September Update: The Psychological Impact of COVID-19

In last month's blog, we highlighted 5 key things we had learnt so far about the impact of the COVID-19 pandemic on global mental health and wellbeing:

1) mental health during the pandemic has been worse than pre-pandemic levels;

2) mental health could potentially return to pre-pandemic levels as lockdown restrictions are lifted;

3) COVID-19 is disproportionately affecting females and young adults and people from BAME groups;

4) health behaviours are also negatively impacted; and

5) sleep appears to be one of the pathways linking stress with poor mental health.

In the past month further published longitudinal studies, pre-prints and research reports have enhanced our understanding about the psychological impact of COVID-19. Here are the 5 things that we have learned this month.

1. Adult mental health during the pandemic (especially for younger adults) has been worse than pre-pandemic levels, but children and adolescents appear less adversely affected

If we look at adults…

• Singapore Life Panel data from adults aged 50-70 showed a significant increase in depressive symptoms experienced by participants in April 2020 in comparison with January 2020 levels. However, overall health status and sleep quality remained consistent at both timepoints.

• In a study of 102 German adults, perceived stress and depression significantly increased after the German government introduced COVID-related restrictions, while anxiety levels decreased.

• A study of Argentinian adults also reported initial increases in depression and decreases in anxiety from timepoint 1 (2 days after mandatory quarantine) and timepoint 2 (2 weeks later). Additionally, at timepoint 3 (50 days after quarantine) depression continued to rise and anxiety began to rise.

These experiences appear even worse for younger adults:

• Researchers in the US found that University students experienced large increases in depression and anxiety during the pandemic in comparison with pre-pandemic levels and the proportion of participants at risk of clinical depression increased from 31% to 65%.

• There are consistent reports from the COVID-19 Social Study that younger adults continue to be disproportionately affected by the COVID-19 pandemic.

However, results were not as stark amongst children and adolescents:

• A recent report from the UK Co-Space study found that parents/carers perceptions of their children’s emotional difficulties did not change over a one-month period during the lockdown; however, they did report a statistically significant increase in behavioural and restless/attentional difficulties over the same period.

• Likewise, the Co-Spyce study reported no change in parents/carers perceptions of preschoolers (ages 2-5) emotional problems over the past month, but did note a reduction in their child/s restless/attentional difficulties.

• A UK-based study of secondary school students showed overall improvements in anxiety and wellbeing during lockdown in comparison with pre-pandemic levels. The authors speculated this may be due to the removal of stressors within the school environment, but also offered the caveat that the second survey was completed a number of weeks after lockdown officially began and when some restrictions were beginning to ease.

2. Mental health has generally improved during lockdown and as lockdown restrictions have been eased

• The latest weekly report from the COVID-19 Social Study showed that in depression and anxiety levels, life satisfaction and happiness were all higher than usual levels when lockdown came in, but all improved over lockdown and as lockdown eased. Improvements have stabilised in the past fortnight.

• Similarly, data from eight waves from the Understanding America Study (UAS) reported that psychological distress significantly increased between March and April 2020 as the COVID-19 pandemic emerged, but distress levels had subsequently declined by June 2020.

• However, an analysis of data from young people (ages 26-29) from the Avon Longitudinal Study of Parents and Young Children (ALSPAC) found that anxiety levels initially increased from pre-pandemic levels and remained stable between April and June, even after the easing of lockdown restrictions. So younger adults may be taking longer to re-adjust.

3. COVID-19 does not affect us all equally

In our last blog we highlighted that gender, age and ethnicity were risk factors for worsening mental health during the COVID-19 pandemic. This month, further longitudinal research has highlighted additional risk factors such as financial problems and being a working parent.

• In a survey of 1041 Spanish adults, females were found to report comparatively more symptoms of depression, anxiety and PTSD, more feelings of loneliness and less spiritual wellbeing than males.

• Further analyses of ALSPAC data showed that female gender, experiencing pre-existing mental health problems, a history of financial problems, and difficulties in accessing mental health information were associated with a greater risk of persistent anxiety.

• Analysis of data from the UK Household Longitudinal Study (UKHLS) highlighted that working parents experienced worsening mental health in comparison with working adults without children and that financial insecurity predicted worsening mental health in both households.

• A survey of Argentinian adults found that females, young people (ages 18 to 25) and those who had seen their income diminished were most adversely psychologically impacted by the COVID-19 pandemic and quarantine in Argentina.

4. Specific characteristics and behaviours may help to buffer the detrimental psychological impact of COVID-19

• Using data from the UKHLS, researchers found that the altruistic behaviour of providing financial assistance to those in need had a positive impact on givers’ subjective wellbeing during the pandemic.

• A survey of adults in the US reported that trait resilience was associated with better overall mental health. Experiences of positivity resonance (a marker of high quality social interactions) mediated this effect, suggesting that high-quality social connection may have played an important role in maintaining mental health during the pandemic.

• Researchers in Serbia found that the behavioural activation system (BAS) was significantly related to the emotional responses of worry and fear, with higher-BAS individuals showing less fear and worry.

• A longitudinal study of US students reported that grit prior to the pandemic significantly predicted pandemic resilience and marginally lower adverse psychological impact. Meanwhile, gratitude prior to the pandemic was protective against adverse effects on academic functioning.

• Analyses of data from the Zurich Project on the Social Development from Childhood to Adulthood (z-proso) revealed that several coping strategies, specifically keeping a daily routine, positive reappraisal/reframing, physical activity, acceptance, and staying in contact with friends and family were associated with reduced emotional distress.

• Data from the COVID-19 Social Study showed that increases in time spent gardening, exercising, reading and other hobbies were associated with decreases in symptoms of depression and anxiety and increases in life satisfaction.

5. Time spent accessing COVID-19-related media content may contribute towards adverse psychological impacts

• A survey of participants in Serbia reported that higher worry was significantly associated with regularly focusing attention on media information about the prevalence of COVID-19.

• Researchers from the COVID-19 Social Study reported that following news about COVID-19 predicted increases in depression and anxiety and decreases in life satisfaction.

• Data from the z-proso study revealed that frequent COVID-19 news seeking was associated with perceived stress and anger.

What do these findings show

This month we have found evidence that children and adolescents may not be as adversely impacted by the pandemic as adults. The removal of school-related stressors may, in part, explain these findings. However, as time progresses and children begin to return to school, further research is warranted to explore the potential longer-term impact of the pandemic and associated restrictions for children and adolescents.

Researchers have begun to explore the potential risk and protective factors of mental health decline during the pandemic. As lockdown restrictions ease and the ability to go outdoors, socialise, exercise and be involved in hobbies outside the home return, questions should be asked about whether individuals return to pre-existing behaviours or whether the pandemic has fundamentally changed the way we choose to live our lives.

This month, findings have shown that experiencing financial problems may contribute towards the negative psychological impact of COVID-19. As government support schemes start coming to an end and difficult decisions are made about global economies, considerations must be made about the mental health consequences of financial decisions for individuals and communities.