How to mitigate the impact of a lockdown on mental health

At the outset of the Covid-19 pandemic, little was known about the impact of population-wide governmental lockdowns. What was known was taken 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 participated, giving 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 behaviors and a pessimistic view of society. Another 50% 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.

Lowest levels of well-being in Hong Kong and Italy

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 due 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.