(2021) 20:42
Watkins‑Martin et al. Ann Gen Psychiatry
https://doi.org/10.1186/s12991-021-00362-2

PRIMARY RESEARCH

Annals of General Psychiatry
Open Access

Depression and anxiety symptoms in young
adults before and during the COVID‑19
pandemic: evidence from a Canadian
population‑based cohort
Kia Watkins‑Martin1,2, Massimiliano Orri1,15, Marie‑Hélène Pennestri2,3,4, Natalie Castellanos‑Ryan5,6,
Simon Larose8, Jean‑Philippe Gouin9, Isabelle Ouellet‑Morin10,11, Nicholas Chadi6,7, Frederick Philippe12,
Michel Boivin13, Richard E. Tremblay4, Sylvana Côté6,14,15 and Marie‑Claude Geoffroy1,2*

Abstract
Background: Concerns have been raised that the COVID-19 pandemic could increase risk for adverse mental healthoutcomes, especially in young adults, a vulnerable age group. We investigated changes in depression and anxiety
symptoms (overall and severe) from before to during the pandemic, as well as whether these changes are linked to
COVID-19-related stressors and pre-existing vulnerabilities in young adults followed in the context of a populationbased cohort.
Method: Participants (n = 1039) from the Quebec Longitudinal Study of Child Development reported on theirdepression (Centre for Epidemiological Studies Depression Scale, short form) and anxiety (General Anxiety Disorder-7
Scale) symptoms and completed a COVID-19 questionnaire during the first wave of the COVID-19 pandemic in thesummer of 2020 (age 22 years). Assessments at age 20 (2018) were used to estimate pre-pandemic depression andanxiety symptom severity.
Results: While mean levels of depression and anxiety symptoms did not change from before to during the first waveof the COVID-19 pandemic (e.g., the mean of depressive symptoms was 9.30 in 2018 and 9.59 in 2020), we observeda slight increase in rates of severe depression (scores ≥ 21) from before (6.1%) to during (8.2%) the pandemic.
Most COVID-19-related variables (e.g., loss of education/occupation, frequent news-seeking) – except living alone– and most pre-existing vulnerabilities (e.g., low SES, low social support) were not associated with changes in depres‑sion or anxiety symptoms. However, results varied as a function of pre-pandemic levels of depression and anxiety:depression and anxiety symptoms increased among adults with the lowest levels of symptoms before the pandemic,
while they decreased among those with the highest levels of symptoms, possibly reflecting a regression to the mean.
Conclusions: Depression and anxiety symptoms in young adults from Québec in Summer 2020 were mostly compa‑
rable to symptoms reported in 2018. Most COVID-19-related stressors and pre-existing vulnerabilities were not associ‑ated with changes in symptoms, except living alone and pre-existing symptoms of depression and anxiety. However,
the increased rate of severe depression warrants further investigation.

*Correspondence: marie-claude.geoffroy@mcgill.ca
2
Department of Educational and Counselling Psychology, McGill
University, Montreal, QC H3A 1Y2, Canada
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Watkins‑Martin et al. Ann Gen Psychiatry(2021) 20:42

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Keywords: COVID-19, Mental health, Depression, Anxiety, Young adults

Background
There is concern that the coronavirus disease 2019
(COVID-19) pandemic has negatively impacted depressive and anxiety symptoms [1, 18, 33], especially among
young adults aged 18–25 years [10, 20, 26, 36]. While
young adulthood is generally a period of good physicalhealth, mental health problems are common [19, 27]. To
date, most studies that have documented putative mental health consequences of the COVID-19 pandemic haverelied on cross-sectional investigations of conveniencesamples [21, 25, 34, 38], from which it is not possible todraw conclusions about whether and how mental healthhas changed from pre-pandemic levels. Only longitudinal studies with pre-pandemic assessments of depression and anxiety symptoms can allow one to quantify
such changes according to a clear temporal sequence andaccount for such sources of bias as seasonality. The few
longitudinal studies with pre-pandemic assessments ofdepression and anxiety symptoms in young adults haveyielded inconsistent findings, with some showing deterioration [5, 42] and others reporting no symptom change
during the COVID-19 pandemic.
To our knowledge, no population-based study in the
Canadian province of Quebec has examined whether themental health of young adults has changed from before
to during the first wave of the pandemic and identified
factors associated with these changes. Using a longitudinal population-based cohort of young adults from Quebec, where strict lockdown measures (e.g., stay-at-homeorders; social distancing; school and business closures)
were implemented at the beginning of the first waveof the COVID-19 pandemic, we aimed to: (1) examine whether and how depression and anxiety symptoms
and the severity of these symptoms changed from thepre-pandemic (participant age: 20 years) to the intrapandemic period during the summer of 2020 (participant
age: 22 years); and (2) investigate whether these changes
were linked to COVID-19-related stressors (e.g., loss of
employment/education; COVID-19-related news-seeking) and/or pre-existing vulnerabilities (e.g., low SES;
severe depression and anxiety).
MethodParticipants

