The evolution in anxiety and depression with the progression of the pandemic in adult populations from eight countries and four continents

Mélissa Généreux*, Philip J. Schluter, Elsa Landaverde, Kevin K.C. Hung, Chi Shing Wong, Catherine Pui Yin Mok, Gabriel Blouin-Genest, Tracey O’sullivan, Marc D. David, Marie Eve Carignan, Olivier Champagne-Poirier, Nathalie Pignard-Cheynel, Sébastien Salerno, Grégoire Lits, Leen D’haenens, David De Coninck, Koenraad Matthys, Eric Champagne, Nathalie Burlone, Zeeshan QadarTeodoro Herbosa, Gleisse Ribeiro-Alves, Ronald Law, Virginia Murray, Emily Ying Yang Chan, Mathieu Roy

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


Nearly a year after the classification of the COVID-19 outbreak as a global pandemic, it is clear that different factors have contributed to an increase in psychological disorders, including public health measures that infringe on personal freedoms, growing financial losses, and conflicting messages. This study examined the evolution of psychosocial impacts with the progression of the pandemic in adult populations from different countries and continents, and identified, among a wide range of individual and country-level factors, which ones are contributing to this evolving psychological response. An online survey was conducted in May/June 2020 and in November 2020, among a sample of 17,833 adults (Phase 1: 8806; Phase 2: 9027) from eight countries/regions (Canada, the United States, England, Switzerland, Belgium, Hong Kong, the Philippines, New Zealand). Probable generalized anxiety disorder (GAD) and major depressive episode (MDE) were assessed. The independent role of potential factors was examined using multilevel logistic regression. Probable GAD or MDE was indicated by 30.1% and 32.5% of the respondents during phases 1 and 2, respectively (a 7.9% increase over time), with an important variation according to countries/regions (range from 22.3% in Switzerland to 38.8% in the Philippines). This proportion exceeded 50% among young adults (18–24 years old) in all countries except for Switzerland. Beyond young age, several factors negatively influenced mental health in times of pandemic; important factors were found, including weak sense of coherence (adjusted odds ratio aOR = 3.89), false beliefs (aOR = 2.33), and self-isolation/quarantine (aOR = 2.01). The world has entered a new era dominated by psychological suffering and rising demand for mental health interventions, along a continuum from health promotion to specialized healthcare. More than ever, we need to innovate and build interventions aimed at strengthening key protective factors, such as sense of coherence, in the fight against the adversity caused by the concurrent pandemic and infodemic.

Original languageEnglish
Article number4845
JournalInternational Journal of Environmental Research and Public Health
Issue number9
Publication statusPublished - 1 May 2021

Bibliographical note

Funding Information: This research was funded by a Canadian Institute of Health Research Operating Grant (OV7-170635).

Open Access: This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (

Publisher Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland.

Citation: Généreux, Mélissa, et al. "The Evolution in Anxiety and Depression with the Progression of the Pandemic in Adult Populations from Eight Countries and Four Continents." International Journal of Environmental Research and Public Health 18.9 (2021): 4845.



  • Pandemic
  • Psychosocial impacts
  • Sense of coherence


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