How do the perceived actions of citizens and governments relate to mental well-being and health around the globe?

We conducted a large-scale survey covering 58 countries, including many low- and middle-income countries at the onset of the COVID-19 pandemic (between March 20th and April 7th 2020). The survey was distributed globally using traditional and social media. In total 108,075 respondents responded to our survey during this time period. In the survey we elicit perceptions of the behavior of fellow citizens, governments, and respondents’ personality traits and mental well-being. To (partially) account for the selected nature of our sample we reweight our sample to be representative in terms of age, gender, income, and education.

We have several key findings.

First, we find that many of the respondents viewed their governments’ reactions to the crisis as insufficient and only a small fraction viewed their government’s response as too extreme (see Figure 1). In addition, a substantial proportion of respondents—36%—indicate that they do not trust their government’s handling of COVID-19, and 34% even state that they believe their government has not been truthful about COVID-19.

Second, we find that pessimistic views of citizens’ and governments’ response are associated with lower mental well-being. We assess mental well-being using two measures: one, the PHQ-8, is a widely-used depression scale, while the second contained items we developed to capture anxieties and worries specific to the COVID-19 pandemic. We regress these two measures of mental well-being on variables that capture respondents’ views of their fellow citizens and government during the COVID-19 pandemic. Our analyses use country and date fixed effects, and control for baseline demographics as well as perceived and actual COVID-19 case prevalence. This means that the coefficient can be interpreted as the change in the dependent variable, in standard deviations of this variable, associated with an increase in the independent variable by one standard deviation.

We find that perceptions of an insufficient public response are not significantly related to the depression index (ß=.036, SE=.022, p=.101) but are related to higher values on the worries index (ß=.140, SE=.020, p<.001). Similarly, perceptions of an insufficient government response are not significantly related to the depression index (ß=.048, SE=.036, p=.180) but are related to higher values on the worries index (ß=.183, SE=.019, p<.001). In addition, a lack of trust in the government’s response is related to both higher values on the depression index (ß=.090, SE=.027, p=.001) and worries index (ß=.093, SE=.018, p<.001), similar to perceptions of the government being untruthful (depression index: ß=.083, SE=.029, p=.005; worries index: ß= .079, SE=.017, p<.001). That is, respondents’ pessimistic beliefs about their fellow citizens’ and government’s response to COVID-19 are related to lower mental well-being, particularly in terms of their anxieties and worries specific to the COVID-19 pandemic.

Our third main finding is that strong government responses to COVID-19 may reduce pessimistic views and improve mental well-being. For this purpose, we study the effect of nationwide lockdowns (“stay-at-home” orders) that were declared in many countries during our study period.  We find that as a country announced a nationwide lockdown, respondents were less likely to view their government as not being truthful (ß=-.115, SE=.056, p=.045), less likely to view the government’s reaction as insufficient (ß=-.165, SE=.068, p=.018), and reported lower values on the worries index (ß=-.091, SE=.044, p=.043). However, we find no statistically significant effect of lockdown announcements around the world on the perceived sufficiency of public response (ß=-.034, SE=.064, p=.594), trust in government (ß=-.090, SE=.067, p=.183), or the depression index (ß=.108, SE=.112, p=.340). We further find that the positive effects of lockdowns are stronger in countries that have exhibit higher levels of trust prior to the pandemic. 

Our analyses reveal that at the onset of the COVID-19 pandemic, a majority of respondents around the world believed that their fellow citizens and government were not doing enough, and that this was associated with worse mental well-being. Decisive actions from policy-makers—operationalized here as the announcement of a nationwide lockdown—were related to positive changes in how respondents perceived their fellow citizens and government both in our cross-country analysis and in the within-country event study, with the latter also finding improvements on mental well-being. These effects—as well as the fact that at the cross-country level, they were somewhat more pronounced in countries with higher levels of pre-COVID trust in government.

However, the durability of the effects of strong government action on mental well-being outcomes are unclear. That is, the rapidly changing information environment, with new developments occurring at a weekly or even daily basis, may trigger renewed uncertainty, particularly when governmental actions are seen as insufficient to quell the ongoing pandemic. As governments around the world debate whether to extend or loosen restrictions, our findings highlight that policymakers may not only need to consider how their decisions affect the spread of COVID-19, but also how such choices influence the mental well-being of their population. This may matter not just for the immediate response to COVID-19, but also for medium- and long-term policies that may require the public and the government to focus on both physical and mental well-being.