The Québec Longitudinal Study of Child Development(QLSCD) [28] is an ongoing population-based cohortthat includes 2120 participants born in 1997/98 in theprovince of Quebec, Canada. From July to August 2020,
participants completed an online survey at age 22 years

about their well-being during the COVID-19 pandemic.
Of the 1593 individuals contacted, 1182 responded in2020 (participation rate: 74%). Of those, 1039 had provided information on their mental health before the pandemic in the Spring of 2018, at age 20 years. The QLSCD,
conducted by the Institut de la Statistique du Québec(ISQ) [9], was approved by ethical committees of the ISQ
and the CHU Sainte-Justine Hospital Research Centre
and written informed consent was obtained.
Measures
Depression and anxiety symptoms before (20 years)
and during (22 years) the COVID‑19 pandemic

Depressive symptoms were self-reported using the Centre for Epidemiological Studies-Depression Scale, shortform, (CES-D) including 12 items; (e.g., “I felt depressed”)
rated from 0 = rarely/never to 3 = most/all of the time
[13, 35, 37]. Anxiety symptoms were self-reported using
the Generalized Anxiety Disorder 7-item scale (GAD-7)
including 7 items (e.g., “Feeling nervous, anxious or onedge”) rated from 0 = not at all to 3 = nearly every day[43]. Scores of 21 to 36 and of 15 to 21 are thought toindicate severe levels of depression and anxiety, respectively [37].
COVID‑19‑related stressors

All participants completed a questionnaire assessing
their worries about the pandemic. Participants indicatedtheir level of concern on a 4-point Likert scale (1 = notat all to 4 = extremely concerned) regarding: having a
degree/certificate/diploma which will not be considered equivalent, compared to those who completed theirdegree prior to the pandemic; not having job prospects
in the near future; and not having enough money to meetbasic needs. The questionnaire also included items about
their living status (alone vs. with others) and the level of
disruption that the pandemic had on their life from midMarch to Summer 2020, including: loss of employment(“I lost my job”; “I closed my business”); loss of education(“All or some of my courses have been rescheduled to Fall2020”; “I have dropped all my courses”; “My internshiphas been postponed or cancelled”); a positive COVID-19
test result (yes vs. no); COVID-19-related daily newsseeking on traditional or social media (< 2 h vs. ≥ 2 h perday); and participants’ geographic region based on theirpostal code (Montreal vs. other regions, as Montreal
was the hardest hit region in the Province of Québec inMarch–August 2020, as per the number of confirmed
cases and COVID-19-related deaths) [7].

Watkins‑Martin et al. Ann Gen Psychiatry(2021) 20:42

Pre‑existing vulnerabilities

Pre-existing vulnerabilities increasing risk for poor mental health [12, 14, 24, 31, 41, 47] were assessed before the
Québec government enforced lockdown measures as of
mid-March 2020: not in education or employment at
22 years (just prior to the onset of the pandemic); having parents of low socioeconomic status (SES) (defined asscores ≤ 1 standard deviation (SD) on SES scale aggregating annual gross income, parental education level, andparental occupational prestige from ages 15 and 17 years)[46]; sexual orientation at 17 years (same sex/bisexual/asexual vs. opposite sex; if missing at 17 years, orientation at 15 years was used); low social support at 19 years(defined as score ≤ 1 SD on the 10-item Social Provision
Scale) [4]; low life satisfaction at 19 years old (defined asa score of ≤ 5 on the following item: “Using a scale of 0 to
10, where 0 means ‘very dissatisfied’ and 10 means ‘very
satisfied’, how do you feel about your life as a whole rightnow?”) [44]; and a chronic learning disability diagnosis asreported by the mother at 15 or 17 years (no vs. yes).
Statistical analyses

