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The Office for National Statistics (ONS) have published two reports looking at COVD-19 and anxiety, and the impact of COVID-19 on those in the shielded population, respectively. The below comments address the elements of the reports which cover mental health.
Dr Wendy Sims-Schouten, Reader (Associate Professor) in Childhood Studies and lead of the Mental Health in Childhood and Education research group at the University of Portsmouth, said:
On the first report:
“The ONS article on Coronavirus and Anxiety highlights, perhaps not surprisingly, that the number of people reporting high levels of anxiety has more than doubled compared with pre-lockdown measures.
“There are a number of striking findings, namely that 39% of people who are married or in a civil partnership, reported high levels of anxiety, compared to 19% pre-pandemic, which may be due to caring responsibilities and home-schooling alongside work. Moreover, the highest levels of anxiety are seen among those aged 65 years and over, which is interesting considering that pre-pandemic this group are less likely to report high levels of anxiety compared to other age groups. This could be related to loneliness, as research highlights a correlation between loneliness and anxiety. Although a note of caution, as recent studies highlight that loneliness is also considerable among younger age groups. Thus, the rise in anxiety among the 65+ could also be down to other factors, such as a sense of helplessness and dependency on others, as well as the higher risk factors associated with the 65+ age group.
On the second report:
“The ONS report COVID-19: guidance on shielding and protecting people defined on medical grounds as extremely vulnerable provides some important data and information in relation to shielding practices and impacts of the clinically extremely vulnerable (CEV). Here ‘clinically extremely vulnerable’ includes people with cancer, severe respiratory conditions, rare diseases that significantly increase the risk of infections, such as homozygous sickle cell, people on immunosuppression therapies, pregnant women with significant heart disease, and other people who have been classed as clinically extremely vulnerable, based on clinical judgement and an assessment of their needs.
“More than 2.2 million, classed as clinically extremely vulnerable, were advised by the government to shield during the coronavirus (COVID-19) pandemic, and the report, based on the Shielding Behaviour Survey, suggests that 62% reported that they were fully following official advice.
“However, a closer look at the report highlights that it is difficult to pinpoint the number of extremely vulnerable people who were shielding, as although 62% self-reported that they were completely following shielding advice, 33% reported mostly following the shielding guidance, and 49% reported leaving the house at least once since they received shielding guidance. This suggests that in reality less than 62% of people were completely following shielding guidance. Thus, the research would have further benefited from qualitative research to provide insight into the meanings, perceptions and understandings that people from various groups and categories of the ‘clinically extremely vulnerable’ embrace in relation to ‘shielding’.
“The research highlights that of the clinically extremely vulnerable, 46% have not registered for support, which raises the question why? The group of the ‘clinically extremely vulnerable’ includes children, those over state pension age and those unable to work for health reasons. Yet, details regarding living arrangements are not provided. Moreover, a relatively large percentage have been furloughed and cannot work from home (31%), perhaps highlighting that there is an issue here with socio-economic position and marginalised and disadvantaged groups as well. The data is divided into gender and age, and this raises the question of where are the voices and experiences of members from ethnic minority communities? The data does not engage with this.
“There is a need to centralise the ‘voice’ of people from different (ethnic minority) communities and backgrounds – this requires direct engagement with these communities and an inclusion of communities in key decisions.”
Prof David Nutt, The Edmond J Safra Chair and Head of the Centre for Neuropsychopharmacology, Division of Brain Sciences, Dept of Medicine, Imperial College London, said:
“This is not surprising – indeed many of us had predicted such. Though some of these people’s anxiety will resolves spontaneously once the lockdown is over many wont. This means there is an immediate need for a coordinated national response focussing on making effective interventions easily accessible.”
Prof Sir Simon Wessely, Regius Professor of Psychiatry, King’s College London, said:
“It’s no surprise that people have become more anxious during the pandemic, but the size of the increase is very troubling. The greatest increase is in those who are married/in partnerships, which is the opposite of what we normally see. This may reflect issues around either home schooling, or home working, or both. Another issue across the board is loneliness – which is not just about living alone, but that our need for rewarding social contact is not being met. This is the wicked nature of a pandemic – it creates intense anxiety, but the measures that we need to control it, which centre on supressing our ability to interact socially, make it more difficult to manage that anxiety. Finally, if as seems likely we are going to have to learn to live with this virus for some time to come, even with a vaccine, high levels of fear will make it more difficult for us to accept the compromises and trade-offs necessary for our collective future. Government may have to lead and not simply follow.”
