Changes in Substance Use and Mental Health Burden among Women during the Second Wave of COVID-19 in Germany
Abstract
:1. Introduction
2. Materials and Methods
2.1. Design and Sampling
2.2. Measures
3. Results
3.1. Sample
3.2. Mental Health and Substance Use
3.3. Alcohol
3.4. Nicotin
4. Discussion
4.1. Substance Use
4.2. Mental Health and Substance Use
4.2.1. Generalized Anxiety and Specific COVID-19 Anxiety
4.2.2. Depression
4.3. Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- World Health Organization. Coronavirus Disease (COVID-19). 2021. Available online: https://www.who.int/emergencies/diseases/novel-coronavirus-2019 (accessed on 10 September 2021).
- Smith, B.; Lim, M. How the COVID-19 pandemic is focusing attention on loneliness and social isolation. Public Health Res. Pract. 2020, 30, 3022008. [Google Scholar] [CrossRef] [PubMed]
- Grasselli, G.; Greco, M.; Zanella, A.; Albano, G.; Antonelli, M.; Bellani, G.; Bonanomi, E.; Cabrini, L.; Carlesso, E.; Castelli, G.; et al. Risk Factors Associated With Mortality Among Patients With COVID-19 in Intensive Care Units in Lombardy, Italy. JAMA Intern. Med. 2020, 180, 1345. [Google Scholar] [CrossRef] [PubMed]
- Cummings, M.J.; Baldwin, M.R.; Abrams, D.; Jacobson, S.D.; Meyer, B.J.; Balough, E.M.; Aaron, J.G.; Claassen, J.; Rabbani, L.E.; Hastie, J.; et al. Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: A prospective cohort study. Lancet 2020, 395, 1763–1770. [Google Scholar] [CrossRef]
- Connor, J.; Madhavan, S.; Mokashi, M.; Amanuel, H.; Johnson, N.R.; Pace, L.E.; Bartz, D. Health risks and outcomes that disproportionately affect women during the Covid-19 pandemic: A review. Soc. Sci. Med. 2020, 266, 113364. [Google Scholar] [CrossRef] [PubMed]
- Hammerschmid, A.; Schmieder, J.; Wrohlich, K. Frauen in Corona-Krise stärker am Arbeitsmarkt betroffen als Männer. 2020. Available online: https://www.diw.de/documents/publikationen/73/diw_01.c.789749.de/diw_aktuell_42.pdf (accessed on 15 September 2021).
- Bundesagentur für Arbeit. Die Arbeitsmarktsituation von Frauen und Männern 2017; Bundesagentur für Arbeit: Nürnberg, Germany, 2018. [Google Scholar]
- Jessen, J.; Spieß, C.K.; Wrohlich, K. Sorgearbeit während der Corona-Pandemie: Mütter übernehmen größeren Anteil-vor allem bei schon zuvor ungleicher Aufteilung. DIW Wochenber. 2021, 88, 131–139. [Google Scholar]
- Bandyopadhyay, S.; Baticulon, R.E.; Kadhum, M.; Alser, M.; Ojuka, D.K.; Badereddin, Y.; Kamath, A.; Parepalli, S.A.; Brown, G.; Iharchane, S.; et al. Infection and mortality of healthcare workers worldwide from COVID-19: A systematic review. BMJ Glob. Health 2020, 5, e003097. [Google Scholar] [CrossRef]
- Gavurova, B.; Ivankova, V.; Rigelsky, M. Relationships between Perceived Stress, Depression and Alcohol Use Disorders in University Students during the COVID-19 Pandemic: A Socio-Economic Dimension. Int. J. Environ. Res. Public Health 2020, 17, 8853. [Google Scholar] [CrossRef]
- Dong, L.; Bouey, J. Public Mental Health Crisis during COVID-19 Pandemic, China. Emerg. Infect. Dis. 2020, 26, 1616–1618. [Google Scholar] [CrossRef]
- Hossain, M.; Tasnim, S.; Sultana, A.; Faizah, F.; Mazumder, H.; Zou, L.; McKyer, E.L.J.; Ahmed, H.U.; Ma, P. Epidemiology of mental health problems in COVID-19: A review. F1000Research 2020, 9, 636. [Google Scholar] [CrossRef]
