Effects of cumulative COVID-19 cases on mental health: Evidence from multi-country survey

Table 1 Percent of categories in individual characteristics by country and survey rounds (1 and 2)

	Arabic		Bangladesh		Canada		China	India		Pakistan		United Kingdom		Ukraine
	1	2	1	2	1	2	1	1	2	1	2	1	2	1	2
Observations	1121	909	299	746	8648	5920	178	1427	68	803	160	29134	83851	1256	606
	Percent of above observations
Healthcare professional
No	40	9	67	69	88	91	65	65	40	44	41	47	66	79	74
Yes	38	66	4	5	7	9	19	19	44	0	34	43	22	9	10
Missing	22	25	29	26	5	0	16	16	16	56	25	10	12	12	16
Age category
Under 25	10	4	69	68	8	16	2	20	7	20	51	6	6	35	15
25-44	44	61	14	14	36	36	43	44	44	35	26	36	31	43	54
45-54	16	9	2	1	15	16	12	11	16	3	4	23	19	9	13
55 and over	7	3	1	1	37	32	26	13	21	2	1	26	34	2	3
Missing	22	22	14	17	5	0	17	13	12	40	18	10	11	11	15
White ethnicity
No	77	21	92	89	20	21	9	88	88	81	73	9	15	3	3
Yes	1	57	0	0	76	78	79	0	0	0	0	82	74	88	82
Missing	22	22	8	11	4	0	12	12	12	19	27	10	11	9	15
Christian religion
No	8	73	92	87	48	52	8	80	78	81	75	48	46	21	22
Yes	70	4	0	0	47	47	32	7	9	0	0	41	39	69	62
Missing	22	22	8	13	5	1	60	13	13	19	25	11	15	11	16
Gender
Female	50	27	22	23	56	54	61	60	56	49	61	74	61	77	74
Male	28	51	68	63	39	45	24	27	31	31	18	15	26	13	9
Missing	22	22	10	14	5	1	15	13	13	20	21	11	13	11	16
Attended university
No	78	79	91	88	51	53	85	38	79	80	83	90	89	90	85
Yes	0	0	0	0	43	47	0	50	9	0	0	0	0	0	0
Missing	22	21	9	12	6	0	15	13	12	20	18	10	11	10	15
Living at own home
No	43	52	64	53	35	41	37	49	0	43	41	25	29	54	41
Yes	35	26	26	35	61	59	51	39	0	38	40	66	61	36	44
Missing	22	22	10	12	5	0	13	12	100	19	19	10	11	10	15
Vulnerable according to government category
No	63	34	74	52	63	66	71	68	0	68	46	70	67	76	54
Age ≥ 70	1	40	9	36	15	34	5	7	0	2	31	4	21	1	29
Chronic disease	2	0	1	0	6	0	2	1	0	2	0	6	0	4	0
Diabetes	2	0	0	0	3	0	4	1	0	0	0	2	0	0	0
Other	3	0	3	0	7	0	1	2	0	3	0	5	0	3	0
Missing	28	26	13	12	6	0	16	19	100	25	23	13	12	16	17
Vulnerable according to government category and require shielding
No	64	0	85	0	75	0	77	72	0	67	0	77	0	72	0
Yes	6	0	2	0	13	0	5	6	0	6	0	7	0	11	0
Missing	30	100	14	100	12	100	18	22	100	26	100	16	100	17	100
Whether experienced coronavirus
No	23	0	42	0	28	0	58	35	0	28	0	22	0	31	0
Yes	49	29	40	23	63	12	26	43	25	43	48	64	25	52	47
Missing	28	71	17	77	8	88	16	22	75	29	53	14	75	17	53
Pre-existing mental health condition
No	42	0	46	1	62	1	74	67	3	40	0	53	0	60	0
Yes	28	3	41	5	31	21	8	11	4	35	11	31	18	23	9
Missing	30	97	13	95	7	79	18	22	93	25	89	16	82	17	91
Drinking alcohol
No	68	64	76	77	20	54	28	57	47	0	0	13	75	17	0
Yes	5	1	12	6	74	22	56	24	35	0	5	75	11	69	1
Missing	27	35	13	17	5	24	16	19	18	100	95	12	14	14	99
Whether taking drug
No	71	65	81	73	83	86	79	78	82	71	69	85	83	83	77
Yes	0	4	8	11	12	14	6	2	1	3	6	2	3	3	2
Missing	28	31	11	15	5	0	15	20	16	26	25	13	13	14	21
Ever experienced suicidal thoughts
No	9	61	70	69	67	77	74	68	66	55	55	59	60	60	53
Yes	62	7	18	16	27	23	10	12	16	19	18	27	26	24	28
Missing	29	32	13	15	6	1	16	21	18	26	27	13	14	16	19
Having mental health support from
No support	18	1	27	3	13	4	6	5	3	30	4	14	5	13	2
Health service provider	6	1	5	1	11	6	2	3	1	8	3	12	8	6	5
Other	3	1	7	1	7	10	2	2	1	4	3	5	4	7	1
Missing	73	97	61	95	69	80	90	89	94	58	90	69	83	75	91

