by Arjun Walia, The Pulse:
- The Facts:
- Few studies have managed to examine mental health needs over time.
- Those that have show that mental health needs in young people have increased markedly since the pandemic compared to pre-2020 figures.
- Lockdowns have had catastrophic consequences on mental mental health and well-being.
- Reflect On:Why were scientists and doctors who raised concerns about lockdowns early on in the pandemic labelled as “anti-lockdown” while being subjected to censorship and ridicule by legacy media?
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Read the full study Mental Health and Wellbeing in Young People in the UK during Lockdown (COVID-19).
Has the mental health time bomb that was predicted in young people as a result of mandated pandemic restrictions come to pass? Sadly, study after study has shown this to be the case. Early in the Covid-19 pandemic, many experts were concerned about the impact of SARS-Cov-2 and mandated restrictions to attempt to curb the spread of the virus. Position pieces from mental health and suicide prevention experts noted particular areas of concern – the needs of young people were highlighted. Suggestions for mitigations were offered. Open letters signed by eminent psychologists and paediatricians in June 2020 urged the government to prioritise children and get them back to school. The government cannot say they were not warned.
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Few studies have managed to examine mental health needs over time. Those that have show that mental health needs in young people have increased markedly since the pandemic compared to pre-2020 figures. In a recent study published in the International Journal of Environmental Research and Public Health we investigated the impact of lockdown restrictions over time (a month apart) beginning in December 2020 (time 1) and followed-up a month later, in January 2021 (time 2). We asked young people currently in lockdown at time 1 to provide retrospective estimates of changes in health and wellbeing in addition to their current mental health using tried and tested psychological measures including depression, wellbeing, rumination, stress and sleep.
We recruited 389 young people (average age 21 years, majority female) via student lists and social media to take part in our study. A good number of them (65%) completed both time 1 and time 2 assessments. Our primary outcome was ‘probable depression’ as indicated by a score of ≥10 on the patient health questionnaire (PHQ-8). The experience of depression was significantly higher than pre-pandemic levels (55%) and did not significantly decrease over time (52%). Higher levels of lockdown severity were associated over time with higher levels of depressive symptoms. That is, the stricter the restrictions, the higher the chance of experiencing depression. Nearly all students had at least one mental wellbeing concern at either time point (97%).
Of course, no scientific study is perfect and neither is this one. We acknowledge that additional factors could have influenced the results observed (such as the university winter break providing a respite at home for some students, though this is also a time for exam preparation in the UK for January exams). We had to rely on retrospective accounts of how students had fared in the times before lockdown which could be subject to memory biases.
Although we used well-tested measures to assess depression quickly, future research would benefit from using a face-to-face diagnostic interview that can provide more information on the nature of symptoms and how they impact individuals lives.
Our study, along with many others, suggests that lockdown led to a wellbeing crisis in young people. We also found that mental wellbeing was worse during the pandemic than beforehand, and that mental wellbeing may have been worse for those in higher levels of lockdown restrictions. This finding is consistent with the recent Collateral Global reviews of systematic reviews showing that the impact of the pandemic and associated restrictions has been severe for children and adolescents and substantial for students.
Now that so much is known about the harms of lockdowns, we believe they should be avoided in the future. There is, for example, little evidence of benefit to the more restrictive Non-Pharmaceutical Interventions over less restrictive ones. A recent analysis suggests that while long periods of lockdown do not reduce the fatality rate, they do have a negative impact on economic growth. Moreover, evidence suggests that cases and infections have tended to start to decline even before lockdowns are implemented. Not locking down the during the recent Omicron wave demonstrated that such devastating interventions are not needed.
High quality evidence on child and mental health in the pandemic shows that socialisation was a key protective factor, as were prosocial behaviours (e.g., helping others). Thus, it will be important to ensure that opportunities for students to socialise face-to-face are maintained and prioritised as the world begins to recover from the pandemic. Universities could increase their support of community voluntary work to boost opportunities for prosocial behaviours.
Increased mental health support at universities requiring significant investment is crucial moving forward. Long-term planning and investment in mental health is needed now, particularly for children and young people, who have been disproportionately affected. Strengthening mental health systems and investing in health workers, will not only help to mitigate some of the harms caused by lockdowns but will also help increase resilience in mental health systems in the future. Co-created digital mental health tools will also be important moving forward and we are involved in applied research to design and deliver these in the UK in partnership with young people.