{"paper_id":"0d079e27-08b3-4b25-baef-abfd42748336","body_text":"Factors affecting self-perceived mental health in the general older population during the Covid19 pandemic: a cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Factors affecting self-perceived mental health in the general older population during the Covid19 pandemic: a cross-sectional study Jenny Koppner, Ann Lindelöf, Fredrik Iredahl, Maxine Tevell, Staffan Nilsson, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3796640/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 01 Mar, 2024 Read the published version in BMC Public Health → Version 1 posted 8 You are reading this latest preprint version Abstract Background Mental health problems among older people are large public health concerns but often go unrecognized and undertreated. During Covid-19 several restrictions regarding social contacts were launched, primarily for the old. The objective of this study is to investigate which factors that had the main negative affect on mental health in the older population during the pandemic. Method A cross-sectional cohort study set in Swedish primary care during the pandemic years 2021–2022. The population constitutes of 70-80-years-old, N = 260. Instruments used are Geriatric depression scale 20 (GDS20); Hospital anxiety and depression scale (HADS), and Perceived stress scale 10 (PSS10). Sociodemography and risk factors are explored. Outcome measures are factors independently associated with decreased mental health. Analyses were performed for the group as a whole and with logistic regression models comparing individuals who stated they were mentally affected by the pandemic to individuals who stated they were not. Results Participants who stated they were mentally affected by the Covid − 19 pandemic reported significantly higher levels of anxiety (p < 0.001), depression (p < 0.001), and stress (p = 0.026) compared to those who stated they were not mentally affected. Explanatory regression models of up to 50% showed that following factors were prominent among individuals who experienced a decline in their mental health due to the Covid − 19 pandemic (n = 24); impaired social life (OR 16.35, p < 0.001, CI 4.17–16.05), change in physical activity (OR 5.76, p = 0.006, CI 1.67–19.87), perceived family situation (OR 30,36, p = 0,008, CI 2,41–382,75), mild/moderate and high anxiety (OR 3.9, p = 0.043, CI 1.37–24.33, OR 10,8, p = 0.011, CI 1.34–57.15 respectively), and female gender (OR 4.7, p = 0.05, CI 1.04–26.15). Conclusion Anxiety, family situation, social life and change in physical activity were the main factors influencing the 70-80-years-old’s self-perceived mental health during the Covid-19 pandemic. Long-term effects of social restrictions on mental health in the older population need to be further investigated. Primary Health Care Mental health General population Older adults Depression Anxiety Stress Covid − 19 Pandemic Figures Figure 1 Figure 2 Introduction The older population in the world is expanding; average life expectancy has increased globally for people aged 60 years and over due to progress in medical technologies, advancements in public health, and improved sanitation ( 1 ). It is well known that this age group has a large burden of somatic disease, however, they also suffer mental health issues; depression is so common among older people that it can be seen as a public health problem ( 2 ). Other common occurrences are scattered families, loss of close ones, less income, and poorer ability to move, which are risk factors for social isolation and loneliness ( 1 ). Social relationships have a significant impact on overall longevity and physical well-being ( 3 ), whereas social isolation and feelings of loneliness are factors associated with higher morbidity and mortality as they affect psychobiological processes, leading to neuroendocrine dysregulation, inflammatory responses, chronic allostatic load, and disturbances in autonomic function ( 3 ). Anxiety and depressive disorders also alter psychobiological processes, above all the stress systems, leading to an increased risk for the onset of chronic disease including physical and cognitive impairment ( 4 ). During the winter of 2019/2020, the virus SARS-CoV-2 was discovered, commonly called Covid-19. Because of the alarming levels of spread and severity of the virus, the World Health Organization characterized the situation as a pandemic on March 11, 2020 ( 5 ). The Covid-19 virus hit the older population the hardest. Studies have shown that high age was a major independent risk factor for severe disease and death ( 6 ). The higher the age the higher the risk; aged 75–79 years, followed by aged 70–74 years constituted the majority of patients in intensive care, and had the highest death rates ( 7 ). Because of this, the Public Health Agency of Sweden introduced several restrictions and recommendations in Sweden for people aged 70 years and older. They were recommended to limit their close contact with others, i.e. avoiding public gatherings, public transportation, stores, and public facilities, even contact with family and friends. The government also established a national ban on visits to nursing homes. ( 8 ) Previous research regarding the effects of the Covid-19 pandemic on mental health in the older population has mainly focused on the early stages of the pandemic. A review from 2020 ( 9 ) discusses possible physiological mechanisms behind effects of covid 19 infection on mental health in older people. An increased vulnerability in this population is advocated. Another review ( 10 ) shows that this population is more likely to suffer mental health issues associated with Covid-19, and that the older population experienced e.g., stress, depression, anxiety, and loneliness during the pandemic. Comparable results were found in a Swedish study ( 11 ) among seniors in an urban setting. However, in a Swedish longitudinal study from 2021, where very early effects of the pandemic on 65–71-year-olds were investigated, results show an equal well-being in the population, or even higher, as before the pandemic ( 12 ). In summary, there is a growing senior population in the world with many risk factors for decreased physical and mental health. Older people were the most vulnerable during the Covid-19 pandemic and they also were one of the population groups most affected by severe restrictions regarding social contacts. Now that we are in the aftermath of the pandemic, it is important to evaluate the consequences of these restrictions to learn for the future. The aim of this study was to investigate which factors affect mental health among 70–80-year-olds during the Covid-19 pandemic. Materials and Methods Study design This is a cross sectional study, in which data was collected within the HOLD- (Healthy OLD people) study situated in the southeast of Sweden, Region Östergötland, as visualized in Fig. 1 . The HOLD-study aims to investigate long-term stress, psychosocial factors, and health factors in an increasingly healthy elderly population in Sweden. Figure 1 in here. Participant recruitment Five Primary Health Care centers (PHC) were recruited, including both rural and urban locations. Inclusion criteria were age 70–80 years old and being listed at one of the included PHCs, thus, all listed 70–80 years old at each PHC formed the population base for the study. All individuals were placed in random order via Excel on a list and the first 100 on the list were initially offered to participate in the study. The goal was to recruit 60 participants at each PHC. If that aim was not reached from the first 100 on the list recruitment continued from the 101st and onwards until the goal was met. Three PHCs (one urban and two rural) were excepted from the goal of 60 individuals, due to the time limit of the HOLD-study, a smaller sample was accepted (55, 52 and 29, respectively). Information about the study, including a consent form, was mailed to the participants, for them to read and reflect upon whether they would like to participate. Shortly thereafter they received a phone call from a research nurse. Phone numbers were searched for on public digital services. Exclusion criteria were: the participant living in a nursing home, inability to find the phone number on public digital services, the participant not answering the phone after three call attempts, inadequate cognitive skills, inadequate written and/or oral Swedish language skills, no hair or hair shorter than 1cm on the scalp (for biochemical analyses in other HOLD sub studies), participants without ability to visit the PHC. If all requirements were met, and the person wanted to participate in the study, an appointment was booked at the PHC for data collection. If the presumptive participant did not come to the appointment without giving notice, he/she was excluded. Data collection The study was conducted from October 2021 to December 2022. All data was collected by the research nurse during the visit to the PHC. Biometric values were collected (weight, height, waist measurement, blood pressure and pulse), as well as samples of blood, hair, and saliva, these were then used for other sub studies of the HOLD-study. All participants answered a questionnaire that consisted of 29 segments. Questions included sociodemographic factors, social life, loneliness, physical activity, perceived health, and effects of the Covid-19 pandemic, including some perceived differences before and during the pandemic. The participants were also asked to choose up to two factors from a given list that they felt had affected them the most by the Covid − 19 pandemic. The question about self-perceived health in the survey was based on the Short Form Health Survey (SF-36) which is a common instrument for measuring quality of life and health. Following three screening scales, all validated in Swedish, were used to assess the participants’ mental health. Perceived Stress Scale-10 (PSS-10); ten questions that measure how the patient has experienced stress during the last month, with a total score of 0–40, where a high score indicates a high level of stress ( 13 ). Hospital Anxiety and Depression scale (HADS); a diagnostic tool that evaluates both anxiety and depression consisting of seven questions about depression and seven questions about anxiety, with a total score of 0–21 respectively then divided into three categories: score 0–7 no depression/anxiety, score 8–10 possible depression/anxiety, score > 11 indicates depression/anxiety ( 14 ), Geriatric Depression Scale-20 (GDS-20); a screening instrument intended to identify depression in elderly people capturing how the patient is feeling now and during the last two weeks with 20 yes-or-no questions, with a total score of 0–20 then divided into two categories: 0–5 = depression is not likely, 6–20 = depression can be suspected ( 15 ). For all three screening scales both total score and division into categories were used in this study. Statistical analysis All data was stored in a common database and statistically analyzed using the SPSS version 28.0 software (SPSS Inc., Chicago, IL, USA). For descriptive statistics, the frequencies were conducted for all variables. Chi 2 -tests were also conducted for all variables. The factors that the participants experienced had affected them the most during the pandemic were calculated. The self-rating scales were transformed into numeric values and categorized. HADS, GDS-20, and PSS-10 were used both with their total score and division into groups. Nonparametric tests Mann Whitney and Kruskal Wallis were used to obtain differences between affected and not affected. Correlations were investigated between \"Has your mental health been affected by the Covid-19 pandemic?