If you are in distress or in need of emotional/psychological support, do not hesitate to call 02 648 40 14 for the community help service helpline, or visit the Community Help Service online.
1.Key messages
The COVID-19 pandemic, along with the successive crises that have tested our societies in recent years, has had a significant impact on the social well-being of the population.
In 2018, nearly one in ten adults reported being unsatisfied with their social contacts. However, social dissatisfaction rose to nearly six in ten during the peaks of the pandemic and the implementation of the lockdowns in 2020–2021.
The proportion of people reporting weak social support increased during the peaks of the COVID-19 pandemic, with three out of ten reporting weak social support compared to two out of ten in 2018.
Loneliness affected an even larger portion of the population, reaching as many as seven in ten individuals during the peak of COVID-19 infections, before declining to six in ten as the situation improved.
The prevalence of social dissatisfaction increased, particularly during the COVID-19 lockdowns
Social dissatisfaction rates were high throughout the COVID-19 crisis and rose significantly during each infection peak, and were linked to the enforcement of strict containment measures (between 52% and 64%, depending on which peak). However, at the beginning of 2022, social dissatisfaction rates declined, impacting less than 25% of the population. After 2022 (with the change of survey type in September 2022), the prevalence of social dissatisfaction remained stable, hovering around 20%.
There were no major sex differences in social dissatisfaction throughout the entire period.
Percentage of the population aged 18 and over presenting social dissatisfaction, by sex, Belgium, 2020-2024 Source: COVID-19 health surveys, BELHEALTH, Sciensano [1-15] The red line marks the change in survey (COVID-19 vs. Belhealth)
Since 2022, young people have been the most affected by social dissatisfaction
In 2020 and 2021, men and women in the middle-aged category (30–64 years) reported higher social dissatisfaction. Nevertheless, after June 2022, the younger age group (18–29 years) showed the highest prevalence of social dissatisfaction, albeit with some fluctuations. Since early 2022 social dissatisfaction percentage had begun to stabilize. This stabilization may also be linked to the end of COVID-19 restrictions.
Men
Women
Percentage of men aged 18 and over presenting social dissatisfaction, by age, Belgium, 2020-2024 Source: COVID-19 health surveys, and BELHEALTH, Sciensano [1-15] The red line marks the change in survey (COVID-19 vs. Belhealth)
Percentage of women aged 18 and over presenting social dissatisfaction, by age, Belgium, 2020-2024 Source: COVID-19 health surveys, and BELHEALTH, Sciensano [1-15] The red line marks the change in survey (COVID-19 vs. Belhealth)
3.Social dissatisfaction in 2018
The proportion of people reporting social dissatisfaction does not show a consistent pattern across different age groups
Before the COVID-19 pandemic, social dissatisfaction varied by age group and did not follow a linear trend. Women (8.4%) and men (8.3%) experienced nearly the same level of social dissatisfaction. A notable difference was observed between the 65-74 age group and those aged 75 and older, likely due to increased health challenges, social isolation, and reduced mobility among the oldest individuals.
Percentage of the population aged 15 and over presenting social dissatisfaction, by age and sex, Belgium, 2018 Source: COVID-19 health surveys, BELHEALTH, Sciensano [1-15] The red line marks the change in survey (COVID-19 vs. Belhealth)
The Walloon Region and Brussels-Capital Region have a higher prevalence of social dissatisfaction compared to the Flemish Region
Social dissatisfaction increased in 2013 among men in the Flemish Region and women in the Walloon Region, but no other significant changes occurred between 2013 and 2018. There were no regional disparities, as social dissatisfaction levels remained similar across all regions.
People with lower level of education experience social dissatisfaction more frequently
A socio-economic gradient existed in the prevalence of social dissatisfaction. After adjusting for age, people in the lowest educational group were 1.8 times more likely to experience social dissatisfaction than those in the highest educational group.
More people reported weak social support during the lockdowns of the COVID-19 pandemic
During the COVID-19 crisis, the number of people reporting weak social support increased during peak infection periods. After March 2022, the percentage of perceived weak social support has stabilised at around 28%.
There were no major sex differences in social dissatisfaction throughout the entire period.
