Larg scale study, 11 European countries: The Unexpected Decline in Feelings of Depression among Adults Ages 50 and Older in 11 European Countries amid the COVID-19 Pandemic

The Unexpected Decline in Feelings of Depression among Adults Ages 50 and Older in 11 European Countries amid the COVID-19 Pandemic. Zachary Van Winkle, Emanuele Ferragina, Ettore Recchi. Socius: Sociological Research for a Dynamic World, August 10, 2021. https://doi.org/10.1177/23780231211032741

Abstract: Findings on the mental health impact of the first wave of the coronavirus disease 2019 (COVID-19) pandemic in Europe are mixed and lack a comparative and longitudinal perspective. The authors used the Survey of Health, Ageing, and Retirement in Europe and fixed-effects regressions to estimate within-individual change in the probability to report feelings of depression between 2005 and 2017 and directly following the first wave of the COVID-19 pandemic in 11 European countries for adults ages 50 and older. The authors found an unprecedented decline in feelings of depression between 2017 and 2020 in all countries that was larger than any previous observed change. The probability to report feelings of depression decreased by 14.5 percentage points on average, ranging from 7 to 19 percentage points in Spain and Switzerland, respectively. Moreover, there were no systematic within-country differences by socioeconomic characteristics, chronic health conditions, virus exposure, or change in activities. These findings challenge conventional wisdom about the mental health impact of the COVID-19 pandemic.

Keywords: COVID-19, mental health, comparative, longitudinal

The first wave of the coronavirus disease 2019 (COVID-19) pandemic forced most European countries to implement wide-reaching restrictions on private and public life. Scholars immediately voiced their concern, suggesting that heightened economic insecurity and social isolation stemming from nonpharmaceutical interventions could lead to a sharp increase in mental health issues (Holmes et al. 2020). Research on the relationship between the COVID-19 pandemic and numerous aspects of mental health, such as psychological distress, feelings of depression and anxiety, and general subjective well-being, has grown rapidly. By the end of 2020, systematic reviews counted more than 2,000 studies in the field (Aknin et al. 2021; Prati and Mancini 2021). The plethora of research results has shown that the impact of the COVID-19 pandemic on subjective well-being is more complex than originally expected.

The majority of studies assume that the pandemic and governments’ containment measures have a negative effect on mental health (e.g., Fiorillo and Gorwood 2020). For example, government-imposed lockdowns as well as quarantine, social distancing, and self-isolation measures reduced social interactions and increased loneliness, both of which are associated with depression (Killgore et al. 2020). Moreover, concerns about one’s own health or the health of loved ones as well as a feeling of uncertainty about the current situation and the future may engender fear and increase feelings of depression. Those feelings of fear and uncertainty may be reinforced by the rapid spread of disinformation, especially on internet platforms. Both of these arguments linking the pandemic to decreased mental health—reduced social interactions and feelings of worry and uncertainty—may be heightened among older adults ages 50 and older.¹ Older adults are more likely than younger or middle-aged adults to become severely ill and be hospitalized following a COVID-19 infection. Therefore, it is likely that older adults did not increase their social interactions after lockdowns were lifted and that the elderly are more concerned about health issues.

In contrast, some studies have argued that the pandemic is associated with increased subjective well-being and mental health, which has been coined the “eye of the hurricane” paradox (Recchi et al. 2020). Perceptions of subjective well-being and mental health may be relative or positional. Individuals comparing themselves with those suffering the most during the pandemic may declare higher levels of well-being than they would have otherwise. In addition, numerous studies have documented astounding resilience and prosocial behavior in the aftermath of natural disasters and other dramatic events, resulting in psychological gains from adversity (Mancini 2019; Quarantelli 1985; Uchida, Takahashi, and Kawahara 2014). Older adults may also be more likely to experience gains in mental health following the pandemic. For example, retired adults were protected from labor market and income uncertainty, which may lead them to perceive a higher degree of well-being relative to adults still active in the labor market.

In this study, we concentrate on adults ages 50 and older, who are medically more vulnerable to COVID-19 than younger segments of the population. Within the group of older adults, there are subgroups that may be more or less vulnerable to the mental health consequences of the pandemic. For example, older adults become increasingly susceptible to the virus with age. Those without a partner, because of never partnering, divorce, or widowhood, may be at an especially heightened risk of social isolation. Older adults who have not yet entered retirement may be put under stress by employment and income uncertainty. Finally, those who either tested positive for COVID-19 or know someone who tested positive may suffer under the effects of social stigma associated with proximity to infection.

In addition to subgroup variation among older adults, there are likely cross-national differences across European countries. Not only were there large country differences in the timing and incidence of COVID-19 during the first wave, but countries also differed in terms of the strictness of measures taken to limit the spread of the virus (Aidukaite et al. 2021; Béland et al. 2021; Cantillon, Seeleib-Kaiser, and Veen 2021; Greve et al. 2021; Moreira et al. 2021). For example, the first wave of the COVID-19 pandemic was especially pronounced in Italy, Spain, and France. In contrast, countries in Central Europe and Eastern Europe, such as Germany and Poland, were left relatively untouched by the first wave. Therefore, if the pandemic does affect mental health negatively, then the association would be expected to be strongest in countries such as Italy and Spain compared with countries such as Germany and Poland. In addition, prepandemic differences in national labor market and social policy institutions increased the ability of certain countries to limit the economic impact of the pandemic for both individuals and society (e.g., Esping-Andersen 1990; Ferragina and Seeleib-Kaiser 2011; Ferragina, Seeleib-Kaiser, and Tomlinson 2013).

