Cross-sectional associations between lifetime use of psychedelic drugs and psychometric measures during the COVID-19 confinement: A transcultural study

The COVID-19 pandemic and the strict lockdowns implemented to limit viral spread created widespread social isolation and stress, which have been linked to increases in anxiety, depression and other forms of psychological distress in population surveys. Parallel to these public-health developments, earlier research and large population surveys have reported potential mental-health and social benefits associated with some psychedelic drugs (for example ayahuasca, psilocybin and LSD), including lower rates of psychological distress and improvements in wellbeing and prosocial behaviours. However, it is uncertain whether lifetime psychedelic drug use is associated with psychological responses to an acute, global stressor such as the first COVID-19 confinement period. Bouso and colleagues set out to examine cross-sectional associations between lifetime use of psychedelic drugs and multiple psychometric measures collected during the first strict lockdowns (April–July 2020). Specifically, the study aimed to compare regular users, occasional users and never-users of psychedelics on markers of psychological distress, peritraumatic stress, perceived social support, a range of psychopathology dimensions, and personality traits, using a multi-language, transcultural online survey approach.

The investigators ran an online, cross-sectional survey in Spanish, English and Portuguese launched on 7 April 2020 and kept open for six weeks. Recruitment used snowball sampling and targeted social media, specialist websites, university channels and community networks; respondents provided informed consent and the study received ethical approval from the Universidad Autónoma de Madrid. The sample was self-selected and included respondents from multiple countries, with large subgroups in Spain and Brazil. Psychometric outcomes comprised validated instruments: the General Health Questionnaire-12 (GHQ-12) for psychological distress (dichotomous scoring, GHQ score, cut-off >4), the Duke-UNC-11 for perceived social support, the Peritraumatic Stress Inventory (PSI) for stress related to potentially traumatic exposure, the Brief Symptom Inventory (BSI; or derived short versions) for psychopathology dimensions and a General Severity Index (GSI), and the 67-item Temperament and Character Inventory (TCI-R-67) for personality traits (novelty seeking, harm avoidance, reward dependence, persistence, self-directedness, cooperativeness, self-transcendence). Questionnaires were used in validated Spanish and English forms and translated into Portuguese by native speakers when necessary. Participants reported lifetime use of specified psychedelic drugs (MDMA in ritual/therapeutic contexts, ayahuasca, psilocybin mushrooms, LSD, peyote, San Pedro, Bufo alvarius/5-MeO-DMT and others) and were classified as regular users (more than once per 6 months), occasional users (tried but not regular) or never-users. The survey also collected extensive sociodemographic data, religion/spirituality indicators, health conditions, confinement-related variables (COVID-19 diagnosis/symptoms among self or relatives, days in confinement, outdoor access, activities during lockdown, changes in diet, libido, employment and income) and self-reported whether past psychedelic use had impacted coping during confinement. Statistical analyses described variables using means, standard deviations and percentages. Group comparisons across user categories used chi-square tests and independent t-tests; ANOVA compared psychometric means by language group. The main associations were assessed with linear regression models predicting psychometric outcomes from psychedelic use (ever vs never, and regular/occasional vs never), adjusting for covariates (age, gender, language, religion and whether the participant practised their religion). The investigators applied a Bonferroni correction for multiple testing, setting the significance threshold at p = 0.002 (0.05/33). Analyses were performed in SPSS v24.

