Descriptives: Mental health represented by WHO-5, PHQ-4 and L-1
Table 1 provide the characteristics of the study population. For women, the level of mental health was represented through the WHO-5 scoring 57.45 ± 18.69, the PHQ-4 being 2.96 ± 2.37, and the L-1 being 6.77 ± 1.85 on average. For men, the present data revealed a WHO-5 scoring 60.04 ± 18.86, the PHQ-4 being 2.26 ± 2.10, and the L-1 being 6.93 ± 1.76 on average. A significant lower PHQ-4 was revealed for men compared to women (p < .001, Tab. 1).
Descriptives: Physical activity, resilience and stress experience
The average total activity of women was 957.23 ± 770.78 [min/week], whereby 631.89 ± 698.1 [min/week] were accounted for by the activity of daily living and 325.39 ± 268.24 [min/week] for sports activities. Men showed a total activity of 993.24 ± 851.84 [min/week], whereby 636.66 ± 770.59 [min/week] were accounted for by the activity of daily living and 356.59 ± 293.03 [min/week] for sports activities. The present data revealed no significant differences regarding the different modalities of physical activity between men and women (all p > .05, Tab. 1)
Table 1. Descriptive data on the study population (n=742)
Variable
|
Total sample (N=742)
|
Women
(n=534)
|
Men
(n=206)
|
Age, yrs
|
28.13±11.46
(16-83)
|
26.71±9.97
(16-76)
|
31.86±14.02 ***
(16-83)
|
Relationship status, n (%)
|
|
|
|
Single
|
379 (51.1)
|
275 (51.5)
|
103 (50.0)
|
solid relationship
|
363 (48.9)
|
259 (48.5)
|
103 (50.0)
|
Children, n (%)
|
|
|
|
No
|
598 (80.6)
|
441 (82.6)
|
155 (75.2) *
|
1
|
85 (11.5)
|
59 (11.0)
|
26 (12.6)
|
2
|
48 (6.5)
|
25 (4.7)
|
23 (11.2)
|
3
|
10 (1.3)
|
8 (1.5)
|
2 (1.0)
|
>3
|
1 (0.1)
|
1 (0.2)
|
0 (0.0)
|
Education, n (%)
|
|
|
|
none, still in school, primary
|
29 (3.9)
|
21 (3.9)
|
8 (3.9) **
|
lower secondary
|
50 (6.7)
|
28 (5.2)
|
22 (10.7)
|
higher secondary
|
373 (50.3)
|
288 (53.9)
|
83 (40.3)
|
Higher
|
290 (39.1)
|
197 (36.9)
|
93 (45.1)
|
Subjective social status (1…10)
|
5.94±1.41
(2-9)
|
5.88±1.38
(2-9)
|
6.09±1.46
(2-9)
|
Mental health
|
PHQ-4 (0…12)
|
2.77±2.32
(0-12)
|
2.96±2.37
(0-12)
|
2.26±2.10 ***
(0-12)
|
WHO-5 (0…100)
|
58.14±18.76
(0-100)
|
57.45±18.69
(0-100)
|
60.04±18.86
(0-100)
|
L1 (0…10)
|
6.81±1.83
(1-10)
|
6.77±1.85
(1-10)
|
6.93±1.76
(1-10)
|
Predictors and moderators
|
Stress (0…100)
|
38.26±28.64
(0-100)
|
38.93±28.66
(0-100)
|
36.65±28.59
(0-100)
|
Resilience (0…100)
|
67.34±19.54
(0-100)
|
65.94±19.83
(2-100)
|
71.04±18.29 **
(0-100)
|
BSA, min/week
|
|
|
|
activity of daily living
|
632.37±717.73
(0-5725)
|
631.89±698.10
(0-5725)
|
636.66±770.59
(1-5585)
|
sports activity
|
333.22±275.60
(0-1530)
|
325.34±268.24
(0-1485)
|
356.59±293.03
(0-1530)
|
total activity
|
965.58±793.38
(15-5835)
|
957.23±770.79
(20-5835)
|
993.24±851.84
(15-5765)
|
*p<0.05, **p<0.01, ***p<0.001 |
Bivariate associations between physical activity scores, mental health (reflected by L-1, WHO-5, PHQ-4), resilience and stress experience in men and women
The three activity indices were correlated with the mental health scores, resilience and stress experience in the entire group, as well as in men and women separately (for a detailed depiction, see Fig. 1). In the total sample, the subcategory total activity significantly correlated with WHO-5 (r = .134, p < .001) and PHQ-4 (r = -.125, p < .001). Sports activity though showed a significant correlation with resilience (r = .131, p < .001), WHO-5 (r =.174, p < .001), and PHQ-4 (r = -.163, p < .001). There were no correlations with activity of daily living (all p > .05).
For women, we found significant correlations between sports activity with WHO-5 (r = .205, p < .001), PHQ-4 (r = -.182, p < .001), and resilience (r = .156, p < .001). The activity of daily living score significantly correlated with PHQ-4 only (r = -.149, p < .001). For men, we found no significant associations between the activity parameters, mental health, wellbeing, resilience and stress. All correlations for the whole group and by gender can be found in Fig. 1A.
