The mental health impact of COVID-19: looking forward. Why we need high-quality longitudinal studies.

This blog has been guest written by Dr Daisy Fancourt, Associate Professor of Psychobiology & Epidemiology at the UCL Institute of Epidemiology & Health Care and leads the COVID-19 Social Study.

Researchers have been aware for years of the adverse effects of social isolation on mental health, incidence of physical illnesses such as coronary heart disease and stroke, and mortality risk ^1,2. But COVID-19 has triggered the largest enforced isolation in living human history. So predicting how this will affect mental health is extremely challenging.

A handful of studies on previous periods of quarantine have already been published. A rapid review published in the Lancet last month identified 24 studies conducted during outbreaks such as Ebola, the H1N1 influenza and severe acute respiratory syndrome (SARS). These have found that it isn’t just social isolation itself that is a challenge. Factors such as boredom, inadequate supplies and information, financial loss, and stigma can have negative psychological effects including post-traumatic stress symptoms, confusion, guilt, and anger ³, with some effects lasting as long as 3 years following the end of quarantine. People from disadvantaged backgrounds (who may face greater financial burdens), young people (for whom there may be significant disruption to their planned education and career pathways), and people with lower educational qualifications appear to be especially vulnerable ³. Even once quarantine measures are lifted, studies have found the persistence of problems including long-lasting changes in health behaviours (e.g. insomnia and lasting increases in alcohol abuse), fragmentation of social engagement (e.g. avoidance of public spaces and contact with others), and adverse effects on work (e.g. reduced work performance, reluctance to work, and increased consideration of resignation) ³.

These effects are all especially concerning as they occurred after just 7-30 days of isolation. Our isolation is anticipated to last significantly longer than this and is happening not just in certain towns and regions but across the globe. Consequently, there could be major immediate and lasting implications for the NHS and mental health services. So it is imperative that we dynamically capture the experiences of individuals and identify potentially protective activities during this period of isolation so that more specific guidance can be given to mitigate against adverse effects. It’s also key that we track what the emerging mental health problems are to enable the development of evidence-based social policies and services that can support individuals beyond the end of this epidemic.

In light of this, UCL has launched a large-scale UK study into the effects of COVID-19 on mental health. The study aims:

1. To understand the psychological and social impact of Covid-19
2. To map how the psychosocial impact evolves over time as social isolation measures get stricter and once measures are relaxed
3. To ascertain which groups are at greatest risk of adverse effects
4. To explore the interaction between psychosocial impact and adherence to healthy and protective behaviours
5. To identify activities during isolation that could buffer against adverse effects

Already, 50,000 people in the UK have taken part and are completing weekly online surveys. We’re producing weekly reports on findings and working with government, public health bodies and the NHS to help shape the support and advice that people are receiving. We’re also starting telephone interviews exploring the experiences of vulnerable groups in more detail.

We’re not alone in this endeavour. UCL is co-leading a new network of international longitudinal studies focused on mental health, working with teams internationally to harmonise measures and undertake collaborative analyses.

Mental health research right now is critical. Finding ways to support people whilst they stay at home will help reduce the pressure on NHS services both for mental health and other health conditions, and could increase adherence to government guidelines. Further, the findings from research will support us in understanding the adverse effects of isolation in more detail and in preparing for future epidemics.

Also, the findings from this research may not all be negative. Lessons following previous epidemics such as SARS include the amazing ability of people to bounce back and even find some positives amidst even the most adverse experiences. What’s more, Covid-19 has focused attention on which jobs really are the most important within society, giving prominence and status to individuals in roles now designated as ‘key workers’ that have previously not been so well acknowledged or valued. Whether this translates to changes in subjective wellbeing amongst these groups will be interesting to discover.

To take part in the study, visit www.covid19study.org or click on this link: https://redcap.idhs.ucl.ac.uk/surveys/?s=TTXKND8JMK. To find out more about the study and see reports, visit www.marchnetwork.org/research. If you are running a longitudinal mental health study of COVID-19, register details of it with the COVID-Mind International Network here: https://www.surveymonkey.com/r/covid-mind-network

 

Further reading

1. Valtorta, N. K., Kanaan, M., Gilbody, S., Ronzi, S. & Hanratty, B. Loneliness and social isolation as risk factors for coronary heart disease and stroke: systematic review and meta-analysis of longitudinal observational studies. Heart 102, 1009–1016 (2016).
2. Holt-Lunstad, J., Smith, T. B., Baker, M., Harris, T. & Stephenson, D. Loneliness and Social Isolation as Risk Factors for Mortality: A Meta-Analytic Review. Perspect. Psychol. Sci. 10, 227–237 (2015).
3. Brooks, S. K. et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. The Lancet 395, 912–920 (2020).