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Study explores inequalities in mental health burden of COVID-19 pandemic

Researchers in Israel have conducted a study exploring the behavioral and psychological impact of the coronavirus disease 19 (COVID-19) pandemic in an effort to understand the biological and environmental factors that may influence how individuals cope with the crisis.

The study spanned a six week period encompassing the end of the first outbreak and the beginning of the second outbreak in Israel, therefore capturing a window of time during which people may have found ways to adapt to new circumstances.

An online survey of almost 5,000 adult participants revealed inequalities in the mental-health burden associated with the pandemic. The researchers say this highlights the importance of understanding differences in people’s ability to cope with the long-term stressful challenges posed by COVID-19.

Alon Chen from the Weizmann Institute of Science in Rehovot and colleagues say such considerations could help to guide future policies and plans for coping with future waves of the pandemic.

A pre-print version of the paper is available on the medRxiv* server, while the article undergoes peer review.

Study: Stress-related emotional and behavioural impact following the first COVID-19 outbreak peak. Image Credit: Chanintorn.v / Shutterstock

COVID-19 presents multiple psychological stressors

The COVID-19 pandemic poses unprecedented challenges, affecting virtually all aspects of living and presenting multiple psychological stressors that could increase the risk for mental illness.

“The pandemic has led to the largest global recession since the Great Depression, and to extreme social isolation due to changes in educational and work activities, local lockdowns, and international travel restrictions,” write Chen and the team.

The researchers say studies investigating the mental health burden of this pandemic and potential approaches to mitigating adverse mental health consequences for vulnerable subgroups are urgently needed.

“So far, most of the work in this area has addressed the acute mental health impact of the COVID-19 pandemic, measured during the outbreak peak,” they say.

To shed light on the long-term mental health-related effects of the pandemic, the researchers collected data during the six week period between the end of the initial outbreak and the beginning of the second one.

The data, therefore, reflect a period in which people have had the opportunity to adapt to and cope with the new circumstances, rather than people’s initial reactions to the outbreak.

What did the study involve?

The researchers conducted an online survey in Israel, where adult participants were asked about COVID-19-related physiological symptoms and behaviors and the effects of the pandemic on their psychological and emotional state. The participants also provided background demographic and medical information.

The team used clinically-validated instruments to assess emotional distress, symptoms, and coping strategies, as well as questions that were specifically designed to assess COVID-19-related concerns.

Over the course of a six week period between April 28th and June 9th, 2020, the researchers obtained 12,125 responses from a total of 4,933 respondents.

“These six weeks of data collection allowed us a broad and dynamic view of the period between the first and the second outbreaks,” write Chen and colleagues.

What did the study find?

Respondents mainly reported being worried about the situation in their country and their relatives contracting the virus.

“These non-self-centered concerns may reflect an increased sense of belonging to the country and community,” suggest Chen and colleagues.

The team observed correlations between the temporal dynamics of five main distress scores and the number of new daily COVID-19 cases.

COVID-19 induced mainly non-self-centred concerns. (a-e) Blue lines represent distributions of responses for specific reasons for worry among all respondents. Orange circles represent response means. (f) Zoomed-in view of the response means shown in panels a-e. Note that all five SE ranges are shorter than the circle diameters and were thus omitted from the plot.

COVID-19 induced mainly non-self-centred concerns. (a-e) Blue lines represent distributions of responses for specific reasons for worry among all respondents. Orange circles represent response means. (f) Zoomed-in view of the response means shown in panels a-e. Note that all five SE ranges are shorter than the circle diameters and were thus omitted from the plot.

All of these scores gradually declined during the first several weeks of the study, when the numbers of new daily COVID-19 cases also declined. Around May 26th, when the number of new daily cases started to rise, the scores also rose.

However, around one week later, these distress scores began to fall, even though daily cases continued to rise.

The researchers say this presumably reflects an adaptation or behavioral habituation to the new situation.

Factors associated with higher emotional burden

A higher emotional burden was associated with living in locations of low socioeconomic status and being unemployed.

The team suggests that the level of community resources may influence an individual’s ability to cope with life challenges. Studies have previously shown that areas with low socioeconomic status, characterized by fewer resources, have been found to be more vulnerable in Israel.

Individuals who had lost their job as a result of the pandemic reported similar levels of emotional distress to those who were unemployed before the pandemic.

Furthermore, people who had become unemployed due to COVID-19 reported using significantly more stress-coping strategies than respondents who were either currently working or unemployed before the pandemic, potentially reflecting higher distress levels among unemployed individuals.

A higher emotional burden was also associated with being female and experiencing physiological symptoms.

Female respondents scored higher on the general emotional distress scale than males. They also reported experiencing more stress-related symptoms and using more coping strategies.

Specifically, females were more likely to report difficulties sleeping, an increased heart rate, and an increased appetite. They were also more likely to report contacting someone for support, exercising or meditating.

“This may suggest that more coping methods are needed to alleviate a greater sense of emotional distress,” write the researchers.

What does the team advise?

Chen and colleagues say the findings highlight the importance of understanding the biological and environmental factors that may affect people’s ability to cope with challenges posed by the COVID-19 pandemic.

“Such considerations should inform planning and policy for the following waves of the pandemic,” they write.

“In light of the dramatic increase in COVID-19 cases and the unprecedented social-economic crisis that Israel and the rest of the world are experiencing, it is of great importance to continue to investigate the long-term mental health effects of the pandemic and its consequences,” concludes the team.

*Important Notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

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