| |

Received: 5 May 2020    Revised: 9 June 2020    Accepted: 19 June 2020

DOI: 10.1002/brb3.1745

ORIGINAL RESEARCH

Risk, resilience, psychological distress, and anxiety at the

beginning of the COVID-19 pandemic in Germany

Moritz Bruno Petzold  | Antonia Bendau  | Jens Plag | Lena Pyrkosch |

Lea Mascarell Maricic | Felix Betzler | Janina Rogoll | Julia Große | Andreas Ströhle

Department of Psychiatry
and Psychotherapy, Charité – Abstract
Universitätsmedizin Berlin, corporate Background: The current COVID-19 pandemic comes with multiple psychological
member of Freie Universität Berlin,
Humboldt-Universität zu Berlin, and Berlin stressors due to health-related, social, economic, and individual consequences and
Institute of Health, Berlin, Germany may cause psychological distress. The aim of this study was to screen the population
Correspondence in Germany for negative impact on mental health in the current COVID-19 pandemic
Moritz Petzold, Department of Psychiatry and to analyze possible risk and protective factors.
and Psychotherapy, Campus Mitte, Charité
- Universitätsmedizin Berlin, Charitéplatz 1, Methods: A total of 6,509 people took part in an online survey in Germany from 27
10117 Berlin, Germany. March to 6 April. The questionnaire included demographic information and ascer-
Email: moritz.petzold@charite.de
tained psychological distress, anxiety and depressive symptoms, and risk and protec-
tive factors.
Results: In our sample, over 50% expressed suffering from anxiety and psychological
distress regarding the COVID-19 pandemic. Participants spent several hours per day
thinking about COVID-19 (M = 4.45). Psychological and social determinants showed
stronger associations with anxiety regarding COVID-19 than experiences with the
disease.
Conclusions: The current COVID-19 pandemic does cause psychological distress,
anxiety, and depression for large proportions of the general population. Strategies
such as maintaining a healthy lifestyle and social contacts, acceptance of anxiety and
negative emotions, fostering self-efficacy, and information on where to get medical
treatment if needed, seem of help, while substance abuse and suppression of anxiety
and negative emotions seem to be associated with more psychological burden.

KEYWORDS

adjustment disorders, anxiety/anxiety disorders, coping, corona, depression

Moritz Bruno Petzold, Antonia Bendau, Julia Große and Andreas Ströhle considered joint first/last author.

Registration: Registered on ClinicalTrials.gov (NCT04331106).

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium,
provided the original work is properly cited.
© 2020 The Authors. Brain and Behavior published by Wiley Periodicals LLC.

Brain and Behavior. 2020;00:e01745.  |

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https://doi.org/10.1002/brb3.1745
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1 |  I NTRO D U C TI O N 1.1 | Pandemic situation in Germany

