The policy response to Covid-19 has required the population to isolate themselves from most of their friends and families. While this has been necessary to contain the spread of coronavirus, it carries significant risks for other health and wellbeing issues, particularly mental health.
Long-term health suffers greatly during recessions (Janke et al, 2020). One of the central non-Covid-19 health consequences of lockdown is the potential risk of increased levels of mental illness. This is likely to be driven by feelings of social isolation, loneliness (Rhode et al, 2016), increased family burden (Ennis and Bunting, 2013) and economic stress caused by job loss, unemployment and job insecurity (Klehe et al, 2012).
While there will be wide variation across the population, economic research suggests that the people most at risk of mental illness tend to be those in social isolation and those with caring responsibilities. Both sets of circumstances can cause increased levels of inactivity and smoking (Shankar et al, 2011) and additional media consumption, which can further increase people’s anxiety and stress levels (Thompson et al, 2017).
What does evidence from economic research tell us?
Poor mental health is extremely detrimental to the economy, life satisfaction and the NHS. Research indicates that mental health costs the economy at least £70 billion through lost output and £10 billion in increased healthcare costs (Layard, 2015). Roughly 2.5% of working adults are absent due to mental health disability (Layard, 2017). Mentally ill workers are also less productive, exhibit exacerbated physical health problems, increase state welfare costs and cause reductions in tax revenues (Layard, 2017).
There is evidence that mental health in the UK has deteriorated by 8.1% on average during the pandemic, with significantly worse effects for younger people and women. General Health Questionnaire (GHQ) scores (which measure the subjective wellbeing on a scale of 0 to 36, with higher scores indicating worse mental health conditions) show that there has been an average increase of 2.5 for women compared with men and of 1.7 (0.99) for 16-24 (25-34) year olds compared with 45-54 year olds (Banks and Xu, 2020).
Research suggests that there are a number of channels through which lockdown could lead to these adverse mental health effects:
Social isolation and loneliness
Early evidence suggests that 5% of the UK has felt lonely during the pandemic (Rees and Large, 2020). Loneliness can lead to increases in anxiety, depression and stress, which may lead to increases in harmful behaviour, for example, suicide and self-harm (Holmes et al, 2020), higher levels of inactivity and smoking (Shankar et al, 2011) and missing regular medication routines (Layard, 2017).
These in turn can affect psychological wellbeing, with the largest effect seen in older people and women (Shankar et al, 2011). But young people can also be disproportionately affected by loneliness and social isolation (Matthews et al, 2018).
Related question: How will lockdown and the recession affect children's health?
There is also some evidence that routine behaviours may change with lockdown – for example, home cooked meals, increased alcohol consumption etc., which may be signs of worsening mental health and are likely to have further implications for people’s physical health and wellbeing (Zahra et al, 2014).
Related question: Will coronavirus worsen the UK's problem with obesity?
Some recent studies are showing that community spirit increased during lockdown, which may ease feelings of social isolation, but this positivity seems to be starting to dissipate (BBC, 2020).
Stress of balancing care-giving responsibilities with employment pressures
Prior to the pandemic, Carers UK estimated that three in five carers face depression (Carers UK, 2014). Through the pandemic, we are seeing a significant increase in care-giving, which, coupled with work pressures, can be linked with increased depression.
This is typically driven by family burden causing financial stress, exclusion, discrimination at work and social isolation (Ennis and Bunting, 2013). Family burden increased the odds of reporting mental health problems by 32%, while the presence of any mental illness in the family increased the odds by 73% (Ennis and Bunting, 2013). Those with children aged 0-4 have a significantly larger increase in mental health problems by 1 GHQ point (Banks and Xu, 2020).
Being employed and providing support for a child has been found to lead to an increase in measures of depression, due to the demanding nature of both work and providing care (Opree and Kalmijn, 2012).
A recent report finds that parents are spending 27 more hours per week on household chores, education and childcare, with women spending 15 more hours than men on domestic duties (Krentz et al, 2020).
Related question: How will the response to coronavirus affect gender equality?
Increased media exposure
Media exposure can be linked with stress, worry and anxiety (Holmes et al, 2020). As an illustration, a US study of the Ebola crisis found that exposure to four or more hours of media coverage of the disease was associated with an increase in psychological distress measures (Thompson et al, 2017).
Economic stresses – such as job loss, unemployment and job insecurity – have all been linked with mental health issues.
Related question: What are the effects of recessions on health?
Specific evidence for the current pandemic has linked financial loss due to quarantine with socio-economic distress and psychological disorders (Brooks et al, 2020). Evidence from this period shows that a decrease in household income is associated with a 1.89 higher GHQ score (Banks and Xu, 2020).
What might be effective policy responses?
The government furlough scheme has been essential in reducing economic stress. Furthermore, the government highlighting the fact that lockdown is an altruistic decision is likely to have improved wellbeing (Brooks et al, 2020).
Related question: The job furlough scheme is coming to an end: what happens next?
Possible policies and initiatives
A recent survey by the Office of National Statistics (ONS) highlights people’s main concerns about lockdown (Davies, 2020). Effective policy should try to minimise these feelings to reduce the likelihood of people experiencing mental health problems due to lockdown.
Figure 1: Concerns about the impact of coronavirus on well-being
Source: Office for National Statistics. Base population for percentage: adults aged 16 years or over who said they were very worried or somewhat worried about the effect COVID-19 was having on their life right now and said it was affecting their well-being.
