Governments have imposed widespread restrictions on public life to cope with the pandemic worldwide. The resulting “social distancing” policies and other measures to contain the incidence of COVID-19 infections led to isolation and solitude for many individuals. Men are disproportionately affected by severe COVID-19 disease progression and show a higher mortality due to COVID-19. However, there is evidence from the scientific literature that women may be more affected by the economic, social and psychological consequences of the pandemic. Sectors with a high share of female employees were disproportionately affected by lockdown related closures, short-time work and job losses. Women are also more likely to work in atypical jobs with lower social security coverage or part-time, which contributes to lower financial security. In the pandemic, at least in families with “traditional” gender roles, the main burden of child care at home was on women because of closed schools and child care . In addition, employees in health care and other essential services are also mostly female and have been exposed to stress, high workload levels and an increased risk of infection during the pandemic. Additionally, in a student population, perceived stress with regard to COVID-19 was shown to be higher in female than in male individuals. Since the beginning of the pandemic, the impact of the COVID-19 situation on mental health in the population has been discussed. At the beginning of the pandemic, researchers drew attention to the necessity to address the public mental health consequences. Some authors argued that a “psychiatric pandemic” was co-occurring with COVID-19. In the meantime, numerous studies in various countries showed that the COVID-19 situation has negatively affected mental health. Population-based studies in Germany found evidence that depressive symptoms, anxiety, sleep disturbances and psychological distress increased as a response to COVID-19.
Research with repeated cross-sectional designs indicated that the implementation of contact restrictions was associated with increased levels of depression and anxiety that seem to have persisted even during the easing of those restrictions. Women experienced higher levels of depression and anxiety than men during the first COVID-19 wave. This corresponds to previous research demonstrating gender differences regarding depression, anxiety and insomnia because of the pandemic . Psychological distress and mental health problems are well-described risk factors for increases in the use of alcohol and other substances. Besides the potential negative effects for individuals,cannabis grow equipment significant increases in alcohol use are also a public health concern. In the German general population, per capita alcohol consumption is high by global standards. In the group of women in Germany, 13.1% drink alcohol in a hazardous pattern, defined for women as more than 10 g pure alcohol per day on average . Among women, alcohol consumption increases with higher socioeconomic status. Women with a higher socioeconomic status are twice as likely to drink hazardously than women with a middle or low socioeconomic status . A number of publications document changes in alcohol consumption under COVID-19 pandemic conditions for different countries, e.g., for the United States, the United Kingdom, Poland, Australia and France. These studies have shown that between one fifth and one quarter of adults increased their alcohol use after the pandemic started. Corresponding to those results, retailers in various countries have reported an increase in the sale of alcoholic beverages since the beginning of contact restrictions or lockdowns. In contrast, a very recent study in 21 EU countries showed that in most countries, with the exception of Ireland and the United Kingdom, there was a decrease in alcohol consumption. However, a reduction in alcohol consumption was less common among people who were particularly stressed by the pandemic. Other studies also found significant associations between higher levels of psychological distress, or depressive or anxiety symptoms and an increase in alcohol use. Among women, psychological distress related to COVID-19 has been significantly associated with the quantity of alcohol use, such as the number of drinks had at the last heaviest drinking event and the number of drinks on a typical occasion. For women, social distancing policies and the resulting loss of social support has been associated with an increase in hazardous drinking during the first lockdown in the USA. Those increases in alcohol consumption under pandemic conditions were interpreted as a dysfunctional coping mechanism for distress caused by the pandemic.
The analysis refers exclusively to the female part of a population-based German sample as it is hypothesized that women have been psychologically burdened by the COVID-19 pandemic differently to men due to their professional, family and social situation. In addition, women and men are known to differ in the extent and pattern of their drinking behavior. The objective of this analysis is to examine whether alcohol consumption changed in a German population-based sample of women under conditions of the COVID- 19 pandemic. In addition, the extent of depressive symptoms, anxiety and COVID-19 specific fears and their influence on alcohol, nicotine and illicit substance consumption are analyzed.A population-based and cross-sectional online survey with a self-selected convenience sample was conducted from October until December 2020. The survey covers the period of the “second wave” of the COVID-19 pandemic in Germany. During this phase, government mandated contact restrictions to contain the pandemic in Germany were relatively strict. Schools remained closed, public life was significantly restricted and people’s daily lives changed significantly. Inclusion criteria were at least 18 years of age and German language capabilities, since the survey was only available in German. Participants were recruited via social media, institutional newsletters and online press releases. Participation was anonymous and there were no financial compensations or other incentives for participation. Electronic informed consent was obtained prior to the start of the survey. Participation was voluntary and anonymous, and participants could withdraw from the study at any time. The study was conducted in accordance with the Declaration of Helsinki, and the Ethics Committee of the University Hospitals Essen has approved the study . The Foundation of University Medicine Essen funded the study. The Open Access Fund of the University of Duisburg-Essen funded the publication of the study.In this population-based sample of women in Germany, nearly one quarter of those who use alcohol increased their alcohol use.
