The coronavirus pandemic impacts on all our daily lives, in many
different ways. We have adapted to wearing masks and socially
distancing from friends, family and neighbours. Some will have lost
loved ones or worry about losing income or jobs as we enter recession.
What effect could these changes have on our mental health as a nation?
And what can research and evidence tell us about what we need to do to
respond to the impact now and over the longer term? Public Health
England (PHE) were asked to provide some evidence on these key
questions for the Department of Health and Social Care (DHSC) early on
in the pandemic.
Gaining an understanding of the particular ways the pandemic can
impact mental health is the first step to effective and proactive
response. The public mental health team at PHE has been interested not
only in direct trauma related to illness and bereavement; but also the
secondary disruption to how we live our lives – interrupted education,
challenges of household life in lockdown, rise in unemployment and
increased financial and housing insecurity.
How the data and information was gathered
Providing evidence and evidence-based recommendations to the
Government is a core role for PHE. Given the speed of the pandemic and
the urgency of the request from DHSC to have evidence to guide early
action, this collection of the evidence had to be undertaken over a
matter of weeks, using as robust a methodology as possible.
A team of public mental health specialists within PHE conducted the
work in early summer. We drew upon evidence gathered for real
time surveillance; recent publications from COVID-19 specific
literature collections and applied evidence on the wider determinants
of mental health from existing reviews and reports.
Although some of this evidence has been superseded by newer evidence
we are keen to share the work we did earlier in the pandemic as it
will still be useful now for other colleagues and partner
organisations working nationally and locally.
What is included in the evidence report?
The publication draws together evidence on the social determinants of
mental health, how they have been impacted in previous infectious
disease outbreaks or recessions; and links to early data and
pre-published evidence on how the determinants were affected during
lockdown. We also summarise mental health impacts for ‘vulnerable’
groups identified as at-risk of worsening mental health.
This evidence mapping work has notable limitations : evidence
searches were not systematic and lower quality evidence was included.
We therefore advise some caution in applying the collected evidence.
Consideration of other evidence sources is important and to assist
this we have included in these documents an annex of other summaries
Key findings from the evidence
Economic recession and the related impacts on unemployment, debt,
poverty and housing insecurity that this brings are highlighted as key
potential drivers of worsening mental health as a result of COVID-19.
These impacts are likely to exacerbate existing inequalities and occur
over the medium term.
We also highlight shorter-term impacts on children’s mental health
from disrupted education and the increased risk of abuse within
households. Other shorter-term impacts we highlight are loneliness
during lockdown, disrupted social support networks and disturbed sleep
patterns, with some protective effects through community responses.
For vulnerable groups we identified the following factors influencing
their mental health –
- People with chronic physical conditions may have higher levels of
anxiety and fear about accessing healthcare and may have limited
access to their usual support network. There is likely to be higher
levels of fear of infection and COVID-19 related stress in this
group, who are also more likely to have pre-existing mental health
- People who have been shielding were more likely to have
pre-existing mental health problems. Quarantine, which has been most
extreme for this group, is associated with reduced mental health :
risk factors that changed include lack of exercise, less access to
the natural environment, loneliness/reduced social interactions and
fear of infection. Early findings suggested that over a third of
people who have been shielding felt that their mental health had
- People with pre-existing mental health conditions are experiencing
increased loneliness, social isolation and a reduction of access to
normal social support, services and resources. A small minority
report benefit from reduction of stressors and increase in social
- People with direct experience of COVID-19 infection are likely to
experience higher rates of Post-Traumatic Stress Disorder (PTSD),
anxiety and depression. There is also an increased risk of PTSD post
intensive care admission.
- People who have been bereaved by any condition during the pandemic
are at increased risk of experiencing complicated grief and
subsequent mental health problems, particularly due to restrictions
on visits to care homes/hospitals, socially distanced funerals as
well as those bereaved being more likely to be isolated during
- Health and Social care workers may experience increased pressures
at work, have anxieties around getting the illness and adequately
protecting family members. A substantial proportion are showing
signs of common mental health disorders during COVID-19, with nurses
and women more affected.
You can access the full reports here.
PHE also publishes regular surveillance
on population mental health and wellbeing during COVID-19.
Visit the Every Mind
Matters website for more resources and advice on mental health
and wellbeing during the coronavirus pandemic.