The coronavirus pandemic impacts on all our daily lives, in many different ways. We have adapted to wearing masks and socially distancing from friends, family and neighbours. Some will have lost loved ones or worry about losing income or jobs as we enter recession. What effect could these changes have on our mental health as a nation? And what can research and evidence tell us about what we need to do to respond to the impact now and over the longer term? Public Health England (PHE) were asked to provide some evidence on these key questions for the Department of Health and Social Care (DHSC) early on in the pandemic.
Gaining an understanding of the particular ways the pandemic can impact mental health is the first step to effective and proactive response. The public mental health team at PHE has been interested not only in direct trauma related to illness and bereavement; but also the secondary disruption to how we live our lives – interrupted education, challenges of household life in lockdown, rise in unemployment and increased financial and housing insecurity.
How the data and information was gathered
Providing evidence and evidence-based recommendations to the Government is a core role for PHE. Given the speed of the pandemic and the urgency of the request from DHSC to have evidence to guide early action, this collection of the evidence had to be undertaken over a matter of weeks, using as robust a methodology as possible.
A team of public mental health specialists within PHE conducted the work in early summer. We drew upon evidence gathered for real time surveillance; recent publications from COVID-19 specific literature collections and applied evidence on the wider determinants of mental health from existing reviews and reports.
Although some of this evidence has been superseded by newer evidence we are keen to share the work we did earlier in the pandemic as it will still be useful now for other colleagues and partner organisations working nationally and locally.
What is included in the evidence report?
The publication draws together evidence on the social determinants of mental health, how they have been impacted in previous infectious disease outbreaks or recessions; and links to early data and pre-published evidence on how the determinants were affected during lockdown. We also summarise mental health impacts for ‘vulnerable’ groups identified as at-risk of worsening mental health.
This evidence mapping work has notable limitations : evidence searches were not systematic and lower quality evidence was included. We therefore advise some caution in applying the collected evidence. Consideration of other evidence sources is important and to assist this we have included in these documents an annex of other summaries of evidence.
Key findings from the evidence
Economic recession and the related impacts on unemployment, debt, poverty and housing insecurity that this brings are highlighted as key potential drivers of worsening mental health as a result of COVID-19. These impacts are likely to exacerbate existing inequalities and occur over the medium term.
We also highlight shorter-term impacts on children’s mental health from disrupted education and the increased risk of abuse within households. Other shorter-term impacts we highlight are loneliness during lockdown, disrupted social support networks and disturbed sleep patterns, with some protective effects through community responses.
For vulnerable groups we identified the following factors influencing their mental health –
- People with chronic physical conditions may have higher levels of anxiety and fear about accessing healthcare and may have limited access to their usual support network. There is likely to be higher levels of fear of infection and COVID-19 related stress in this group, who are also more likely to have pre-existing mental health problems.
- People who have been shielding were more likely to have pre-existing mental health problems. Quarantine, which has been most extreme for this group, is associated with reduced mental health : risk factors that changed include lack of exercise, less access to the natural environment, loneliness/reduced social interactions and fear of infection. Early findings suggested that over a third of people who have been shielding felt that their mental health had worsened.
- People with pre-existing mental health conditions are experiencing increased loneliness, social isolation and a reduction of access to normal social support, services and resources. A small minority report benefit from reduction of stressors and increase in social support.
- People with direct experience of COVID-19 infection are likely to experience higher rates of Post-Traumatic Stress Disorder (PTSD), anxiety and depression. There is also an increased risk of PTSD post intensive care admission.
- People who have been bereaved by any condition during the pandemic are at increased risk of experiencing complicated grief and subsequent mental health problems, particularly due to restrictions on visits to care homes/hospitals, socially distanced funerals as well as those bereaved being more likely to be isolated during lockdown.
- Health and Social care workers may experience increased pressures at work, have anxieties around getting the illness and adequately protecting family members. A substantial proportion are showing signs of common mental health disorders during COVID-19, with nurses and women more affected.
You can access the full reports here.
PHE also publishes regular surveillance on population mental health and wellbeing during COVID-19.
Visit the Every Mind Matters website for more resources and advice on mental health and wellbeing during the coronavirus pandemic.