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Lancet COVID-19 Commission Releases First Report on Pandemic Consequences on Mental Health

A Q&A with Dr Lara Aknin, Chair of the Mental Health Task Force

In June 2020, as the COVID-19 pandemic continued to escalate, Dr Lara Aknin was invited to a virtual meeting with other academics and public health experts to discuss the launch of the Lancet COVID-19 Commission. Its aim was to offer governments, civil society, and the United Nations practical solutions to the challenges of the pandemic.

Dr Aknin, a Distinguished University Professor of Psychology at Simon Fraser University, was asked to form one of twelve task forces under the Commission. Hers would focus on mental health and wellbeing. She brought together a team of epidemiologists, psychologists, economists, medical doctors, and mental health specialists who began searching for the best available evidence on how COVID-19 has impacted mental health across the world.

In February, the Task Force released a preprint of its first report. The COVID-Minds Network interviewed Dr Aknin and discussed her team’s main findings.

1. What was the goal of the Lancet Mental Health Task Force in writing this report?

Our goal was to try to understand and document what was happening to mental health as a result of the pandemic. We wanted to propose the most important and relevant questions, support mental health and wellbeing during this time, and offer recommendations on what could be done about it.

2. With the large and growing volume of global research on COVID-19 and mental health, how did the Task Force identify studies and areas of research to focus on?

As a group we decided on three key overarching questions. How does contracting COVID-19 influence the brain? How has living during COVID-19 impacted mental health and wellbeing? What should be done to support mental health and wellbeing in response?

These questions formed the main structure of the report. Given that we were trying to offer a relatively rapid summary of the best evidence, we focused our efforts on what we believed to be the most robust and informative studies. As one task force member put it, studies had to “earn their ink,” so to speak. In other words, they had to earn their place in the report with meaningful representative samples, informative methods, pre-registration, and/or rigorous measurements.

3. The Task Force chose four areas of mental health with associated measures. What were they and what were your main findings?

We focused on four key outcomes that have been assessed widely during the pandemic: mental health, wellbeing, loneliness and self-harming behaviour. Within these, we examined anxiety, depression, stress, positive and negative emotions, life satisfaction, feelings of isolation and social connection, physical self-harm and suicidal ideation and attempts.

Regarding overall mental health, a number of studies using diverse methodologies (repeated cross-sectional and longitudinal designs) documented an increase in stress, anxiety, and depression. Wellbeing results were more mixed. Positive emotions declined and negative emotions were more frequent, but life satisfaction remained relatively stable as did feelings of social connection and loneliness.

4. Did this surprise the Task Force?

Yes! We were open to the idea that people were experiencing hardship and that certain groups were suffering more than others. We were curious to document who might be most acutely impacted. But I think it was quite a surprise—even to experts who study life evaluations—to see these notable pockets of resilience. There had also been much early speculation and fears around an epidemic of loneliness, and yet we didn’t see the rise that was expected.

Many of us would have been sceptical had it been a singular study here, a singular study there, but as we try to make clear in the report, most large-scale international studies were showing little to no change. The consistency and convergence of these data drawn from large international samples with various methodologies is hard to argue with.

There may be some methodological details inflating life satisfaction in certain samples, but we also need to consider the possibility that maybe life satisfaction or life evaluation ratings have indeed remained stable. That's what we're seeing so far. This might change as time goes on and new variants emerge and second or third waves rise, but a notable stability in life evaluations is worth acknowledging.

5. Among the report’s recommendations, increasing safe access to childcare and elementary schooling stands out among increasing mental health research and care. Why did the Task Force emphasise this group?

The key logic for this recommendation was two-fold. First, access to safe childcare and elementary schooling meets many critical needs for children, including supervised play, emotional support, socialisation skills, mental stimulation, and nutrition. Second, data suggest that parents of young children were showing some of the largest declines in mental health during the pandemic, in part due to an influx of childcare duties and household chores. As such, this change would help two potentially vulnerable groups.

6. Does the Task Force see this as a crucial time to raise awareness and appreciation of mental health? Are we at a turning point?

The COVID-19 pandemic has shone a much-needed spotlight on the importance of mental health and wellbeing, which is under-supported in most countries around the globe. As we note in our paper, mental illness impacts nearly a third of working age adults in some countries and only a small proportion is able to access evidence-based treatments that provide a favourable chance of recovery. Now is a critical time to invest in mental health. We argue that it is wise to do so proactively and embed services within the context of citizens’ everyday life, from social care services to school and work.

7. What will the next report focus on and when will it be published?

The first report was focused on the early months of the pandemic, up to December 2020. The next will likely follow mental health through the subsequent waves of the pandemic, the additional lockdowns, the start of vaccination campaigns, and the fatigue that has come as people have begun a second year of living a very altered life. We anticipate having the second report available in September or October 2021.

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