Percentage of the population aged 18 and over perceiving weak social support, by sex, Belgium, 2020-2024 Source: COVID-19 health surveys, BELHEALTH, Sciensano [1-15] The red line marks the change in survey (COVID-19 vs. Belhealth)
People aged 50-64 are the most likely to perceive their social support as weak
Among men, those aged 50-64 reported the lowest levels of perceived social support throughout the entire survey period. The least to report low perceived support was the 65+ age group. In October 2022, the difference between the 50-64 age group and the other categories became greater.
Among women, the group which reported the strongest social support was the 50-64 age group. After October 2022, the 18-29 age group became the group perceiving the best social support, and the gap between them and the other age categories widened until February 2023.
Men
Women
Percentage of men aged 18 and over perceiving weak social support, by age, Belgium, 2020-2024 Source: COVID-19 health surveys, BELHEALTH, Sciensano [1-15] The red line marks the change in survey (COVID-19 vs. Belhealth)
Percentage of women aged 18 and over perceiving weak social support, by age, Belgium, 2020-2024 Source: COVID-19 health surveys, BELHEALTH, Sciensano [1-15] The red line marks the change in survey (COVID-19 vs. Belhealth)
5.Perceived weak social support in 2018
Perceived weak social support remains consistent across age and sex
Overall, there was little difference in weak support by sex. In 2018, 15% of men and 16% of women reported experiencing weak support.
People in the Flemish Region report the lowest level of weak social support
The Walloon Region and the Brussels-Capital Region had a higher prevalence of weak social support compared to the Flemish Region. No clear trend over time is observed.
A socio-economic gradient exists for weak social support
After adjusting for age, people in the lowest educational group were 2.0 times more likely to experience weak social support than those in the highest educational group.
We observed peaks in loneliness corresponding to the lockdowns during the COVID-19 pandemic. Since June 2023, following the change in survey type, feelings of loneliness stabilized at 57%.
There were no major sex differences in loneliness throughout the entire period.
Percentage of the population aged 18 and over perceived loneliness, by sex, Belgium, 2021-2024 Source: COVID-19 health surveys, BELHEALTH, Sciensano [1-15] The red line marks the change in survey (COVID-19 vs. Belhealth)
Young adults aged 18-29 are the most affected by loneliness
Among men, loneliness remained high most of the period in the 18–29 age group. However, following the change in survey type in June 2023, this group had the lowest prevalence compared to other age categories. From that point onward, men aged 50 to 64 appeared to be the most affected.
Among women, loneliness remained high in the 18–29 age group, while the 65+ age group was generally the least affected. However, with the launch of the BELHEALTH survey in June 2023, loneliness prevalence among women aged 65+ increased, making them the second most affected group.
According to the World Health Organization, health is a state of complete physical, mental, and social well-being, shaped by a complex set of factors. Both health and mental illness extend beyond biological and psychological aspects, encompassing interconnected social dimensions. Social factors play a crucial role in shaping, maintaining, and promoting health and in influencing the incidence, prevalence and persistence of diseases [17]. Given their impact, it is essential to consider key social determinants of mental and physical health, including social satisfaction, social support and loneliness.
Social health is a broad term that generally refers to two related but distinct concepts. On one hand, it can refer to the overall health of a society; on the other, it describes how individuals within that society coexist and interact. Additionally, social health can refer to an individual’s ability to engage with others and function within a social environment. In this sense, it reflects the quality of social connections and the extent to which people can interact and build relationships. [18] Although the COVID-19 pandemic is becoming less of a threat, new challenges with profound social and economic consequences for the population continue to emerge [19].
In Belgium, the Health Interview Survey (HIS) is one of the primary sources of systematic data on social health indicators in the general population. During the COVID-19 crisis, online health surveys were conducted at regular intervals to monitor the evolution of social health. Data was collected between April 2020 and June 2022. Since October 2022, the BELHEALTH cohort has been tracking mental health and well-being in the population every four months. While the COVID-19 Health Survey used a mixed longitudinal and cross-sectional approach— following the same participants over time while recruiting new ones at each data collection point— BELHEALTH relies on a longitudinal design, following the same cohort of participants throughout the study. To ensure representativeness of the general population, data is weighted for age. However, it is important to note that neither the COVID-19 nor the BELHEALTH survey were designed to be fully representative of the Belgian population; rather their goal is to track trends in mental health disorders within the study population.
