Mental health during the COVID-19 pandemic: Some worse, some better, and some the same

The global COVID-19 pandemic has affected people’s mental health in different, and sometimes unexpected, ways.

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The COVID-19 pandemic has been a once-in-a-generation event that has had far-reaching impacts on the global economy, politics, population health, and the social well-being of communities around the world. Some might say the pandemic has brought out the best and worst in us. As we are over 2 years into the pandemic, a large body of studies has been generated in that time that has studied the effects of the COVID-19 pandemic on mental health and well-being. Some people experienced worsening mental health during the pandemic; others actually experienced improved mental health, and yet others experienced little to no change in their mental health. Allow me to elaborate on each of these outcomes.

 

Worsening mental health

            The most common and expected outcome of the COVID-19 pandemic is that there has declining mental health during this time period. And in fact, a growing number of studies has reported increased anxiety, depression, and substance abuse problems during the pandemic. Some have attributed it to the effects of the virus itself and others to the various measures taken to reduce COVID-19 transmission including city lockdowns, social distancing, and economic effects such as business closings, unemployment, etc. But the pandemic has had different effects on different people, and there may be some predisposing factors that made some individuals more vulnerable than others. At least one study found that individuals with prior mental health problems were much more likely to experience worsening mental health during the pandemic.

Improving mental health

While some individuals experienced increased mental distress during the COVID-19 pandemic, others actually experienced improvements in their mental health! Human beings can be incredibly resilient, and various studies have found that many individuals who experience disasters and incredibly stressful events have been able to develop new internal strengths and strive after their experiences. Findings from the Great Depression found improved population health, increased life expectancy, and decreased mortality for almost all age groups during that era.

            I’ve been involved in several studies that have found that some individuals have reported psychological growth and emotional strength-building during the pandemic. These studies concerned U.S. veterans, who may be particularly resilient and different from other adults, although this needs further investigation. In one nationally representative study of U.S. veterans, we found that over 40% reported experiencing moderate to great levels of post-traumatic psychological growth during the pandemic. In another study, three groups of veterans were assessed over time during the pandemic, and it was found that veterans who were recently homeless as well as veterans who had a psychotic disorder reported better mental health resilience during the pandemic than healthy controls.

There are various theories that may explain this. It may be that threatening situations force some individuals to “rise to the occasion” and tap into strengths they weren’t fully aware of. Another explanation may be - as Nietzsche stated “To live is to suffer, to survive is to find some meaning in the suffering” - meaning suffering may imbue meaning. Also in a strange way, people who were already suffering may find comfort in seeing others suffer along with them during the COVID-19 pandemic either through a sense of unity and collective existential angst, normalizing their distress.

Staying the same

Contrary to many expert predictions, rates of suicide across multiple countries and populations did not increase during the COVID-19 pandemic, and suicide rates mostly stayed the same or slightly decreased during the pandemic. Researchers are still trying to understand why this is, but some of the reasons may be similar to those described above that help individuals thrive or maintain stability during times of adversity.

            In addition to suicide, studies have reported that the prevalence of severe mental illness  has remained stable after one year into the pandemic. This is perhaps less surprising since there are various biological and developmental factors that influence onset or relapse of severe mental illness and these factors exist independent of the COVID-19 pandemic. One might also look to the remarkable ways that tele-mental health and virtual care was able to be offered during the pandemic that may have helped millions globally maintain their mental health. And in fact, new technological innovations and healthcare delivery methods may have been developed during this time that will remain after the pandemic has passed.

Conclusions

In conclusion, the COVID-19 pandemic affected the mental health of people in different ways. Certainly, many individuals experienced extreme stress during this period, but some individuals have also maintained stability and thrived. The COVID-19 pandemic may be described as a “stress test” on people and systems in that it exacerbated pre-existing problems or fortified areas of mental strengths. At our brand-new journal, npj Mental Health Research, we welcome research and commentary on the various impacts and implications of the COVID-19 pandemic on mental health.

 

Jack Tsai

Editor-in-Chief, npj Mental Health Research