\" and the variables: sex, age, education level, civil status, financial status, family situation, changes in social life, changes in feelings of loneliness, changes in physical activity, GDS-20 divided into groups, HADS depression (HADS-D) divided into groups, HADS anxiety (HADS-A) divided into groups, and PSS-10 divided into groups, Separate analyses for men and women were also performed. In the final binary logistic regression model only yes- and no-answers were included for the dependent variable “Has your mental health been affected by the Covid − 19 pandemic”. The level of statistical significance was set at p = 0.05. Results In total N = 260 participants were included in the study. Demographic data is presented in Table 1 . A majority of the participants were women, and the most common civil status was married or cohabited. Education levels were quite equally distributed between secondary school, university/college, and primary school. Almost all participants were doing well financially and experienced that they had a good family situation. Most of the participants reported a good social life, and that they rarely felt lonely, often participated in social activities, and perceived their health as good. Table 1 Participant characteristics in total and divided into gender. Variables Total N = 260 % (n) Men n = 114 % (n) Women n = 146 % (n) Civil status Single 28% (72) 20% (23) 34% (49) Married/cohabited 72% (186) 80% (90) 66% (96) Education Primary school 29% (76) 30% (34) 30% (42) Secondary school 35% (88) 34% (38) 35% (50) University/college 35% (90) 36% (41) 35% (49) Financial status Good 94% (142) 97% (110) 92% (132) Bad 6% (15) 3% (4) 8% (11) Family situation Good 92% (236) 94% (106) 91% (130) Bad 2% (6) 2% (2) 3% (4) Neither good nor bad 6% (14) 4% (5) 6% (9) Social life Good 86% (222) 83% (95) 88% (127) Bad 2% (5) 2% (2) 2% (3) Neither good nor bad 12% (32) 15% (17) 10% (15) Feeling of loneliness Rarely 96% (249) 98% (112) 95% (137) Often 4% (10) 2% (2) 5% (8) Participating in social activities Often 74% (191) 73% (83) 75% (108) Rarely 26% (66) 27% (30) 25% (36) Self-perceived health Good 87% (225) 90% (103) 84% (122) Bad 13% (34) 10% (11) 16% (23) As shown in Table 2 , only a few participants have had confirmed Covid-19 disease themselves, but many have had a close relative who has been sick with Covid-19. Almost every 10th person felt that their mental health was affected by the Covid pandemic, and slightly more reported that they did not know. When asked to choose up to two factors, from a given list, that affected them the most during the Covid − 19 pandemic, social distancing was the most common, followed by a feeling of uncertainty, and fear of a close relative, or themselves, catching Covid − 19 infection (Fig. 2 ). Table 2 Participant characteristics regarding the Covid − 19 pandemic. Variables Total % (n) Men % (n) Women % (n) Have you had a confirmed Covid-19 infection? Yes 13% (35) 11% (12) 16% (23) No 82% (211) 84% (95) 80% (116) Do not know 5% (12) 5% (6) 4% (6) Has anyone close to you had confirmed Covid − 19 infection? Yes 70% (180) 64% (72) 74% (108) No 25% (65) 28% (32) 23% (33) Do not know 5% (12) 8% (9) 3% (5) Has your mental health been affected negatively by the Covid − 19 pandemic? Yes 9% (24) 4% (5) 13% (19) No 79% (204) 88% (99) 72% (105) Do not know 11% (30) 8% (9) 15% (21) Self-perceived change in feeling of loneliness during the Covid − 19 pandemic Negative change 9% (24) 4% (5) 13% (19) Positive change 4% (10) 4% (4) 4% (6) No change 87% (225) 92% (105) 83% (120) Self-reported change of social life during the Covid − 19 pandemic Negative change 14% (36) 11% (13) 16% (23) Positive change 6% (15) 7% (8) 5% (7) No change 80% (207) 82% (93) 79% (114) Figure 2 in here Depression, anxiety, and stress were all common among the participants. As many as 64% (n = 174) met the scores for likely depression in GDS-20, but in HADS-D only 2% (n = 5) reached risk of depression. However, in HADS-D 76% (n = 197) were categorized as dejection. Every 5th participant (n = 52) reported mild to moderate anxiety in HADS-A, and 5% (n = 13) high such. The distribution of self-reported stress was: low stress 1,9% (n = 5), moderate stress 96,9% (n = 251), and high stress 1,2% (n = 3) among the total study population. As shown in Table 3 , when comparing those who experienced to be mentally affected by the Covid-19 Pandemic with those who did not feel mentally affected significant differences concerning GDS, HADS-D, HADS-A, and PSS scales could be seen among the affected compared to the non-affected. A third group, “do not know if affected” (n = 30), showed the same pattern as the affected group concerning these scales when comparing all three. Table 3 Mental health issues and self-reported effect on mental health by the Covid − 19 pandemic. Variables Yes, affected No, not affected N Mean rank N Mean rank P-value GDS-20 24 160 203 108 <0.001 HADS depression 24 137 203 111 0.053 HADS anxiety 24 160 203 108 < 0.001 PSS 10 24 142 203 110 0.026 Comparison between self-reported negative effect on mental health by Covid − 19 pandemic and rating scales detecting mental health issues in the study population, (divided into: yes, affected; no, not affected) and Geriatric Depression Scale 20 items (GDS-20), Hospital Anxiety and Depression scale (divided into HADS depression and HADS anxiety), and Perceived Stress Scale 10-items (PSS-10). Total scores were used for all screening scales. Mann Whitney-U test was used for analyses. There was a correlation between participants perceiving their mental health having been negatively affected by the Covid-19 pandemic (yes- or no-answers only) and following variables: sex where women were more affected than men (r = 0.185, p = 0.03), negative change in social life (r = 0.320, p < 0.001), worse family situation (r = 0.253, p < 0.001), change in physical activity (r = 0.231, p < 0.001), and higher scores on GDS-20 (r = 0.258, p < 0.001), HADS-D (r = 0.129, p = 0.04), and HADS-A (r = 0.369, p < 0.001). Similar results were shown when those who answered that they did not know if their mental health had been affected by the Covid − 19 pandemic was added to the correlation analysis. When comparing men and women, female gender was significantly correlated with single civil status (r = 0.168, p = 0.007), more feelings of loneliness r = 0.133, p = 0.03), changes in physical activity (r = 0.215, p < 0.001), higher scores on GDS-20 (r = 0.214, p < 0.001), and HADS-A (r = 0.164, p = 0.008). Table 4 Risks for being affected by psychosocial factors during the Covid − 19 pandemic . Independent variables P-value OR (95% CI) Gender Men Reference Reference Women 0.045 5.22 (1.04–26.15) Family situation Good Reference Reference Neither good nor bad 0.006 9.82 (1.94–49.68) Bad 0.008 30.36 (2.41-382.75) Change in social life during the Covid − 19 pandemic No change Reference Reference Negative change < 0.001 16.35 (4.17–16.05) Positive change 0.35 3.17 (0.29–34.53) Physical activity No change Reference Reference Change 0.006 5.76 (1.67–19.87) HAD anxiety None – very low Reference Reference Mild-moderate 0.017 5.78 (1.37–24.33) High 0.024 8.74 (1.34–57.15) GDS − 20 No depression Reference Reference Depression likely 0.74 1.32 (0.26–6.83) Comparing those participants who experienced a negative effect on mental health during the pandemic and those who did not. The regression model is statistically significant with p < 0,001, df 9, Cox & Snell R square 0,267, and Nagelkerke R square 0,550. In Table 4 a comparison is shown between the participants that reported deteriorated mental health due to the Covid − 19 pandemic and those that did not reported such effect. Increased risks were seen among those affected, especially those who experienced a bad family situation, those who reported a negative change in their social life, those with anxiety, and for women. Also, those who reported a change in physical activity had significantly changed mental health. The final regression model explains up to 50% of the risk for deteriorated mental health during the Covid − 19 pandemic when exposed to various psychosocial factors. Discussion In summary, the most important findings in this study were that participants who perceived that their mental health had been negatively affected by the covid-19 pandemic had more symptoms of anxiety, depression/dejection, and stress. When analyzing risk factors for experiencing a decline in mental health during the pandemic, of these, only anxiety fell out as a risk factor, as well as a negative change in social life, a change in physical activity, experiencing a bad family situation, and female gender. Anxiety is common in the older population ( 16 , 17 ), and during the Covid − 19 pandemic an increase was likely to occur as this age group was especially vulnerable to the virus, more socially isolated, and the special situation of a pandemic is associated with uncertainty regarding both the present and the future. Studies performed during the Covid − 19 pandemic confirmed increased anxiety among the older adults ( 10 , 11 , 18 ). Our result reflects what other research have found and suggests that anxiety is of major concern when evaluating and predicting mental health in the older population during pandemic-like conditions. The participants in this study reported that the factors affecting them the most during the Covid-19 pandemic were social distancing, uncertainty, and fear of a close relative, or themselves, catching Covid-19. Comparable results are found in previous studies, but few asked their participants such a direct question, and, thus, their results are concluded more indirectly ( 10 , 18 , 19 ). However, to our surprise, the majority of our study participants did not perceive that the Covid − 19 pandemic had affected their mental health. This contrasts with previous studies. In two reviews from 2022 ( 10 , 18 ) it is concluded that older adults are prone to suffer mental health issues due to the Covid 19 pandemic, e.g: loneliness, depression, anxiety, and stress. One major reason for this dissimilarity may be due to a large majority of our participants living with a partner, and, thus, were not completely socially isolated, which might also explain why they experienced a low degree of loneliness and perceived their mental health as good. In line with this hypothesis, a previous Swedish study found an association between decreased mental wellbeing and social isolation among older adults ( 11 ). Another factor to consider is that Sweden did not apply lock downs, as most other nations, and therefor loneliness and social isolation might be less of an influence on our population. In Sweden it is estimated that approximately 300,000 people are socially isolated, pre-pandemic, which is defined as a person living alone, meeting relatives, friends, or acquaintances twice a month or less. After retirement social isolation increases, and in the age group 75–84 years every 10th person is socially isolated ( 20 ). It is known that the pandemic increased social isolation in this age group and several studies show that this affected their mental health ( 10 , 11 , 18 ). In accordance with this our study found that those who experienced a deteriorating social life during the pandemic also suffered from declining mental health. Interestingly though, as many as 80% reported no change in their social life, and 6% reported a positive change, few lived alone, and they were doing well in general. A possible explanation could be that these participants adapted well to the pandemic changes. Supporting this are the findings of Özdemir and Çelen ( 21 ) who saw that increased stress among old adults was associated to social isolation and chronic disease, and Sardella et al ( 22 ) whose results show that living with someone might be a factor of resilience. Studies also show that this age group have good psychological coping and adaptability, and that activities such as social media use, communication with others e.g. neighbors, seeking social support, and keeping themselves busy during the pandemic were successful protective measures ( 23 , 24 ). We did not ask specifically about our participants’ social media use or communications with others during the pandemic, but in Sweden internet access and use is high, and in the ages 70 and older up to 75% use social media daily, thus, it is possible that this has acted as a favorable factor in our studied population ( 25 ). Previous study results show that, in general, older women suffer from more anxiety, fear, worry, depression, and depressive symptoms than older men ( 2 , 17 ). In this study we found a similar pattern with women being more negatively affected mentally by the pandemic than men. These findings were expected and are consistent with other research during the pandemic, e.g. C Reppas-Rindlisbacher et al who found that women were twice as likely to report depressive symptoms than men ( 26 ), and F Hou et al reporting that women were more affected by anxiety and stress ( 27 ). Uniformly, there are findings suggesting that older women might be more vulnerable in facing the Covid − 19 pandemic than older men ( 22 ). According to WHO, 14% of the world’s population aged 60 and over suffer from at least one mental health disorder, depression and anxiety being the most common, and more than a quarter of all deaths by suicide occur in this age group ( 16 ). When comparing GDS 20, HADS-D and HADS-A to self-reported negative effect on mental health by the Covid − 19 pandemic in this study, symptoms of anxiety and stress in HADS-A and PSS 10 fall out as strong predictors for declined self-perceived mental health due to the pandemic (p < 0.001 and p = 0.026 respectively). Depression also falls out as a strong predictor, however, only in GDS 20 (p < 0.001) and not in HADS-D (p = 0.053), which was somewhat surprising. But, in HADS-D a large majority scored as “dejection”, in fact the exact same percentage (76%) as those who scored “likely depression” in GDS 20. This discrepancy between the two screening scales is in line with the findings of G. Campbell et al. ( 3 ), and is probably because GDS 20 is designed especially for the older population whereas HADS is constructed for the adult population in general. In contrast to other studies ( 28 , 29 ), like for depression, stress does not fall out as a risk factor. A reason for this might be, as discussed earlier, that most of our population lived in a relationship and few felt lonely, which could have increased their psychological resilience. One could also argue that stress levels might be lower later in the pandemic as fewer became severely ill after vaccinations started, restrictions lessened, and both the present and the future were less uncertain. However, our participants did state that social distancing and uncertainty were two of the factors that affected them the most, but apparently only a minority were so affected that they experienced decreased mental health. A major strength in this study is the use of reliable and well-validated screening scales that together capture different aspects of mental illness. In addition, there is good agreement between the self-rating scales, which further strengthens our result. Two different scales for depression were used, which we consider to be a strength. For anxiety only HADS was used. This could be considered a limitation. However, HADS is well renowned and used frequently for investigating anxiety, also in older people. Furthermore, our results regarding anxiety are very rigid and show consistent statistical significance in the different analyses, thus, we consider our results reliable and unlikely to change direction using another