People’s mental health suffered when strict COVID-19 control measures were put in place by their governments, according to two new studies.

In one longitudinal analysis drawing on data from 15 countries excluding the U.S., policies with higher stringency were associated with higher mean psychological distress scores during the first 15 months of the pandemic (standardized coefficients β=0.014, 95% CI 0.005-0.023), reported Rafael Goldszmidt, PhD, of the Brazilian School of Public and Business Administration in Rio de Janeiro, and colleagues.

People living in areas with stricter containment policies also ranked lower in scores of self-reported life evaluations (β=-0.010, 95% CI -0.015 to -0.004), they noted in Lancet Public Health.

On top of policy stringency, pandemic intensity also took a toll on the mental health of residents. Countries with a higher number of deaths per 100,000 inhabitants saw residents with higher mean psychological distress scores (β=0.016, 95% CI 0.008-0.025) and lower life evaluations (β=-0.010, 95% CI -0.017 to -0.004).

For this analysis, Goldszmidt and team looked at the government response stringency of eight policies: school closures, workplace closures, cancellation of public events, restrictions on gatherings, public transportation closures, stay-at-home requirements, restrictions to domestic travel, and international travel restrictions.

When breaking down the policies individually, certain ones had a greater effect on mental health than others. After controlling for pandemic intensity, restrictions on gatherings, stay-at-home requirements, and international travel restrictions were each tied with greater psychological distress scores and lower life evaluations. School and workplace closures, public transport closures, cancellation of public events, and restrictions to domestic travel didn’t bear a significant impact on mental health.

Women tended to be more affected than men, the authors noted. More specifically, women older than 30 had a stronger negative association between policy stringency and life evaluation versus younger women.

Goldszmidt’s group also found that countries that implemented an elimination strategy as opposed to a COVID-containment strategy tended to have less stringent policies, which led to less of a mental health toll on residents. These countries also tended to see fewer deaths.

Only four countries included in the analysis pursued a COVID-elimination strategy: Australia, Japan, Singapore, and South Korea. The other 11 countries — Canada, Denmark, Finland, France, Germany, Italy, the Netherlands, Norway, Spain, Sweden, and the U.K. — had mitigation strategies.

“Governmental responses to the COVID-19 pandemic have been widely debated,” said co-author Lara B. Aknin, PhD, of Simon Fraser University in Burnaby, British Columbia, Canada, in a statement. “At first sight, it may seem that eliminator countries implemented much harsher strategies than other countries because of their widely reported international travel bans. But, in reality, people within these borders enjoyed more freedom and less restrictive domestic containment measures overall than citizens in mitigator countries.”

Echoing this, Goldszmidt added, “Mitigation strategies may be associated with worse mental health outcomes at least in part because containment measures such as long periods of lockdowns and physical distancing can impede social connections.”

“Strategies that aim to eliminate transmission while promoting early actions and targeted stringency can reduce deaths while also protecting people’s mental health in the process,” he suggested. “At the same time, governments need to provide clear and consistent information about policy measures to increase residents’ confidence in the government’s handling of the pandemic.”

This longitudinal analysis collected mental health data from the 15 countries between April 27, 2020, and June 28, 2021. A total of 432,642 adult responses to the Imperial College London-YouGov COVID-19 Behavior Tracker Global Survey were included in the analysis.

Psychological distress was measured via the four-item Patient Health Questionnaire, and life evaluation was measured with the Cantril Ladder question, which asks respondents to evaluate their current life situation on a scale from 0 to 10.

Looking Towards Australia

In the second study simultaneously published in Lancet Public Health, which focused specifically on Australia, researchers pinpointed exactly which groups bore the brunt of these mental health effects.

Using a quasi-experimental design, Mark Wooden, MSc, of the University of Melbourne, and colleagues found that lockdown was tied to a modest — but statistically significant — decline in mental health for residents.

Wooden’s group compared residents of Victoria in 2020 to those living in other parts of Australia who were not placed under a lockdown.

As was seen in the first study, lockdowns took a much greater mental health toll on women compared with men, with women seeing a 2.2-point drop in the five-item Mental Health Inventory score versus a relatively small 0.6-point drop for men.

Women who lived in apartments saw a 4.1-point drop, while those living in semi-detached houses, terraced houses, or townhouses saw an average 4.8-point drop. Women living in separated houses saw the smallest impact on mental health (1.7-point drop).

Furthermore, women in couples with children under the age of 15 saw a 4.4-point drop in their mental health score during lockdown. Interestingly, single mothers didn’t see this effect.

“This gendered effect may be due to the additional workload associated with working from home while having to care for and educate their children at the same time, heightening already existing inequalities in household and caring responsibilities,” Wooden suggested in a statement.

“It may seem unexpected that this trend did not apply to single mothers,” he added. “One reason for this may be the financial support package Australia’s federal government provided this group with as part of its economic recovery response, which could have eased concerns and anxiety about lockdowns.”

“Single mothers are more likely to have experienced life without a safety net and strong support system before the pandemic,” he continued. “As such, they may have found it easier to adapt to sudden changes than women in coupled households.”

Wooden’s group pointed out that these findings are exclusive to Australians, and may not reflect mental health implications in other countries.

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