The new virus SARS-CoV-2 has now rapidly spread to nearly all coun- The first case in Germany was detected in January 2020 (Bayrisches
tries over the world, and the World Health Organization (WHO) de- Staatsministerium für Gesundheit und Pflege, 2020), and case num-
clared an international pandemic in March 2020 (Ghebreyesus, 2020). bers have been rising afterward (see Figure 1). In parallel, stepwise
The pandemic comes with a large number of potential stressors that more rules appeared to inhibit a further exponential growth of the
might cause psychological distress and mental health burden (Inter- infection numbers, for example, the closure of all educational, cul-
Agency Standing Committee,  2020). Potential stressors related to tural and gastronomical institutions, and a reduction in retail and
the virus might be the fear of an infection with COVID-19 and the service sectors (Bundesgesundheitsministerium,  2020). Since 23
consequences for oneself or loved ones. The taken measures that March, throughout Germany, more rigorous national rules became
aim to slow down the spreading of the virus also come with lots of effective, including further closures of institutions and restrictions
stressors such as social isolation, economic consequences, and un- of physical contact and staying outside. To our knowledge, there
certainty about the future (Inter-Agency Standing Committee, 2020). is no published research on factors of psychological distress in the
Therefore, an increase in psychological distress and negative conse- general population in Germany during the current pandemic. Hence,
quences for the mental health of large populations worldwide can be the aim of the present study was to assess psychological distress,
assumed. In a rapid developing situation with a pandemic of a scale anxiety, and depression with regard to the COVID-19 pandemic and
that was not known in the last 50 years, substantial research on the to analyze possible risk and protective factors.
psychological consequences of the pandemic is lacking. First studies
provide evidence regarding psychological distress in the context of
the COVID-19 pandemic. An online survey in the general population 2 | M E TH O DS
in China (Wang, Pan, Wan, Tan, Xu, Ho, et al., 2020) showed that
more than half of the participants rated the psychological impact 2.1 | Design
of the events as moderate-to-severe and 16.5% reported depres-
sive and 28.8% anxiety symptoms of moderate-to-severe intensity This is a cross-sectional observational study using a convenience
during the initial stage of the pandemic. These proportions seemed sample of the general population in Germany via online survey, ap-
to be relatively stable—a second survey 4 weeks later showed no proved by the ethics committee of Charité Universitätsmedizin Berlin
significant reduction in those symptoms (Wang, Pan, Wan, Tan, Xu, (EA1/071/20) and registered on ClinicalTrials.gov (NCT04331106).
McIntyre, et al., 2020). Another study from China showed a lower
prevalence of symptoms of psychological distress in Chinese work-
force during the COVID-19 outbreak (Tan, Chew, et al., 2020; Tan, 2.2 | Recruitment
Hao, et al., 2020), and particularly, individuals with preexisting (men-
tal) health issues seem to suffer from psychological strain in the con- To survey the psychological dimension of the COVID-19 pandemic,
text of the pandemic (Hao et al., 2020). an online self-report questionnaire via SoSci Survey was used. Data
Studies that focused on the psychological consequences of pre- collection started 27 March 2020, when in Germany, 42,288 cases
vious epidemics or pandemics showed that these were associated of infection and 253 deaths attributed to COVID-19 were reported
with substantial psychological distress and mental health problems, (Robert Koch Institut, 2020). The end of the first wave of data col-
for example, during the Ebola epidemic 2014 (Greenberg, Wessely, lection was 10  days later: 6 April 2020, when in Germany 95,391
& Wykes, 2015; Mohammed et al., 2015) or the SARS outbreak in cases and 1,434 deaths were reported (Robert Koch Institut, 2020).
2003 (Maunder et al., 2006). Recruitment was primarily done via social media and the website of

Covid-19 Situa in Germany

120000
Recruitment
Period
100000
27.03 - 06.04.

80000

Cases
60000
Governemt
declares Deaths
"shutdown" Recovered
40000

20000
F I G U R E 1   COVID-19 situation during
0 recruitment. aData from Robert Koch
05.03. 08.03. 11.03. 14.03. 17.03. 20.03. 23.03. 26.03. 29.03. 01.04. 04.04. 07.04. 09.04. Institut (RKI, 2020)
BRUNO PETZOLD et al. |
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the Charité. Completing the entire survey required 10–15 min. The participants (N  =  5,721) completed all pages. Average percentage of
present paper only examines cross-sectional data of the first wave. missing data on item level was 2.1% (range: 0.0–7.1). Missing data were
Further longitudinal measurements will be carried out. All partici- handled by casewise deletion. All analyses were carried out using IBM
pants gave informed consent prior to participation. Figure 1 shows SPSS Statistics Version 25. Significance level was set to .05 (two-tailed).
the COVID-19 situation in Germany during recruitment period re- For the analysis, descriptive statistics, Pearson’s and Spearman’s cor-
garding cases of infection, death, and recovery. relations, and t tests for independent samples were used.

