Changes in mental health among drug users during Covid-19. Evidence from a repeated cross-sectional survey in Belgium

Background: The spread of Covid-19 and subsequent governmental restrictions had a substantial impact on both our mental and physical health. By using data collected from the very first month of the pandemic, this study offered unique, evidence-based insights into the changes in mental health of drug users – a vulnerable subpopulation - during the Corona pandemic, and whether these changes differed by type of drug and socio-demographic characteristics.

Method: We used a convenience sample from four waves of PWUD Web Survey (2020-2021). Participants were Belgian adults (≥ 18 years) who consumed cannabis, cocaine, amphetamines, and/or ecstasy in the past month (N = 4897). Mental health was assessed using self-reported anxiety (General Anxiety Disorder-7) and depression (Patient Health Questionnaire-9) scales. Statistically weighted prevalence estimates were computed to ensure cross-wave comparability.

Results: We found a steady increase in anxiety and depression between April 2020 and March 2021, coinciding with a long period of social distancing and isolation. This is however followed by a substantial decline between March and October 2021, when the measures relaxed and most people had been vaccinated. Furthermore, there was a substantially higher percentage of respondents with severe mental distress among daily users compared to weekly or monthly users. The findings showed also higher percentages of severe mental illness among the amphetamine and cocaine users compared to ecstasy or cannabis users. Respondents aged 18 to 29, females, primary degree holders, or the unemployed experienced higher rates of anxiety and depression compared to their counterparts.

Conclusion: These results offered novel, empirical evidence of increased mental distress during the rapid spread of the COVID-19 pandemic and, more notably how it varies by social-demographic and drug habit characteristics. This information is paramount in understanding the health consequences of the current and future crises and consequently in designing effective support responses.