COVID-19 reached Austria and in particular the federal state of Tyrol in February 2020, when an Italian couple living in Innsbruck was tested positive for SARS-CoV-2 after returning from Lombardy, a region in northern Italy that has been one of the most affected areas at the beginning of the pandemic (1). Next to general recommendations like the mandatory use of protective mouth/nose masks in public places, distance keeping, and vigilant hand washing, the Austrian government meanwhile has imposed three lockdowns (March 16th–April 7th, November 3rd–December 6th, December 26th–January 24th) that were associated with a number of confinements, e.g., travel restrictions, cancellation of events, school and university closure, restaurant closure, etc. as well as quarantine and exit restrictions. Obviously, such measures result in profound changes in people's everyday life like disruption of daily routines and those affected may experience a lack of personal freedom and develop unhealthy lifestyle behaviors (2).

Notably, the term “stress” is not understood or felt in the same way in all cultures (3). It is a dynamic process between body and mind when the requirements of a situation are greater than the available resources. Accordingly, individual cognitions and environmental evaluations play a central role in this process (4). Following Lazarus and Folkman, the relationship between personal and environmental factors and personal coping strategies also affects the extent to which a situation is perceived as stressful. Thus, the extent to which a stressful situation is perceived as such depends not only on the situation itself, but also on personal beliefs, characteristics and perceptions (5). Furthermore, the experience of new conditions, unpredictability, threat to self, and loss of control are thought to trigger neurophysiological stress responses (6). For the purpose of this study, we therefore assumed that the COVID-19 pandemic can be seen as a global stressor. The study population and all people worldwide face an uncertain future both privately and economically and thus, the pandemic is perceived as a threat to life, whether financially, socially or physically (7).

Quarantine is generally an important tool for disease control, but it is often associated with a negative impact on mental health (8). A number of studies have shown that the psychological distress caused by isolation can last for months or years after quarantine (9, 10) and is frequently associated with increased levels of anxiety, depression, frustration, insecurity, agitation, sleep disturbances, and boredom (8), the latter of which having a reinforcing effect on perceived and emotional stress (11). Accordingly, it is not surprising that boredom has been reported to be of major relevance in the context of a pandemic like SARS and COVID-19 (12, 13).

Boredom is experienced when an activity is perceived as under- or overwhelming or of low value (14). Bored people may experience a loss of control over their environment, may feel separated and therefore be more aware of their psychological problems (15). They show a higher susceptibility to cognitive and affective dysregulation (16–18), depressive symptoms and anxiety (19–21), are more likely to break the rules of social isolation, and have an increased risk to use drugs (11). On the other hand, social isolation per se is a challenge for people who use drugs or alcohol in harmful ways (22) and it can trigger substance use among vulnerable groups of people who have experienced trauma or mental health problems in the past (23).

Next to boredom, disconnection from society and social contacts in the context of quarantine may cause loneliness (24), which represents a further risk factor for mental and physical illness (24, 25). Of note, the mortality rate of lonely adults is comparable to that of obese people and smokers (26) and loneliness has been related to suicidal intentions and parasuicidal behavior (27). However, increasing social connectedness does not necessarily lead to a reduction of loneliness (28).

In the meantime, a number of studies from all over the world have described the impact of the COVID-19 pandemic on mental health (29). A survey from China, for example, reported on moderate to severe depressive or anxiety symptoms in 16.5 and 28.8% of 1,210 study participants, respectively. In addition, more than half of study participants rated the psychological impact of the pandemic as moderate to severe (30). Similarly, an increased prevalence of fear, anxiety, and depression was observed in the United states (31), Chile (32), and various European countries, e.g., France and Italy (33, 34). Pieh et al. investigated a representative sample of the Austrian general population during the first lockdown and found depressive symptoms in 21.0%, anxiety symptoms in 19.0%, and insomnia in 15.7% of 1,005 study participants (35).

