Covid-19 and mental health: A window of opportunity for social science
15 June 2020
By Professor Louise Arseneault FMedSci FAcSS (Professor of Developmental Psychology, King’s College London and Mental Health Leadership Fellow for the UKRI Economic and Social Research Council)
The Covid-19 pandemic has brought a general sense of loss across borders: loss of lives, employment, relationships, homes, education, and opportunities. People’s care and concern for others have found new meaning in a changing world marked by distance, limits and warnings. As the situation continues to evolve, initiatives are now being developed to capture, understand and, above all, mitigate the profound impact of the pandemic on individuals and society. For these reasons, mental health should be a priority and social science can play a central role. Understanding what is happening now is crucial to recovery, and so is learning the lessons to prepare for an uncertain future.
Mental health priorities in a time of crisis
The virus attacks the body pervasively(1), including the brain. However, the current crisis provided us with a striking reminder that physical and mental health are profoundly intertwined. While the number of reported Covid-19 cases in the UK is around 285,000, most people will have experienced periods of feeling down, distressed, and anxious during the past few months. An increase in anxiety and depression symptoms is an expected response to the prevailing sense of loss, threat and uncertainty brought by the situation. However, we could potentially see more people experiencing ongoing mental health disorders due to the pandemic. A position paper recently published in Lancet Psychiatry suggested specific research priorities and key questions for mental health, social and brain sciences. That paper provides a useful strategy and urges coordinated efforts across disciplines and across sectors to address the impact of Covid-19 on mental health.
It will be important to track and report fluctuation in rates of anxiety, depression, self-harm, and suicide across the population – but let’s not ignore other possible mental health outcomes, such as alcohol and drug addiction, and eating and obsessive-compulsive disorders (OCD). These data will provide valuable insight into the consequences of the situation on mental health and wellbeing. This mental health priority calls for greater collaboration with computer science to develop the technology needed to collect and process real time data. An example is the University of Washington Covid-19 Response Study which aims to examine how Covid-19 affected mental health among 500 adult residents of one county in Washington State. Participants were asked to complete a daily 3-minute survey and also to provide information about their demographic background. Over-time patterns of interactions (e.g., anxiety, depression, loneliness) can be visualized on a freely-accessible dashboard.
Another priority is understanding the mental health risks for key workers who experienced greater exposure to the virus and its impact during the peak of the outbreak. This includes monitoring rates of PTSD. Prior studies have focused on mental health among emergency workers, pre-pandemic, to identify factors associated with episodes of PTSD and evaluate the efficacy of resilience intervention(2). New post-pandemic studies are needed for at least two reasons. First, the mental health risk has been magnified during the crisis and second, the group of key workers affected has changed and expanded because of this pandemic. Findings would help determine targeted responses to a subgroup of the population who may need most attention and care.
Related to this, Black and Asian Minority Ethnic (BAME) groups in England have a two- to three-fold increase in their risk of dying from the virus (after adjustment for geographical region)(3). This could exacerbate their risks of mental health difficulties. Research has an important role in promoting understanding of how social context influences – and possibly determines – this inequity. We need to understand who, why, how, and what we can do to mitigate this harmful impact.
Important questions remain as to how can we promote good mental health and wellbeing in the wake of the pandemic and the lockdown. For example, will current strategies – including encouraging people to exercise or to socialise online – actually result in beneficial outcomes? Also, what methods are effective in upscaling resources to promote good mental health and ensure the majority of the population have basic tools to find what works for them? A greater focus on mental health is a necessary part of the response to the current situation and will be a key element of our recovery. The Covid-19 Social Study will be central for providing rapid answers to such pressing questions. This study aims to examine the effects of the virus and social distancing on adults in the UK during the outbreak of Covid-19 and to identify at-risk groups, protective activities and patterns of changes in mental health and loneliness among 90,000 people around the UK.
Brighter future or uncertain days ahead: the long-term consequences of the pandemic
Past research indicated that the true mental health impact of World War II on civilians came to light only years after the war ended, and showed that the association between war and anxiety increased over time(4). While we must envisage better days are coming, the impacts of Covid-19 will be long term, extending beyond the lockdown period as the social and economic consequences of the virus unfold worldwide. Young people will be disproportionately affected by economic hardship and an uncertain future. Research priorities must capture the longer-term mental health consequences of the pandemic, which could potentially be more severe than the outcomes of the outbreak period and the lockdown to help devise appropriate solutions.
The crisis has prompted a number of much needed initiatives, for example, those providing informal support and building a sense of community during isolation: neighbours ringing each other, grocery shops protecting time for the elderly, people distributing food to those who lost their jobs, restaurants cooking for NHS staff, postal workers checking on vulnerable people, empty hotels offering shelter to homeless people, and so on. However, the world may become a threatening and lonely place for those most affected when these hastily constructed support systems inevitably recede. We need to think now about how initiatives that have proved effective can continue to be resourced and adapted. The pandemic created a crisis situation that needed a rapid response. It is up to us to turn some of those responses into sustainable supports.
Increased interdisciplinarity as a research response
Almost all aspects of life have been altered by Covid-19. It has affected our freedoms, our economy, our social relationships, our health services, our bodies and our minds. Interdisciplinary research will be essential for finding sustainable, effective, and far-reaching ways to address these changes and the new needs they reveal. Researchers and research funders need to consider how to measure and address the immediate impact of the situation on mental health and wellbeing, but also how to plan for the long-term impact of the pandemic. This will require even greater interdisciplinary collaboration. But the research community is willing, as we ought to recognize that “We are all in this together”.
(1) Wadman M, Couzin-Frankel J, Kaiser J, Matacic C (online) How does coronavirus kill? Clinicians trace a ferocious rampage through the body, from brain to toes. Science. (doi:10.1126/science.abc3208).
(2) Wild J, El-Salahi S, Tyson G, Lorenz H, Pariante CM, Danese A, Tsiachristas A, Watkins E, Middleton B, Blaber A, Ehlers A. (online) Preventing PTSD, depression and associated health problems in student paramedics: protocol for PREVENT-PTSD, a randomised controlled trial of supported online cognitive training for resilience versus alternative online training and standard practice. BMJ Open. https://bmjopen.bmj.com/content/8/12/bmjopen-2018-022292
(3) Aldridge RW, Lewer D, Vittal Katikireddi S, Mathur R, Pathak R, Buns R, Fragaszy EB, Johnson AM, Devakumar D, Abubakar I, Hayward A (online). Black, Asian and Minority Ethnic groups in England are at increased risk of death from COVID-19: indirect standardisation of NHS mortality data. Wellcome Open Research. (https://wellcomeopenresearch.org/articles/5-88#article-comments)
(4) Frounfelker R, Gilman SE, Betancourt TS, et al. (2018) Civilians in World War II and DSM-IV mental disorders: Results from the World Mental Health Survey Initiative. Social Psychiatry & Psychiatric Epidemiology. 53, 207–219. (doi:10.1007/s00127-017-1452-3).
Professor Louise Arseneault is Professor of Developmental Psychology at King’s College London and Mental Health Leadership Fellow for the Economic and Social Research Council (ESRC). Her research focuses on the study of harmful behaviours such as violence and substance dependence, their developmental origins, their inter-connections with mental health, and their consequences for victims. Louise also studies the impact of social relationships including social support and loneliness on mental health.
The perspectives expressed in these commentary pieces represent the independent views of the authors, and as such they do not represent the views of the Academy or its Campaign for Social Science.
This article may be republished provided you place the following statement and link at the top of the article: This article was originally commissioned and published by the Campaign for Social Science as part of its COVID-19 programme.