6 September 2021
Written by Dawn Teh
Daily COVID-19 updates in the form of case numbers, hospitalisations, and deaths have become commonplace for understanding how badly the virus is affecting various parts of the world.
But one metric that's often less spoken about is the mental health impact of this pandemic.
Every day, people continue to lose their jobs, get forced into isolation, grapple with the anxiety of possible infection, and more. And researchers are saying that the compounding effects of these various stressors are taking a toll on people's mental health.
Surveys conducted by the JAMA Network shows that the rates of depression symptoms in the US population were more than three times higher during the COVID-19 pandemic compared to pre-COVID-19. Similar findings were recorded by other countries like Australia, the UK, and Germany.
What's more worrying is that this psychological effect of the pandemic may be more closely related to COVID-19 case numbers than we think.
Surveys by the Centers for Disease Control and Prevention (CDC) in the US found that as COVID-19 numbers peaked in the early summer of 2020, so would reported symptoms of depression and anxiety. The reverse was also true when those numbers started decreasing towards the end of that season.
While more empirical evidence is still needed to establish how exactly COVID-19 (with its related social and economic effects) is affecting our emotional wellbeing, the strong correlation is too hard for healthcare professionals to ignore.
At this point, several explanations have been put forward to make sense of how this multifaceted phenomenon is causing a deterioration in global levels of mental wellbeing. And this includes factors like widespread social isolation, financial stress, fear of catching COVID-19 and more.
Movement restrictions, social distancing, and lockdowns have become the standard protocol for combatting COVID-19 in most countries. While it has been effective in minimizing the spread of the virus, an unintended effect of this has been increased feelings of loneliness.
In one study conducted between June to August 2020, 29% of participants (aged 50+) from 26 different European countries reported feeling lonely. 40% of this group also said that these feelings have worsened since the start of the pandemic. Furthermore, the researchers found that the effect of loneliness was associated with a six to ten-time increased risk of lowered mood, anxiety symptoms, and sleep issues.
Similar results were also found in other countries and across age groups. In fact, one study found that younger people had an increased risk of feeling lonely during the pandemic. Another also reported higher rates of mental disorder symptoms and substance use in US young adults since the onset of this period.
It's clear from these numbers that socialisation is an essential need for our health and wellbeing. This is why experts suggest that in pandemic scenarios, more can be done to prepare people in anticipation of reduced interaction with others. This includes things like raising awareness of how people can remain connected to loved ones while remaining socially distanced, or providing more online support for at-risk groups.
Quarantine is not a new strategy used to contain disease spread. In fact, the earliest recordings of it being employed by Italy date back to hundreds of years ago.
As a result of its long history, a sizeable amount of research has been done looking at how quarantine (related to various outbreaks like SARS and Influenza) affects mental health. And the resounding conclusion is that it's not great for our psychological wellbeing.
In a review of these various studies, it was found that isolation, boredom, and loss of routine were significant causes of mental distress for participants. But another interesting finding was that, compared to un-quarantined people, quarantined individuals were more likely to experience increased levels of anxiety related to getting infected with the disease or transmitting it to others. Furthermore, a worrying post-quarantine effect includes the stigmatization that one can experience from the community.
These combined effects of quarantine led many participants to experience post-traumatic stress symptoms, feelings of exhaustion, depressed mood, and increased irritability.
COVID-19 has been described by many as not only being the biggest public health disaster of our century, but also the cause of the most severe global economic crisis. It has resulted in reduced productivity, job losses, disruptions to global supply chains, the dissolution of entire industries, and more.
The impact of these economic and financial stresses on individuals' mental health has been staggering.
Research in the US conducted by Kaiser Family Foundation (KKF) found that adults who experienced job loss within their household during the pandemic reported higher rates of anxiety and/or depressive symptoms compared to adults from households without job losses (53% vs 32%, respectively).
Another Health Tracking Poll by the KKF conducted in mid-July 2020 also found that a higher share of households experiencing job or income loss (compared to those with no loss of job) reported that pandemic-related worry or stress caused them to experience at least one adverse effect on their mental health and wellbeing (46% vs 59%, respectively). This included symptoms like difficulty sleeping or eating, increases in alcohol consumption or substance use, and worsening chronic conditions.
Unfortunately, the economic impact of COVID-19 has been even greater for the young. The Organisation for Economic Co-operation and Development (OECD) reports that during the start of the pandemic, the youth unemployment rate was twice as high as the average for the general population. And countries are still finding it hard to bring rates back to pre‑COVID-19 levels.
When the OECD took into account any kind of job-related disruption, a similar pattern was found. 51% of the 18‑29 year‑olds stated that either they or someone in their household had some kind of negative employment-related event (like reduced working hours or being placed on a job retention scheme). But this dropped to 46% for 30‑49 year‑olds and 37% for 50‑64 year‑olds.
