Pharmacopsychiatry 2020; 53(05): 237-238
DOI: 10.1055/a-1190-5029
Letter to the Editor

Cross-Cultural Validity of Psychological Distress Measurement During the Coronavirus Pandemic

Shuyan Liu
1   Department of Psychiatry and Psychotherapy (CCM), Charité – Universitätsmedizin Berlin, Germany
Andreas Heinz
1   Department of Psychiatry and Psychotherapy (CCM), Charité – Universitätsmedizin Berlin, Germany
› Author Affiliations

The coronavirus pandemic has had a disruptive impact on everyday life across large parts of the world [1]. Qiu et al. reported that, in China, more than one-third of respondents (34.4% of 52 730 respondents) experienced psychological distress during the COVID-19 pandemic [2]. To assess the psychological distress, they developed a COVID-19 Peritraumatic Distress Index (CPDI) questionnaire. However, the CPDI has never been applied in the European context. This highlights the importance of how the CPDI questionnaire might perform in a clinical setting to assess mental state of the general population in Germany. Here we take a similar approach to survey how people living in Germany are coping psychologically with the disruption engendered by the COVID-19 outbreak. We aim to provide advice to the public on how to prevent distress and build coping skills.

We conducted an online survey on Siuvo platform identical to that used in previous studies in China [2]. The survey included a socio-demographic assessment and the CPDI questionnaire. The conduct of the study was approved by the Ethics Committee of Charité – Universitätsmedizin Berlin (ref: EA1/132/15).

1007 German respondents (aged 18 years or older) participated (750 females; age range: 18–81, Mean=42.0, SD=13.2). The average CPDI score from this Germany-based sample (Mean=21.9, SD=12.6) was 1.8% lower than that previously reported for the China-based sample (Mean=23.7, SD=15.4). Thus, in Germany, 24.1% of respondents reported psychological distress (ranging from 20.6% mild to 3.6% severe stress), ratings substantially lower than in China where 34.4% of the population reported distress (29.3% mild and 5.1% severe). This difference may reflect a comparatively higher testing rate in Germany, which may confer a sense of security and where individuals are tested early on and included those with no or mild symptoms. Moreover, Germany has a lower overall death rate for COVID-19 (5.0%) as compared to China (5.6%) as of May 17, 2020 (, and previous studies suggest that self-reported fear is positively associated with death rate by country [3]. Indeed, the majority of respondents (39.3%) reported being “worried in general” during the ongoing COVID-19 pandemic. COVID-19 has generated fear of death and social rejection [4].

It is of interest that less than 3% of respondents endorsed a coronavirus-related conspiracy theory (e. g. epidemic was “deliberately manufactured to serve the interest of powerful forces”).

A role of socio-demographic factors on respondents’ psychological distress was evident in both Germany and China. Female and younger people reported relatively higher levels of psychological distress. Thus, reported stress levels were higher in females vs. males both in Germany (Mean (SD)=22.7 (13.1) vs. 19.3 (11.0), p=0.002) and China (Mean (SD)=24.9 (15.0) vs. 21.4 (16.0), p <0.001). In Germany, higher levels of psychological distress were associated with younger age (Pearson r=− 0.12, p<0.001, two-tailed). Researchers reported that females and students in China experienced a greater psychological impact of the outbreak, and also reported higher levels of stress, anxiety, and depression [5]. Among young people, anxieties about future career and socioeconomic status appear to contribute to psychosocial stress associated with general anxieties about infection and social isolation [5]. However, our German-based sample did not involve participants under 18 years. Interestingly, the China-based sample reported that those under 18 years had the lowest CPDI score (Mean (SD)=14.8 (13.4) [2], arising from a fact that a relative low morbidity rate and China’s strict home quarantine enforcement among this age group.

In Germany, less educated respondents had a greater propensity to report psychological distress (Pearson r=− 0.05, p=0.09, two-tailed). A study in China reported that those with no formal education have a higher risk of depression during the COVID-19 pandemic [6]. One implication is that local authorities might best provide information in plain language, or in graphical format, in order to inform the general public in relation to the outbreak.

Regarding information sources in relation to the pandemic, 47.4% of our respondents reported obtaining “information only from reliable sources” is the best way to use social media to improve wellbeing. This finding supports the importance of reliable information provision, such as that provided by the World Health Organization, the Germany Federal Ministry of Health and the Robert Koch Institute.

We acknowledge limitations to our findings, not least their descriptive nature. Our results are limited by absence of biographical and social data which might reveal vulnerability factors. It is unclear what happened before the outbreak, and our data will need independent replication. Our motivation was to highlight the impact of this unprecedented event on the mental health of the population. In this regard it lays a foundation for a follow-up study and provides a guideline that can support planning and preparation in the event of a recurrence of the outbreak or widespread transmission of COVID-19.

As use a design and instrument deployed previously in China and, within its limitations, our data provide cross-cultural insight into the impact of the outbreak. We note that individuals in the sample are engaging in physical (e. g. walking or jogging being regarded as the most popular exercise among 54.8% of respondents) and cognitive activities (e. g. reading being most listed by 70.0% of respondents). State and local decision makers might avail of these data when targeting interventions for vulnerable populations (e. g. establish a national and local mental-health hotline and psychological counselling services) [7]. We also highlight the potential importance of providing information in plain and simple language including availing of widespread social media. Cross-cultural studies involving longitudinal research is urgently needed to identify resilience factors and to promote optimal coping styles.

Publication History

Received: 26 February 2020
Received: 28 May 2020

Accepted: 28 May 2020

Article published online:
24 June 2020

© 2020. Thieme. All rights reserved.

© Georg Thieme Verlag KG
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