06 Oct COVID-19 and mental health: a ‘tsunami’ of problems ?

The COVID-19 pandemic has undoubtedly been a challenging period for many of us. But what has its impact on our mental health really been like? In the first few months of the crisis there were predictions that the pandemic would create a ‘tsunami’ of mental health problems. In the week leading up to this year’s World Mental Health Day (October 10^th), it is relevant to consider to what extent these gloomy prognoses have come true.

A look at the available evidence reveals that far from resembling a tsunami – a sweeping force that overpowers everything in its wake – the mental health impact of the COVID-19 pandemic can be more appropriately characterized as a series of localised floods. Specific groups of people have been disproportionately affected by worsened mental health. For many of these people, a response limited to specialist mental health services does not suffice: mental health and well-being can only be sustainably improved by addressing root causes and broader social inequalities.

COVID-19 mental health impact: what does the data say?

In Spring 2020, when countries across the world were in lockdown and billions of people remained largely at home, there were widespread worries about the mental health problems which the COVID-19 pandemic might cause. In May 2020, members of the UK Royal College of Psychiatrists warned that the negative impact of COVID-19 on mental health, combined with the ‘storing up’ of problems during the lockdown, could lead to a ‘tsunami’ of new cases.

Numerous attempts have been made to assess the impact of the pandemic on people’s mental health. Several studies have found that in the first lockdown period in spring 2020, there was indeed a noticeable increase in mental health problems. For example, data from the UK Household Longitudinal Study indicated that by late April 2020, the mental health of the UK population had deteriorated compared to pre-COVID-19 trends. The greatest increases in mental distress were observed in young people (18-34 years), women, and people living with young children. Similarly, the mental health impact of the COVID-19 pandemic in Denmark, France, and the Netherlands during March–July 2020 was found to be greatest among younger individuals and individuals with a history of mental illness.

Fewer studies have examined changes in mental health that have occurred since the first lockdown period in spring 2020. However, the general picture is that after the early stages of lockdown many people’s mental health improved again, suggesting that most people ‘bounced back’ relatively quickly. Although such a ‘resilient mental health trajectory’ is the most commonly observed response, researchers from the UK-based COVID-19 Psychological Research Consortium emphasize that there also certainly people who will experience long-term distress. Indeed, there will be different patterns of change, or ‘different slopes for different folks’. Future longitudinal research will allow for improved insights into the long-term mental health trends during the COVID-19 crisis.

Boosting mental health services

Following news reports about a tsunami of mental health problems, a commonly heard response was a call for greater investment in mental health services to deal with the expected surge in cases. However, such calls were criticized by some as distracting from the need to provide broader social and economic support. For example, members of the Society and Mental Health COVID-19 Expert Group at King’s College London pointed out that “increased levels of anxiety and sadness are normal and understandable responses” to a crisis like COVID-19, and that for most people these are not symptoms of mental health disorders that require therapeutic intervention. Instead, they argue, the most effective support for many of these people is of a practical nature. This includes financial support, ensuring housing security, and the (re)building of informal social support networks. Other scholars, too, have highlighted how psychological distress in the COVID-19 context is highly sensitive to social inequalities, meaning it cannot and should not be entirely medicalised.

The need for a broader approach

Helping those people who are most likely to experience long-term mental health problems requires an understanding of the complex social determinants of mental health. A focus on social inequality highlights that people who are historically disadvantaged in society are typically among the people most affected by the immediate and long-term mental health shocks caused by COVID-19. Drivers of the unequal burden of mental health problems linked to COVID-19 include the gendered distribution of domestic responsibilities during lockdown periods; the unequal economic repercussions of the crisis; and the overrepresentation of ethnic minority groups in stressful ‘frontline’ professions. For many people who were already marginalized in various ways prior to the pandemic, the pandemic has intensified the precariousness of maintaining good mental health, as well as worsened difficulties in accessing appropriate support.

The increased attention for mental health problems during the COVID-19 pandemic should be channelled to tackle these inequalities. This requires a structurally informed “rebuilding” agenda that spans economic policies to maintain safety nets of income; ensuring unequal access to health services; and investments to support mutual aid, community groups and voluntary sector organizations. These types of strategies are costly and far from straightforward, but they outweigh the social and economic costs of long-term mental health problems. This year’s Mental Health Day, appropriately themed “Mental Health in an Unequal World” provides a valuable opportunity to broaden the conversation on mental health in times of COVID-19, and openly discuss the need for structural transformations.