Multivariate analysis: Prediction of the mental health by resilience, stress experience and sports activity during lockdown
Multiple regressions analyzed whether mental health (represented by L1, WHO-5, PHQ-4) was predicted by resilience, stress experience, sports activity, as well as their interactions. Regarding life satisfaction, increases in L1-scores correlated significantly with increases in resilience (β = .648, p < .001), as well as decreases in stress experience (β =-.109, p < .001) The inclusion of the product terms did not explain significant additional variance in the L1 score (R2 Change = .003, F Change(4, 734) = 1.032, p > .05), revealing no significant interactions. The total variance explained by the model as a whole was R2 = .460, F(3, 738) = 211.291, p < .001. Results further showed that the WHO-5 score was significantly moderated by resilience (β = .677, p < .001), stress (β = -.212, p < .001) and sports activity (β = .060, p = .014). The inclusion of product terms further revealed an interaction between resilience and sports activity (β = -.064, p = .009) reflecting that wellbeing of those participants with a low resilience and low sports activity is impaired the most (see Fig. 2A). However, this model explained only slightly more variance in the WHO-5 score (R2 Change = .006, F Change (4, 734) = 2.436, p = .046). The total variance explained by the model as a whole was R2 = .569, F(3, 738) = 326.882, p < .001. Moreover, increases in PHQ-4 scores correlated significantly with decreases in resilience (β = -.593, p < .001), decreases in sports activity (β = -.063, p = .017) and increases in stress (β = .263, p < .001). The inclusion of the product terms did explain only little additional variance in the PHQ-4 score (R2 Change = .014, F Change (4, 734) = 5.201, p < .001) revealing significant interactions between stress experience and resilience (β = -.093, p < .001) reflecting a lower resilience as well as a higher stress experience during lockdown being associated with more anxious and depressive symptoms. Furthermore, we found a significant interaction between sports activity and resilience (β = .073, p = .006) (Fig. 2B). Thus, low sports activity and low resilience was associated with highest symptoms of depression and anxiety. The total variance explained by the model as a whole was R2 = .490, F(3, 436) = 237.97, p < .001.
For women, life satisfaction was significantly predicted by stress experience (β = -.146, p < .001) and resilience (β = .655, p < .001). The inclusion of product terms revealed no significant interaction (R2 Change = .004, F Change(4, 526) = .967, p = .425). The total variance explained by the full model was R2 = .486, F(3, 530) = 167.28, p < .001. For psychological wellbeing, we found significant associations for stress experience (β = -.234, p < .001) and resilience (β = .665, p < .001) but not sports activity (β = .055, p = .055). The inclusion of product terms indicated a slight interaction between sports activity and resilience, but this was not significant after FDR correction (β = .059, p = .047), R2 Change= .005, F Change(4, 526) = 1.592, p = .175. The total variance explained by the model as a whole was R2 = .570, F(3, 530) = 236.23, p < .001. With regard to affective symptoms, we found significant associations for stress experience (β = .278, p < .001) and resilience (β = -.586, p < .001) in women. Again, sports activity did not appeared as a significant predictor in the female sample (β = -.059, p = .059). The inclusion of product terms revealed a significant interaction between resilience and stress experience (β = -.110, p < .001), R2 Change= .015, F(4, 526) = 3.927, p = .004. The interaction between sports activity and resilience failed to reach significance. The total variance explained by the model as a whole was R2 = .497, F(3, 530) = 176.282, p < .001. Overall, analyses showed that especially resilience and stress experience are the most relevant predictors of mental health in women. Furthermore, sports activity had a small wellbeing-enhancing effect in women with low resilience.
For men, life satisfaction was significantly predicted by resilience (β = .647, p < .001) but not stress (β = .006, p = .907). The inclusion of product terms revealed no significant interaction, R2 Change= .015, F Change(4, 200) = 1.336, p = .258. The total variance explained by the full model as a whole was R2 = .409, F(3, 204) = 48.752, p < .001. For psychological wellbeing, we found significant associations for stress experience (β = -.162, p < .001) and resilience (β = .712, p < .001) but not sports activity (β = .080, p = .081). The inclusion of product terms suggested an interaction between sports activity and resilience, but this did not remain significant after correction (β = -.101, p = .032), R2 Change= .012, F Change(4, 200) = 1.451, p = .291. The total variance explained by the model as a whole was R2 = .569, F(3, 204) = 91.908, p < .001. With regard to affective symptoms, we found significant associations for stress experience (β = 0.229, p < .001) and resilience (β = -0.592, p < .001). The interaction between sports activity and resilience was not significant after adjusting for multiple testing (β = .115, p = .032), R2 Change = .441, F Change(4, 200) = 1.470, p = .231. The total variance explained by the model as a whole was R2 = .441, F(3, 204) = 55.330, p < .001. The present data revealed, that in men with lower resilience, sports activity was associated with fewer symptoms of depression and anxiety and better psychological wellbeing.