Double trouble: How severe lockdown restrictions have taken a toll on population mental health
This article is based on research carried out by Jane Fisher, Karin Hammarberg, Maggie Kirkman, Thach Tran, Heather Rowe, Jayagowri Sastry, Ruby Stocker, Hau Nguyen, and Sally Popplestone, on behalf of the Monash COVID-19 Mental Health Research Group, Global and Women’s Health Unit, School of Public Health and Preventive Medicine.
As millions of Australians adapt to being in lockdown, coming out of lockdown, or living with the threat of future lockdowns, the consequences for population mental health of the restrictions needed to manage coronavirus outbreaks are of increasing concern to the community and policymakers.
Our research, published in the Journal of Affective Disorders, found that, compared with states and territories where restrictions were easing, the severe COVID-19 restrictions in Victoria in July and August 2020 were associated with near double the population prevalence of moderate to severe depressive and generalised anxiety symptoms.
We collected responses from 24,000 people from all Australian states and territories across two surveys.
Survey one was initiated just days after the national lockdown began in April 2020, while survey two was conducted during Melbourne’s second wave in July and August 2020. This allowed our team to compare the impact of the stage four restrictions in Victoria with that in the rest of the country where there were fewer restrictions.
There were two major findings.
Clinically significant depressive and anxiety symptoms substantially higher in Victoria
First, there were no between-state differences in the population burden of mental health problems at survey one, when the restrictions across the country were similar.
However, by survey two, prevalence rates of clinically significant depressive and anxiety symptoms were substantially and significantly higher in Victoria than in other states and territories.
In survey two:
44% of Victorians reported moderate to severe symptoms of depression, compared with 32% of people living in other parts of the country.
One third (34%) of Victorians reported moderate to severe symptoms of anxiety, compared with 23% of people in other states and territories.
Increased irritability was widespread but nevertheless higher in Victoria (73%) than elsewhere in Australia (58%).
One in five people had experienced at least occasional thoughts that they would be better off dead in the previous two weeks. This was found throughout the country and, despite stage four restrictions, was not more prevalent in Victoria.
Mental health indicators had not improved in locations where restrictions had eased
Second, we had anticipated that, where restrictions had been reduced or removed, people would be feeling better. However, we found that, in states and territories where restrictions had eased in the four-month interval between surveys one and two, mental health indicators had not improved. Furthermore, fewer people were feeling optimistic about the future.
Many people in Australia are feeling dispirited and demoralised. Some are mourning losses of agency and autonomy, connections with family and friends, and participation in milestone events, an experience called disenfranchised grief.
We found in both surveys that there were high proportions of people experiencing mild to moderate symptoms. These may not cause disability, but nevertheless suggest that a lower-than-usual sense of wellbeing is pervasive.
Mental health problems more closely linked to restrictions rather than a fear of infection
Despite more Victorians having had, by survey two, direct experience of COVID-19 through being infected, tested, living with, or knowing someone with COVID-19, the research found people’s mental health problems were more closely linked to public health restrictions on their daily lives than a fear of infection.
In large part, these reactions are normal human adjustments to abnormal and threatening circumstances over which we have little agency. However, these psychological states are all associated with reductions in energy, functional efficiency, optimism, humour, creativity, engagement, and capacities to concentrate and solve problems.
We found in both surveys that some groups of people are particularly adversely affected. These include those who occupied the lowest socioeconomic positions, lived alone, had caregiving responsibilities, had lost jobs, were students whose courses had been suspended, were members of marginalised minority groups, were women, or aged 18 to 29 years.
To our knowledge, this is the first research in the world to enable us to measure the psychological burden of more, compared to less, severe restrictions.
We need to remember that typically in non-COVID-19 times, about 5% of people would report moderate to severe symptoms of depression in the previous two weeks.
While recognising their importance in preventing the spread of COVID-19, these findings demonstrate the significant adverse psychological consequences of restrictions.
Whole-of-community mental health promotion, and targeted strategies for sub-groups
We acknowledge the work of the Commonwealth, state, and territory governments and the health sector in seeking to address the pandemic-related mental health problems by increasing availability of, and access to, mental health services.
About 11% of Australians used these services in 2020. However, our data shows that the problem is much larger and more complex than can be addressed effectively by formal mental health care.
Most people do not see themselves as needing psychiatric services, or that these will address the problems they are experiencing, such as having to close a business, lose income or a job, social isolation, cancelled family events, and the burden of unpaid caregiving.
Our evidence suggests that a multicomponent approach is needed, with a strong focus on mental health promotion for the whole community, in addition to targeted strategies for sub-groups.
Australia needs a pathway to psychological recovery that complements the National Cabinet’s current economic and pandemic management plans.
We agree with the World Health Organisation’s call for a response in which education, labour, justice, transport, environment, housing, and welfare sectors are involved in initiatives to promote mental health, as well as the health sector.
We think it is essential that there are wide community consultations about what might assist. As the pandemic continues, these findings provide evidence to inform policy planning for recovery from lockdowns.