Among the various dimensions of social health monitored in these surveys, we focus on the following three disorders:
COVID-19 health survey and Belhealth survey Percentage of the population (aged 18 and over) who are dissatisfied with their social contacts, based on responses to the question about their social contacts in the past two weeks. Participants could choose from the following answers: 1 = Very unsatisfying, 2 = Rather unsatisfying, 3 = Rather satisfying, and 4 = Very satisfying. Social dissatisfaction is defined as the percentage of people who answered “very unsatisfying” or “rather unsatisfying.”
Health Interview Survey Percentage of the population (aged 15 and over) who are dissatisfied with their social contacts, based on responses to the question “How do you find your social contacts?”. Social dissatisfaction corresponds to the percentage of people who answered “rather dissatisfied” or “really dissatisfied”.
Perceived weak social support
Participants from the COVID-19 and BELHEALTH survey (aged 18 and over), as well as from the HIS (aged 15 and over), were asked to assess their perceived level of support from those around them using the Oslo Social Support Scale (OSSS-3). The total score serves as an assessment of social support.
Loneliness
COVID-19 health survey and Belhealth survey Participants (aged 18 and over) were asked to assess their level of loneliness by using the 6-item DeJong Gierveld Loneliness Scale[20]. This loneliness score was then categorized into three levels: not lonely (score of 0 or 1), moderately lonely (score of 2, 3 or 4) and severely lonely (a score of 5 or 6). Loneliness was defined as feeling moderately or severely lonely.
References
First COVID-19 health survey: preliminary results. Deposit number D/2020/14.440/50. Brussels: Sciensano; 2020. doi: 10.25608/ydnc-dk63
Second COVID-19 health survey: preliminary results. Deposit number D/2020/14.440/52. Brussels: Sciensano; 2020. doi: 10.25608/rkna-ee65
Third COVID-19 health survey: preliminary results. Deposit number D/2020/14.440/54. Brussels: Sciensano; 2020. doi: 10.25608/xkg3-xz50
Fourth COVID-19 health survey: preliminary results. Deposit number D/2020/14.440/80. Brussels: Sciensano; 2020. doi: 10.25608/jmgf-2028
Fifth COVID-19 health survey: preliminary results. Deposit number D/2020/14.440/96. Brussels: Sciensano; 2020. doi: 10.25608/xcxd-7784
Sixth COVID-19 health survey: preliminary results. Deposit number D/2021/14.440/30. Brussels: Sciensano; 2021. doi: 10.25608/j877-kf56
Seventh COVID-19 health survey: preliminary results. Deposit number D/2021/14.440/50. Brussels: Sciensano; 2021. doi: 10.25608/ht7a-8923
Eighth COVID-19 health survey: preliminary results. Deposit number D/2021/14.440/82. Brussels: Sciensano; 2021. doi: 10.25608/hqy9-m065
Ninth COVID-19 health survey: preliminary results. Deposit number D/2022/14.440/3. Brussels: Sciensano; 2022. doi: 10.25608/evrs-je22
Tenth COVID-19 health survey: preliminary results. Deposit number D/2022/14.440/18. Brussels: Sciensano; 2022. doi: 10.25608/mve9-bk51
Harandi TF, Taghinasab MM, Nayeri TD. The correlation of social support with mental health: A meta-analysis. Electronic Physician. 2017 Sep 25;9(9):5212.
De Jong Gierveld J, Van Tilburg T. A 6-Item Scale for Overall, Emotional, and Social Loneliness: Confirmatory Tests on Survey Data. Research on Aging. 2006;28(5):582–98.
In 2018, 12% of the population reported the use of sleeping pills or tranquilizers in the last 2 weeks, and 8% reported recent use of antidepressants. The consumption of sleeping pills or tranquilizers started to decrease in 2008, while the consumption of antidepressants continued to increase.
Consumption of psychotropic medicines was more frequent in the lowest educated group compared to the highest educated group.
2.Background
In Belgium, the Health Interview Survey is one of the main sources of systematic data on mental health indicators in the general population. It namely monitors the self-reported use of sedatives (sleeping pills or tranquilizers) and antidepressants in Belgium since 1997. For the sedatives, the Health Interview Survey is the only available data source, since those drugs are not reimbursed and therefore, do not figure in the health insurance data.
