Trends of depression and anxiety during massive civil unrest and COVID-19 in Hong Kong, 2019–2020

Both COVID-19 and unrest are posing a significant threat to population mental health across the globe. This study examined trends of probable depression and anxiety during a time of civil unrest and concurrent COVID-19 in Hong Kong. Four random digit dialing telephone surveys were conducted in July 2019 (n = 1112), February–March 2020 (n = 2003), April–May 2020 (n = 2008), and July–August 2020 (n = 2034). The prevalence of probable depression increased from 25.7% (95% CI: 23.2–28.3) in July 2019 to 28.2% (95% CI: 26.2–30.1) in February–March 2020, and then decreased to 15.3% (95% CI: 14.0–17.0) in April–May 2020 and 13.7% (95% CI: 12.2–15.2) in July–August 2020. The prevalence of probable anxiety was 19.2% (95% CI: 17.5–20.9) in February–March 2020 and then stabilized in April–May 2020 and July–August 2020 (14.1%, 95% CI: 12.0–15.8). Probable depression and anxiety were more prevalent among persons with high relative to low daily routine disruptions. Combined high unrest-COVID-19 stress was associated with probable depression and anxiety across all persons; high unrest stress alone was associated with probable mental disorders at high daily routine disruptions. Civil unrest and COVID-19 are jointly associated with depression and anxiety among Hong Kong citizens. While population mental health improved, daily routine disruptions is a risk factor of mental disorders at every time-point.