- Galea, S.; Merchant, R.M.; Lurie, N. The Mental Health Consequences of COVID-19 and Physical Distancing: The need for prevention and early intervention. JAMA Intern. Med. 2020, 180, 817–818. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Saltzman, L.Y.; Hansel, T.C.; Bordnick, P.S. Loneliness, isolation, and social support factors in post-COVID-19 mental health. Psychol. Trauma Theory Res. Pract. Policy 2020, 12 (Suppl. 1), S55–S57. [Google Scholar] [CrossRef]
- Zhao, S.Z.; Wong, J.Y.H.; Wu, Y.; Choi, E.P.H.; Wang, M.P.; Lam, T.H. Social Distancing Compliance under COVID-19 Pandemic and Mental Health Impacts: A Population-Based Study. Int. J. Environ. Res. Public Health 2020, 17, 6692. [Google Scholar] [CrossRef] [PubMed]
- Cénat, J.M.; Blais-Rochette, C.; Kokou-Kpolou, C.K.; Noorishad, P.-G.; Mukunzi, J.N.; McIntee, S.-E.; Dalexis, R.D.; Goulet, M.-A.; Labelle, P.R. Prevalence of symptoms of depression, anxiety, insomnia, posttraumatic stress disorder, and psychological distress among populations affected by the COVID-19 pandemic: A systematic review and meta-analysis. Psychiatry Res. 2020, 295, 113599. [Google Scholar] [CrossRef]
- Bäuerle, A.; Steinbach, J.; Schweda, A.; Beckord, J.; Hetkamp, M.; Weismüller, B.; Kohler, H.; Musche, V.; Dörrie, N.; Teufel, M.; et al. Mental Health Burden of the COVID-19 Outbreak in Germany: Predictors of Mental Health Impairment. J. Prim. Care Community Health 2020, 11, 2150132720953682. [Google Scholar] [CrossRef]
- Bäuerle, A.; Teufel, M.; Musche, V.; Weismüller, B.; Kohler, H.; Hetkamp, M.; Dörrie, N.; Schweda, A.; Skoda, E.-M. Increased generalized anxiety, depression and distress during the COVID-19 pandemic: A cross-sectional study in Germany. J. Public Health 2020, 42, 672–678. [Google Scholar] [CrossRef]
- Hetkamp, M.; Schweda, A.; Bäuerle, A.; Weismüller, B.; Kohler, H.; Musche, V.; Dörrie, N.; Schöbel, C.; Teufel, M.; Skoda, E.-M. Sleep disturbances, fear, and generalized anxiety during the COVID-19 shut down phase in Germany: Relation to infection rates, deaths, and German stock index DAX. Sleep Med. 2020, 75, 350–353. [Google Scholar] [CrossRef] [PubMed]
- Bräscher, A.-K.; Benke, C.; Weismüller, B.M.; Asselmann, E.; Skoda, E.-M.; Teufel, M.; Jungmann, S.M.; Witthöft, M.; Pané-Farré, C.A. Anxiety and depression during the first wave of COVID-19 in Germany–Results of repeated cross-sectional surveys. Psychol. Med. 2021, 1–5. [Google Scholar] [CrossRef] [PubMed]
- World Health Organization. Global Status Report on Alcohol and Health 2018; World Health Organization: Geneva, Switzerland, 2019. [Google Scholar]
- Lange, C.; Manz, K.; Rommel, A.; Schienkiewitz, A.; Mensink, G. Alkoholkonsum von Erwachsenen in Deutschland: Riskante Trinkmengen, Folgen und Maßnahmen. J. Health Monit. 2016, 1, 2–21. [Google Scholar] [CrossRef]
- Rodriguez, L.M.; Litt, D.M.; Stewart, S.H. Drinking to cope with the pandemic: The unique associations of COVID-19-related perceived threat and psychological distress to drinking behaviors in American men and women. Addict. Behav. 2020, 110, 106532. [Google Scholar] [CrossRef] [PubMed]
