healthcare in urban centers might have mitigated
the ongoing negative impact on mental health.

Other risk factors, namely COVID-19 infection, unemployment, first-
generation immigrant status, and obesity, may have non-specific or
specific effects. Having had COVID-19 infection can worsen acute
(Rogers et al., 2020) and long-term mental health, cognition, and
physical health (Di Gennaro et al., 2023), yet not necessarily universally.
Larger negative effects have been associated with severe COVID-19
infection, likely worsening well-being and mental health (Huang et al.,
2022). Job strain that can lead to unemployment is a known risk factor
for depression (Köhler et al., 2018). First-generation immigrants have
faced most severe isolation (Gama et al., 2022). Regarding obesity,
BMI-threshold for obesity varies based on ethnicity and is lower in
low-income than middle-/high-income countries. While within each
country, obesity is likely associated with larger worsening of well-being
and mental health, at the global level the effect of obesity is probably
counterbalanced by higher income in countries with larger BMI, likely
driving the association to non-significance (P-score), or even in the
opposite direction (WHO-5).

Importantly, having multiple risk factors increased the pandemic's impact on well-being and mental health, suggesting that public health prevention, promotion and interventions should prioritize individuals with specific and, especially, multiple risk factors and reduce risk factors globally.

Finally, COVID-19-related deaths, restriction stringency, and their
ratio were only minimally associated with well-being and P-score, sug-
gesting that the pandemic and a more complex network of factors needs
to be considered to understand how modifiable and non-modifiable
factors might interact.

Regarding coping strategies, exercise or walking, internet use and direct social contact were most important. Exercise or walking are a positive intervention for physical and mental health (Firth et al., 2020). With appropriate limitations to restrict virus spread, exercise or walking

should be allowed. Exercise in open spaces might be a compromise not
to spread virus in close spaces, and to also expose persons to sun light
and green areas which might boost the effect of exercise alone. Gov-
ernments should facilitate internet access, including for those unlikely to
afford it. Moreover, allowing direct social contact whenever possible/-
safe seems relevant to cope with the pandemic.

Strengths of COH-FIT include the longitudinal data collection at the population level for >2 years, describing the trends of outcomes over time accounting for COVID-19 deaths and restrictions. Most studies published to date covered a limited time since COVID-19 outbreak. A recent large meta-analysis showed that the majority of studies measuring mental health during COVID-19 were limited to time points up to around 100 days since first recorded COVID-19 case (Salanti et al., 2022). Also, COH-FIT covered the population level with representative samples and population demographic weighting from all continents, used validated psychometric instruments, and assessed a comprehensive set of risk factors. Also, according to a recent living meta-analysis of cohort studies measuring mental health changes during versus before the COVID-19 pandemic (Sun et al., 2023), only one used WHO-5 as an outcome.

Limitations include the cross-sectional design at the individual level
paired with retrospective recall to allow for calculation of pre- to intra-
pandemic status, which however we assessed using regression and evi-
dence synthesis approaches. Furthermore, we did not detect a drift in the
retrospective recall of the pre-pandemic WHO-5 or P-factor during the
study period and the pre-pandemic WHO-5 values were similar in COH-
FIT compared to published pooled matched country scores of the general
population. Moreover, we mixed non-representative with representative
samples. However, we weighted the non-representative sample, and
having representative data from numerous countries is one of the unique
strengths of COH-FIT. Moreover, importantly, results in WHO-5 and the
P-score did not significantly differ between representative and non-
representative COH-FIT samples. Accounting for severity of COVID-19
infections was not possible due to the anonymous nature of data and
absence of link to clinical records. In addition, multivariable and
network analyses were not conducted, as they go beyond the aims of this
global descriptive report, and will require a specifically dedicated
approach. Importantly, while this work provides a unique global over-
view of COVID-19 pandemic impact on the population mental health
and well-being, only few to no responses came from several regions
including middle East is not well-represented, nor is much of South
American and the Caribbean. Also, we did not account for vaccinations
in our analyses, and future works will focus on this. Moreover, digital
barriers precluded a larger participation from larger strata of the pop-
ulation, and more data are needed from subjects older than 65 years old.
Finally, some risk factors might vary within each country, such as the
impact of obesity, or socio-economic status. Indeed, detailed within-
country analyses leveraging COH-FIT data will better investigate the
impact of those two risk factors. More broadly, only local reports from
individual countries can inform local policies, and such COH-FIT reports
are being prepared to complement global findings described in this
work.