screening tool. Physical activity is known as an important factor for maintaining good mental health, and the same has been shown for older people during the pandemic ( 30 , 31 ). The results of this study indicate that a change in physical activity is a possible strong risk factor for declining mental health (p = 0.006, OR 5.76), however, the direction of change is unknown due to how the question was formed. This, of course, is a limitation. Regarding that our analysis found a correlation between change in physical activity and a decline in social life (r = 0.156, p = 0.012) indicates that the change is negative (i.e. reduced physical activity), but we cannot know for sure. Another limitation is the possible impact of recall bias affecting the result, a well-known phenomenon to take into consideration when using self-reported data, but, in general self-reports are considered reliable and well established ( 32 ). Our focus on a single question, “Has your mental health been affected negatively by the Covid − 19 pandemic?”, for much of our analyses is also a limitation that could make our results more vulnerable. Not least since the sub-population answering this question “Yes” was small (n = 24), which indicates carefulness when analyzing the results. Those who answered “Do not know” (n = 30) were considered to be included into this sub-population as sub-analyses showed that their mental health was nearly identical to those who answered “Yes”. This would have more than doubled the sub population size, and, thus, strengthened the analyzes. However, they were excluded since it might be that these participants had equally poor mental health before the pandemic, and, thus, their screening scores would not reflect a decline during to the pandemic. A strength to consider, though, is that the base population of the HOLD-study is a robust size, N = 260, and recruited from the general primary care population with few exceptions, which indicates that it is a good representation of the age group. Conclusion Risk factors for decreased mental health during the Covid − 19 pandemic detected in this study were a negative change in social life, a change in physical activity, experiencing a bad family situation, anxiety, and female gender. Surprisingly, depression and stress were not found to be risk factors. However, anxiety along with depression and stress were more common among those who stated that their mental health had been negatively affected by the pandemic compared to those who did not. More longitudinal studies regarding mental health issues in the older population are needed, in general and to better understand the consequences on their mental health from such exceptional societal stress as a pandemic constitutes in order to form a hypothesis for how to preserve older people´s mental health during similar future events. Abbreviations GDS 20 Geriatric Depression Scale 20 items HADS Hospital Anxiety and Depression Scale HADS A–Hospital Anxiety and Depression Scale–Anxiety HADS D–Hospital Anxiety and Depression Scale–Depression HOLD Healthy OLD people PHC Primary Health Care center PSS 10 Perceived Stress Scale 10 items Declarations Ethics approval and consent to participate The study was approved by the Swedish Ethics Review Authority (Dnr 2019-05617, Dnr 2020-05143, Dnr 2020-06154). All original data will be stored for at least 10 years and will be available on request. In line with the Declaration of Helsinki, the participants were given oral and written information about the study before signing the consent form. All participants gave their oral and written informed consent to participate before inclusion. Consent for publication Consent for publication has been given. Availability of data and materials Data are available on request to Linköping University Electronic Press https://ep.liu.se Competing interest We declare that no competing interests exists. Funding This work was funded by regional research grants from the County Council of Östergötland, Sweden. Authors’ contribution JK, ÅF, SN and AT conceived and designed the study. JK, HIL, FI, and AL took part in data collection. JK, ÅF, HIL, and MT analyzed and interpreted data. JK, HIL, ÅF and MT wrote the paper. JK, HIL, ÅF, SN, FI, and AL reviewed and edited the paper. All authors approved the final manuscript. Acknowledgements We wish to express our gratitude to all participants for their contribution to research, all partaking Primary Health Care centers and their staff, and research engineer Helena Quist for help with organizing data. References Fakoya OA, McCorry NK, Donnelly M. Loneliness and social isolation interventions for older adults: a scoping review of reviews. BMC Public Health. 2020;20(1):129. Differences in mental. health problems among older people: a review and epidemiological study. Summary available in English. https://www.folkhalsomyndigheten.se/contentassets/85e04b9f6cde4e8daa2894d389ade1ad/skillnader-psykisk-ohalsa-aldre-personer.pdf [2023-12-12]: Public Health Agency of Sweden; 2019. Schrempft S, Jackowska M, Hamer M, Steptoe A. Associations between social isolation, loneliness, and objective physical activity in older men and women. BMC Public Health. 2019;19(1):74. Lever-van Milligen BA, Verhoeven JE, Schmaal L, van Velzen LS, Revesz D, Black CN, et al. The impact of depression and anxiety treatment on biological aging and metabolic stress: study protocol of the MOod treatment with antidepressants or running (MOTAR) study. BMC Psychiatry. 2019;19(1):425. Organization WHO. WHO Director-General's opening remarks at the media briefing on COVID-19–11 March 2020 2020 [2022-09-15]. Available from: https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020 . Romero Starke K, Reissig D, Petereit-Haack G, Schmauder S, Nienhaus A, Seidler A. The isolated effect of age on the risk of COVID-19 severe outcomes: a systematic review with meta-analysis. BMJ Glob Health. 2021;6(12). Consequences of COvid. – 19 infection control measures on people of 70 years of age and older. Summary available in English. https://www.folkhalsomyndigheten.se/pubreader/pdfview/81272?browserprint=1 [2023-12-12]: Public Health Agency of Sweden; 2023. What happened when. during the pandemic? Only available in Swedish. https://www.folkhalsomyndigheten.se/smittskydd-beredskap/utbrott/aktuella-utbrott/covid-19/nar-hande-vad-under-pandemin/ [2023-12-12]: Public Health Agency of Sweden; 2023. Grolli RE, Mingoti MED, Bertollo AG, Luzardo AR, Quevedo J, Reus GZ, et al. Impact of COVID-19 in the Mental Health in Elderly: Psychological and Biological Updates. Mol Neurobiol. 2021;58(5):1905–16. Bafail DA. Mental Health Issues Associated With COVID-19 Among the Elderly Population: A Narrative Review. Cureus. 2022;14(12):e33081. Dove A, Guo J, Calderon-Larranaga A, Vetrano DL, Fratiglioni L, Xu W. Association between social isolation and reduced mental well-being in Swedish older adults during the first wave of the COVID-19 pandemic: the role of cardiometabolic diseases. Aging. 2022;14(6):2462–74. Kivi M, Hansson I, Bjälkebring P. Up and About: Older Adults' Well-being During the COVID-19 Pandemic in a Swedish Longitudinal Study. J Gerontol B Psychol Sci Soc Sci. 2021;76(2):e4–e9. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24(4):385–96. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361–70. Gottfries GG, Noltorp S, Norgaard N. Experience with a Swedish version of the Geriatric Depression Scale in primary care centres. Int J Geriatr Psychiatry. 1997;12(10):1029–34. Organization WHO. Mental health of older adults. https://www.who.int/news-room/fact-sheets/detail/mental-health-of-older-adults [2023-12-12]: World Health Organization; 2023. Wolitzky-Taylor KB, Castriotta N, Lenze EJ, Stanley MA, Craske MG. Anxiety disorders in older adults: a comprehensive review. Depress Anxiety. 2010;27(2):190–211. Cocuzzo B, Wrench A, O'Malley C. Effects of COVID-19 on Older Adults: Physical, Mental, Emotional, Social, and Financial Problems Seen and Unseen. Cureus. 2022;14(9):e29493. Cori L, Curzio O, Adorni F, Prinelli F, Noale M, Trevisan C et al. Fear of COVID-19 for Individuals and Family Members: Indications from the National Cross-Sectional Study of the EPICOVID19 Web-Based Survey. Int J Environ Res Public Health. 2021;18(6). Four percent are socially isolated. Only available in Swedish. Statistics Sweden; 2019. https://www.scb.se/hitta-statistik/artiklar/2019/fyra-procent-ar-socialt-isolerade/ . [2023-12-12]. Ozdemir PA, Celen HN. Social loneliness and perceived stress among middle-aged and older adults during the COVID-19 pandemic. Curr Psychol. 2023:1–10. Sardella A, Lenzo V, Basile G, Musetti A, Franceschini C, Quattropani MC. Gender and Psychosocial Differences in Psychological Resilience among a Community of Older Adults during the COVID-19 Pandemic. J Pers Med. 2022;12(9). Brooke J, Clark M. Older people's early experience of household isolation and social distancing during COVID-19. J Clin Nurs. 2020;29(21–22):4387–402. Fuller HR, Huseth-Zosel A. Lessons in Resilience: Initial Coping Among Older Adults During the COVID-19 Pandemic. Gerontologist. 2021;61(1):114–25. The Swedes and the Internet. 2023, Chap. 9. https://svenskarnaochinternet.se/rapporter/svenskarna-och-internet-2023/english/#chapter9 [2023-12-12]: Internetstiftelsen; 2023 [. Reppas-Rindlisbacher C, Mahar A, Siddhpuria S, Savage R, Hallet J, Rochon P. Gender Differences in Mental Health Symptoms Among Canadian Older Adults During the COVID-19 Pandemic: a Cross-Sectional Survey. Can Geriatr J. 2022;25(1):49–56. Hou F, Bi F, Jiao R, Luo D, Song K. Gender differences of depression and anxiety among social media users during the COVID-19 outbreak in China:a cross-sectional study. BMC Public Health. 2020;20(1):1648. Ahmadi A, Allahverdipour H, Valiee S, Pashazadeh F, Ghassab-Abdollahi N, Abdoli F, et al. COVID-19 stress and coping strategies among older adults: a systematic review of qualitative evidences. BMC Psychol. 2023;11(1):333. Taylor S, Landry CA, Paluszek MM, Fergus TA, McKay D, Asmundson GJG. Development and initial validation of the COVID Stress Scales. J Anxiety Disord. 2020;72:102232. Callow DD, Arnold-Nedimala NA, Jordan LS, Pena GS, Won J, Woodard JL, et al. The Mental Health Benefits of Physical Activity in Older Adults Survive the COVID-19 Pandemic. Am J Geriatr Psychiatry. 2020;28(10):1046–57. Cosco TDWA, Riadi I, Kervin L, Best J, Raina P. Reduced ability to engaged in social and physical activity and mental health of older adults during the COVID – 19 pandemic: longitudinal analysis from the Canadian Longitudinal Study on Aging. The Lancet. 2021;398:0140–6736. Mainous AG 3rd, Hueston WJ. Using other people's data: the ins and outs of secondary data analysis. Fam Med. 1997;29(8):568–71. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 01 Mar, 2024 Read the published version in BMC Public Health → Version 1 posted Editorial decision: Revision requested 04 Feb, 2024 Reviews received at journal 19 Jan, 2024 Reviewers agreed at journal 19 Jan, 2024 Reviewers invited by journal 03 Jan, 2024 Editor assigned by journal 03 Jan, 2024 Editor invited by journal 29 Dec, 2023 Submission checks completed at journal 29 Dec, 2023 First submitted to journal 23 Dec, 2023 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-3796640\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":264440438,\"identity\":\"56e0f81e-7175-49d8-82c6-f663b580c730\",\"order_by\":0,\"name\":\"Jenny Koppner\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA40lEQVRIiWNgGAWjYBACxgYwlQDlVljwkKrljARhLVAA1cLYJkFYLXN777HHPAxpcubSvQcfV86TkDE4wP7wAV6H9ZxLN+ZhyDG2nHMu2fDsNgkegwM8xgZ4tczIMZPmYahI3HAjx0yyEaKFDa/zGOe/gWsx/9k4B6SF/fkP/LbwgLTkgG1hbGwAaWEww6cD6Bege+YYpAH9csZYsuGYBI/kYR5jvA4zbD9jJvGmIhkYYj2GHxtqbOz5jrc//IBXSwMDAxMPMIQM4CYz43UWA4M8yHEg3xoQEYmjYBSMglEwQgEAm+BBgoy6rbwAAAAASUVORK5CYII=\",\"orcid\":\"\",\"institution\":\"Linköping University\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Jenny\",\"middleName\":\"\",\"lastName\":\"Koppner\",\"suffix\":\"\"},{\"id\":264440439,\"identity\":\"523f6cc0-c4a9-47d0-9457-e3ef4909340e\",\"order_by\":1,\"name\":\"Ann Lindelöf\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Linköping University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Ann\",\"middleName\":\"\",\"lastName\":\"Lindelöf\",\"suffix\":\"\"},{\"id\":264440440,\"identity\":\"589745c0-5c9e-4101-8266-1b2411b8e07a\",\"order_by\":2,\"name\":\"Fredrik Iredahl\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Linköping University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Fredrik\",\"middleName\":\"\",\"lastName\":\"Iredahl\",\"suffix\":\"\"},{\"id\":264440441,\"identity\":\"45ccb9d1-d23d-4d9b-994c-fc3ededaec70\",\"order_by\":3,\"name\":\"Maxine Tevell\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Linköping University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Maxine\",\"middleName\":\"\",\"lastName\":\"Tevell\",\"suffix\":\"\"},{\"id\":264440442,\"identity\":\"ebbfd8da-31a6-43fe-9e66-2a52dc38e020\",\"order_by\":4,\"name\":\"Staffan Nilsson\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Linköping University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Staffan\",\"middleName\":\"\",\"lastName\":\"Nilsson\",\"suffix\":\"\"},{\"id\":264440443,\"identity\":\"af9aef27-9560-458d-b58c-748b5aef1dd2\",\"order_by\":5,\"name\":\"Annika Thorsell\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Linköping University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Annika\",\"middleName\":\"\",\"lastName\":\"Thorsell\",\"suffix\":\"\"},{\"id\":264440444,\"identity\":\"c8dd9fbc-a2a1-452c-b918-6a9d0a2bf2d1\",\"order_by\":6,\"name\":\"Åshild Faresjö\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Linköping University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Åshild\",\"middleName\":\"\",\"lastName\":\"Faresjö\",\"suffix\":\"\"},{\"id\":264440445,\"identity\":\"08fe5ffa-6a1a-4ab6-ab4a-94eddf613ee3\",\"order_by\":7,\"name\":\"Hanna Israelsson Larsen\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Linköping University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Hanna\",\"middleName\":\"Israelsson\",\"lastName\":\"Larsen\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2023-12-23 13:59:48\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-3796640/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-3796640/v1\",\"draftVersion\":[],\"editorialEvents\":[{\"content\":\"https://doi.org/10.1186/s12889-024-18199-1\",\"type\":\"published\",\"date\":\"2024-03-01T15:01:12+00:00\"}],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":49126969,\"identity\":\"003db62c-60ea-4735-ba37-f59f61318eb6\",\"added_by\":\"auto\",\"created_at\":\"2024-01-03 14:58:54\",\"extension\":\"jpeg\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":336273,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cstrong\\u003eOverview of the HOLD study protocol\\u003c/strong\\u003e.