Two years of COVID-19: persistently reduced well-being and increases in global psychopathology during the pandemic in a representative Austrian population-sample within the COH-FIT study

Introduction: The COVID-19 pandemic worsened well-being and mental health worldwide, but effects have diminished over time. However, prospective national data within representative samples remain scarce. We aimed to examine the change in well-being and psychopathology from pre-pandemic to intra-pandemic times in an Austrian representative general population sample, to identify vulnerable subgroups, and explore most effective coping strategies to mitigate the impact of COVID-19. Methods: Data were collected in Austria as part of the Collaborative Outcomes Study on Health and Functioning During Infection Times (COH-FIT) survey, an international, multilingual, anonymous online survey assessing mental health indicators during COVID-19. Adults ≥18 years old participated through nationally representative sampling across three waves from 05/2020-04/2022. Outcomes included the WHO well-being index (WHO-5) and a global psychopathology score ('P-score'), alongside 12 predefined risk factors and 16 coping strategies. Results: Across 4,148 adults, the mean WHO-5 well-being score decreased by 7.5 ± 17.7 points from the pre-pandemic baseline (73.2 ± 19.7) to the intra-pandemic average (65.7 ± 24.1) (p<.001). Participants with female sex, pre-existing mental or physical health conditions, and unemployment experienced greater declines. The proportion of individuals scoring <50, indicating depression, increased from 12.6% pre-pandemic baseline to 25.1% intra-pandemic, and the proportion scoring <29, indicating major depression, increased from 3.3% to 9.7% (both p<.001). The 'P-score' increased by 9.6 ± 15.0 points from 24.1 ± 19.5 pre-pandemic baseline to 33.7 ± 22.4 intra-pandemic (p<.001) with the same risk groups (except female sex). Although the greatest deterioration in both outcomes occurred during the mid-pandemic period (04/2021), neither well-being nor 'P-score' levels returned to pre-pandemic baseline values by 04/2022, nor to values from 05/2020 (Wave 1). Greater deterioration in WHO-5 and the P-score were associated with female sex, unemployment, pre-existing mental or physical disorders, and COVID-19 infection. The most commonly reported helpful coping strategies included internet use, physical activity, media consumption, social media and remote interaction, and meaningful hobbies. Discussion: COVID-19 had a persistent negative impact on well-being and mental health in Austria. Vulnerable subgroups - including those with prior health conditions and unemployment - were particularly affected. The findings underscore the importance of implementing public health measures together with targeted interventions, preventive measures, and long-term psychosocial support, especially for risk populations.