A comprehensive meta-analysis has revealed the unique impact of national circumstances on people’s mental wellbeing during the pandemic.
The analysis, published 18 October 2022 in the Annals of Internal Medicine, found that although symptoms of anxiety and depression uniformly increased in the early days of the pandemic, after the first two months, changes in symptoms varied widely across different populations.
Researchers from the University of Bern, Switzerland, reviewed 43 studies including some 330,000 participants, to track mental health symptoms during the first year of the pandemic, measuring self-reported parameters such as changes in symptoms of psychological distress, sleep disturbances, and mental well-being.
Lead author, Dr Georgia Salanti, said that the results of the nonlinear dose–response meta-analysis, which is more powerful than standard meta-regression because it can incorporate data from cohorts recruited exclusively during the pandemic, found that tougher lockdowns and more cases were linked with larger increases in depression and anxiety.
“The numbers of cases and the stringency of the measures are strongly correlated over time, and it is very difficult to disentangle their effects on mental health: surges in cases can have a direct detrimental effect on mental health and in most countries prompted an increase in the stringency of containment measures,” Dr Salanti explained.
“[However], the heterogeneity [after two months] could not be attributed to observed population or country characteristics.
“Because we had access only to aggregated country-level data (for both the outcome and the stringency index), we could not account for individual differences in work and living conditions or for regional variations in policies within countries.
“For example, persons with young children would be more affected by schools closing, and regions relying economically on tourism would be affected mostly by travel restrictions and restaurant closures.”
The authors pointed out that although most of the data showed an overall increase in mental health symptoms from before to during the pandemic, there were a few studies in which symptoms actually decreased from their pre-pandemic values.
“A small study of 99 mainly young people identified by snowball sampling suggested improvement in depression symptoms during the pandemic, with decreased academic stress during the initial phase of the pandemic a possible explanation,” Dr Salanti said.
“Overall, our analysis indicates that during a global pandemic we should never lose sight of the negative consequences on mental health for the average population or the community, but also that some populations have completely different trajectories in mental health.”
Their findings were supported by a similar study released four days earlier (14 October 2022), by the University of Adelaide, which found that by mid-2021, wellbeing amongst Australians was higher overall than French, Germans, and South Africans.
According to the team of Australian and international researchers who compared the four countries in the wake of COVID, in May 2021 there were clear differences in observable levels of wellbeing between countries, with Australia overall the most well-off and France reporting the lowest.
The team suggested this is likely due to the different COVID circumstances at the time, with the survey coming before Australia saw high cases, while France still had heavy restrictions to manage their caseload. Throughout the sample period, Germany experienced the highest increase in COVID cases and death rate.
“These cross-country differences in individual well-being might, in part, be explained by differences in the health and economic situation in the four countries, and the policy measures of their respective governments at the time of our survey,” the authors explained.
“Accordingly, Australia was in the best position with closed borders and low case numbers and low death rate, while South Africa benefitted from the lowest ‘alert Level 1’ before the third wave struck both countries. Germany started to ease its restrictions during our sample period, while France only planned for a gradual return to normal life towards the end of our sample period.
“Furthermore, [Australia’s] low number of COVID cases and low death rate could have had a reassuring effect on individuals. Together with the access to specific COVID mental health support from early 2021, these contextual features could help explain the comparably high level of mental well-being amongst survey respondents in Australia during the sample period.”
South African respondents reported comparably high overall well-being.
“However, we found that South Africa was the only country in which there was a positive correlation between functional well-being and financial well-being in terms of expected future financial security, which could be explained by the weaker financial support packages for people affected by COVID in this country,” the authors said.
“That is, without financial support, if individuals are restricted in their mobility and ability to go about their daily activities, this jeopardizes their expected future financial security.”
A surprising finding was the effect of education on the different dimensions of well-being, with education positively associated with social well-being and financial well-being in terms of expected future financial security in Australia, and negatively associated with functional well-being in France and in Germany.
“In Australia, higher education is associated with higher incomes and employment, and these income and employment advantages of better educated Australians is reflected in their higher financial well-being,” the authors noted.
“At the same time, more highly educated individuals require better conditions in order to be satisfied with their well-being, which could help explain the negative association between education and functional well-being in France and Germany.”
“In particular, individuals with higher levels of education tend to engage more in outdoor and sportive leisure activities as they search to reduce stress and counterbalance their sedentary working lives, which they were unable to do due to the public health restrictions associated with the pandemic.”
The study concluded that although peoples’ physical well-being might be safeguarded through strict health restrictions, their mental, functional, and financial well-being are likely to suffer, and importantly, the interrelation between these different dimensions of individual well-being should be considered, to prevent gains in one dimension being offset by losses in another.
“Our results indicate that it is important to address the link between mental well-being and financial well-being in terms of current money management stress. We thus suggest a continuous investment in mental health programs, such as the ongoing ‘Head to Health’ initiative in Australia,” the authors said.
“Our results also support the importance of timely financial support, such as disaster payments and unemployment benefits to try and alleviate impairments of financial well-being and the associated spill-over effects into other dimensions of well-being.”
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