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eIn the HOLD-study 260 inhabitants in the Southeast of Sweden, between the age of 70-80 years, were randomly asked to participate. At the inclusion subjects were studied in regards of biometric data, surveys, blood samples, hair sample, and saliva.\\u003c/em\\u003e\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"floatimage1.jpeg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-3796640/v1/667a662e7a5799b9196493c4.jpeg\"},{\"id\":49126968,\"identity\":\"0042f081-6a15-4a06-9ffa-fc0bf05f2cf7\",\"added_by\":\"auto\",\"created_at\":\"2024-01-03 14:58:53\",\"extension\":\"png\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":9784,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cstrong\\u003eFactors affecting the participants.\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eDistribution of factors chosen by participants as those that affected them the most during the Covid -19 pandemic. Each participant was asked to choose up to two options.\\u003c/em\\u003e\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Onlinedrawingimage1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-3796640/v1/490438c46cfa80ae4303337e.png\"},{\"id\":51958510,\"identity\":\"37d2876f-92a0-4f07-aaf7-f3c9295cb92a\",\"added_by\":\"auto\",\"created_at\":\"2024-03-04 15:16:56\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":602851,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-3796640/v1/90c09007-274d-4715-ac3d-2c589e91bd2b.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Factors affecting self-perceived mental health in the general older population during the Covid19 pandemic: a cross-sectional study\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eThe older population in the world is expanding; average life expectancy has increased globally for people aged 60 years and over due to progress in medical technologies, advancements in public health, and improved sanitation (\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e). It is well known that this age group has a large burden of somatic disease, however, they also suffer mental health issues; depression is so common among older people that it can be seen as a public health problem (\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e). Other common occurrences are scattered families, loss of close ones, less income, and poorer ability to move, which are risk factors for social isolation and loneliness (\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e). Social relationships have a significant impact on overall longevity and physical well-being (\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e), whereas social isolation and feelings of loneliness are factors associated with higher morbidity and mortality as they affect psychobiological processes, leading to neuroendocrine dysregulation, inflammatory responses, chronic allostatic load, and disturbances in autonomic function (\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e). Anxiety and depressive disorders also alter psychobiological processes, above all the stress systems, leading to an increased risk for the onset of chronic disease including physical and cognitive impairment (\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eDuring the winter of 2019/2020, the virus SARS-CoV-2 was discovered, commonly called Covid-19. Because of the alarming levels of spread and severity of the virus, the World Health Organization characterized the situation as a pandemic on March 11, 2020 (\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e). The Covid-19 virus hit the older population the hardest. Studies have shown that high age was a major independent risk factor for severe disease and death (\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e). The higher the age the higher the risk; aged 75\\u0026ndash;79 years, followed by aged 70\\u0026ndash;74 years constituted the majority of patients in intensive care, and had the highest death rates (\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e). Because of this, the Public Health Agency of Sweden introduced several restrictions and recommendations in Sweden for people aged 70 years and older. They were recommended to limit their close contact with others, i.e. avoiding public gatherings, public transportation, stores, and public facilities, even contact with family and friends. The government also established a national ban on visits to nursing homes. (\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e)\\u003c/p\\u003e \\u003cp\\u003ePrevious research regarding the effects of the Covid-19 pandemic on mental health in the older population has mainly focused on the early stages of the pandemic. A review from 2020 (\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e) discusses possible physiological mechanisms behind effects of covid 19 infection on mental health in older people. An increased vulnerability in this population is advocated. Another review (\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e) shows that this population is more likely to suffer mental health issues associated with Covid-19, and that the older population experienced e.g., stress, depression, anxiety, and loneliness during the pandemic. Comparable results were found in a Swedish study (\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e) among seniors in an urban setting. However, in a Swedish longitudinal study from 2021, where very early effects of the pandemic on 65\\u0026ndash;71-year-olds were investigated, results show an equal well-being in the population, or even higher, as before the pandemic (\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eIn summary, there is a growing senior population in the world with many risk factors for decreased physical and mental health. Older people were the most vulnerable during the Covid-19 pandemic and they also were one of the population groups most affected by severe restrictions regarding social contacts. Now that we are in the aftermath of the pandemic, it is important to evaluate the consequences of these restrictions to learn for the future. The aim of this study was to investigate which factors affect mental health among 70\\u0026ndash;80-year-olds during the Covid-19 pandemic.\\u003c/p\\u003e\"},{\"header\":\"Materials and Methods\",\"content\":\"\\u003cp\\u003eStudy design\\u003c/p\\u003e \\u003cp\\u003eThis is a cross sectional study, in which data was collected within the HOLD- (Healthy OLD people) study situated in the southeast of Sweden, Region \\u0026Ouml;sterg\\u0026ouml;tland, as visualized in Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e. The HOLD-study aims to investigate long-term stress, psychosocial factors, and health factors in an increasingly healthy elderly population in Sweden.\\u003c/p\\u003e \\u003cp\\u003eFigure \\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e \\u003cb\\u003ein here.\\u003c/b\\u003e\\u003c/p\\u003e \\u003cp\\u003eParticipant recruitment\\u003c/p\\u003e \\u003cp\\u003eFive Primary Health Care centers (PHC) were recruited, including both rural and urban locations. Inclusion criteria were age 70\\u0026ndash;80 years old and being listed at one of the included PHCs, thus, all listed 70\\u0026ndash;80 years old at each PHC formed the population base for the study. All individuals were placed in random order via Excel on a list and the first 100 on the list were initially offered to participate in the study. The goal was to recruit 60 participants at each PHC. If that aim was not reached from the first 100 on the list recruitment continued from the 101st and onwards until the goal was met. Three PHCs (one urban and two rural) were excepted from the goal of 60 individuals, due to the time limit of the HOLD-study, a smaller sample was accepted (55, 52 and 29, respectively). Information about the study, including a consent form, was mailed to the participants, for them to read and reflect upon whether they would like to participate. Shortly thereafter they received a phone call from a research nurse. Phone numbers were searched for on public digital services. Exclusion criteria were: the participant living in a nursing home, inability to find the phone number on public digital services, the participant not answering the phone after three call attempts, inadequate cognitive skills, inadequate written and/or oral Swedish language skills, no hair or hair shorter than 1cm on the scalp (for biochemical analyses in other HOLD sub studies), participants without ability to visit the PHC. If all requirements were met, and the person wanted to participate in the study, an appointment was booked at the PHC for data collection. If the presumptive participant did not come to the appointment without giving notice, he/she was excluded.\\u003c/p\\u003e \\u003cp\\u003eData collection\\u003c/p\\u003e \\u003cp\\u003eThe study was conducted from October 2021 to December 2022. All data was collected by the research nurse during the visit to the PHC. Biometric values were collected (weight, height, waist measurement, blood pressure and pulse), as well as samples of blood, hair, and saliva, these were then used for other sub studies of the HOLD-study. All participants answered a questionnaire that consisted of 29 segments. Questions included sociodemographic factors, social life, loneliness, physical activity, perceived health, and effects of the Covid-19 pandemic, including some perceived differences before and during the pandemic. The participants were also asked to choose up to two factors from a given list that they felt had affected them the most by the Covid \\u0026minus;\\u0026thinsp;19 pandemic. The question about self-perceived health in the survey was based on the Short Form Health Survey (SF-36) which is a common instrument for measuring quality of life and health. Following three screening scales, all validated in Swedish, were used to assess the participants\\u0026rsquo; mental health. Perceived Stress Scale-10 (PSS-10); ten questions that measure how the patient has experienced stress during the last month, with a total score of 0\\u0026ndash;40, where a high score indicates a high level of stress (\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e). Hospital Anxiety and Depression scale (HADS); a diagnostic tool that evaluates both anxiety and depression consisting of seven questions about depression and seven questions about anxiety, with a total score of 0\\u0026ndash;21 respectively then divided into three categories: score 0\\u0026ndash;7 no depression/anxiety, score 8\\u0026ndash;10 possible depression/anxiety, score\\u0026thinsp;\\u0026gt;\\u0026thinsp;11 indicates depression/anxiety (\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e), Geriatric Depression Scale-20 (GDS-20); a screening instrument intended to identify depression in elderly people capturing how the patient is feeling now and during the last two weeks with 20 yes-or-no questions, with a total score of 0\\u0026ndash;20 then divided into two categories: 0\\u0026ndash;5\\u0026thinsp;=\\u0026thinsp;depression is not likely, 6\\u0026ndash;20\\u0026thinsp;=\\u0026thinsp;depression can be suspected (\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e). For all three screening scales both total score and division into categories were used in this study.\\u003c/p\\u003e \\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eStatistical analysis\\u003c/h2\\u003e \\u003cp\\u003eAll data was stored in a common database and statistically analyzed using the SPSS version 28.0 software (SPSS Inc., Chicago, IL, USA). For descriptive statistics, the frequencies were conducted for all variables. Chi\\u003csup\\u003e2\\u003c/sup\\u003e-tests were also conducted for all variables. The factors that the participants experienced had affected them the most during the pandemic were calculated. The self-rating scales were transformed into numeric values and categorized. HADS, GDS-20, and PSS-10 were used both with their total score and division into groups. Nonparametric tests Mann Whitney and Kruskal Wallis were used to obtain differences between affected and not affected. Correlations were investigated between \\\"Has your mental health been affected by the Covid-19 pandemic?