2.1. Context, Study Design, and Population Recruited
The data were collected through an online anonymous survey which ran from 10 April to 6 May 2020, during the first lockdown declared in Switzerland. Switzerland was the second country in Europe (after Italy) to declare a state of emergency on 16 March 2020, following the declaration of the COVID-19—an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)—pandemic by the World Health Organization (WHO). The Swiss Government took severe measures on 20 March 2020, such as keeping only essential shops open and prohibiting gatherings of more than five people. Nevertheless, citizens were allowed to go out [38
]. On 8 April, the reproductive number of COVID-19 dropped significantly below 1 and the number of confirmed cases and hospitalized cases decreased enough to allow a phase of easing restrictions [38
], with the end of lockdown on April 29.
Electronic flyers and videos introducing the study were disseminated through the website “Mental et COVID-19: on en parle”, as well as through institutional and private social media platforms (e.g., the podcast called “Le Short”, LinkedIn, and a website of a local association). The survey was carried out online, on the EFS Platform of Unipark® (Questback GmbH, Cologne, Germany), which was hosted in a BSI/ISO 27001 certified data centre owned by Datagroup Bremen GmbH. The participants IP addresses were not saved and no identifiable information was collected (e.g., the participants filled their belonging to an age class or house income category). Thus, anonymity was guaranteed, and there was no way to link participants with responses. The Vaud Ethics Committee authorized such an anonymous survey (CER-VD1.0_200604). Participants were informed of the aims, risks, and benefits of the study. Those who chose to participate provided informed consent. The survey took approximately 20 min to complete; participants were free to skip any questions they did not wish to answer and could stop participating at any time. A total of 525 participants agreed to participate to the study and all met the eligibility criteria (aged over 18 years and currently residing in the French-speaking regions of Switzerland). Of those, 431 finished the survey.
Participants provided information regarding their gender, age class (18–30, 31–40, 41–50, 51–60, more than 61 years old), marital status, number of children (none, 1, 2, or more than 3), education level, monthly family income category, employment status, citizenship (Swiss, dual citizenship, other), and pregnancy status for women (the variables are detailed in Table 1
). They also provided information about how many people were living together (including children), the area of the living space, and whether there was access to a balcony or garden.
Changes experienced. A total of 22 items covering the major areas of life were used to collect information on the changes that might have been experienced by the participants during the four weeks preceding the survey. Only seven items explicitly asked if they were associated with the current COVID-19 situation. Each area questioned and the type of response associated are detailed in the following.
Work (4 changes tracked). The participants responded with “yes” or “no” to four items concerning the occurrence of changes in their work lifestyle, the shift to teleworking, the shift to partial unemployment, and a decrease in household income due to the current COVID-19 situation. They responded by “less”, “equal”, or “more than usual” to the items concerning their workload and the current COVID-19 situation.
Social life (1 change tracked). The response format was a 5-point scale, ranging from “never” to “all the time”, for the question whether there had been times when the current COVID-19 situation had hindered their social life and relationships with others, including family, friends, and acquaintances.
Home environment (2 changes tracked). Two items were considered: one on home-schooling and one on house cleaning frequency. The participants responded with “yes” or “no”, regarding whether the children with whom they lived were home-schooled due to pandemic. They answered the item regarding house cleaning frequency with “less”, “equal”, or “more than usual”.
Mode of transportation (1 change tracked). Participants indicated, with “yes” or “no”, whether they had changed their transportation habits in the last 4 weeks. Information on their usual and actual transportation habits (walking, cycling, public transport, by car) were also collected.
Leisure Activities (2 changes tracked). Participants indicated, with “yes” or “no”, whether they had done activities that were different than usual, due to the current situation of COVID-19. They answered, with a 5-point scale ranging from “never” to “all the time” to the questions: “did you accomplish less activities than usual” and “did you have to stop doing some things”.
Physical activity (1 change tracked). Information on physical activity practiced was collected through two questions: one regarding how often they usually exercise for at least 20 min (never, almost never, less than once a week, once a week, twice a week, three times a week, or more) and one on the frequency of practice in the last 4 weeks.
