Few longitudinal studies exist examining how concern about COVID-19 changes over time and its influence on mental wellbeing. We aimed to examine changes in concern about COVID-19 and its association with symptoms of mental disorders in the Republic of Georgia.   
There were 1195 respondents at the population level and 455 individual repeat responders.  Among population-level survey respondents, the probability of reporting mental disorder symptoms increased in 2021 compared to 2020 for PTSD (OR 1.82), depression (OR 1.40), adjustment disorder (OR 1.80), and marginally for anxiety (OR 1.17). For the individual repeat respondents, the probability increased for reporting depression (OR 1.88) and adjustment disorder (OR 2.56). The perceived burden of concern about COVID-19 worsened in 2021 compared to 2020 at both population-level and individual repeat responders for almost all sources of concern. Increases in sources of concern centred around access to health care, infecting others, and conflict in the home. Having PTSD symptoms were associated with an increased COVID-19 concern score from 2020 to 2021. There were limited changes in coping strategies between 2020 and 2021.
Conclusions 
Our study revealed the burden of mental health symptoms and concern about COVID-19 remain high. Considering the ongoing nature of the pandemic, there is a need to further support response strategies to protect against worse mental health.