Each panel in a column shows percentages of categories/responses of a characteristic/question. Total respondents in each category were divided by observations shown at the beginning of the table and then multiplied by 100, to get the percentage.

Table 2 Summary statistics of mental health scores by country and survey rounds

		PHQ-9		GAD-7		IES-R
		Round 1	Round 2	Round 1	Round 2	Round 1	Round 2
Arabic	Mean	7.85	6.27	5.28	4.56	20.81	17.14
	SD	6.97	6.88	5.78	5.56	18.79	19.12
	n	596	481	596	486	539	430
	Missing	525	428	525	423	582	479
Bangladesh	Mean	8.07	7.45	5.76	5.45	23.28	21.86
	SD	5.79	6.91	5.38	5.69	18.08	20.35
	n	205	462	205	485	179	419
	Missing	94	284	94	261	120	327
Canada	Mean	6.11	6.97	4.40	4.94	15.10	16.96
	SD	6.44	6.70	5.32	5.46	17.87	18.24
	n	7653	5721	7684	5770	7329	5554
	Missing	995	199	964	150	1319	366
China	Mean	4.38		3.25		11.61
	SD	4.91		4.20		13.63
	n	127		124		117
	Missing	51		54		61
India	Mean	4.99	4.07	3.46	2.43	14.65	10.24
	SD	5.56	5.34	4.38	3.31	16.49	12.00
	n	820	41	823	42	741	38
	Missing	607	27	604	26	686	30
Pakistan	Mean	8.55	8.64	5.10	5.37	19.02	19.59
	SD	7.34	7.51	5.56	5.42	17.26	19.18
	n	412	85	413	90	376	75
	Missing	391	75	390	70	427	85
United Kingdom	Mean	7.70	8.21	5.46	6.04	17.01	19.19
	SD	6.47	7.03	5.51	5.92	17.51	18.93
	n	22166	64382	22343	65056	20780	59966
	Missing	6968	19469	6791	18795	8354	23885
Ukraine	Mean	6.63	7.81	4.17	5.02	14.93	15.55
	SD	6.10	6.51	4.65	5.20	15.34	15.41
	n	860	421	863	426	782	382
	Missing	396	185	393	180	474	224
Total	Mean	7.24	8.09	5.11	5.93	16.55	18.98
	SD	6.49	7.01	5.45	5.88	17.57	18.88
	n	32839	71593	33051	72355	30843	66864
	Missing	10027	20667	9815	19905	12023	25396

PHQ-9: Patient health questionnaire-9; IES-R: Impact of Events Scale-Revised; GAD-7: Generalized anxiety disorder-7.

