Since the beginning of the COVID-19 pandemic and subsequent restrictions, there has been increasing attention on the way in which our mental health and wellbeing have been impacted by the pandemic. Evidence has pointed to individual basic needs being threatened or removed by the impact of COVID-19 restrictions. People have been left fearing for their jobs due to the potential economic downturn, received limited access to education through school closures, experienced initial reductions in food availability through panic buying, and have encountered threats to their health through COVID-19 itself and the reduction in access to healthcare services. Fundamentally, the need for a sense of connection has been compromised, with people left unable to see friends and family for extended periods of time.
There has been an influx in global research exploring the psychological impact of the COVID-19 pandemic. Longitudinal studies are important to explore the impact of COVID-19 across time and to facilitate comparisons in population mental health pre-, during, and post-COVID-19. As a result, the COVID-MINDS Network aims to bring together researchers in the field to facilitate collaborative working and data-sharing to enable cross-cultural comparisons.
This blog is the first of a monthly series of research updates from the COVID-MINDS Network summarising the impact of the COVID-19 pandemic on global mental health and wellbeing. Here are the 5 things we've learnt this month.
1. Mental health and wellbeing during lockdown have been worse than prior to the COVID-19 pandemic:
• An analysis of the UK Household Longitudinal Study (UKHLS) panel highlighted the psychological impact of COVID-19 using data preceding the pandemicncompared to data captured during the pandemic. In a sample of 42330 UK adults, clinically significant levels of mental distress increased from 18.9% in 2018 to 27.3% in April 2020.
• Data from the Zurich Project on the Social Development from Childhood to Adulthood (z-proso) have been used to explore the psychological impact of the COVID-19 pandemic on young adults in Switzerland. Perceived stress and anger levels were significantly higher during the COVID-19 pandemic in comparison with pre-pandemic levels.
• Researchers in the UK analysed data from COVID-19 surveys nested within the Avon Longitudinal Study of Parents and Children (ALSPAC), which showed increases in participant anxiety and lower wellbeing during COVID-19 from pre-pandemic levels. Furthermore, the percentage of participants classified as experiencing “probable anxiety disorder” was almost double during COVID-19.
• A comparatively smaller longitudinal survey of students in China reported significant increases in negative affect, anxiety and depression after 2 weeks of confinement when compared with pre-confinement scores.
• Students in the US have been completing weekly assessments about anxiety and depression over a two-year period. Participants reported increases in anxiety and depression in comparison with the term preceding the COVID-19 pandemic. Viewing COVID-19-related news was significantly associated with psychological impact, although the influence of demographic variables was not explored.
2. Mental health and wellbeing could potentially return to pre-pandemic levels as lockdown restrictions are lifted:
• Researchers in Denmark administered a survey across two waves (Wave 1: March 31 to April 6, 2020; Wave 2: 3 weeks later). Wave 1 findings were compared with data from the Danish Mental Health and Wellbeing Survey 2016, which showed initial reductions in wellbeing and increases in depression and anxiety compared with pre-Covid-19 levels. However, psychological wellbeing was found to increase between Waves 1 and 2, which corresponded with the lifting of lockdown restrictions.
• A recent study in China reported results from an online survey across two different time-points during the pandemic (timepoint 1: at the point of recommended self-isolation; timepoint 2: after there had been a decline in the number of new suspected cases). Levels of stress, anxiety and depression did not significantly change between the two timepoints; however, the perceived impact of the pandemic significantly reduced over time.
• Researchers in the UK have been collecting data on a weekly basis exploring the longitudinal psychological impact of COVID-19. Depression and anxiety levels have been decreasing throughout the 18 weeks of the study. Whilst the overall level is still higher than pre-pandemic averages, the results indicate that levels are returning to normal levels.
3. COVID-19 is not affecting us all in the same way
Across multiple studies, younger adults, people of female gender and people from BAME groups have been experiencing worse psychological responses to the COVID-19 pandemic.
• Findings from the z-proso study indicated that female young adults had a higher risk than males of emotional distress prior to and during the pandemic, whilst having a migrant background was associated with higher levels of perceived stress. Additionally, social stressors, stressful life events, trust and self-rated health were all associated with subsequent high stress levels during the pandemic.
• Data from the UKHLS showed that increases in mental distress during the pandemic were greatest in 18-24 year olds, women and people living with young children.
• In both the ALSPAC and GS, depression and anxiety were greater in women, younger populations, individuals with pre-existing physical or mental health problems and people living alone or in socioeconomic adversity.
• Although stress, anxiety and depression did not significantly differ between two time-points during the pandemic, a survey in China highlighted that any adverse psychological impacts observed were higher for females and young people.
• Data from a small sample of students in China highlighted that higher scores on anxiety and depression were predictors of increases in negative affect, depression and anxiety.
• Findings from the UK COVID Social Study reported that levels of depression and anxiety are highest in young adults, people living alone, people living with children, those with a lower household income, people from BAME groups, and people living in urban areas. People living with a pre-existing mental health problem also reported higher levels of depression and anxiety.
4. People’s health behaviours are also affected by the COVID-19 pandemic.
• Data obtained via mobile phone sensing and self-reported momentary assessments showed that a US student sample were more sedentary in comparison to the term preceding the pandemic.
• A comparison of health-related behaviours pre-pandemic and during the pandemic using data from the UKHLS showed that smoking and e-cigarette use declined but the proportion of people drinking on four or more days per week and binge drinking increased.
• The UK COVID Social Study has shown that health behaviours during the lockdown has stayed constant for the majority of respondents. However, 17% of adults have reported eating more than usual, 23% have reported eating less healthy than usual, 40% have reported weight gain, 17% have reported drinking more than normal and 33% have reported smoking more than normal. The report also highlights some key between-group differences in health behaviour changes. These include older adult respondents being the least likely to have changed health behaviours, and younger adults, women and people from BAME groups being more likely to have drunk less than usual.
5. Sleep appears to be one of the pathways linking stress with poor mental health
Although there is still limited evidence regarding the factors that may mediate the relationship between the COVID-19 pandemic and mental health outcome, researchers in China reported that the impact of COVID-19 death on levels of stress, anxiety and depression were significantly mediated by decreased sleep quality. A further study in China reported that the degree of threat individuals experienced from COVID-19 was significantly correlated with insomnia. Furthermore, data from the COVID-19 Social Study showed that that the number of adversity experiences and number of adversity worries during the pandemic were associated with reduced sleep quality.
What research questions do these findings pose?
We're learning more about the effects of the COVID-19 pandemic on mental health every week. The findings from the past month show that continued research is needed to explore how future stages of the pandemic impact on wellbeing and mental health, with a particular focus on populations who may be most at risk. Changes in health behaviours during the pandemic and the potential beneficial and detrimental outcomes of such behaviours on mental health also require further consideration. Psychological impact during the predicted second wave, economic crises and the ending of government support schemes should be closely monitored to identify strategies needed to prevent a future mental health pandemic.
You can also find up-to-date longitudinal studies on our website.