2.3 | Eligibility criteria 3 | R E S U LT S

Except the minimum age of 18  years, residence in Germany, and 3.1 | Sample characteristics
the ability to complete the questionnaire in German, there were no
other inclusion or exclusion criteria. 70.1% of the participants were female (N  =  4,563), 29.0% male
(N = 1,887), and 0.9% identified as diverse (N = 59). Mean age was
36.2 years (SD = 11.65, range 18–99). 37.6% reported to have chil-
2.4 | Assessment dren (N = 37.6%). 15.1% had a secondary school degree (N = 985),
32.4% had a higher education entrance qualification (N  =  2,109),
The online questionnaire contained demographic information and and 50.0% had a university degree (N = 3,254). 16.7% of the par-
the experiences with the virus (e.g., being in quarantine, tested or ticipants reported to work in a medical context (N = 1,084). 10.7%
diagnosed for the coronavirus). Additionally, the subjective risk of of the participants suffered from a severe physical illness (N = 695).
being infected within the next month was rated from 0% to 100% The participants lived in a household with 2.54 persons on average
and the daily average amount of hours spent thinking about COVID- (including themselves).
19 was recorded.
To screen for general anxiety and depressive symptoms, the
ultra-brief screening scale of the Patient Health Questionnaire-4 3.2 | Experiences with COVID-19
(PHQ-4) (Löwe et al., 2010) was used. The intensity of four items de-
scribing major anxiety/depressive symptoms was rated on a 4-point Figure 2 shows the experiences of the participants with COVID-19.
scale from 0 (“not at all”) to 3 (“nearly every day”). The PHQ-4 can be About one third of the participants knew someone diagnosed with
examined as a total score or be divided into an anxiety (GAD-2) and COVID-19 or already suspected themselves to be infected. About
a depression subscale (PHQ-2). 7% were currently under quarantine, and <5% had been tested
To assess selected aspects of anxiety regarding COVID-19, nine for COVID-19. About 1% of the sample had been diagnosed with
items were included (e.g., the fear of being infected and the fear of COVID-19.
social or economic consequences). All statements were rated on a
6-point Likert scale, ranging from 1 (“not true at all”) to 6 (“totally
true”). Additionally, a modified version of the validated DSM-5 3.3 | Risk perception and contact
Severity-Measure-For-Specific-Phobia-Adult-Scale (Beesdo-Baum
et al., 2012) was used to ascertain the extent of anxiety symptoms Average rating of the risk of being infected with COVID-19 within
caused by the pandemic. The scale consists of 10 items, rated on a the next month was 38.3% (SD = 25.26, range: 0–100). Most partici-
5-point Likert scale from 0 (“never”) to 4 (“all the time”). pants rated the risk with 50% (21.8%, N = 1,422). The lowest 25% of
The questionnaire inquired eight items regarding protective fac- the sample ranked it as 20.0% or lower. Median of risk perception
tors in dealing with the pandemic (e.g., self-efficacy in general, social was 40.0%. The highest 25% ranked the risk at least as 50%. Average
self-efficacy) and five items targeting risk factors (e.g., suppression, rating of the risk of being infected with influenza (“flu”) was 18.2%
substance use). Protective and risk factors were adapted from the rec- (SD = 19.89, range: 0–100) and the median 10.0%. Most participants
ommendations on coping with psychological distress in the pandemic rated the risk with 10.0% (20.6%, N  =  1,341). Women evaluated
of the Inter-Agency Standing Committee (IASC) of the United Nations both risks higher than men (COVID-19: M = 40.17%; SD = 0.37 vs.
(UN) (Inter-Agency Standing Committee, 2020). Items were rated on a M = 33.93%; SD = 0.58; p < .001; influenza: M = 18.92%; SD = 0.30
6-point Likert scale. All questions were administered in German. vs. M = 16.60%; SD = 0.43, p < .001).
25.7% (N = 1,673) of the participants did not have any contact
with persons closer than one-meter distance outside of their house-
2.5 | Data analysis hold during the last week. 40.2% (N = 2,916) reported contact with
1–3 persons and 24.3% (N  =  1578) with 4–10 persons, while 9.9%
The questionnaire consisted of eight pages. We included only par- (N = 642) reported contact with 10 or more persons. There were no
ticipants who completed at least page 4 (N  =  6,509). 93.6% of the significant gender differences in the amount of contact.
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4 of 10       BRUNO PETZOLD et al.

Do you know people that Did you already think that Did you already get tested
were already diagnosed you might have a Covid- for Covid-19?
with a Covid-19 infecon? 19 infecon?
4.4%

26.7% 27.7%

73.7% 72.3%
95.6%

No Yes No Yes No Yes

Were you already diagnosed with Are you currently in quaranne?

