Mental health during the COVID-19 pandemic
The COVID-19 pandemic has impacted the mental health of people across the globe.[1][2][3][4] The pandemic has caused widespread anxiety, depression, and post-traumatic stress disorder symptoms.[4][5][6] According to the UN health agency WHO, in the first year of the COVID-19 pandemic, prevalence of common mental health conditions, such as depression and anxiety, went up by more than 25 percent.[7][8] The pandemic has damaged social relationships, trust in institutions and in other people, has caused changes in work and income, and has imposed a substantial burden of anxiety and worry on the population.[9] Women and young people face the greatest risk of depression and anxiety.[2][6]
For an associated topic, see Impact of the COVID-19 pandemic on neurological, psychological and other mental health outcomes.
COVID-19 triggered issues caused by substance use disorders (SUDs). The pandemic disproportionately affects people with SUDs.[10] The health consequences of SUDs (for example, cardiovascular diseases, respiratory diseases, type 2 diabetes, immunosuppression and central nervous system depression, and psychiatric disorders), and the associated environmental challenges (such as housing instability, unemployment, and criminal justice involvement), are associated with an increased risk for contracting COVID-19. Confinement rules, as well as unemployment and fiscal austerity measures during and following the pandemic period, can also affect the illicit drug market and patterns of use among consumers of illicit drugs drastically.
Mitigation measures (i.e. physical distancing, quarantine, and isolation) can worsen loneliness, mental health symptoms, withdrawal symptoms, and psychological trauma.
Mental health under COVID-19 by population and professions[edit]
Individuals with mental health disorders[edit]
Due to a lack of pre-COVID comparative data and non-representative sampling, few research were able to clearly identify changes in mental health caused by the COVID-19 environment. However, a study in Belgium compared the registration of mental health problems in primary care during and before the pandemic. They found a relative increase in registered mental health problems during the pandemic, as well as relatively more care provided to patients with mental health problems.[50] Young people, people with pre-existing mental health disorders, and people who are financially disadvantaged have been found to face an increase in declining mental health. Some demographics appear to have been under researched (e.g., culturally and linguistically diverse populations and indigenous peoples), while some research methodologies have not been utilized (e.g. there was a lack of qualitative and mixed-methods studies).[51]
Other mental health consequences[edit]
Relationships[edit]
The stress of the pandemic was cited as being a major cause in the increased numbers of break-ups and divorces which was observable from mid-2020 onwards as the upheaval of societal norms prompted people to reconsider their lives, relationships and jobs.[117] Relationship experts noted that people often do not recognize the impact that stress can have on a relationship and a couple's ability to be good partners to each other.[117] Some of the causes cited included the stresses brought about by living in cramped and shared spaces, arguments over the division of housework, and differing attitudes towards the seriousness of the virus with some partners choosing not to observe government guidelines over quarantine, mask mandates, or vaccinations.[118] The influence of unemployment and/or wage decreases brought about as a result of the pandemic was also cited, noting that this can manifest as anxiety, anger and frustration as well as an increased likelihood of domestic abuse.[119]
A survey by Relate, a UK relationship-support charity, in April 2020 found that nearly a quarter of people had felt that lockdown had been placing additional pressures on their relationship.[120] In couples where one party chose to get vaccinated while the other did not, tensions arose over the anger felt towards the partner for depriving them of their chance to enjoy life again.[121] As the pandemic took away “well-established routines that offered comfort, stability and rhythm”, according to Ronen Stilman, a psychotherapist and spokesperson for the UK Council for Psychotherapy, it left many partners around the world with limited opportunities to “seek other forms of support or stimulation”[117] beyond their relationship, which put them under severe strain.[119] The pandemic was also noted as acting as a catalyst for break-ups that may have been impending already, especially when the previous separate routines of partners had served to mask problems in this regard.[119] As of December 2020 it was noted the number of couples seeking relationship counseling had "surged" during lockdown.[120] As 2020 drew to a close, divorce rates around the world had noticeably increased with many previously content couples having separated due to the cumulative stresses brought about by COVID-19. British law firm Stewarts logged a 122% increase in enquiries between July and October 2020, compared with the same period in 2019.[119] In the US, 'Legal Templates', a legal contract-creation site, reported a 34% increase in sales of its basic divorce agreement, in the first half of 2020, compared to the same time period in 2019.[118] It was reported that newlyweds married in the previous five months to that made up 20% of these sales.[119] A noticeable increase in the number of applications for divorce during the coronavirus pandemic also occurred in Sweden.[122] The UK charity Citizens Advice reported a spike in searches for online advice on ending a relationship.[119] In January 2022 it was revealed the U.K.’s largest family law firm reported a 95% increase in divorce inquiries during the pandemic (detecting a majority of inquiries coming from women).[118]
