Since August, the COVID-Minds Network has published monthly summaries of what we are learning about the impact of the pandemic on mental health across the world.
Most significantly, we’ve seen that national lockdowns had a clear impact on individuals’ mental health and wellbeing, and that particular groups are more negatively affected than others, such as young adults, females, and people from Black, Asian and ethnic minority backgrounds. We’ve also examined the benefits of physical activity in preserving mental health and investigated the psychological issues related to “Long Covid.”
This month, we further investigated the disproportionate affect that COVID-19 has had on young adults and the implications for compliance and further lockdowns. We’ve looked at emerging papers regarding the psychological symptoms of Long Covid, as well as research on why the pandemic has affected the mental health of women more than men. Finally, as many countries embark on more lockdowns, we have discussed how the public can improve their mental health by controlling the amount of media they consume on the topic of the pandemic.
1. Young people: how has the pandemic affected their mental health?
The COVID-19 Social Study, which continually surveys a large sample of the UK population, has consistently found that levels of depression and anxiety are highest among 18-29-year-olds in the UK. Data from the UK Household Longitudinal Study also shows that increases in mental health problems during the national lockdown were highest among those aged 18-34 years. Another study using UK longitudinal data found that anxiety levels among 27-29-year-olds was almost double that of pre-pandemic levels in 2013/2014. Further, a UK national probability study tracking changes in mental health from before the pandemic and into the lockdown period found that being young was one of the characteristics associated with increased mental distress.
Similar results have been found in other contexts. An Australian survey noted that the proportion of adolescents experiencing probable mental illness was much higher than pre-pandemic prevalence rates. According to qualitative findings of the CoVAC longitudinal study, young people in Uganda have reported being most affected by loss of livelihoods, schooling and increased psychological stress caused by strained family relationships during the lockdown. On average, young adults in Switzerland perceived their stress and anger levels as higher during the pandemic than before, according to a prospective-longitudinal cohort study. In India longitudinal studies have also demonstrated the psychological impact of COVID-19. Undergraduate medical students have particularly struggled with stress and anxiety.
2. Young people and compliance: is there a relationship with their mental health?
Despite their poor mental health, young people have been identified as the group most likely to ignore or bend rules to control COVID-19. Since the early months of the pandemic they have been identified as less compliant than other age groups, as outlined, for example, in studies in Italy and Russia. However this is not universal, as indicated in studies in Zurich, Lebanon, and Malaysia.
Given young adults’ high rates of mental health challenges and low levels of compliance, the relationship between the two is worth investigating. Current research indicates that it is complex.
Some young people have cited mental and physical health as reasons for not strictly following disease control measures. On the other hand, adolescents have reported that they socially distanced themselves for fear of judgement from peers. These adolescents also showed greater depressive symptoms. Additionally, young people and adolescents have been most impacted by the secondary social consequences of the pandemic than the disease itself.
There is also evidence that mental health does not really relate to compliance in young people. For example, worrying about contracting COVID-19 has not influenced their health behaviour, according to a preprint study of young American adults. This might be true across age groups, as shown by results from the COVID-19 Social Study on adults in the UK.
3. Long Covid and its psychological and mental health symptoms
Last month we listed relevant articles on the topic of “Long Covid”: the term for the wide-ranging conditions suffered by survivors who do not return to their normal state of health. Research is still emerging, but it is becoming apparent that among the challenges they face, psychopathologies, neurological issues, and mental health issues are common.
Having a psychiatric diagnosis has been identified as an independent risk factor for COVID-19, and COVID-19 itself has been found to predict an increased risk of new psychiatric diagnoses following infection, especially anxiety disorders, insomnia and dementia. These problems appear in particular in relation to Long Covid. Similar to other viruses, SARS-CoV-2 has led to “fatigue, hallucinations, ‘brain fog,’ delirium, memory loss, tachycardia, numbness and tingling, and shortness of breath,” indicating a complex relationship between it and the central nervous system. Such neuropsychiatric symptoms appeared during the Russian influenza epidemic and the outbreaks of SARS and MERS. It is therefore likely that the pandemic will lead to a high burden of neuropsychiatric comorbidity. Patients, often called “long haulers,” have described feeling helpless, fearful and in despair. They have also described the difficulty of finding clinicians and peers who sympathise or can provide answers for their poor health. Many feel alone and ignored.
More longitudinal research is needed to properly determine the relationship between the virus, neuropathologies, and psychological health.
4. Women and COVID-19: why has the pandemic disproportionately affected female mental health?
Research has shown that during the pandemic, women’s mental health has been more negatively impacted than men’s. According to the COVID-19 Social Study, women in the UK have higher rates of depression and anxiety and report lower levels of life satisfaction and happiness. They are also more concerned about contracting COVID-19. This is also true in other countries, such as Austria, China, Iran, and Cuba where women have had higher levels of distress and fear. During the first five weeks of the lockdown in Spain, women experienced significant increases in depression and loneliness.
Possible reasons are that women have faced a greater burden providing childcare while continuing to work. Increased domestic violence, which is common after disasters, could have also worsened female mental health, especially for those with a history of intimate partner or sexual violence. Another study has found that women’s levels of depression or worries have related to how much they distrust the government. As policies have increased in stringency, their concerns have increased and then gradually declined once public health measures were at their highest.
Researchers are calling for health policy that takes into account the health disparities women face and their vulnerability to COVID-19—not in terms of risk of severe disease but structural factors that affect their health. Females comprise the majority of health workforces, lack access to reproductive healthcare during pandemics, are underrepresented in drug development, and have a baseline higher risk of mental health disorders.
5. Lessons from lockdown: how can the public better cope with future confinement?
As countries impose further restrictions on movement to control subsequent waves of COVID-19, individuals can adopt certain behaviours to protect their mental health. In particular, lowering levels of media consumption regarding the crisis may positively impact our psychological health.
During the UK lockdown, those who increased their consumption of news related to the pandemic were more likely to experience a decline in mental health and wellbeing. The same was true in Spain, where increases in media and social media use were significantly associated with an increase in negative ‘affect.’ Similar studies have been conducted in Brazil, Russia, and other countries. In the United States, people who absorbed more media had greater psychological distress and felt more threatened by the virus.
Public trust and support for government leadership is crucial to mitigating this effect. An American survey found that individuals who had strong confidence in political leaders’ handling of the crisis perceived the disease as less threatening to the health of the population, the economy, and their personal health and financial situation. Clinicians and governments are being encouraged to adopt communications strategies to protect population mental health, such as recommending the public try to avoid excessive exposure to media.