Table 3 Lockdown and survey dates by country

Country	First lockdown		Second lockdown		Survey period		Can we capture lockdown effects?
	Start	End	Start	End	Round 1	Round 2
Bangladesh	March 26, 2020	May 16, 2020	April 5, 2021	July 14, 2021	July 1, 2020-July 25, 2020	January 19, 2021-March 18, 2021	No
Canada	March 18, 2020	May 18, 2020	November 7, 2020	January 8, 2021	August 18, 2020-October 2, 2020	December 21, 2020-March 30, 2021	No
China	January 23, 2020	April 8, 2020			June 24, 2020-August 7, 2020		No
India	March 25, 2020	June 7, 2020	April 19, 2021	May 31, 2021	July 1, 2020-September 20, 2020	January 22, 2021-April 1, 2021	No
Pakistan	March 24, 2020	May 9, 2020	May 8, 2021	May 18, 2021	June 10, 2020-September 24, 2020	February 2, 2021-March 29, 2021	No
Saudi Arabia	March 29, 2020	June 21, 2020			June 3, 2020-October 7, 2020	January 16, 2021-April 1, 2021	Yes, in round 1
Ukraine	March 17, 2020	April 24, 2020			June 11, 2020-September 30, 2020	January 7, 2021-March 25, 2021	No
United Kingdom	March 23, 2020	July 4, 2020	November 5, 2020	December 2, 2020	April 28, 2020-August 6, 2020	November 12, 2020-February 18, 2021	Yes, in both rounds

Table 4 Ordinary least squares regression of mental health scores on cumulative coronavirus disease 2019 case, lockdown, and individual characteristics (survey round 1)

