Article Text

Original research
Social, financial and psychological stress during an emerging pandemic: observations from a population survey in the acute phase of COVID-19
  1. Rebecca Robillard1,2,
  2. Mysa Saad1,
  3. Jodi Edwards3,
  4. Elizaveta Solomonova4,
  5. Marie-Hélène Pennestri5,6,
  6. Alexander Daros7,
  7. Samuel Paul Louis Veissière4,
  8. Lena Quilty7,8,
  9. Karianne Dion1,2,
  10. Ashley Nixon1,2,
  11. Jennifer Phillips9,10,
  12. Raj Bhatla9,11,
  13. Edward Spilg12,
  14. Roger Godbout6,
  15. Bashour Yazji13,
  16. Cynda Rushton14,
  17. Wendy A Gifford15,
  18. Mamta Gautam9,
  19. Addo Boafo16,
  20. Rick Swartz17,
  21. Tetyana Kendzerska18
  1. 1Sleep Research Unit, The Royal’s Institute of Mental Health Research, Ottawa, Ontario, Canada
  2. 2School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
  3. 3Brain and Heart Nexus Research Program, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
  4. 4Culture, Mind and Brain Research Group, Division of Social and Transcultural Psychiatry, McGill University, Montreal, Quebec, Canada
  5. 5Department of Educational & Counselling Psychology, McGill University, Montreal, Quebec, Canada
  6. 6Laboratoire et Clinique du sommeil, Hôpital en santé mentale Rivières-des-Prairies, CIUSSS du Nord-de-l'Ile-de-Montreal, Montreal, Quebec, Canada
  7. 7Addictions and Psychology Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
  8. 8Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
  9. 9Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
  10. 10Mood Disorders Research Unit, The Royal's Institute of Mental Health Research, Ottawa, Ontario, Canada
  11. 11Corporate Leadership, Royal Ottawa Mental Health Centre, Ottawa, Ontario, Canada
  12. 12Physician Wellness, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
  13. 13Clinical Investigation Unit, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
  14. 14Clinical Ethics, Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland, USA
  15. 15School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
  16. 16Mental Health Program, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
  17. 17Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  18. 18Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
  1. Correspondence to Dr Rebecca Robillard; rebecca.robillard{at}


Introduction The negative impacts of COVID-19 have rippled through every facet of society. Understanding the multidimensional impacts of this pandemic is crucial to identify the most critical needs and to inform targeted interventions. This population survey study aimed to investigate the acute phase of the COVID-19 outbreak in terms of perceived threats and concerns, occupational and financial impacts, social impacts and stress between 3 April and 15 May 2020.

Methods 6040 participants are included in this report. A multivariate linear regression model was used to identify factors associated with stress changes (as measured by the Cohen’s Perceived Stress Scale (PSS)) relative to pre-outbreak retrospective estimates.

Results On average, PSS scores increased from low stress levels before the outbreak to moderate stress levels during the outbreak (p<0.001). The independent factors associated with stress worsening were: having a mental disorder, female sex, having underage children, heavier alcohol consumption, working with the general public, shorter sleep duration, younger age, less time elapsed since the start of the outbreak, lower stress before the outbreak, worse symptoms that could be linked to COVID-19, lower coping skills, worse obsessive–compulsive symptoms related to germs and contamination, personalities loading on extraversion, conscientiousness and neuroticism, left wing political views, worse family relationships and spending less time exercising and doing artistic activities.

Conclusion Cross-sectional analyses showed a significant increase from low to moderate stress during the COVID-19 outbreak. Identified modifiable factors associated with increased stress may be informative for intervention development.

Trial registration number NCT04369690; Results.

  • public health
  • COVID-19
  • mental health

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

Statistics from

Supplementary materials

  • Supplementary Data

    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.


  • Contributors RR, TK and JE were involved in project administration and participants’ recruitment as site primary investigators. RR, MS, AN and TK were additionally involved in the following: analyses of data and drafting of the manuscript. RR, MS, JE, ESo, M-HP, AD, SPLV, LQ, KD, AN, JP, RB, ESp, RG, BY, CR, WAG, MG, AB, RS and TK were involved in the following: study conception and design, interpretation of data, revising the manuscript critically for the accuracy and important intellectual content, and final approval of the version to be published. RR, MS, JE, ESo, M-HP, AD, SPLV, LQ, KD, AN, JP, RB, ESp, RG, BY, CR, WAG, MG, AB, RS and TK are accountable for all aspect of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the Clinical Trials Ontario—Qualified Research Ethics Board via the Ottawa Health Science Network (Protocol number 2131).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. Proposals to access data from this study can be submitted to the corresponding author and may be made available upon data sharing agreement.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.