All statistical analyses were conducted in IBM SPSS,
version 26, using cohort weights to ensure representativeness of the sample. First, we described the COVID19-related stressors and pre-existing vulnerabilities
variables using counts and percentages. Second, we
tested whether (a) a mean symptom score and (b) a severity category of depressive and anxiety symptoms changed
from before to during the COVID-19 pandemic using
paired t-tests. Third, we calculated change in depression
and anxiety symptoms by subtracting the mean symptom score before the pandemic (20 years) to the meanscore during the pandemic (22 years). We standardized
the mean change score (change/SD of change) to easeinterpretation; positive scores indicate an increase indepression and anxiety symptoms. Then, we examinedcrude associations between COVID-19-related stressors and pre-existing vulnerabilities variables and change
in depression and anxiety symptoms, using t-tests and
ANOVAs. The double-sided p-value for significance wasset at 0.05. We used multiple imputation (MI) to generate 100 datasets to handle missing values on risk factors.
Missing values ranged from 0.9% (loss of employment)
to 17.9% (sexual minority); there was no missing data for
COVID-19-related stressors.

Results
Descriptive statistics on COVID-19-related stressors andpre-existing vulnerabilities are shown in Table 1. Figure 1 depicts descriptive statistics for COVID-19-related

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Table 1 Descriptive statistics of the COVID-19-related stressors
and pre-existing vulnerabilities, weightedn%  Male417

40.1

  Female

622

59.9

COVID-19-related stressors
Sex

Living status
  Alone90

8.7

  With others

949

91.3

  No

790

76.0

  Yes

249

24.0

  No

805

77.5

  Yes

234

22.5

  No

1030

99.0

  Yes

9

1.0

   < 2 h

783

75.0

   ≥ 2 h

256

25.0

  No

831

80.0

  Yes

208

20.0

  No

941

90.6

  Yes

98

9.4

  No

873

84.0

  Yes

166

16.0

  No

921

88.6

  Yes (Gay, Lesbian, Asexual)

118

11.4

  No

892

87.3

  Yes

147

12.7

  No

901

86.7

  Yes

138

13.3

  No

963

92.7

  Yes

76

7.3

  No/low/moderate

975

93.8

  ­Severec

64

6.2

  No/low/moderate

990

95.3

  ­Severec

49

4.7

Loss of employment

Loss of education

Positive COVID-19 test

Daily COVID-19-related news-seeking

Living in Montreal

Pre-existing vulnerabilities
Not in education or employed (22 years, pre-pandemic)

Low SES families (15, 17 years)aSexual minority (15, 17 years)

Low social support (19 years)a

Low life satisfaction (19 years)b

Learning disability diagnosis (15, 17 years)

Pre-existing depression symptoms (20 years)

Pre-existing anxiety symptoms (20 years)

Watkins‑Martin et al. Ann Gen Psychiatry(2021) 20:42

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Table 1 (continued)
Data were compiled from the final master file of the Québec Longitudinal Studyof Child Development (1998–2020), Québec Government, Québec Statistic
Institute
Maximum N available ranges from 869 to 1039
a

Defined as scores < 1 standard deviation of the sample meanbDefined as scores of 0 to 5 a scale of 0 to 10, where 0 means ‘very dissatisfied’and 10 means ‘very satisfied’cSevere symptoms were defined by Centre for Epidemiological StudiesDepression scale scores ≥ 21 and Generalized Anxiety Disorder 7-item scalescores ≥ 15

concerns. The vast majority of young adults reported thatthey were “not at all concerned” about (a) having a compromised diploma; (b) loss of job prospects or (c) having
enough money to meet basic needs, whereas 10.2, 21.4

