Lifestyle changes and mental health during the COVID-19 pandemic: A repeated, cross-sectional web survey

•Overall lifestyle worsened after several months of the COVID-19 pandemic.•Rates of depression and anxiety remained similar during the study period.•Previous mental disease was independently associated with an unhealthier lifestyle.•Depression, anxiety and alcohol abuse were associated with unhealthier lifestyles. This study aimed to compare self-reported changes on lifestyle behaviors during two phases of the COVID-19 pandemic in Spain, and to evaluate clinical and sociodemographic factors associated with lifestyles. Two cross-sectional web surveys were conducted during lockdown (April 15-May 15, 2020) and seven months later (November 16-December 16, 2020). Lifestyle behaviors were self-reported by a multidimensional scale (SMILE-C). Two separate samples of respondents were analyzed. A multivariate regression model was performed to evaluate the association of SMILE-C scores with demographic and clinical variables. The sample comprised, 3412 participants from the first survey (S1) and in the S1 and 3635 from the second (S2). SMILE-C score decreased across surveys (p