The use of cross-sectional and nonharmonized data sources limits the ability of researchers to assess whether cross-national differences are substantive or a methodological artifact. Sources of methodological differences include the measurement of mental health, target population, survey design, and analytical approach. For example, the foci and measurement instruments of studies range from anxiety, sadness, and depression to inclinations to self-harm, insomnia, and suicide. Most of these are measured through ad hoc questionnaire items or established psychological scales. The target populations of these studies vary across both contexts and selected groups, such as specific occupational or age groups, to local communities and nationally representative samples. The results of numerous studies are based on cross-sectional surveys, most of which rely on convenience and unsystematic sampling (Prati and Mancini 2021). Repeated cross-sectional surveys have enabled researchers to compare the prevalence of mental health issues in pre- and postpandemic periods found in different samples. Other cross-sectional surveys fielded during the pandemic have asked respondents to assess the impact of the COVID-19 on their own mental health. However, the latter cross-sectional approach likely exacerbates the impact of the pandemic because of social desirability bias and lack of a prepandemic baseline estimate of mental health.

Repeated cross-sectional designs have their merits in estimating change in population health across time (Yee and Niemeier 1996). For example, repeated sampling accounts for population change (e.g., compositional differences in the target population). However, longitudinal studies, despite problems with panel attrition and target population definition, are needed to assess within-individual change across time. This is especially important if compositional change masks changes in the underlying population. Some studies have adopted longitudinal designs, taking as a starting point the early months of the pandemic (Fancourt, Steptoe, and Bu 2021; Varga et al. 2021). Varga et al. (2021), for example, tracked respondents’ self-assessed COVID-19-related anxiety in four European countries (the United Kingdom, Denmark, the Netherlands, and France) and found large similarities and a common trend of slight decline in anxiety from March to July 2020. However, an accurate estimate of how the pandemic influenced subjective well-being should ideally cover a longer longitudinal window of observation and include comparable information from the same respondents before and during the pandemic.²

A few studies have used longitudinal data sources based on representative samples from single countries. The results of these studies indicate considerable within- and cross-national heterogeneity. In the United Kingdom, an increase in psychological distress from 2017 to April 2020 and a substantial decrease from April to June 2020 were found (Niedzwiedz et al. 2021). Yet the level of distress remains above prepandemic levels (Daly, Sutin, and Robinson forthcoming). Another study showed that anxiety rose in comparison with prepandemic levels, but not depression (Kwong et al. 2020). Still another showed that young respondents drove the overall increase in depression levels in the United Kingdom (Pierce et al. 2020). Evidence from the Netherlands shows stability in anxiety and depression in the overall population (van der Velden et al. 2020) and among a subsample of individuals diagnosed with depression prior to the pandemic (Pan et al. 2021). A Swedish panel study did not reveal significant changes in indicators of well-being and even demonstrated an increase in self-rated health (Kivi, Hansson, and Bjälkebring 2021). Similarly, a longitudinal study in France found evidence for a rise in average levels of subjective well-being compared with the period from 2017 to 2019 (Recchi et al. 2020). In sum, a lack of comparability among studies hinders substantive insight on how cross-national differences in the exposure and government response might translate into country variation in the relationship between the COVID-19 pandemic and mental health.

We contribute to this debate, providing a unique longitudinal and comparative assessment of the pandemic impact on subjective feelings of depression—one of the most studied outcomes to assess people’s mental health—in a segment of the population that has a higher risk for severe infection and social isolation. Using seven waves of the Survey of Health, Ageing, and Retirement in Europe (SHARE) and individual fixed-effects regression models, we investigate within-individual changes in feelings of depression across 15 years and 11 countries on a sample of older adults.

Our approach has at least four advantages compared with previous literature in the field. First, our long observation period allows us to assess the amount of change in depression levels at seven points in time before the pandemic (2005, 2007, 2009, 2011, 2013, 2015, and 2017) and in the months directly following the first wave of the COVID-19 pandemic in Europe (May to August 2020). Second, we are able to use a comparable measure of mental health to investigate the existence of common or dissimilar trends in depression levels across 11 European countries (Sweden, Denmark, Germany, France, Belgium, Switzerland, the Netherlands, Italy, Spain, the Czech Republic, and Poland). The countries in our study differ both in terms of prepandemic economic performance and institutional arrangements but also in their exposure and response to the pandemic. Third, we provide a stress-test measurement of depression trends with a focus on an epidemiologically vulnerable population. Specifically, our target population of men and women ages 50 and older compose a segment of the population in which we would expect to find a growth in feelings of depression due to the pandemic. Fourth, we are able to assess heterogeneity in pandemic’s effect on mental health across a wide array of socioeconomic characteristics as well as individuals’ exposure to the virus, their vulnerability, and the impact of the pandemic on their everyday lives.