100

Not at all concerned

90

Somewhat concerned

Percentage of sample

80
70
60

Very concerned
Extremely concerned
59.9

55.4
47.2

50
40

31.4

30.0

30

30.6
15.8

20
6.9

10
0

and 14.0% reported that they were ‘very or extremely
concerned’, respectively. As shown in Table 2, there
was no difference in the means of depression and anxiety symptoms from before to during the pandemic, asreported by participants in July–August 2020. However,while the prevalence of severe anxiety did not increasesignificantly, that of severe depression did, with 6.2%
of participants reporting severe depressive symptoms
before the pandemic compared to 8.1% during the pandemic (increase of 1.9%; p = 0.041).
Figure 2 and Additional file 1: Table S1 depict standardized change in depression and anxiety from before thepandemic (20 years) to during the pandemic (22 years)
as a function of COVID-related stressors. Symptoms ofdepression and anxiety did not vary according to COVID19-related stressors, except for participants living alone

5.6

3.3

Having a degree, cerficate or
diploma which will not be
considered equivalent to those
whose studies have not been
affected by COVID-19

9.4

4.6

Not having prospects for a job in the Not having enough money to meetnear futurebasic needs

Fig. 1 Descriptive statistics of the COVID-19-related concerns, n = 1039, weighted. Data were compiled from the final master file of the Québec
Longitudinal Study of Child Development (1998–2020), Québec Government, Québec Statistic Institute

Table 2 Descriptive statistics for depression and anxiety symptoms before (20 years) and during (22 years) the COVID-19 pandemic,n = 1039, weighted
Before COVID-19 pandemic(20y)

During COVID-19 pandemic(22y)

P Value for differences
before vs. during the
pandemic.153

Depressive symptoms, mean (SD)9.30 (6.42)

9.59 (6.79)

Severe depression symptoms, N (%) a64 (6.2%)

80 (8.1%).041

Anxiety symptoms, mean (SD)4.73 (4.61)

4.45 (4.70).060

Severe anxiety symptoms, N (%)a51 (4.9%)49 (4.7%).807

Data were compiled from the final master file of the Québec Longitudinal Study of Child Development (1998–2020), Québec Government, Québec Statistic Institutea

Severe symptoms were defined by Centre for Epidemiological Studies-Depression scale scores ≥ 21 and Generalized Anxiety Disorder 7-item scale scores ≥ 15

Watkins‑Martin et al. Ann Gen Psychiatry(2021) 20:42

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Fig. 2 Change in depression and anxiety Z-scores from before (age 20 years) to during the COVID-19 pandemic (age 22 years) as a function ofvariables in the COVID-19 questionnaire; n = 1039, weighted. Data were compiled from the final master file of the Québec Longitudinal Study ofChild Development (1998–2020), Québec Government, Québec Statistic Institute. Positive scores indicate a deterioration of mental health

who reported a slight increase in depressive symptoms(0.22, SD). Figure 3 and Additional file 1: Table S1 depict
standardized changes in depression and anxiety symptoms as a function of pre-existing vulnerabilities. Participants with pre-existing severe symptoms of depression
and anxiety experienced a significant decrease in depressive and anxiety symptoms from before to during the
pandemic. That is, individuals with severe depression atage 20 years experienced a decrease in depressive symptoms from 20 to 22 years (1.26 SD), while those withsevere anxiety experienced a decrease in anxiety symptoms of 1.61 SD. In sensitivity analyses, we divided participants into quintiles according to their depressive andanxiety levels at 20 years: (1) very low (0–20%); (2) low(21–40%); (3) average (41–60%); (4) high (61–80%); and(5) very high (81–100%) and explored changes in symptom levels from before to during COVID-19 using ANOVAs. As depicted in Fig. 4 and Additional file 2: Table S2,

there was a significant increase in depression and anxiety
symptoms among young adults with the lowest levels of
symptoms at baseline. To illustrate, participants with very
low levels of depressive symptoms at age 20 years experienced a significant increase in symptoms from age 20
to 22 years (0.49 SD, p < 0.001), while those with very low
levels of anxiety experienced an increase in symptoms of
0.38 SD (p < 0.001). As previously reported, young adults
with the highest levels of depression and anxiety symptoms at baseline experienced a decrease in symptoms
from before to during COVID-19.