Across the world, in countries like Australia, Israel, and the UK, young people are experiencing more psychological distress as they face an increased risk of financial strain, uncertainty about the future, and lack of job security.
The world is looking forward to things getting back to normal, where we might be able to gather in stadiums or travel internationally without restrictions once again. But even when that day does come, these future freedoms will never be able to replace the special moments and milestones that people have lost along the way.
All over the world, many have missed economic opportunities that may never return, skipped important rites of passage like proms, given up dream weddings, and were unable to be next to dying loved ones.
More research needs to be done to enlighten us about the long-term impact of such losses on mental health. However, anecdotal evidence from the media suggests that missing out on these important life events do add to the overall decline in emotional wellbeing that many are feeling since the onset of the pandemic.
While the COVID-19 virus doesn't discriminate between people, research is telling us that it isn't turning out to be the "great equalizer" we thought it would be. In fact, it has only widened existing socio-economic gaps across societies around the world. And it's clear that some will come out of this pandemic better off than others in terms of mental health.
Research from the UK (by University College London) conducted during the early phase of COVID-19 lockdown has found that low-income households were more likely to see higher rates of depression, anxiety, suicidal ideation, and self-harm.
Recovery from mental health issues for this demographic has also been slower. The same study reported reduced symptoms for the general UK population by the summer of 2020, but levels remained consistently higher for individuals from households with lower income.
This pattern of poorer mental health in lower socio-economic groups due to COVID-19 is emerging as a global phenomenon, as similar findings have been reported in research coming from other countries like the US, Japan, and Italy.
These statistics aren't surprising considering that those in this group are perpetually disadvantaged in multiple pandemic-related economic and health factors. Low wage workers are more likely to be in industries most greatly impacted by lockdown measures — like tourism and hospitality. They also faced a higher likelihood of contracting the virus as many would have also been in essential services like nursing, teaching, and policing.
Another group of concern is ethnic minorities. The same UCL researchers found that 33.7% of white participants reported deteriorating mental health during the pandemic. But this statistic was higher for those from ethnic minorities (45.6%), as they reported greater levels of depressive and anxiety symptoms along with lower life satisfaction.
The researchers concluded that there is likely to be a mix of racial and economic factors at play as people from ethnic minority groups are likely to be from lower-income households. Therefore, they're more likely to experience the compounding effects of financial stress compared to those of white ethnicity.
Participants from racial minority backgrounds within this same study also reported experiencing higher rates (42%) of discrimination during the pandemic — this is compared to only 24% for people of white ethnicity. And while more research needs to be done to clarify the causative link between increased discrimination and mental health, it's likely that such experiences can lead to reduced emotional wellbeing.
During the first wave of the pandemic, a lot of emphasis was placed on protecting the elderly as they were at greater risk of developing serious illness from the COVID-19 virus. However, the indirect effects of COVID-19 have taken a toll on younger individuals all over the world as well — just in a different way.
Consistent findings across different countries (like Japan, Australia and Canada) have shown that youth and young adults are experiencing more mental health issues compared to those in older age groups ever since the start of the pandemic.
In the US, a survey conducted in December 2020 showed that 56% of adults aged 18-24 reported having symptoms of anxiety and depression during the pandemic. This is in contrast to 29-48% for older adults.
This is most likely due to a mixture of the above-mentioned factors, including increased risk of loneliness and unemployment, along with disruptions to daily life and pessimism about the future.
Medical professionals are calling for more mental health support to be directed at young people as they face this crucial developmental period in their lives through a pandemic. Doing so is not only important for their current wellbeing, but for the viability of our future.
It's clear that more action needs to be taken to address the mental health impact of the COVID-19 pandemic — starting with public health policy.
As a start, global organizations (like the United Nations) have already published guidelines to guide government health organizations through this process. And it's encouraging to see that many countries around the world are taking action. According to a World Health Organization (WHO) report, 116 or 89% of responding countries are currently implementing some form of mental health and psychosocial support (MHSS) plan.
However, the lack of funding for initiatives was still highlighted as an issue as it could impact how successful implementation will be — especially for lower income countries. Only 17% of countries with MHSS plans have fully ensured additional funding for its implementation.
Another hurdle identified by the WHO was ensuring people still had access to support as 93% of countries reported limiting mental health service during COVID-19. Suggested measures to address this include increasing telehealth options and crisis hotlines along with improving basic psychosocial training for health workers at COVID-19 treatment centres.
Governments must realise that the mental health toll of COVID-19 has and will continue to be detrimental if more action isn't taken. If they don't, the cost of not doing enough to prioritize our emotional wellbeing could far outweigh the effects of the virus itself in the long-term.
The author, Dawn Teh, is a health writer and former psychologist who enjoys exploring topics about the mind, body, and what helps humans thrive.