Rise in UK depression and anxiety rates identified during COVID-19 lockdowns

Although many studies have been conducted over the past two years, during and after the implementation of coronavirus disease 2019 (COVID-19) restrictions, the long-term effects of these events remain unclear.

A new study published on the preprint server medRxiv* discusses changes in the prevalence of depressive and anxiety symptoms during the COVID-19 pandemic and their association with individual and environmental factors.

Study: Depressive and anxiety symptoms during the COVID-19 pandemic: a two-year follow-up. Image Credit: fizkes/Shutterstock.com

Introduction

The onset of the COVID-19 pandemic was quickly followed by significant changes in the global economy, social interactions, education and health systems. Some of the common stressors that affected individuals during the pandemic included fear of becoming seriously ill and dying from COVID-19, isolation from loved ones and friends due to social distancing measures, loss of employment, childcare and school facilities, which has subsequently caused formerly working parents to become full-time carers for children at home, increased financial pressure and the redirection of most services of health towards the management of the crisis posed by COVID-19.

The rapid spread of coronavirus 2 (SARS-CoV-2) responsible for severe acute respiratory syndrome, along with high COVID-19 mortality and overstretched hospital systems, have supported global efforts to rapidly develop highly effective vaccines. The subsequent large-scale deployment of COVID-19 vaccines resulted in a short-term reduction in case rates, which was then followed by a gradual easing of most pandemic restrictions.

Some researchers have described an inverse relationship between the stringency of COVID-19 restrictions and mental health, while others have shown a positive association. These mixed results highlight the need to better understand the context, which could confound the results of such association studies. Additionally, predictors of poor mental health should also be revised as baseline experiences change.

About the study

The current study addresses long-term changes in public mental health between March 2020 and April 2022. These changes were assessed based on data from the University College London COVID-19 Social Study (CSS) ( UCL), which included more than 75,000 adults during the study period.

Researchers looked at mental health symptoms with the established Generalized Anxiety Disorder Assessment (GAD-7), contextual factors like severity index, number of cases and deaths, and individual predictors like level of trust people had in their government, health services, and access to essential services, as well as whether the person had contracted COVID-19.

Study results

COVID-19 restrictions were the strictest during the first lockdown from March 21, 2020 to August 23, 2020, and the second and third lockdowns from September 21, 2020 to April 11, 2021. The number of daily cases increased after the first containment.

Daily COVID-19 related deaths peaked during lockdown periods. However, COVID-19-related deaths declined during the second lockdown, which was attributed to the rollout of vaccines that began in December 2020.

A slight increase in symptoms of depression and anxiety was reported during both periods of confinement compared to intermittent periods of relaxation. While these symptoms were high at the start of the first lockdown, they quickly declined thereafter. In August 2020, anxiety and depressive symptoms increased again until the third lockdown.

The next slow decline in these symptoms continued until the end of 2021, when they started to increase again. However, depressive symptoms decreased again between March and April 2022. During the first lockdown, the increase in cases was inversely associated with anxiety and depressive symptoms, but not thereafter.

Additionally, an increase in COVID-19 deaths was initially linked to depressive symptoms that eventually declined over time. Vaccination was also associated with a moderate increase in depressive symptoms during the second and third confinements.

Depressive symptoms were higher as trust in government, health care, and availability of essentials declined, with this effect strengthening over time. There was a slight increase in depressive symptoms as knowledge of the disease increased; however, this change was only evident during the first lockdown.

Pandemic-related stress was associated with more depressive symptoms, especially during the first lockdown. The association between COVID-19 stress and these symptoms has remained consistent, although weaker over time, indicating that people have only partially adapted to the fear of becoming fatally ill with this infection. This was likely due to increased knowledge of the odds of surviving COVID-19 through personal or social acquaintances and increased awareness of the infection.

Strict policies had the greatest impact when they affected social interactions. In fact, even an increase in deaths due to infection was not associated with depressive symptoms at the end of the study period, although the opposite effect was observed earlier in the pandemic. This could be due to the rollout of vaccination, after which deaths remained at a lower and stable level and were no longer a main source of terror.

The occurrence of COVID-19 itself was linked to an increase in depression throughout the study. In fact, as the pandemic progressed, this association grew stronger, possibly due to the actual inflammatory effects of SARS-CoV-2 on the brain.

However, these symptoms could be alleviated by offering social support. The importance of social support,”arguably the most important predictor overall,” cannot be overstated.

Consequences

The current study tracked changes in symptoms related to anxiety and depression over the two years following the start of the pandemic. It is the longest UK study to track such symptoms over this period.

The results of the study supported the association of early uncertainty and fear that prevailed at the start of the lockdown with these symptoms, although they decreased thereafter. The next increase in these symptoms was associated with the increase in COVID-19 cases and the resulting implementation of restrictions in late 2020 and early 2021.

At the end of the final lockdown, depressive and anxiety symptoms decreased again, despite the high number of new COVID-19 cases. Other factors associated with these symptoms included a lack of trust in government, health systems, and essential service commodities or supplies. Conversely, social support improves mental health.

Interestingly, the repeated call to protect the National Health Service (NHS) at the start of the pandemic was associated with a loss of confidence in its ability to deal with the crisis. Disruptions to health services due to many effects related to the pandemic, as well as the fear of infection that has led many people to avoid medical consultations and other health care-seeking behaviors, have also had negative effects on mental health.

Perceived unavailability of mental health support due to overall health service load could also explain the relationship with higher anxiety and depressive symptoms..”

The current study highlights the importance of factors such as social support, fear of being infected with SARS-CoV-2, history of COVID-19, trust in government, health care and the access to essential goods and services, as well as restrictions on social networks. contact and their ability to affect mental health during a crisis such as the current pandemic. Furthermore, these results demonstrate that other factors such as strict policies and the number of cases/deaths are less directly associated with mental health impacts and that their influence varies depending on the prevailing situation in the country.

This could have important implications for policy-making and for a better understanding of the mental health of the general public during a national or global health crisis..”

*Important Notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be considered conclusive, guide clinical practice/health-related behaviors, or treated as established information.

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