In conclusion, the COVID-19 pandemic adversely affected well-being and mental health of the general population globally, with differences across countries with different income, across different strata of the population with a-priori defined risk factors, increasingly in presence of more concomitant risk factors, yet with very small associations with COVID-19-related deaths and restrictions, and with overall a return to near-pre-pandemic values after >2 years into the pandemic. Nevertheless, during infection times groups at risk should be protected and risk factors should be targeted, and access to exercise or walking (ideally in open spaces), internet use, direct social contact and other effective coping strategies should be facilitated to promote and protect wellbeing and mental health during infection times. Results inform public health prevention and intervention policies, at the global level, which should target those at particular risk.
## Statement of ethics

The online survey launches on the COH-FIT website (www.coh-fit.com) occurred immediately after the first ethics committee/Institutional Review Board (IRB) approval (Aristotle University of Thessaloniki, Greece, 04/27/2020). Afterwards, prior to active local/national investigator outreach and advertisement activities regarding COH-FIT dissemination, approval or waiver (due to the anonymous, observational nature of the study) was obtained from at least one national IRB.

## Funding statement

All the institutions and funding agencies are listed in eTable 7. COH-FIT PIs and collaborators have applied/are actively applying for several national and international grants to cover expenses related to the coordination of the study, website, nationally representative samples, advertisement of the study, and future dissemination of study findings.