\\\" and the variables: sex, age, education level, civil status, financial status, family situation, changes in social life, changes in feelings of loneliness, changes in physical activity, GDS-20 divided into groups, HADS depression (HADS-D) divided into groups, HADS anxiety (HADS-A) divided into groups, and PSS-10 divided into groups, Separate analyses for men and women were also performed. In the final binary logistic regression model only yes- and no-answers were included for the dependent variable \\u0026ldquo;Has your mental health been affected by the Covid \\u0026minus;\\u0026thinsp;19 pandemic\\u0026rdquo;. The level of statistical significance was set at p\\u0026thinsp;=\\u0026thinsp;0.05.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003eIn total N\\u0026thinsp;=\\u0026thinsp;260 participants were included in the study. Demographic data is presented in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e. A majority of the participants were women, and the most common civil status was married or cohabited. Education levels were quite equally distributed between secondary school, university/college, and primary school. Almost all participants were doing well financially and experienced that they had a good family situation. Most of the participants reported a good social life, and that they rarely felt lonely, often participated in social activities, and perceived their health as good.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eParticipant characteristics in total and divided into gender.\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"4\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eVariables\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eTotal N\\u0026thinsp;=\\u0026thinsp;260\\u003c/p\\u003e \\u003cp\\u003e% (n)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eMen n\\u0026thinsp;=\\u0026thinsp;114\\u003c/p\\u003e \\u003cp\\u003e% (n)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eWomen n\\u0026thinsp;=\\u0026thinsp;146\\u003c/p\\u003e \\u003cp\\u003e% (n)\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCivil status\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSingle\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e28% (72)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e20% (23)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e34% (49)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMarried/cohabited\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e72% (186)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e80% (90)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e66% (96)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eEducation\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePrimary school\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e29% (76)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e30% (34)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e30% (42)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSecondary school\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e35% (88)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e34% (38)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e35% (50)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eUniversity/college\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e35% (90)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e36% (41)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e35% (49)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eFinancial status\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eGood\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e94% (142)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e97% (110)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e92% (132)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBad\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e6% (15)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e3% (4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e8% (11)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eFamily situation\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eGood\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e92% (236)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e94% (106)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e91% (130)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBad\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2% (6)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2% (2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e3% (4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNeither good nor bad\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e6% (14)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e4% (5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e6% (9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eSocial life\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eGood\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e86% (222)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e83% (95)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e88% (127)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBad\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2% (5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2% (2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e2% (3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNeither good nor bad\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e12% (32)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e15% (17)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e10% (15)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eFeeling of loneliness\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eRarely\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e96% (249)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e98% (112)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e95% (137)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eOften\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e4% (10)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2% (2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e5% (8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eParticipating in social activities\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eOften\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e74% (191)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e73% (83)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e75% (108)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eRarely\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e26% (66)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e27% (30)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e25% (36)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eSelf-perceived health\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eGood\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e87% (225)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e90% (103)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e84% (122)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBad\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e13% (34)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e10% (11)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e16% (23)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003eAs shown in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e, only a few participants have had confirmed Covid-19 disease themselves, but many have had a close relative who has been sick with Covid-19. Almost every 10th person felt that their mental health was affected by the Covid pandemic, and slightly more reported that they did not know. When asked to choose up to two factors, from a given list, that affected them the most during the Covid \\u0026minus;\\u0026thinsp;19 pandemic, social distancing was the most common, followed by a feeling of uncertainty, and fear of a close relative, or themselves, catching Covid \\u0026minus;\\u0026thinsp;19 infection (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eParticipant characteristics regarding the Covid \\u0026minus;\\u0026thinsp;19 pandemic.\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"4\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eVariables\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eTotal\\u003c/p\\u003e \\u003cp\\u003e% (n)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eMen\\u003c/p\\u003e \\u003cp\\u003e% (n)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eWomen\\u003c/p\\u003e \\u003cp\\u003e% (n)\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eHave you had a confirmed Covid-19 infection?\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e13% (35)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e11% (12)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e16% (23)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e82% (211)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e84% (95)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e80% (116)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDo not know\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e5% (12)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e5% (6)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e4% (6)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eHas anyone close to you had confirmed Covid \\u0026minus;\\u0026thinsp;19 infection?\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e70% (180)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e64% (72)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e74% (108)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e25% (65)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e28% (32)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e23% (33)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDo not know\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e5% (12)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e8% (9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e3% (5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eHas your mental health been affected negatively by the Covid \\u0026minus;\\u0026thinsp;19 pandemic?\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e9% (24)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e4% (5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e13% (19)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e79% (204)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e88% (99)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e72% (105)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDo not know\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e11% (30)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e8% (9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e15% (21)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eSelf-perceived change in feeling of loneliness during the Covid \\u0026minus;\\u0026thinsp;19 pandemic\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNegative change\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e9% (24)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e4% (5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e13% (19)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePositive change\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e4% (10)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e4% (4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e4% (6)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNo change\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e87% (225)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e92% (105)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e83% (120)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eSelf-reported change of social life during the Covid \\u0026minus;\\u0026thinsp;19 pandemic\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNegative change\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e14% (36)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e11% (13)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e16% (23)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePositive change\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e6% (15)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e7% (8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e5% (7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNo change\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e80% (207)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e82% (93)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e79% (114)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003eFigure \\u003cspan refid=\\\"Fig2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e \\u003cb\\u003ein here\\u003c/b\\u003e\\u003c/p\\u003e \\u003cp\\u003eDepression, anxiety, and stress were all common among the participants. As many as 64% (n\\u0026thinsp;=\\u0026thinsp;174) met the scores for likely depression in GDS-20, but in HADS-D only 2% (n\\u0026thinsp;=\\u0026thinsp;5) reached risk of depression. However, in HADS-D 76% (n\\u0026thinsp;=\\u0026thinsp;197) were categorized as dejection. Every 5th participant (n\\u0026thinsp;=\\u0026thinsp;52) reported mild to moderate anxiety in HADS-A, and 5% (n\\u0026thinsp;=\\u0026thinsp;13) high such. The distribution of self-reported stress was: low stress 1,9% (n\\u0026thinsp;=\\u0026thinsp;5), moderate stress 96,9% (n\\u0026thinsp;=\\u0026thinsp;251), and high stress 1,2% (n\\u0026thinsp;=\\u0026thinsp;3) among the total study population.\\u003c/p\\u003e \\u003cp\\u003eAs shown in Table \\u003cspan refid=\\\"Tab3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e, when comparing those who experienced to be mentally affected by the Covid-19 Pandemic with those who did not feel mentally affected significant differences concerning GDS, HADS-D, HADS-A, and PSS scales could be seen among the affected compared to the non-affected. A third group, \\u0026ldquo;do not know if affected\\u0026rdquo; (n\\u0026thinsp;=\\u0026thinsp;30), showed the same pattern as the affected group concerning these scales when comparing all three.