Purpose To examine the joint associations of civil unrest and COVID-19 with probable anxiety and depression during the first half of 2020 in Hong Kong. Associations were compared between persons with low or high assets. Methods A population-representative sample of 4011 Hong Kong Chinese residents aged 15 years or older were recruited between February and May 2020. Respondents reported current anxiety and depressive symptoms, unrest stress, COVID-19 stress, assets (savings and home ownership), and demographics. Results Stress due to unrest and COVID-19 was associated with higher prevalence of probable anxiety and depression; persons with both stressors had higher prevalence. This pattern was consistent among persons with low or high assets, but the probabilities of mental disorder were substantially higher among persons with fewer assets. Conclusions The effect of stressors on probable anxiety and depression are cumulative: persons with stress due to civil unrest and to COVID-19 reported more mental disorders than persons with stress due to only one, or none of these factors. Overall high assets appear to buffer the consequences of stressors, lowering the risk of mental disorder.

This study examined prevalences of anxiety and depression and their correlations with daily routines among Hong Kong Chinese during the COVID-19 pandemic. Random digit dialing recruited two population-representative samples of 6029 residents during a period of low infection and limited intervention (survey 1:n = 4021) and high incidence and intensive measures (survey 2:n = 2008). Prevalence of anxiety for survey 1 and survey 2 were 14.9% and 14% and depression were 19.6% and 15.3%, respectively. Increased odds of anxiety and depression were associated with disrupted routines and lower socioeconomic status in both surveys, whereas depression was inversely related to the novel preventive routine of avoiding going to crowded places in survey 1. The prevalences of anxiety and depression were higher than preceding public health/social crises. A heavier burden of psychiatric conditions was evidenced amongst people experiencing disrupted daily routines across different phases of the pandemic and without novel preventive routines in the early phase.

Currently little is known about the interrelations between changes in psychiatric symptoms and changes in resources (personal, social, financial) amid large-scale disasters. This study investigated trajectories of psychiatric symptoms and their relationships with different patterns of changes in personal, social, and financial resources between 2020 and 2022 amid the COVID-19 pandemic. A population-representative sample (N = 1333) was recruited to complete self-report instruments at the pandemic’s acute phase (February–July 2020, T1), and again at 1-year (March–August 2021, T2) and 1.5-year (September 2021–February 2022, T3) follow-ups. Respondents reported depressive and anxiety symptoms, self-efficacy, perceived social support, and financial capacity. Growth mixture modeling (GMM) identified four trajectories of depressive and anxiety symptoms: resilience (72.39–74.19%), recovery (8.40–11.93%), delayed distress (7.20–7.35%), and chronic distress (8.33–10.20%). Four patterns were demonstrated in resource changes: persistent high resources (40.89–47.64%), resource gain (12.08–15.60%), resource loss (6.30–10.43%), and persistent low resources (28.73–36.61%). Loss and gain in financial resources characterized chronic distress and resilience, respectively. Loss in personal resources characterized delayed distress, whereas loss or no gain in social resources was related to chronic/delayed distress. Respondents in resilience were also more likely to have persistent high resources while those with delayed/chronic distress were more likely to have persistent low resources. These results provide an initial evidence base for advancing current understanding on trajectories of resilience and psychopathology in the context of resource changes during and after large-scale disasters.

This study examined the associations of perceived social capital and income change since the outbreak with probable depression and preventive behaviors during the COVID-19 pandemic in Hong Kong. Random digit dialing recruited a population-representative sample of 3011 Hong Kong Chinese aged ≥ 15 years (mean = 44, 55% females) between February 25 and April 29 2020. Respondents reported social capital (perceived interpersonal trust, social harmony, and sense of belonging), income change since the outbreak (loss vs. gain/no change), depressive symptoms, preventive behaviors, and demographics. Controlling for sociodemographics, lack of perceived interpersonal trust was associated with probable depression and avoiding contact with people with respiratory symptoms. Lack of perceived sense of belonging was associated with probable depression and decreased odds of adopting preventive behaviors. Lack of perceived social harmony was associated with probable depression and increased odds of used face masks among respondents with income loss only. Our results suggest that social capital is related to lower risk of depression and to higher chance of used face masks particularly among those experiencing income loss related to COVID-19. Prevention of mental health problems and promotion of effective preventive behaviors could be implemented by focusing on support for those who are socioeconomically disadvantaged.