Monitoring mental health is particularly important in times of any public health crisis. However, inconsistent and low-frequency data made mental health assessment quite challenging during the coronavirus disease 2019 (COVID-19)-induced global health crisis.
Study: Mental health concerns during the COVID-19 pandemic as revealed by helpline calls. Image Credit: engagestock/Shutterstock.com
The authors of research work in Nature used data from helplines to estimate the effects of the COVID-19 pandemic, the containment policies, and the income support policies separately. They collected humongous amounts of data from 23 helplines across 14 European countries, the USA, China, Hong Kong, Israel, and Lebanon. The total dataset covered 8 million individual calls made between 2019 and 2021.
The researchers also documented the composition of helpline calls, call volumes and their pandemic-related determinants. Helpline data is a real-time manifestation of revealed distress and mental health concerns across a range of topics. Being unaffected by researchers’ study design, this data closely resembles clinical data. Moreover, as this data is digitally recorded, it’s particularly relevant in a pandemic when face-to-face contact is impossible owing to shelter-in-place (SIP) orders and the risk of infection.
“International helpline call data shed light on a statistical blind spot of pandemic policy: mental health concerns and general distress of the population.”
Call volumes increased across helplines
After six weeks of the first COVID-19 outbreak, call volumes peaked 35% above pre-pandemic levels. This is consistent with the helpline data of the US Disaster Distress Helpline where weekly calls increased from 500 to around 3000, suggesting that COVID-19-related sources of distress displaced pre-existing reasons for distress calls.
After the week six peak, call volumes gradually decreased to reach 6.2% above pre-pandemic levels by week 11. When the starting point of the pandemic was defined as the time of implementations of the first SIP order, an increase of 11.2% was observed in call volumes by week 2, and after that, call volumes steadily increased until week eight before they started to decrease.
Caller issues and conversation topics changed after the outbreak
Relationship issues were the most prevalent topic in most pre-COVID-19 calls, and women placed 61% of all distress calls. Before and after the pandemic, between 45% and 81% of calls were placed by first-time or sporadic callers. The composition of calls changed significantly during the first wave of the COVID-19 pandemic. While the calls in the category ‘fear’ (including fear of infection) increased, with 2.4 percentage points, the share of all other conversation topics decreased.
Changes in call dynamics
During the second pandemic wave, call volumes increased with an increase in infections and tightening of non-pharmaceutical interventions (NPIs). In Germany, the call volumes increased continuously in early 2021, but they decreased in France. The diverging patterns observed in call dynamics in Germany and France were consistent with upswings and downswings in infections and the government measures in the two countries. However, the conversation topics of callers remained the same across the helplines and through two distinct waves of the pandemic.
Interpretation of the results
Overall, the study results suggest that the COVID-19 pandemic decreased other kinds of anxieties (arising from domestic violence, addiction, or suicidal ideation) in people, perhaps by shifting their focus towards fear of infection, loneliness, and distress of others. Consequently, helpline calls increased during the pandemic, but the proportion of suicide and addiction-related calls decreased. An actual decline in suicides was observed across several countries during the early stages of the pandemic.
There is no evidence suggesting the socio-demographic status, health, occupation, or nationality of the caller population, typically constituted by the most vulnerable members of society, which could have impacted the study results. Moreover, the study eliminated all time-invariant specificities of the helpline caller population, removing any potential sample selection bias.
Taken together, the increase in helpline call volumes during the pandemic was driven mainly by fear and loneliness, although later in the pandemic, the callers raised concerns about physical health. However, relationship issues, violence, suicidal ideation, and economic problems no longer remained the prevalent conversation topics after the pandemic started. This pattern was seen through both the COVID-19 waves. The statistical analysis of the helpline data indicated an increase in suicide-related calls when containment policies became more stringent but declined as income support was extended, implying that financial benefits given to workers and businesses alleviated the distress triggered by the pandemic-related lockdown.