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab3\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 3\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eMental health issues and self-reported effect on mental health by the Covid \\u0026minus;\\u0026thinsp;19 pandemic.\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"6\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eVariables\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eYes, affected\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c5\\\" namest=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eNo, not affected\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"1\\\" nameend=\\\"c6\\\" namest=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eN\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eMean rank\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eN\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eMean rank\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eP-value\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eGDS-20\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e24\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e160\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e203\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e108\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eHADS depression\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e24\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e137\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e203\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e111\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.053\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eHADS anxiety\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e24\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e160\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e203\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e108\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003ePSS 10\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e24\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e142\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e203\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e110\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.026\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cem\\u003eComparison between self-reported negative effect on mental health by Covid \\u0026minus;\\u0026thinsp;19 pandemic and rating scales detecting mental health issues in the study population, (divided into: yes, affected; no, not affected) and Geriatric Depression Scale 20 items (GDS-20), Hospital Anxiety and Depression scale (divided into HADS depression and HADS anxiety), and Perceived Stress Scale 10-items (PSS-10). Total scores were used for all screening scales. Mann Whitney-U test was used for analyses.\\u003c/em\\u003e \\u003c/p\\u003e \\u003cp\\u003eThere was a correlation between participants perceiving their mental health having been negatively affected by the Covid-19 pandemic (yes- or no-answers only) and following variables: sex where women were more affected than men (r\\u0026thinsp;=\\u0026thinsp;0.185, p\\u0026thinsp;=\\u0026thinsp;0.03), negative change in social life (r\\u0026thinsp;=\\u0026thinsp;0.320, p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), worse family situation (r\\u0026thinsp;=\\u0026thinsp;0.253, p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), change in physical activity (r\\u0026thinsp;=\\u0026thinsp;0.231, p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), and higher scores on GDS-20 (r\\u0026thinsp;=\\u0026thinsp;0.258, p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), HADS-D (r\\u0026thinsp;=\\u0026thinsp;0.129, p\\u0026thinsp;=\\u0026thinsp;0.04), and HADS-A (r\\u0026thinsp;=\\u0026thinsp;0.369, p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001). Similar results were shown when those who answered that they did not know if their mental health had been affected by the Covid \\u0026minus;\\u0026thinsp;19 pandemic was added to the correlation analysis. When comparing men and women, female gender was significantly correlated with single civil status (r\\u0026thinsp;=\\u0026thinsp;0.168, p\\u0026thinsp;=\\u0026thinsp;0.007), more feelings of loneliness r\\u0026thinsp;=\\u0026thinsp;0.133, p\\u0026thinsp;=\\u0026thinsp;0.03), changes in physical activity (r\\u0026thinsp;=\\u0026thinsp;0.215, p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), higher scores on GDS-20 (r\\u0026thinsp;=\\u0026thinsp;0.214, p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), and HADS-A (r\\u0026thinsp;=\\u0026thinsp;0.164, p\\u0026thinsp;=\\u0026thinsp;0.008).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab4\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 4\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eRisks for being affected by psychosocial factors during the Covid \\u0026minus;\\u0026thinsp;19 pandemic\\u003c/b\\u003e.\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"3\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eIndependent variables\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eP-value\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eOR (95% CI)\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eGender\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMen\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eReference\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eReference\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWomen\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0.045\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e5.22 (1.04\\u0026ndash;26.15)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eFamily situation\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eGood\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eReference\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eReference\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNeither good nor bad\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0.006\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e9.82 (1.94\\u0026ndash;49.68)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBad\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0.008\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e30.36 (2.41-382.75)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eChange in social life during the Covid \\u0026minus;\\u0026thinsp;19 pandemic\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNo change\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eReference\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eReference\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNegative change\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e16.35 (4.17\\u0026ndash;16.05)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePositive change\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0.35\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e3.17 (0.29\\u0026ndash;34.53)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003ePhysical activity\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNo change\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eReference\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eReference\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eChange\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0.006\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e5.76 (1.67\\u0026ndash;19.87)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eHAD anxiety\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNone \\u0026ndash; very low\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eReference\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eReference\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMild-moderate\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0.017\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e5.78 (1.37\\u0026ndash;24.33)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eHigh\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0.024\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e8.74 (1.34\\u0026ndash;57.15)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eGDS \\u0026minus;\\u0026thinsp;20\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNo depression\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eReference\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eReference\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDepression likely\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0.74\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1.32 (0.26\\u0026ndash;6.83)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cem\\u003eComparing those participants who experienced a negative effect on mental health during the pandemic and those who did not. The regression model is statistically significant with p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0,001, df 9, Cox \\u0026amp; Snell R square 0,267, and Nagelkerke R square 0,550.\\u003c/em\\u003e \\u003c/p\\u003e \\u003cp\\u003eIn Table\\u0026nbsp;\\u003cspan refid=\\\"Tab4\\\" class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003ea comparison is shown between the participants that reported deteriorated mental health due to the Covid \\u0026minus;\\u0026thinsp;19 pandemic and those that did not reported such effect. Increased risks were seen among those affected, especially those who experienced a bad family situation, those who reported a negative change in their social life, those with anxiety, and for women. Also, those who reported a change in physical activity had significantly changed mental health. The final regression model explains up to 50% of the risk for deteriorated mental health during the Covid \\u0026minus;\\u0026thinsp;19 pandemic when exposed to various psychosocial factors.\\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eIn summary, the most important findings in this study were that participants who perceived that their mental health had been negatively affected by the covid-19 pandemic had more symptoms of anxiety, depression/dejection, and stress. When analyzing risk factors for experiencing a decline in mental health during the pandemic, of these, only anxiety fell out as a risk factor, as well as a negative change in social life, a change in physical activity, experiencing a bad family situation, and female gender. Anxiety is common in the older population (\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e), and during the Covid \\u0026minus;\\u0026thinsp;19 pandemic an increase was likely to occur as this age group was especially vulnerable to the virus, more socially isolated, and the special situation of a pandemic is associated with uncertainty regarding both the present and the future. Studies performed during the Covid \\u0026minus;\\u0026thinsp;19 pandemic confirmed increased anxiety among the older adults (\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e). Our result reflects what other research have found and suggests that anxiety is of major concern when evaluating and predicting mental health in the older population during pandemic-like conditions.\\u003c/p\\u003e \\u003cp\\u003eThe participants in this study reported that the factors affecting them the most during the Covid-19 pandemic were social distancing, uncertainty, and fear of a close relative, or themselves, catching Covid-19. Comparable results are found in previous studies, but few asked their participants such a direct question, and, thus, their results are concluded more indirectly (\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e). However, to our surprise, the majority of our study participants did not perceive that the Covid \\u0026minus;\\u0026thinsp;19 pandemic had affected their mental health. This contrasts with previous studies. In two reviews from 2022 (\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e) it is concluded that older adults are prone to suffer mental health issues due to the Covid 19 pandemic, e.g: loneliness, depression, anxiety, and stress. One major reason for this dissimilarity may be due to a large majority of our participants living with a partner, and, thus, were not completely socially isolated, which might also explain why they experienced a low degree of loneliness and perceived their mental health as good. In line with this hypothesis, a previous Swedish study found an association between decreased mental wellbeing and social isolation among older adults (\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e). Another factor to consider is that Sweden did not apply lock downs, as most other nations, and therefor loneliness and social isolation might be less of an influence on our population.