• Sheng Zhi Zhao, Janet Yuen Ha Wong, Tzu Tsun Luk, Abraham Ka Chung Wai, Tai Hing Lam, and Man Ping Wang.
• School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region.
• Int. J. Infect. Dis. 2020 Nov 1; 100: 431-433.

ObjectivesTo compare the mental health burden before and during the COVID-19 outbreak and identify the vulnerable groups by sociodemographic factors.MethodsWe analyzed repeated cross-sectional data from the Hong Kong Family and Health Information Trend Survey (FHInTS) in 2016 (N = 4036) and 2017 (N = 4051) and the COVID-19 Health Information Survey (CoVHInS) in April 9-23, 2020 (N = 1501) using population-based random samples of general adults by landline telephone and online panel. Stress (Perceived Stress Scale 4), anxiety symptoms (General Anxiety Disorders 2), depression symptoms (Patient Health Questionnaire-2), subjective happiness (4-point Likert item), and sociodemographic factors were collected.ResultsCompared with 2016 and 2017, the stress level increased by 28.3%, prevalence of anxiety increased by 42.3%, and the depression symptoms and unhappiness have doubled (all P for trends <0.001) during the COVID-19 outbreak. The increases in stress levels were significantly larger among older and less educated respondents (P for interactions <0.001).ConclusionHong Kong had a mental health emergency even with no lockdown and well-managed outbreaks. Older and under-privileged people will suffer most. Public mental health interventions are urgently needed particularly for the older adults and individuals with primary or lower education attainment.Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.

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