Effects of alcohol misuse on the evolution of anxiety during the COVID-19 pandemic in France: results from CONFINS cohort

Sep 30, 2026

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Prospective longitudinal analysis of anxiety trajectories during the COVID-19 pandemic in France examines whether pre-existing alcohol misuse predicts changes in symptoms. Anxiety is assessed with GAD-7 and associations with alcohol misuse, defined by AUDIT-C, are estimated using segmented linear mixed models. Gender and perceived loneliness at baseline are evaluated as effect modifiers. Among 1868 participants, alcohol misuse links to higher anxiety beginning the second lockdown in women and in those with high perceived loneliness, highlighting vulnerable groups for targeted mental health support.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages11

Reading Time28 min

AccessFree to download

Abstract

Objectives

Design and setting

Participants

Primary outcome and methods

Results

Conclusions

Introduction

Alcohol misuse and mental health context

COVID-19 lockdowns and anxiety evolution

Perceived loneliness and alcohol use

Open access Original research To cite: Galesne C, Arsandaux J, Macalli M, et al. Effects of alcohol misuse on the evolution of anxiety during the COVID-19 pandemic in France: results from CONFINS cohort. BMJ Open 2026;16:e105567 . doi:10 . 1136/ bmjopen-2025-105567 ► Prepublication history and additional supplemental material for this paper are available online. To view these files, please visit the journal online ([https://doi.org/10.1136/](https://doi.org/10.1136/)[ ](https://doi.org/10.1136/)[bmjopen-2025-105567](bmjopen-2025-105567)) . Received 23 May 2025 Accepted 16 December 2025 © Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY. Published by BMJ Group. 1Bordeaux Population Health, University of Bordeaux College of Health Sciences, Bordeaux, France 2Laboratoire de psychologie des Pays de la Loire, Nantes University, Nantes, France 3Kappa Santé, Paris, France 4Kap Code, Paris, France 5Department of General Practice, University of Bordeaux College of Health Sciences, Bordeaux, France Correspondence to Dr Shérazade Kinouani; sherazade. kinouani@u[bordeaux.fr](bordeaux.fr) Effects of alcohol misuse on the evolution of anxiety during the COVID-19 pandemic in France: results from CONFINS cohort Charline Galesne,1 Julie Arsandaux,2 Mélissa Macalli,1 Nathalie Texier,3,4 Stéphane Schück,3,4 Christophe Tzourio ,1 Shérazade Kinouani 1,5 ABSTRACT Objectives to describe the evolution of anxiety during the COVID-19 pandemic in France and to assess whether it differed according to pre-existing alcohol misuse. Design A prospective longitudinal study. Setting A French online cohort: CONFINS. Data has been collected since the first lockdown in April–May 2020 until January 2022. Participants 1868 participants being at least 18 years of age and who had been confined in France by government measures. Primary outcome measure The primary outcome was anxiety, measured through Generalised Anxiety Disorder– seven items (GAD-7) . Its association with alcohol misuse (defined using AUDIT-C score) was estimated using segmented linear mixed models. Interactions with gender and perceived loneliness at baseline were evaluated. Results Of the 1868 included participants, 729 responded to at least one follow-up questionnaire (median followup time: 46 weeks) . We identified 58% as having preexisting alcohol misuse. Alcohol misuse was significantly associated with an increased GAD-7 score starting at the second lockdown in women (β=0 .30; p=0 .014) and in participants having a high perceived loneliness (β=0.59; p=0 .011) . Conclusions Pre-existing alcohol misuse appeared to bea risk factor for anxiety during the COVID-19 pandemic, particularly for women and those with high perceived loneliness. Mental health support should be proposed to these vulnerable groups in the event of a future health crisis. INTRODUCTION Alcohol misuse is the term used to describe different types of alcohol consumption that may be harmful to mental or physical health because of the frequency of use, the amount consumed per occasion or the risks taken atthe time of consumption. Beyond the individual health consequences, alcohol misuse has significant social repercussions, contributing to relationship difficulties, professional problems and an increase in accidentsand violence.1 In France, the burden of STRENGTHS AND LIMITATIONS OF THIS STUDY ⇒ A longitudinal design: Data were collected during the three French lockdowns and a few months afterwards. ⇒ A broad adjustment: tending to estimate unbiased association. ⇒ A sensitivity analysis: to partly estimate the direction of the association between alcohol misuse and anxiety. ⇒ A convenience sample, not representative of the French population. ⇒ A high attrition rate during follow-up. alcohol use is high, with nearly 50 000 deaths attributed to alcohol consumption in 2009, representing 13% of total mortality among men and 5% among women.2 The bidirectional rel

FAQs

How was anxiety measured in the CONFINS cohort analysis?

Anxiety was measured using the Generalised Anxiety Disorder-7 items (GAD-7).

How was alcohol misuse defined for the study?

Alcohol misuse was defined using the AUDIT-C score and evaluated for associations with anxiety outcomes.

Which groups showed the clearest increase in anxiety after alcohol misuse?

In women, anxiety scores increased significantly starting from the second lockdown; a similar pattern was observed among participants with high perceived loneliness.

Sep 30, 2026

Uploaded by Muffet