\\u003c/p\\u003e \\u003cp\\u003eIn Sweden it is estimated that approximately 300,000 people are socially isolated, pre-pandemic, which is defined as a person living alone, meeting relatives, friends, or acquaintances twice a month or less. After retirement social isolation increases, and in the age group 75\\u0026ndash;84 years every 10th person is socially isolated (\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e). It is known that the pandemic increased social isolation in this age group and several studies show that this affected their mental health (\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e). In accordance with this our study found that those who experienced a deteriorating social life during the pandemic also suffered from declining mental health. Interestingly though, as many as 80% reported no change in their social life, and 6% reported a positive change, few lived alone, and they were doing well in general. A possible explanation could be that these participants adapted well to the pandemic changes. Supporting this are the findings of \\u0026Ouml;zdemir and \\u0026Ccedil;elen (\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e) who saw that increased stress among old adults was associated to social isolation and chronic disease, and Sardella et al (\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e) whose results show that living with someone might be a factor of resilience. Studies also show that this age group have good psychological coping and adaptability, and that activities such as social media use, communication with others e.g. neighbors, seeking social support, and keeping themselves busy during the pandemic were successful protective measures (\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e). We did not ask specifically about our participants\\u0026rsquo; social media use or communications with others during the pandemic, but in Sweden internet access and use is high, and in the ages 70 and older up to 75% use social media daily, thus, it is possible that this has acted as a favorable factor in our studied population (\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003ePrevious study results show that, in general, older women suffer from more anxiety, fear, worry, depression, and depressive symptoms than older men (\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e). In this study we found a similar pattern with women being more negatively affected mentally by the pandemic than men. These findings were expected and are consistent with other research during the pandemic, e.g. C Reppas-Rindlisbacher et al who found that women were twice as likely to report depressive symptoms than men (\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e), and F Hou et al reporting that women were more affected by anxiety and stress (\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e). Uniformly, there are findings suggesting that older women might be more vulnerable in facing the Covid \\u0026minus;\\u0026thinsp;19 pandemic than older men (\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eAccording to WHO, 14% of the world\\u0026rsquo;s population aged 60 and over suffer from at least one mental health disorder, depression and anxiety being the most common, and more than a quarter of all deaths by suicide occur in this age group (\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e). When comparing GDS 20, HADS-D and HADS-A to self-reported negative effect on mental health by the Covid \\u0026minus;\\u0026thinsp;19 pandemic in this study, symptoms of anxiety and stress in HADS-A and PSS 10 fall out as strong predictors for declined self-perceived mental health due to the pandemic (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001 and p\\u0026thinsp;=\\u0026thinsp;0.026 respectively). Depression also falls out as a strong predictor, however, only in GDS 20 (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001) and not in HADS-D (p\\u0026thinsp;=\\u0026thinsp;0.053), which was somewhat surprising. But, in HADS-D a large majority scored as \\u0026ldquo;dejection\\u0026rdquo;, in fact the exact same percentage (76%) as those who scored \\u0026ldquo;likely depression\\u0026rdquo; in GDS 20. This discrepancy between the two screening scales is in line with the findings of G. Campbell et al. (\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e), and is probably because GDS 20 is designed especially for the older population whereas HADS is constructed for the adult population in general.\\u003c/p\\u003e \\u003cp\\u003eIn contrast to other studies (\\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e), like for depression, stress does not fall out as a risk factor. A reason for this might be, as discussed earlier, that most of our population lived in a relationship and few felt lonely, which could have increased their psychological resilience. One could also argue that stress levels might be lower later in the pandemic as fewer became severely ill after vaccinations started, restrictions lessened, and both the present and the future were less uncertain. However, our participants did state that social distancing and uncertainty were two of the factors that affected them the most, but apparently only a minority were so affected that they experienced decreased mental health.\\u003c/p\\u003e \\u003cp\\u003eA major strength in this study is the use of reliable and well-validated screening scales that together capture different aspects of mental illness. In addition, there is good agreement between the self-rating scales, which further strengthens our result. Two different scales for depression were used, which we consider to be a strength. For anxiety only HADS was used. This could be considered a limitation. However, HADS is well renowned and used frequently for investigating anxiety, also in older people. Furthermore, our results regarding anxiety are very rigid and show consistent statistical significance in the different analyses, thus, we consider our results reliable and unlikely to change direction using another screening tool. Physical activity is known as an important factor for maintaining good mental health, and the same has been shown for older people during the pandemic (\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e). The results of this study indicate that a change in physical activity is a possible strong risk factor for declining mental health (p\\u0026thinsp;=\\u0026thinsp;0.006, OR 5.76), however, the direction of change is unknown due to how the question was formed. This, of course, is a limitation. Regarding that our analysis found a correlation between change in physical activity and a decline in social life (r\\u0026thinsp;=\\u0026thinsp;0.156, p\\u0026thinsp;=\\u0026thinsp;0.012) indicates that the change is negative (i.e. reduced physical activity), but we cannot know for sure. Another limitation is the possible impact of recall bias affecting the result, a well-known phenomenon to take into consideration when using self-reported data, but, in general self-reports are considered reliable and well established (\\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e). Our focus on a single question, \\u0026ldquo;Has your mental health been affected negatively by the Covid \\u0026minus;\\u0026thinsp;19 pandemic?\\u0026rdquo;, for much of our analyses is also a limitation that could make our results more vulnerable. Not least since the sub-population answering this question \\u0026ldquo;Yes\\u0026rdquo; was small (n\\u0026thinsp;=\\u0026thinsp;24), which indicates carefulness when analyzing the results. Those who answered \\u0026ldquo;Do not know\\u0026rdquo; (n\\u0026thinsp;=\\u0026thinsp;30) were considered to be included into this sub-population as sub-analyses showed that their mental health was nearly identical to those who answered \\u0026ldquo;Yes\\u0026rdquo;. This would have more than doubled the sub population size, and, thus, strengthened the analyzes. However, they were excluded since it might be that these participants had equally poor mental health before the pandemic, and, thus, their screening scores would not reflect a decline during to the pandemic. A strength to consider, though, is that the base population of the HOLD-study is a robust size, N\\u0026thinsp;=\\u0026thinsp;260, and recruited from the general primary care population with few exceptions, which indicates that it is a good representation of the age group.\\u003c/p\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003eRisk factors for decreased mental health during the Covid \\u0026minus;\\u0026thinsp;19 pandemic detected in this study were a negative change in social life, a change in physical activity, experiencing a bad family situation, anxiety, and female gender. Surprisingly, depression and stress were not found to be risk factors. However, anxiety along with depression and stress were more common among those who stated that their mental health had been negatively affected by the pandemic compared to those who did not. More longitudinal studies regarding mental health issues in the older population are needed, in general and to better understand the consequences on their mental health from such exceptional societal stress as a pandemic constitutes in order to form a hypothesis for how to preserve older people\\u0026acute;s mental health during similar future events.\\u003c/p\\u003e\"},{\"header\":\"Abbreviations\",\"content\":\"\\u003cdiv class=\\\"DefinitionList\\\"\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eGDS 20\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eGeriatric Depression Scale 20 items\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eHADS\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eHospital Anxiety and Depression Scale\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eHADS\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eA\\u0026ndash;Hospital Anxiety and Depression Scale\\u0026ndash;Anxiety\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eHADS\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eD\\u0026ndash;Hospital Anxiety and Depression Scale\\u0026ndash;Depression\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eHOLD\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eHealthy OLD people\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003ePHC\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003ePrimary Health Care center\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003ePSS 10\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003ePerceived Stress Scale 10 items\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003c/div\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eEthics approval and consent to participate\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe study was approved by the Swedish Ethics Review Authority (Dnr 2019-05617, Dnr 2020-05143, Dnr 2020-06154). All original data will be stored for at least 10 years and will be available on request. In line with the Declaration of Helsinki, the participants were given oral and written information about the study before signing the consent form. All participants gave their oral and written informed consent to participate before inclusion.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eConsent for publication has been given.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAvailability of data and materials\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eData are available on request to Linköping University Electronic Press https://ep.liu.se\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting interest\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eWe declare that no competing interests exists.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis work was funded by regional research grants from the County Council of Östergötland, Sweden.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthors\\u0026rsquo; contribution\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eJK, \\u0026Aring;F, SN and AT conceived and designed the study. JK, HIL, FI, and AL took part in data collection. JK, \\u0026Aring;F, HIL, and MT analyzed and interpreted data. JK, HIL, \\u0026Aring;F and MT wrote the paper. JK, HIL, \\u0026Aring;F, SN, FI, and AL reviewed and edited the paper. All authors approved the final manuscript.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgements\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eWe wish to express our gratitude to all participants for their contribution to research, all partaking Primary Health Care centers and their staff, and research engineer Helena Quist for help with organizing data.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eFakoya OA, McCorry NK, Donnelly M. Loneliness and social isolation interventions for older adults: a scoping review of reviews. BMC Public Health. 2020;20(1):129.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eDifferences in mental. health problems among older people: a review and epidemiological study. Summary available in English. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://www.folkhalsomyndigheten.se/contentassets/85e04b9f6cde4e8daa2894d389ade1ad/skillnader-psykisk-ohalsa-aldre-personer.pdf\\u003c/span\\u003e\\u003cspan address=\\\"https://www.folkhalsomyndigheten.se/contentassets/85e04b9f6cde4e8daa2894d389ade1ad/skillnader-psykisk-ohalsa-aldre-personer.pdf\\\" targettype=\\\"URL\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e [2023-12-12]: Public Health Agency of Sweden; 2019.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eSchrempft S, Jackowska M, Hamer M, Steptoe A. Associations between social isolation, loneliness, and objective physical activity in older men and women. BMC Public Health. 2019;19(1):74.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eLever-van Milligen BA, Verhoeven JE, Schmaal L, van Velzen LS, Revesz D, Black CN, et al. The impact of depression and anxiety treatment on biological aging and metabolic stress: study protocol of the MOod treatment with antidepressants or running (MOTAR) study. BMC Psychiatry. 2019;19(1):425.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eOrganization WHO. WHO Director-General's opening remarks at the media briefing on COVID-19\\u0026ndash;11 March 2020 2020 [2022-09-15]. Available from: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020\\u003c/span\\u003e\\u003cspan address=\\\"https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020\\\" targettype=\\\"URL\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eRomero Starke K, Reissig D, Petereit-Haack G, Schmauder S, Nienhaus A, Seidler A. The isolated effect of age on the risk of COVID-19 severe outcomes: a systematic review with meta-analysis. BMJ Glob Health. 