Evidence suggests that group activities are among the most helpful for combating social isolation and loneliness (Cattan et al, 2005). As lockdown makes many group activities infeasible, managing social isolation and loneliness is even more difficult and requires novel interventions to facilitate and encourage community support, social connectedness, exercise, etc. (Holmes et al, 2020).
Many of the recommended policies stress digital intervention, which are crucial to tackling both social isolation and loneliness. Less digitally connected people require resources, such as government and non-profit organisations, to link them to organisations providing equipment and internet subsidies, such that they can join community groups providing online physical, leisure and educational classes (Son et al, 2020).
Holmes et al (2020) outline some potential new initiatives to help us develop a better understanding of the prevalence and impact of social isolation. These include trying to monitor and report feelings of anxiety, depression, self-harm, and suicide rates, perhaps using digital interventions to do so, and trying to focus on reaching vulnerable groups. More generally, they identify that there is considerable scope to use digital interventions to help to treat loneliness and social isolation.
Krentz et al (2020) identify employers as key actors in helping to reduce the mental health effects of the pandemic – for example, by improving the flexibility of work (perhaps via paid, partially paid and unpaid leave allowances), and by factoring care-giving into reviews, promotions, planning and layoff decisions.
Finally, Layard (2015) suggests the need for improved access to psychological therapy, through the continued funding of Improving Access to Psychological Therapies (IAPT). This government programme has been successful and is a cost-saving alternative for the NHS. Mental illness costs on average £2,000 per year per person, which contrasts with a £650 per person one-off cost of the IAPT programme.
What is the evidence and how good is it?
It is simply too early to assess the impact of lockdown on non-Covid-19 health conditions. New research will be required after the pandemic to assess fully the impact on wider wellbeing.
A recent report suggests that social distancing has significantly decreased life satisfaction, daily happiness and sense of purpose, and significantly increased levels of anxiety (Fujiwara et al, 2020).
Evidence from an ONS survey, which categorises ‘lockdown loneliness’ in terms of people whose wellbeing had been affected by loneliness in the last seven days, finds an estimated 14.3% of the population feeling ‘lockdown lonely’ (Rees and Large, 2020).
Table 1: Characteristics of those feeling lonely that are linked to lockdown loneliness
Source: Rees and Large, 2020.
Many studies related to social isolation and loneliness look at a sub-sample of a country’s population, typically looking only at vulnerable groups (for example, older people). Similarly, research on the effect of isolation – for example, on children – is fairly limited to extreme circumstances – for example, children of neglect (Maguire et al, 2015).
Banks and Xu (2020) use extensive data from the UK Household Longitudinal Study on health and wellbeing; but the GHQ provides a broad measure of subjective wellbeing. As a result, a degree of caution is advised as the survey was not designed with Covid-19 nor specific mental health issues in mind. Furthermore, their analysis is based on comparisons to an estimated counterfactual world of what mental health figures would be in the absence of Covid-19. This is challenging and leaves room for error. But their analysis will be further strengthened as respondents participate in future waves of the study.
What research is under way?
The Health Economics Study Group is involved in a study of ‘Short- and long-term impacts of Covid-19 restrictions on older children’s health-related behaviours, learning and wellbeing study (CONTRAST)’
LSE compiled a report on the wellbeing costs of Covid-19 in the UK, available here.
Below are the Covid-19 research and innovation related to health effects of lockdown supported by UKRI. An updated list can be found here:
- Understanding Society Covid-19 study: Michaela Benzeval, University of Essex
- Rapid evidence review: the effects of social isolation – Craig Morgan, Kings College London
- The effects of social distancing policies on children’s language development, sleep and executive functions: Nayeli Gonzalez-Gomez, Oxford Brooks University
- The impact of the Covid-19 crisis on nutrition: Martin O’Connell, Institute for Fiscal Studies
- A longitudinal mixed-methods population study of the UK during the Covid-19 pandemic: Psychological and social adjustment to global threat, Richard Bentall, University of Sheffield
- The University of Sheffield and Ulster University are studying the impact of lockdown on young people. Information can be found here.
What further evidence is needed?
New research is needed on how household habits have changed since lockdown – for example, eating, smoking, drinking, exercise, etc. – as these are often correlated with mental wellbeing. People who would not usually be categorised as ‘socially isolated’ now fall into this category. More research is needed on the effects of lockdown on a UK representative sample, that is, people who are not traditionally at risk for mental health issues due to social isolation.
Research is needed on the potential implications for wellbeing (anxiety/stress) from fewer visits to health practices (for example, for cancer treatments, urgent referrals, etc. – Payne, 2020).
Research on how front-line workers can be supported and how to mitigate stress for these individuals (Holmes et al, 2020).
Research on the easing of lockdown measures and the implications for mental health under a ‘new normal’ (for example, caution towards use of public transport, job security, etc.).
Research on screen time and how increased exposure to pandemic information and misinformation has affected mental health.
Where can I find out more?
- Effect of the 2020 COVID-19 lockdown on long-term health: Caitlin Notley speaks about the long-term health effects of lockdown.
- COVID-19, social isolation, and loneliness: A review of research on the effects of Covid-19 on social isolation and loneliness.
- The risks of social isolation: A look at the effects of social isolation and loneliness on physical, mental and cognitive health.
- Mental health deserves priority over railways: Richard Layard argues that the highest value for money in government spending comes from treating mental illness (in the Financial Times).
Who are UK experts on this issue?
- Rory O’Connor, University of Glasgow
- Michael Shields, Monash University
- Barbara Petrongolo, Queen Mary University of London
- Caitlin Notley, UEA
- Miriea Jofre-Bonet, Office of Health Economics
- Paul Dolan, LSE
- Richard Layard, LSE