The Tyrolean ski resort Ischgl played a critical role in the pan-European spread of the pandemic in March 2020. Because of that, five Tyrolean communities (Ischgl, See, Kappl, Galtür, and St. Anton am Arlberg) were quarantined on March 13th, and the entire federal state of Tyrol (population of 757,634) was quarantined from March 19th to April 7th. In order to expand on the above mentioned findings of Pieh et al. and focusing on the population of Tyrol, the current ongoing longitudinal study aims to investigate the psychological impact of the COVID-19 pandemic and associated quarantine measures over a 12-month period. In addition, we aim to investigate whether these impacts are affected by sociodemographic and individual-level factors and whether modifiable factors (e.g., resilience, social support) moderate the effects of the pandemic over time. Focusing on the associations of sociodemographic and COVD-19 related variables with psychological distress, loneliness, and boredom, we report here the cross-sectional findings obtained in the 8-week baseline assessment. Other data related to resilience, extraversion, spirituality, and emotion regulation strategy usage will be presented in other reports. Future longitudinal data will be collected and will be reported at a later stage.

Out of 961 study participants from the general population of Tyrol 14.4% reached a GSI T score ≥ 63 and could therefore be considered as severely distressed, which corroborates the findings of a recent study from the United States (46, 47). 22.6% suffered from severe loneliness (TILS score ≥ 7), and boredom levels lay by a mean of 25.9 ± 11.0 points in the MSBS-SF (range: 7–56). Importantly, women, singles, low-income people as well as those who were unemployed were significantly more often affected by all of the selected outcomes compared to the remaining sample and they had significantly more frequently consumed alcohol or other substances since the outbreak of the pandemic in order to feel better. Our findings on psychological distress related to COVID-19 largely support those of previous investigations from different countries (30, 34, 35, 48). Rossi et al. (34), for example, investigated a large sample from the general population of Italy and found a higher risk for different mental health outcomes including perceived stress among women and those experiencing working, financial, relationship, or housing problems. Similarly, the majority of seriously distressed people from the United States reported that pandemic-related disruptions of education, employment, and finances negatively affected their mental health (46), and Pieh et al. (35), who had investigated a representative sample of the Austrian general population found highest mental health problems among women as well as unemployed and low-income people, i.e., among individuals who are generally known to be at increased risk of impaired mental health (49, 50). In addition, they found younger study participants to be most burdened, which is again in agreement with the above mentioned survey from the United States (46) and is also reflected in our finding of loneliness and boredom being most prevalent amongst those from 18 up to the age of 29 (30%, each), followed by the age group from 30 to 49 (24.3 and 25.6%, respectively). However, belonging to a certain age group was not associated with a higher degree of psychological distress as assessed by the BSCL in our sample and accordingly, loneliness and boredom may represent less salient stressors compared to e.g., pandemic-associated working or financial problems.

Nonetheless, loneliness has been one of the most frequently identified personal stress factors during this pandemic (28). Of note, more than one fifth of our sample reported to suffer from severe loneliness, whereas in an earlier population study from Denmark merely 4.6% scored above the same cut-off of the TILS (42). A higher risk to be affected from severe loneliness was found among singles and people who were unemployed or working from home as well as among those with low income or living in a small flat, which is in line with the findings of earlier studies (51). Furthermore, as mentioned above, loneliness was especially prevalent in younger study participants, which also corroborates the findings of other surveys from different countries, e.g., the United States (52), the United Kingdom (53), and Norway (51). Young and middle-aged adults have previously been shown to need more social contacts (51) and to be motivated to build and expand their social network outside their family of origin (54), which is why they may be particularly affected by loneliness in the context of pandemic-related restrictions.

During the SARS outbreak in 2003, feeling bored has been the biggest challenge in complying with quarantine regulations (12). In the context of the COVID-19 pandemic, boredom has been the most common reported feeling in China, followed by anxiety and worry, and the degree of boredom correlated with the occurrence of depression, anxiety, and stress (13). On the other hand, boredom can be a key emotion enabling people to change their behavior and thus reach a more satisfying situation (55). During a pandemic, however, the state of boredom may be associated with negative aspects. People tend to have more time available but cannot use it as desired because of isolation and restrictions, which may subsequently lead to depression (33). The possibility to counteract boredom by changing behavior is often prevented by social isolation (56). Accordingly, our finding of boredom being most prevalent among those who were unemployed, single or in a relationship but not living together, childless, or working from home is not surprising. People living in more rural areas may probably have had more opportunities to escape the quarantine situation and to positively change their behavior, which is why urban residents may have been more burdened by boredom among our sample.

