**4. Discussion**

This is one of the first and largest surveys on mental health during the current COVID-19 pandemic in a European society. Although the cohort reflects a relatively well educated and financially secure sample, we found evidence for a substantial mental burden with increased levels of psychosocial distress, irritability (anger/aggression), anxiety, and depressive symptoms. Moreover, participants reported overall lower well-being, lower sense of coherence, decreased sexual contentment, less healthy diet, and almost half of the sample indicated worsened sleep. Our results further indicate that participants with pre-existing mental conditions show more depression and anxiety, less well-being, less sense of coherence, and worse coping skills in terms of the pandemic and the measures taken. Most importantly and also most concerning is the finding of a one-month prevalence of 5% IPV, which is already close to one-year prevalence rates [29] and for which there were indices that this has currently increased. Both women and men experienced more anger and aggression. Both predominantly directed their anger at others rather than themselves.

While we do not present an analysis of risk factors, in line with current research [6], we found that women showed higher levels of anxiety and depression and worse coping, even though small effect sizes restrict these findings. One explanation, however, might be that women seem to lapse into traditional roles. While women report to predominantly spend their time with household chores and cooking, men mainly reported watching movies/TV and going to work. It seems conceivable that an imbalanced distribution of child care and household responsibilities led to fear of or actual work place changes for women, which might, in turn, have further increased women's burden.

Besides the negative impact the current COVID-19 pandemic seems to have on our world population, participants also reported opportunities and pointed out what seemed helpful and beneficial. Almost one-fifth of the sample noted that the current pandemic offers the opportunity to be thankful for and appreciate what we have with 15% assuming that a process of reevaluation might take place. As many as 16% believe that the situation might lead to a sharpened view for environmental and climate issues. More than one-third found comfort in their families, children, and life partners. Almost one-fifth experienced talking to others and friends as beneficial. Exercise and staying active also seemed to help people coping with the COVID-19 pandemic.

The current study offers several strengths and limitations. While some authors argue that sample sizes between *n* = 1000 and *n* = 3000 are usually sufficient enough to make assertions for the general population [30], despite the large sample size, norm deviations for various demographics lead to limitations concerning representativeness. First, in our data set, we found a large gender imbalance. The German population consists of 50.66% women and 49.34% men [31]. Yet, in our study, we found 83.1% females and 15.2% males. However, the phenomenon of gender imbalance in online surveys with women representing the majority is established, as women are more likely to participate in online surveys [32]. Moreover, gender imbalance has been observed in other recent COVID-19 online surveys. Di Renzo et al. [33] reported 80% female respondents and Hsing-Ying Ho et al. [34] reported 66% female respondents. Further potential explanations might be the following: (1) women are more likely to use social media [35] (2) with women staying more at home during the lockdown than men, they had the occasion to participate in surveys, (3) the title of the survey included the term "mental health," which may have spoken more to women than to men, and (4) women are impacted by affective disorders twice as much as men, so they may have had a higher incentive to participate. Second, our sample was well educated. While 17.6% of the German population hold a university degree [36], in our sample we found 30.6% with a Bachelor's degree, a Master's degree or diploma. The unemployment rate in our sample was higher than in the German population (9.9% in our sample and 6.2% in the German population [37]). Mean age (40.36 years in our sample and 44.5 years in the German population [38]) and household status (23.9% reported living alone in our sample vs. 21.13% single households in Germany [39]), however, did not seem to differ widely. Taken together, the demographic deviations from the norm restrict representativeness. Moreover, we did not investigate depression and anxiety rates before the pandemic. Thus, we can only draw a comparison between current pandemic values and reference values. We did, however, check for pre-existing mental and physical illness. Concerning pre-existing mental conditions, the occurrence corresponds to point prevalence in Germany [40]. Thus, a resulting bias cannot be expected. Further on, we did not explore the extent to which women were involved in child care during the lockdown, which included closing of day care and schools. Beyond that, we did not control for social desirability effects. These aspects should be taken into account for future studies. Yet, using a mixed-methods approach, we present comprehensive European data that gives a valuable insight into potential challenges and protective factors for mental health during the height of lockdown measures in Germany.
