As the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) took a firmer hold on the UK, the government introduced a lockdown on March 24, 2020, in an all-out attempt to ‘flatten the curve’ of infections. While the number of deaths has fallen in response, a new study published in the journal medRxiv in April 2020 reports that the pandemic is also associated with increased anxiety and depression in UK adults experiencing isolation.
The study was motivated by the need to understand how the COVID-19 pandemic has affected mental health and wellbeing. The researchers used a convenience sample, recruited via social media, and an online survey collected data.
All participants were above 18 years, spoke English, and were residents of the UK at the time of the outbreak. The data comes from the first two weeks of the government lockdown, where users were asked to fill out an online survey, which included elements from the Hospital Anxiety and Depression Scale, WHO-5, and OXCAP-MH - all tests to measure mental wellbeing.
The test was aimed at discovering if mental health was affected by five factors:
- Whether the subject was experiencing coronavirus symptoms
- Whether the subject was in a group that was vulnerable to SARS-CoV-2
- Whether the subject was an ‘essential worker’
- Whether the subject was in isolation because of COVID-19
- The community interactions that the subject was experiencing
The data used by the study came from approximately 600 people participants. Three-quarters were female, with an average age of 37 years. The overwhelming majority were white, and most were employed.
Over a quarter of the participants said they were being treated for mental disorders, such as mood disorders in a fifth, and neurotic disorders, stress-related conditions, and somatoform disorders, a group of psychiatric disorders that cause unexplained physical symptoms, in about 14% of the participants.
The study found that people who were experiencing coronavirus symptoms or in a vulnerable group did not display significant differences in mental health and wellbeing. Both these groups made up over a tenth of each of the total number of participants.
Greater anxiety and depression were experienced by those who self-isolated before the lockdown due to coronavirus symptoms. This group had lower levels of overall wellbeing and quality of life, as compared to those who did not. People who felt isolated to a greater extent after the lockdown began shared these characteristics.
Those people who felt that COVID-19 might threaten their livelihood – about 46% - said that they were more depressed and enjoyed a lower quality of life. Essential workers (about a third) were much less depressed than the average.
On the other hand, those who believed that the pandemic had actually encouraged more people to be kinder towards each other made up over two-thirds of the group. These people were less depressed and said their quality of life was higher, on average, with better wellbeing, compared to those who did not appreciate greater kindness from other people during the lockdown.
The same feelings were reported by those who said the local community had drawn closer together since the lockdown began. Finally, people with a sense of being supported by the social system as a whole or in any part were happier, less depressed, and had both a higher sense of wellbeing and greater quality of life.
What do the results mean?
According to the study, current general anxiety and depression scores are higher than normal, and more so in women than men. The study suggests that the absence of significant pathological depression or anxiety in essential workers may be due to the importance of their work and/or public recognition of their efforts (though it acknowledges that their findings are open to interpretation).
The association of depression and anxiety with isolation and poor social support emphasizes the need for newer ways of keeping people connected and supported during times of poor social contact.
The OXCAP-MH tool used in this study gives value to individual freedom to do one’s own thing, in terms of both self-identity and competence.
There are some significant limitations to the study: the sample was restricted to those who fill out forms on social media, while males, as well as black and minority ethnic groups, were underrepresented. The fact that the data was collected over a relatively short time frame limits the conclusions that can be drawn.
The study forms a small part of a long-term tracking program to understand how the pandemic and the lockdown affected mental health and wellbeing. The preliminary results indicate the need to study this area more, to design policies in public health emergencies that alleviate the impact of sweeping measures on mental health.
medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.