Covid-19, mental health and lockdowns 

The Covid-19 pandemic is affecting people's mental health. But what helps and hinders people in getting through a lockdown? A new study led by researchers at the University of Basel, Switzerland, has addressed this question using data from 78 countries across the world. The results hint at the pivots and hinges upon which the individual's psyche rests in the pandemic.

At the outset of the Covid-19 pandemic, little was known about the impact of population-wide governmental lockdowns. What was known was drawn from restricted quarantines of small groups of people. "On the one hand, such drastic changes to daily routines can be detrimental to mental health," explains Professor Andrew Gloster from the University of Basel, co-leader of the study now published in PLOS One.

"On the other hand, because the entire population was more or less equally affected during the lockdown, it remained unclear whether this impact would occur." 

To address this question, Gloster and his international colleagues conducted an online survey in 18 languages. Almost 10,000 people from 78 countries took part, providing information about their mental health and overall situation during the Covid-19 lockdown.

One in ten respondents reported low levels of mental health – including negative affect, stress, depressive behaviours and a pessimistic view of society. Another 50 per cent had only moderate mental health, which has previously been found to be a risk factor for further complications. These figures are consistent with other studies addressing the impact of the pandemic on mental health.

Overall, the responses in the different surveyed countries were largely similar. However, although no country emerged as either consistently better or worse across all outcomes, there were some differences. Hong Kong and Turkey reported more stress than other countries; the USA reported more depressive symptoms; and well-being was lowest in Hong Kong and Italy. Participants in Austria, Germany and Switzerland, on the other hand, reported significantly fewer negative emotions (negative affect) than the average level across all countries.

These differences are likely down to a combination of chance, nation-specific responses to the pandemic, cultural differences and factors such as political unrest. Beyond that, they may in part be explained by factors the researchers found to be connected to outcomes. Loss of financial income compared to pre-lockdown levels and not having access to basic supplies were consistently associated with worse outcomes. Factors that consistently improved outcomes were having social support, higher education levels, and being able to respond and adapt flexibly to the situation.

"Public health initiatives should target people without social support and those whose finances worsen as a result of the lockdown. Based on these results, interventions that promote psychological flexibility like acceptance and commitment therapy hold promise when it comes to mitigating the impact of the pandemic and lockdowns," says Gloster. Given the continued fluid development of the pandemic and its economic consequences, attention to people's mental health remains important.

Meanwhile, a study from the University of Surrey in the UK has found that practising

gratitude and looking to the future helps to safeguard mental wellbeing during Covid-19 lockdowns.

Researchers from the University of Surrey investigated the effectiveness of three psychological interventions – nostalgia, a sentimentality for the past; gratitude, recognising the good things currently in our life; and best possible self, thinking about positive elements of the future –  and how they each affect wellbeing during lockdowns. 

Personal characteristics such as emotion regulation (the ability to respond to and manage an emotional experience) and attachment orientations (how a person views their relationships to others) were also examined. It is believed that such traits may be an indicator of how an individual responds to lockdowns.

Investigating which intervention was the most effective, researchers worked with 216 participants who were each assigned to one of four groups, each one practising either nostalgia, gratitude or best possible self, plus a control group. 

Those practising a nostalgic approach were instructed to think of a sentimental memory in their life that occurred before the lockdown; for gratitude, participants were encouraged to list three things that went well in their day and why this was; and for best possible self those involved were asked to think about where they imagine themselves in the future after lockdown has lifted. Those in the control group were each asked to recall the plot of a recent television or film they had viewed. Participants were then asked about their thoughts and feelings.

Researchers found that those who participated in the best possible self and gratitude interventions reported higher levels of social connectedness than those who practised nostalgia. Those in the best possible self group were also found to experience significantly more positive emotion than those in the nostalgia group. Researchers believe that gratitude and best possible self direct attention towards positive aspects of a person's life by giving them hope and prevent individuals from dwelling on their current situation.

Amelia Dennis, a postgraduate researcher at the University of Surrey, said: "All three interventions have proven beneficial to people experiencing a difficult time in their life. However, as lockdowns have continued people have been presented with unusual challenges and many have struggled. We found that looking to the future and appreciating what is positive in our lives currently is more psychologically beneficial than reminiscing about the past. 

"The current restrictions and any future lockdowns have removed our sense of control of our lives. For the sake of our wellbeing, we need to acknowledge what we do have rather than regretting what we have lost." 

Participants were also surveyed on their personal characteristics regarding attachment and emotion regulation. Researchers found that those with low attachment anxiety (ie believe they are worthy of love) and those with lower attachment avoidance (ie inclined to feel others are trustworthy) were most likely to experience greater wellbeing during lockdown. Those with higher emotion regulation were also found to be more resilient to their current circumstances, which protects their overall wellbeing.

Jane Ogden, Professor of Health Psychology at the University of Surrey, said: "The two lockdowns last year dramatically affected our mental and emotional wellbeing and it is likely any future ones will have the same affect. Reports of increased levels of depression and anxiety are worrying because these can negatively impact upon our physical health. It is important that we understand which psychological techniques can most benefit and support people during unsettling and difficult times."