The COVID-19 pandemic and policy measures enacted to contain the spread of the coronavirus have had nationwide psychological effects. This study aimed to assess the impact of the first 15 months of the COVID-19 pandemic on the level of anxiety (GAD-7 scale) and depression (PHQ-9 scale) of the Belgian adult population. A longitudinal study was conducted from April 2020 to June 2021, with 1838 respondents participating in 6 online surveys. Linear mixed models were used to model the associations between the predictor variables and the mental health outcomes. Results showed that the prevalence of symptoms of anxiety and depression was higher in times of stricter policy measures. Furthermore, after the initial stress from the outbreak, coping and adjustment were observed in participants, as symptoms of anxiety and depression decreased during times of lower policy restrictions to almost the same level as in pre-COVID times (2018). Though time trends were similar for all population subgroups, higher levels of both anxiety and depression were generally found among women, young people, people with poor social support, extraverts, people having pre-existing psychological problems, and people who were infected/exposed to the COVID-19 virus. Therefore, investment in mental health treatment programs and supports, especially for those risk groups, is crucial.

Background: Knowledge on the bi-directional association between employment status and mental health is important, as it affects multiple dimensions of our daily lives, both at the individual and societal level. Given that the mental health status and employment situation of individuals are likely to change over time, there is an important need for longitudinal data to better understand causality patterns in this association and the underlying mechanisms. Methods: A systematic review was carried out based on the PRISMA guidelines in 3 electronic databases: PubMed, Embase, and PsycInfo. Studies eligible for inclusion were cohort studies, involving the general population, and assessing the relationship between employment status and mental health longitudinally. Results: In total, 3,733 studies were identified and 36 met the inclusion criteria. The eleven studies focusing on the social causation hypothesis highlighted the negative long-term impact of unemployment and unstable employment on mental health. Four studies observed mental health improvements upon re-entering employment, although limited and in more specific contexts. The fourteen studies focusing on the health selection hypothesis found a lower probability for individuals with mental health problems in finding and maintaining employment. Finally, the eleven studies assessing the two hypothesis simultaneously found that mental health problems were both a consequence of and risk factor for poor employment status, although some important moderating factors, such as gender differences, influence the direction and strength of the association. Conclusions: This review underscores the bi-directional association between the employment status and mental health of individuals, highlighting the need to develop targeted prevention (e.g. mental health support in the workplace) and interventions strategies (e.g. supported employment programs) in both the mental health and labor market systems. Key messages: • The bidirectional link between employment and mental health highlights the need for concurrent responses to break the vicious cycle between poor mental health and social exclusion. • To reduce the clinical and social burden of mental health problems, gender differences must be taken into account in mental health and employment support practices and policies.

Introduction: International research has shown that trauma exposure can lead to mental health disorders and affect social support. However, there is little insight into trauma exposure and its related issues in the general population of Belgium. Methods: Secondary cross-sectional data on the general adult population were retrieved from the Belgian Health Interview Survey. Using a representative sample, data were collected on trauma exposure in the past 12 months, and the disclosure of trauma, social support, depressive/anxiety symptoms and background factors were investigated. Results: In total, 7728 participants were included in this study, and 4.8% (N = 369) reported trauma exposure within the past 12 months. People with trauma exposure (4.8%, N = 369) consistently had more anxiety and depressive symptoms than those without trauma (p < 0.001), and people with multiple trauma exposures had more symptoms than those with a single trauma (p < 0.001). Social support was observed to be lower among those with trauma exposure (p < 0.001), and 17.1% had never disclosed their trauma to anyone. Sexual violence was higher among women (64.5%) and was also the least disclosed form of trauma. Conclusions: Trauma exposure is associated with poorer mental health in Belgium. Around a fifth of those who experience trauma do not disclose their trauma, which is the most common after sexual violence.

Between April 2020 and June 2022, the Belgian Health Institute (Sciensano) launched 11 online “COVID-19 Health Surveys” to assess the impact of COVID-19 and the subsequent policy responses on people's attitudes, behaviors and overall physical, mental and social well-being. Results showed an increase in the prevalence of anxiety and depression when policy measures became stricter to contain the rise of COVID-19 infections and deaths. Due to the substantial impact the crisis had on mental health, it is crucial to continue the monitoring efforts in the aftermath of the COVID period. In order to track changes over time and explore potential predictors and risk factors, the study design of the COVID-19 Health Surveys shifted to a longitudinal cohort approach (BELHEALTH). Among the 50,000 participants in the COVID-19 Health Surveys, a total of 12,000 individuals agreed to be part of the BELHEALTH cohort and participate in the online surveys every three months. Results of the BELHEALTH cohort (October 2022 and February 2023) show that the percentage of adults experiencing anxiety and depression are significantly lower compared with the percentages during high restriction periods, but remain high compared to the percentages during pre-pandemic times (Health Interview Survey 2018). Several other mental health indicators are monitored, such as subjective mental health, life satisfaction, sleep quality, concerns regarding current societal challenges, etc. The mental health indicators from the COVID-19 Health Surveys and the BELHEALTH cohort, together with mental health indicators from other sources, are communicated on the epidemiological dashboard of the institute.

Background: Health and employment are interrelated, but this can be both the result of social causation and health selection. Insights in the association between health and employment should be explored in different settings and countries because contextual factors may differ. In this study we investigate if at the Belgian population level, ill health leads to a higher risk of unemployment. Methods: We used data from the Belgian health interview survey 2018 linked with administrative data from the compulsory health insurance including information on employment status in 2018 and 2019. The sample for this study consisted of people with a paid job, aged 18-64 year, with no record of having being unemployed in 2018 (n = 3769). Multivariate logistic regression was used to assess if the risk of becoming unemployed in 2019 varied in function of the health status assessed in the 2018 survey. Results: After adjustment for age, sex, education and social support, the risk of becoming unemployed was significantly higher for people with moderate to very bad self-rated health compared to those in good health (OR 2.76; 95% CI 1.34-5.67). Similarly, unemployment in the year following participation in the survey was significantly higher among people with activity limitations because of health problems (OR 2.32; 95% CI 1.14-4.72). The higher the number of chronic diseases and conditions, the higher the risk of unemployment (OR 1.37; 95% CI 1.13-1.53). Specific predictors of unemployment were a history of serious depression in the past 12 months (OR 4.47; 95% CI 1.85-10.80) and hypertension (OR 2.54; 95% CI 1.08-6.00). Conclusions: In Belgium, health problems are a risk factor of getting unemployed. Especially people with a history of serious depression in the past year have a higher risk to lose their job. The findings confirm the health selection of unemployment and the need for the labour market to invest in interventions to support people with health problems to keep or find a job. Key messages: • As employment is a fundamental right, also for people with health problems, further efforts are needed to create an inclusive labour market, with also job opportunities for more vulnerable people. • To be able to understand better the link between health and unemployment at population level, longitudinal population data are needed including both dimensions.