A longitudinal study of risk and protective factors for symptoms of adjustment disorder during the COVID-19 pandemic

Figures & data

Table 1. Pandemic-related and clinical characteristics (N = 15,169).

Characteristic	T1	T2	T3
Lockdown stringency^a	M (SD)	M (SD)	M (SD)
	56.87 (9.32)	72.10 (8.69)	55.72 (10.10)
	n (%)	n (%)	n (%)
Reduced income due to pandemic^b
No	10291 (68.1%)	4568 (75.8%)	4607 (78.3%)
Yes	4823 (31.9%)	1462 (24.2%)	1275 (21.7%)
Face-to-face contact^c
No contact	1557 (10.3%)	402 (7.6%)	219 (4.2%)
<once a week	3609 (23.8%)	1323 (25.1%)	1010 (19.4%)
once a week	2144 (14.1%)	785 (14.9%)	737 (14.2%)
1–2 times a week	3183 (21.0%)	928 (17.6%)	1082 (20.8%)
3–6 times a week/everyday	4663 (30.8%)	1828 (34.7%)	2159 (41.5%)
Digital social contact^d
No contact	494 (3.3%)	210 (3.0%)	198 (3.4%)
<once a week	1417 (9.3%)	813 (11.7%)	772 (13.2%)
once a week	1316 (8.7%)	753 (10.8%)	708 (12.1%)
1–2 times a week	2803 (18.5%)	1381 (19.9%)	1199 (20.5%)
3–6 times a week/everyday	9126 (60.2%)	3800 (54.6%)	2959 (50.7%)
News consumption^e
I do not watch, read or listen to news	1091 (7.2%)	614 (8.8%)	705 (12.1%)
<30 min a day	7385 (48.7%)	3671 (52.8%)	3530 (60.5%)
30–60 min a day	3980 (26.3%)	1789 (25.7%)	1087 (18.6%)
1–2 h a day	1515 (10.0%)	563 (8.1%)	326 (5.6%)
2–3 h a day	622 (4.1%)	175 (2.5%)	98 (1.7%)
>3 h a day	563 (3.7%)	145 (2.1%)	90 (1.5%)

Notes. Lockdown stringency according to the Oxford Stringency Index. Reduced income = Reduced monthly household income due to the COVID-19 pandemic. Face-to-face contact = Face-to-face contact with loved ones or friends. Digital social contact = Digital social contact with loved ones or friends, e.g. by phone, Skype, or Zoom. News consumption = Hours a day watching, reading, or listening to the news or other information about the COVID-19 pandemic.

Missing values: T1: ^an = 0, ^bn = 55, ^cn = 13, ^dn = 13, ^en = 13. T2: ^an = 8065, ^bn = 9139, ^cn = 9903, ^dn = 8212, ^en = 8212. T3: ^an = 9328, ^bn = 9287, ^cn = 9962, ^dn = 9333, ^en = 9333.

Table 2. Health-related characteristics (N = 15,169).

Characteristic	T1	T2	T3
Current health status^a
Very good	4406 (29.1%)	1396 (20.1%)	1263 (21.6%)
Good	6620 (43.7%)	3069 (44.1%)	2634 (45.1%)
Satisfactory	3299 (21.8%)	1910 (27.5%)	1467 (25.1%)
Bad	827 (5.5%)	583 (8.4%)	472 (8.1%)
COVID-19 infection^b
No	14856 (98.0%)	6325 (90.9%)	5083 (87.1%)
Yes	296 (2.0%)	632 (9.1%)	752 (12.9%)
Diagnosis of mental disorder^c
No	11932 (78.7%)	5210 (74.9%)	4323 (74.1%)
Yes, recovered	1940 (12.8%)	1082 (15.6%)	972 (16.7%)
Yes, currently affected	1280 (8.4%)	665 (9.6%)	541 (9.3%)
Trauma during pandemic^d
No	13705 (92.3%)	5923 (89.1%)	4982 (88.6%)
Yes	1150 (7.7%)	721 (10.9%)	642 (11.4%)
Trauma before pandemic^e
No	10582 (71.3%)
Yes	4263 (28.7%)
Probable adjustment disorder^f (ADNM-8 > 22)	2826 (18.7%)	1444 (21.5%)	962 (17.1%)
ADNM-8 total score^g	M (SD)	M (SD)	M (SD)
	16.03 (6.45)	16.51 (6.65)	15.41 (6.47)

Notes: COVID-19 infection = Infected (i.e. tested positive) with COVID-19. ADNM-8 = Adjustment Disorder – New Module 8.