## CRediT authorship contribution statement

**Marco Solmi:** Writing – review & editing, Writing – original draft, Validation, Supervision, Project administration, Methodology, Funding acquisition, Data curation, Conceptualization. **Trevor Thompson:** Formal analysis. **Andrés Estrade:** Conceptualization, Agorastos Agorastos: Conceptualization. **Joaquim Radua:** Writing – review & editing. **Samuele Cortese:** Writing – review & editing. **Elena Dragioti:** Writing – review & editing. **Davy Vancampfort:** Writing – review & editing. **Lau Caspar Thygesen:** Writing – review & editing. **Harald Aschauer:** Writing – review & editing, Conceptualization. **Monika Schlögelhofer:** Writing – review & editing. **Elena Aschauer:** Writing – review & editing. **Andres Schneeberger:** Writing – review & editing. **Christian G. Huber:** Writing – review & editing. **Gregor Hasler:** Writing – review & editing. **Philippe Conus:** Writing – review & editing. **Kim Q. Do Cuénod:** Writing – review & editing. **Roland von Känel:** Writing – review & editing. **Gonzalo Arrondo:** Writing – review & editing. **Paolo Fusar-Poli:** Writing – review & editing. **Philip Gorwood:** Writing – review & editing. **Pierre-Michel Llorca:** Writing – review & editing. **Marie-Odile Krebs:** Writing – review & editing. **Elisabetta Scanferla:** Writing – review & editing. **Taishiro Kishimoto:** Writing – review & editing. **Golam Rabbani:** Writing – review & editing. **Karolina Skonieczna-Żydecka:** Writing – review & editing. **Paolo Brambilla:** Writing – review & editing. **Angela Favaro:** Writing – review & editing. **Akihiro Takamiya:** Writing – review & editing. **Leonardo Zoccante:** Writing – review & editing. **Marco Colizzi:** Writing – review & editing. **Julie Bourgin:** Writing – review & editing. **Karol Kamiński:** Writing – review & editing. **Maryam Moghadasin:** Writing – review & editing. **Soraya Seedat:** Writing – review & editing. **Evan Matthews:** Writing – review & editing. **John Wells:** Writing – review & editing. **Emilia Vassilopoulou:** Writing – review & editing. **Ary Gadelha:** Writing – review & editing. **Kuan-Pin Su:** Writing – review & editing. **Jun Soo Kwon:** Writing – review & editing. **Minah Kim:** Writing – review & editing. **Tae Young Lee:** Writing – review & editing. **Oleg Papsuev:** Writing – review & editing. **Denisa Manková:** Writing – review & editing. **Andrea Boscutti:** Writing – review & editing. **Cristiano Gerdunda:** Writing – review & editing. **Diego Saccon:** Writing – review & editing. **Elena Righi:** Writing – review & editing. **Francesco Monaco:** Writing – review & editing. **Giovanni Croatto:** Writing – review & editing. **Guido Cereda:** Writing – review & editing. **Jacopo Demurtas:** Writing – review & editing. **Natascia Brondino:** Writing – review & editing. **Nicola Veronese:** Writing – review & editing. **Paolo Enrico:** Writing – review & editing. **Pierluigi Politi:** Writing – review & editing. **Valentina Ciappolino:** Writing – review & editing. **Andrea Pfennig:** Writing – review & editing. **Andreas Bechdolf:** Writing – review & editing. **Andreas Meyer-Lindenberg:** Writing – review & editing. **Kai G. Kahl:** Writing – review & editing. **Katharina Domschke:** Writing – review & editing. **Michael Bauer:** Writing – review & editing. **Nikolaos Koutsouleris:** Writing – review & editing. **Sibylle Winter:** Writing – review & editing. **Stefan Borgwardt:** Writing – review & editing. **Istvan Bitter:** Writing – review & editing. **Judit Balazs:** Writing – review & editing. **Pál Czobor:** Writing – review & editing. **Zsolt Unoka:** Writing – review & editing. **Dimitris Mavridis:** Writing – review & editing. **Konstantinos Tsamakis:** Writing – review & editing. **Vasilios P. Bozikas:** Writing – review & editing. **Chavit Tunvirachaisakul:** Writing – review & editing. **Michael Maes:** Writing – review & editing. **Teerayuth Rungnirundorn:** Writing – review & editing. **Thitiporn Supasitthumrong:** Writing – review & editing. **Ariful Haque:** Writing – review & editing. **Andre R. Brunoni:** Writing – review & editing. **Carlos Gustavo Costardi:** Writing – review & editing. **Felipe Barreto Schuch:** Writing – review & editing. **Guilherme Polanczyk:** Writing – review & editing. **Jhoanne Merlyn Luiz:** Writing – review & editing. **Lais Fonseca:** Writing – review & editing. **Luana V. Aparicio:** Writing – review & editing. **Samira S. Valvassori:** Writing – review & editing. **Merete Nordentoft:** Writing – review & editing. **Per Vendsborg:** Writing – review & editing. **Sofie Have Hoffmann:** Writing – review & editing. **Jihed Sehli:** Writing – review & editing. **Norman Sartorius:** Writing – review & editing. **Sabina Heuss:** Writing – review & editing. **Daniel Guinart:** Writing – review & editing. **Jane Hamilton:** Writing – review & editing. **John Kane:** Writing – review & editing. **Jose Rubio:** Writing – review & editing. **Michael Sand:** Writing – review & editing. **Ai Koyanagi:** Writing – review & editing. **Aleix Solanes:** Writing – review & editing. **Alvaro Andreu-Bernabeu:** Writing – review & editing. **Antonia San José Cáceres:** Writing – review & editing. **Celso Arango:** Writing – review & editing. **Covadonga M. Díaz-Caneja:** Writing – review & editing. **Diego Hidalgo-Mazzei:** Writing – review & editing. **Eduard Vieta:** Writing – review & editing. **Javier Gonzalez-Peñas:** Writing – review & editing. **Lydia Fortea:** Writing – review & editing. **Mhaela Honciuc:** Writing – review & editing. **Anna Moniuszko-Malinowska:** Writing – review & editing. **Igor Łoniewski:** Writing – review & editing. **Jerzy