A new report suggests the pandemic only minimally impacted people’s mental health. Its results have drawn out skepticism from some mental health experts and caused others to rethink the impact of COVID-19.

Sun Y, Wu Y, Fan S, Dal Santo T, Li L, Jiang X et al. Comparison of mental health symptoms before and during the covid-19 pandemic: evidence from a systematic review and meta-analysis of 134 cohorts. BMJ 2023; 380 :e074224 doi:10.1136/bmj-2022-074224

 

“My initial reaction to the study was shock,” says Alisa Ruby Bash, PsyD, LMFT, who runs a private marriage counseling practice and works part-time at a university in the counseling center. “That definitely has not been my experience in my practice.”

The research compiles 137 studies that look at people’s general mental health, anxiety symptoms, and depression symptoms in 2018, 2019, and 2020. On average among all participants, the results showed participants experienced no changes in general mental health and anxiety symptoms from 2019 to 2020, and minimal deterioration in depression symptoms.

Sun Y, Wu Y, Fan S, Dal Santo T, Li L, Jiang X et al. Comparison of mental health symptoms before and during the covid-19 pandemic: evidence from a systematic review and meta-analysis of 134 cohorts. BMJ 2023; 380 :e074224 doi:10.1136/bmj-2022-074224

 

On average among women and female participants, some studies showed no to minimal deterioration in the three categories, while others showed no to slight improvement.

Sun Y, Wu Y, Fan S, Dal Santo T, Li L, Jiang X et al. Comparison of mental health symptoms before and during the covid-19 pandemic: evidence from a systematic review and meta-analysis of 134 cohorts. BMJ 2023; 380 :e074224 doi:10.1136/bmj-2022-074224

 

“There's just a scale of people's ability to cope; of how much they were affected by it,” Bash says of the results. “But I can't imagine anybody being unaffected with their mental health.”

Further, they say that report does not account for individual factors that could have impacted the changes—or lack thereof—in participants' mental health statuses.

Hjorthøj C, Madsen T. Mental health and the covid-19 pandemic. BMJ 2023; 380 :p435 doi:10.1136/bmj.p435

 

“While the present study clearly shows that we need not be overly concerned about the general population’s mental health in relation to the COVID-19 pandemic…Pandemic or not, there is a strong need to provide preventive mental health interventions for those most at risk of poor mental health outcomes,” they write.

Hjorthøj C, Madsen T. Mental health and the covid-19 pandemic. BMJ 2023; 380 :p435 doi:10.1136/bmj.p435

 

 

Mental health vs illness

 

To properly interpret the results of the study, it may be important to understand and distinguish between definitions of mental health and mental illness, says Mayra Mendez, Ph.D., a licensed psychotherapist and program coordinator for intellectual and developmental disabilities and mental health services at Providence Saint John's Child and Family Development Center in Santa Monica, CA

“A disorder is the product of functional interference,” says Mendez. “It's usually much more pervasive, and it's not just associated with and having an experience that is distressing, but will pass. It's more of a permanent state of being.”

The current study looks at mental health status, and anxiety and depression symptoms, which may or may not fall under anxiety and depression diagnoses per the DSM. 

Mendez said her practice did not experience a large change in their numbers of new patients—they typically have a full list of clients, with an about 10-person waitlist, which stayed relatively consistent over the last few years, she says—but they did experience an increase in appointments for some returning patients. 

In the peak of the pandemic, many of her patient’s symptoms escalated, largely for people with anxiety, Mendez says.

“If I had been seeing them once a week, those sessions either became more intense or increased to twice a week for a period of time because their anxiety was so high,” she adds. “That anxiety was mostly driven by the unknown, listening to the news too much, catastrophizing that information.”

Clients with depression tended to experience increases in confusion and a need for reassurance, she says.

 

What does mental health look like in a partially post-pandemic society

 

In her personal and professional life, Bash has seen people’s social anxieties plummet and then slowly rise since March 2020. If she could chart what she’s noticed as a trend on a graph, the time before the pandemic might be plotted on the top left of a U-shaped parabola, and losses and lockdowns during 2020 at the inflection point.

“It really got very low during the peak of the pandemic—really, really low. Now, we’re not quite at where we were pre-pandemic, but we're getting there,” explains Bash.

Mendez too notes that social reopenings have positively impacted her clients' health. For many, peak-pandemic escalations have dribbled closer to starting levels, she adds.

“Talk of death has decreased very significantly, and clients are seeing that the support that they need is still there,” says Mendez. 

 

Are we mentally okay, really?

 

While it’s important to recognize the mental health progress we’ve made, it’s also important to recognize how much farther we still need to go, Bash says. (For example, “We've not had mask mandates for over a year, but people are affected,” she adds.)

This impact is understandable—natural even—due to the chemical impact isolation, loss, and lockdowns had on the mind, she says.

“We carved out these neural pathways of isolating ourselves—sitting at home if you're feeling a little bit off,” explains Bash. “People are much more prone now to revert to old behaviors.”

Reversing the revert could take more time still. But exactly how much will depend on the individual.

“It's an individual thing—it always has been,” says Mendez of not only ridding ourselves of pandemic behaviors but tackling any kind of mental health complication. “What the takeaway should be, is that if you have concerns and you're noticing something different in the way you are living your life, thinking through problem-solving, interacting with your world, then you need to seek help—pandemic related or not.”