A review of the available literature on the impact of the coronavirus disease 2019 (COVID-19) pandemic on adult mental health in the UK by Public Health England has revealed a decline in mental health across the UK population since the beginning of the pandemic. The review article, which is currently available on the medRxiv* preprint server, has provided a detailed description of possible risk factors and protective behaviors.
Study: The impact of the COVID-19 pandemic on adult mental health in the UK: A rapid systematic review. Image Credit: CameraCraft/ Shutterstock
*Important notice: medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.
Background
The outbreak of COVID-19, a novel disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has significantly impacted many countries' socioeconomic and healthcare structures, including the UK. As an outcome of multiple national lockdowns and strict control measures, a considerable proportion of the UK population has faced temporary or permanent job loss. As reported by several studies, financial insecurity due to pandemic-related restrictions has negatively impacted the mental health of the adult population in the UK.
In the current study, the scientists have systematically reviewed all available literature describing the impact of the COVID-19 pandemic on adult mental health in the UK. Moreover, they have examined which populations have been affected most by the pandemic and the protective factors that can be used as supportive interventions to boost mental health.
Study design
In the review, scientists included all journal articles and preprints reporting primary quantitative or qualitative findings on adult mental health in the UK during the pandemic. They specifically analyzed depression, anxiety, stress, self-harm, and suicide as most commonly experienced mental health symptoms. They screened more than 4000 articles published between March 2020 and March 2021, and finally selected 102 articles for review.
Important observations
As reported in the review article, the prevalence of adverse mental health problems increased significantly in the UK adult population during the first lockdown in March 2020 compared to pre-pandemic years.
Anxiety and depression
A sharp increase in anxiety and depression cases was observed when the first lockdown was introduced, followed by a gradual decline. In contrast, fewer than expected referrals to primary care mental health services were observed during the lockdown. This could be because of the unavailability of GP appointments or the fear of contracting the disease. Regarding referrals to secondary care services, a gradual and long-term increase was observed following an initial drop at the beginning of the first lockdown.
Self-harm and suicide
In Oxford and Derby, comparatively reduced self-harm cases were reported in hospitals during the first lockdown. Among reported cases of self-harm, lack of support services, isolation, and physical or psychological abuse were identified as primary causative factors. In contrast, Birmingham experienced an increased reporting of self-harm cases during lockdown.
There was no evidence indicating any change in suicide rates during the pandemic; however, more adults reported experiencing thoughts of suicide.
Overall, a correlation was found between pandemic-related stress and anxiety and negative body image, body dissatisfaction, and abnormal eating behaviors.
What are the possible risk factors?
The highest impact of the pandemic on mental health was observed among women, young adults, people belonging to the LGBTQ community, socio-economically deprived people, people with pre-existing health conditions, and people who contracted COVID-19.
The incidence of physical and psychological abuse, self-harm and suicide thoughts, loneliness, and over-drinking was higher among women than men. However, recovery from adverse mental health issues was faster for women than men.
Among young adults, students were particularly at risk of depression, anxiety, and loneliness. In general, younger people with low income or a history of mental illness experienced more anxiety during lockdown. Worse mental health was experienced by people with financial insecurity, unemployed people, and those relying on government benefits.
A relatively higher impact of lockdown on mental health was observed in people living alone or experiencing a poor relationship with a partner. Similarly, a gradual worsening of mental health was observed in people living with children.
Inaccessibility to social and medical support services had negatively impacted the mental health of children and young adults with physical or mental disabilities and those with dementia.
Hospitalized COVID-19 patients experienced more post-traumatic stress disorder symptoms than non-hospitalized patients with milder symptoms. In general, people who spent more time watching COVID-19 related news, or those with a feeling of loneliness due to self-isolation, experienced more depression and anxiety.
What are the protective factors?
People who remained connected to friends and family experienced better mental health consequences. Similarly, people with a pet experienced good mental health during lockdown.
Regarding lifestyle-related factors, people who regularly practiced yoga, meditation, or other physical exercises experienced an overall improvement in mental health during lockdown.
Study significance
A negative impact of the COVID-19 pandemic has been observed in the adult population of the UK. As identified in the current report, maintaining a healthy lifestyle and strengthening social networks are the key to maintain a good mental health status during pandemics.
*Important notice: 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.
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