	PHQ-9		GAD-7		IES-R
	Round 1	Round 2	Round 1	Round 2	Round 1	Round 2
Daily cumulative COVID-19 case/1000000	0.075a	2.121c	0.041	1.750c	0.225a	1.543a
	[-0.01, 0.16]	[1.58, 2.66]	[-0.03, 0.11]	[1.28, 2.22]	[-0.02, 0.47]	[-0.05, 3.14]
Dummy for first lockdown withdraw		-0.658c		-0.450c		-1.224b
		[-0.97, -0.34]		[-0.73, -0.17]		[-2.16, -0.29]
Dummy for first lockdown withdraw1(date-first lockdown withdraw date)		-0.018c		-0.014c		-0.043c
		[-0.03, -0.01]		[-0.02, -0.01]		[-0.07, -0.02]
Date-first lockdown withdraw date		0.006b		0.000		0.004
		[0.00, 0.01]		[-0.00, 0.01]		[-0.01, 0.02]
Healthcare professional (1 = yes, 0 = no)	-0.402c	-0.737c	-0.328c	-0.631c	-1.394c	-2.185c
	[-0.54, -0.26]	[-0.89, -0.58]	[-0.45, -0.21]	[-0.77, -0.49]	[-1.81, -0.98]	[-2.65, -1.72]
Age (base: Below 25)	0.000	0.000	0.000	0.000	0.000	0.000
25-44	-1.084c	-1.428c	-0.482c	-0.713c	-2.350c	-2.091c
	[-1.34, -0.83]	[-1.75, -1.11]	[-0.71, -0.26]	[-0.99, -0.43]	[-3.10, -1.60]	[-3.02, -1.16]
45-54	-1.958c	-2.345c	-1.456c	-1.737c	-3.992c	-3.366c
	[-2.24, -1.68]	[-2.69, -1.99]	[-1.70, -1.21]	[-2.05, -1.43]	[-4.83, -3.15]	[-4.39, -2.34]
55 and over	-2.956c	-3.108c	-2.179c	-2.284c	-5.568c	-4.085c
	[-3.24, -2.67]	[-3.47, -2.75]	[-2.43, -1.93]	[-2.60, -1.97]	[-6.42, -4.72]	[-5.15, -3.02]
White (1 = yes, 0 = no)	0.360c	0.482c	0.299c	0.413c	-1.120c	-0.054
	[0.17, 0.55]	[0.23, 0.74]	[0.13, 0.47]	[0.19, 0.64]	[-1.69, -0.55]	[-0.80, 0.69]
Christian (1 = yes, 0 = no)	-0.206c	-0.036	0.018	0.222c	0.522c	0.829c
	[-0.34, -0.07]	[-0.19, 0.12]	[-0.10, 0.13]	[0.08, 0.36]	[0.13, 0.91]	[0.37, 1.29]
Male (1 = yes, 0 = no)	-1.189c	-1.231c	-1.039c	-1.042c	-2.997c	-3.719c
	[-1.34, -1.03]	[-1.43, -1.03]	[-1.18, -0.90]	[-1.22, -0.86]	[-3.46, -2.53]	[-4.31, -3.13]
Attended university (1 = yes, 0 = no)	-1.141c	0.000	-0.545c	0.000	-1.254c	0.000
	[-1.34, -0.94]	[0.00, 0.00]	[-0.72, -0.37]	[0.00, 0.00]	[-1.85, -0.65]	[0.00, 0.00]
Living at own home (1 = yes, 0 = no)	-0.885c	-1.105c	-0.489c	-0.692c	-1.432c	-2.270c
	[-1.04, -0.73]	[-1.30, -0.91]	[-0.63, -0.35]	[-0.86, -0.52]	[-1.89, -0.97]	[-2.83, -1.71]
Vulnerable according to government category (base: Not vulnerable)	0.000	0.000	0.000	0.000	0.000	0.000
