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Shocked-relaxed-tired: Mental health during the three waves of the Covid-19

Background: Several recent studies reported that Covid-19 pandemic induces significant mental distress. It remains unknown, however, whether mental distress persists or undergoes extinction in response to consecutive Covid-19 waves. We here examine mental distress prior to and across the three Covid-19 waves. Methods: We measured stress and depressive symptoms prior to and across the three Covid-19 waves in a well-established population-based sample. A total of 330 participants completed e-questionnaires prior to and during the Covid-19 waves. Friedman's repeated-measures and Wilcoxon rank sum pairwise test with Bonferroni correction were used to investigate repeated-measure differences, while the Kruskal-Wallis test was used to assess the effect of behavioral and physiological parameters on mental health. Results: We found significantly increased mental distress during each of the Covid-19 waves compared with the pre-Covid-19 period. Increased mental distress was more common in women and most pronounced during the 1st and in particular, the 3rd Covid-19 wave. The stress and depressive symptoms increased during pandemic compared with the pre-Covid-19 period by a maximum of 1.58 and 3.63 times, respectively. Negative emotions and loneliness were identified as the most significant risk factors of Covid-19-induced mental distress, while resilience was found to be protective. Conclusions: Mental distress surged during all the Covid-19 waves without showing extinction. This pattern is mechanistically reminiscent of the post-traumatic stress disorder. Our results suggest that the Covid-19 pandemic underlies development of a novel chronic mental health disorder and do not exclude possible further deterioration of mental health in case of future Covid-19 waves.