Discussion
Using a population-based cohort of young adults
with data collected 2 years before the pandemic and4 months after the onset of the first wave of the pandemic (Summer 2020) in the province of Quebec, thisstudy examined changes in symptoms of depressionWatkins‑Martin et al. Ann Gen Psychiatry(2021) 20:42

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Fig. 3 Change in depression and anxiety Z-scores from before (age 20 years) to during the COVID-19 pandemic (age 22 years) as a functionof pre-existing vulnerabilities; n = 1039, weighted. Data were compiled from the final master file of the Québec Longitudinal Study of Child
Development (1998–2020), Québec Government, Québec Statistic Institute. Positive scores indicate a deterioration of mental healthand anxiety and investigated whether these changes arelinked to pandemic-related stressors and/or pre-existing vulnerabilities. On average, young adults did notreport change in depression and anxiety levels acrossthe full spectrum of symptom severity. However, theprevalence of severe depressive symptoms increasedby 1.9% during the initial months of the pandemic,
while there was no change in severe anxiety symptoms.
Most COVID-19-related stressors (with the exceptionof living alone) and variables pertaining to pre-existing
vulnerabilities (e.g., low SES, low social support) were
not associated with changes in symptoms of depression and anxiety. Contrary to expectations [5, 42], we
did not observe a generalized worsening of depressive
and anxiety symptoms during the pandemic among
participants with severe pre-pandemic depression
and anxiety. However, supplemental analyses investigating changes in depression and anxiety symptoms

according to different levels of pre-existing symptoms(very low; low; average; high; very high) revealed thatyoung adults with low levels of symptoms before thepandemic experienced a deterioration in mental healthduring the pandemic. Conversely, those with high levelsof pre-existing symptoms at age 20 years experienced
an improvement at age 22 years.
Our findings showing no increase in depression andanxiety symptoms from before to during the pandemic
are comparable to a prior longitudinal study [42] usinga sample of 768 young adults living in Switzerland. This
study found that internalizing symptoms (assessed using
depressive, anxiety, and suicidal ideation and self-injury
items from the Social Behavior Questionnaire) did not
significantly increase from before (20 years) to during the
pandemic in April 2020 (22 years). In contrast, a studyof 624 undergraduate students (mean age: 19.6 years)
in Baoding, China, found that symptoms of depressionWatkins‑Martin et al. Ann Gen Psychiatry(2021) 20:42

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Fig. 4 Change in A depression and B anxiety Z-scores from before (age 20 years) to during the COVID-19 pandemic (age 22 years) as a function of
categories of levels of pre-existing symptoms; n = 1039, weighted. Data were compiled from the final master file of the Québec Longitudinal Studyof Child Development (1998–2020), Québec Government, Québec Statistic Institute. Positive scores indicate a deterioration of mental healthWatkins‑Martin et al. Ann Gen Psychiatry(2021) 20:42