- Jacob, L.; Smith, L.; Armstrong, N.C.; Yakkundi, A.; Barnett, Y.; Butler, L.; McDermott, D.T.; Koyanagi, A.; Shin, J.I.; Meyer, J.; et al. Alcohol use and mental health during COVID-19 lockdown: A cross-sectional study in a sample of UK adults. Drug Alcohol Depend. 2021, 219, 108488. [Google Scholar] [CrossRef]
- Chodkiewicz, J.; Talarowska, M.; Miniszewska, J.; Nawrocka, N.; Bilinski, P. Alcohol Consumption Reported during the COVID-19 Pandemic: The Initial Stage. Int. J. Environ. Res. Public Health 2020, 17, 4677. [Google Scholar] [CrossRef]
- Stanton, R.; To, Q.G.; Khalesi, S.; Williams, S.L.; Alley, S.J.; Thwaite, T.L.; Fenning, A.S.; Vandelanotte, C. Depression, Anxiety and stress during COVID-19: Associations with changes in physical activity, sleep, tobacco and alcohol use in australian adults. Int. J. Environ. Res. Public Health 2020, 17, 4065. [Google Scholar] [CrossRef]
- Rolland, B.; Haesebaert, F.; Zante, E.; Benyamina, A.; Haesebaert, J.; Franck, N. Global Changes and Factors of Increase in Caloric/Salty Food Intake, Screen Use, and Substance Use During the Early COVID-19 Containment Phase in the General Population in France: Survey Study. JMIR Public Health Surveill. 2020, 6, e19630. [Google Scholar] [CrossRef]
- Lee, B.P.; Dodge, M.J.L.; Leventhal, A.; Terrault, N.A. Retail Alcohol and Tobacco Sales During COVID-19. Ann. Intern. Med. 2021, 174, 1027–1029. [Google Scholar] [CrossRef] [PubMed]
- Kilian, C.; Rehm, J.; Allebeck, P.; Braddick, F.; Gual, A.; Barták, M.; Bloomfield, K.; Gil, A.; Neufeld, M.; O’Donnell, A.; et al. Alcohol consumption during the COVID-19 pandemic in Europe: A large-scale cross-sectional study in 21 countries. Addiction 2021. [Google Scholar] [CrossRef]
- Boschuetz, N.; Cheng, S.; Mei, L.; Loy, V.M. Changes in Alcohol Use Patterns in the United States During COVID-19 Pandemic. Wis. Med. J. 2020, 119, 171–176. [Google Scholar]
- McPhee, M.D.; Keough, M.T.; Rundle, S.; Heath, L.M.; Wardell, J.D.; Hendershot, C.S. Depression, Environmental Reward, Coping Motives and Alcohol Consumption During the COVID-19 Pandemic. Front. Psychiatry 2020, 11, 1128. [Google Scholar] [CrossRef]
- Wardell, J.D.; Kempe, T.; Rapinda, K.K.; Single, A.; Bilevicius, E.; Frohlich, J.R.; Hendershot, C.S.; Keough, M.T. Drinking to Cope During COVID-19 Pandemic: The Role of External and Internal Factors in Coping Motive Pathways to Alcohol Use, Solitary Drinking, and Alcohol Problems. Alcohol. Clin. Exp. Res. 2020, 44, 2073–2083. [Google Scholar] [CrossRef] [PubMed]
- Kraus, L.; Loy, J.K.; Wilms, N.; Starker, A. Altersspezifische Trends des risikoreichen Alkoholkonsums in Deutschland: Parallele oder unterschiedliche Verläufe? Bundesgesundheitsblatt Gesundh. Gesundh. 2021, 64, 652–659. [Google Scholar] [CrossRef] [PubMed]
- Piontek, D.; Kraus, L.; De Matos, E.G.; Atzendorf, J. Der epidemiologische suchtsurvey 2015. Sucht 2016, 62, 259–269. [Google Scholar] [CrossRef]
- Kroenke, K.; Spitzer, R.L.; Williams, J.B. The PHQ-9: Validity of a brief depression severity measure. J. Gen. Intern. Med. 2001, 16, 606–613. [Google Scholar] [CrossRef]
- Spitzer, R.L.; Kroenke, K.; Williams, J.B.; Löwe, B. A brief measure for assessing generalized anxiety disorder: The GAD-7. Arch. Intern. Med. 2006, 166, 1092–1097. [Google Scholar] [CrossRef] [Green Version]
