Did COVID-19 restriction compliance increase depressive symptoms in young adults?

By Hugo Francisco de SouzaAug 8 2023Reviewed by Sophia Coveney

In a recent study published in the journal PLOS One, researchers used a cross-sectional survey of adults from Canada and France between 18-29 to evaluate the association between coronavirus disease 2019 (COVID-19) restriction compliance and depressive symptoms.

Their results found a strong association between increased adherence and major depressive symptoms. More than 30% of young adults reported depressive symptoms, necessitating the inclusion of mental health interventions for these age groups during COVID-19-driven social isolation.

Mental health impacts of COVID-19

The advent and progression of the COVID-19 pandemic saw nations worldwide implement policies and jurisdictions to curb the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). These public health preventive measures were tailored to local COVID-19 severity.

They included both educational guidance (hygiene recommendations through multimedia) and enforceable jurisdictions, including social isolation, face-mask usage, and stay-at-home orders.

These measures were found to help flatten the COVID-19 spread curve and proved effective in reducing the pandemic’s impact. Still, evidence collected during March-August 2020 (the first wave) suggests that older adults (above 30) were more likely to comply with these regulations than younger individuals.

Previous work has implied that the mental toll of social isolation especially impacted adults between the ages of 18-29, and these age groups were more likely to report depression, anxiety, and suicidal ideation than their older counterparts.

Previous research has focused mainly on older adults, with analyses evaluating the mental toll of only one or a few preventive measures. The cumulative toll of complying with multiple concurrent preventive measures remains unexplored. Furthermore, results from these studies remain confounding, with some reporting positive associations between depressive symptoms and COVID-19 regulation compliance, while others reported no association or even negative associations between these variables. Most studies in the field have been conducted on individuals from the US, with a need for more literature available for other world regions.

Thus, there is a need to elucidate the additive impacts of the entire spectrum of public health policies on mental health and depressive symptoms, especially in young adults at higher risk.

About the study

In the present study, researchers employed a cross-sectional longitudinal survey approach to investigate the correlation between COVID-19 norm compliance and mental health. They hypothesized that individuals who showed higher compliance (i.e., more stringent social distancing and self-isolation) would also report increased mental trauma due to reduced social support.

Researchers collected data through the France-Canada Observatory on COVID-19, Youth health and Social well-being (FOCUS) study between 8^th October and 23^rd December 2020. The FOCUS study aimed to collect anonymous COVID-19 impact data from France and Canada's youth and young adults, which showed exceptionally high infection rates (17% and 19%, respectively) compared to other regions globally.

The online questionnaire comprised questions on sociodemographics, access to health and social services, experiences during COVID-19, and health outcomes, including mental health.

For the present study, respondents between the ages of 18-29 who completed questionnaire sections on COVID-19 jurisdiction compliances, sociodemographics, and mental health were included. This resulted in a Canadian cohort of 3,246 respondents and a French cohort of 2,680 young adults (total = 5,926).

Researchers built a COVID-19 compliance profile based on social-isolation preventive measures. Measures included staying home, only making trips outside when essential, social gathering avoidance, meeting friends avoidance, and social bubble maintenance.

The Patient Health Questionnaire-9 (PHQ-9) was used to assess short-term (two weeks) mental health. PHQ-9 scores greater than 15 were defined as ‘major depressive symptoms.’ Cluster analyses were used to build and refine compliance profile results, and multivariate analyses were used to evaluate any associations between PHQ-9 scores and compliance profiles, using sociodemographic data as covariates.

Study findings

More than 30% of respondents were observed to report major depressive symptoms, with proportions in Canada (36.4%) being slightly higher than those in France (23.4%).

This may be attributed to decades of mental health awareness in Canada versus the still-prevalent social stigma associated with mental health illness in France, implying that the French observation may be an underestimation of the actual degree of major depressive symptoms among youth in the country.

Significant sociodemographic differences were observed between Canadian and French respondents, with the former having higher sexual-minority representation and lower education levels than the latter. Canadian young adults were more likely to have employment compared to their age- and sex-match French counterparts. A larger proportion of French respondents reported living alone than the Canadian cohort.

COVID-19 regulation compliance profile clustering identified four distinct profiles – high, medium-high, medium-low, and low.

“In both countries, major depressive symptoms (Canada: 39.8%, France: 27.9%) were more prevalent among highly compliant participants than those who reported a low level of compliance (Canada: 32.7%, France: 17.7%).”

Jesson et al. (2023)

Researchers did identify that while the association between compliance and mental health was present for both sample cohorts, the strength of association was higher in France than in Canada, with low/no-income, ethnic-racial and sexual minorities being the worst affected.

“Previous studies showed that sexual and gender minority youth experienced financial difficulties, limited access to gender-affirming resources, and increased experiences of discrimination, which therefore may increase the risk for depression.”

Jesson et al. (2023)

Conclusions

In the present study, researchers used data from the FOCUS study to investigate the association between COVID-19 regulation compliance and mental health in French and Canadian youth aged 18-29. Of the 5,926 respondents included in the survey, 30.5% were found to suffer from major depressive symptoms (PHQ-9 scores > 15). Canadians were observed to be overall worse affected than their French counterparts, but this might be attributed to the greater mental health awareness in the former country versus the still prevalent stigma associated with mental health in the latter.

While the study does present numerous limitations, including its employing a non-probability sampling design and the recruitment process biasing it towards respondents concerned with COVID-19, thereby excluding those less affected by the pandemic, these findings highlight how young adults who complied with COVID-19 norms to a larger extent were likely mentally and emotionally affected by social distancing more than those who ‘bent the rules.’

“As such, this study provides new evidence in [favor] of the development and promotion of strategies that enhance access of young adults to equitable and non-judgemental mental health services. This is especially important for young adults who experienced various forms of social exclusion (e.g., poverty, racism, homophobia) during the COVID-19 pandemic.”

Jesson et al. (2023)