Covid-19?
0.9%
7.4%

92.6%
99.1%

No Yes No Yes

F I G U R E 2   Experiences with COVID-19 (N = 6,509)

3.4 | Hours spent thinking about COVID-19 their personal life. 48.1% reported to be afraid of the consequences
for their personal health if getting infected. 78.3% reported to be
On average, the participants thought about COVID-19 for 4.45 hr/ afraid of the consequences for the health of their relatives. 61.2%
day (SD = 3.80, range from 0 to 24). 25% of the participants thought were afraid of the social consequences, while 47.3% reported to be
<2 hr, while 25% thought 6 hr or more per day about COVID-19. 10% afraid of the economic consequences on their life. 17.1% of the par-
reported to think more than 10  hr/day about COVID-19. Women ticipants stated that their concern about COVID-19 was exagger-
spent significantly more hours per day thinking than men (M = 4.57; ated, and 25.1% stated that their anxiety would lead to limitations
SD = 3.82 vs. M = 4.15, SD = 3.75; p < .00). in their daily life. Women showed higher rates of anxiety in almost
Participants who spent 2  hr or more thinking about COVID-19 every item. The strongest differences compared to men could be
differed significantly from participants who thought <2  hr about found in anxiety of experiencing general (M = 4.23 vs. M = 3.81) and
COVID-19. The former showed higher scores in the PHQ-4 (M = 4.6, social consequences (M = 4.06 vs. M = 3.61) due to COVID-19.
SD = 3.2 vs. M = 2.6, SD = 2.5; p < .001) and in the phobia question-
naire (M = 1.2, SD = 0.7 vs. M = 0.6, SD = 0.4; p < .001).
3.6 | Associations with COVID-19 anxiety

3.5 | Anxiety regarding COVID-19 Table  1 shows correlations of demographics, experiences with co-
rona, and protective and risk factors with selected aspects of anxiety
Figure 3 shows the distribution of answers to the questions about regarding COVID-19. People of higher age (r = .012, p < .001) stated
anxiety regarding COVID-19. to think more hours per day about COVID-19. People suffering from
44.8% of the participants agreed to be afraid to get infected with a severe physical illness reported less hours (r  =  −.08, p < .001).
COVID-19. 67.7% were afraid of the consequences of COVID-19 for Experiences with COVID-19 showed some small statistically
BRUNO PETZOLD et al. |
      5 of 10

Anxiety and Covid-19

100% 1.4
3.4 5.5
10.7
15.7 16.9 7.6
90% 21.6 22.3 12.3
13.1
80% 40.6 12.0
15.5 14.7
70% 22.2
20.8 12.6
21.0 24.3
60% 16.9 15.7

Totally true [6]

50% 24.0
22.8 18.1
19.2 14.1 30.0 [5]
21.4 16.7
40% [4]

30% 14.3 [3]

14.9 19.8
13.9 [2]
24.4 23.4
20% 38.3
8.8 15.3 Not true at all [1]
30.7
13.7
10% 7.1 18.9
11.6 11.9 9.2
5.2 5.8
0%
I am afraid to I am afraid of I am afraid of I am afraid of I am afraid of I am afraid of My anxiety My anxiety
get infected the the the the social the economic concerning concerning
with Corona consequences consequences consequences consequences consequences Corona is Corona leads to
of the Corona for my health if for the health of Corona of Corona on exaggerated limitaons of
Pandemic on I get infected of my relaves my life my daily life
my life if I get infected

F I G U R E 3   Anxiety regarding COVID-19

significant but no meaningful correlations with anxiety regarding 4 | D I S CU S S I O N

COVID-19. All different forms of self-efficacy showed significant
negative correlations with all aspects of COVID-19 anxiety (range In this study, we wanted to explore how the current COVID-19 pan-
from r = −.08 to −.46). Normalization, social contacts, and knowledge demic is connected to a psychological burden, especially to upcom-
where to get medical treatment showed significant negative correla- ing anxiety, among the general population in Germany.
tions ranging from r = −.07 to r = −.24.