The use of psychotropic drugs is measured during the last 2 weeks in people aged 15 and over.
3.Consumption of psychotropic medicines
Situation in 2018
Belgium
In 2018, 12.3% of the population used sedatives (sleeping pills or tranquilizers) and 7.6% used antidepressants in the past 2 weeks. More women than men consumed sedatives (15% in women vs 9.5% in men) and antidepressants (9.8% vs 5.3%).
The consumption of sedatives increased with age, particularly after 45 years in women and after 65 years in men.
The consumption of antidepressants is particularly high in women after 45 years of age.
In 2018, the consumption of sedatives is slightly higher in Wallonia and in Flanders than in Brussels, but the regional differences are narrow and not significant.
The consumption of antidepressants is slightly lower in Flanders than in the other regions, but the differences are only significant in women.
Trends
Belgium
From 1997 to 2008, the consumption of sedatives in the population increased, then it decreased in 2013 and in 2018 when considering both genders together. In men the consumption remained stable round 10%, while it decreased from 19% in 2008 to 15% in 2018 in women.
Since 1997, the consumption of antidepressants has doubled in both genders.
Regional specificities
The consumption of sedatives used to be significantly lower in Flanders than in the 2 other regions until 2008 in both genders. After 2008, as the use of sedatives continued to increase in Flanders while slightly decreasing in the other regions, the regional differences narrowed and quasi disappeared by 2018.
There was a socio-economic gradient in the consumption of sedatives and antidepressants. A higher proportion of people from the lowest educational group consumed sedatives (17.7% vs 12.3%) and antidepressants (10.3% vs 6%) than from the highest educational group.
Consumption of sleeping pills or tranquilizers and antidepressants, by educational level, Belgium, 2018 Source: Own calculations based on Health Interview Survey, Sciensano, 2018 [1]
If you are in distress or in need of emotional/psychological support, do not hesitate to call 02 648 40 14 for the community help service helpline, or visit the Community Help Service online.
1.Key messages
The COVID-19 pandemic and consecutive crises that have challenged our societies in recent years bear a heavy toll on the mental health of the population.
While in 2018, about one in ten adults screened positive for depression and anxiety, almost one in four were affected during the peaks of the pandemic and restrictive measures in 2020-2021.
A major disaster such as the pandemic has long-lasting psychological effects on the population, which has been facing additional challenges from the wars, the energy crisis, the cost of life and climate change.
2.The prevalence of anxiety and depression from 2020 onwards
On Sciensano’s epidemiological dashboard, one can explore dynamic data visualizations about mental health during the COVID-19 crisis up to June 2022. Additionally, an interactive app provides updated data on mental and social health from the BELHEALTH cohort since October 2022. It is important to note that the COVID-19 and BELHEALTH surveys were not designed to be fully representative of the Belgian population, but rather to track trends in mental health disorders within the study population.
Tracking anxiety and depression disorders over time with online surveys
During the COVID-19 crisis, there was a significant rise in anxiety disorders and depressive disorders, particularly during peaks in contamination and the implementation of strict containment measures. A decrease was observed in 2022, with anxiety and depressive disorders affecting less than 20% of the population overall. It should be noted that in 2022, despite the announcement of the end of the COVID-19 crisis, other major crises emerged, such as the war in Ukraine and its economic consequences.
Up to June 2022, data come from the COVID-19 Health Surveys. As of October 2022, the same group of people were followed in the BELHEALTH survey to assess the evolution of anxiety and depressive disorders in time and the potential risk and protective factors involved.
The data collected from 2023 onwards indicate a gradual decline in these problems among the participants. However, anxiety and depressive disorders rose again slightly in the winter (November 2023 and March 2024) to decrease in June 2024 to 17% and 15% respectively.
Throughout the entire period, anxiety disorders consistently had a higher prevalence compared to depressive disorders.
Percentage of the population aged 18 and over presenting anxiety or depressive disorders in the health surveys (COVID-19 and BELHEALTH), Belgium, 2024 Source: COVID-19 health surveys, BELHEALTH, Sciensano [1-10,12-16] The red line marks the change in survey (COVID-19 vs. Belhealth)
Anxiety and depressive disorders tend to decrease with age for both genders
In Belgium, the groups most at risk of experiencing anxiety and depression disorders include women, young adults, people with lower education, people living alone and as single parents, and residents of the Walloon Region.