Samochowiec:** Writing – review & editing. **Łukasz Kiszkiel:** Writing – review & editing. **Maria Marlicz:** Writing – review & editing. **Paweł Sowa:** Writing – review & editing. **Wojciech Marlicz:** Writing – review & editing. **Georgina Spies:** Writing – review & editing. **Brendon Stubbs:** Writing – review & editing. **Joseph Firth:** Writing – review & editing. **Sarah Sullivan:** Writing – review & editing. **Asli Enez Darcin:** Writing – review & editing. **Hatice Aksu:** Writing – review & editing. **Nesrin Dilbaz:** Writing – review & editing. **Onur Noyan:** Writing – review & editing. **Momoko Kitazawa:** Writing – review & editing. **Shunya Kurokawa:** Writing – review & editing. **Yuki Tazawa:** Writing – review & editing. **Alejandro Anselmi:** Writing – review & editing. **Cecilia Cracco:** Writing – review & editing. **Ana Inés Machado:** Writing – review & editing. **Natalia Estrade:** Writing – review & editing. **Diego De Leo:** Writing – review & editing. **Jackie Curtis:** Writing – review & editing. **Michael Berk:** Writing – review & editing. **Andre F. Carvalho:** Writing – review & editing. **Philip Ward:** Writing – review & editing. **Scott Teasdale:** Writing – review & editing. **Simon Rosenbaum:** Writing – review & editing. **Wolfgang Marx:** Writing – review & editing. **Adrian Vasile Horodnic:** Writing – review & editing. **Liviu Oprea:** Writing – review & editing. **Ovidiu Alexinschi:** Writing – review & editing. **Petru Ifteni:** Writing – review & editing. **Serban Turliuc:** Writing – review & editing. **Tudor Ciuhodaru:** Writing – review & editing. **Alexandra Bolos:** Writing – review & editing. **Valentin Matei:** Writing – review & editing. **Dorien H. Nieman:** Writing – review & editing. **Iris Sommer:** Writing – review & editing. **Jim van Os:** Writing – review & editing. **Therese van Amelsvoort:** Writing – review & editing. **Ching-Fang Sun:** Writing – review & editing. **Ta-wei Guu:** Writing – review & editing. **Can Jiao:** Writing – review & editing. **Jieting Zhang:** Writing – review & editing. **Jialin Fan:** Writing – review & editing. **Liye Zou:** Writing – review & editing. **Xin
**Yu:** Writing – review & editing. **Xinli Chi:** Writing – review & editing. **Philippe de Timary:** Writing – review & editing. **Ruud van Winkel:** Writing – review & editing. **Bernardo Ng:** Writing – review & editing. **Edilberto Peña de León:** Writing – review & editing. **Ramon Arellano:** Writing – review & editing. **Raquel Roman:** Writing – review & editing. **Thelma Sanchez:** Writing – review & editing. **Larisa Movina:** Writing – review & editing. **Pedro Morgado:** Writing – review & editing. **Sofia Brissos:** Writing – review & editing. **Oleg Aizberg:** Writing – review & editing. **Anna Mosina:** Writing – review & editing. **Damir Krinitski:** Writing – review & editing. **James Mugisha:** Writing – review & editing. **Dena Sadeghi-Bahmani:** Writing – review & editing. **Farshad Shey-bani:** Writing – review & editing. **Masoud Sadeghi:** Writing – review & editing. **Samira Hadi:** Writing – review & editing. **Serge Brand:** Writing – review & editing. **Antonia Errazuriz:** Writing – review & editing. **Nicolas Crossley:** Writing – review & editing. **Dragana Ignjatovic Ristic:** Writing – review & editing. **Carlos López-Jaramillo:** Writing – review & editing. **Dimitris Efthymiou:** Writing – review & editing. **Praveenlal Kuttichira:** Writing – review & editing. **Roy Abraham Kallivayalil:** Writing – review & editing. **Afzal Javed:** Writing – review & editing. **Muhammad Iqbal Afridi:** Writing – review & editing. **Bawo James:** Writing – review & editing. **Omonefe Joy Seb-Akahomen:** Writing – review & editing. **Jess Fiedorowicz:** Writing – review & editing. **Jeff Daskalakis:** Writing – review & editing. **Lakshmi N. Yatham:** Writing – review & editing. **Lin Yang:** Writing – review & editing. **Tarek Okasha:** Writing – review & editing. **Aïcha Dahdouh:** Writing – review & editing. **Jari Tiihonen:** Writing – review & editing. **Jae Il Shin:** Writing – review & editing. **Jinhee Lee:** Writing – review & editing. **Ahmed Mhalla:** Writing – review & editing. **Lotfi Gaha:** Writing – review & editing. **Takoua Brahim:** Writing – review & editing. **Kuanysh Altynbekov:** Writing – review & editing. **Nikolay Negay:** Writing – review & editing. **Saltanat Nurmagambetova:** Writing – review & editing. **Yasser Abu Jamei:** Writing – review & editing. **Mark Weiser:** Writing – review & editing. **Christoph U. Correll:** Writing – review & editing. Writing – original draft, Visualization, Validation, Supervision, Resources, Project administration, Funding acquisition, Data curation, Conceptualization.

Declaration of competing interest

Conflict of interest statements of all authors are detailed in eTable 8.

Data availability

Data are not publicly available, currently. Data are currently being used for additional global publications. Local data are available to local COH-FIT collaborators. We estimate making data available upon request and with a specific project proposal in 2025.

Acknowledgements

All authors thank all respondents who took the survey so far, funding agencies and all professional and scientific national and international associations supporting or endorsing the COH-FIT project. We would also like to acknowledge the contributions made by Friedrich Leisch and Björn Gerdle to the success of this project.

Supplementary materials

Supplementary material associated with this article can be found, in the online version, at doi:10.1016/j.psychres.2024.115972.

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