COVID-19, mental health and alcohol in Sweden

In 2020, the first year of the pandemic, overall alcohol consumption in Sweden decreased by 6 per cent. However, alcohol-related harm – at least in terms of mortality – did not decrease as might have been expected. This suggests that while many people drank less, some groups increased their alcohol use, offsetting the potential benefits of the overall decline. This interpretation is further supported by the fact that treatment-seeking for alcohol-related problems did not show a clear decrease during this period.

Aim of the study

This study examines whether alcohol consumption increased due to the COVID-19 pandemic in Sweden among two groups considered particularly vulnerable in previous research:

1, individuals who experienced financial difficulties, including unemployment, due to the pandemic, and

2, those who faced pandemic-related mental health challenges.

The pandemic caused economic disruption in Sweden, affecting multiple sectors of the economy and creating greater labour market uncertainty. This led to rising unemployment and heightened financial insecurity for many individuals.

Unemployment is often linked to increased alcohol consumption, as some individuals may use drinking as a coping mechanism. At the same time, financial hardship can limit purchasing power, potentially leading to reduced alcohol intake. This means that the pandemic’s impact on drinking behaviour could go in either direction.

Across many countries, including Sweden, the pandemic was linked to a rise in mental health problems, largely due to increased social isolation and heightened stress from the pandemic and the related restrictions. Several studies have found that poor mental health during this period was associated with higher alcohol consumption, a pattern also observed during previous societal crises. However, evidence from the Sweden remains limited.

Since previous research suggests that financial difficulties may also contribute to reduced drinking, we conducted additional analyses to assess the likelihood of reporting decreased alcohol consumption in relation to financial and mental health problems.

Method

The study is based on a national cross-sectional survey of the general population in Sweden, with approximately 18,000 respondents each year. The sample was randomly drawn from a register of residents aged 17–84. Participants could respond via a self-administered questionnaire or a telephone interview.

In the second half of 2020, three questions specifically related to the pandemic were added, addressing changes in alcohol consumption, financial difficulties, and mental health:

• Alcohol consumption: “How has your alcohol consumption changed since the COVID-19 pandemic began in mid-March, compared to the same time-period last year?” Responses were categorized as increased, decreased or no change.
• Financial impact: “Have you experienced any negative consequences regarding your work or finances due to the COVID-19 pandemic? (e.g. unemployment or reduced income.)
• Mental health impact: “Has your mental health been negatively affected due to the COVID-19 situation?”

For the last two questions, a six-point scale ranging from “not at all” to “a very high degree” was recoded into three categories: no negative effects (0), low to medium effects (1–3), and high effects (4–5). Respondents answering “Don’t know” were excluded from the analyses.

The analysis also included four background variables: legal gender (women, men), highest completed education (three levels), age (four groups), and the number of months since the pandemic began at the time of respondents’ survey completion. The total sample comprised 9,122 respondents.

Results

Among all participants, 69 per cent reported no change in their alcohol consumption during the study period in 2020 compared to the same period in 2019. A decrease in drinking was more common (17 per cent) than an increase (5 per cent), while 9 per cent of respondents were unsure.

Regarding pandemic-related challenges, 35.5 per cent of respondents reported experiencing financial problems, and 57.2 per cent reported negative effects on their mental health. Approximately 11 per cent in each group experienced these effects to a high or very high degree, while 9 per cent indicated that they did not know.

In the statistical analysis, financial problems, mental health problems, and the four background variables were examined simultaneously. The results indicate that individuals experiencing negative impacts on mental health were more likely to report increased alcohol consumption than without such impacts, suggesting that alcohol may have been used as a coping mechanism for pandemic-related stress and anxiety. These findings align with results from several other studies conducted in other countries.

Mixed effects of mental health on alcohol consumption

At the same time, some individuals with mental health challenges reported decreased alcohol consumption. This mixed pattern indicates that the effects of mental health problems on drinking behaviour varied across different groups and likely depended on specific circumstances during the pandemic.

These circumstances may include social isolation and reduced alcohol availability, which likely had a stronger impact on younger age groups. Additional analyses showed that participants with mental health problems who reported decreased consumption were significantly younger than those who reported an increase.

A possible explanation is that younger people tend to consume alcohol more in social settings – such as restaurants and bars- compared to older groups. When these opportunities for social interaction were largely eliminated during the pandemic, younger individuals not only experienced reduced contact with friends, which may have affected their mental health, but also had fewer occasions for social drinking.

Overall, the variability in these findings highlights the complex relationship between COVID-19-related mental health problems and alcohol consumption. They also complement aggregate level studies that found no clear effect of the pandemic on mental health (in terms of suicide) or on alcohol-related harm (in terms of alcohol-related mortality.)

Finally, the analysis showed that financial problems were not significantly associated with changes in alcohol consumption- neither increases nor decreases.

Conclusion

This study reveals a complex and heterogeneous relationship between mental health problems and changes in alcohol consumption at the individual level during the pandemic. While some individuals increased their alcohol intake, likely as a coping mechanism, others reduced their drinking – possibly due to restricted availability or changes in social routines.

These divergent patterns underscore the importance of considering both individual and contextual factors when examining the relationship between mental health and substance use during societal crises. Further research is therefore needed to increase our understanding of the mechanisms driving these differences.

This article is written by Björn Trolldal, Researcher at CAN and Karolinska institutet, Stockholm.