- Petzold, M.B.; Bendau, A.; Plag, J.; Pyrkosch, L.; Maricic, L.M.; Rogoll, J.; Betzler, F.; Große, J.; Ströhle, A. Development of the COVID-19-Anxiety Questionnaire and first psychometric testing. BJPsych Open 2020, 6, e91. [Google Scholar] [CrossRef] [PubMed]
- Backhaus, K.; Erichson, B.; Weiber, R. Fortgeschrittene Multivariate Analysemethoden: Eine Anwendungsorientierte Einfüh-rung; Springer-Verlag: Berlin, Germany, 2015. [Google Scholar]
- Tabachnick, B.G.; Fidell, L.S.; Ullman, J.B. Using Multivariate Statistics; Pearson: Boston, MA, USA, 2007; Volume 5. [Google Scholar]
- Vanderbruggen, N.; Matthys, F.; Van Laere, S.; Zeeuws, D.; Santermans, L.; Ameele, S.V.D.; Crunelle, C.L. Self-Reported Alcohol, Tobacco, and Cannabis Use during COVID-19 Lockdown Measures: Results from a Web-Based Survey. Eur. Addict. Res. 2020, 26, 309–315. [Google Scholar] [CrossRef] [PubMed]
- Weerakoon, S.; Jetelina, K.; Knell, G. Longer time spent at home during COVID-19 pandemic is associated with binge drinking among US adults. Am. J. Drug Alcohol Abus. 2020, 47, 98–106. [Google Scholar] [CrossRef]
- Torres, O.V.; O’Dell, L.E. Stress is a principal factor that promotes tobacco use in females. Prog. Neuropsychopharmacol. Biol. Psychiatry 2016, 65, 260–268. [Google Scholar] [CrossRef] [Green Version]
- Gupta, A.K.; Nethan, S.T.; Mehrotra, R. Tobacco use as a well-recognized cause of severe COVID-19 manifestations. Respir. Med. 2021, 176, 106233. [Google Scholar] [CrossRef] [PubMed]
- Cousijn, J.; Kuhns, L.; Larsen, H.; Kroon, E. For better or for worse? A pre–post exploration of the impact of the COVID-19 lockdown on cannabis users. Addiction 2021, 116, 2104–2115. [Google Scholar] [CrossRef]
- Bartel, S.J.; Sherry, S.B.; Stewart, S.H. Self-isolation: A significant contributor to cannabis use during the COVID-19 pandemic. Subst. Abus. 2020, 41, 409–412. [Google Scholar] [CrossRef]
- Imtiaz, S.; Wells, S.; Rehm, J.; Hamilton, H.A.; Nigatu, Y.T.; Wickens, C.M.; Jankowicz, D.; Elton-Marshall, T. Cannabis Use during the COVID-19 Pandemic in Canada: A Repeated Cross-sectional Study. J. Addict. Med. 2020. [Google Scholar] [CrossRef]
- Anker, J. Co-Occurring Alcohol Use Disorder and Anxiety: Bridging the Psychiatric, Psychological, and Neurobiological Perspectives. Alcohol Res. Curr. Rev. 2019, 40, arcr.v40.1.03. [Google Scholar] [CrossRef] [PubMed]
- Wu, P.; Liu, X.; Fang, Y.; Fan, B.; Fuller, C.J.; Guan, Z.; Yao, Z.; Kong, J.; Lu, J.; Litvak, I.J. Alcohol abuse/dependence symptoms among hospital employees exposed to a SARS outbreak. Alcohol Alcohol. 2008, 43, 706–712. [Google Scholar] [CrossRef] [PubMed]
- De Goeij, M.C.; Suhrcke, M.; Toffolutti, V.; van de Mheen, D.; Schoenmakers, T.M.; Kunst, A.E. How economic crises affect alcohol consumption and alcohol-related health problems: A realist systematic review. Soc. Sci. Med. 2015, 131, 131–146. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Gritsenko, V.; Skugarevsky, O.; Konstantinov, V.; Khamenka, N.; Marinova, T.; Reznik, A.; Isralowitz, R. COVID 19 Fear, Stress, Anxiety, and Substance Use among Russian and Belarusian University Students. Int. J. Ment. Health Addict. 2020, 1–7. [Google Scholar] [CrossRef]
