Covid-19 & Easing Lockdown: A Ticking Mental Health Timebomb?

As the lockdown restrictions here in England begin to get eased, all the focus is now shifting towards returning to work, being out and out about more, starting to be able to meet someone from another household and the possible return of school (at least for some children).

Having spent seven or so weeks being told to stay at home to protect the NHS and save lives, the message now is shifting towards being able to take the next steps towards the 'new normal' and remaining 'alert' whilst maintaining social distancing. 

And there's no doubting that for many people, covid-19 and the lockdown has had an impact on their mental health and wellbeing. There has been anxiety, stress and worry about many aspects of life including health, education, employment, finances, being restricted and much more. I know that in the very early days of the pandemic and lockdown I suffered some stress as I adjusted to what it all meant for home, health, work and keeping a roof over our heads.

These sorts of concerns were being echoed all over the country with the ONS (Office For National Statistics) reporting in April, through their Opinions and Lifestyle Survey, that over 4 in 5 adults in Great Britain said they were very worried or somewhat worried about the effect that the coronavirus (COVID-19) was having on their life right then. At that time, just over half of adults said covid-19 was affecting their well-being and nearly half of adults reported high levels of anxiety. Covid-19 and lockdown impacted on our mental health.

Of course, whilst everyone experienced elements of social isolation, lifestyle disruption, impacts on income, employment and education, everyone's individual circumstances will vary, and some who are at higher risk may have had to isolate and restrict their actions even more than some others of us.   

Over recent days there have been a number of commentators and other people beginning to talk about a 'mental health ticking timebomb.' There seems to be a sense that the anxiety and mental health impacts of covid-19 and lockdown will continue even after lockdown eases, and that more and more people will need help to address their coronavirus-induced mental health issues.  

So will the mental health impacts of covid-19 continue in the post lockdown era?

Anxiety, Stress and Covid-19 

The ONS survey and anecdotal experience online and from my clients certainly shows that during lockdown, and particularly the early stages of the pandemic, many people experienced increased anxiety, worry and stress.

As mentioned in an earlier article, Shevlin et al (Anxiety, Depression, Traumatic Stress, and COVID-19 Related Anxiety in the UK General Population During the COVID-19 Pandemic, April 2020), investigated the prevalence of Covid-19 related anxiety, generalised anxiety, depression and trauma symptoms in a representative sample of the UK population during an early phase of the pandemic.

They found that there were higher reported levels of anxiety, depression and trauma symptoms compared to previous population studies, but not dramatically so.  Anxiety,  depression and trauma symptoms were predicted by young age, presence of children in the home, and high estimates of personal risk. Anxiety and depression symptoms were also predicted by low income, loss of income, and pre-existing health conditions in self and other.

Shelvin et al concluded that, "The UK population, especially older citizens, were largely resilient in the early stages of the pandemic. However, several specific COVID-related variables are associated with psychological distress: particularly having children at home, loss of income because of the pandemic, as well as having a pre-existing health condition, exposure to the virus and high estimates of personal risk."

As would be expected, those impacted (or potentially so) by education impacts, loss of income and health concerns. And of course it's not possible from this data to assess the ongoing impact under lockdown and how people adjusted and learnt to cope, or how people continued to struggle with anxiety, depression and stress.

It's a similar story in the USA where Twenge & Joiner (Mental distress among US adults during the COVID-19 pandemic, 2020) concluded that mental distress was considerably higher in a nationally representative sample of U.S. adults in late April 2020 compared to a nationally representative sample from 2018, providing "an early indication that serious mental illness has become strikingly more common during the COVID-19 pandemic". 

And another study from the USA by Adams-Prassl et al (The Impact of the Coronavirus Lockdown on Mental Health. 2020) has suggested that the large negative effect on mental health has been entirely driven by the impact on women's mental health. They suggest that the negative effect on women’s mental health cannot be explained by an increase in financial worries or childcare responsibilities.

"The health impact of the crisis, measured by the number of confirmed Covid-19 cases and deaths per capita, also cannot explain the negative impact of state-wide lockdown orders on women’s mental health. Taken together, the evidence presented in this paper shows that the health costs of the coronavirus pandemic are likely to go well beyond the rising death toll and the number of cases." 

That negative impact on women's mental health is not something that has featured prominently in other medical research and certainly it requires further study to understand the impact, prevalence and factors that could be driving it.

And, of course, things are now shifting to easing the lockdown and whilst some people seem keen to be able to go out and do more and return to more of a sense of normality, others may have increased concerns and worries about returning to work and increased activity outside of the home, along with the anxiety about contracting the disease or it having a resurgence. 

Having spent week after week being told to stay at home and watching the ever increasing death toll, it's more than understandable that you may have worries and fears about getting out and doing more whilst the virus is still having such a health impact. 

covic 19 mental health hypnotherapy ely

 

Post Lockdown Mental Health

In balance to those concerns I've just described, I've written recently about how our brains are not that great at predicting how we will feel in the future. In many other aspects of life it has been shown that we predict we will feel worse than actually turns out to be the case. Whilst concerns are valid as you think ahead, you may well find that once life picks up and you are doing more, then you discover that you are more resilient and can handle and cope with things better than you expected.

