What about long-term mental health during COVID-19?

THE protracted nature of the COVID-19 pandemic has taken many of us by surprise. From being confident a few months ago that we had dodged the bullet of widespread transmission of COVID-19 in the community, Australians have been confronted with the reality of new waves of the pandemic.

This has resulted in drawn-out and strict lockdowns at a time when many Australians expected to have resumed normality after a stressful 2020. These developments have resulted in renewed stress on many Australians who are dealing with financial difficulties, loneliness, pressures of home-schooling, and worry about infection. These unexpected stressors that millions of Australians have endured in 2021 may be eroding people’s mental health in ways we did not see in 2020.

There is no doubt that mental health problems have increased since the beginning of the COVID-19 pandemic. Many studies have found that up to one-quarter of people are experiencing depression and up to one-third are experiencing anxiety during the pandemic. Other studies have found that approximately 11% of people have been reporting suicidal thoughts. Information collected by the Australian Bureau of Statistics revealed that in June 2021 approximately 20% of adults were reporting high or very high psychological distress. This trend was confirmed by data indicating that Australians have been seeking mental health services at very high rates during the pandemic, with 15 million Medicare Benefits Schedule-subsidised services delivered in April 2021.

There have been many other indicators that the need for mental health assistance has surged since the 2021 lockdowns commenced. Reflecting the unprecedented need for mental health assistance presently seen during the lockdowns, Lifeline received 3345 crisis calls on 2 August 2021 — the most in a single day in its 58-year history.

As Australia plans its way through the pandemic by promoting vaccinations, restricting transmission, and maintaining contact tracing, there is also a need to plan how we manage the longer term mental health effects of the pandemic. What can we expect in the next few months, and indeed, for the rest of the year as we emerge from lockdowns?

We can learn a lot about what to expect from mental health patterns in other countries that have been through lockdowns and, as a result of achieving sufficient community vaccination rates sooner than Australia, have opened up after lockdowns. One study in the UK has been assessing people very regularly throughout the COVID-19 pandemic, which affords a snapshot of how mental health is changing over time. This study found that 2 months into lockdown, which is approximately where much of Australia is positioned now, the rate of anxiety had decreased marginally relative to earlier periods during the pandemic. However, at that stage more than half of the people participating in the study were still reporting anxiety.

Worryingly, this longitudinal research program found that 3 months after the lockdowns commenced in the UK and restrictions were beginning to ease, half of people still reported being worried about the pandemic, one in four were still reporting loneliness, and one in 10 were reporting suicidal thoughts. In each wave of these assessments, those most vulnerable to these mental health problems were young adults, the unemployed, single parents, and people with long term health conditions.

This overseas experience tells us that many Australians will continue to have mental health problems even after lockdowns are eased. We need to focus our attention particularly on those who are most vulnerable to the mental health problems in the pandemic, including younger adults and those with financial stress. There are steps that can be taken for people with mental health concerns during this time.

The Traumatic Stress Clinic at the University of New South Wales recently completed a trial of a brief mental health program aimed to reduce anxiety and depression during the pandemic. This program was initially developed in collaboration with the World Health Organization to train people in skills that have proven efficacy in coping with adversity, and has been shown across numerous trials to reduce common mental disorders. To manage pandemic-related issues, the original program was adapted to address pandemic-related worries, social isolation, and financial stress. It involved a six-session small group program delivered by clinical psychologists by video-conferencing. In an initial trial of distressed people from across Australia, 6 months after participating in the program, people who received it were still experiencing marked reductions in anxiety, depression and worries.

To address the psychological problems caused by the seemingly never-ending lockdowns occurring across Australia, the University of New South Wales is evaluating the best way to deliver mental health programs to people who may never have accessed mental health services before. This program is comparing the video-conferencing program versus an application that is downloaded onto people’s phones. This program is offered free as part of ongoing trials. To express interest in participating in these trials, see here. These options are particularly important at the moment because waiting times to see psychologists are currently very long, often taking many months.

We need to act now in order to minimise the long term mental health effects of the pandemic. As the world has realised the problems associated with long COVID-19, there is also the need to acknowledge the long term effects of mental health problems caused by protracted social isolation, financial stress, and fear of poor health. There are means available to address these concerns. Just as we are encouraging everyone to be vaccinated to protect them against COVID-19, people should also be urged to seek the mental health care they need to keep psychologically healthy at this difficult time.

Richard Bryant is Scientia Professor of Psychology at the University of New South Wales, and Director of the UNSW Traumatic Stress Clinic.

The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.