While many studies have been conducted in the past two years, both during and after the introduction of restrictions for 2019 disease (COVID-19), the long-term effects of these events remain unclear.
A new study published on the preprint server medRxiv† discusses changes in the prevalence of depressive and anxiety symptoms over the course of the COVID-19 pandemic and their association with individual and environmental factors.
Study: Depressive and anxiety symptoms during the COVID-19 pandemic: a two-year follow-up. Image credit: fizkes/Shutterstock.com
The onset of the COVID-19 pandemic was quickly followed by extensive changes in the global economy, social interactions, education and healthcare systems. Some of the common stressors that affected individuals during the pandemic included the fear of becoming seriously ill and dying from COVID-19, isolation from loved ones and friends due to social distancing measures, loss of work, childcare and school facilities, which then led to previously working parents to become full-time caregivers for children at home, increased financial pressures and the reorientation of most health care services on coping with the crisis caused by COVID-19.
The rapid spread of the causal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), as well as the high mortality of COVID-19 and congested hospital systems, supported global efforts to rapidly develop highly effective vaccines. The subsequent large-scale deployment of COVID-19 vaccines led to a reduction in the number of cases in the short term, followed by a gradual easing of most pandemic restrictions.
Some researchers have described an inverse association between the strictness of COVID-19 restrictions and mental health, while others have shown a positive association. These mixed results emphasize the need to better understand the context, which could confound the results of such association studies. In addition, the predictors of poor mental health also need to be revised as background experiences change.
About the study
The current study examines long-term changes in human mental health between March 2020 and April 2022. These changes were assessed based on data from the University College London (UCL) COVID-19 Social Study (CSS), in which more than 75,000 adults participated. during the study period.
The researchers examined psychological symptoms using the well-established Generalized Anxiety Disorder Assessment (GAD-7), contextual factors such as the stringency index, number of cases and deaths, and individual predictors such as people’s trust in their government, health care, and access to essential services, as well as whether the person had contracted COVID-19.
The COVID-19 restrictions were most severe during both the first lockdown from March 21, 2020 to August 23, 2020 and the second and third lockdown from September 21, 2020 to April 11, 2021. The daily number of cases increased after the initial lockdown.
Daily COVID-19-related deaths peaked during lockdown periods. However, the number of COVID-19-related deaths fell during the second lockdown, which was attributed to the vaccine rollout that began in December 2020.
A small increase in depression and anxiety symptoms was reported during the two lockdown periods compared to the intermittent periods of relaxation. While these symptoms were high at the start of the initial lockdown, they quickly subsided after that. In August 2020, both anxiety and depressive symptoms increased again until the third lockdown.
The next slow decrease in these symptoms continued until late 2021, when they started to increase again. However, depressive symptoms decreased again between March and April 2022. During the first lockdown, increased numbers of cases were inversely associated with anxiety and depressive symptoms, but not thereafter.
In addition, an increase in deaths from COVID-19 was initially linked to depressive symptoms that eventually decreased over time. Vaccination was also associated with a moderate increase in depressive symptoms during the second and third lockdowns.
Depressive symptoms were higher as trust in government, health care and the availability of essentials declined, and this effect became stronger over time. There was a small increase in depressive symptoms as knowledge of the disease increased; however, this change was only apparent during the initial shutdown.
Stress related to the pandemic was associated with more depressive symptoms, especially during the initial lockdown. The link between COVID-19-related stress and these symptoms remained consistent, although weaker over time, suggesting that people were only partially adapting to the fear of becoming fatally ill with this infection. This was probably caused by a greater knowledge of COVID-19 survival from personal or social acquaintances and getting to know the infection better.
Strict policies had the greatest impact when it affected social interactions. Even an increase in deaths from the infection was not associated with depressive symptoms at the end of the study period, although the opposite effect was seen earlier in the pandemic. This may have been due to the roll-out of vaccinations, after which the number of deaths remained at a lower and stable level and was no longer a primary source of terror.
The occurrence of COVID-19 itself had been associated with an increase in depression during the study. As the pandemic progressed, this association became even stronger, perhaps because of SARS-CoV-2’s actual inflammatory effects on the brain.
However, these symptoms can be mitigated by providing social support. The importance of social support,”perhaps the most important predictor in general,” cannot be emphasized enough.
The current study tracked the evolution of symptoms related to anxiety and depression over the course of two years from the start of the pandemic. This is the longest UK study to monitor such symptoms during this period.
The study results confirmed the association of early uncertainty and anxiety that prevailed at the start of the lockdown with these symptoms, although they decreased thereafter. The next rise in these symptoms was related to rising COVID-19 cases and the consequent implementation of restrictions towards the end of 2020 and early 2021.
When the latest lockdown ended, depressive and anxiety symptoms eased again, despite the number of new COVID-19 cases remaining high. Other factors associated with these symptoms included a lack of trust in government, healthcare systems, and essential goods or services. Conversely, social support improved mental health.
Interestingly, the repeated calls to protect the National Health Service (NHS) early in the pandemic have been accompanied by a loss of confidence in its ability to cope with the crisis. Health care disruptions due to many pandemic-related effects, as well as the fear of infection that led many to avoid medical consultations and other care-seeking behaviors, also negatively impacted mental health.
Perceived unavailability of mental health support due to the overall burden of health care could also explain the relationship with higher anxiety and depressive symptoms†
The current study highlights the importance of factors such as social support, fear of becoming infected with SARS-CoV-2, a history of COVID-19, trust in government, healthcare and access to essential goods and services, as well as restrictions on social contact. , and their ability to impact mental health during a crisis such as the current pandemic. In addition, these findings show that other factors, such as strict policies and the number of cases/deaths, are less directly related to mental health impacts and that their influence varies with the prevailing situation in the country.
This could have important implications for policy making and for better understanding the mental health of the general public during a national or global health crisis.†
medRxiv publishes preliminary scientific reports that are not peer-reviewed and therefore should not be considered conclusive, should guide clinical practice/health-related behavior, or be treated as established information.
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