- Reznik, A.; Gritsenko, V.; Konstantinov, V.; Yehudai, M.; Bender, S.; Shilina, I.; Isralowitz, R. First and Second Wave COVID-19 Fear Impact: Israeli and Russian Social Work Student Fear, Mental Health and Substance Use. Int. J. Ment. Health Addict. 2021, 1–8. [Google Scholar] [CrossRef]
- Boden, J.; Fergusson, D.M. Alcohol and depression. Addiction 2011, 106, 906–914. [Google Scholar] [CrossRef] [PubMed]
- McHugh, R.K. Alcohol Use Disorder and Depressive Disorders. Alcohol Res. Curr. Rev. 2019, 40, arcr.v40.1.01. [Google Scholar] [CrossRef]
- Wachtler, B.; Michalski, N.; Nowossadeck, E.; Diercke, M.; Wahrendorf, M.; Santos-Hövener, C.; Lampert, T.; Hoebel, J. Sozioökonomische Ungleichheit und COVID-19–Eine Übersicht über den Internationalen Forschungsstand. 2020. J. Health Monit. 2020, 5. [Google Scholar] [CrossRef]
- Dorn, A.V.; Cooney, R.E.; Sabin, M.L. COVID-19 exacerbating inequalities in the US. Lancet 2020, 395, 1243–1244. [Google Scholar] [CrossRef]
- Burström, B.; Tao, W. Social determinants of health and inequalities in COVID-19. Eur. J. Public Health 2020, 30, 617–618. [Google Scholar] [CrossRef]
- Hoebel, J.; Michalski, N.; Wachtler, B.; Diercke, M.; Neuhauser, H.; Wieler, L.H.; Hövener, C. Socioeconomic differences in the risk of infection during the second SARS-CoV-2 wave in Germany. Dtsch. Aerzteblatt Online 2021, 118, 269–270. [Google Scholar] [CrossRef]
- Bono, F.; Matranga, D. Socioeconomic inequality in non-communicable diseases in Europe between 2004 and 2015: Evidence from the SHARE survey. Eur. J. Public Health 2018, 29, 105–110. [Google Scholar] [CrossRef]
- Lago, S.; Cantarero, D.; Rivera, B.; Pascual, M.; Blázquez-Fernández, C.; Casal, B.; Reyes, F. Socioeconomic status, health inequalities and non-communicable diseases: A systematic review. J. Public Health 2018, 26, 1–14. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Lechner, W.V.; Laurene, K.R.; Patel, S.; Anderson, M.; Grega, C.; Kenne, D.R. Changes in alcohol use as a function of psychological distress and social support following COVID-19 related University closings. Addict. Behav. 2020, 110, 106527. [Google Scholar] [CrossRef] [PubMed]
- Bäuerle, A.; Graf, J.; Jansen, C.; Dörrie, N.; Junne, F.; Teufel, M.; Skoda, E.-M. An e-mental health intervention to support burdened people in times of the COVID-19 pandemic: CoPE It. J. Public Health 2020, 42, 647–648. [Google Scholar] [CrossRef] [PubMed]
n | % | |
---|---|---|
Age | ||
18–24 | 439 | 15.6 |
25–34 | 731 | 26 |
35–44 | 624 | 22.2 |
45–54 | 552 | 19.2 |
55–64 | 348 | 12.4 |
>65 | 119 | 4.3 |
Education | ||
university degree | 1143 | 40.6 |
university attendance certificate | 909 | 32.3 |
secondary education | 737 | 26.2 |
no school certificate | 9 | 0.3 |
others | 15 | 0.5 |
Relationship status | ||
married/partner | 1792 | 63.7 |
single | 770 | 27.4 |
divorced | 192 | 6.8 |
widowed | 38 | 1.4 |
others | 21 | 0.7 |
Children under 18 years | 789 | 28 |
Occupational status | ||
employee | 1704 | 79 |
freelancer | 194 | 9 |
civil service | 133 | 4.7 |
others | 126 | 5.8 |
Unemployment | 76 | 2.7 |
Changes occupational/financial situation COVID-19 | ||
job threatened | 398 | 14.1 |
short-time work | 304 | 10.8 |
take debts | 156 | 5.5 |
job loss | 143 | 5.1 |
