As the COVID-19 pandemic enters its second year, new, fast-spreading variants have caused an increase in infections in many countries and new lockdowns. The devastation of the pandemic – millions of deaths, economic strife and unprecedented restrictions on social interaction – has already had a marked effect on people’s mental health. Researchers around the world are studying the causes and impacts of this stress, and some fear that the deterioration in mental health may persist long after the pandemic is over. Ultimately, scientists hope to be able to use the mountains of data collected in mental health studies to link the impact of particular control measures to changes in people’s well-being and to inform the management of future pandemics.
The data that will emerge from these studies will be enormous, says sociologist James Nazroo of the University of Manchester, UK. “It’s a really ambitious science,” he says.
More than 42% of people polled by the US Census Bureau in December reported symptoms of anxiety or depression in December, up from 11% the previous year. Data from other surveys suggest the picture is similar around the world (see “COVID mental stress”). “I don’t think it’s going to go back to baseline anytime soon,” says clinical psychologist Luana Marques, of Harvard Medical School in Boston, Massachusetts, who is monitoring the mental health impacts of the crisis in American populations. and elsewhere.
Major events that rocked societies, such as the 9/11 terrorist attack in New York, left some people in psychological distress for years, Marques says. A study1 of more than 36,000 New York residents and emergency workers revealed that more than 14 years after the attack, 14% still suffered from post-traumatic stress disorder and 15% suffered from depression – rates much higher than in comparable populations (5% and 8%, respectively).
Fear and isolation
Pandemic-related distress likely stems from people’s limited social interactions, tensions between confined families and fear of illness, says psychiatrist Marcella Rietschel of the Central Institute for Mental Health in Mannheim, Germany.
Studies and surveys conducted so far in the pandemic consistently show that young people, rather than older people, are most vulnerable to increased psychological distress, possibly because their need for social interactions is stronger. The data also suggests that young women are more vulnerable than young men, and people with young children, or an already diagnosed psychiatric disorder, are particularly at risk for mental health problems. “The things we know predispose people to mental health problems and conditions have increased overall,” says Victor Ugo, a campaign manager specializing in mental health policy at United for Global Mental Health, a group of advocacy for mental health in London.
Scientists conducting large, detailed international studies say they may eventually be able to show how particular COVID control measures — such as lockdowns or restrictions on social interactions — reduce or exacerbate mental health stress, and whether certain populations, such as ethnic minority groups, are disproportionately affected by certain policies. This could help inform the response to this pandemic and those to come, the researchers say.
“We have a real opportunity, a natural experiment, of how different countries’ policies impact people’s mental health,” says epidemiologist Kathleen Merikangas of the US National Institutes of Mental Health in Bethesda, Maryland.
To bring the studies together, Daisy Fancourt, a psychoneuroimmunologist at University College London, launched the Wellcome-funded CovidMinds program, which brought together around 140 longitudinal studies from more than 70 countries. These recruit a large number of participants and collect health information at regular intervals. CovidMinds connects scientists from different countries and encourages the use of standardized questionnaires so that results can be directly compared in international collaborations. “It can allow us to compare the psychological response to the political response from country to country,” she says.
This collection of studies is a mix of existing population cohorts and studies established at the start of the pandemic. Existing cohorts are advantageous because their composition tends to mirror that of the general population, so their results can be generalized. And because long-term population cohorts will have data on participants from before the pandemic, they can accurately quantify changes in mental health, says epidemiologist Klaus Berger of the University of Münster in Germany, who presides over the German national cohort, one of the largest in the world. health cohorts.
But large established cohorts move relatively slowly and usually sample infrequently. The new cohorts lack the database collected before the pandemic, but many can follow the dynamics of the crisis in a more agile way.
Fancourt leads one of the biggest new studies, the UK COVID-19 Social Study. The study recruited – mostly via social media – more than 72,000 UK adults in the first weeks of the country’s first lockdown in March. Participants complete a weekly 10-minute online questionnaire, which includes questions identifying feelings of anxiety or depression.
“With survey responses arriving at a rate of one every 20 seconds, we gain insights into how people are psychologically and socially reacting to the pandemic in real time, and see specifically how that has changed in response to things like new government measures coming, or lockdown measures being eased,” Fancourt says. For example, she says, the high levels of anxiety and depression that the study found in its first few weeks have decreased during the lockdown, instead of increasing as some had expected.
“Together, these types of studies will tell us how government policies are experienced in different segments of society and help us understand how we should manage this pandemic and future pandemics,” says Nazroo, who is participating in the survey at the European Union scale. on the European Health, Aging and Retirement Cohort and other COVID and mental health related surveys.
Another study, called the COVID-19 Health Care Workers Study, aims to quantify how health care workers, who have faced unprecedented levels of illness and death, have coped. The study collects data from 21 countries, including low-income countries in Latin America and Africa where mental health resources are limited (see ‘Mental Health Surveillance’). “We want to compare between countries to find out what is happening that is different,” says Olatunde Ayinde, researcher on the Nigerian arm of the study. He thinks the geographic variations are likely to stem from differences in the quality of mental health services, the availability and types of social care offered, and levels of poverty. Many countries in Africa have only a fraction of mental health practitioners compared to high-income countries. “We want to know what is responsible for the differences,” says Ayinde.
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