The World Health Organisation declared the COVID-19 outbreak a global pandemic on 11 March 2020. Almost a year later, research on how it has affected mental health across the world continues to grow. While the disease has not affected everyone equally—and has even led to positive changes for some—it has harmed particular groups who were vulnerable to the consequences of lockdown and social distancing.
In this blog we investigate three of these groups. We look at how pregnant mothers have responded in the last year and how young people continue to face specific challenges alongside social distancing and isolation. We also emphasise the importance of increasing research in low- and middle-income countries where the pandemic’s repercussions on mental health, economies, and job prospects may be long-lasting.
1. Maternal mental health and COVID-19
A recent commentary outlined the additional challenges that pregnant women have faced during the pandemic. COVID-19 may have especially harmed mothers with perinatal mood and anxiety disorders or women living in difficult financial or social situations.
Studies have shown that the mental health of expectant mothers has indeed taken a toll. Rates of psychological distress have been high among pregnant women around the world, including Spain, Norway, Ireland, Switzerland, the Netherlands, and the United Kingdom. During the height of the pandemic in the United States, pregnant mothers were lonely, depressed and anxious. The proportion of pregnant women with moderate-to-high anxiety, in particular, significantly increased with the onset of the pandemic.
Other studies have examined the causes and protective factors of maternal mental health. A Canadian study analysed how changes to prenatal care and birth plans were significantly associated with elevated depression and anxiety. Such symptoms may be just as prevalent in women who have not caught the virus as those who have, as suggested by a case control study in India. Lockdowns, in particular, have worsened mental health, especially among pregnant women who lacked social support.
Another study showed that postnatal depression is positively associated with fear of COVID-19, although this can be mediated with health care access. Maintaining physical activity, too, could play an important role in protecting the mental health of pregnant women. A cross-sectional study found that those who reported changes in their exercise routines during the pandemic had significantly higher depression scores.
2. The pandemic’s effects on young people
In the last year, it has become clear that the COVID-19 pandemic has disproportionately affected young people. Studies published recently show that their poor mental health has longitudinally correlated with peak infection times during the pandemic, but wider issues are emerging as research on this group differentiates. The pandemic has adversely affected teenagers with eating disorders, with almost a quarter of respondents in a US survey reporting decreased motivation to recover. Young males, in particular, have seen their friendships suffer, feeling more lonely and less satisfied with their peers. Data from twelve studies has shown a longitudinal increase in depression among adolescents in the United States, Peru, and the Netherlands. Multiracial adolescents and those who experienced lockdown had worse changes in their mental health.
3. The need for more research in low- and middle-income countries
Most research on the mental health effects of the pandemic concern higher-income countries. In comparison, there are few published studies on mental health and COVID-19 in low- and middle-income countries. Researchers have called for more mental health investigations and for the integration of psychosocial services into national pandemic responses.
Available evidence indicates that mental health in poorer communities could be more severe than in affluent places and is closely linked with decreased income and family and community relationship changes. A Guatemalan study found that parents were struggling psychologically much more than people who did not have children in high-risk and low-income communities. Over half of mothers in a study in rural Bangladesh reported increased depression and anxiety, which accompanied increased partner violence, food insecurity, and reduced monthly income. Other social factors have also influenced depression in lower-income countries. Stigma, in particular, was the strongest predictor of depression in a cross-sectional study of the Democratic Republic of Congo, Haiti, Rwanda and Togo.
In most countries, the pandemic has disrupted mental health services and psychiatric treatment, which has been considered nonessential in some nations. Community telehealth services have been proposed as a way to manage severe mental illness during the pandemic.
The long-term detrimental effects on psychological health is also a concern. Individuals may face the pandemic’s repercussions for years to come as economies take time to recover. Protecting youth, in particular, will be crucial especially as a significant proportion of the world’s young live in low- and middle-income countries. It will require mental health interventions and opportunities for employment during and after the pandemic.
As the global community hopes and waits for the pandemic’s gradual decline, it is important to remember that particular groups of people will need support long after lockdowns and social distancing ends. Women who had to manage higher stress, anxiety and depression while pregnant may need additional support and recovery services. A mental health crisis may continue to emerge among young adults who have been more affected than older age groups and may suffer great social and economic consequences. Finally, our understanding of the psychological effects of the pandemic in low- and middle-income countries is far from adequate compared to higher-income nations. More research and services are needed to support those without psychological resources and to improve our understanding of the pandemic’s global impact on mental health and wellbeing.