Background: Since the first cases of the novel coronavirus disease SARS-CoV-2 were reported in December 2019 in China, the virus has spread in most countries. The aim of the present study was to assess initial data on the mental health burden of the German public during the COVID-19 pandemic. Methods: A cross-sectional study was conducted in Germany and collected complete datasets from 15 704 German residents aged 18 years and over. Besides demographics, generalized anxiety (GAD-7), depression (PHQ-2) and psychological distress (DT) were assessed. Furthermore, COVID-19-related fear, trust in governmental actions to face COVID-19 and the subjective level of information regarding COVID-19 were covered. Results: Significantly increased symptoms were highly prevalent in all dimensions: generalized anxiety (44.9%), depression (14.3%), psychological distress (65.2%) and COVID-19-related fear (59%). Females and younger people reported higher mental burden. Trust in governmental actions to face COVID-19 and the subjective level of information regarding COVID-19 are negatively associated with mental health burden. However, the subjective level of information regarding COVID-19 is positively associated with increased COVID-19-related fear. Conclusions: The provision of appropriate psychological interventions for those in need and the provision of transparency and comprehensible information are crucial during the current pandemic.

Background: Healthcare professionals (HPs) are the key figures to keep up the healthcare system during the COVID-19 pandemic and thus are one of the most vulnerable groups in this. To this point, the extent of this psychological burden, especially in Europe and Germany, remains unclear. This is the first study investigating German HPs after the COVID-19 outbreak. Methods: We performed an online-based cross-sectional study after the COVID-19 outbreak in Germany (10–31 March 2020). In total, 2224 HPs (physicians n = 492, nursing staff n = 1511, paramedics n = 221) and 10 639 non-healthcare professionals (nHPs) were assessed including generalized anxiety (Generalized Anxiety Disorder-7), depression (Patient Health Questionnaire-2), current health status (EQ-5D-3L), COVID-19-related fear, subjective level of information regarding COVID-19. Results: HPs showed less generalized anxiety, depression and COVID-19-related fear and higher health status and subjective level of information regarding COVID-19 than the nHPs. Within the HP groups, nursing staff were the most psychologically burdened. Subjective levels of information regarding COVID-19 correlated negatively with generalized anxiety levels across all groups. Among HPs, nursing staff showed the highest and paramedics the lowest generalized anxiety levels. Conclusions: In the context of COVID-19, German HPs seem to be less psychological burdened than nHPs, and also less burdened compared with existing international data.

Background: The World Wide Web has become an essential source of health information. Nevertheless, the amount and quality of information provided may lead to information overload. Therefore, people need certain skills to search for, identify, and evaluate information from the internet. In the context of health information, these competencies are summarized as the construct of eHealth literacy. Previous research has highlighted the relevance of eHealth literacy in terms of health-related outcomes. However, the existing instrument assessing eHealth literacy in the German language reveals methodological limitations regarding test development and validation. The development and validation of a revised scale for this important construct is highly relevant. Objective: The objective of this study was the development and validation of a revised German eHealth literacy scale. In particular, this study aimed to focus on high methodological and psychometric standards to provide a valid and reliable instrument for measuring eHealth literacy in the German language. Methods: Two internationally validated instruments were merged to cover a wide scope of the construct of eHealth literacy and create a revised eHealth literacy scale. Translation into the German language followed scientific guidelines and recommendations to ensure content validity. Data from German-speaking people (n=470) were collected in a convenience sample from October to November 2020. Validation was performed by factor analyses. Further, correlations were performed to examine convergent, discriminant, and criterion validity. Additionally, analyses of measurement invariance of gender, age, and educational level were conducted. Results: Analyses revealed a 2-factorial model of eHealth literacy. By item-reduction, the 2 factors information seeking and information appraisal were measured with 8 items reaching acceptable-to-good model fits (comparative fit index [CFI]: 0.942, Tucker Lewis index [TLI]: 0.915, root mean square error of approximation [RMSEA]: 0.127, and standardized root mean square residual [SRMR]: 0.055). Convergent validity was comprehensively confirmed by significant correlations of information seeking and information appraisal with health literacy, internet confidence, and internet anxiety. Discriminant and criterion validity were examined by correlation analyses with various scales and could partly be confirmed. Scalar level of measurement invariance for gender (CFI: 0.932, TLI: 0.923, RMSEA: 0.122, and SRMR: 0.068) and educational level (CFI: 0.937, TLI: 0.934, RMSEA: 0.112, and SRMR: 0.063) were confirmed. Measurement invariance of age was rejected. Conclusions: Following scientific guidelines for translation and test validation, we developed a revised German eHealth Literacy Scale (GR-eHEALS). Our factor analyses confirmed an acceptable-to-good model fit. Construct validation in terms of convergent, discriminant, and criterion validity could mainly be confirmed. Our findings provide evidence for measurement invariance of the instrument regarding gender and educational level. The newly revised GR-eHEALS questionnaire represents a valid instrument to measure the important health-related construct eHealth literacy.

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

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

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