Has the pandemic really caused a ‘tsunami’ of mental health problems? | Mental health
H.How is the UK population coping with the ongoing coronavirus crisis? According to some media reports and commentators in the mental health community, we are now facing “the greatest threat to mental health since World War II” and a potential “tsunami” of mental health problems.
With a team of experts from the Universities of Sheffield, Ulster, Liverpool, UCL and Royal Holloway and Bedford College, I have been monitoring the mental health of the UK population since the beginning of the crisis. When we look at our results, we think this tsunami narrative is misleading. If uncritically accepted, it could undermine efforts to protect the health of the population and also our ability as a nation to recover after the crisis is over. Here’s why.
Like many other mental health researchers, we quickly realized the importance of understanding how the pandemic is affecting the well-being of ordinary people. Working with survey firm Qualtrics, as of March 23, 2020 (the first week of the lockdown), we recruited 2,025 adults who were representative of the UK population in terms of age, gender, household income, political attitudes and many other factors. We measured mental health but also wanted to make our survey as comprehensive as possible, asking about family relationships, adherence to social distancing, attitudes towards vaccines, belief in conspiracy theories about Covid-19, and many other things. We have followed these people since then (the last survey was before Christmas) and have used other methods such as telephone interviews and internet-based psychological tests and diaries to enrich our understanding. We also helped friends in other countries to start parallel surveys. What did we find
It will take a tremendous effort to tie all this data together and get a complete picture of how the British people have fared during these extraordinary times, but we can already see some important patterns. In the first week of lockdown, we saw higher rates of depression, anxiety and stress than reported in previous UK population surveys, and similar results have been reported by other researchers in the UK and elsewhere. In all of these studies, it appeared that people who had previously suffered from mental health problems, were poor, young, or at home with young children suffered the worst.
But few studies have looked at changes that have occurred since that initial lockout period, and when these changes are examined the picture is different. We saw an overall reduction in the number of people reporting psychiatric symptoms above the threshold, and similar results were reported by other research groups. This picture of adaptation and resilience should come as no surprise, as we know from previous research that individual, interpersonal trauma (such as sexual assault) is far more psychologically damaging than collective trauma such as natural disasters. This is, at least in part, because strong social ties protect people from stress and often people come together in a crisis to help each other and create a sense of belonging and a common identity with neighbors.
At the same time, it is important to recognize that the average level of psychological symptoms in the population can never be particularly informative. Even if the population were really hit by a tidal wave of mental illness, what could anyone do about it (it would not be possible to have a clinical psychologist in every neighborhood)? Instead, when we use advanced statistical methods to discover different patterns of change, we find that the majority of the population (56.6% for anxiety and depression) were resilient and at no point showed signs of mental illness. This is in contrast to a small group who were consistently unwell (6.3%), some who got worse after starting with low (16.9%) or moderate symptoms (11.6%), and some who did have shown a significant improvement in their mental health (8.6%)). Overall, around a quarter of the population is doing badly. This picture of what we might call “different slopes for different people” doesn’t look like a tsunami.
What could drive these differences? People in these different groups assume different positions. By and large, we found that individuals with a history of mental illness who were lonely, did not tolerate uncertainty, were deathly afraid, and felt they had little control over their lives tended to do poorly. In a separate study of Spanish people with friends in Madrid, we also found that people who started out with positive beliefs about the world (they thought the world was basically a good place) often experienced “post-traumatic growth”. They used the pandemic as an opportunity to reassess their lives and change for the better.
However, pandemics are dynamic and diverse, so how people react over time depends not only on where they start but also on how events develop. It’s important to recognize that some of the aftermath of the pandemic has been beneficial – people who have kept their jobs have often saved money, the daily commute has been eliminated for some, and we have found that most parents of older children enjoyed it have to have their children at home (although, as mentioned, having young children at home is stressful).
We found that the economic threats associated with the pandemic were most symptomatic, while exposure to the virus appeared to have little impact (although very few of our samples required hospital treatment and we know from other studies that those who who do this are very likely to have persistent post-traumatic stress disorder).
Because of its dire implications, the “tsunami” narrative risks becoming a self-fulfilling prophecy. Our more nuanced understanding of the psychological impact of the pandemic, on the other hand, has practical implications. The government’s best way to preserve the mental health of the population is by protecting people from the economic fallout from the pandemic and by providing practical support to parents of young children. If additional resources are available for mental health services, they should be directed to those who are most at risk, e.g. For example, people with pre-existing mental health problems, people hospitalized for the virus, or frontline workers.
In the long term, studies like ours can help set the framework for a UK resilience strategy. Hopefully, when the next crisis hits our nation on a similar scale, we will be better prepared to withstand the shock.
Richard Bentall is Professor of Clinical Psychology at the University of Sheffield
The Covid-19 Consortium for Psychological Research also includes Todd Hartman, Jilly Gibson-Miller, Liat Levita, Anton Martinez, Thomas Stocks and Sarah Butter (University of Sheffield); Mark Shevlin, Jamie Murphy, and Orla McBride (University of Ulster); Kate Bennett (University of Liverpool); Liam Mason (UCL) and Ryan McKay (Royal Holloway and Bedford College). The project website is: www.sheffield.ac.uk/psychology-consortium-covid19