COVID-19 Social Distancing, Mental Health, and Coping Strategies in Greece

The study examines how COVID-19-related social restriction measures (lockdowns, quarantines, and social distancing) affected mental health outcomes and coping strategies in Greece during the second pandemic wave. Against a backdrop of prior evidence linking non-pharmacological interventions to mental health deterioration and Greece’s recent history of economic hardship (associated with increased depression and suicidality), the research aims to quantify depression, anxiety, stress, and trauma-related distress, and to identify demographic, exposure-related, and behavioral predictors, including adherence to quarantine and coping styles.

Prior outbreaks (SARS, MERS, H1N1) and early COVID-19 studies indicate elevated depression, anxiety, stress, and trauma-related distress not only among infected individuals and healthcare workers but also the general population due to financial insecurity, uncertainty, restrictions of personal liberties, stigma, daily-life disruption, and social isolation. Meta-analyses during COVID-19 report modest to substantial psychological impacts. Greek studies during the pandemic have shown adverse mental health effects, with vulnerabilities linked to female gender, younger age, and unemployment. Domestic conflict and social isolation have been highlighted as key correlates of poorer mental health in international samples. Coping literature distinguishes problem-focused, emotion-focused, and avoidant strategies, with positive reframing and acceptance often protective, and avoidant strategies associated with worse outcomes.

Design: Cross-sectional online survey during Greece’s second COVID-19 wave (Feb 3–Jun 1, 2021). Recruitment via snowball sampling through social media and professional mailing lists. Ethics approvals from Autonomous University of Madrid (CEI-106-206) and Scientific College of Greece HREC; procedures adhered to the Declaration of Helsinki. Participants: N=650 after data cleaning (465 female, 71.5%); mean age 33.13 years (SD=12.2; range 18–77); mean education 16.6 years (SD=4.2). Most were employed/students (89.8%); 57.5% followed moderate restrictions, 17.7% severe, 4% none. Measures: - Epidemic-Pandemic Impacts Inventory (EPII; abbreviated 29-item subset) assessing COVID-19 exposure and impacts on work, finance, education, home life, and social isolation (Yes/No). - Quarantine adherence level (four levels from none to severe). - Depression Anxiety Stress Scales (DASS-21; Greek validated) for depression and stress. - Generalized Anxiety Disorder-7 (GAD-7) for anxiety. - CRIES-8 for trauma-related distress. - Brief COPE (14 items used) summarizing problem-focused, emotion-focused, and avoidant coping. Procedure: Online consent, anonymous participation; mental health helpline provided at completion. Data analysis: SPSS v23. Descriptive statistics and correlation matrix for demographics and outcomes. Four hierarchical linear regressions predicting CRIES-8, DASS-Depression, DASS-Stress, and GAD-7. Step 1: demographics (gender, age, employment, relationship status, living with children by age); Step 2: EPII exposure items; Step 3: quarantine adherence (dummy coded). Additional chi-square tests and correlations examined associations between coping styles, demographics, and outcomes.

- Prevalence/severity: 21.3% reported moderate-to-extremely severe anxiety (GAD-7); 33% moderate-to-extremely severe depression (DASS-21); 31.8% moderate-to-severe stress (DASS-21); 38% had clinically significant trauma-related distress (CRIES-8 >17). Mean CRIES-8=13.76 (SD=10.5). - Correlations: Trauma distress correlated with depression r=.46, stress r=.53, anxiety r=.51 (all p<.001). Depression with anxiety r=.74 and stress r=.71 (p<.001). Anxiety with stress r=.83 (p<.001). Age negatively correlated with depression (r=-.14) and stress (r=-.18); anxiety (r=-.15) (all p<.001 or p<.01). - Group differences: Women reported higher depression (M=11.42 vs 8.30), stress (M=16.31 vs 12.06), and anxiety. Single status and unemployment were weakly associated with higher depression severity (χ2 tests p≤.033). - Hierarchical regressions: Adherence level to restrictions did not add predictive power in any model. Significant predictors across outcomes (standardized betas from final models): • CRIES-8: Increase in verbal arguments/conflict at home (β=.23, p<.0001), separation from family/close friends (β=.14, p<.001), female gender (β=.13, p<.001). Adjusted R2≈.095. • DASS-Depression: Separation from family/close friends (β=.23, p<.001), increase in verbal arguments/conflict (β=.19, p<.001), marital status (single higher; β=-.13, p=.004), unable to get enough/healthy food (β=.11, p=.002), employment status (unemployed higher; β=.11, p=.004), female gender (β=.08, p=.027). Adjusted R2≈.19. • DASS-Stress: Increase in verbal arguments/conflict (β=.36, p<.001), separation from family/close friends (β=.21, p<.001), unable to get enough/healthy food (β=.12, p<.001), younger age (β=-.10, p=.021), female gender (β=.09, p=.009). Adjusted R2≈.26. • GAD-7: Increase in verbal arguments/conflict (β=.28, p<.001), separation from family/close friends (β=.23, p<.001), female gender (β=.11, p=.002), younger age (β=-.10, p=.033), unable to get enough/healthy food (β=.08, p=.034). Adjusted R2≈.21. - Coping: Most endorsed strategies: acceptance, positive reframing, planning, active coping, self-distraction. Avoidant coping correlated moderately with trauma (r=.52), stress (r=.52), depression (r=.51), anxiety (r=.50) (all p<.001). Emotion-focused and problem-focused coping showed weaker positive correlations with distress indices. Gender differences: women more often used self-distraction, active coping, emotional support, behavioral disengagement, venting, instrumental support, and positive reframing (several p<.01).

The study demonstrates substantial psychological burden among Greek adults during the second COVID-19 wave, with one-fifth to one-third experiencing moderate-to-severe symptoms across anxiety, depression, and stress, and nearly two-fifths reporting clinically significant trauma-related distress. Pandemic-related life disruptions—particularly increased verbal conflict within the home, separation from family and close friends, and difficulty accessing enough or healthy food—were stronger predictors of adverse mental health than demographic factors or the stringency of quarantine adherence itself. This suggests the psychological toll stemmed predominantly from social and domestic disruptions and material insecurity rather than the formal level of restrictions followed. Demographic vulnerabilities were evident: women, younger individuals, and the unemployed/single reported higher symptom levels, consistent with broader epidemiological patterns of mental health inequality. Coping shifted toward individual resilience strategies (acceptance, reframing, planning, active coping) with reduced reliance on social support, reflecting both physical and psychological distancing; however, avoidant coping was associated with worse outcomes. These findings highlight the need for targeted supports addressing domestic conflict, social isolation, and basic needs during public health crises.

This study adds evidence that COVID-19 social restriction measures were associated with notable psychological burden in Greece, with domestic conflict, social separation, and food insecurity emerging as key risk factors. Demographic vulnerabilities included female gender, younger age, and unemployment/single status. Interventions should prioritize mitigating domestic conflict, enhancing social connection despite distancing, and ensuring access to basic needs, alongside promoting adaptive coping (e.g., acceptance, positive reframing, planning) and discouraging avoidant strategies. Future research should employ longitudinal designs to clarify causal pathways, evaluate the efficacy of targeted supports, and determine how voluntary versus imposed restrictions differentially affect mental health.

- Cross-sectional design precludes causal inference. - Online convenience sampling may bias the sample (excludes those with limited internet access). - Reliance on self-report measures without clinical verification may over- or underestimate symptom severity. - Abbreviated versions of some instruments (EPII, Brief COPE subset) may limit measurement breadth. - Generalizability may be limited due to sampling approach and demographic composition.