and anxiety (as measured by the PHQ-4) significantly
increased from before (December 2019) to during the
pandemic (February 2020) [22].
Although on average we did not observe changes
across the full spectrum of symptom severity, the prevalence of severe depression slightly increased by 1.9% frombefore to during the pandemic. However, the prevalenceof severe anxiety did not change, suggesting that mental health consequences of the pandemic might differ
depending on the type of symptom. This is in line witha recent systematic review and meta-analysis of 65 longitudinal cohort studies by Robinson and colleagues thatfound that compared to symptoms of anxiety, increases
in depressive symptoms tended to be larger and remained
elevated beyond the first months of the pandemic [40].
None of the COVID-19-related stressors were associated with a change in depression and anxiety symptoms,
except for those living alone who experienced a slightincrease in depressive symptoms. These findings are inline with results from a large prospective panel study
weighted to population proportions (n = 36,520) andconducted over the first 20 weeks of lockdown in the
UK that identified living alone as a risk factor for higher
symptoms of depression and anxiety during the pandemic. While most pre-existing vulnerabilities were notassociated with change in depression and anxiety symptoms, we found that participants with pre-existing severe
manifestations of depression and anxiety at age 20 years
experienced a significant decrease in depressive and anxiety symptoms between 2018 and the summer of 2020.
Pre-existing mental health vulnerabilities have been identified in several cross-sectional studies as a risk factor formental health deterioration during the pandemic [15, 29,
39, 45, 48], yet evidence from longitudinal studies is relatively scarce and contradictory, to date [40]. To illustrate,
in a longitudinal study conducted on three psychiatry
case–control cohorts in the Netherlands (N = 1517, mean
age: 56.1 years), the COVID-19 pandemic did not seem toexacerbate the severity of pre-existing symptoms among
those with severe pre-pandemic mental health problems[30], which researchers suggested might be explained bystay-at-home orders allowing for the implementation of
more structured and consistent daily routines [30, 32]. In
contrast, a cohort study on young adults in Switzerland
identified pre-pandemic emotional distress as the largest risk factor for increased emotional distress during the
pandemic [42].
In our study, symptoms of youth with severe pre-existing symptoms did not deteriorate but rather improved,
possibly reflecting a natural improvement of mental illness over time, an effect of seasonality (2018 data werecollected in the spring, while 2020 data were collectedin the summer), or a reduction in social stressors during

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periods of confinement. Conversely, young adults withlow levels of depression and anxiety symptoms experienced a significantly greater deterioration in mental
health from before to during the pandemic. These resultscorrespond with findings from a longitudinal study by
Hamza and colleagues conducted with students at a
Canadian university (N = 773), in which participants withpre-existing mental health problems showed decreasing depressive and anxiety symptoms from before (May2019) to during (May 2020) the pandemic, whereas
their peers without pre-existing mental health problems
showed increasing depressive and anxiety symptoms during the pandemic [17]. Importantly, such findings mightreflect the negative impact of increased social isolation(due to widespread closures and social distancing regulations) on young adults without pre-existing mental
health problems. However, we cannot rule out the possibility that these findings merely reflect a regression to themean, a statistical phenomenon that makes values thatare extreme at the first point of measurement more likely
to be closer to the distribution mean at subsequent pointsof measurement. This phenomenon may explain why weobserved decreased symptoms at age 22 years among
those with the highest symptom levels at age 20, as wellas increased symptoms at age 22 years among those withthe lowest levels of pre-existing symptoms at age 20.
Altogether, these conflicting findings about the mental
health consequences of the pandemic may be attributed
to several different factors. Firstly, changes in depression
and anxiety symptoms might vary according to the typeand severity of government lockdown measures in placewhen symptoms were assessed [2]. Indeed, the systematic review of longitudinal studies by Robinson and colleagues mentioned above found that while there was an
overall increase in mental health symptoms from before
to during pandemic, this increase was most pronounced
during the early stages of the pandemic (March–April2020) before decreasing back toward pre-pandemic levels
over the following months (May–July 2020). Data for thecurrent study was collected in July–August 2020, during
which time Quebecers were newly permitted to gather
in private (up to 10 people from 3 different households)
and public settings (up to 50 people in movie theaters,
reception halls, and places of worship, among other locations) after months of strict lockdown [23]. Participants’
newfound ability to socialize after months of isolation
may have offset the impact of pandemic-related stressexperienced during the strict lockdown period. Indeed,a German study examining the effects of different kinds
and levels of restrictive public health measures during
the pandemic (e.g., quarantine/lockdown/stay-at-homeorders) on symptoms of anxiety and depression foundthat stricter restrictions, greater reduction of socialWatkins‑Martin et al. Ann Gen Psychiatry(2021) 20:42

