Mental Health, Loneliness and Life Satisfaction in the Dynamic Context of Pandemic Policies and Healthcare Burden: A Two-Year Cohort Study in the Netherlands

Introduction: Research suggests that the COVID-19 pandemic has affected mental health, however understanding of who has been affected most and why is incomplete. We aimed to understand how changes in mental health varied in the dynamic context of transmission numbers and pandemic (social) restrictions, and whether trends varied between population groups.Methods: We analyzed longitudinal data from 92,062 individuals who participated in the cohort of the Corona Behavioral Unit (National Institute of Public Health and the Environment, Netherlands) between April 2020 and January 2022 using multivariable linear mixed models. The main outcomes were general mental health, life satisfaction and loneliness.Findings: As the number of COVID-19 related hospital admissions and the strictness of pandemic policies increased, people’s feelings of loneliness increased while mental health and satisfaction deteriorated. Vice versa, as restrictions were relaxed, loneliness decreased and mental health improved. Younger people, those with lower educational levels and living alone were more likely to have negative outcomes. Only for age did trajectories over time differentiate considerably: younger participants were impacted substantially more by pandemic restrictions than older participants. These patterns were consistent across multiple pandemic waves.Discussion: The findings suggest that COVID-19 burden on health care and the pandemic restrictions – rather than the physical threat of COVID-19 – reduced mental health and satisfaction with life for younger people in particular. However, people appeared resilient as they recovered during periods when restrictions were relaxed. The present study highlights the importance of monitoring and supporting well-being during a pandemic, in particular to reduce loneliness during periods of intensive social restrictions amongst younger people.Funding Information: The Corona Behavioral Unit initiative has been made possible by funding from ZonMW, the Dutch Ministry of Health, Welfare and Sport and the National Institute for Public Health and the Environment (RIVM). Declaration of Interests: We declare no competing interests.Ethics Approval Statement: The cohort study does not meet the requirement as laid down in the Law for Research Involving Human Subjects (WMO) and was therefore exempted by the Centre for Clinical Expertise at RIVM from formal ethical review (Study number G&M-561).