Has the pandemic really caused a 'tsunami' of mental health problems?
By Richard Bentall
Our research shows coronavirus ‘winners’, ‘losers’, and a lot of resilience. Understanding that can help us target support better
How is the population of the UK coping with the continuing coronavirus crisis? According to some media reports and commentators in the mental health community, we are now facing “the greatest threat to mental health since the second world war” and a potential “tsunami” of psychological problems.
With a team of experts from the Universities of Sheffield, Ulster, Liverpool, UCL and Royal Holloway and Bedford College I have been monitoring the mental health of the UK population since the beginning of the crisis. Looking at our findings, we think that this tsunami narrative is misleading. If accepted uncritically, it could undermine efforts to protect the health of the population and also our ability as a nation to recover once the crisis is over. Here is why.
Like many other mental health researchers, we quickly recognised the importance of understanding how the pandemic affected the wellbeing of ordinary people. Working with the survey company Qualtrics, beginning on 23 March 2020 (the first week of lockdown) we recruited 2,025 adults who were representative of the UK population in age, sex, household income, political attitudes and many other factors. We measured mental health, but also aimed to make our survey as broad as possible, asking about family relationships, adherence to social distancing, attitudes towards vaccines, belief in Covid-19 conspiracy theories and many other things. We have been following these people ever since (the last survey was before Christmas) and have used other methods such as telephone interviews and internet-based psychological tests and diaries to enrich our understanding. We have also helped friends in other countries to launch parallel surveys. What have we found?
It will take an enormous effort to link all this data and create a rounded picture of how the UK population has fared in these extraordinary times, but we can already see some important patterns. In the first week of lockdown, we saw higher rates of depression, anxiety and stress than had been reported in previous UK population surveys, and similar findings have been reported by other researchers in the UK and elsewhere. Across all these studies, it seemed that people who had previously suffered from mental health difficulties, who were poor, young or who had small children at home were suffering the worst.
But only a few studies have examined changes that have occurred since that first lockdown period, and when these changes are examined a different picture emerges. We have seen an overall reduction in the number of people who report “above threshold” levels of psychiatric symptoms and similar findings have been reported by other research groups. This picture of adaptation and resilience should not be surprising because we know from previous research that individual, interpersonal traumas (for example, sexual assaults) are far more mentally damaging than collective traumas such as natural disasters. This is at least in part because strong social bonds protect people against stress and, during a crisis, people often come together to help each other, creating a sense of belonging and a shared identity with neighbours.
At the same time, it is important to recognise that average levels of psychological symptoms in the population could never be particularly informative. Even if there really were a tidal wave of mental illness washing over the population, what would anyone be able to do about it (it would not be possible to install a clinical psychologist in every neighbourhood)? Instead, when we use advanced statistical methods to discover different patterns of change, we see that the majority of the population (56.5% in the case of anxiety and depression) have been resilient, showing no evidence of mental illness at any time. These are contrasted with a small group who have been unwell throughout (6.5%), some who have deteriorated after starting with low (17%) or moderate symptoms (11.5%) and some who have shown considerable improvement in their mental health (8.5%). So, in total, about a quarter of the population is doing badly. This picture of what we might call “different slopes for different folks” does not look like a tsunami.
What could be driving these differences? People in these different groups are starting from different positions. Broadly, we found that individuals with a history of mental illness, who were lonely, who were intolerant of uncertainty, who were prone to death anxiety and who felt they had little control over their lives tended to do poorly. In a separate study of the Spanish population with friends in Madrid, we also found that people who started out with positive beliefs about the world (they thought that the world was fundamentally a good place) often experienced “post-traumatic growth”; they used the pandemic as an opportunity to re-evaluate their lives and change for the better.
But pandemics are dynamic and multifaceted, so that how people react over time depends not only on where they start out from but also on how events unfold. It is important to recognise that some of the consequences of the pandemic have been beneficial – people who have kept their jobs have often saved money, the daily commute has been eliminated for some, and we found that most parents of older children have enjoyed having their kids at home (although, as already noted, having young children at home is stressful).
We found that the economic threats associated with the pandemic were most linked with symptoms, whereas exposure to the virus seemed to have little effect (although very few of our sample have required hospital treatment and we know from other studies that those who do are very likely to suffer from persisting post-traumatic stress disorder).
Because of its bleak implications, the “tsunami” narrative carries the risk of becoming a self-fulfilling prophecy. Our more nuanced understanding of the psychological effects of the pandemic, by contrast, has practical implications. The government can most preserve the population’s mental health by protecting people from the economic consequences of the pandemic and by providing practical support to parents of young children. When additional resources are available for mental health services, they should be directed to those who are most vulnerable, for example those with pre-existing mental health difficulties, or those who have been hospitalised because of the virus, or frontline workers.
Looking to the long-term, studies such as ours can help provide the framework for a UK-wide resilience strategy. When the next crisis of a similar scale befalls our nation, we will hopefully be better prepared to withstand the shock.
My ongoing exploration into therapy related topics.