healthcare Article Severe Mental Health Symptoms during COVID-19: A Comparison of the United Kingdom and Austria Sanja Budimir 1,2, * , Christoph Pieh 1 , Rachel Dale 1 and Thomas Probst 1   Citation: Budimir, S.; Pieh, C.; Dale, R.; Probst, T. Severe Mental Health Symptoms during COVID-19: A Comparison of the United Kingdom and Austria. Healthcare 2021, 9, 191. https://doi.org/10.3390/healthcare 9020191 Academic Editors: Fabrizia Giannotta and Yunhwan Kim Received: 23 December 2020 Accepted: 4 February 2021 Published: 9 February 2021 Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affil- iations. Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). 1 Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, 3500 Krems an der Donau, Austria; christoph.pieh@donau-uni.ac.at (C.P.); rachel.dale@donau-uni.ac.at (R.D.); thomas.probst@donau-uni.ac.at (T.P.) 2 Department of Work, Organization and Society, Ghent University, 9000 Gent, Belgium * Correspondence: sanja.budimir@donau-uni.ac.at; Tel.: +43-27-328-932-531 Abstract: This study evaluated severe psychological symptoms in the United Kingdom and Austria after four weeks of lockdown due to COVID-19. Two cross-sectional online surveys were performed with representative population samples according to age, gender, region, and education. Depressive symptoms were measured with the Patient Health Questionnaire (PHQ-9), anxiety symptoms with the Generalized Anxiety Disorder scale (GAD-7), and insomnia symptoms with the Insomnia Severity Index (ISI). The sample size was N = 1005 for Austria (52% women) and N = 1006 (54% women) for the UK. In total, 3.2% of the Austrian sample and 12.1% of the UK sample had severe depressive symptoms (PHQ-9 ≥ 20 points; χ 2 (1) = 57.24; p < 0.001), 6.0% in Austria vs. 18.9% in the UK had severe anxiety symptoms (GAD-7 ≥ 15 points; χ 2 (1) = 76.17; p < 0.001), and 2.2% in Austria and 7.3% in the UK had severe insomnia (ISI; ≥22 points; χ 2 (1) = 28.89; p < 0.001). The prevalence of severe depressive, anxiety or insomnia symptoms was around three times higher in the UK than in Austria. Keywords: COVID-19 lockdown; mental health; depression; anxiety; insomnia; United Kingdom; Austria 1. Introduction The Coronavirus disease 2019 (COVID-19) has spread quickly throughout the world [1]. In Europe alone, there are currently (26 January 2021) around 33 million confirmed COVID- 19 cases and around 709,000 confirmed deaths [2]. The reported incidence rates across countries in Europe differed both during the first lockdowns in March/April of 2020 and to date (e.g., the UK has 1450 deaths per million vs. Austria (AT) with 822 deaths per million). According to the WHO/European COVID-19 official information (data as of 30 April 2020) the United Kingdom (UK) was the country with the most confirmed COVID-19 deaths (26,000) in Europe, while Austria (AT) was hit much less strongly by the COVID-19 pandemic, with 580 confirmed deaths at that time [2]. Taking the different population sizes of Austria (approximately nine million, with 65 deaths per million) and the UK (approximately 67 million, with 390 deaths per million) into account, during the first lockdown in March/April 2020, when this study was conducted, there were around six times more deaths due to COVID-19 in relation to the population in the UK than in Austria. As COVID-19 spreads easily between people who are in close contact [1], most govern- ments have enacted restrictions to prevent the uncontrolled spread of the virus. The gov- ernmental restrictions due to COVID-19 started on different dates but were comparable in Austria and the UK. In Austria, measures against COVID-19 became obligatory on 16 March 2020. There were only five exceptions to the ban that allowed people to enter public places: activities to avert an immediate danger to life, limb, or property; profes- sional activity (if working from home was not possible); errands to cover necessary basic needs; care and assistance for people in need of support; exercise outdoors (e.g., running, walking) alone and with pets/people living in the same household. A distance of at least 1 m to other people had to be ensured. In the UK, measures against COVID-19 became Healthcare 2021, 9, 191. https://doi.org/10.3390/healthcare9020191 https://www.mdpi.com/journal/healthcare