Preexisting chronic conditions | ||
mental disorders | 687 | 24.4 |
chronic respiratory diseases | 348 | 12.4 |
hypertension | 319 | 11.3 |
diabetes | 90 | 3.2 |
cardiovascular diseases | 81 | 2.9 |
M | MED | SD | Min | Max | >Cut-Off * | |
---|---|---|---|---|---|---|
Depressive Symptoms (PHQ 2) | 1.9 | 2 | 1.8 | 0 | 6 | 20.4% |
Generalized Anxiety (GAD 7) | 6.8 | 6 | 5.5 | 0 | 21 | 23.6% |
COVID-19-Anxiety Questionnaire | 19.1 | 18 | 6.9 | 1 | 40 | - |
n | % | |
---|---|---|
Any alcohol use last 30 days | 1898 | 67.5 |
Days with alcohol use (last 30 days) | ||
no alcohol use | 915 | 32.5 |
1–8 | 1308 | 46.5 |
9–24 | 491 | 17.5 |
25 and more | 99 | 3.5 |
Drinks */occasion | ||
1–2 | 1422 | 74.9 |
3–4 | 346 | 18.2 |
5–6 | 85 | 4.5 |
7–8 | 37 | 1.9 |
9 or more | 8 | 0.4 |
Changes alcohol use (n = 1898) | ||
less alcohol use | 351 | 18.5 |
no difference | 1111 | 58.5 |
more alcohol use | 436 | 23 |
Nicotine use | 676 | 24 |
Changes nicotine use (n = 676) | ||
less nicotine use | 74 | 10.9 |
no difference | 410 | 60.7 |
more nicotine use | 192 | 28.4 |
Other substance use | ||
Cannabis | 75 | 2.7 |
Amphetamine | 20 | 0.7 |
Cocaine | 13 | 0.5 |
Opioid analgesics/sedatives (not prescribed) | 12 | 0.4 |
Changes other substance use (n = 120) | ||
less substance use | 24 | 20 |
no difference | 43 | 35.8 |
more substance use | 53 | 44.2 |
B | SE | Wald | df | p | Odds Ratio Exp (B) | 95% CI | ||
---|---|---|---|---|---|---|---|---|
Alcohol | ||||||||
PHQ 2 | 0.067 | 0.048 | 1.957 | 1 | 0.162 | 1.069 | 0.973 | 1.175 |
GAD 7 | 0.074 | 0.018 | 17.076 | 1 | 0.000 | 1.077 | 1.040 | 1.116 |
COVID-19 Anxiety Questionnaire | 0.012 | 0.0110. | 1.135 | 1 | 0.248 | 1.013 | 0.991 | 1.034 |
Constant | −2.094 | 0.176 | 141.745 | 1 | 0.000 | 0.123 | ||
Nicotine | ||||||||
PHQ 2 | 0.044 | 0.075 | 0.345 | 1 | 0.557 | 1.045 | 0.902 | 1.211 |
GAD 7 | 0.121 | 0.028 | 18.371 | 1 | 0.000 | 1.129 | 1.068 | 1.194 |
COVID-19 Anxiety Questionnaire | 0.022 | 0.016 | 2.029 | 1 | 0.154 | 1.023 | 0.992 | 1.054 |
Constant | −2.463 | 0.280 | 77.398 | 1 | 0.000 | 0.085 |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Schecke, H.; Fink, M.; Bäuerle, A.; Skoda, E.-M.; Schweda, A.; Musche, V.; Dinse, H.; Weismüller, B.M.; Moradian, S.; Scherbaum, N.; et al. Changes in Substance Use and Mental Health Burden among Women during the Second Wave of COVID-19 in Germany. Int. J. Environ. Res. Public Health 2021, 18, 9728. https://doi.org/10.3390/ijerph18189728
Schecke H, Fink M, Bäuerle A, Skoda E-M, Schweda A, Musche V, Dinse H, Weismüller BM, Moradian S, Scherbaum N, et al. Changes in Substance Use and Mental Health Burden among Women during the Second Wave of COVID-19 in Germany. International Journal of Environmental Research and Public Health. 2021; 18(18):9728. https://doi.org/10.3390/ijerph18189728
Chicago/Turabian StyleSchecke, Henrike, Madeleine Fink, Alexander Bäuerle, Eva-Maria Skoda, Adam Schweda, Venja Musche, Hannah Dinse, Benjamin Maurice Weismüller, Sheila Moradian, Norbert Scherbaum, and et al. 2021. "Changes in Substance Use and Mental Health Burden among Women during the Second Wave of COVID-19 in Germany" International Journal of Environmental Research and Public Health 18, no. 18: 9728. https://doi.org/10.3390/ijerph18189728