Though many studies have been conducted over the last two years, both during and after coronavirus disease 2019 (COVID-19) restrictions were implemented, 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 rapidly followed by extensive alterations to 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 because of social distancing measures, loss of employment, childcare, and school facilities, which subsequently caused previously working parents to become full-time caregivers for children at home, increased financial strain, and the reorientation of most healthcare services towards dealing with the crisis posed by COVID-19.
The rapid spread of the causative severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), as well as the high mortality of COVID-19 and overburdened hospital systems, supported global efforts to quickly develop highly effective vaccines. The subsequent large-scale deployment of COVID-19 vaccines led to a short-term reduction in case rates, which was then followed by a gradual relaxation of most pandemic restrictions.
Some researchers have described an inverse relationship between the stringency of COVID-19 restrictions and mental health, while others showed a positive association. These mixed results emphasize the need to better understand the context, which could confound the results of such association studies. Moreover, the predictors of poor mental health should also be revised as background experiences change.
About the study
The current study discusses long-term changes in public 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), which included more than 75,000 adults during the study period.
The researchers examined mental health symptoms with the established Generalized Anxiety Disorder Assessment (GAD-7), contextual factors like the stringency index, number of cases and deaths, and individual predictors like the level of confidence that people had in their government, healthcare services, and access to essential services, as well as whether the individual had contracted COVID-19.
COVID-19 restrictions were strictest during both the first lockdown from March 21, 2020, to August 23, 2020, as well as the second and third lockdowns from September 21, 2020, to April 11, 2021. Daily case counts increased after the first lockdown.
Daily COVID-19-related deaths peaked during lockdown periods. However, COVID-19-related deaths decreased during the second lockdown, which has been attributed to the rollout of vaccines that began in December 2020.
A small increase in depression and anxiety symptoms was reported during the two lockdown periods as compared to the intermittent periods of relaxation. While these symptoms were high at the beginning of the first lockdown, they decreased quickly thereafter. In August 2020, both anxiety and depressive symptoms again increased until the third lockdown.
The following slow decline in these symptoms continued until the end of 2021 when they began to rise again. However, depressive symptoms decreased again between March and April 2022. During the first lockdown, increased case counts were inversely associated with anxiety and depressive symptoms, but not afterward.
Moreover, an increase in deaths due to COVID-19 was initially linked to depressive symptoms that eventually declined over time. Vaccination also was associated with a moderate increase in depressive symptoms during the second and third lockdowns.
Depressive symptoms were higher as confidence in government, healthcare, and availability of essentials waned, with this effect strengthening over time. There was a small increase in depressive symptoms as knowledge of the disease increased; however, this change was only evident during the first lockdown.
Stress related to the pandemic was associated with more depressive symptoms, especially during the first lockdown. The association between COVID-19-related stress and these symptoms remained consistent, though weaker over time, thus indicating that people adjusted only partly to the fear of getting mortally sick with this infection. This was likely driven by increased knowledge of the chances of surviving COVID-19 from personal or social acquaintances and getting more familiar with the infection.
Stringent policies had the greatest impact when they affected social interactions. In fact, even an increase in deaths due to the infection was not associated with depressive symptoms at the end of the study period, though the opposite effect was observed earlier in the pandemic. This could be due to the vaccination rollout, following which deaths remained at a lower and stable level and no longer presented a primary source of terror.
The occurrence of COVID-19 itself was linked to increases in depression throughout the study. In fact, as the pandemic progressed, this association became stronger, perhaps because of the actual inflammatory effects of SARS-CoV-2 on the brain.
However, these symptoms could be mitigated by offering social support. The importance of social support, “arguably the most important predictor overall,” cannot be over-emphasized.
The current study tracked the evolution of symptoms relating to anxiety and depression over the course of two years from the start of the pandemic. This is the longest British study to follow up on such symptoms during this period.
The study findings corroborated the association of early uncertainty and fear that was prevalent at the start of the lockdown with these symptoms, though they decreased thereafter. The next rise in these symptoms was associated with rising COVID-19 cases and the resulting implementation of restrictions towards the end of 2020 and the start of 2021.
When the final lockdown ended, depressive and anxiety symptoms declined again, despite new COVID-19 case numbers remaining high. Other factors that were associated with these symptoms included a lack of confidence in the government, healthcare systems, and essential commodities or service supplies. Conversely, social support enhanced mental health.
Interestingly, the repeated call to protect the National Health Service (NHS) early on in the pandemic was associated with a loss of confidence in its ability to cope with the crisis. Disruptions of healthcare services due to many pandemic-related effects, as well as the fear of infection that led many to avoid medical consultations and other healthcare-seeking behaviors, also had negative impacts on mental health.
Perceived unavailability of mental health support due to overall load on the health service could also explain the relationship with higher anxiety and depressive symptoms.”
The current study highlights the importance of factors like social support, fear of being infected with SARS-CoV-2, a history of COVID-19, confidence in government, healthcare, and access to essential goods and services, as well as restrictions on social contact, and their ability to affect mental health during a crisis such as the current pandemic. Furthermore, these findings demonstrate that other factors like stringent policies and case/death counts are less directly associated with impacts on mental health and that their influence varies with the prevailing situation in the country.
This could provide important implications for policy making and for a better understanding of 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 regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.