# Psychological outcomes of depression after legally enforced quarantine during the COVID-19 pandemic: a cross-sectional study

## TL;DR

People with depression experienced more psychological distress during enforced quarantines in the pandemic and needed more support.

## Contribution

The study shows that individuals with pre-existing depression face significantly higher psychological distress during quarantines.

## Key findings

- Individuals with depression had significantly higher psychological distress scores during quarantine.
- Those with depression reported lower coping and resilience scores and used support systems more frequently.
- A model explained 31.2% of the variance in psychological distress based on factors like age, gender, and health status.

## Abstract

Legally enforced quarantines during the COVID-19 pandemic resulted in increased psychological distress, particularly among individuals with pre-existing mental health conditions. In this study, part of the Cologne Corona Counselling and Support for Infected and Contact Persons During the Quarantine Period (CoCo-Fakt) project, we hypothesised that individuals with pre-existing depression experienced greater psychological distress during legally imposed quarantine/isolation and thus require additional support. We also aimed to explore whether coping mechanisms and resilience can enhance the care provided to at-risk individuals facing similar situations.

This study included 10,033 participants (infected and contact persons) registered with the Cologne Public Health Department between December 2020 and January 2021. We collected data via online questionnaires covering demographics, mental health status, coping strategies, resilience, and support system usage.

Individuals suffering from depression (ISFDs, n = 260) reported significantly higher psychological distress scores than individuals not suffering from depression (INSFDs, n = 9773; p < 0.001). ISFDs also reported significantly lower coping (p < 0.001) and resilience (p < 0.001) scores and used support systems approximately six times more often. Backwards elimination regression analysis revealed significantly higher psychological distress scores among individuals who were female, were younger, had higher educational level, had COVID-19, and had a chronic disease other than depression. No significant interactions were found in the moderation analyses. The model accounted for 31.2% of the observed variance.

The findings suggest the need for tailored interventions to help both ISFDs and INSFDs develop coping strategies and resilience during quarantines. Ensuring that sufficient therapeutic services and support are available for ISFDs is crucial for maintaining good mental health.

The online version contains supplementary material available at 10.1186/s12889-025-25751-0.