The rapid transmission of COVID-19, lack of therapeutic treatments and vaccinations, the uncertainty of the epidemic situation of COVID-19, and the implementation of a series of public health measures have significantly affected both physical and mental health. A recent position paper in Lancet Psychiatry explored psychological, social, and neuroscientific consequences of COVID-19.1 Data collection on mental health in the general population was emphasized as an immediate priority. Previous studies have focused on stress in the Canadian population during COVID-19.2 To our knowledge, no previous study has used a validated instrument for the assessment of depressive symptoms in the Canadian community during the COVID-19 crisis that can be compared to the level of depressive symptoms in the general population before COVID-19.
The aim of the proposed study was to evaluate the impact of the COVID-19 pandemic on depressive symptoms in a community sample of adults in Quebec, Canada. We wanted to quantify the prevalence of depressive symptoms and the association between depressive symptoms and fear of contracting the COVID-19 and fear of economic problems caused by the pandemic. Ethics approval was obtained from the Institutional Review Board of the Douglas Mental Health University Institute.
The Association of Canadian Studies conducted in partnership with the Douglas Foundation a web survey from May 1 to May 6, 2020, using computer-assisted web interviewing technology. A total of 1,638 Quebecers, 18 years or older, were recruited from the Leger Opinion’s online panel, which includes over 100,000 active Quebec residents. A total of 1,607 respondents completed the Patient Health Questionnaire-8 (PHQ-8) and were included in the final sample. All respondents were provided with information about the study and gave consent before participating. Respondents received remuneration from Léger Marketing in accordance with their usual incentive structure. The survey took about 20 minutes to complete. Using data from the 2016 Census, results were weighted according to sex, age, mother tongue, region, education level, and presence of children in the household to ensure a representative sample of the Quebec population.
Depressive symptoms were assessed using the PHQ, a 9-item questionnaire designed to assess depressive symptoms in the previous 2 weeks. For this study, we used PHQ-8, which excludes the suicidal item.3 PHQ-8/PHQ-9 scores of 10 or higher are considered as moderate to high level of depressive symptoms, while scores between 5 and 9 are considered as mild depressive symptoms.3
Fear of contracting the COVID-19 virus was assessed by one question: “Are you personally afraid of contracting the COVID-19 (Coronavirus)?” Response categories were “very afraid,” “somewhat afraid,” “not very afraid,” and “not afraid at all.” Fear of economic problems was assessed by the question: “Since the beginning of the crisis have you (a) lost your job and pay permanently; (b) lost your job and pay, temporarily; (c) lost some of your pay or lost some income from your work; and (d) had no impact on my job.
Public use data from the 2015/2016 Canadian Community Health Survey (CCHS)4 was used to compare the prevalence of depressive symptoms before COVID-19 (CCHS) and during COVID-19 (Quebec). Depressive symptoms in the CCHS were assessed in 8 provinces/territories, not including Quebec (see Table 1).
Table 1.
Depressive Symptoms in Two Canadian Surveys before and during COVD-19.
| Overall | Quebec Sample, May 2020 (n = 1,607) | CCHS, 2015/2016 (n = 52,996)a | ||||||
|---|---|---|---|---|---|---|---|---|
| % | PHQ-8 Score M (SD) |
PHQ-8 Score: ≥10, % | PHQ-8 Score: 5 to 9, % | % | PHQ-9 Score M (SD) |
PHQ-9 Score: ≥10, % | PHQ-9 Score: 5 to 9, % | |
| 5.09 (5.94) | 19.2 | 20.9 | 2.79 (3.92) | 6.8 | 14.9 | |||
| Sex | ||||||||
| Male | 48.7 | 4.49 (5.91) | 16.7 | 18.1 | 48.8 | 2.42 (3.52) | 4.7 | 13.8 |
| Female | 51.3 | 5.66 (5.91) | 21.6 | 23.6 | 51.2 | 3.15 (4.23) | 8.7 | 16.0 |
| Age | ||||||||
| 18 to 24 Years | 10.2 | 8.18 (6.15) | 37.8 | 26.8 | 11.6 | 3.85 (4.54) | 11.3 | 19.9 |
| 25 to 34 Years | 15.5 | 6.29 (6.24) | 24.1 | 29.7 | 18.2 | 2.92 (3.79) | 6.3 | 17.1 |
| 35 to 44 Years | 15.6 | 5.58 (5.86) | 22.0 | 24.3 | 15.8 | 2.83 (3.98) | 6.9 | 15.6 |
| 45 to 54 Years | 17.6 | 5.78 (6.71) | 22.3 | 21.9 | 19.1 | 2.79 (3.97) | 7.0 | 14.7 |
| 54 to 64 Years | 18.2 | 4.06 (5.28) | 14.0 | 16.7 | 17.3 | 2.55 (3.92) | 6.6 | 12.6 |
| 65 Years and over | 22.9 | 2.87 (4.44) | 7.9 | 13.0 | 18.0 | 2.06 (3.20) | 3.7 | 11.7 |
