Interview with Prof Klaus Lieb & Dr Angela Kunzler. How has the Covid-19 pandemic affected our mental health? Moreover, have we been able to bounce back? A new study about resilience amid the Covid-19 pandemic in the EU will be presented at an event of the European Parliament’s Panel for the Future of Science and Technology (STOA) on 25 January. Lead authors are Prof Klaus Lieb, Scientific Director of the Leibniz Institute for Resilience Research (LIR), and psychologist Dr Angela Kunzler, Research Associate in the group of Prof Lieb. They also suggest a number of policy options to deal with this serious health problem.
Why this study about mental health and resilience during the Covid-19 pandemic?
Klaus Lieb: The Covid-19 pandemic has had an enormous impact on us and our mental wellbeing. Not only did the immediate disease-related threats had an effect, but also the policy measures that aimed to fight the pandemic. Travel-related restrictions or school closures have imposed tremendous challenges on the public at large as well as specific population groups like children and adolescents or employees.
International research, including systematic literature reviews, has shown an increased mental burden and stress-related mental health problems such as symptoms of anxiety and depression in different population groups during the pandemic.
However, none of this previous evidence synthesis solely focused on the situation in the European Union. Next to missing information about the general mental health effects of the pandemic in the Member States, we also wanted to know what the impact of governmental measures to both contain the pandemic and to support certain populations (i.e. economic aid) were, as well as the potential risk and protective factors for mental health.
What had been neglected in previous studies as well, is stress resilience – the phenomenon of maintaining or quickly regaining mental health during or after adversities. From the perspective of resilience research, especially a stronger focus on protective factors for mental health seemed important to us as these factors can contribute to resilient responses of the European population amid the various stressors of the Covid-19 pandemic.
In short, what is your study about exactly?
Angela Kunzler: Our study reviews the existing scientific evidence until March 2021 regarding five questions related to psychosocial and mental health effects in the EU:
- Which pandemic-related policy responses – containment and support measures, have been implemented in the Member States?
- What are the psychosocial and mental health effects of the pandemic, including the identified policy responses?
- Which risk factors at country, population, or individual level favour the development of psychosocial and mental health issues?
- Which protective factors at the country, population, or individual level foster resilient responses, that is, mental health despite the pandemic stressors?
- What are current policy recommendations and evidence-based guidelines regarding mental health?
That sounds like a lot of work!
Angela Kunzler: Yes indeed. We have performed literature searches in 11 databases and have inspected around 7,600 studies. Besides 27 previous literature reviews, the literature search yielded 90 observational studies on mental health, comprising evidence for various population groups – the general population, patients, employees, as well as different age groups – in 14 EU Member States and the United Kingdom. These studies cover a period from January to December 2020, with most studies carried out between spring and summer 2020.
In general, what are the main conclusions from the study?
Angela Kunzler: We found a consistent increase of stress-related mental symptoms (anxiety, depression, general psychological distress) in the general population during the pandemic compared to before, which is in line with previous findings from the literature reviews identified in this report.
Over the further course of the pandemic – especially during and shortly after the first wave for which most data were available – the level of mental symptoms then remained stable at the higher level in contrast to before the pandemic or re-improved compared to the previously higher values from the pandemic in most population groups.
The included studies used various statistical methods to examine changes in mental health. Therefore, the exact extent of mental health changes is mostly unclear. Based on the currently available data, we could also not draw reliable conclusions regarding the mental health impact of Covid-19 policy responses.
Did anything surprising come out of this? Was it for example surprising that: “As the pandemic progressed, mental health either remained stable or re-improved”?
Angela Kunzler: Yes, on the one hand, this result was surprising. On the other hand, it is also conceivable that – in the aftermath of the initial shock of the disease outbreak as a public health threat and unknown stressors such as travel restrictions – people developed various strategies to cope with the pandemic. For example, a positive reappraisal of the pandemic and the related containment measures might have contributed to rather resilient responses over the further course of the pandemic – at least during the period which we examined, so until March 2021.
We do know from resilience research and previous studies on other macro-stressors (for example the terrorist attacks on 11th September 2001) that resilience is not a rarely observed phenomenon. Instead, after potentially traumatic events, most people either show stable mental health trajectories or a temporarily increased mental burden which is followed by a recovery of mental health.
We should also consider the potential delay in scientific publications on mental health, which might have affected the findings of this study. Since the included studies are primarily limited to the first wave of the Covid-19 pandemic, the results of future research investigating mental health at later stages of the pandemic (second, third wave etc.) might differ from the current findings. The medium- and long-term psychosocial and mental health consequences are still mostly unclear.
Another unexpected result concerned the lack of mental health data for many EU Member States as well as for several population groups (e.g., children and adolescents, non-healthcare employees).
Was there a difference between different population groups? Men and women? Countries?
Angela Kunzler: At country level, we could find no clear tendency that the citizens of any specific Member State(s) are more at risk for or more protected from a deterioration of mental health amidst the pandemic.
When we compared the mental health changes between all identified population groups, the general population was the most burdened group during the first wave compared to before the pandemic. This finding is also in line with our preliminary works.
At an individual level, especially women, citizens with low socioeconomic status (e.g., financial insecurity), those experiencing loneliness, and individuals with many fears (of Covid-19) were more at risk of mental health problems.
On the other hand, social support, financial stability, more physical/recreational activities, and psychological resilience factors like self-efficacy (the belief in one’s ability to succeed in a specific task) were the most relevant protective factors for mental health.
Overall, we found that there is still a need for more research on protective factors which were only investigated by one third of the 90 studies. There are also particular research gaps concerning social, work-related, and pandemic-related protective factors.
The study gives advice about policy options – which options are these?
Angela Kunzler & Klaus Lieb: We suggest four policy options based on our study findings:
- First, an EU-wide monitoring study on mental health in the general population, conducted over a longer period during the pandemic and in its aftermath, which measures the prevalence of mental symptoms as well as of clinically relevant diagnoses of mental disorders.
- Second, we suggest increasing the awareness amongst the public and policymakers at the European and national levels about the mental health consequences of the pandemic, protective factors, and the efficacy of psychosocial and mental health interventions. This option could be realised by funding programmes to promote research activities, for example, longitudinal studies on specific population groups (for example non-healthcare employees, Covid-19 patients) and in those Member States that have not been investigated to date.
- Third, we propose an EU-wide research study on mental health services. For this, the infrastructure of the European Health Data Space for health data sharing between the EU countries could be used. This study would allow researchers to make more reliable conclusions about how the national (mental) healthcare systems have responded to the pandemic.
- These conclusions could then in turn feed into the development of a European emergency preparedness plan to counteract negative mental health consequences of the pandemic as part of the European Health Union. This strategy would benefit the EU, for example, by providing psychosocial support resources (for example helplines or digital resources) for the general population and vulnerable groups. This preparedness plan could also define criteria to ensure a sufficient supply of (critical) mental health services during and after health emergencies.
Klaus Lieb: I also think that especially the mental health impact of government support measures should be further investigated. The pandemic is likely to have enormous medium- and long-term consequences on different areas of life (e.g., economic, mental health, social). Hence, from the perspective of resilience research, more knowledge about how these measures possibly buffer negative mental health effects in later phases of the pandemic and in its aftermath will be very relevant to identify protective factors for potential future public health emergencies.
STOA online event: ‘Coping with the pandemic: Psychosocial consequences of the corona crisis’, Tuesday 25 January 2022 at 15:00h CET