Missing values: T1: ^an = 156, ^bn = 17, ^cn = 159, ^dn = 1547, ^en = 1557, ^fn = 1295, ^gn = 51. T2: ^a n = 9446, ^bn = 8212, ^cn = 9447, ^dn = 9766, ^fn = 9690, ^gn = 8447. T3: ^a n = 10,575, ^bn = 9334, ^cn = 10,575, ^dn = 10,787, ^fn = 10,769, ^gn = 9526.

Table 3. Pandemic-related stressors (N = 15,169).

PaSS Domain	T1 M (SD)	T2 M (SD)	T3 M (SD)
Restricted social contact^a	1.53 (0.90)	1.59 (0.86)	1.21 (0.86)
Problems with childcare^b	0.38 (0.83)	0.32 (0.75)	0.27 (0.70)
Work-related problems^c	0.62 (0.83)	0.48 (0.77)	0.40 (0.71)
Fear of infection^d	1.65 (0.78)	1.69 (0.77)	1.51 (0.81)
Burden of infection^e	0.64 (0.84)	0.71 (0.78)	0.63 (0.73)
Restricted activity^f	1.56 (0.85)	1.63 (0.83)	1.34 (0.85)
Crisis management/communication^g	1.21 (0.87)	1.43 (0.89)	1.28 (0.90)
Restricted access to resources^h	0.83 (0.79)	0.91 (0.77)	0.75 (0.76)
Difficult housing condition^i	0.60 (0.77)	0.54 (0.71)	0.45 (0.65)

Notes. PaSS = Pandemic Stressor Scale. 0 = ‘Not at all burdened’; 1 = ‘Somewhat burdened’; 2 = ‘Moderately burdened’; 3 = ‘Strongly burdened’.

Missing values: T1: ^a n = 38, ^bn = 38, ^cn = 981, ^dn = 25, ^en = 25, ^fn = 33, ^gn = 22, ^hn = 22, ⁱn = 38. T2: ^a n = 10,135, ^bn = 8319, ^cn = 8397, ^dn = 8289, ^en = 8288, ^fn = 8303, ^gn = 8281, ^hn = 8281, ⁱn = 8319. T3: ^a n = 9515, ^bn = 9421, ^cn = 9591, ^dn = 9403, ^en = 9403, ^fn = 9409, ^gn = 9400, ^hn = 9400, ⁱn = 9421.

Figure 1. Effect estimates of the linear mixed regression analysis.

Notes. ≥10 years = 10 or more years of schooling. Reduced income = Reduced monthly household income due to the coronavirus. Financial support = Receiving financial support from the government. Maintenance/repair/etc. = Maintenance, repair, construction. More at home = Spent more time at home due to the coronavirus pandemic. Social dist. = Spent more time at home as a precautionary measure (social distancing). Self-isolation = Stayed at home in self-isolation because of self-infection. Quarantine = Stayed at home due to contact with infected people or being in risk areas. Face contact = Face-to-face contact with loved ones or friends. Face contact at work = Work involves (almost) daily face-to-face contact with other people. Digital contact = Digital contact with loved ones or friends, e.g. by phone, Skype, or Zoom. News = Hours a day watching, reading, or listening to the news or other information about the coronavirus pandemic. COVID-19 inf. = Infected (i.e. tested positive) with the coronavirus.

Reference categories: ^aMale. ^bLess than 10 years of schooling. ^cVery low. ^dNo. ^eOther. ^fNo. ^gI have no personal contact with other people. ^hI have no contact by phone, skype, etc. ⁱI do not watch, read or listen to news about the coronavirus pandemic. ^jVery good. ^kNo.

Figure 2. Interaction between time and reduced monthly household income.

Table 4. Effect estimates of risk factors and stressors on symptoms of adjustment disorder (N = 15,169).

