How the COVID-19 pandemic affected mental health and wellbeing, key determinants of health, and health inequities

By Nidhi Saha, BDSReviewed by Danielle Ellis, B.Sc.Jul 11 2022

A new study posted to the medRxiv* preprint server investigated the effects of the coronavirus disease 2019 (COVID-19) pandemic on mental health, the important health determinants, and disparities resulting from such effects. To fully understand these effects, the researchers designed a pan- Canadian population-based prospective COVID-19: HEalth and Social Inequities across Neighbourhoods (COHESION) cohort.

*Important notice: medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.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 onset of the COVID-19 pandemic has significantly diminished several social factors, including possibilities of access to resources that promote health and wellbeing and in-person social contacts. Patient safety efforts to curb transmission have halted economic activity, resulting in huge unemployment and income losses, limiting people's daily mobility and opportunity for face-to-face social communication. COVID-19 restrictions such as lockdown, confinement, and physical separation lessen social interactions, raise a sense of isolation and emotional distress, and reduce levels of social engagement. These factors have significantly impacted the wellbeing and mental health of global populations.

According to evidence from Canada, certain populations, including adolescents, older individuals, women, and racialized communities, are disproportionately at risk for social isolation, domestic violence, and anxiety. Restrictive measures impede daily movement and physical activity, and lower activity zones have been associated with depressive symptoms and sleep problems. Additionally, dwindling outdoor spaces and legislative restrictions limit regular commute; hence, residential living circumstances have gained an increasingly vital role. 

Studies have demonstrated that the prevalence of COVID-19 is higher among priority communities struggling under substandard social and environmental conditions. Urban sprawl and living in poor housing facilities affect mental health and wellbeing. Furthermore, continued proximity to home surroundings during lockdowns exacerbates these effects.

Economic distress, associated with wage abatement and job insecurity, has significantly contributed to Canadians' mental health burden––and is also linked to housing instability and food insecurity. As a result, harmful health behaviors such as alcoholism or drug abuse are on the rise and have been related to worsening mental health outcomes.

In the face of these circumstances, there is a growing need to comprehend the relationships between factors like living conditions and neighborhood and behavioral patterns, for example – transportation, interpersonal interactions, sleep, and mental wellbeing dynamics – specifically, the unanticipated long-term ramifications of the ongoing COVID-19 pandemic and mitigation measures. Furthermore, the impacts are likely to differ among demographic groupings, for instance – according to gender, age, racialized communities, or deprivation level.

The study

This study entailed COHESION Study; the COHESION Project is a two-phase, pan-Canadian, population-based, prospective cohort study. COHESION Phase 1 took place between May 2020 and September 2021. During this time, the COHESION research platform gathered monthly data related to COVID-19, including infection and vaccination status, beliefs and attitudes pertaining to pandemic-related measures, and information on participants' health and wellbeing, sleep, boredom, adaptability, drug use, living standards, interpersonal relationships, events, and transportation. COHESION Phase 2 began in May 2022. All Phase 1 participants were invited to join in Phase 2, and an additional 10,000 people were recruited.

The present study reported that COHESION was unique in incorporating the Visualization and Evaluation of Route Itineraries, Travel Destinations, Activity Spaces, and Social Interactions (VERITAS-Social) questionnaire into the baseline, as well as follow-up surveys of the two phases. It was modified for COHESION to identify a probable list of up to twenty tasks.

Veritas-Social is an interactive questionnaire based on a map that collects a person's social network and activity locations. It is adapted from the VERITAS tool, which provides information on places and activities.

Phase 2 of COHESION would continue to implement the survey method at the health region level, based on Census data from 2016 (i.e., age composition, gender, income, educational attainment, and ethnicity). Researchers gathered geo-target respondents based on sampling quotas. 

Results

The Phase 1 COHESION Study involves 1,268 participants who are mostly from Ontario (47%) and Quebec (33%), of the age-range 48 ± 16 years old, and are mostly women and White, having a university degree (63%) and living in large urban areas. 

The first year of follow-up demonstrated considerable temporal fluctuations in standardized measures of wellbeing, anxiety, depression, loneliness, and psychological distress, as indicated by the monthly prospective questionnaires.

Significant temporal fluctuations in standardized indices of wellbeing, anxiety, depressed mood, loneliness, and emotional stress were observed during the first year of follow-up. At baseline, 72%, 14%, and 18% of subjects indicated a monthly usage of alcohol, cigarettes and/or vaping, and cannabis, respectively. 

Therefore, throughout the study, wellbeing dropped in waves, although sleep duration remained unchanged. However, loneliness levels remained higher during all follow-up waves compared to the pre-pandemic era. Moreover, fluctuations in mental health indices were detected throughout the follow-up period. Depression and emotional stress indices were much lower during the festive season.

Conclusion

The study emphasizes the significance of monitoring and evaluating the unforeseen consequences of the ongoing COVID-19 pandemic on mental health and health equity. Effective and modified public health policies and programs are warranted, for instance – pedestrianizing streets, extending access to parks, improving housing conditions and neighborhoods, providing permanent supportive housing, and implementing neighborhood greening programs.

The study presents a complete picture of how the COVID-19 pandemic has impacted the mental health and wellbeing of the Canadian population. Flexible infrastructure can address the local needs of the population and could enable better recuperation from the impacts of the ongoing pandemic.

*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.