How Did Mental Health Change During the COVID-19 Pandemic?

What you need to know

• Over half of participants reported worsening mental health during the COVID-19 pandemic, but prospective symptom measures showed little change on average.
• Young people, those with prior mental health diagnoses, and unemployed individuals were at higher risk of worsening symptoms.
• Discrepancies between perceived and measured symptom changes may be due to recall biases in estimating past symptom severity.

Examining Mental Health Changes During the Pandemic

The COVID-19 pandemic has been a globally stressful experience, raising concerns about potential negative impacts on mental health. To investigate this, researchers conducted a large study in the UK examining changes in symptoms of depression, anxiety, and post-traumatic stress disorder (PTSD) from before to during the pandemic.

Study Methods

The study combined data from three cohorts:

1. The Genetic Links to Anxiety and Depression (GLAD) study
2. NIHR BioResource studies
3. The Repeated Assessment of Mental Health in Pandemics (RAMP) study

In total, 34,465 participants completed online questionnaires assessing mental health symptoms. Importantly, 12,718 participants from the GLAD study had also completed mental health assessments before the pandemic, allowing for prospective measurement of symptom changes.

The researchers used three approaches to assess changes in mental health:

1. Prospective symptom change: Comparing pre-pandemic and current symptom scores (GLAD participants only)
2. Retrospective symptom change: Asking participants to recall their pre-pandemic symptoms and comparing to current symptoms
3. Perceived change: Participants’ ratings of how their mental health had changed since the pandemic began

Perceived Worsening of Mental Health

Overall, 55.9% of participants reported that their depression symptoms had worsened since the start of the pandemic, with 15.9% saying they were “much worse” and 40% saying they were “a little worse.” Similarly, 54% reported worsening anxiety symptoms.

The rates of perceived worsening varied across the different cohorts:

• GLAD: 62.8% reported worsening depression, 62% worsening anxiety
• NIHR BioResource: 39.9% reported worsening depression, 36.5% worsening anxiety
• RAMP: 70.4% reported worsening depression, 68.9% worsening anxiety

These findings suggest that a majority of participants felt their mental health had deteriorated during the pandemic. However, the prospective symptom measures told a different story.

Prospective Symptom Changes

For the GLAD participants with pre-pandemic symptom data, the researchers found:

• A small decrease in depression symptoms (effect size d = -0.07)
• A small decrease in anxiety symptoms (d = -0.06)
• A small increase in PTSD symptoms (d = 0.04)

While these changes were statistically significant due to the large sample size, they were very small in magnitude and not considered clinically meaningful. For context, reliable change is estimated to be around 7 points on the depression scale (PHQ-9), 5 points on the anxiety scale (GAD-7), and 4 points on the PTSD scale (PCL-6) used in this study. The observed changes were much smaller than these thresholds.

Explaining the Discrepancy

Why did so many participants report worsening mental health if the prospective symptom measures showed little change? The researchers found evidence that this may be due to recall biases when estimating past symptom severity.

When asked to recall their pre-pandemic symptoms, participants tended to underestimate how severe their symptoms had been. On average, retrospective estimates were 3.11 points lower on the depression scale and 2.64 points lower on the anxiety scale compared to the actual pre-pandemic scores.

This tendency to underestimate past symptom severity could contribute to an experience of worsening mental health, even if current symptoms haven’t actually increased. If someone recalls their past symptoms as less severe than they truly were, current symptoms may feel worse in comparison.

Risk Factors for Worsening Symptoms

While average symptom changes were small, the researchers identified several factors associated with greater risk of worsening mental health during the pandemic:

Prior Mental Health Diagnoses

Having a pre-existing mental health diagnosis was associated with higher risk of worsening symptoms. This included diagnoses of:

• Depression and anxiety
• Eating disorders
• Obsessive-compulsive and related disorders (OCRDs)
• PTSD
• Autism spectrum disorder (ASD)
• Personality disorders

Demographic Factors

• Gender: Females showed higher risk of worsening anxiety and PTSD symptoms (but not depression) compared to males.
• Age: Young adults (16-25 years old) were at higher risk of worsening symptoms across depression, anxiety, and PTSD compared to other age groups.
• Employment: Being unemployed was associated with higher risk of worsening symptoms across all three domains. Being a student was associated with higher risk of worsening depression symptoms specifically.

Implications of the Findings

These results have two key implications:

1. Certain groups appear to be at higher risk for worsening mental health during the pandemic, including young people, those with prior mental health diagnoses, and unemployed individuals. These groups may need prioritized mental health support both during the ongoing pandemic and beyond.

2. There can be significant discrepancies between perceived changes in mental health and changes measured by symptom scales. This highlights the importance of using multiple assessment methods in both research and clinical practice.

The tendency to underestimate past symptom severity may contribute to feeling that one’s mental health has worsened, even if current symptoms are similar to the past. While these perceptions are still important and valid, they may not always align with other measures of symptom change.

Limitations and Future Directions

The study authors note some limitations, including:

• The sample was predominantly female and White, limiting generalizability.
• Prospective symptom data was only available for individuals with prior depression or anxiety diagnoses.
• Analyses relied on self-reported mental health diagnoses.

Future research could examine how discrepancies between perceived and measured symptom changes evolve over time, and how they may influence important behaviors like seeking mental health treatment. Additionally, investigating modifiable risk factors (e.g., emotion regulation strategies, loneliness) could inform the development of targeted interventions to support at-risk groups.

Conclusions

This large UK study found that while many people perceived their mental health as worsening during the COVID-19 pandemic, prospective symptom measures showed little change on average. Young people, those with prior mental health diagnoses, and unemployed individuals appeared to be at higher risk for worsening symptoms. The discrepancy between perceived and measured changes may be partially explained by a tendency to underestimate past symptom severity. These findings highlight the complex nature of assessing mental health changes and the importance of prioritizing support for vulnerable groups during times of widespread stress and disruption.