BACKGROUND: Although several studies have documented the impact of the COVID-19 pandemic on mental health, the long-term effects remain unclear. AIMS: To examine longitudinal changes in mental health before and during the consecutive COVID-19 waves in a well-established probability sample. METHOD: An online survey was completed by the participants of the COVID-19 add-on study at four time points: pre-COVID-19 period (2014-2015, n = 1823), first COVID-19 wave (April to May 2020, n = 788), second COVID-19 wave (August to October 2020, n = 532) and third COVID-19 wave (March to April 2021, n = 383). Data were collected via a set of validated instruments, and analysed with latent growth models. RESULTS: During the pandemic, we observed a significant increase in stress levels (standardised β = 0.473, P < 0.001) and depressive symptoms (standardised β = 1.284, P < 0.001). The rate of increase in depressive symptoms (std. covariance = 0.784, P = 0.014), but not in stress levels (std. covariance = 0.057, P = 0.743), was associated with the pre-pandemic mental health status of the participants. Further analysis showed that secondary stressors played a predominant role in the increase in mental health difficulties. The main secondary stressors were loneliness, negative emotionality associated with the perception of COVID-19 disease, lack of resilience, female gender and younger age. CONCLUSIONS: The surge in stress levels and depressive symptoms persisted across all three consecutive COVID-19 waves. This persistence is attributable to the effects of secondary stressors, and particularly to the status of mental health before the COVID-19 pandemic. Our findings reveal mechanisms underlying the surge in mental health difficulties during the COVID-19 waves, with direct implications for strategies promoting mental health during pandemics.

Department of Neurology Barrow Neurological Institute Phoenix Arizona USA; and Franke Global Neuroscience Education Center Barrow Neurological Institute Phoenix Arizona USA

Division of Epidemiology Department of Quantitative Health Sciences Mayo Clinic Rochester Minnesota USA

Division of Preventive Cardiology Department of Cardiovascular Medicine Mayo Clinic Rochester Minnesota USA

Division of Preventive Cardiology Department of Cardiovascular Medicine Mayo Clinic Rochester Minnesota USA; and Marriot Heart Disease Research Program Mayo Clinic Rochester Minnesota USA

Institute for Molecular and Translational Medicine Faculty of Medicine and Dentistry Palacký University Olomouc Czech Republic

Institute for Molecular and Translational Medicine Faculty of Medicine and Dentistry Palacký University Olomouc Czech Republic; and Department of Neurology Gloucestershire Hospitals NHS Foundation Trust Gloucester UK

International Clinical Research Centre St Anne's University Hospital Brno Czech Republic

International Clinical Research Centre St Anne's University Hospital Brno Czech Republic; and 2nd Department of Internal Medicine St Anne's University Hospital Brno and Masaryk University Brno Czech Republic

International Clinical Research Centre St Anne's University Hospital Brno Czech Republic; and Department of Global Health and Population Harvard T H Chan School of Public Health Harvard University USA

International Clinical Research Centre St Anne's University Hospital Brno Czech Republic; and Research Centre for Toxic Compounds in the Environment Masaryk University Brno Czech Republic

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