contact, and greater perceived changes in daily life wereassociated with poorer mental health [2].
Secondly, depression and anxiety symptoms may varyin accordance with government socioeconomic policies, which differ across countries. Soon after the onsetof the pandemic, the Canadian government introduced
relatively generous payments for workers and postsecondary students whose income earning abilities
were negatively impacted (e.g., reduction in hours; jobloss) by the COVID-19 pandemic [3, 16]. These government measures may have had a protective effect against
depression and anxiety. For example, a survey study using
data collected by the US Census Bureau from April toJuly 2020 found that the prevalence of depressive andanxiety symptoms varied across states by what the investigators called “household income shock” [8] (i.e., theexperience of job loss and/or partial income loss), which
was buffered by state-level differing socioeconomic policies (e.g., access to Medicaid, unemployment insurance,and suspended utility shut-offs) [8]. Despite the potentially buffering effects of the Canadian government’s economic response plan against symptoms of depression andanxiety, it is worth noting that future professional opportunities were still among the primary COVID-related
concerns shared by young adults, with 21.4% of our participants stating that they were very or extremely concerned by future job prospects (see Fig. 1).
Lastly, the normal process of psychological adaptation
following distressing events might also come into play inexplaining the inconsistent findings on the impact of thepandemic on the mental health of young adults [6, 34].
Consistent with findings from a meta-analysis indicatingthat mental health deteriorated at the onset of the pandemic before returning to baseline levels by mid-2020[40], a prospective longitudinal study in the UK examining anxiety and depression over the first 20 weeks of lockdown (March 23–August 9, 2020) found that there wasa significant decrease in depressive and anxiety symptoms throughout both the strict lockdown period andthe period during which lockdown measures were eased[11]. Moreover, the same study found that younger adults
showed faster improvements in depression and anxiety
symptoms compared to older adults [11]. This suggeststhat while some studies find young adults to be at greaterrisk for mental health problems during the pandemic,
they may be better able to psychologically adapt to challenging circumstances relative to older adults, or that factors contributing to persistent internalizing symptoms
may have been alleviated by the confinement measures(e.g., lack of commute; additional rest time; accommodations for final exams). However, given that most studies

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on the mental health impact of the COVID-19 pandemic
on young adults were conducted during the first wave of
the pandemic in 2020, the mental health impact of thesubsequent waves is still unclear.

Methodological considerations
This study has a number of strengths, including its longitudinal design; the use of standardized measures ofdepression and anxiety; and data collected before andduring the pandemic from the same participants. We
acknowledge the following limitations. As in all longitudinal surveys, attrition occurred over the years andthe most vulnerable individuals were underrepresented.
Although all analyses were weighted, such differential
attrition could potentially result in underestimation of
the rates of anxiety and depression and consequentlyof the mental impact of COVID-19. Mental health outcomes were measured by self-report questionnaires,
which do not provide clinical diagnoses. While we wereable to use longitudinal data with mental health assessments before and during the COVID-19 pandemic, it isdifficult to differentiate between mental health changes
attributable to the pandemic versus developmental
changes that are typical for this age group or changes
due to seasonal effects, since pre-pandemic measures
were obtained in the spring, while intra-pandemic
measures were collected during the summer.
Conclusion
In this sample of young adults from the Canadianprovince of Québec, we found that depressive and anxiety symptoms did not significantly change during thefirst wave of the COVID-19 pandemic, although theprevalence of severe depression did slightly increase,especially among those who were living alone during the lockdown. Moreover, while the majority of theyoung adults showed a pattern of symptoms consistent
with adaptation to the pandemic, levels of depressive
and anxiety symptoms increased among those with thelowest levels of symptoms before the pandemic. Futurestudies should track the mental health of young adults
throughout the subsequent waves of the COVID-19
pandemic to better understand whether this observation reflets a regression to the mean or a need to
improve access to mental health services for youth whoare newly struggling with symptoms of depression andanxiety.

