Association between mental health trajectories and somatic symptoms following a second lockdown in Israel: A longitudinal study

Menachem Ben-Ezra*, Yaira Hamama-Raz, Robin Goodwin, Elazar Leshem, Yafit Levin

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Objectives To identify mental health prospective trajectories before and after a second lockdown during the COVID-19 pandemic and their associations with somatic symptoms. Design Prospective Study. Setting Population-based study drawn from a probability-based internet panel of over 100 000 Israelis. Participants Adults aged 18 years or more, representative of the adult Israeli population. The participants were measured at two time points (time 1 (T1) pre-second lockdown N=1029; response rate=76.17%; time 2 (T2) post-second lockdown N=764; response rate=74.24%). Main outcome measures Trajectories of anxiety and adjustment disorder based on clinical cut-off score for probable diagnoses across T1-T2, somatic symptoms at T2. The four trajectories: stable-low, (no probable diagnosis), stable-high (stable probable diagnosis), exacerbation (no probable diagnosis at T1, probable diagnosis at T2), recovery (probable diagnosis at T1, no probable diagnosis at T2). Results Three anxiety trajectories predicted probable somatic symptoms (stable-high OR=6.451; exacerbation OR=5.379; recovery OR=2.025) compared with the stable-low trajectory. The three adjustment disorder trajectories also predicted somatic symptoms (stable-high OR=4.726; exacerbation OR=6.419; recovery OR=4.666) compared with the stable-low trajectory. Conclusions Our data show elevated somatic symptoms among those whose mental health trajectories were poor, exacerbated and those who recovered following the second lockdown. The presentation of somatic symptoms may mask psychological vulnerabilities, even among those who appear to have recovered from the stressor. This indicates that lockdown may be a double-edged sword and should be carefully administered given these populations vulnerabilities.

Original languageEnglish
Article numbere050480
JournalBMJ Open
Issue number9
StatePublished - 2 Sep 2021
Externally publishedYes


  • COVID-19
  • anxiety disorders
  • epidemiology
  • mental health


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