Previously submitted to: JMIR Mental Health (no longer under consideration since Sep 29, 2025)
Date Submitted: Sep 29, 2025
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Self-rated health and mental health before and during the early phase of the COVID-19 pandemic in Germany: the population-based German National Cohort (NAKO) study
ABSTRACT
Background:
The COVID-19 pandemic and accompanying social distancing measures might have caused adverse health consequences.
Objective:
To describe changes in participants’ self-rated health and mental health (depression, anxiety, and stress), and investigate factors associated with them.
Methods:
We collected data from the German National Cohort (NAKO). We first described changes in participants’ self-rated health and mental health from the baseline examination (1 to 6 years earlier) to the early phase of the COVID-19 pandemic. We then applied the multinomial logistic regression model (self-rated health) and the quantile regression model (mental health) to investigate the potential factors associated with the health status and changes.
Results:
: After a median of 3.1 [2.1, 4.1] years from baseline to the early pandemic phase, 39.3% of participants (N = 91,809) with good health and 69.7% with less good health status at baseline reported better health. However, the percentage of participants with high depression, anxiety, and stress scores (≥10) increased from 6.2%, 4.1%, and 4.3% to 8.6%, 5.6%, and 10.1%, respectively. In the multivariable models, we found that being younger, being male, highly educated, being employed, having higher life satisfaction at baseline, being more physically active, drinking heavily, and experiencing improved anxiety symptoms were associated with improved self-rated health. In contrast, smoking and having mental health disorders were all associated with worse self-rated health. Our results showed that being younger, being female, smoking, drinking heavily, and drinking more since baseline were associated with higher depression scores. Having had a coronavirus test was associated with worse self-rated health and more severe anxiety and stress.
Conclusions:
During the early COVID-19 pandemic, many participants experienced improvements in self-rated health but suffered deterioration in mental health and physical activity engagement. Female participants, those who were physically inactive, and those with pre-existing mental disorders were more likely to report poorer health.
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