It is important to be cautious when drawing conclusions from the BMJ’s recent review of data concerning the effects of the covid pandemic and lockdown on mental health.
There has been a lot of interesting discussion around the review already. Let’s take a closer look at it.
People affected differently
The abstract of the BMJ review tells us that 94,411 titles and abstracts were reviewed, including data from 137 unique studies. It admits that most of the studies reviewed contained data from higher-income countries. That suggests that fewer results were available for poorer countries, which makes sense but highlights the need for more comprehensive data-gathering when it comes to global phenomena. We can easily imagine how much worse the results of a stringent lockdown and a crippling pandemic can be for people living in countries where life, in some respects at least, was already harder than it was to start with than in countries with a higher average income. In other words, different groups of people will have been affected differently by the pandemic and government policies reacting to it.
Further, while there was no overall downward trend perceptible from the data reviewed, women and female participants experienced a worsening of depression and anxiety symptoms over the course of the pandemic, which it characterises as symptoms worsening by ‘minimal or small amounts.’
Please think of the children
The BMJ review admits that it did not include the viewpoints of children, a group likely to be worst hit by the effects of the pandemic itself and the concurrent lockdown on mental health and wellbeing. As the data from 2020-2022 can only tell us about the immediate reported results of the pandemic and lockdown on the minds of the young, we should also be cautious about concluding that children were relatively unaffected. We will have to watch out for the continuing effects of two partially-lost years on the mental health of young people as time plays out and further information becomes available.
NHS data tell us that NHS referrals for mental health services increased by 16.2% in 2022. When it comes to children, the NHS reports that mental health problems in children were measured to have increased considerably from 2017 to 2021.
We should be careful not to undermine the experiences of individuals.
Furthermore, we will have to turn our attention to the effects of the pandemic and lockdown on non-western countries and the global south, if we want to achieve a clearer picture on what has happened to humanity as a whole. The BMJ review includes data from two Chinese databases, and cites an article from the New York Times mentioning that the ‘spike’ in symptoms indicating mental health problems observed during the period of the pandemic has changed the prevailing attitude in China regarding mental health. It is now, the New York Times suggests, more possible to talk about these things in China. If so, we must welcome this. However the fact that China has experienced such a significant ‘spike’ in symptoms of mental unwellness that it seems to have changed the Chinese attitude towards talking about mental health means that we should pause before concluding that the effects of 2020-2022 on mental health worldwide have been minimal.
Biases
Aside from the two Chinese databases, all data included in the review appears to have come from western countries such as Canada and Switzerland. Therefore, while the amount of data crunched by the BMJ researchers is impressive, it is nowhere near exhaustive enough to make general conclusions about the effects of lockdown on mental health, something that it recognises. For all the data that we have, there is a lot more that we do not have, such as information from countries in South America, Africa, and south Asia, as well as further data from western sources.
Considering that there remain stigma around seeking treatment for mental health issues, particularly regrettably amongst the most vulnerable groups, and remembering that the economic effects of lockdown fell of course most heavily upon those already facing financial pressure, we should remain sceptical about the likelihood that either the pandemic itself, or the concomitant lockdown, have had only a negligible effect on mental health. We should also be careful not to undermine the experiences of individuals, such as the women and children reporting worsening of mental health symptoms, who have suffered, not just as a result of the coronavirus, but of government policy regarding it as well.
For further information on research conducted, see -
Children’s mental health in a time of lock down