Recently, a systematic review and meta-analysis was published in The British Medical Journal, which looked at mental health symptoms before and during the Covid-19 pandemic.
This review examined 137 published studies, predominantly from rich countries in Europe and Asia, that measured psychological distress in the general population before, during and after the COVID pandemic.
It says that at a population level in these countries, there was little change in the prevalence of mental ill-health. Although it did recognise that women saw increased levels of depression symptoms than men.
But is this the full picture?
The answer, as is usually the case in mental health, is that it depends. Professor Michael Sharpe, Emeritus Professor of Psychological Medicine at the University of Oxford explains:
“The overall finding is that, contrary to popular narratives, the average level of distress in the population did not substantially increase and the pandemic was not associated with a ‘tsunami of mental illness’. This finding is about population averages and does not mean that some individuals have not suffered greatly. It does however remind us that the general population is more resilient to traumatic events than is often assumed.”
This study only examined the population as a whole. It did not break down the impact on individual demographics and groups whose mental health is more vulnerable. It also did not examine the impact on the populations of low-and-middle income countries, where less research has been carried out and there is less data available to review.
Dr Gemma Knowles, from the ESRC Centre for Society and Mental Health, King’s College London, said:
“The paper answers a broad question. In doing this, it risks obscuring important effects among the most affected and disadvantaged groups and, from that, obscuring possible widening of inequalities in mental distress that occurred because of the pandemic.
There is evidence from other studies of considerable variation – with some people’s mental health improving and others’ deteriorating. This may mean no overall increase, but this shouldn’t be interpreted as suggesting the pandemic didn’t have major negative effects among some groups.
The sub-group analyses are limited and don’t, for example, include analyses by SES, ethnic group, or by direct impacts of the pandemic on income, work, etc. Individual studies, including our recent study, that have considered these domains suggest quite marked effects in some of the most affected and disadvantaged groups.”
So, who are the groups that were more adversely impacted by the pandemic?
Children and young people
There has been an alarming increase in the number of children and young people needing treatment for mental health problems since 2020. In fact, according to the latest figures, the number of referrals to CAMHS in England has increased by 39% in the last year.
These numbers include children who are suicidal, self-harming, suffering serious depression or anxiety, and those with eating disorders. Hospital admissions for eating disorders are rising as well, with an 82% rise from 2019 to 2022.
During the first year of the pandemic, 2020-21, under-18s being referred for NHS mental health treatment totalled 839,570. Staggeringly, in 2021-22, more than 1.1million children were referred.
On the 31st of March 2022, the Department for Education released a report which documented the impact of the pandemic on the mental health of teenagers. It found that the pandemic had led to increased depressive symptoms in adolescents, and that girls were more affected than boys.
Many reports found that women’s mental health was more impacted than men’s during the early days of the pandemic.
Women who were pregnant, postpartum, miscarrying, or who experienced intimate partner violence were at especially high risk for developing longer-lasting mental health problems.
People with existing mental health problems
Early studies in the pandemic found that Individuals with pre-existing mental disorders were at increased risk for exacerbation of mental ill-health, in particular during the lockdown periods when access to treatment was reduced. Additionally, people with existing mental health problems reported higher feelings of distress and anxiety about the risks of COVID infection.
However, even among this group, the impact of the pandemic was not universal. Whilst there were many people who saw their symptoms of depression and anxiety increase, or who experienced relapses, other psychiatric patients showed symptom decrease due to, for example, experiencing relief from social pressures.
Dr Roman Raczka, Chair of the British Psychological Society’s Division of Clinical Psychology, said:
“The findings of the systematic review confirm what studies have indicated – that the mental health of the general population did not significantly worsen during the pandemic due to the high level of resilience.
However, early studies indicated increasing mental health concerns for people who had existing problems, and there is evidence that the pandemic played a key role in worsening mental health for particular groups, including children and young people, women and parents living in poverty.
We do not yet have the full picture and further studies are needed into the impact of the pandemic on groups experiencing long-standing social and health inequities.”
People on low incomes or in insecure housing
People on lower incomes suffered substantially during the pandemic. In the UK, they were more than twice as likely to experience economic hardship relative to top quintile earners. For people already on low incomes, the anxiety about losing their job was overwhelming.
In the UK, immigrants and black, Asian and other ethnic minorities were more likely to experience economic hardship just after the first lockdown. Compared with their white counterparts, these groups were also found to suffer a larger decline in subjective wellbeing at the beginning of the March 2020 lockdown in the UK.
This new study does show that Population level studies are useful for looking at the big picture. But they can mask the underlying trends and inequalities of vulnerable groups. So, whilst this study is welcomed, and it is encouraging to see that at a population level we are largely resilient to global events such as pandemics, it is important we don’t forget to examine the nuance.
By ignoring the details, we run the risk of making broad generalisations that ignore vulnerable groups who need tailored support.
“Although it appears to be widely accepted that most nations are now past the peak of the pandemic, concerns remain about potential long-term effects of Covid-19 on peoples’ wellbeing. The initial indications demonstrated in the review give us cause to be optimistic however, at least regarding people’s overall mental health. It provides a useful guide regarding the formulation of public health policy and planning concerning mental health provision and support for future pandemics, and similar widespread health related events. The review indicates that in the context of large-scale societal events and disturbances, it might be of greater value to focus on protecting the mental health of more vulnerable cohorts rather than deploying mental health interventions at scale. Rigorous, high quality research is needed to evaluate the mental health of populations following the Covid-19 pandemic.”
Sarah Markham, BMJ Patient Panel.