The final sample comprised 2,974 respondents (mean age 36 years), of whom 29% were male, 70% female and 1% other genders. Language distribution was 54% Spanish, 23% Portuguese and 23% English; the largest national subsamples were Spain (N = 1,191), Brazil (N = 652) and the United States (N = 265). Overall, 1,103 participants (37%) reported lifetime use of psychedelic drugs: 497 regular users (17%), 606 occasional users (20%) and 1,968 never-users. About 28% reported a physical disease and 31% a mental disorder, with anxiety (12.3%) and depression (10.4%) the most common reported psychological conditions. Comparisons of baseline characteristics showed that regular users were slightly older, disproportionately male, more often English speakers, more frequently agnostic or religious and more likely to practice religion or identify as spiritual. Regular users also reported greater past use of non-psychedelic drugs and tended to use psychedelics alone or within rituals/therapeutic contexts, whereas occasional users more often used them socially (with friends, at parties or festivals). Confinement-related findings: 90.4% reported no COVID-19 symptoms, 17% had a relative with COVID-19, and 4.7% reported a relative dying from COVID-19. Most respondents had been confined at least 20 days. Regular psychedelic users reported more time outdoors and greater access to outdoor spaces, followed fewer anti-contagion tips, and rated higher wellbeing and lower discomfort during confinement compared with never-users. Activity patterns differed: regular users reported more involvement in music/singing, yoga/pilates and meditation, and better dietary changes and higher libido/sexual activity; never-users reported more aerobic exercise, more TV/COVID-news consumption and videogame playing. Regarding socioeconomic impact, 17% lost jobs and 47.4% experienced income reduction. Psychometric comparisons across language groups found Portuguese respondents had higher mean GHQ-12 scores (greater distress), and Spanish respondents scored higher on peritraumatic stress, somatization and depression than English respondents. Perceived social support scores were similar across languages. In adjusted linear regression analyses, lifetime use of psychedelic drugs was associated with lower psychological distress on the GHQ-12, higher scores on the TCI traits novelty seeking and self-transcendence, and lower cooperativeness. When stratified by frequency, regular users (vs never-users) had lower psychological distress and lower peritraumatic stress, and reported greater perceived social support; occasional users showed lower peritraumatic stress but not the broader suite of benefits seen in regular users. Subjective appraisals indicated that 49% of users felt their past psychedelic use had a large positive impact on coping during confinement; this was 73% among regular users versus 31% among occasional users. The extracted text does not provide detailed effect sizes, confidence intervals or all p-values for these associations beyond noting the Bonferroni-corrected significance threshold, except for one language comparison (Spanish vs English peritraumatic stress, p = 0.001).

Bouso and colleagues interpret their findings cautiously, noting that lifetime psychedelic drug use—particularly regular use defined as at least once per 6 months—was associated with lower psychological distress and peritraumatic stress, and with greater perceived social support during the initial COVID-19 lockdown. The authors outline two non-exclusive explanations: first, that psychedelic use itself may exert protective effects (via psychological processes such as mystical-type experiences, decentring, or neurobiological actions of 5-HT2A agonists including anti-inflammatory and neuroplastic effects); second, that people with pre-existing personality traits (for example higher self-transcendence or novelty seeking) are more likely to use psychedelics regularly. They note that both processes may contribute. The personality differences observed—higher self-transcendence and novelty seeking, lower cooperativeness among users—are discussed in light of prior studies. The investigators point to longitudinal and neuroimaging evidence suggesting self-transcendence can increase after psychedelic experiences and has been associated with cortical changes in ayahuasca users, which supports the possibility of experience-driven trait change. Nonetheless, they acknowledge that the cross-sectional design cannot disentangle pre-existing trait differences from effects of drug use. Other contextual factors that may account for observed associations are highlighted. Regular users reported greater access to outdoor spaces and engagement with activities linked to wellbeing (music, yoga, meditation), and better diet and sexual activity during confinement; these behaviours could mediate mental-health differences. The setting of psychedelic use also differed: regular users more often reported solitary, ritual or therapeutic use, contexts that may be associated with safer practices and different psychosocial outcomes compared with recreational or party use. The authors also situate their findings within broader substance-use trends during the pandemic, noting mixed changes in alcohol, cannabis and other drug consumption. Key limitations acknowledged include the cross-sectional, self-selected and gender-biased sample (70% women), overrepresentation of Spanish speakers, lack of matching between user groups on characteristics such as age, gender and religion, and potential unmeasured confounders. The short interval of confinement at time of survey response (mostly 20–30 days) limits extrapolation to longer lockdowns. The authors also caution that psychometric comparisons across cultures are challenging and that other variables not assessed may have influenced results. Strengths they cite include the large sample size, the precise timing during the first lockdown and the transcultural, multilingual approach. Overall, the investigators recommend longitudinal and prospective studies to clarify causal pathways and mechanisms underlying the associations observed.

The study reports that lifetime use of psychedelic drugs—particularly regular use—was associated with lower measures of psychological distress and peritraumatic stress and with greater perceived social support during the first COVID-19 confinement period. Given the observational cross-sectional design, the authors emphasise that these associations may reflect either protective effects of psychedelics or pre-existing individual differences in people who use them frequently. They conclude that future longitudinal research is needed to disentangle these possibilities and to investigate the potential roles psychedelics might play in coping with pandemic-related psychological challenges.