Prof Dame Til Wykes, Vice Dean Psychology and Systems Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, said:
“Previous pandemics and evidence from other countries suggests that in general we will feel anxious. In fact those with more anxiety tend to follow the lockdown rules and social distancing. Previous reports have shown similar findings that younger people are less anxious and also less likely to stick to all the rules. But anxiety should reduce over time as lockdown is relaxed and we all try out previously risky behaviours.”
“I remember being very anxious when I first walked out into the main high street after a few weeks of only exercising very near home. After a few times I felt much more comfortable.”
“The ONS report shows that there are a large number of people who might be classed as “cases” of high anxiety that clinical psychologists might expect to treat in mental health services. But we don’t yet know whether these problems will persist as lockdown is reduced. But probably there will be some people who will need extra encouragement to go back to their normal way of life.
“Juggling home school, work and spending more time in close proximity to a loved one seems to produce more anxiety and these issues will persist as employment prospects and lack of school will not return to normal until after the summer. So some help is needed and the best is to reduce daily hassles, such as concerns about finances. Although the government has helped with employment so far, additional help is warranted especially for families who currently have free school meals.”
“There are differences in anxiety for sections of the population. For those who are shielding, older people report less worsening of their mental health than younger people (under 59). This is the opposite for the general population”
“Anxiety is to be expected but some people may experience less. Some children, for instance, felt less anxiety when they were not being bullied face to face at school.”
“Although the report suggests 19 million adults are anxious, we need to understand how many will need treatment from mental health services, so follow-up is required. But we do need to treat highly anxious individuals. They don’t need an app – they need highly professional face-to-face therapy to help them integrate back into the world and achieve their personal goals.”
Dr Dean Burnett, Honorary research associate at Cardiff University Psychology School, said:
“It is unfortunate that so many people are experiencing a substantial drop in their mental health since the pandemic and lockdown began, but it is far from unexpected. The circumstances that most people are having to endure right now are, in many ways, almost designed to maximise stress, and if there’s one thing that has been repeatedly linked to a very wide range of mental health problems, it’s stress.
“The fact that people who already expressed anxiety over loneliness were the most potently affected makes sense. Humans are an incredibly social species by nature, and even when alone the fact that we can venture out and interact with others is a comfort. Being denied that options, due to circumstance or health issues or geography or anything else, is a major cause of stress and anxiety. In a situation where the population is under lockdown and practicing social distancing (for valid reasons), far more people are going to feel socially excluded, and experience high stress and anxiety, with subsequent detrimental effects on mental health, particularly if they were already prone to such thinking.
“That married or civil partnership individuals have also reported a sharp rise in anxiety is also consistent with what we know about stress. As the reports reveal, such people tend to have more commitments and responsibilities, often involving children, so have a lot more depending on them, like the home schooling of said children. More dependents and responsibilities, particularly if they’re important things that involve duties you’ve no training or experience in, can also lead to a great deal more stress. It could also be that the children mentioned are teens, so are experiencing high degrees of stress on their end and acting accordingly, making for a more stressful household all round.
“It’s also worth flagging up that, while living with someone under lockdown can protect against loneliness, it can also come with stresses of its own. It’s not automatically suggestive of a flawed relationship, but there’s a great deal of difference between “living with someone” and “being trapped with someone”, no matter how much you care for them. Our homes provide a psychological safe place that reduces stress on an instinctive level, but if you have to share it with someone who is also stressed and cannot leave, it can undermine this process and thus make your home more stressful, not less. Basically, high stress and anxiety among couples does not automatically mean bad marriages or relationships (although those will undoubtedly be well represented in the data)
“People over 65 experiencing the highest rise in anxiety is also logical, as this is the group that has been repeatedly told they are at most risk from Covid19. They have all the stressful issues of the lockdown situation to deal with that other groups may be experiencing, as well as the knowledge that contracting the virus is far more likely to prove fatal to them. Much of the stress highlighted by other groups (loneliness, financial worries, schooling duties etc.) are more ‘abstract’, in that they are genuine concerns, but don’t pose an immediate physical danger to anyone. That’s not the case for the older generation, their lives are literally more at risk from the virus, and genuine immediate dangers are even more stressful again, so you expect a decline in the mental health of such people in the current circumstances.
“Finally, those vulnerable individuals shielding would likely be the most anxious of all. For all the reasons discussed above, but they also have the pre-existing stresses that come with the health condition that requires them to shield in the first place, and they have to observe the maximum expression of lockdown, avoiding all human contact and staying at home as much as possible, and the virus is clearly the most dangerous for them. They will be enduring the heaviest load of stress from all that’s going on, and would undoubtedly be experiencing a consequential drop in mental health very acutely.”
ONS Reports
All our previous output on this subject can be seen at this weblink:
www.sciencemediacentre.org/tag/covid-19
Declared interests
None received.