Aged 70 or above	-0.898c	-1.105c	-0.764c	-0.985c	-1.954c	-2.909c
	[-1.18, -0.62]	[-1.52, -0.69]	[-1.01, -0.52]	[-1.35, -0.62]	[-2.81, -1.10]	[-4.19, -1.63]
Chronic disease	0.361b	0.345b	0.533c	0.543c	1.245c	1.644c
	[0.08, 0.64]	[0.03, 0.66]	[0.29, 0.78]	[0.26, 0.83]	[0.41, 2.08]	[0.70, 2.59]
Diabetes	0.034	-0.064	0.102	0.139	0.867	1.185
	[-0.43, 0.49]	[-0.63, 0.50]	[-0.30, 0.50]	[-0.36, 0.64]	[-0.50, 2.23]	[-0.49, 2.86]
Other	0.915c	0.846c	0.390c	0.355b	0.811a	1.208b
	[0.62, 1.21]	[0.49, 1.20]	[0.13, 0.65]	[0.04, 0.67]	[-0.07, 1.70]	[0.15, 2.27]
Vulnerable according to government category and require shielding (1 = yes, 0 = no)	1.087c	1.096c	0.909c	0.945c	4.281c	3.513c
	[0.83, 1.34]	[0.76, 1.43]	[0.68, 1.13]	[0.65, 1.24]	[3.51, 5.05]	[2.52, 4.50]
Experienced coronavirus (1 = yes, 0 = no)	0.324c	0.220b	0.237c	0.181b	0.410a	0.547b
	[0.18, 0.47]	[0.05, 0.39]	[0.11, 0.36]	[0.03, 0.33]	[-0.01, 0.83]	[0.05, 1.05]
Pre-existing mental health condition (1 = yes, 0 = no)	3.447c	3.256c	3.158c	3.091c	8.608c	8.227c
	[3.26, 3.63]	[3.04, 3.47]	[3.00, 3.32]	[2.90, 3.28]	[8.06, 9.16]	[7.60, 8.86]
Drinking alcohol (1 = yes, 0 = no)	0.251c	-0.082	0.234c	-0.101	0.410	-0.277
	[0.08, 0.42]	[-0.30, 0.13]	[0.08, 0.38]	[-0.29, 0.09]	[-0.10, 0.92]	[-0.91, 0.36]
Taking drug (1 = yes, 0 = no)	0.794c	1.303c	0.725c	0.729c	2.262c	2.527c
	[0.48, 1.11]	[0.76, 1.84]	[0.45, 1.00]	[0.25, 1.21]	[1.33, 3.19]	[0.95, 4.11]
Ever experienced suicidal thoughts (1 = yes, 0 = no)	3.101c	2.976c	1.623c	1.503c	6.054c	5.812c
	[2.95, 3.25]	[2.80, 3.15]	[1.49, 1.75]	[1.35, 1.66]	[5.61, 6.50]	[5.30, 6.32]
Mental health support from (base: No support)	0.000	0.000	0.000	0.000	0.000	0.000
Health service provider	0.134	0.245a	-0.052	-0.021	0.008	-0.030
	[-0.11, 0.37]	[-0.03, 0.52]	[-0.26, 0.16]	[-0.26, 0.22]	[-0.71, 0.72]	[-0.85, 0.79]
Other	1.072c	1.269c	0.521c	0.666c	3.042c	3.542c
	[0.77, 1.38]	[0.91, 1.63]	[0.25, 0.79]	[0.35, 0.98]	[2.14, 3.95]	[2.49, 4.59]
Constant	7.050c	7.213c	4.651c	4.590c	16.577c	16.791c
	[6.73, 7.37]	[6.69, 7.73]	[4.37, 4.93]	[4.13, 5.05]	[15.62, 17.54]	[15.26, 18.32]
Observations	28560	21077	28710	21202	26913	19785
Adjusted R2	0.279	0.261	0.214	0.203	0.180	0.172