4.1 | Time spent thinking about COVID-19

3.7 | Specific COVID-19 phobia symptoms
First, we found that the participants spend a tremendous amount
The overall score of the modified Specific-Phobia Scale was 10.15 of time (285  min on average per day) thinking about COVID-19-
(SD  =  6.95), with women showing significantly higher scores than related aspects during the day. If we compare this to the time
men (M = 10.67, SD = 6.94 vs. M = 8.88, SD = 6.78; p > .001). amount of worrying healthy people usually show with a range be-
tween 28 and 55  min (Dupuy, Beaudoin, Rhéaume, Ladouceur, &
Dugas,  2001; Verkuil, Brosschot, Gebhardt, & Thayer,  2010), this
3.8 | Depressive and anxiety symptoms clearly exceeds the “normal” time period. On the one hand, ad-
dressing emerging problems by “constructive thinking” by finding
The participants showed an average PHQ-4 Score of 4.15 (SD = 3.19, solutions or gathering new important information for decision-
range 0–12). 25% of the participants showed a score of at least 6, making may help coping with difficult situations (Drach-Zahavy
while 10% of them showed a score of at least 9. Women showed & Somech, 2002). On the other hand, ruminating as a “repetitive,
a significantly higher PHQ-4 Score (indicating more depressive and prolonged, and recurrent negative thinking” is a vulnerability fac-
anxious symptomatology) than men (M = 4.4 vs. M = 3.5). tor for anxiety, depression, and other mental disorders as well as
The participants showed an average PHQ-2 Score of 2.11 raising physiological stress (Watkins & Roberts,  2020; Whisman,
(SD = 1.70, range 0–6). 25% of the sample showed a score of at least Du Pont, & Butterworth,  2020). Thus, our results underline the
3 and 10% a score of at least 5. The average GAD-2 Score was 2.03 need of officially promoting a careful monitoring and regulation of
(SD = 1.76, range 0–6). 25% of the participants showed a score of at the personal amount of time spent with thoughts about COVID-19
least 3, while 10% showed a score of at least 5. in everyday life.
TA B L E 1   Associations of demographics, experiences with corona, and protective and risk factors with anxiety

I am afraid of the consequences of the corona My anxiety concerning corona My anxiety concerning corona leads to Hours thinking about
|

pandemic on my life is exaggerated limitations in my daily life corona per day

6 of 10      

Demographics
Age −.018 .007 .028* .119***
*
Having children −.030 .010 −.012 −.065***
Working in medical context .051** .060*** .070** −.044***
** *** ***
Preexisting severe physical illness −.064 −.040 −.122 −.080***
Number of people in household −.007 −.013 −.001 −.011
Experiences with corona
Being in quarantine .014 .033** .071*** .031***
Knowing someone diagnosed −.007 −.003 −.020 .008
*** *** ***
Suspected to be infected .048 .080 .075 .050***
Having been tested −.012 −.007 .006 .032
Having been diagnosed −.020 −.014 .001 .010
Recovered −.035 .011 −.010 .016
Protective factors
Self-efficacy general −.414*** −.198*** −.457*** −.292***
Self-efficacy health −.221*** −.179*** −.319*** −.222***
*** *** ***
Self-efficacy social −.376 −.108 −.322 −.186***
Self-efficacy economic −.363*** −.078*** −.220 *** −.134***
*** *** ***
Normalization −.191 −.236 −.323 −.195***
Social contacts −.168*** −.073*** −.206*** −.091***
*** *** ***
Know where to get medical −.135 −.072 −.159 −.095***
treatment
Know where to get psychosocial −.094*** −.043*** −.097*** −.081***
treatment
Risk factors
Suppression .339*** .306*** .423*** .232***
Reduced physical activity .170 ** .097*** .192*** .125***
*** *** ***
Reduced healthy diet .179 .105 .198 .149***
More substance use .143*** .077*** .173*** .143***

*Significant at .05 level;