Watkins‑Martin et al. Ann Gen Psychiatry(2021) 20:42

Supplementary Information
The online version contains supplementary material available at https://​doi.​
org/​10.​1186/​s12991-​021-​00362-2.
Additional file 1: Table S1. Change in depression and anxiety symptoms
from before to during the COVID-19 pandemic. Table S2. Change indepression and anxiety symptoms from before the pandemic to during
the pandemic according to different levels of symptoms severity before
the pandemic.
Acknowledgements
The larger Quebec Longitudinal Study of Child Development was supported
by funding from the Quebec provincial government’s Ministry of Health andMinistry of Family Affairs, the Lucie and André Chagnon Foundation, the Fonds
de Recherche du Québec en Société et Culture, Canada’s Social Sciences andHumanities Research Council, the Canadian Institutes of Health Research,
the Centre Hospitalier Universitaire de Sainte-Justine, and the Institut de laStatistique du Québec. The authors thank Alain Girard and Elise Chartrand fortheir contributions to the statistical analysis and all participants of the QuebecLongitudinal Study of Child Development.
Authors’ contributions
Each author has sufficiently contributed to the manuscript to justify author‑
ship and responsibility for the content. KW-M, M-CG, and MO conceived anddesigned the study. MB, RT, M-CG, and SC acquired the data. M-CG analyzed
the data and all of the authors interpreted the data. KW-M, M-CG, and MO
wrote the initial drafts, and SL, J-PG, IO-M, NC, FP, MB, RT, M-HP, NC-R, and SC
revised the paper for important intellectual content. All of the authors readand gave their final approval of the version to be published and agreed to beaccountable for all aspects of the work.
Funding
This project was supported by l’Observatoire sur l’Éducation et la Santé desEnfants, funded by FRQ-SC. Drs Pennestri, Chadi and Castellanos-Ryan holda Junior 1 salary award from the Fonds de recherche du Québec en santé(FRQS). Drs Gouin, Ouellet-Morin, Boivin, Tremblay, and Geoffroy hold aCanada Research Chair.
Availability of data and materials
The data that support the findings of this study are available from the QuebecLongitudinal Study on Child Development (QLSCD) but restrictions apply
to the availability of these data. Data access QLSCD data are accessible toresearchers on the premises of the Centre d’accès aux données de recherchede l’Institut statistique du Quebec (CADRISQ) located in Montreal and Quebec
City. To access the data, researchers affiliated with an institution in Quebec
must create a profile and fill out an access request including, among otherthings, the purpose and aim of the research project, a summary of the analysis
plan, the contact information of any researchers associated with the project,
and the location where they want to use the data. Once received, the accessrequest is analyzed by the Research Data Access Point team, which makes thenecessary follow-up to obtain the required authorizations and communicatesthe results to the researchers. Researchers receive the necessary support
for the submission of their access request and the implementation of theirprojects. More information can be found on the Research Data Access Point
website (https://​www.​stat.​gouv.​qc.​ca/​resea​rch/#/​accue​il). Numerous interna‑
tional collaborations have been established since the start of the study.

Declarations
Ethics approval and consent to participate
The Quebec Longitudinal Study on Child Development (QLSCD), conductedby the Institut de la Statistique du Québec (ISQ), was approved by ethicalcommittees of the ISQ and the CHU Sainte-Justine Hospital Research Centre
and written informed consent was obtained.
Consent for publication
Not applicable.

Page 10 of 12

Competing interests
None declared.
Author details
1
Department of Psychiatry, McGill Group for Suicide Studies, Douglas Mental
Health University Institute, Montreal, QC, Canada. 2 Department of Educationaland Counselling Psychology, McGill University, Montreal, QC H3A 1Y2, Canada.
3
Hôpital en Santé Mentale Rivière-des-Prairies (CIUSSS-NIM), Montreal, QC,
Canada. 4 Department of Psychology, University of Montreal, Montreal, QC,
Canada. 5 School of Psychoeducation, University of Montreal, Montreal, QC,
Canada. 6 CHU Ste-Justine Research Centre, Montreal, QC, Canada. 7 Depart‑
ment of Pediatrics, University of Montreal, Montreal, QC, Canada. 8 Educational
Sciences, Laval University, Quebec, QC, Canada. 9 Department of Psychol‑ogy, Concordia University, Montreal, QC, Canada. 10 School of Criminology,
University of Montreal, Montreal, QC, Canada. 11 Research Center of the Mon‑
treal Mental Health University Institute, Montreal, QC, Canada. 12 Departmentof Psychology, UQAM, Montreal, QC, Canada. 13 School of Psychology, Laval
University, Quebec, QC, Canada. 14 Department of Social and Preventive Medi‑cine, University of Montreal, Quebec, Canada. 15 Bordeaux Population Health,
Université de Bordeaux, INSERM 1219, Bordeaux, France.
Received: 1 July 2021 Accepted: 11 August 2021

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