As we learn to live with COVID-19, Aela O’Flynn reviews the evidence published on the impact lockdown has had on mental health.
Isolation - a word that is all too familiar. While physical and social isolation have been vital to slow the spread of COVID-19, the inevitable consequences are beginning to emerge. As COVID-fatigue sets in, could we be on the brink of a mental health crisis?
This virus has infiltrated every aspect of our lives, everything including our physical health, our finances, and our social lives have all suffered. However, the World Health Organisation now warns that the pandemic could spark "an upsurge in the severity of mental illness". The isolation, fear and uncertainty of lockdown has had a significant impact on mental health in Ireland. A survey from the Mental Health Reform found that over 50% of Irish adults who currently access mental health services believe that the pandemic has had either a negative or very negative impact on their mental health. Among the general population, 74.9% agreed that, "the COVID-19 pandemic will have long-term implications for the mental health and well-being in our society", and 75.2% agreed that "the Government should develop a mental health strategy to address the impact of the COVID-19 pandemic". This call to action has been echoed on an international level by the UN's Policy Brief on Mental Health.
A research collaboration between UCD and Maynooth University has delved further into the mental health effects of lockdown in Ireland. The study consisted of details of the daily emotional well-being of 604 Irish adults on the 24th of March, the same day that all non-essential businesses were instructed to close. Most people had already begun working from home, whilst schools and colleges had been closed for almost two weeks. Participants answered a series of questions to reconstruct the events of the initial lockdown day, alongside their associated emotions. The findings of the survey suggest activities which may have respectively helped or hindered our mental health in lockdown. Activities associated with positive effects on emotional well-being included exercising, gardening, and pursuing a hobby. Conversely, activities which had the most negative impact were using social media, home schooling children, and seeking information about COVID 19.
Younger adults, primarily those aged 18-29, reported greater feelings of loneliness and isolation than those over 50
Studies like this are vital to assist governmental decision-making to implement the necessary public health measures while minimising the negative impact on mental health. Twenty-four of the world’s leading experts published a position paper in The Lancet earlier this year emphasising the necessity of mental health research during COVID-19 to enable adequate service planning. While the UCD and Maynooth study provides an extremely useful insight into the immediate effect of lockdown in Ireland, it is slightly limited as it only contains data from a single day at the beginning of the most restrictive phase of lockdown. It does not take into account whether people's wellbeing and routines adapted over the course of quarantine. DCU's School of Psychology recently produced a paper which analysed how mental health issues during the pandemic differed between demographics. This study followed participants for longer, contacting them once a month for the three months from April to July, thus allowing them to somewhat account for adaptation to restrictions. The results indicated that younger adults, primarily those aged 18-29, reported greater feelings of loneliness and isolation than those over 50. The wellbeing of young females was shown to fare significantly worse than young males. Those who spent more than four hours per day on social media also reported significantly worse mental health.
Another study from China considered life-disruption one month into the pandemic. Variation was noted in mental health effects between participants with different lifestyles. People who worked from home or in the office during the COVID-19 outbreak fared better in both mental and physical health than those who stopped working altogether. It was also found that those who had higher levels of physical activity during the outbreak were more negatively impacted by higher COVID-19 rates in their area than those who were less physically active. This was believed to be because they felt the ill effects of restricted activity more than someone who tended to be less active.
It will be a long wait before we can truly know the long-term mental health effects of the pandemic, and the fallout that will follow
All these studies are observational, and thus limited by design. It will be a long wait before we can truly know the long-term mental health effects of the pandemic, and the fallout that will follow. While evidence is still limited on wellbeing during COVID lockdowns, we can look to evidence gathered during previous pandemics for further guidance. A review of existing evidence on the impact of quarantine was published in The Lancet earlier this year and identified the most significant stressors during and after quarantine. Suggestions for governments to mitigate the negative mental health impact included minimising time spent in quarantine, providing adequate information and supplies to those in quarantine, reducing boredom, emphasising the altruistic reasons to isolate, and providing additional support to at-risk groups, such as health care workers.
So as we learn to live with COVID, what can we do as individuals to support our mental health? We all know the necessary steps to protect our physical health in the pandemic, but we have not been given the same guidance to protect our mental health. In truth, it's personal. What is helpful for one person may not be helpful to the next, and we all cope with adversity differently. But here are some tactics that might help; the literature indicates strategies we can use to combat boredom and anxiety in lockdown. Keep boredom at bay with physical activity, hobbies, and any social interaction, even of a remote nature. While anxiety about the virus is inevitable and it is important to inform ourselves, constant updates on every new scrap of information can be detrimental to our mental health. Limit anxiety by restricting time spent on news and social media sites, and focusing on your own day to day tasks and activities instead.
We must acknowledge when our wellbeing is suffering, and take proactive steps to preserve our emotional health
In these utterly unprecedented circumstances, it's hardly surprising that mental health takes a hit. It will impact everyone, but in different ways, and to different extents. We need to be mindful of those around us, but also ourselves. We must acknowledge when our wellbeing is suffering and take proactive steps to preserve our emotional health. Get out, get active, and stay connected. And above all, don't be afraid to ask for help.
If you are suffering with mental health difficulties at this time, please reach out to a friend, a family member, or someone you trust. There are also a number of services available to support you, such as Jigsaw (jigsawonline.ie), Pieta House (pieta.ie/contact), Mental Health Ireland (firstname.lastname@example.org), and several others which can be found on the HSE website (https://www2.hse.ie/services/mental-health-supports-and-services-during-coronavirus/).