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Pandemic Impact on Mental Health Was 'Mixed Across Europe'

The impact of COVID-19 on mental health in Europe was not as substantial as predicted, according to an investigation by UK researchers who reported no clear pattern of improvement or worsening of mental health problems for those with pre-existing conditions.

The COVID-19 pandemic caused "immediate and far-reaching" disruption to society, the economy, and healthcare services, highlighted the authors of a new study, published in The Lancet Psychiatry. They added that following the onset of the pandemic in March 2020, mental health was "swiftly recognised as an area of concern".

They pointed out that the potential consequences of the pandemic and associated social restrictions included an "increase in psychological distress, increase in new onsets of mental health conditions, and worsening of difficulties already experienced by people living with mental health conditions". Moreover, pandemic-related service disruption had the potential to exacerbate such effects on mental health.

Modest Rise in Depression and Anxiety

For the systematic review, the researchers, led by a team at the NIHR Mental Health Policy Research Unit at University College London (UCL) and King's College London, searched four electronic databases (MEDLINE, PsycINFO, Embase, and CINAHL) for articles published between 1 March, 2020, and 1 February, 2022, and four pre-print servers (MedRxiv, PsyArXiv, Wellcome Open Research, and JMIR) for articles registered between 1 March, 2020, and 7 March, 2022.

They identified 177 studies from 20 high-income European countries comparing mental health and mental health service use outcomes either before and during the pandemic, or over the course of the pandemic. The authors explained that they had focussed on high-income countries in Europe because of the "similarities" between its countries in timing of COVID-19 waves, health service responses, and social restrictions.

"Across Europe, depression and anxiety disorders became more common following the onset of the pandemic," revealed the researchers. However, this was a "modest rise" they noted, and could be interpreted as an "acute response to a global event" that caused widespread "disruption, fear, financial hardship, and grief". Later in 2020, depression and anxiety rates reduced again, but fluctuated over the following year, they pointed out.

"This increase reverted fairly quickly, but continued to fluctuate throughout the pandemic, which may have corresponded in part to the introductions of further lockdowns," the authors speculated.

Dr Nafiso Ahmed, UCL Psychiatry, and lead author, explained that the COVID-19 pandemic had a "considerable" effect on mental health across Europe, but overall, the impacts were "not as substantial" as many people had predicted early on. "We did not see a 'second pandemic' of mental health problems," she stressed.

Patterns of Change Unclear

Early in the pandemic there was an initial period of fewer new diagnoses of mental illness, highlighted the authors. This was likely due to "fewer people accessing mental health services", which were disrupted while these transitioned to being delivered remotely. Service use increased later in 2020 and through 2021, they said, but "did not return to pre-pandemic levels".

Professor Sonia Johnson (UCL Psychiatry), director of the Mental Health Policy Research Unit, and senior author, said: "The disparity we found between increased prevalence of mental health problems and reduced service use suggests that the pre-existing treatment gap in addressing mental health problems may have increased, which could have potential long-term repercussions."

In addition, "no clear pattern of change" in mental health symptom severity and associated outcomes in adults with pre-existing mental health conditions was observed, reported the authors. They did, however, find some evidence of worsening symptoms for children and young people with pre-existing mental health problems.

Suicidal behaviour did not appear to change significantly overall when pre-pandemic levels were compared to various timepoints in 2020 and 2021, according to the authors.

Societal Factors May Be More Influential Than the Pandemic

"Globally, provision of mental health services has long lagged behind demand, and in recent years this demand has continued to rise without sufficient increase in service provision, said Professor Johnson. Whilst the pandemic may have played a role in worsening this treatment gap, "societal factors may play a greater role in driving rates of mental illness than the pandemic itself," she added. 

Although the study was a comprehensive overview of existing evidence, the researchers highlighted that there was still little evidence on a wider range of mental health problems, such as psychosis or bipolar disorder, or for high-risk groups such as people from ethnic minority backgrounds or those who were more directly affected by COVID-19. The review therefore "might have missed trends" for certain groups, they acknowledged, and as such, further research was needed to understand the long-term impact of the pandemic on mental health.

"While there may not have been a major increase in mental health problems at the population level, for many individuals, the pandemic has had devastating consequences for their mental health, emphasised Dr Ahmed. It was "vital" that mental health services were improved, she urged, and that "we work with people with lived experience of mental illness to understand how to meet their needs".

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