There is no multi-country/multi-language study testing a-priori multivariable associations between non-modifiable/modifiable factors and validated wellbeing/multidimensional mental health outcomes before/during the COVID-19 pandemic. Moreover, studies during COVID-19 pandemic generally do not report on representative/weighted non-probability samples. The Collaborative Outcomes study on Health and Functioning during Infection Times (COH-FIT) is a multi-country/multi-language survey conducting multivariable/LASSO-regularized regression models and network analyses to identify modifiable/non-modifiable factors associated with wellbeing (WHO-5)/composite psychopathology (P-score) change. It enrolled general population-representative/weighted-non-probability samples (26/04/2020-19/06/2022). Participants included 121,066 adults (age=42±15.9 years, females=64 %, representative sample=29 %) WHO-5/P-score worsened (SMD=0.53/SMD=0.74), especially initially during the pandemic. We identified 15 modifiable/nine non-modifiable risk and 13 modifiable/three non-modifiable protective factors for WHO-5, 16 modifiable/11 non-modifiable risk and 10 modifiable/six non-modifiable protective factors for P-score. The 12 shared risk/protective factors with highest centrality (network-analysis) were, for non-modifiable factors, country income, ethnicity, age, gender, education, mental disorder history, COVID-19-related restrictions, urbanicity, physical disorder history, household room numbers and green space, and socioeconomic status. For modifiable factors, we identified medications, learning, internet, pet-ownership, working and religion as coping strategies, plus pre-pandemic levels of stress, fear, TV, social media or reading time, and COVID-19 information. In multivariable models, for WHO-5, additional non-modifiable factors with |B|>1 were income loss, COVID-19 deaths. For modifiable factors we identified pre-pandemic levels of social functioning, hobbies, frustration and loneliness, and social interactions as coping strategy. For P-scores, additional non-modifiable/modifiable factors were income loss, pre-pandemic infection fear, and social interactions as coping strategy. COH-FIT identified vulnerable sub-populations and actionable individual/environmental factors to protect well-being/mental health during crisis times. Results inform public health policies, and clinical practice.
Collaborative outcomes study on health and functioning during infection times (COH-FIT): Insights on modifiable and non-modifiable risk and protective factors for wellbeing and mental health during the COVID-19 pandemic from multivariable and network analyses / M. Solmi, T. Thompson, S. Cortese, A. Estradé, A. Agorastos, J. Radua, E. Dragioti, D. Vancampfort, L.C. Thygesen, H. Aschauer, M. Schlögelhofer, E. Aschauer, A. Schneeberger, C.G. Huber, G. Hasler, P. Conus, K.Q.D. Cuénod, R. Von Känel, G. Arrondo, P. Fusar-Poli, P. Gorwood, P. Llorca, M. Krebs, E. Scanferla, T. Kishimoto, G. Rabbani, K. Skonieczna-Żydecka, P. Brambilla, A. Favaro, A. Takamiya, L. Zoccante, M. Colizzi, J. Bourgin, K. Kamiński, M. Moghadasin, S. Seedat, E. Matthews, J. Wells, E. Vassilopoulou, A. Gadelha, K. Su, J.S. Kwon, M. Kim, T.Y. Lee, O. Papsuev, D. Manková, A. Boscutti, C. Gerunda, D. Saccon, E. Righi, F. Monaco, G. Croatto, G. Cereda, J. Demurtas, N. Brondino, N. Veronese, P. Enrico, P. Politi, V. Ciappolino, A. Pfennig, A. Bechdolf, A. Meyer-Lindenberg, K.G. Kahl, K. Domschke, M. Bauer, N. Koutsouleris, S. Winter, S. Borgwardt, I. Bitter, J. Balazs, P. Czobor, Z. Unoka, D. Mavridis, K. Tsamakis, V.P. Bozikas, C. Tunvirachaisakul, M. Maes, T. Rungnirundorn, T. Supasitthumrong, A. Haque, A.R. Brunoni, C.G. Costardi, F.B. Schuch, G. Polanczyk, J.M. Luiz, L. Fonseca, L.V. Aparicio, S.S. Valvassori, M. Nordentoft, P. Vendsborg, S.H. Hoffmann, J. Sehli, N. Sartorius, S. Heuss, D. Guinart, J. Hamilton, J. Kane, J. Rubio, M. Sand, A. Koyanagi, A. Solanes, A. Andreu-Bernabeu, A.S.J. Cáceres, C. Arango, C.M. Díaz-Caneja, D. Hidalgo-Mazzei, E. Vieta, J. Gonzalez-Peñas, L. Fortea, M. Parellada, M.A. Fullana, N. Verdolini, E. Andrlíková, K. Janků, M.J. Millan, M. Honciuc, A. Moniuszko-Malinowska, I. Łoniewski, J. Samochowiec, Ł. Kiszkiel, M. Marlicz, P. Sowa, W. Marlicz, G. Spies, B. Stubbs, J. Firth, S. Sullivan, A.E. Darcin, H. Aksu, N. Dilbaz, O. Noyan, M. Kitazawa, S. Kurokawa, Y. Tazawa, A. Anselmi, C. Cracco, A.I. Machado, N. Estrade, D. De