**Significant at .01 level;
***Significant at .001 level; and bold values represent significant values of a size of at least .1
BRUNO PETZOLD et al.
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4.2 | Risk perception of getting infected with psychological and social determinants may have a larger influence
COVID-19 on anxiety in that early phase of the pandemic than immediate
experiences with this virus itself. This is undermined by our find-
Second, we found that the risk perception of getting infected with ing that self-efficacy (meaning a person’s believe in his or her own
COVID-19 in the next 4 weeks was very high. These data show that as ability to master situations or show a certain behavior) showed es-
expected, the fear of becoming infected with COVID-19 is very prevalent sential significant negative correlations with COVID-19 anxiety.
in the general population. Even in a time where the prevalence of COVID- Furthermore, the acceptance of anxiety and negative emotions, so-
19 infections seems difficult to estimate, the risk rating of being infected cial support, and the knowledge, where to get treatment, if needed,
within the next 4 weeks seems to be higher than the expected number were negatively associated with different aspects of COVID-19
of infections in 4 weeks. An infection probability of 40% within the next anxiety. This is in line with the recommendations on how to reduce
4 weeks (the median) would mean over 30 million of infected people in the psychological distress in the pandemic (Inter-Agency Standing
Germany by beginning of May which seems rather unlikely when the cur- Committee,  2020; International Federation of Red Cross & Red
rent development is taken into account (Robert Koch Institut, 2020). Crescent Societies,  2020; World Health Organization,  2020). For
correlational analyses only allowing noncausal assumptions, we can-
not determine the direction of these effects. Further longitudinal
4.3 | Anxiety regarding COVID-19 studies can give more information on causal relationships. For the
factor of the acceptance of negative emotions, previous research
Our data show, that overall, about half of the participants stated to that showed a negative circle of fear and suppression of anxiety dur-
be anxious about the consequences of the COVID-19 pandemic on ing the Zika outbreak in Canada (Dillard, Yang, & Li, 2018) supports
their life. Fears regarding COVID-19 targeted more on social than on the hypothesis that the suppression of negative emotions might
personal aspects. Besides the fear of general consequences, most have an influence on future anxiety and negative emotions.
fear was expressed with respect to consequences for the health of Low self-efficacy has been shown to be connected with higher
relatives as well as concerning the social consequences of the pan- anxiety (Bandura, 1988; Muris, 2002). Our results make the assump-
demic. Social consequences caused more concerns than economic tion reasonable that self-efficacy could be a protective factor also
ones. This result goes in line with other research showing that social against pandemic-driven anxiety and future longitudinal studies
support is very important for coping with adverse life events and re- should test this assumption.
duces hopelessness (Tham, Ibrahim, Hunt, Kapur, & Gooding, 2020). The result that working in a medical context is associated with
In the current situation, fears regarding the COVID-19 pandemic more anxiety regarding the COVID-19 pandemic is in line with find-
have to be seen as normal consequences in an exceptional situation ings from a recent study from hospitals in Singapore and India that
rather than as pathologic reactions (Petzold, Plag, & Ströhle, 2020a, showed high proportions of physical and psychological strain in
2020b). Differentiation, what amount of fear seems to be realistic and healthcare workers (Chew et al., 2020). A further comparison of dif-
what is exaggerated, is almost impossible to draw. To get a picture of ferent professions in the healthcare sector would be interesting—as
the percentage of people that develop a level of anxiety regarding for example in a study in Singapore nonmedical healthcare workers
COVID-19 that itself leads to constraints in daily life, we asked the par- (e.g., pharmacists, technicians) reported more psychological strain
ticipants whether they thought that their anxiety is exaggerated and than medical personnel (Tan, Chew, et al., 2020; Tan, Hao, et al.,
whether this led to limitations in their daily life. About 17% of the sam- 2020).
ple rated their level of anxiety as exaggerated, and about 25% of the These results are of a high practical value as they empirically
sample stated that the anxiety itself would result in limitations in their underpin the recommendations on the reduction of psychological
daily life. These first data show that there is a relevant percentage of distress in the current pandemic that are given by international or-
the general population, in which the anxiety regarding the COVID-19 ganizations (Inter-Agency Standing Committee, 2020; International
pandemic leads to significant burden in daily life. These proportions Federation of Red Cross & Red Crescent Societies,  2020; World
are comparable with findings from China during the initial COVID-19 Health Organization, 2020) and show that the acceptance of anxiety
outbreak (Wang, Pan, Wan, Tan, Xu, Ho, et al., 2020), where more than and negative emotions, social contacts, self-efficacy, and to know
half of the participants reported a moderate-to-severe psychological where to get medical treatment are important factors associated
impact of the COVID-19 pandemic on themselves, while about 17% of with reduced psychological burden. We also found evidence that
reported moderate-to-severe depressive symptoms and nearly 30% supports the recommendation of maintaining a healthy lifestyle and
reported moderate-to-severe anxiety symptoms. to avoid suppression of negative emotions.