Term	b	SE	p	95% CI Low	95% CI Up
Intercept	7.37	0.56	<.001	6.26	8.47
Age (in years)	0.02	0.00	<.001	0.02	0.03
Gender (ref. male)
Female	0.92	0.08	<.001	0.75	1.08
Diverse	1.43	0.58	.014	0.29	2.58
Education (ref. < 10 years^a)
≥10 years	0.33	0.24	.180	−0.15	0.81
Vocational studies	0.33	0.26	.208	−0.18	0.83
Completed studies	0.22	0.24	.368	−0.26	0.70
Income (ref. very low)
Low	−0.03	0.16	.845	−0.35	0.29
Medium	0.02	0.16	.897	−0.30	0.34
High	−0.18	0.17	.278	−0.52	0.15
Reduced income (ref. no)
Yes	0.16	0.10	.115	−0.04	0.35
T2 × Yes	0.42	0.16	.009	−0.11	0.73
T3 × Yes	0.28	0.17	.104	−0.06	0.61
Work status (ref. no work)
Training/study: Yes	−0.18	0.14	.202	−0.46	0.10
Employed part-time: Yes	−0.09	0.14	.515	−0.37	0.19
Employed full-time: Yes	−0.23	0.15	.113	−0.52	0.05
Self-employed: Yes	−0.44	0.17	.012	−0.78	−0.10
Freelancer: Yes	−0.01	0.21	.948	−0.41	0.39
Retired: Yes	−0.75	0.29	.011	−1.33	−0.17
Seeking work: Yes	−0.16	0.28	.579	−0.71	0.40
Other: Yes	−0.11	0.18	.531	−0.24	0.46
Work area^e (ref. other area)
Health care	−0.25	0.12	.042	−0.48	−0.01
Public security	0.02	0.19	.924	−0.35	0.39
Retail, Services	0.04	0.17	.817	−0.30	0.38
Maintenance/repair/etc.	0.05	0.22	.810	−0.39	0.50
Education	−0.05	0.13	.709	−0.30	0.20
Not working	0.21	0.27	.439	−0.32	0.73
Face-to-face contact (ref. no contact^b)
<once a week	−0.35	0.13	.006	−0.61	−0.10
once a week	−0.38	0.14	.009	−0.66	−0.09
1–2 times a week	−0.48	0.14	<.001	−0.75	−0.21
3–6 times a week or every day	−0.33	0.13	.014	−0.59	−0.07
Virtual social contact (ref. no contact^c)
<once a week	−0.12	0.19	.529	−0.49	0.25
once a week	−0.22	0.19	.256	−0.59	0.16
1–2 times a week	−0.22	0.18	.217	−0.58	0.13
3–6 times a week	−0.31	0.17	.075	−0.65	0.03
News consumption (ref. no consumpt.)
<30 min. a day	−0.06	0.12	.600	−0.29	0.17
30–60 min a day	0.41	0.13	.001	0.16	0.66
1–2 h a day	0.77	0.15	<.001	0.47	1.07
2–3 h a day	1.09	0.20	<.001	0.69	1.48
>3 h a day	1.53	0.21	<.001	1.12	1.94
Current health status (ref. very good)
Good	0.95	0.08	<.001	0.79	1.10
Satisfactory	2.16	0.10	<.001	1.97	2.35
Poor	4.11	0.15	<.001	3.82	4.40
Diagnosis of mental disorder (ref. no)
Yes, recovered	1.06	0.12	<.001	0.82	1.31
Yes, currently affected	3.20	0.15	<.001	2.90	3.50
T2 × Yes, recovered	−0.21	0.18	.261	−0.58	0.16
Yes, currently affected	−0.87	0.23	<.001	−1.33	−0.42
T3 × Yes, recovered	−0.54	0.20	.006	−0.922	−0.16
Yes, currently affected	−0.68	0.25	.006	−1.17	−0.19
COVID-19 infection (ref. no)
Yes	−0.02	0.14	.907	−0.28	0.25
Trauma during pandemic (ref. no)
Yes	0.97	0.16	<.001	0.67	1.27
T2 × Yes	0.50	0.24	.033	0.04	0.96
T3 × Yes	0.66	0.24	.006	0.19	1.14
Trauma before pandemic (ref. no)
Yes	0.38	0.08	<.001	0.21	0.54
PaSS: Restricted face-to-face contact	1.03	0.05	<.001	0.93	1.13
PaSS: Problems with childcare	−0.23	0.05	<.001	−0.32	−0.13
PaSS: Work-related problems	0.89	0.06	<.001	0.77	1.00
PaSS: Fear of infection	1.21	0.05	<.001	1.11	1.32
PaSS: Burden of infection	0.01	0.05	.851	−0.08	0.10
PaSS: Restricted activity	0.42	0.05	<.001	0.32	0.51
PaSS: Crisis management/commun.	0.63	0.05	<.001	0.53	0.74
T2 × Crisis management	0.00	0.08	.972	−0.15	0.15
T3 × Crisis management/commun.	−0.31	0.08	<.001	−0.47	−0.15
PaSS: Restricted resources	.063	.050	.206	−0.04	0.16
PaSS: Diff. housing condition	1.20	0.06	<.001	1.09	1.31
Lockdown stringency	−0.01	0.00	.006	−0.02	−0.00

Notes. Ref. = reference category. Interaction effects with time (T2, T3) were included if significant. ^a< 10 years = Less than 10 years of schooling. ^b No personal face-to-face contact with other people. ^c No digital contact by phone, skype, etc. with other people.

Figure 3. Interaction between time and mental health disorder.

Figure 4. Interaction between time and trauma exposure.

Data availability

The detailed sociodemographic information of the dataset does not fully protect the anonymity of the respondents. For this reason, the entire dataset cannot be made publicly available. However, excerpts of the data on a higher aggregation level can be provided upon justified request by the first author.