Educational differences in mental health-related quality of life during the COVID-19 pandemic in Germany: The mediating role of pandemic-induced psychosocial stress

Christina Kersjes^1*Ibrahim Demirer²Timo Pförtner³Florian Beese¹Jens Hoebel¹Susanne Schnitzer⁴Elvira Mauz^1*

• ¹Department of Epidemiology and Health Monitoring, Robert Koch Institute (RKI), Berlin, Germany
• ²Research Center for Health Communication and Health Services Research, University Hospital Bonn, Bonn, North Rhine-Westphalia, Germany
• ³Department of Research Methods, Faculty of Human Sciences, University of Cologne, Cologne, Germany
• ⁴Institute of Medical Sociology and Rehabilitation Science, Charité University Medicine Berlin, Berlin, Baden-Württemberg, Germany

Objectives: A large body of evidence shows poorer mental health among lower socioeconomic groups, with chronic stress being an important pathway in this relationship. It was expected that the mental health of people with low socioeconomic status may have been particularly affected by the COVID-19 pandemic. While it has been established that stress also impacted mental health during the pandemic, the aim of this study was to analyze if pandemicinduced psychosocial stress (PIPS) mediated educational differences in mental health-related quality of life (MHRQOL) and which life domains were particularly affected.: The data came from the population-based representative study 'Corona Monitoring Nationwide -Wave 2 (RKI-SOEP-2),' from November 2021-February 2022, restricted to the working age population (18-67 years; n = 7,425). The mediating role of PIPS in educational differences (fractional rank variable from 0 [lowest] to 1 [highest education]) in MHRQOL was assessed for the life domains family, partnership, financial situation, work/school, social life, and leisure time. We used causal mediation analysis to estimate the total, indirect, and direct effects.Results: MHRQOL increased with higher education. Higher education was associated with more PIPS in the domains family, social life, and leisure time, while lower education was associated with more financial PIPS. PIPS in the life domains family, financial situation, leisure time, and social life significantly mediated educational differences in MHRQOL. No significant mediation effect was found for partnership and work/school PIPS.PIPS contributed to educational differences in MHRQOL, with different educational levels showing more stress in different life domains. Group-targeted and life domainspecific approaches for prevention and intervention should be considered.