Nearly one third of smokers increased their nicotine use and more than forty percent who used other substances increased their sub-stance use during the COVID-19 pandemic. One in five women reported major depressive symptoms and nearly one quarter at least mild symptoms of generalized anxiety.Depressive symptoms and specific COVID-19-related fears did not contribute significantly to an increase in alcohol or nicotine use. The proportion of approximately one quarter of the participants who reported an increase in their alcohol corresponds with the results of previous studies, which found similar rates of alcohol use during the first wave of COVID-19. The most significant increase in alcohol consumption in the 35–55 year old group may be explained by the fact that in this group the stress of childcare, homeschooling or caring for elderly relatives may have been more prevalent. Due to the ongoing social distancing policies, the opportunity to drink alcohol at parties, bars, restaurants or events decreased markedly. This may explain the decrease in alcohol consumption in the youngest age group, in which almost the same number of women reduced as increased their alcohol consumption. Due to the social distancing measures, it is likely that the increased alcohol consumption primarily occurred in private settings with family members, closest friends or alone. Social distancing and self-isolation came along with the disruption of daily routines, boredom, loss of daily structure and lack of social contacts, which were identified as motives for a rise in alcohol consumption during the pandemic. A US study also found that the longer people spent time at home, the higher the risk of binge drinking at home. The relief of negative emotions and stress caused by the pandemic might have been a further motivator to drink more alcohol. Increases in alcohol consumption can negatively affect physical health in various ways; it is a leading risk factor for global disease burden and causes substantial health loss. Alcohol use is an important cause of traffic accidents and self-harm among young people and promotes various types of cancer. Alcohol use also adversely affects cardiovascular diseases such as hypertension in a dose-dependent manner. In the context of COVID-19, the negative health impacts of alcohol use are important to consider as both cardiovascular diseases and cancer increase the risk for severe COVID-19 disease progression or mortality. With regard to nicotine, its use is also highly correlated with mental stress in women. In addition, external reasons may also have led to an increase in nicotine consumption. Contact restrictions and working from home meant that many people stayed mainly in their home environment. For smokers, this may mean that the smoking bans in public and reduced social control disappeared and may have led to an increase in cigarette consumption. Active smoking is a well-studied risk factor for the development and worsening of COPD, asthma and chronic respiratory diseases. Non-smokers in households with smokers may also have been more exposed to secondhand smoke during the pandemic and associated “stay at home” policies. Passive smoking increases the risk of asthma,mobile grow system reduced lung function and respiratory tract infections in children.
Tobacco use has a special role in the context of COVID-19 because of its negative impact on several preexisting conditions that promote the risk of severe COVID-19 disease progression. In the small subgroup of participants who use any illicit substances, predominantly cannabis, consumption increased considerably more than for alcohol and nicotine. These results were contrary to a Belgian sample that found no changes in cannabis use. However, the results are consistent with a longitudinal Dutch study that also found an increase in cannabis use during COVID-19, but no increase in the severity of cannabis use disorder in daily consumers. In this study, mental well being was reduced and contributed significantly to changes in cannabis use. In Canada, self-isolation was associated with an increase in consumption in male cannabis users; coping with depression motivated the use of more cannabis than pre-pandemic, and an increase in cannabis use was associated with financial concerns and lower education.Symptoms of generalized anxiety were the only mental health factor that predicted an increase in alcohol and nicotine use in this sample. Previous studies have shown diverse findings regarding alcohol use and anxiety under COVID-19 conditions. An Australian study found an association between anxiety and alcohol use, whereas another study in the United Kingdom found no correlation between alcohol use and anxiety in an adult sample who were in self-isolation. In general, the association of alcohol use and symptoms of anxiety and anxiety disorders are well documented. Although the COVID-19 pandemic is a novel situation, research on other collective stressful events such as SARS 1 in 2003 or the economic crisis in 2008 demonstrated that those events were associated with an increase in alcohol use, partly mediated by depression and anxiety symptoms. Evidence of specific COVID-19-related anxiety as an influencing factor is less clear. In contrast to generalized anxiety, specific fear of COVID-19 did not contribute significantly to explain changes in substance use in our study. This corresponds to findings from a US study, which also found that the subjective fear of virus infection was not associated with an increase in substance use. Another international study group found, however, a significant association between COVID-19-related fear and increases in substance use among Russian, Belarusian and Israeli students during the first wave of COVID-19. The finding that depressive symptoms do not significantly contribute to the increase in alcohol consumption is rather unexpected since previous studies showed the opposite effect. In general, an increase in depressive symptoms is a risk factor for alcohol use and vice versa. Major depression and alcohol use disorder are closely associated. The presence of either disorder doubles the risk of the second disorder. Co-occurrence of AUD and depressive disorders is associated with greater severity and worse prognosis for both disorde. In our female sample, one in five reported depressive symptoms above the cut-off in the PHQ, indicating that COVID-19 negatively affects mood and mental well being, but drinking alcohol to cope with depression does not seem to be the preferred option.