And of course, let's remember that whereas there are many aspects of this situation, from Government decisions to other people's behaviour to the virus itself, outside of our control, what we need to focus on are the things we are in control of such as frequent hand washing, using hand sanitiser and wearing a face covering (where beneficial) and taking measures such as social distancing, working remotely and ensuring good ventilation.  You can also take steps that research suggests will benefit your mental health and wellbeing, such as exercise, getting enough sleep and finding time to relax (e.g. why not download one of my free hypnosis downloads?).

And research from China, who are ahead of us in easing the lockdown, suggests that there may not be a mental health timebomb as more people return to work as part of easing lockdown (although the exact steps in China are obviously different politically and culturally from here). 

Tan et al (Is returning to work during the COVID-19 pandemic stressful? A study on immediate mental health status and psychoneuroimmunity prevention measures of Chinese workforce, 2020) studied the immediate psychological impact and psychiatric symptoms of the Chinese workforce (673 participants) who returned to work after lockdown and quarantine in Chongqing, China.

"As the study was conducted at a time when China was facing the COVID-19 pandemic and imposed lockdown and quarantine measures, the full impact of COVID-19 on the mental health of the workplace at its peak could be captured...Our study suggests that the experience of returning to work during the COVID-19 pandemic did not confer an increase in the prevalence of PTSD symptoms, depression, anxiety and stress..."

Naturally there were those within their sample who were experiencing anxiety, depression, insomnia and stress, however frequent practice of hand hygiene, wearing face masks and workplace practices such as improved workplace hygiene and concern from employers about your health seemed to be associated with less mental health symptoms in employees.

Mental Health And Healthcare Workers 

So whilst many of us may find that, in fact, we are more resilient and cope better post lockdown than we may have anticipated, what about one group who have been at the front line of the covid-19 response, healthcare workers?

Pappa et al (Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Brain, Behavior, and Immunity, 2020) carried out a review to analyse existing evidence on the prevalence of depression, anxiety and insomnia among health care workers during the Covid-19 outbreak. Thirteen studies were included in the analysis with a combined total of 33,062 participants.

Perhaps unsurprisingly, they found evidence that a high proportion of healthcare professionals have experienced significant levels of anxiety, depression and insomnia during COVID-19 pandemic.  

And Sasangohar et al (Provider burnout and fatigue during the COVID-19 pandemic: lessons learned from a high-volume intensive care unit, 2020) have talked about the emotional and physical toll on healthcare workers.

In making recommendations for lessons to be learned from the pandemic they write, "Limited resources, longer shifts, disruptions to sleep and to work-life balance, and occupational hazards associated with exposure to COVID-19 have contributed to physical and mental fatigue, stress and anxiety, and burnout."

They highlight the need to find feasible and practical methods to asses health care workers' fatigure and burnout.

What remains to be seen is how the ongoing psychological distress of healthcare workers translates into the next stages of the pandemic and any ongoing prevalence of PTSD, anxiety and depression.

This research has highlighted the high prevalence rates of depression, anxiety and insomnia of healthcare professionals. Yet, as with the rest of us, how much of a ticking mental health timebomb exists from the pandemic and the associated downturn in the economy will only become clear in the coming weeks and months. 

Stay safe,

Dan Regan

Hypnotherapy in Ely & Newmarket 

 

 

References: 

Adams-Prassl, A., Boneva, T., Golin, M. and Rauh, C., 2020. The Impact of the Coronavirus Lockdown on Mental Health: Evidence from the US (No. 2020-030).

Pappa, S., Ntella, V., Giannakas, T., Giannakoulis, V.G., Papoutsi, E. and Katsaounou, P., 2020. Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Brain, Behavior, and Immunity.

Sasangohar, F., Jones, S.L., Masud, F.N., Vahidy, F.S. and Kash, B.A., 2020. Provider burnout and fatigue during the COVID-19 pandemic: lessons learned from a high-volume intensive care unit. Anesthesia and analgesia.

Shevlin, M., McBride, O., Murphy, J., Miller, J.G., Hartman, T.K., Levita, L., Mason, L., Martinez, A.P., McKay, R., Stocks, T.V. and Bennett, K.M., 2020. Anxiety, Depression, Traumatic Stress, and COVID-19 Related Anxiety in the UK General Population During the COVID-19 Pandemic.

Tan, W., Hao, F., McIntyre, R.S., Jiang, L., Jiang, X., Zhang, L., Zhao, X., Zou, Y., Hu, Y., Luo, X. and Zhang, Z., 2020. Is returning to work during the COVID-19 pandemic stressful? A study on immediate mental health status and psychoneuroimmunity prevention measures of Chinese workforce. Brain, Behavior, and Immunity.

Twenge, J. and Joiner, T., 2020. Mental distress among US adults during the COVID-19 pandemic.