Leo, J. Curtis, M. Berk, A.F. Carvalho, P. Ward, S. Teasdale, S. Rosenbaum, W. Marx, A.V. Horodnic, L. Oprea, O. Alexinschi, P. Ifteni, S. Turliuc, T. Ciuhodaru, A. Bolos, V. Matei, D.H. Nieman, I. Sommer, J. Van Os, T. Van Amelsvoort, C. Sun, T. Guu, C. Jiao, J. Zhang, J. Fan, L. Zou, X. Yu, X. Chi, P. De Timary, R. Van Winkel, B. Ng, E. Peña De León, R. Arellano, R. Roman, T. Sanchez, L. Movina, P. Morgado, S. Brissos, O. Aizberg, A. Mosina, D. Krinitski, J. Mugisha, D. Sadeghi-Bahmani, F. Sheybani, M. Sadeghi, S. Hadi, S. Brand, A. Errazuriz, N. Crossley, D.I. Ristic, C. López-Jaramillo, D. Efthymiou, P. Kuttichira, R.A. Kallivayalil, A. Javed, M.I. Afridi, B. James, O.J. Seb-Akahomen, J. Fiedorowicz, J. Daskalakis, L.N. Yatham, L. Yang, T. Okasha, A. Dahdouh, J. Tiihonen, J.I. Shin, J. Lee, A. Mhalla, L. Gaha, T. Brahim, K. Altynbekov, N. Negay, S. Nurmagambetova, Y.A. Jamei, M. Weiser, C.U. Correll. - In: EUROPEAN NEUROPSYCHOPHARMACOLOGY. - ISSN 0924-977X. - 90:(2025 Jan), pp. 1-15. [10.1016/j.euroneuro.2024.07.010]
Collaborative outcomes study on health and functioning during infection times (COH-FIT): Insights on modifiable and non-modifiable risk and protective factors for wellbeing and mental health during the COVID-19 pandemic from multivariable and network analyses
P. Brambilla;
2025
Abstract
There is no multi-country/multi-language study testing a-priori multivariable associations between non-modifiable/modifiable factors and validated wellbeing/multidimensional mental health outcomes before/during the COVID-19 pandemic. Moreover, studies during COVID-19 pandemic generally do not report on representative/weighted non-probability samples. The Collaborative Outcomes study on Health and Functioning during Infection Times (COH-FIT) is a multi-country/multi-language survey conducting multivariable/LASSO-regularized regression models and network analyses to identify modifiable/non-modifiable factors associated with wellbeing (WHO-5)/composite psychopathology (P-score) change. It enrolled general population-representative/weighted-non-probability samples (26/04/2020-19/06/2022). Participants included 121,066 adults (age=42±15.9 years, females=64 %, representative sample=29 %) WHO-5/P-score worsened (SMD=0.53/SMD=0.74), especially initially during the pandemic. We identified 15 modifiable/nine non-modifiable risk and 13 modifiable/three non-modifiable protective factors for WHO-5, 16 modifiable/11 non-modifiable risk and 10 modifiable/six non-modifiable protective factors for P-score. The 12 shared risk/protective factors with highest centrality (network-analysis) were, for non-modifiable factors, country income, ethnicity, age, gender, education, mental disorder history, COVID-19-related restrictions, urbanicity, physical disorder history, household room numbers and green space, and socioeconomic status. For modifiable factors, we identified medications, learning, internet, pet-ownership, working and religion as coping strategies, plus pre-pandemic levels of stress, fear, TV, social media or reading time, and COVID-19 information. In multivariable models, for WHO-5, additional non-modifiable factors with |B|>1 were income loss, COVID-19 deaths. For modifiable factors we identified pre-pandemic levels of social functioning, hobbies, frustration and loneliness, and social interactions as coping strategy. For P-scores, additional non-modifiable/modifiable factors were income loss, pre-pandemic infection fear, and social interactions as coping strategy. COH-FIT identified vulnerable sub-populations and actionable individual/environmental factors to protect well-being/mental health during crisis times. Results inform public health policies, and clinical practice.
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