Food intake (1 change tracked). The participants indicated, using a 5-point scale ranging from “never” to “all the time”, at which frequency they had eaten more or less than usual in the past 4 weeks, due to the current situation of COVID-19.
Traumatic events (5 changes tracked). One item queried on the occurrence of unexpected events in the last four weeks, with no specific association to the COVID-19 situation (sickness, conflict, financial difficulties, deaths, moving out). The participants answered, with “yes” or “no”, whether:
They had any novel sickness, any major illnesses they already had, a major illness affecting a family member close to them, an accident or injury, or if they had started caring for/helping a relative or friend;
they had broken up with a close relative (their lover, family, friends) or had conflicts with neighbours;
they had major financial difficulties;
someone in their close circle died (spouse or partner, one of their children, their father or mother, a sibling, another relative or close friend) or if they had lost their house pet;
they moved out: a voluntary move, a forced relocation, or the loss of their home; or
none of the above events.
Less accomplishment than participants would have liked (4 changes tracked). Four items were formulated, in the same way (all finishing in “you would have liked to do”), to collect information on respondent’s frustration regarding different aspects of their life:
workload (more, enough, or less than preferred),
accomplish fewer things (always, often, sometimes, rarely, never),
hang out more or less frequently than preferred (yes or no), and
do physical activity more or less than preferred (yes or no).
Quality of Life.
To evaluate the mental and physical health-related quality of life (HRQoL) of the participants, the French version of the Short Form-12 (SF12) was used [39
]. The SF12 is a standard scale of mental and physical health functioning. It contains 12 items and 8 dimensions: physical functioning (PF, 2 items), role limitations due to physical health problems (RP, 2 items), bodily pain (BP, 1 item), general health (GH, 1 item), vitality (VT, 1 item), social functioning (SF, 1 item), role limitations due to emotional problems (RE, 2 items), and mental health (MH, 2 items) [40
Risk Perception of COVID-19.
Ten items were designed, according to the standard risk perception questionnaire developed by the Municipal Public Health Service Rotterdam-Rijnmond and the National Institute for Public Health and the Environment [41
]: one on knowledge (a 4-point scale), one on the perception of seriousness of the disease (a 4-point scale), two on perception of susceptibility to the disease and the extent of anxiety (2- and 5-point scales, respectively), four on perception of efficacy (a 5-point scale ranging from “certainly not”/“never” to “most certainly”/“always”) and self-efficacy, and one on the information sources they believed (detailed in supplementary material, Table S1
2.3. Statistical Analysis
Descriptive statistics—frequencies with proportions and means with standard deviations (SD)—were used to describe the profiles of respondents and the changes experienced. Multivariate regressions were used to determine which participant characteristics were associated with each change. Obvious imposed, unwished, and unexpected changes were regrouped into three dimensions and one score was created for each dimension, by summing equivalent weights for the considered items. A higher score indicates more changes experienced. The scores for the imposed changes were regrouped into five items: changes in household income, in work lifestyle (comprising shift to teleworking and partial unemployment), starting home-schooling, and in social life interactions. The score for unexpected changes was established based on the occurrence of five traumatic events: sickness, conflict, financial difficulties, death, and moving out. The score for unwished changes included the four items on those things that did not go as desired. A score was also generated for the overall number of changes experienced by each participant. Multivariate regression models adjusted for sex, age, citizenship, number of children at home, education status, employment status, and lockdown duration (in weeks) were applied, in order to identify associations of change scores with the mental or the physical HRQoL, as well as with the risk perception of COVID-19. Similar statistics were conducted to identify the association of risk perception of COVID-19 with the mental or the physical HRQoL. Multinomial logistic regression was used to test the relationship between the risk perception of COVID-19 and the four change scores, after controlling for the sociodemographic factors. All analyses were carried out using the STATA 14 software (StataCorp LLC., College Station, TX, USA).