Author: Jil Molenaar, University of Antwerp

References

Allwood, L., & Bell, A. (2020). Briefing—COVID-19: Understanding inequalities in mental health during the pandemic. Centre for Mental Health. https://www.centreformentalhealth.org.uk/sites/default/files/2020-07/CentreforMentalHealth_CovidInequalities_0.pdf

BBC. (2020, May 10). Coronavirus lockdown around the world in pictures. BBC News. https://www.bbc.com/news/world-52602589

Bernardini, F., Attademo, L., Rotter, M., & Compton, M. T. (2021). Social Determinants of Mental Health As Mediators and Moderators of the Mental Health Impacts of the COVID-19 Pandemic. Psychiatric Services, 72(5), 598–601. https://doi.org/10.1176/appi.ps.202000393

Pierce, M., Hope, H., Ford, T., Hatch, S., Hotopf, M., John, A., Kontopantelis, E., Webb, R., Wessely, S., McManus, S., & Abel, K. M. (2020). Mental health before and during the COVID-19 pandemic: A longitudinal probability sample survey of the UK population. The Lancet Psychiatry, 7(10), 883–892. https://doi.org/10.1016/S2215-0366(20)30308-4

Rizvi, A. (2020, November 25). Covid-19 pandemic is causing a mental health “tsunami”, experts say. The National News. https://www.thenationalnews.com/uae/health/covid-19-pandemic-is-causing-a-mental-health-tsunami-experts-say-1.1117792

Rose, N., Manning, N., Bentall, R., Bhui, K., Burgess, R., Carr, S., Cornish, F., Devakumar, D., Dowd, J. B., Ecks, S., Faulkner, A., Ruck Keene, A., Kirkbride, J., Knapp, M., Lovell, A. M., Martin, P., Moncrieff, J., Parr, H., Pickersgill, M., … Sheard, S. (2020). The social underpinnings of mental distress in the time of COVID-19 – time for urgent action. Wellcome Open Research, 5, 166. https://doi.org/10.12688/wellcomeopenres.16123.1

Roxby, P. (2020, May 16). Psychiatrists fear “tsunami” of mental illness after lockdown. BBC News. https://www.bbc.com/news/health-52676981

Shevlin, M., Butter, S., McBride, O., Murphy, J., Gibson-Miller, J., Hartman, T. K., Levita, L., Mason, L., Martinez, A. P., McKay, R., Stocks, T. V. A., Bennett, K., Hyland, P., & Bentall, R. P. (2021). Refuting the myth of a ‘tsunami’ of mental ill-health in populations affected by COVID-19: Evidence that response to the pandemic is heterogeneous, not homogeneous. Psychological Medicine, 1–9. https://doi.org/10.1017/S0033291721001665

Shim, R. S. (2020). Mental Health Inequities in the Context of COVID-19. JAMA Network Open, 3(9), e2020104. https://doi.org/10.1001/jamanetworkopen.2020.20104

Sze, S., Pan, D., Nevill, C. R., Gray, L. J., Martin, C. A., Nazareth, J., Minhas, J. S., Divall, P., Khunti, K., Abrams, K. R., Nellums, L. B., & Pareek, M. (2020). Ethnicity and clinical outcomes in COVID-19: A systematic review and meta-analysis. EClinicalMedicine, 29. https://doi.org/10.1016/j.eclinm.2020.100630

Varga, T. V., Bu, F., Dissing, A. S., Elsenburg, L. K., Bustamante, J. J. H., Matta, J., van Zon, S. K. R., Brouwer, S., Bültmann, U., Fancourt, D., Hoeyer, K., Goldberg, M., Melchior, M., Strandberg-Larsen, K., Zins, M., Clotworthy, A., & Rod, N. H. (2021). Loneliness, worries, anxiety, and precautionary behaviours in response to the COVID-19 pandemic: A longitudinal analysis of 200,000 Western and Northern Europeans. The Lancet Regional Health – Europe, 2, 100020. https://doi.org/10.1016/j.lanepe.2020.100020