During nearly two years of repeated COVID-19 lockdowns again, we have heard a lot of concern from many different angles about the mental health effects of forcing people to stay home and away from friends and family.
Several research projects have been undertaken to attempt to quantify the effects on mental health.
However, the speed with which the research was created meant in some cases sacrificing the quality of the research, and some research found evidence of an effect on mental health, and others did not.
To understand the highly mixed results, my colleagues and I conducted a review of all mental health studies conducted during the first year of the epidemic.
We included 33 published papers that studied nearly 132,000 people in different regions of the world.
We found that social restrictions in general doubled people’s odds of experiencing mental health symptoms. This means, among those who participated in these studies, those who experienced lockdown were twice as likely to develop mental ill health than those who did not.
This finding can be broken down into more detail by different mental health symptoms. Social restrictions increased people’s odds of experiencing depressive symptoms more than 4.5 times, their odds of experiencing stress increased nearly 1.5 times, and their odds of feeling lonely nearly doubled.
When we delved deeper into these findings, we found that the length of lockdowns and strictures affected mental health symptoms differently. For example, strict lockdowns increased depression, while the emergence of social restrictions increased stress. Low social restrictions, where there were some restrictions in place but not total lockdown, were associated with increased anxiety.
Also, mental health outcomes differed by age, with young adults and middle-aged adults reporting greater negative mental health symptoms than older adults.
What lessons can we draw from these findings?
The results give us a good idea of what public health communication should look like in the event of future epidemics.
Anxiety was more prevalent when lower restrictions were imposed. This may be due to the fact that people were concerned about the fragility of the situation and where the virus might spread. The introduction of such measures should be accompanied by public health messages and interventions focused on alleviating chronic fear and anxiety.
During periods of severe social restrictions, the predominant mental health problem was depression, which meant that mental health responses should focus on combating depression-related symptoms such as hopelessness and loss of purpose.
The stress findings suggest that symptoms are likely to intensify during the early stages of social restriction application. This is probably because the onset of restrictions is conveying to people an increased severity of the epidemic threat, and people have to work hard to reorganize their lives if the restrictions involve the need to work from home and home school.
During these times, providing messages and interventions that help people manage their stress, such as dealing with work stress or the stress of homeschooled children, can be especially important. For parents, making them feel empowered in the classroom at home and promoting strategies that promote positive family functioning (such as constructive communication and problem solving) can reduce parental and family stress.
Given the social limitations that have been found to be associated with increased loneliness, promoting digital technologies to keep people feeling connected is also important.
Through all of these mental health issues, the messages that convey these symptoms are expected to help individuals normalize and acknowledge the nature and severity of their symptoms. This, in turn, may prompt people to seek help with their mental health symptoms.
The quality of the search was poor
Another important point to highlight from our review is that the research conducted during the first year of the pandemic was generally of poor quality.
This is because good measures of social restrictions are difficult to obtain in studies. Some studies did not detail the specific restrictions put in place in different cities, or did not ask study participants to what extent they complied with the restrictions.
Also, some studies have surveyed people’s mental health symptoms on the day social restrictions were first applied. Most people will likely experience a sharp but temporary spike in mental health symptoms that may decrease naturally after the initial lockdown announcements. This means that it is difficult to deal with the true mental health effects of social restrictions on the first day of restrictions being put into effect.
However, the effects of social restrictions on mental health symptoms were similar across studies where people were surveyed simultaneously and where they were surveyed on more than one occasion during restrictions. This indicates that the estimated effects appear to be robust, although many studies do not have the best assessments of social constraints.
The results of our review show that although we have a way to go in the way we research the mental health effects of COVID-19 social restrictions, preliminary research highlights that these restrictions have already negatively impacted citizens’ mental health.
Although these restrictions may be an effective public health response to mitigate the spread of viruses such as COVID-19, a coordinated response is needed to protect people’s physical and mental health.
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