4.4 | Risk and protective factors 4.5 | Depressive and anxiety symptoms

Interestingly, personal experiences with COVID-19 were not In our sample, the average PHQ-4 Score was with a mean of 4.15
strongly connected to COVID-19 anxiety. This could mean that higher than the PHQ-4 Score that has been reported by previous
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8 of 10       BRUNO PETZOLD et al.

research in the general population of 1.76 (Löwe et al., 2010). With participate in our study, which might have led to a rather young sam-
all given precautions, this could show that in the current situa- ple. Furthermore, people who show higher levels of psychological
tion there is an increase in depressive and anxiety symptoms in distress and anxiety might be more likely to take part in a study like
the German general population. Due to the nature of the study, ours. This could have led to an overestimation of these factors in our
this cannot be interpreted as a robust and reliable research result sample. This strategy of recruitment does reduce the generalizability
and should be merely seen as an empirical fundament to build hy- of our results which is shown by several differences between the
potheses in this direction. If elevated levels of anxiety and depres- demographics in our sample and the general population in Germany.
sion turn out reliable and robust in other studies and especially The sample shows in comparison with the general population a
in the longitudinal course, appropriate interventions should be much higher gender imbalance, a lower average age, and a higher
established to reduce psychological strain—for example, cognitive percentage of persons working in a medical context (Bundesinstitut
behavioral therapy (Ho, 2020). In a first longitudinal study from für Bevölkerungsforschung, 2020).
China (Wang, Pan, Wan, Tan, Xu, McIntyre, et al., 2020), a sta- Our study is a cross-sectional examination and does not allow
tistically significant but not clinically relevant reduction in PTSD any causal interferences. Our questionnaire was rather short, using
symptoms as a result of the COVID-19 pandemic was found from simple scales, not all of them were validated. Therefore, all of the
end of January to end of February 2020. At the same time, there study results in general should rather be interpreted as first hints,
were no significant changes regarding anxiety, depression, and which might be helpful for further studies as well as to empirically
stress. Furthermore, the study identified protective factors such underpin existing recommendations on the reduction in psychologi-
as confidence in doctors and satisfaction with health information, cal distress in the pandemic.
risk perception and outcome expectation (perceived survival like-
lihood), and personal precautionary measures (Wang, Pan, Wan,
Tan, Xu, McIntyre, et al., 2020). 5 | CO N C LU S I O N

