As the COVID-19 pandemic enters its second year, new, rapidly spreading variants have caused an increase in infections in many countries and new lockdowns. The devastation of the pandemic – millions of deaths, economic conflicts and unprecedented brakes on social interactions – has already had a marked effect on people’s mental health. Researchers around the world are studying the causes and impacts of this stress, and some fear that deterioration in mental health will persist long after the pandemic has subsided. Ultimately, scientists hope they can use mountains of data collected in mental health studies to link the impact of particular control measures to changes in people’s well-being and to inform the management of future pandemics.
The data that will emerge from these studies will be enormous, says sociologist James Nazroo of the University of Manchester, UK. “It’s a really ambitious science,” he says.
More than 42% of those polled by the US Census Bureau in December reported symptoms of anxiety or depression in December, an increase from 11% the year before. Data from other surveys suggests the picture is similar around the world (see “Mental stress from COVID”). “I don’t think it’s going to get back to basics anytime soon,” says clinical psychologist Luana Marques, of Harvard Medical School in Boston, Massachusetts, who is monitoring the effects of the crisis on mental health in American populations and elsewhere. .
Major events that rocked societies, like the 9/11 terrorist attack in New York City, have left some people in psychological distress for years, Marques says. A study1 of more than 36,000 New York residents and first responders found that more than 14 years after the attack, 14% still suffered from post-traumatic stress disorder and 15% suffered from depression – rates significantly higher. higher than in comparable populations (5% and 8%, respectively).
Fear and isolation
The distress likely stems from people’s limited social interactions, tensions between families locked together and fear of illness, explains psychiatrist Marcella Rietschel of the Central Institute of Mental Health in Mannheim, Germany.
Studies and surveys conducted so far into the pandemic consistently show that young people, rather than the elderly, are most vulnerable to increased psychological distress, perhaps because their need for social interactions is greater. Data also suggests that young women are more vulnerable than young men, and that people with young children, or previously diagnosed psychiatric disorders, are at particularly high risk for mental health problems. “The things we know predispose people to mental health problems and conditions have been increased overall,” says Victor Ugo, a campaign worker specializing in mental health policy at United for Global Mental Health, an advocacy group of mental health in London.
Scientists leading large, detailed international studies say they may eventually be able to show how particular COVID control measures – such as lockdowns or restrictions on social interactions – reduce or exacerbate health-related stress mental health, and whether certain populations, such as ethnic minority groups, are disproportionately affected by certain policies. This could help inform the response to this pandemic and future ones, the researchers say.
“We have a real opportunity, a natural experience, of the impact of policies in different countries on people’s mental health,” says epidemiologist Kathleen Merikangas of the US National Institutes of Mental Health in Bethesda, Maryland.
Mental health surveillance
Tackling the psychological impact of the COVID pandemic in a developing country like India has been particularly difficult, says Mythili Hazarika, clinical psychologist at Guwahati Medical College in Assam, India. Public resources are scarce and awareness of mental health issues is low, she says.
When the COVID crisis erupted, Hazarika launched a telephone counseling service with six emergency helplines loaned to her by the Assam Police. In one preliminary study out of 239 callers last April, she and her colleagues found that 46% suffered from anxiety, 22% from some form of depression, and 5% had suicidal thoughts. That was enough to convince the government to act and, after months of wrangling with the authorities, Hazarika and her colleagues launched a remote mental health service called Monon in June.
They guidelines developed for tele-advice during a disaster and trained 400 volunteer counselors. Anyone who tested positive for COVID-19 in Assam has received a call from the service. This proactive approach is crucial, says Hazarika, as the stigma and lack of awareness means few people would think of calling a hotline. “In rural areas, mental illness means you have to go to an asylum and no one can cure you,” she says.
The easing of restrictions means that in-person counseling is once again possible. But by December, the service had called more than 43,000 people and gathered preliminary data on about half of the mental well-being. They found that 9% had symptoms of anxiety, 4% had some form of depression, and over 12% of people suffered from stress. related to COVID19.
To bring the studies together, Daisy Fancourt, a psychoneuroimmunologist at University College London, launched the Wellcome-funded CovidMinds program, which brought together around 140 longitudinal studies in more than 70 countries. These recruit large numbers of participants and collect health information at regular intervals. CovidMinds connects scientists from different countries and encourages the use of standardized questionnaires so that results can be directly compared in international collaborations. “It can allow us to compare the psychological response with the political response across countries,” she says.
This collection of studies is a mix of existing population cohorts and studies established at the start of the pandemic. Existing cohorts are advantageous because their compositions tend to mirror that of the general population, so their results can be generalized. And because long-standing population cohorts will have data on pre-pandemic participants, they will be able to accurately quantify changes in mental health, says epidemiologist Klaus Berger of the University of Münster in Germany, who chairs the German national cohort, one of the largest in the world. health cohorts.
But large established cohorts move relatively slowly and seldom sample frequently. The new cohorts lack the baseline data collected before the pandemic, but many can follow the dynamics of the crisis in a more agile way.
Fancourt is leading one of the most important new studies, the UK COVID-19 Social Study. The study recruited – mainly via social media – over 72,000 UK adults in the first weeks of the country’s first lockdown, in March. Participants complete a weekly 10-minute online quiz, which includes questions that identify feelings of anxiety or depression.
Real time data
“With survey responses every 20 seconds, we get insight into how people are responding psychologically and socially to the pandemic in real time, and see precisely how that has changed in response to things like the arrival of news. government measures, or lockdown measures are relaxed, ”Fancourt said. For example, she says, the high levels of anxiety and depression that the study found in its first few weeks declined during the lockdown, rather than increased as some had predicted.
“Together these types of studies will tell us how government policies are experienced in different segments of society and help us understand how we need to deal with this pandemic and future pandemics,” says Nazroo, who is participating in the survey at the scale of the European Union. on the Health, aging and retirement cohort in Europe and other surveys related to COVID and mental health.
Another study, called the COVID-19 Health Care Workers Study, aims to quantify how health workers, who have faced unprecedented levels of illness and death, coped. The study collects data from 21 countries, including low-income countries in Latin America and Africa where mental health resources are limited (see “Mental health surveillance”). “We want to compare between countries to find out what’s going on different,” says Olatunde Ayinde, a researcher on the Nigerian arm of the study. He believes that geographic variations are likely to stem from differences in the quality of mental health services, the availability and types of social care offered, and levels of poverty. Many countries in Africa have only a fraction of mental health practitioners compared to high-income countries. “We want to know what is responsible for the differences,” says Ayinde.
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