Young adults, aged between 18 and 29, are particularly vulnerable to anxiety and depressive disorders, with a higher prevalence among women. Several factors specific to this life phase—including the transition to higher education, entry into the job market, and the pursuit of financial independence—coupled with the changes imposed by the pandemic and the heightened sensitivity of young people to social issues, contribute to their increased vulnerability to these disorders [17].
Regarding the peaks that are linked to the COVID-19 pandemic, the two youngest age categories (18-49 years) appear to be particularly affected, showing a more significant increase in cases. In contrast, individuals over the age of 50 exhibit a more stable trend throughout this period, with less pronounced variations.
From 2022 on, the prevalence of anxiety and depressive disorders is more stable. However, anxiety disorders remain high among the working-age population as of November 2023, especially compared to those aged 65+ and older. Among women, a clear age-related gradient persists for anxiety disorders. Depressive disorders showed an increase in November 2023 for individuals aged 30-49 and men aged 50-64, and in March 2024 for both genders in the 18-29 group.
3.The prevalence of anxiety and depression in 2018
Women present more often anxiety and depressive disorders compared to men
Based on these psychometrics questionnaires, in 2018, 11.2% of the Belgian population aged 15 and over presented an anxiety disorder and 9.4% presented a depressive disorder. For both disorders, women had a higher prevalence (14.2% for anxiety and 10.7% for depression) than men (7.9% for anxiety and 8% for depression).
The trend shows that anxiety remains high over time, while depression returns to its pre-2013 level
The prevalence of anxiety disorders increased among people of both sexes in 2013 compared with previous years, and this increase was maintained in 2018.
The prevalence of depressive disorders also increased in 2013 among people of both sexes. Subsequently, in 2018, the pre-2013 figures were repeated, with a clearer drop among women than among men between these two years. It should be noted, however, that the questionnaires used to assess the presence of anxiety and depression were different in 2018 than in previous surveys. Consequently, trends should be interpreted with caution.
The Walloon Region and the Brussels-Capital Region have higher prevalences compared to the Flemish Region
The Walloon Region had a higher prevalence of anxiety and depressive disorders compared to the Brussels Capital Region and the Flemish Region and the Brussels Capital Region had a higher prevalence compared to the Flemish Region.
Between 2008 and 2013, the prevalence of anxiety disorders increased in all regions. Between 2013 and 2018, it continued to rise in the Walloon region, especially among women but also among men, whereas this was not the case in the other regions.
Since 2001, depressive disorders among women have been less frequent in the Flemish Region than in the Brussels-Capital Region and the Walloon Region. This trend has also been observed among men since 2008.
Men
Women
Prevalence of anxiety disorders in men in Belgium and its regions, 2001-2018b b break in series, change of instrument Source: Own calculations based on Health Interview Survey, Sciensano, 2001-2018 [11]
Prevalence of anxiety disorders in women in Belgium and its regions, 2001-2018b b break in series, change of instrument Source: Own calculations based on Health Interview Survey, Sciensano, 2001-2018 [11]
Men
Women
Prevalence of depressive disorders in men in Belgium and its regions, 2001-2018b b break in series, change of instrument Source: Own calculations based on Health Interview Survey, Sciensano, 2001-2018 [11]
Prevalence of depressive disorders in women in Belgium and its regions, 2001-2018b b break in series, change of instrument Source: Own calculations based on Health Interview Survey, Sciensano, 2001-2018 [11]
People in the group with the lowest level of education were more likely to have an anxiety or depressive disorder
There is a strong socio-economic gradient in the prevalence of mental health disorders. After age-adjustment, anxiety disorders were 2.3 times more frequent in people from the lowest educational group compared to the highest educational group. Depressive disorders were 3 times more frequent in people from the lowest educational group compared to the highest educational group.
Mental health is the capacity of each of us to feel, think, and act in ways that enhance our ability to enjoy life and deal with the challenges we face. It is a positive sense of emotional and spiritual well-being that respects the importance of culture, equity, social justice, interconnections, and personal dignity [18]. Due to the high frequency of mental problems in Western societies and the significance of their costs in human, social, and economic terms, mental health is now regarded as a public health priority. Mental health particularly deteriorated during the COVID-19 crisis [19].