As vaccinations began to be extended to children, differences of opinion between parents also strained marriages and relationships.[118]
Suicides[edit]
The pandemic triggered concern over increased suicides, caused by social isolation due to quarantine and social-distancing guidelines, fear, and unemployment and financial factors.[123][124] A 2020 study reported that suicide rates were either the same or lower than before the pandemic began, especially in higher income countries, as often happens in crises.[125]
The number of crisis hotlines calls increased, and some countries established new hotlines. For example, Ireland launched a new hotline aimed at older generations that received around 16,000 calls in its first month in March 2020.[126] The Kids Helpline in the Australian state of Victoria reported a 184% increase in calls from suicidal teenagers between early December 2020 and late May 2021.[127]
A March 2020 survey of over 700,000 people in the UK reported that 1 in 10 people had suicidal thoughts as a result of lockdown. Charities such as the Martin Gallier Project[128] as of November 2020 had intervened in 1,024 suicides during the pandemic.[129]
Suicide cases remained constant or decreased, although the best evidence is often delayed.[130] According to a study conducted on twenty-one high and upper-middle-income countries in April–July 2020, the number of suicides remained static.[131] These results were attributed to factors, including the composition of mental health support, financial assistance, family/community support, use of technology to connect, and time spent with family members. Despite this, isolation, fear, stigma, abuse, and economic fallout increased.[132] Self-reported levels of depression, anxiety, and suicidal thoughts were elevated during lockdown, according to evidence from several countries, but did not appear to have increased suicides.[131]
According to CDC surveys conducted in June 2020, 10.7 percent of adults aged 18 and up said they had seriously considered suicide in the previous 30 days. They ranged in age from 18 to 24 and were classified as members of minority racial/ethnic groups, unpaid caregivers, and essential workers.[133]
Few studies have been conducted to examine suicides in low- and lower-middle-income countries. WHO stated, “in 2016, low- and middle-income countries accounted for 79 percent of global suicides.” This is because of registration system limitations, and lack of real-time suicide data.[131]
Middle income Myanmar and Tunisia were studied along with low-income Malawi. The study reported that, “In Malawi, there was reportedly a 57% increase in January–August 2020, compared with January–August 2019, and in Tunisia, there was a 5% increase in March–May 2020, compared with March–May, 2019. By contrast, in Myanmar, there was a 2% decrease in January–June 2020, compared with January–June 2019.”[131]
Long-term consequences[edit]
According to the Inter-Agency Standing Committee (IASC) Guidelines on Mental Health and Psychosocial Support, the pandemic produced long-term consequences. Deterioration of social networks and economies, survivor stigma, anger and aggression, and mistrust of official information are long-term consequences.[13]
While some consequences reflect realistic dangers, but other stem from lack of knowledge.[178] Many community members show altruism and cooperation in a crisis, and some experience satisfaction from helping others.[179] Some may have positive experiences, such as pride about coping. One study examined how individuals cope and find meaning across 30 countries.[180] The study reported that people who were able to reframe their experiences in a positive way had lower levels of depression, anxiety, and stress. Gender, socioeconomic factors, physical health, and country of origin were not associated with outcome measures. Another study of nearly 10,000 participants from 78 countries found similar results, with 40% reporting well-being.[181] Another study reported that positive stressor reframing allowed individuals to view the adversity as a growth opportunity, rather than a crisis to be avoided.[180]
Once recovered from COVID-19, many will continue to experience long-term effects of the virus. Of these effects may include a lost or lessened sense of taste and smell, which is a result of the virus affecting cells in the nose. While this symptom is not fatal, an absence of these senses for a prolonged amount of time can cause lack of appetite, anxiety, and depression.[182] Those admitted to the ICU while battling their direct infection of the COVID-19 virus experience mental health consequences as a result of this stay, including PTSD, anxiety, and depression.[183]