Since December 2019, the coronavirus disease-2019 (COVID-19) has been keeping the world in suspense. Proven risk factors for a severe course of COVID-19 are common diseases like diabetes, hypertension, cardiovascular or respiratory disorders. Until today, little is known about the psychological burden of individuals suffering from these high-risk diseases regard to COVID-19. The aim of the study was to define the impact of the coronavirus pandemic on behavior and mental health in individuals at high risk for developing a severe COVID-19 course. Items assessed generalized anxiety (GAD-7), COVID-19-related fear, adherent/dysfunctional safety behavior, and the subjective risk perception of regarding symptoms, having a severe course and dying because of COVID-19. Data were compared between participants with the high risk diseases and individuals without any of those diseases. 16,983 respondents completed the study. Generalized anxiety, COVID-19-related fear, adherent/dysfunctional safety behavior and subjective risk perception were elevated in participants with high-risk diseases. The increased COVID-19-related fear as a functional concern is a conclusion on the increased risk of a severe course. The functionality of the fear is reflected in people’s increased need for security and includes an increase in both adherent and dysfunctional safety behavior that underlines the need for psychological support strategies.

Background Governmental restrictions of daily life are key elements in reducing the transmission of COVID-19, but they have also put a strain on people’s mental health. Preventive policies differ all over the world as well as over different periods of time, and depend mostly on current infection rates. In Germany, there were two periods of restraint of varying severity, during which the government used different combinations of containment and mitigation measures to protect risk groups and to lower the number of hospitalizations. Methods In two online studies, we aimed to determine differences and similarities in COVID-19-related fear, generalized anxiety, depression and distress levels, as well as in the adherence to safety behaviour between the first lockdown in March and April and the second lockdown in November. Results This study showed continued high psychological burden and even increased levels of depression symptoms, as well as less safety behaviour in the second phase of restrictions. Conclusions The results hint at a prolonged negative impact on people’s mental health and their safety behaviour despite lesser restrictions in the second lockdown, which may be interpreted as pandemic fatigue and hence strengthens the argument for a low-threshold access to psychological care.

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(1) The aim of the study is to assess the psychological burden of individuals with diabetes during the COVID-19 pandemic in comparison to matched controls. (2) Over the course of eight weeks, 9 April to 3 June 2020, 253 individuals with diabetes and 253 matched controls, using Propensity Score Matching (PSM), participated in this cross-sectional study. Participants completed an anonymous survey including demographics, depressive symptoms (PHQ-2), generalized anxiety (GAD-7), COVID-19-related fear, risk perception, and safety behavior. (3) While patients with diabetes expected their risk of infection similar to controls, they reported a higher probability of the occurrence of symptoms, severe course, and dying of COVID-19. Patients with diabetes showed no elevated generalized anxiety or depressive symptoms. However, they reported higher COVID-19-related fear and more adherent and dysfunctional safety behavior compared to controls. (4) From a public health view, it seems encouraging that despite the somatic risk condition, generalized anxiety and depression are not higher in patients with diabetes than in controls. Patients with diabetes report higher COVID-19-related fear, increased risk perception, and behavioral changes. This suggests that individuals with diabetes, as a significant risk group of severe COVID-19, show an adequate perception and functional reaction to the current pandemic.

Zusammenfassung Hintergrund Auswirkungen der COVID-19-Pandemie auf die psychische Gesundheit zeigten sich bereits früh. Das Ausmaß der Auswirkungen, insbesondere kumulativ über die lang anhaltende Zeit der Pandemie, ist für Deutschland noch nicht umfassend untersucht worden. Ziel der Arbeit Ziel der Studie war es, psychische Belastungen sowie COVID-19-bezogene Erlebens- und Verhaltensweisen zu erheben und deren Veränderung über die verschiedenen Phasen der Pandemie in Deutschland darzustellen. Material und Methoden In die deutschlandweite onlinebasierte Querschnittsstudie (10.03.–27.07.2020) konnten 22.961 Menschen eingeschlossen werden (Convenience Sample). Erhoben wurden: generalisierte Angst (GAD-7), Depression (PHQ-2), psychischer Distress (DT) sowie COVID-19-bezogene Erlebens- und Verhaltensweisen wie COVID-19-bezogene Angst, Vertrauen in staatliche Maßnahmen, subjektives Informiertheitslevel, adhärentes Sicherheitsverhalten und persönliche Risikoeinschätzung für Ansteckung/Erkrankungsschwere. Die Pandemie wurde retrospektiv in 5 Phasen (Anfangs‑, Krisen‑, Lockdown‑, Neuorientierungsphase und „neue Normalität“) eingeteilt. Ergebnisse Es zeigten sich im Vergleich zu Prä-COVID-19-Referenzwerten anhaltend erhöhte Werte in GAD‑7, PHQ‑2 und DT. COVID-19-bezogene Angst, Informiertheitslevel, Vertrauen, Sicherheitsverhalten und die Einschätzung, an COVID-19 zu erkranken, zeigten, nach initial starkem Anstieg, einen Abfall bis z. T. unter den Ausgangswert. Ausnahme waren konstante Einschätzungen, einen schweren Verlauf von COVID-19 zu haben bzw. daran zu versterben. Diskussion Die durch alle Pandemiephasen anhaltend erhöhten Werte psychischer Belastung verdeutlichen die Notwendigkeit nachhaltiger Unterstützungsangebote. Sinkende Werte in Bezug auf Vertrauen in staatliche Maßnahmen und das subjektive Informiertheitslevel unterstreichen das Gebot gezielter Aufklärung.