Emerging evidence on COVID-19’s impact on mental health and health inequalities

Different groups of people in the UK are experiencing the coronavirus (COVID-19) pandemic and the lockdown very differently. One area of concern is the impact of the pandemic on mental health and how this is affecting some groups much more than others.

Good mental health is an asset and is also linked to good physical health – both of which support positive social and economic outcomes for individuals and society. Mental health disorders account for almost a quarter of the total burden of ill health in the UK. Poor mental health is strongly associated with social and economic circumstances, including living in poverty, low-quality work, unemployment and housing. There is also a well-documented burden of mental health disordersfollowing disasters, including evidence from previous viral outbreaks. This suggests that COVID-19, and the response to the pandemic, could have a significant impact on the nation’s mental health through increased exposure to stressors. Exacerbating this, there has been a loss of coping mechanisms for many, and reduced access to mental health treatment. Here we draw together emerging evidence on aspects of the pandemic that are impacting on mental health, and inequalities in who is affected most.

How is mental health being affected by the pandemic?

More than two-thirds of adults in the UK (69%) report feeling somewhat or very worried about the effect COVID-19 is having on their life. The most common issues affecting wellbeing are worry about the future (63%), feeling stressed or anxious (56%) and feeling bored (49%).

While some degree of worry is understandably widespread, more severe mental ill health is being experienced by some groups. IFS analysis of longitudinal data from the Understanding Society studyfound that, taking account of pre-pandemic trajectories, mental health has worsened substantially (by 8.1% on average) as a result of the pandemic. Groups have not been equally impacted; young adults and women – groups with worse mental health pre-pandemic – have been hit hardest.

The UCL COVID-19 social study of 90,000 UK adults has monitored mental health symptoms throughout lockdown, finding levels of anxiety and depression fell in early June as lockdown measures began to lift. But these remained highest among young people, those with lower household income, people with a diagnosed mental illness, people living with children, and people living in urban areas.

This emerging evidence reveals a widening of pre-existing inequalities in mental health. Looking at the drivers of poor mental health in the pandemic can shine a light on the reasons for this.

More on this topic:

• Longitudinal changes in mental health and the COVID-19 pandemic: evidence from the UK Household Longitudinal Study
• The gender gap in mental wellbeing during the COVID-19 outbreak: evidence from the UK
• The COVID-19 pandemic and its impact on inequality of opportunity in psychological distress in the UK.

Drivers of worsening mental health during the pandemic

Social isolation

Lockdown has brought social isolation to many, particularly people living alone or those who have been shielding. Social isolation is an objective measure, which may or may not lead to the subjective feeling of loneliness. Perhaps surprisingly, the proportion of people reporting they feel lonely often or always during lockdown has been similar to pre-pandemic, at around 5% (2.6 million) during April. But groups that have been disproportionately affected by loneliness include working-age adults living alone, those in poor health, and people in rented accommodation.

However, social isolation has the potential for detrimental effects other than loneliness. There have, for example, been serious concerns about victims of domestic abuse being locked down with perpetrators. A report by MPs found 16 people – 14 women and 2 children – were killed in the first 3 weeks of lockdown, and calls to the national helpline Refuge were 49% higher than usual. This is an unintended impact of lockdown that urgently needs further study and action to safeguard those at risk.

Job and financial losses

The economic impact of lockdown has hit people unequally, causing immediate impacts on mental health. The Mental Health Foundation reports over a third of people in full-time work surveyed were concerned about losing their job, and mental health impacts on people who were unemployed were widespread and severe. A quarter reported not coping well with the stress of the pandemic (twice as many as those in employment), almost half were worried about not having enough food to meet basic needs, and one in five had experienced suicidal thoughts.

The advantages of good work are wider than the financial benefits it brings and there is evidence that volunteering also has mental health benefits. Numbers volunteering, however, have halved during the pandemic. This is because volunteers may be in at risk groups, or their activities have been halted, potentially putting five million people – often older or vulnerable – at additional mental health risk.

Housing insecurity and quality

People’s housing and their ability to afford housing are strong influences on mental health. People who rent have experienced greater financial impacts during the pandemic than those who own their homes, another example of a driver for poor mental health that is socioeconomically patterned.

During lockdown, people have spent far more time than usual in their homes. Quality of housing and the opportunities it affords – including personal and outdoor space – are highly variable. For example, one in eight households (12%) in Great Britain have no access to a private or shared garden, and black people in England are nearly four times as likely as white people to have no access to outdoor space at home (37% versus 10%).

Working in a front-line service

Evidence from past outbreaks, as well as early evidence from this pandemic, indicates that we are likely to see an increase in mental health problems such as depression, substance misuse and post-traumatic stress disorder for front-line health and care workers. We plan to explore this issue in more detail in future.

Loss of coping mechanisms

In addition to presenting new or enhanced stressors, the pandemic has diminished many of the mechanisms people typically use to cope with stress. The most popular coping mechanisms during lockdown have been staying in touch with friends and family and taking daily outdoor exercise, which has helped nearly half of the adults surveyed. Work has also been important, with the value for mental wellbeing extending beyond the financial benefits.

Many though have lost jobs or been furloughed, exercise and access to outdoor spaces has been limited, and some people have not been able to meet with friends or family. There are inequalities in these deficits: job loss is socioeconomically patterned, some groups cannot get outdoors, and some are unable to remain digitally connected to friends and family. All of this increases the likelihood that the pandemic will increase mental health inequalities.

Reduced access to mental health services

While mental health is determined by much broader factors than access to mental health services, these are critical for people experiencing mental illness. Services were already stretched with many providers reporting an inability to meet the demand rising prior to the pandemic, and lockdown is adding pressure that is likely to increase in future.

The Royal College of Psychiatrists reports almost half of psychiatrists have seen increases in urgent and emergency cases during lockdown, but also that a similar proportion have seen falls in routine appointments. There are fears people are staying away until they reach crisis point, which will result in a flood of exacerbated and untreated mental illness after the pandemic, and mental health providers are already reporting significant increases in demand and severity of new referrals. The charity Mind has found that almost a quarter of people who tried to access mental health services during a fortnight in April failed to get any help.

What are the implications?

Good mental health is an important national asset in its own right. Additionally, poor mental health is strongly associated with worse physical health. Thus the impacts of the pandemic on mental health could lead to a longer term erosion of people’s physical health, further affecting their ability to lead fulfilling lives. The unequal impacts of the pandemic may lead to a widening of pre-existing health inequalities, as well as affecting people who have not previously experienced poor mental health. Failing to value and invest in mental health during the pandemic risks storing up significant mental and physical health problems for the future – at great human and economic cost.