Our results suggest that in this early phase of the COVID-19 pan-
4.6 | Gender effects demic with low percentages of diagnosed cases in our study popula-
tion, we can already observe its fundamental impact on anxiety and
In our sample, women showed higher scores of COVID-19 anxiety, psychological distress. This can be seen in about half of our sample
more time of thinking about COVID-19 per day, as well as more stating fears regarding the consequences of the pandemic as well as
depressive symptoms than men. This is in line with the results of in the high number of average hours of thinking about the pandemic
other studies regarding the psychosocial distress caused by the per day. Regarding the role of protective and risk factors, our results
COVID-19 pandemic (Qiu et al., 2020; Wang, Pan, Wan, Tan, Xu, Ho, suggest that there might be stronger links to psychological and social
et al., 2020). Up to now, it is not possible to draw conclusions if this determinants and psychological distress as a result of the pandemic
is something specific to the COVID-19 pandemic as higher values compared to personal experiences with COVID-19 infections. The
of anxiety and depression are reported in women in general (Salk, role of the recommended strategies to reduce psychological distress
Hyde, & Abramson, 2017). in the pandemic such as a healthy lifestyle, social support, accept-
ance of negative emotions, and avoidance of suppression and sub-
stance abuse is supported by our data.
4.7 | Strengths and limitations
C O N FL I C T O F I N T E R E S T
Our study represents the first study that assesses psychological dis- The authors declare that there is no conflict of interest.
tress, anxiety, and depression as well as risk and protective factors
in the current COVID-19 pandemic in Germany. We started recruit- AU T H O R C O N T R I B U T I O N S
ment quite early so we assessed our participants still in a situation Moritz Bruno Petzold, Julia Große, and Antonia Bendau involved
where case numbers were rising exponentially and media cover- in literature research, designed the study, collected data, ana-
age was really large. This allows to study the psychological conse- lyzed the data, interpreted the data, and wrote and revised the
quences at an early stage of the pandemic and lays a good basis for manuscript. Jens Plag involved in literature research and ethics
further longitudinal follow-ups. With a sample size of over 6,000 committee communication, designed the study, and revised the
participants, our sample is large enough to detect even small effects. manuscript. Lena Pyrkosch involved in literature research and data
Our sample was fully registered and approved by the local ethics protection committee communication, designed the study, and re-
committee. vised the manuscript. Lea Mascarell Maricic involved in literature
Nevertheless, there are some limitations. We recruited our research, designed the study, translated the language, and revised
sample as convenience sample mainly through social media. This the manuscript. Felix Betzler, Janina Rogoll, and Andreas Ströhle
might have led to a sample bias. People who are familiar with or involved in literature research, designed the study, and revised the
have easy access to social media might have been more likely to manuscript.
BRUNO PETZOLD et al. |
      9 of 10

E T H I C A L S TA N DA R D S lesson for all challenging environments. Journal of Mental Health

(Abingdon, England), 24(1), 1–3. https://doi.org/10.3109/09638​
The authors assert that all procedures contributing to this work
237.2014.1000676
comply with the ethical standards of the relevant national and in- Hao, F., Tan, W., Jiang, L. I., Zhang, L., Zhao, X., Zou, Y., … Tam, W. (2020).
stitutional committees on human experimentation and with the Do psychiatric patients experience more psychiatric symptoms during
Helsinki Declaration of 1975, as revised in 2008. COVID-19 pandemic and lockdown? A case-control study with service
and research implications for immunopsychiatry. Brain, Behavior, and
Immunity, 87, 100–106. https://doi.org/10.1016/j.bbi.2020.04.069
PEER REVIEW Ho, C. S., [Cyrus Sh], Chee, C. Y. & Ho, R. C. [Roger Cm] (2020). Mental
The peer review history for this article is available at https://publo​ health strategies to combat the psychological impact of COVID-
ns.com/publo​n/10.1002/brb3.1745. 19 beyond paranoia and panic. Annals of the Academy of Medicine,
Singapore, 49(3), 155–160.
Inter-Agency Standing Committee (2020). Briefing note on addressing
DATA AVA I L A B I L I T Y S TAT E M E N T
mental health and psychosocial aspects of COVID-19 Outbreak- Version
The data that support the findings of this study are available from 1.1. Retrieved from https://inter​agenc​ystan​dingc​ommit​tee.org/
the corresponding author upon reasonable request. syste​m/files/​2 020-03/MHPSS​%20COV​I D19%20Bri​efing​%20Not​
e%202%20Mar​ch%202020-Engli​sh.pdf.
International Federation of Red Cross and Red Crescent Societies
ORCID
(2020). Mental Health and Psychosocial Support for Staff, Volunteers
Moritz Bruno Petzold  https://orcid.org/0000-0002-7801-1434 and Communities in an Outbreak of Novel Coronavirus. Retrieved from
Antonia Bendau  https://orcid.org/0000-0002-3789-6205 https://pscen​t re.org/wp-conte​n t/uploa​d s/2020/02/MHPSS-in-
nCoV-2020_ENG-1.pdf.
Löwe, B., Wahl, I., Rose, M., Spitzer, C., Glaesmer, H., Wingenfeld,
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