The scales were selected with particular emphasis on validated, short, and population-level scales that had been used in other health surveys, including the pre-COVID-19 BE.HIS, and were already translated and validated in French, Dutch, and English. The primary outcome, psychological distress, was measured with the GHQ-12 as in the BE.HIS. GHQ-12 is a 12-item scale of common mental disorders [31] that displays good psychometric properties, with a Chronbach’s alpha score of 0.90 on the Likert scale [32, 33]. We used the GHQ scoring method, which returns a continuous score ranging from 0 to 12, with a score of 4 or more indicating the likelihood of a mental disorder [33].

We explored health, social, and occupational risk factors. Health risk factors were related to the direct or indirect exposure of the population to the COVID-19 outbreak and to subjection to the subsequent lockdown measures. Exposure was assessed using an index that was constructed on the basis of eight dichotomous (yes/no) questions about proven (tested or diagnosed) or suspected COVID-19 infection of the respondent and/or of someone living with the respondent and/or of a relative or acquaintance. The COVID-19 exposure index ranged from 0 (low exposure) to 8 (high exposure). We also calculated the length of time for which respondents had been subjected to the lockdown measures, using the number of days between 18 March 2020 and the day of completion of the questionnaire.

Social risk factors were related to social activity and support. The volume of social activity was assessed using an adaptation of the Social Participation Measure (SPM), an adaptation that was developed as part of the Common Cold Project [34]. Respondents were asked about the frequency of six types of social activity during a normal week, before and after the start of the lockdown period. The score for change in social activity between a normal week and the first week of the lockdown period ranged from − 18 (considerable increase in activity) to 18 (considerable decrease in activity). Social support was assessed using the 3-item Oslo Social Support Scale, which returns a score ranging from 3 (poor social support) to 14 (strong social support). The social support scores were categorised into three groups (3 to 8: weak; 9 to 11: moderate; 12 to 14: strong social support) [35]. Social isolation was measured using the Short Loneliness Scale (LON), ranging from 3 (low level of loneliness) to 12 (high level of loneliness) [36].

Occupational risk factors were related to changes in occupational status, workload, and income. Respondents were asked whether they had experienced changes in their income, employment status, and/or working conditions (such as increased teleworking) following the COVID-19 outbreak and lockdown measures. Finally, socio-demographics (age, gender, occupational status, and educational status) and items allowing the identification of specific vulnerable subgroups (household composition, profession, and previous history of long-term illness) were also requested and included as control variables. The full questionnaire is available online in French, Dutch, and English (

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