R U OK? Understanding mental health in a global pandemic

Today is R U OK? Day, an annual moment to reflect on mental-health harm prevention through the simple act of reaching out. This year’s R U OK? Day comes at a time when vast swathes of the country are in lockdown, and many people are suffering the long-term mental health effects that come with a global pandemic.

But what exactly are the numbers on mental health and COVID-19? Who is affected worst, and what scientific research is being done behind the scenes to understand the scale of the problem?

What’s the data?

“There have been hundreds and hundreds of studies done around the world about mental health during the pandemic, and basically they’re all saying the same thing,” says Richard Bryant, Scientia Professor of Psychology at UNSW Sydney. “There’s been a significant increase in anxiety and depression.”

But Bryant says that Australia is lacking the kinds of longitudinal studies that have informed clinical psychology in overseas countries that have had more drastic impacts from the pandemic.

“We can learn lessons from what’s happening overseas,” he says. “For example, if we look at the UK, one study in particular found that in the first month or two of a lockdown, which is where we were a month ago in the eastern parts of Australia, they had up to a third of people reporting anxiety and depression.

“But when they sampled a few months later when things were opening up, anxiety and depression may have reduced, but they were still finding significant levels, with a quarter of people still suffering from some anxiety and depression, and one in 10 having suicidal thoughts.”

And while mental health impacts from COVID are significant, they’re merely the tip of an already prolific pre-pandemic iceberg: a 2018 Lancet commission on global mental health and sustainable development found that even the highest-income countries have inadequate mental healthcare infrastructure across the board.

There is some longitudinal data in Australia that’s beginning to paint a picture of the long-term trends.

The Australian Institute for Health and Welfare (AIHW) has been collaborating with the Centre for Social Research and the Australian National University’s Centre for Social Research and Methods to build a picture on loneliness and psychological distress during the pandemic. The data has been collected in ongoing troves in April, May, August and November 2020 and again in January and April 2021. August data collection is ongoing.

The results show that the proportion of people experiencing psychological distress – as measured by the Kessler 6 Scale – rose from 8.4% in February 2017 to 10.6% in April 2020, with a fall in May 2020 to 9.7% and an increase to 10.9% in October last year. The proportion of people experiencing psychological distress in April 2021 was lower than the peaks of the previous year, but it’s not a huge leap to imagine that rates in August 2021 – at a time when large sections of the population were experiencing prolonged lockdowns – would be high. Hearteningly, increasing levels of psychological distress do not appear to have raised suicide rates across the nation.

The data shows what we already intuitively know: that levels of psychological distress trace the contours of tightened and relaxed restrictions, with lockdowns having the severest impact on psychological wellbeing – though it’s important to note that alternatives to lockdown would have their own, likely severe, mental health consequences.

But how do these impacts play out across and within communities?

Age and mental health

Younger people have experienced the highest levels of psychological distress throughout the global pandemic. When the AIHW data gatherers controlled for factors like relationship problems, rising stress and employment loss, young people were no worse off than older people in K6 scores: the disproportionate impact on the young was tightly related, then, to the instability of youth, both economically and socially.

“There’s pretty good consensus globally that young adults seem to be the most affected across the board,” agrees Bryant. “Basically, their capacity to cope with lockdowns, social restrictions and limited interactions [is limited].

“For a lot of older people, they’ve got a degree of financial stability because of where they are in life, so they have a bit of a buffer to cope with the economic fallout.”

It’s the lack of this buffer, Bryant says, that means many of the worst mental health effects also play out among disadvantaged communities, who also tend to labour under higher COVID rates and lower vaccination coverage.

Alarmingly, recent data shows a spike in self-harm and suicide among children and adolescents in the context of the pandemic. In New South Wales in particular, presentations to emergency departments for self-harm and suicidal thoughts reportedly increased by 47% since before the pandemic.

“We know there’s a massive wait for kids to access professional services,” says Emily Berger, a developmental psychologist at Monash University and author of a recent story in The Conversation about harm reduction. “And we know that rates of self-harm increase when people are under increased stress, experiencing adversity and stresses in their life.

“Obviously COVID-19 has been a traumatic experience for a lot of people and it might have increased stressors in people’s lives in other areas, such as financial stress or family violence.

“Children are also without protective factors such as access to friends, exercising regularly, socialisation with peers, [and] access to supportive teachers. So I think it’s no surprise, when you put those risk factors together, why we’ve seen an increase in self-injury.”

Read more: The psychology of COVID compliance

Alcohol, drugs and family violence

At the beginning of the pandemic, there was a steep rise in demand for online alcohol and other drug supports, according to the Foundation for Alcohol Research and Education (FARE). The National Alcohol and Other Drugs (AOD) Hotline recorded a doubling in calls in the early months of 2020 compared with 2019.

In April this year, researchers analysing Ambulance Victoria data reported that while ambulance attendances for alcohol intoxication during early 2020 were comparable to the previous year, rates of attendance increased as lockdowns wore on. Notably, attendance rates were intimately associated with disturbing events like government announcements.

The study found that economic disadvantage and location played into these rates, emphasising the perhaps unsurprising fact that mental ill-health and its associated harms disproportionately affect the most vulnerable.

“Now that we’re 18 months into the pandemic, we’ve got a few different datasets that we look at when we want to know what’s happening with alcohol,” says FARE CEO Caterina Giorgi.

One such dataset is sales: “Takeaway alcohol has increased by 27% in 2020 compared with 2019, or by $3 billion,” Giorgi says. “So what we know is that there’s this huge flow of alcohol into the home that we didn’t see before, and if you consider that takeaway alcohol accounted for 80% of the market even before the pandemic, then that starts to raise some concerns.

“We’re starting to be really concerned about those hidden harms from alcohol, the ones that aren’t as visible, like alcohol’s role in family violence, its impact on mental health, its contribution to chronic disease.”

In June 2021, the ABS released figures showing that police recorded instances of family and domestic-violence-related sexual assault rose by 13% between 2019 and 2020, as compared with a 2% increase between 2018 and 2019.

Meanwhile, a July 2020 statistical bulletin from the Australian Institute of Criminology reported that the onset of the COVID-19 pandemic coincided with either the onset or escalation of sexual violence and coercive control for many Australian women.

Giorgi says that FARE surveys have shown that one in five people has increased their drinking since the start of the pandemic, often because of boredom or anxiety. It’s in the complex nexus between alcohol, mental health and family violence that much of the harm plays out.

Looking to the future

“One of the things we can say is that the great majority of people will bounce back,” Bryant says. “We know that whenever there’s hard times, most people are resilient, so once people are vaccinated, the community gets back to [some] normality, most people will be resilient.”

However, Bryant says there will be a small proportion who suffer longer-term impacts from the pandemic: “There’s going to be a proportion of people, ranging from 10% to 15%, who actually will have difficult and persistent problems, and we know this from previous pandemics.”

But, Bryant says, this percentage of people disproportionately harmed will not be standard across the board, but concentrated among those more at risk, including younger people and the disadvantaged.

Ultimately, we won’t have a full picture of the mental health impacts of COVID-19 until it’s a foregone conclusion. “So, we need to get a comprehensive picture, what is collected, what needs to be collected, and build a comprehensive profile,” says Bryant.