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• We examined psychological impact of the COVID-19 pandemic on the general population in 4 different societies with divergent public health strategies and outcome: South Korea, Hong Kong, France and the U.S.A. • An online survey was conducted to understand the relationship between mental health, social factors and demographic variables and to compare psychological distress among these 4 societies. • Loneliness, but not social network size contributed to deteriorating mental health but the size of the effects varied across the 4 regions. • Successful mitigation of the spread of the virus did not protect the general population from deterioration of mental health. • There is an urgent need to prepare better for an impending mental illness epidemic as the pandemic shows no sign of ending. The COVID-19 crisis has resulted in disruption of everyday life worldwide but the impact and response to the pandemic have not been uniform. Many countries rapidly deployed physical-distancing mandates to curb the spread of the virus; others did not. Social distancing strategies are necessary to reduce the transmission of the virus but there may be unintended consequences. We examined psychological distress in four societies with distinct public health strategies (South Korea, Hong Kong, France and the United States) to identify common and region-specific factors that may contribute to mental health outcome during the pandemic. From March to July of 2020, a survey of demographics, general health, mental health, loneliness and social networks was conducted. Overall, younger age, greater concern for COVID, and more severe loneliness predicted worse psychological outcome but the magnitudes of these effects varied across the four regions. Objective measures of social isolation did not affect mental health. There were also notable differences in psychological outcome; Hong Kong, with very strict social distancing protocols plus ongoing political unrest, suffered the most drastic deterioration of mental health. To prepare for an impending mental health crisis, concerted efforts to reduce loneliness should be integrated into a comprehensive public health strategy. [ABSTRACT FROM AUTHOR]