The German COVID-19 Survey on Mental Health: Primary Results
Authors: Jung Stefanie , Kneer Jonas , Kruger Tillmann H.C. 
Published: May 2020

First cases of COVID-19 were reported in Wuhan, China in early December
2019. Preliminary data from China indicated that the pandemic and its
associated lockdown measures may have a substantial impact on mental health
and well-being, with evidence of increased levels of psychological distress,
anxiety, depressive symptoms and insomnia.1,2 In March
2020, the German government agreed upon a substantial catalogue of measures
including contact bans that came into effect on 22 March. Such measures are
unprecedented for the majority of people and may affect their lives
tremendously. Thus, the current survey was immediately developed to
systematically assess mental health in response to these measures.

Methods
The survey was approved by the local ethics committee at Hannover
Medical School, Germany and included web-based self-report measures as
outlined below. First wave data were taken during the height of lockdown
measures in Germany from 1 April to 15 April 2020.

Results

Demographics
A total of 3,545 volunteers took part in this cross-sectional
survey. Mean age was 40.36 years (SD = 11.70; 83.1% female, 15.2% male),
mean educational years 15.87 (SD = 4.19), 9.9% were unemployed and 23.9%
reported living alone. Acute or chronic disease was reported by 36.7%
(physical) and 24.7% (mental) of subjects.

Distress, Anxiety and Depression
Psychosocial distress as measured with the PHQ stress module (items
12a-12j of PHQ-D) was at M = 6.36 (SD = 0.89), implying mild
psychosocial distress (range 5-9). Depression and anxiety as assessed by
PHQ-4 was at M = 3.80 (SD = 3.03) and significantly higher than in a
reference sample (t(6008) = 32.78, p = 0.00).3 The
mean well-being score (WHO-5) was 50.7 (SD = 23.8) (range 0-100), with
normal individuals having a mean score of 75 and subjects with major
depression 37.5.4 The majority of subjects (60%)
indicated very good or fair, 26.9% poor or very poor subjective coping
with the pandemic and corresponding measures. Calculation of gender
differences revealed higher scores for depression and anxiety (t(3459) =
4.93, p = 0.00) and poorer coping in women (U = 678156, p =
0.00).

Sleep, irritability & violence
Using comparative questions on a 5-point Likert scale 45.3% of
participants reported worsened sleep compared to pre-pandemic times. Of
all participants 50.9% reported being more easily irritated (compared to
12.2% feeling less easily irritated) and 29% reported experiencing more
anger and aggression (compared to 12.8% experiencing less). Of these
65.5% directed their anger and aggression at others, while 32.6%
directed it at themselves. Most importantly, 5% of all participants
reported experiencing interpersonal violence (IPV) on a verbal (98.4%),
physical (41.9%) or sexual (30.2%) level. In case of verbal violence,
77.3% reported experiencing more verbal violence lately (compared to
3.4% experiencing less). Regarding physical violence, 19.5% reported
experiencing increased levels (compared to 2.8% experiencing less) and
in case of sexual violence more people reported experiencing increased
sexual violence lately (11.1%) compared to 1.7% that experienced
less.

Discussion
This is one of the first and largest surveys on mental health during
COVID pandemic in a European society. Although the cohort reflects a
relatively well educated and financially secure sample, there is evidence of
substantial mental burden with increased levels of stress, anxiety,
depressive symptoms, sleep disturbance and irritability. Most importantly
and also most concerning is the finding of a one-month prevalence of 5% IPV,
which is already close to one-year prevalence rates5
and for which there were indices that this has currently increased. We think
it is of vital importance to continuously monitor the mental health of the
general public during this pandemic and its aftermath and to carefully
screen for IPV and its risk factors such as stress, sleep problems and
anger.6