| Language | ||||||||
| English | 7.8 | 5.30 (5.74) | 19.4 | 23.4 | 85.9 | 2.83 (3.99) | 7.1 | 15.0 |
| French | 77.2 | 4.83 (5.84) | 18.0 | 19.9 | 2.2 | 2.56 (3.73) | 6.7 | 13.7 |
| Other | 6.2 | 5.86 (6.01) | 17.2 | 32.3 | 9.4 | 2.46 (3.19) | 3.9 | 14.7 |
| Multiple | 8.9 | 6.62 (6.66) | 30.8 | 20.3 | 2.5 | 2.86 (4.16) | 6.4 | 15.4 |
| Marital status | ||||||||
| Single | 29.2 | 7.22 (6.77) | 31.1 | 26.3 | 30.7 | 3.46 (4.39) | 9.7 | 18.1 |
| Married | 32.0 | 4.04 (5.47) | 13.0 | 16.8 | 50.0 | 2.20 (3.35) | 4.1 | 12.2 |
| Common law | 26.5 | 4.46 (5.28) | 16.0 | 21.6 | 7.7 | 3.31 (4.39) | 9.1 | 17.9 |
| Divorced, widow, separated | 12.1 | 4.02 (4.85) | 13.4 | 18.0 | 11.6 | 3.23 (4.49) | 9.0 | 16.5 |
| Education | ||||||||
| High school or less | 31.6 | 5.67 (6.73) | 20.5 | 23.4 | 39.860.2 | 3.17 (4.30) | 8.7 | 16.5 |
| Post-secondary | 68.4 | 4.75 (5.43) | 18.3 | 20.0 | 2.53 (3.62) | 5.5 | 13.9 | |
| Incomeb | ||||||||
| <$20,000 | 8.4 | 7.14 (6.97) | 27.3 | 28.9 | 7.2 | 4.59 (5.42) | 16.6 | 20.0 |
| $20,000 to $39,000 | 17.7 | 5.85 (6.68) | 24.3 | 19.6 | 14.2 | 3.35 (4.45) | 9.4 | 17.2 |
| $40,000 to $59,000 | 21.0 | 5.22 (6.29) | 22.5 | 17.9 | 14.5 | 2.84 (3.93) | 6.9 | 16.0 |
| $60,000 to $79,000 | 16.4 | 4.88 (5.32) | 17.0 | 21.3 | 14.5 | 2.73 (3.85) | 6.6 | 15.0 |
| $80,000 and more | 36.5 | 4.47 (5.36) | 16.0 | 22.3 | 49.7 | 2.37 (3.38) | 4.7 | 13.2 |
| Quebec region | ||||||||
| Montreal | 49.9 | 5.49 (6.20) | 21.8 | 21.4 | ||||
| Quebec city | 10.1 | 4.41 (5.15) | 11.7 | 25.8 | ||||
| Other region | 40.0 | 4.76 (5.77) | 17.9 | 19.0 | ||||
Note. Weighted data are presented. PHQ = Patient Health Questionnaire; CCHS = Canadian Community Health Survey.
a The PHQ-9 was used in the following provinces and territories: Newfoundland and Labrador (n = 3,056), Prince Edward Island (n = 1,733), Nova Scotia (n = 4,504), New Brunswick (n = 3,100), Ontario (n = 30,303), Manitoba (n = 5,035), Saskatchewan (n = 4,320), and Northwest Territories (n = 945). Only the total PHQ-9 scores and not the individual items nor the PHQ-8 scores were available in the CCHS public use file.
b197 individuals did not respond in the Quebec survey, 96 individuals did not respond in the CCHS.
We found a high level of depressive symptoms in our sample: 22% of females and 17% of males reported a moderate to high level of depressive symptoms during COVID-19. This was more than 2 times higher compared to the CCHS (9% of females, 5% of males). Young adults aged 18 to 24 years reported the highest prevalence of moderate to high depressive symptoms (38%).
A similar association between depressive symptoms and sociodemographic characteristics was observed in both surveys: females, younger participants, and those with lower educational attainment and low income reported the highest level of depressive symptoms.
Regression analyses suggested that fear of contracting the COVID-19 virus (β [SE] = 1.22 [0.17]; P < 0.001) and economic problems (lost job/pay permanently: β [SE] = 4.51 [0.92]; P < 0.001; lost some pay/income from work: β [SE] = 0.99 [0.45]; P < 0.05) was associated with depressive symptoms when entered simultaneously in the model, even after controlling for sex, age, ethnicity, marital status, language, income, and education.
Although other factors could potentially explain differences in the prevalence of depressive symptoms between the CCHS and this study (e.g., geography and sample characteristics), the high prevalence of depressive symptoms in our sample is disconcerting. The true prevalence might even be higher, as the PHQ-8 excludes the suicidal item, which might result in a lower summary score compared to the PHQ-9 (used in the CCHS). Immediate priorities to reduce mental health issues and support well-being are important during a public health crisis like COVID-19. In light of the high prevalence of mental health problems during COVID-19, proactive prevention and intervention strategies are warranted to implement for susceptible populations with disadvantaged psychological and sociological characteristics such as people with fears, economic stress, and adolescents.5
Footnotes
Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding: The author(s) disclosed receipt of the following financial support for the research and/or authorship of this article: The research was funded by Douglas Foundation.
ORCID iDs: Norbert Schmitz, PhD 
https://orcid.org/0000-0001-7777-6323
Xiangfei Meng, PhD
https://orcid.org/0000-0002-0857-1305
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