Despite the global impact of COVID-19, studies comparing the effects of COVID-19 on population mental health across countries are sparse. This study aimed to compare anxiety and depression symptoms during the COVID-19 lockdown among adults from 11 countries and to examine their associations with country-level COVID-19 factors and personal COVID-19 exposure. A cross-sectional survey was conducted among adults (≥18 years) in 11 countries (Brazil, Bulgaria, China, India, Ireland, North Macedonia, Malaysia, Singapore, Spain, Turkey, United States). Mental health (anxiety, depression, resilient coping, hope) and other study data were collected between June–August 2020. Of the 13,263 participants, 62.8% were female and 51.7% were 18–34 years old. Participants living in Brazil had the highest anxiety and depression symptoms while participants living in Singapore had the lowest. Greater personal COVID-19 exposure was associated with increased anxiety and depression symptoms, but country-level COVID-19 factors were not. Higher levels of hope were associated with reduced anxiety and depression; higher levels of resilient coping were associated with reduced anxiety but not depression. Substantial variations exist in anxiety and depression symptoms across countries during the COVID-19 lockdown, with personal COVID-19 exposure being a significant risk factor. Strategies that mitigate COVID-19 exposure and enhance hope and resilience may reduce anxiety and depression during global emergencies.

ATOD use among LGB students was more prevalent than heterosexuals during the past 30 days, year, and life-time. LGB students report more negative alcohol consequences.

Bisexual women had greater odds of using alcohol, tobacco, and marijuana than heterosexual women and lesbians. They also had greater odds of using all illicit drugs (except steroids) and misusing prescription drugs than heterosexual women and greater odds of using amphetamines other than meth, sedatives, and ecstasy when compared to lesbians. Lesbians had greater odds of using tobacco, marijuana, sedatives, hallucinogens, other illegal drugs and misusing prescription drugs than heterosexual women. Conclusions/Importance: The study confirms increased ATOD use among sexual minority women as compared to their heterosexual counterparts with bisexual women having the highest use. This is the first study to examine misuse of prescription drugs among a large number of lesbian and bisexual college women, and contributes to the scant literature addressing college women's ATOD use by sexual orientation.

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Our findings support the buffering effect of social support from ATs and have important implications for successful recovery in both the physical and psychological aspects for injured athletes.