In Belgium, the Health Interview Survey (HIS) is one of the main sources of systematic data on mental health indicators in the general population. During the COVID-19 crisis, online health surveys were organized at regular time intervals to follow the evolution of the mental health of the population. Data were collected between April 2020 and June 2022. From October 2022, the BELHEALTH cohort follows up mental health and wellbeing in the population every 4 months. While the COVID-19 Health Survey used a mixed longitudinal and cross-sectional approach (addressing the same participants and recruiting new ones at each data collection point), BELHEALTH uses a longitudinal approach (follow-up of the same cohort of participants throughout data collection points). Cross-sectional data of BELHEALTH were used here. In order to achieve a representativeness of the general population, data are? weighted for age, with a different methodology between the two surveys.
Among the various dimensions of mental health that are monitored in this survey, we focus on the following two disorders:
However, it should be noted that the evaluation of mental health problems in the population through a health survey has a number of limitations. These are mainly related to the fact that the estimates are based on screening instruments for psychological problems and thus are not obtained by clinical diagnostic tools, which may be more nuanced. Nevertheless, the results of general population health surveys are generally in line with the findings of specific mental health surveys.
More serious mental health disorders like schizophrenia and bipolar disorders are not presented here. Indeed, health interview surveys are not a valid instrument to capture such complex conditions. Moreover, information about suicidal behaviors can be found on a specific page.
Definitions
GAD-7: General Anxiety Disorder 7-item
The GAD-7 is a screening tool for general anxiety disorder (GAD). Participants aged 15 and older (for HIS) and 18 and older (for other surveys) are asked to evaluate the frequency, if ever, of experiencing 7 core anxiety symptoms in the last 2 weeks. The total score obtained allows to evaluate anxiety severity. [20]
Anxiety disorders
Participants aged 15 and older (for HIS) and 18 and older (for other surveys) with a score of 10 or over out of 21 in the GAD-7 tool were considered to have an anxiety disorder.
PHQ-9: Patient Health Questionnaire 9-item depression scale
The PHQ-9 is a screening tool for major depressive disorder and other depressive disorders. Participants aged 15 and older (for HIS) and 18 and older (for other surveys) are asked to evaluate the frequency of 9 symptoms in the last 2 weeks. [21]
Depressive disorders
Participants aged 15 and older (for HIS) and 18 and older (for other surveys) with a combination of answers meeting the criteria specific for major depressive disorder and other depressive disorders for the PHQ-9 were considered to have a depressive disorder.
References
First COVID-19 health survey: preliminary results. Deposit number D/2020/14.440/50. Brussels: Sciensano; 2020. doi: 10.25608/ydnc-dk63
Second COVID-19 health survey: preliminary results. Deposit number D/2020/14.440/52. Brussels: Sciensano; 2020. doi: 10.25608/rkna-ee65
Third COVID-19 health survey: preliminary results. Deposit number D/2020/14.440/54. Brussels: Sciensano; 2020. doi: 10.25608/xkg3-xz50
Fourth COVID-19 health survey: preliminary results. Deposit number D/2020/14.440/80. Brussels: Sciensano; 2020. doi: 10.25608/jmgf-2028
Fifth COVID-19 health survey: preliminary results. Deposit number D/2020/14.440/96. Brussels: Sciensano; 2020. doi: 10.25608/xcxd-7784
Sixth COVID-19 health survey: preliminary results. Deposit number D/2021/14.440/30. Brussels: Sciensano; 2021. doi: 10.25608/j877-kf56
Seventh COVID-19 health survey: preliminary results. Deposit number D/2021/14.440/50. Brussels: Sciensano; 2021. doi: 10.25608/ht7a-8923
Eighth COVID-19 health survey: preliminary results. Deposit number D/2021/14.440/82. Brussels: Sciensano; 2021. doi: 10.25608/hqy9-m065
Ninth COVID-19 health survey: preliminary results. Deposit number D/2022/14.440/3. Brussels: Sciensano; 2022. doi: 10.25608/evrs-je22
Tenth COVID-19 health survey: preliminary results. Deposit number D/2022/14.440/18. Brussels: Sciensano; 2022. doi: 10.25608/mve9-bk51
