Understanding Our Psychological Reactions to COVID

In early 2020, while many of us were stocking up on food and toilet paper, a team of researchers was at work planning, and securing funding for, an 18-month project ‘to monitor and assess the long-term psychological, social, economic, and political impact of the pandemic on the lives of ordinary adults in the general population.'

The COVID-19 Psychological Research Consortium Study is led by Professor Richard Bentall at the University of Sheffield, with Professor Mark Shevlin at Ulster University, and consists of an international team of clinical, developmental, and health psychologists, plus political scientists and statisticians.

They recruited a representative sample of over 2,000 UK adults and collected information, at intervals, on ‘their psychological and physical health, their engagement with social distancing and other hygienic practices, their thoughts and beliefs in relation to a potential vaccine for COVID-19, their political views, as well as their level of satisfaction in relation to how their government is managing the crisis.'

This remarkable project has already led to more than 40 publications, freely available to the public. I will summarise just two, both concerning our psychological well-being, or otherwise, during the pandemic.

The first study, entitled ‘Anxiety, depression, traumatic stress and COVID-19-related anxiety in the UK general population during the COVID-19 pandemic,’¹ was conducted over the week beginning 23 March 2020, 52 days after the first confirmed COVID-19 case in the UK, and the day the Prime Minister announced the ‘lockdown’ that required everyone in the UK to stay at home.

The survey found higher levels of anxiety and depression compared with pre-COVID population studies, ‘but not dramatically so.’ Anxiety or depression was predicted by young age, living with children, high estimates of personal risk, low income, loss of income, and pre-existing health conditions in self and others. The researchers concluded:

‘The fact that the prevalence of psychological problems observed in the present study was not dramatically higher than those reported in previous studies suggests that the population, at an early stage of the pandemic, has successfully adapted to the unprecedented changes that have been forced on their lifestyles. However, we have identified certain key groups who may be more vulnerable to the social and economic challenges of the pandemic, particularly those whose income has been affected, who have children living in the home, and who have pre-existing health conditions that make them vulnerable to the more devastating effects of the COVID-19 virus.’

These minimal increases in anxiety and depression, only among certain groups, stood in stark contrast to ominous warnings, on the BBC, of a ‘tsunami’ of referrals, from the Royal College of Psychiatrists, in May 2020. Indeed the other paper I present here is titled ‘Refuting the myth of a ‘tsunami’ of mental ill-health in populations affected by COVID-19: Evidence that response to the pandemic is heterogeneous, not homogeneous.’² It reported data at three-time points.

The overall prevalence of anxiety-depression had remained stable. Meanwhile, COVID-related trauma symptoms had reduced, perhaps because of ‘habituation to the situation, causing individuals to be less ‘alert’ to the virus or reduced frequency of upsetting COVID-19 imagery in the media.’

Furthermore, three groups were identified, reflecting stability, deterioration, and improvement. The majority of the sample ‘exhibited resilient mental health trajectories . . . characterised by minimal changes in anxious-depressive or PTSD symptomology’ suggesting that 'although some individuals may exhibit long-term distress following traumatic-adverse events, resilience (maintaining healthy outcomes or ‘bouncing back’ following such events) is the most common and consistently observed response'. About 5 percent reported severe psychological distress during the first months of lockdown. About 8 percent reported improvement in psychological well-being.

This time the researchers concluded:

‘The emergence of both improving and deteriorating classes in the current study suggests that while it may have taken several months for some individuals to adjust and adapt to the situation, for others, deterioration may have only emerged after months of increased caring duties, balancing home and work life, or with the end of the furlough scheme [income subsidies] looming.’

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Some might characterise the outcomes measured by Bentall and his colleagues as ‘mental illnesses’ or ‘psychiatric disorders’ occurring only in those of us with biochemical imbalances and genetic predispositions, and requiring psychiatric drugs. What this impressive body of work shows, however, is that our reactions to the pandemic are exactly that, understandable, emotional, reactions to distressing life events. The image I am left with is not of a tsunami of people with biologically based mental illnesses but of a young couple (or single parent) with three young kids at home who have just lost, or are about to lose, their meager income. Of course, they are scared. Of course, they have days when all seems hopeless. Targeting the causes of their fear and hopelessness will help them more than applying a scientifically dubious diagnostic label to their emotions ('Anxiety Disorder', 'Major Depressive Episode,' etc.) and recommending a medical solution.

The unsubstantiated and simplistic ‘medical model’ approach to understanding human distress has brought us to the bizarre situation where we are prescribing antidepressants to one in five women and one in eight men every year.³ Furthermore, poorer people are significantly more likely to receive such a prescription.³ Perhaps the pandemic, and this fine body of research it has spawned, will help us shift our approach to ‘mental health' in the future, with a greater focus on human relationships and rights and a bit less on labels and drugs.