2021;6(12).\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eConsequences of COvid. \\u0026ndash;\\u0026thinsp;19 infection control measures on people of 70 years of age and older. Summary available in English. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://www.folkhalsomyndigheten.se/pubreader/pdfview/81272?browserprint=1\\u003c/span\\u003e\\u003cspan address=\\\"https://www.folkhalsomyndigheten.se/pubreader/pdfview/81272?browserprint=1\\\" targettype=\\\"URL\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e [2023-12-12]: Public Health Agency of Sweden; 2023.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eWhat happened when. during the pandemic? Only available in Swedish. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://www.folkhalsomyndigheten.se/smittskydd-beredskap/utbrott/aktuella-utbrott/covid-19/nar-hande-vad-under-pandemin/\\u003c/span\\u003e\\u003cspan address=\\\"https://www.folkhalsomyndigheten.se/smittskydd-beredskap/utbrott/aktuella-utbrott/covid-19/nar-hande-vad-under-pandemin/\\\" targettype=\\\"URL\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e [2023-12-12]: Public Health Agency of Sweden; 2023.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eGrolli RE, Mingoti MED, Bertollo AG, Luzardo AR, Quevedo J, Reus GZ, et al. Impact of COVID-19 in the Mental Health in Elderly: Psychological and Biological Updates. Mol Neurobiol. 2021;58(5):1905\\u0026ndash;16.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eBafail DA. Mental Health Issues Associated With COVID-19 Among the Elderly Population: A Narrative Review. Cureus. 2022;14(12):e33081.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eDove A, Guo J, Calderon-Larranaga A, Vetrano DL, Fratiglioni L, Xu W. Association between social isolation and reduced mental well-being in Swedish older adults during the first wave of the COVID-19 pandemic: the role of cardiometabolic diseases. Aging. 2022;14(6):2462\\u0026ndash;74.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eKivi M, Hansson I, Bj\\u0026auml;lkebring P. Up and About: Older Adults' Well-being During the COVID-19 Pandemic in a Swedish Longitudinal Study. J Gerontol B Psychol Sci Soc Sci. 2021;76(2):e4\\u0026ndash;e9.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eCohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24(4):385\\u0026ndash;96.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eZigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361\\u0026ndash;70.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eGottfries GG, Noltorp S, Norgaard N. Experience with a Swedish version of the Geriatric Depression Scale in primary care centres. Int J Geriatr Psychiatry. 1997;12(10):1029\\u0026ndash;34.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eOrganization WHO. Mental health of older adults. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://www.who.int/news-room/fact-sheets/detail/mental-health-of-older-adults\\u003c/span\\u003e\\u003cspan address=\\\"https://www.who.int/news-room/fact-sheets/detail/mental-health-of-older-adults\\\" targettype=\\\"URL\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e [2023-12-12]: World Health Organization; 2023.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eWolitzky-Taylor KB, Castriotta N, Lenze EJ, Stanley MA, Craske MG. Anxiety disorders in older adults: a comprehensive review. Depress Anxiety. 2010;27(2):190\\u0026ndash;211.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eCocuzzo B, Wrench A, O'Malley C. Effects of COVID-19 on Older Adults: Physical, Mental, Emotional, Social, and Financial Problems Seen and Unseen. Cureus. 2022;14(9):e29493.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eCori L, Curzio O, Adorni F, Prinelli F, Noale M, Trevisan C et al. Fear of COVID-19 for Individuals and Family Members: Indications from the National Cross-Sectional Study of the EPICOVID19 Web-Based Survey. Int J Environ Res Public Health. 2021;18(6).\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eFour percent are socially isolated. Only available in Swedish. Statistics Sweden; 2019. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://www.scb.se/hitta-statistik/artiklar/2019/fyra-procent-ar-socialt-isolerade/\\u003c/span\\u003e\\u003cspan address=\\\"https://www.scb.se/hitta-statistik/artiklar/2019/fyra-procent-ar-socialt-isolerade/\\\" targettype=\\\"URL\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e. [2023-12-12].\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eOzdemir PA, Celen HN. Social loneliness and perceived stress among middle-aged and older adults during the COVID-19 pandemic. Curr Psychol. 2023:1\\u0026ndash;10.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eSardella A, Lenzo V, Basile G, Musetti A, Franceschini C, Quattropani MC. Gender and Psychosocial Differences in Psychological Resilience among a Community of Older Adults during the COVID-19 Pandemic. J Pers Med. 2022;12(9).\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eBrooke J, Clark M. Older people's early experience of household isolation and social distancing during COVID-19. J Clin Nurs. 2020;29(21\\u0026ndash;22):4387\\u0026ndash;402.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eFuller HR, Huseth-Zosel A. Lessons in Resilience: Initial Coping Among Older Adults During the COVID-19 Pandemic. Gerontologist. 2021;61(1):114\\u0026ndash;25.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eThe Swedes and the Internet. 2023, Chap. 9. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://svenskarnaochinternet.se/rapporter/svenskarna-och-internet-2023/english/#chapter9\\u003c/span\\u003e\\u003cspan address=\\\"https://svenskarnaochinternet.se/rapporter/svenskarna-och-internet-2023/english/#chapter9\\\" targettype=\\\"URL\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e [2023-12-12]: Internetstiftelsen; 2023 [.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eReppas-Rindlisbacher C, Mahar A, Siddhpuria S, Savage R, Hallet J, Rochon P. Gender Differences in Mental Health Symptoms Among Canadian Older Adults During the COVID-19 Pandemic: a Cross-Sectional Survey. Can Geriatr J. 2022;25(1):49\\u0026ndash;56.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eHou F, Bi F, Jiao R, Luo D, Song K. Gender differences of depression and anxiety among social media users during the COVID-19 outbreak in China:a cross-sectional study. BMC Public Health. 2020;20(1):1648.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eAhmadi A, Allahverdipour H, Valiee S, Pashazadeh F, Ghassab-Abdollahi N, Abdoli F, et al. COVID-19 stress and coping strategies among older adults: a systematic review of qualitative evidences. BMC Psychol. 2023;11(1):333.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eTaylor S, Landry CA, Paluszek MM, Fergus TA, McKay D, Asmundson GJG. Development and initial validation of the COVID Stress Scales. J Anxiety Disord. 2020;72:102232.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eCallow DD, Arnold-Nedimala NA, Jordan LS, Pena GS, Won J, Woodard JL, et al. The Mental Health Benefits of Physical Activity in Older Adults Survive the COVID-19 Pandemic. Am J Geriatr Psychiatry. 2020;28(10):1046\\u0026ndash;57.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eCosco TDWA, Riadi I, Kervin L, Best J, Raina P. Reduced ability to engaged in social and physical activity and mental health of older adults during the COVID \\u0026ndash;\\u0026thinsp;19 pandemic: longitudinal analysis from the Canadian Longitudinal Study on Aging. The Lancet. 2021;398:0140\\u0026ndash;6736.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eMainous AG 3rd, Hueston WJ. Using other people's data: the ins and outs of secondary data analysis. Fam Med. 1997;29(8):568\\u0026ndash;71.\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":true,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-public-health\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"pubh\",\"sideBox\":\"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/pubh/default.aspx\",\"title\":\"BMC Public Health\",\"twitterHandle\":\"@BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Primary Health Care, Mental health, General population, Older adults, Depression, Anxiety, Stress, Covid − 19, Pandemic\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-3796640/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-3796640/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eBackground\\u003c/h2\\u003e \\u003cp\\u003eMental health problems among older people are large public health concerns but often go unrecognized and undertreated. During Covid-19 several restrictions regarding social contacts were launched, primarily for the old. The objective of this study is to investigate which factors that had the main negative affect on mental health in the older population during the pandemic.\\u003c/p\\u003e\\u003ch2\\u003eMethod\\u003c/h2\\u003e \\u003cp\\u003eA cross-sectional cohort study set in Swedish primary care during the pandemic years 2021\\u0026ndash;2022. The population constitutes of 70-80-years-old, N\\u0026thinsp;=\\u0026thinsp;260. Instruments used are Geriatric depression scale 20 (GDS20); Hospital anxiety and depression scale (HADS), and Perceived stress scale 10 (PSS10). Sociodemography and risk factors are explored. Outcome measures are factors independently associated with decreased mental health. Analyses were performed for the group as a whole and with logistic regression models comparing individuals who stated they were mentally affected by the pandemic to individuals who stated they were not.\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e \\u003cp\\u003eParticipants who stated they were mentally affected by the Covid \\u0026minus;\\u0026thinsp;19 pandemic reported significantly higher levels of anxiety (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), depression (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), and stress (p\\u0026thinsp;=\\u0026thinsp;0.026) compared to those who stated they were not mentally affected. Explanatory regression models of up to 50% showed that following factors were prominent among individuals who experienced a decline in their mental health due to the Covid \\u0026minus;\\u0026thinsp;19 pandemic (n\\u0026thinsp;=\\u0026thinsp;24); impaired social life (OR 16.35, p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001, CI 4.17\\u0026ndash;16.05), change in physical activity (OR 5.76, p\\u0026thinsp;=\\u0026thinsp;0.006, CI 1.67\\u0026ndash;19.87), perceived family situation (OR 30,36, p\\u0026thinsp;=\\u0026thinsp;0,008, CI 2,41\\u0026ndash;382,75), mild/moderate and high anxiety (OR 3.9, p\\u0026thinsp;=\\u0026thinsp;0.043, CI 1.37\\u0026ndash;24.33, OR 10,8, p\\u0026thinsp;=\\u0026thinsp;0.011, CI 1.34\\u0026ndash;57.15 respectively), and female gender (OR 4.7, p\\u0026thinsp;=\\u0026thinsp;0.05, CI 1.04\\u0026ndash;26.15).\\u003c/p\\u003e\\u003ch2\\u003eConclusion\\u003c/h2\\u003e \\u003cp\\u003eAnxiety, family situation, social life and change in physical activity were the main factors influencing the 70-80-years-old\\u0026rsquo;s self-perceived mental health during the Covid-19 pandemic. Long-term effects of social restrictions on mental health in the older population need to be further investigated.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Factors affecting self-perceived mental health in the general older population during the Covid19 pandemic: a cross-sectional study\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2024-01-03 14:58:49\",\"doi\":\"10.21203/rs.3.rs-3796640/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"decision\",\"content\":\"Revision requested\",\"date\":\"2024-02-04T11:30:18+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2024-01-19T11:44:28+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"394c1055-f524-459c-b1b0-368d44a04841\",\"date\":\"2024-01-19T05:42:33+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2024-01-03T09:40:10+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2024-01-03T09:38:57+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvited\",\"content\":\"\",\"date\":\"2023-12-29T11:00:51+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2023-12-29T10:43:44+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"BMC Public Health\",\"date\":\"2023-12-23T13:45:43+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-public-health\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"pubh\",\"sideBox\":\"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/pubh/default.aspx\",\"title\":\"BMC Public Health\",\"twitterHandle\":\"@BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"0890a5af-df1c-40ce-9e65-38ae0c2122e1\",\"owner\":[],\"postedDate\":\"January 3rd, 2024\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"published-in-journal\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2024-03-04T15:11:45+00:00\",\"versionOfRecord\":{\"articleIdentity\":\"rs-3796640\",\"link\":\"https://doi.org/10.1186/s12889-024-18199-1\",\"journal\":{\"identity\":\"bmc-public-health\",\"isVorOnly\":false,\"title\":\"BMC Public Health\"},\"publishedOn\":\"2024-03-01 15:01:12\",\"publishedOnDateReadable\":\"March 1st, 2024\"},\"versionCreatedAt\":\"2024-01-03 14:58:49\",\"video\":\"\",\"vorDoi\":\"10.1186/s12889-024-18199-1\",\"vorDoiUrl\":\"https://doi.org/10.1186/s12889-024-18199-1\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-3796640\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-3796640\",\"identity\":\"rs-3796640\",\"version\":[\"v1\"]},\"buildId\":\"qtupq5eGEP_6zYnWcrvyt\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}