The onset of the COVID-19 pandemic – particularly the ongoing restrictions and their consequences – has caused worldwide concern about the impact on mental health. “Our study shows that the pandemic has left its mark on mental health – not only in the short term, but also in the later stages of the pandemic,” says Annette Peters.
In the present analysis, 79,239 NAKO participants were surveyed at three points in time before the pandemic (2014–2019), in spring 2020 (early pandemic phase) and in autumn 2022 (late pandemic phase) about depressive symptoms, anxiety symptoms, stress and their self-reported health. The evaluation of the standardized and medically established questionnaires shows that the proportion of participants with depressive symptoms rose from 5.9 per cent before the pandemic to 9.7 per cent in autumn 2022, moderate to severe anxiety symptoms from 3.9 per cent to 6.2 per cent, and moderate to severe stress from 4.1 per cent to 10.2 per cent. At the same time, the proportion of symptom-free individuals declined, while the group experiencing all three conditions – depression symptoms, anxiety symptoms and stress – more than doubled by the late phase of the pandemic.
Self-Rated Health: Trend Reversal by 2022
Another remarkable finding was the trend in self-perceived health on a 5-point scale from bad to excellent: at the beginning of the pandemic, many people rated their health as slightly better than before. The proportion of those with “very good” health initially rose from 36.5 percent before the pandemic to 44.4 percent in 2020. By 2022, however, this trend had reversed: only 30.5 percent reported “very good” health, and reports of “less good” health were about twice as common as before the pandemic.
Younger Adults and Women Particularly Affected
NAKO analysis found that younger adults under the age of 40 and women were particularly affected, with more frequent decreases in both perceived health and psychological symptoms than older people and men. Middle and older age, on the other hand, tended to have a protective effect: stable or even improved outcomes were more common in these groups. “The results indicate that certain population groups – especially younger people, and women – were more severely affected by mental consequences of the pandemic,” explains Yanding Wang, first author of the publication and PhD-student at Helmholtz Munich.
Sustained Prevention Efforts Needed
The results show that the mental burden caused by the pandemic was a long-lasting change that persisted even after many protective measures were lifted, the research team concludes. “We therefore need permanent, low-threshold services to promote mental health,” says Annette Peters. “This is an important way to prevent the long-term mental consequences of the pandemic from becoming an additional, avoidable burden of disease in the population.”
The German National Cohort (NAKO), the largest population study in Germany, collected comprehensive health data before and at the beginning of the COVID-19 pandemic. It thus provides unique insights into the long-term effects of the pandemic on the health of the German population. Ongoing examinations of participants will also show how the observed changes develop over time.
Original Publication
Wang et al., 2026: Changes in Mental Health During the COVID-19 Pandemic: An Analysis of Data from the German National Cohort (NAKO) for the Years 2014–2022. Deutsches Ärzteblatt International. DOI: 10.3238/arztebl.m2025.0218
