Health-related quality of life and mental well-being of healthy and diseased persons in 8 countries: Does stringency of government response against early COVID-19 matter?

Di Long, Juanita A Haagsma, Mathieu F Janssen, John N Yfantopoulos, Erica I Lubetkin, Gouke J Bonsel, Di Long, Juanita A Haagsma, Mathieu F Janssen, John N Yfantopoulos, Erica I Lubetkin, Gouke J Bonsel

Abstract

Objectives: Our study aimed to (1) assess health-related quality of life (HRQoL) and mental well-being of healthy and diseased persons in the general population during the early stage of the COVID-19 pandemic and (2) examine the relationship between HRQoL and mental well-being and individual characteristics and government response against COVID-19, as measured by the stringency index.

Methods: A web-based survey was administered to a cohort of persons from the general population of eight countries: Greece, Italy, the Netherlands, Russia, South Africa, Sweden, the United Kingdom (UK) and the United States of America (US) from April 22 to May 5 and May 26 to June 1, 2020. Country-level stringency indices were adopted from the COVID-19 Government Response Tracker. Primary outcomes were HRQoL, measured using the EQ-5D-5L, and mental well-being, measured using the World Health Organization-5 Well-Being (WHO-5).

Findings: 21,354 respondents were included in the study. Diseased respondents had lower EQ-5D-5L and WHO-5 scores compared to healthy respondents. Younger respondents had lower WHO-5 scores than older respondents. The stringency index had a stronger association with the EQ-5D-5L and WHO-5 among diseased respondents compared to healthy respondents. Increasing stringency was associated with an increase in EQ-5D-5L scores but a decrease in the WHO-5 index.

Conclusion: The stringency of government response is inversely related to HRQoL and mental well-being with a small positive relation with HRQoL and strong negative relation with mental well-being. The magnitude of effects differed for healthy and diseased persons and by age but was most favourable for diseased and older persons.

Keywords: COVID-19; EQ-5D-5L; HRQoL; Stringency index; WHO-5; Well-being.

Conflict of interest statement

The authors declare that they have no conflict of interest.

© 2021 The Authors. Published by Elsevier Ltd.

Figures

Fig. 1
Fig. 1
Health domain of the EQ-5D-5L and WHO-5, for eight countries during the early stage of the COVID-19 pandemic (n = 21,354).
Fig. 2
Fig. 2
HRQoL and mental well-being (EQ-5D-5L index, EQ VAS and WHO-5 index) in eight countries during the early stage of the COVID-19 pandemic (n = 21,354) Note to Fig. 2: EQ-5D-5L value set of the US is chosen for all countries to allow comparison across countries. The number in the figure refers to the ranking by country in each outcome.
Fig. 3
Fig. 3
EQ-5D-5L index and WHO-5 according to age categories and stringency of government response, for healthy (N = 11,418) and diseased (N = 9936) persons separately.
Fig. 4
Fig. 4
Optimal health domains of HRQoL and mental well-being according to the stringency of government response among healthy (A, N = 11,418) and diseased (B, N = 9936) persons separatelyNote to Fig. 4: optimal health refers to “no problems” for EQ-5D-5L and “at no time” for WHO-5.

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