^aP < 0.10.

^bP < 0.05.

^cP < 0.01.

¹See Table 3 for dates of first lock down period.

95% confidence intervals are in brackets. PHQ-9: Patient health questionnaire-9; IES-R: Impact of Events Scale-Revised; GAD-7: Generalized anxiety disorder-7; COVID-19: Coronavirus disease 2019.

Table 5 Ordinary least squares regression of mental health scores on cumulative coronavirus disease 2019 case, lockdown, and individual characteristics (survey round 2)

	PHQ-9		GAD-7		IES-R
	Round 1	Round 2	Round 1	Round 2	Round 1	Round 2
Daily cumulative COVID-19 case/1000000	0.195c	0.433c	0.129c	0.557c	0.454c	1.265c
	[0.18, 0.21]	[0.23, 0.63]	[0.11, 0.15]	[0.38, 0.74]	[0.40, 0.51]	[0.67, 1.86]
Dummy for second lockdown withdraw		-0.507c		-0.343b		-1.077b
		[-0.83, -0.18]		[-0.63, -0.05]		[-2.04, -0.11]
Dummy for second lockdown withdraw1(date-second lockdown withdraw date)		-0.034c		-0.038c		-0.104c
		[-0.06, -0.01]		[-0.06, -0.02]		[-0.18, -0.03]
Date-second lockdown withdraw date		0.013		-0.002		0.034
		[-0.01, 0.03]		[-0.02, 0.02]		[-0.03, 0.10]
Healthcare professional (1 = yes, 0 = no)	-0.693c	-0.747c	-0.540c	-0.587c	-2.325c	-2.551c
	[-0.80, -0.58]	[-0.86, -0.63]	[-0.64, -0.44]	[-0.69, -0.48]	[-2.65, -2.00]	[-2.89, -2.21]
Age (base: Below 25)
25-44	-1.147c	-1.339c	-0.333c	-0.445c	-1.043c	-0.715b
	[-1.34, -0.96]	[-1.55, -1.13]	[-0.50, -0.16]	[-0.63, -0.26]	[-1.60, -0.49]	[-1.33, -0.10]
45-54	-2.059c	-2.245c	-1.310c	-1.421c	-2.263c	-1.750c
	[-2.27, -1.85]	[-2.47, -2.02]	[-1.50, -1.12]	[-1.63, -1.22]	[-2.88, -1.65]	[-2.42, -1.08]
55 and over	-3.455c	-3.639c	-2.424c	-2.521c	-4.792c	-4.223c
	[-3.66, -3.25]	[-3.87, -3.41]	[-2.61, -2.24]	[-2.72, -2.32]	[-5.40, -4.18]	[-4.89, -3.55]
White (1 = yes, 0 = no)	-0.291c	-0.243c	-0.326c	-0.249c	-2.114c	-1.667c
	[-0.42, -0.16]	[-0.38, -0.11]	[-0.44, -0.21]	[-0.37, -0.13]	[-2.49, -1.74]	[-2.07, -1.27]
Christian (1 = yes, 0 = no)	-0.017	0.018	0.174c	0.183c	0.752c	0.795c
	[-0.11, 0.08]	[-0.08, 0.12]	[0.09, 0.26]	[0.10, 0.27]	[0.47, 1.03]	[0.50, 1.09]
Male (1 = yes, 0 = no)	-1.470c	-1.476c	-1.491c	-1.523c	-4.418c	-4.798c
	[-1.57, -1.37]	[-1.58, -1.37]	[-1.58, -1.40]	[-1.62, -1.43]	[-4.72, -4.12]	[-5.12, -4.48]
Attended university (1 = yes, 0 = no)	-0.699c	0.000	-0.543c	0.000	-0.174	0.000
	[-0.96, -0.43]	[0.00, 0.00]	[-0.78, -0.31]	[0.00, 0.00]	[-0.95, 0.60]	[0.00, 0.00]
Own home (1 = yes, 0 = no)	-1.328c	-1.391c	-0.899c	-0.957c	-2.985c	-3.338c
	[-1.44, -1.22]	[-1.51, -1.27]	[-1.00, -0.80]	[-1.06, -0.85]	[-3.32, -2.65]	[-3.69, -2.99]
Vulnerable according to government category and require shielding (1 = yes, 0 = no)	1.355c	1.393c	1.083c	1.124c	3.932c	3.929c
	[1.25, 1.46]	[1.28, 1.51]	[0.99, 1.18]	[1.02, 1.23]	[3.61, 4.26]	[3.59, 4.27]
Experienced coronavirus (1 = yes, 0 = no)	0.747c	0.715c	0.566c	0.535c	2.601c	2.398c
	[0.64, 0.85]	[0.61, 0.82]	[0.47, 0.66]	[0.44, 0.63]	[2.30, 2.91]	[2.08, 2.71]
Pre-existing mental health condition (1 = yes, 0 = no)	2.808c	2.745c	2.278c	2.266c	7.150c	7.160c
	[2.62, 2.99]	[2.55, 2.94]	[2.11, 2.44]	[2.10, 2.44]	[6.60, 7.70]	[6.60, 7.73]
Drinking alcohol (1 = yes, 0 = no)	2.300c	2.506c	1.714c	1.875c	5.976c	6.400c
	[2.17, 2.43]	[2.36, 2.65]	[1.60, 1.83]	[1.75, 2.00]	[5.59, 6.37]	[5.98, 6.82]
Taking drug (1 = yes, 0 = no)	1.232c	1.359c	0.539c	0.562c	3.126c	3.270c
	[1.01, 1.46]	[1.10, 1.62]	[0.34, 0.74]	[0.33, 0.79]	[2.46, 3.79]	[2.51, 4.03]
Ever experienced suicidal thoughts (1 = yes, 0 = no)	4.405c	4.379c	2.749c	2.716c	9.625c	9.747c
	[4.29, 4.52]	[4.26, 4.49]	[2.65, 2.85]	[2.61, 2.82]	[9.30, 9.95]	[9.41, 10.09]
Mental health support from (base: No support)
Health service provider	0.322c	0.342c	-0.024	-0.051	-0.124	-0.288
	[0.10, 0.55]	[0.11, 0.57]	[-0.22, 0.17]	[-0.26, 0.15]	[-0.79, 0.54]	[-0.97, 0.39]
Other	1.041c	1.300c	0.686c	0.854c	2.979c	3.572c
	[0.78, 1.31]	[1.02, 1.58]	[0.45, 0.92]	[0.61, 1.10]	[2.20, 3.76]	[2.75, 4.40]
Constant	8.201c	8.292c	6.023c	5.496c	17.577c	16.168c
	[7.98, 8.42]	[7.84, 8.74]	[5.83, 6.22]	[5.10, 5.90]	[16.94, 18.21]	[14.84, 17.50]
Observations	62938	57985	63545	58547	58966	54202
Adjusted R2	0.315	0.318	0.228	0.230	0.222	0.228

^bP < 0.05.

^cP < 0.01.

¹See Table 3 for dates of first lock down period.

95% confidence intervals are in brackets. PHQ-9: Patient health questionnaire-9; IES-R: Impact of Events Scale-Revised; GAD-7: Generalized anxiety disorder-7; COVID-19: Coronavirus disease 2019.