It has previously been suggested that due to a lack of external stimulation, bored individuals may develop a tendency toward anger, outbursts of rage, aggression, and deficits in anger control (57). This could not be confirmed in our study with merely 66 out of 961 respondents stating that their propensity to violence had increased during the pandemic. However, when interpreting the data presented in this paper, one has to consider that they have been collected in the early stages of the pandemic and it remains to be seen whether this will change in the long-term.

Previous studies have shown that loneliness, social isolation and/or a change in employment can trigger substance use in susceptible individuals, which can manifest itself as a worsening in existing addictions or as a relapse after abstinence (22, 58). It is alarming that one fifth of our sample stated that they had consumed alcohol or other substances in order to feel better and studies from Belgium and Australia found even higher rates of substance use to cope with mental stress during the COVID-19 pandemic (59). Notably, study participants who had consumed alcohol or other substances since the outbreak of the pandemic were more frequently affected by psychological distress (36.3%; OR = 5.68), loneliness (39.4%, OR = 2.86), and boredom (32.8%, d = 0.77). Longitudinal data are needed to investigate whether these outcomes persist after the COVID-19 pandemic and whether this may lead to an increase of long-lasting mental health problems including drug use in the general population. At the same time, it will be critical to expand mental health services to serve those most at risk and identify options of maintaining social contacts and remaining active despite pandemic-related restrictions.

Notwithstanding the implications of our findings, there are a number of limitations that should be considered. First, we conducted an online survey and people who were not reached by advertising as well as those who have problems with internet usage could not participate in the survey. However, we tried to reach a heterogeneous group of the Tyrolean population from all socio-economic backgrounds. This was done through advertisements in different local newspapers and various social media. In addition, posters and flyers were used to draw attention to the study. Of course, a distortion of the results cannot be ruled out, as people with a higher burden may have been more likely to participate in the study. Moreover, merely 1.3% of study participants stated to work from home, whereas a recent study found that at least half of the Austrian workforce worked from home during the pandemic (60). Accordingly, a sample bias has to be taken into account, which limits the generalizability of the obtained results. Secondly, the information obtained was obviously self-reported, which can result in social desirability bias. An additional limitation is the lack of knowledge about levels of psychological distress, loneliness, and boredom before the COVID-19 outbreak and causal relationships can therefore not be deduced from these data. Moreover, the heterogeneity of study participants was relatively high in terms of age, living conditions, or socioeconomic status. Therefore, we cannot exclude the possibility that subgroups differ in terms of the parameters surveyed. However, due to the longitudinal design of this study we will be able to collect follow-up data to explore how the investigated issues change in the course of the pandemic.

Notwithstanding these limitations, our findings reemphasize the relevance of promoting mental health during the COVID-19 pandemic.

Our results suggest that women, singles, low-income people as well as those who are unemployed may particularly be affected by psychological distress, loneliness, and boredom during the COVID-19 pandemic and that they are exposed to an increased risk of substance use in order to feel better. In addition, young and middle-aged adults may specifically be burdened by loneliness and boredom. In order to prevent mental health problems it will be critical to identify options of maintaining social contacts and remaining active despite pandemic-related restrictions.

The datasets presented in this article are not readily available because its proprietary nature or ethical concerns. Requests to access the datasets should be directed to Franziska Tutzer, franziska.tutzer@i-med.ac.at.

The studies involving human participants were reviewed and approved by ethics committee of the Medical University Innsbruck. The patients/participants provided their written informed consent to participate in this study.

AH, BF-A, SP, BH, and BP designed the study and wrote the protocol. Recruitment was performed by FT and AC. GK undertook statistical analysis. FT wrote the first draft of the manuscript. All authors contributed to and have approved the final manuscript.

BH owns part of the IPRs of the CHES software tool. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.