Coping with stress and alcohol consumption during covid-19 lockdown

Background: Lockdowns have been implemented to limit the spread of the 2019 coronavirus disease (COVID-19). While effective, it has also been reported that lockdowns negatively affect psychological wellbeing, which has been associated with increased substance misuse.

Objective: To investigate the impact of the COVID-19 lockdown on alcohol consumption.

Methods: An online survey was conducted among the Dutch population [1]. Number of alcoholic drinks and number of drinking days per week were collected. This was done for the pre-lockdown period (15 January–14 March 2020) and the first Dutch lockdown (15 March–11 May 2020). Using 1-item scales, stress was assessed on a scale ranging from absent (0) to extreme (10) [2]. Coping with stress was assessed with the corresponding subscale of the Fantastic Lifestyle Checklist [3]. Perceived immune fitness was assessed using a scale ranging from 0 (very poor) to 10 (excellent) [4]. Assessed COVID-19 symptoms included sneezing, runny nose, sore throat, cough, and malaise/feeling sick, high temperature (up to 38 Celsius), fever (38 Celsius and higher), shortness of breath, and chest pain [1]. Severity was rated as none (0), mild (1), moderate (2), or severe (3). The sum score of items served as the COVID-19 symptom severity score. COVID-19 symptom presence was calculated as the sum of symptoms with a score > 0. Assessments before and during the COVID-19 lockdown were compared using the Related Samples Wilcoxon Signed Rank Test. For each variable, difference scores (Δ, lockdown – before lockdown) were calculated. For the difference scores, Pearson's correlations with alcohol consumption outcomes were calculated.

Results: Data of N=761 participants were analyzed (mean (SD) age 42.3 (19.0), 61.6% female). Compared to pre-lockdown, the lockdown period was associated with poorer mood (e.g. anxiety, depression, loneliness, fatigue, loneliness) and increased stress levels (all p<0.0001). The Δ stress scores correlated significantly with the quantity (r=0.117, p=0.002) and frequency (r=0.088, p=0.018) of alcohol consumption. The Δ coping with stress scores correlated significantly with both the quantity (r=-0.200, p<0.0001) and frequency (r=-0.229, p<0.0001) of alcohol consumption. Significant correlations were found between Δ perceived immune fitness and Δ stress (r=-0.288, p<0.0001) and Δ coping with stress (r=0.360, p<0.0001), as well as between Δ perceived immune fitness and the quantity (r=-0.082, p=0.030), but not the frequency (r=-0.019, p=0.614) of alcohol consumption. About half of the participants did not alter weekly alcohol consumption during lockdown (50.4%), whereas 25.9% reported a decrease, and 23.8% reported an increase. The increase in stress was greatest among those that increased alcohol consumption (p=0.025), while coping with stress was poorest for this group (p=0.001). Only for those that increased alcohol consumption, a significant poorer perceived immune fitness (p=0.012), and an increase in both the presence (p=0.013) and severity (p=0.007) of COVID-19 symptoms was found.

Conclusions: A substantial number of individuals increased alcohol consumption during lockdown. Increased alcohol consumption was associated with poorer perceived immune fitness and increased presence and severity of COVID-19 symptoms. These effects were not seen in individuals that did not increase alcohol consumption, presumably due to attaining better coping strategies for lockdown-related stress