[Change in psychological burden during the COVID-19 pandemic in Germany: fears, individual behavior, and the relevance of information and trust in governmental institutions].

Background: The potential impact of the COVID-19 pandemic on mental health was evident early on. The extent of the effects, especially cumulative over the long period of the pandemic, has not yet been fully investigated for Germany.
Objectives: The aim of the study was to determine psychological burden as well as COVID-19-related experience and behavior patterns and to show how they changed during the different phases of the pandemic in Germany.
Materials and Methods: The Germany-wide online-based cross-sectional study (03/10-07/27/2020) included 22,961 people (convenience sample). Generalized anxiety (GAD-7), depression (PHQ-2), and psychological distress (DT) were collected, as well as COVID-19-related experiences and behavior patterns: COVID-19-related fear, trust in governmental actions, subjective level of information, adherent safety behavior, and personal risk assessment for infection/severe course of illness. The pandemic was retrospectively divided into five phases (initial, crisis, lockdown, reorientation, and new normality).
Results: Compared to pre-COVID-19 reference values, GAD‑7, PHQ‑2, and DT levels were significantly elevated and persistent throughout the different phases of the pandemic. COVID-19-related fear, information level, trust, safety behavior, and the risk assessment for infection/severe course of illness showed, after initial strong increase, a strong decrease to partly below the initial value. Exceptions were constant risk assessments of having a severe course of illness or dying of it.
Conclusions: The increased levels of psychological burden, which have persisted throughout all phases of the pandemic, illustrate the need for sustainable support services. Declining values over the duration of the pandemic in terms of trust in governmental actions and the feeling of being well informed underline the need for more targeted education.