Monitoring the mental health impact of COVID-19 to build a roadmap for recovery
16 September 2020
We talk to Dr Alex Kwong about why longitudinal cohort studies are essential for understanding the full consequences of the pandemic on mental health, and how they can inform our roadmap to recovery.
The COVID-19 pandemic has been a challenging time for us all. So it’s not surprising that mental health experts and charities have expressed concern about the influence of the pandemic and lockdown on our mental health. Many of them have come together to urge the Prime Minister to make mental health a key cornerstone of the nation’s post-pandemic recovery for children and young people as well as adults.
Backing up these calls is a flurry of surveys and research into the impact of coronavirus restrictions on mental health in the UK. But not all of this work has been as useful as it could have been.
“Mental health researchers from across the world were very keen to explore the impact of COVID-19 on mental and physical wellbeing,” says Dr Alex Kwong, a research fellow at the University of Edinburgh.
“Various types of research studies were quickly set up, with a notable initial rise in convenient online surveys, which were sent to thousands of ‘random’ people in different populations. Researchers were able to get results fast and used this to get a rapid estimate of what was going on and how bad the situation might be”
But while these surveys can tell you whether people are anxious or depressed right now, most of them have no baseline data from before the pandemic for comparison. This makes it hard to know how the spread of the virus and resulting lockdowns have really influenced the nation’s mental health.
Instead of relying on convenience surveys that yield isolated data, Alex and his collaborators at Bristol University and the University of Edinburgh have been analysing data from two existing longitudinal cohort studies. These are large groups of people who have been providing regular information about their mental and physical health for decades.
The first is the Avon Longitudinal Study of Parents and Children (ALSPAC) based in Bristol, also known as ‘Children of the 90s’. This study recruited 15,000 pregnant women in the early 1990s and has followed the mental and physical health of the women and their children for nearly three decades.
The second, Generation Scotland, recruited 24,000 families in Scotland between 2006 and 2011 and has followed their health ever since. Both studies are part of the Health Data Research Alliance, brought together by Health Data Research UK (HDR UK) to unite the UK’s health data research organisations and resources.
In response to the pandemic, the two studies sent out detailed surveys to their participants, asking for detailed information about their mental health, along with questions about the impact of COVID-19 and possible infection.
“We analysed the data from the two cohorts and looked at changes in depression, anxiety, and mental well-being as a result of the pandemic,” says Alex, who was the co-lead researcher on the study.
Surprisingly, the researchers found that levels of depression remained relatively stable despite the pandemic, but the number of people suffering from anxiety rose dramatically.
We found that the number of young people in the ALSPAC study reporting anxiety has doubled during the pandemic to almost 25%,” says Alex.
Alex and his collaborators expected that levels of anxiety would begin to drop as lockdown restrictions began to ease across the UK. Instead, results from a second follow up survey showed that anxiety continued to remain worryingly high in this young population.
“When we broke it down, we saw that particular groups were suffering more with anxiety than others – specifically females, individuals living alone, people who already had financial problems, people with pre-existing mental health conditions, and those who reported difficulties accessing mental health services before the pandemic,” Alex says.
“Now we’re trying to look into what exactly is driving these feelings of anxiety,” he explains. “We’re asking ‘How worried are you about your finances?’ ‘How worried about you are paying your mortgage?’ ‘How worried are you about catching COVID or not being able to buy food or access medication, and how worried are you that you’re not able to see your friends or family?’ Then we’re looking at how these things link into anxiety and depression scores.”
Importantly, many of these worries could be helped by specific practical actions delivered through direct local and national support, creating a roadmap to recovery that puts mental health first.
By sharing their findings with HDR UK, who are providing regular updates to the Government’s SAGE committee, Alex and his colleagues have already had an impact on policy.
“We found that living in isolation was detrimental to mental health during the pandemic, so we shared that data with HDR UK. The next week the government brought out the policy allowing people living alone to form social support bubbles,” says Alex.
“I hope that our work can continue to help direct resources to protect those most at risk from mental health problems as we move through the months ahead and to the post-pandemic recovery. Longitudinal data is key for driving this research forward.”
Health Data Research UK is working to make health data securely and safely accessible for research to improve people’s lives. Find out more at hdruk.ac.uk, and follow on Twitter @hdr_uk and LinkedIn.
- Coronavirus: Young people’ more anxious during lockdown’ – BBC
- Mental health during the COVID-19 pandemic in two longitudinal UK population cohorts – MedRxiv
- Longitudinal evidence for persistent anxiety in young adults through COVID-19 restrictions – Wellcome Open Research
- Avon Longitudinal Study of Parents and Children (ALSPAC)
- Generation Scotland
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