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The long journey to understanding the mental health impact of COVID-19

Published: 01 December 2020

John Geddes, Professor of Epidemiological Psychiatry at Oxford University, discusses the importance of looking at both the direct and indirect effects of the pandemic on mental health a month after NIHR published its dynamic themed review of 'ongoing' COVID-19.

The psychological effects of COVID-19

Infectious diseases often have major effects on long-term brain health - both psychiatric and neurological symptoms. The media has focused on the immediate effects of COVID-19, but as was shown recently in the NIHR themed review “Living with COVID”, it is equally important to consider the direct and indirect long-term consequences that COVID-19 will have on the population, particularly on mental health.

Some good work is already being done. A team of researchers from the NIHR Leicester Biomedical Research Centre put together a long-term study aiming to assess 10,000 people who've been admitted to hospital with COVID-19. ‘Post-hospitalisation COVID 19’ (aka PHOSP-COVID) is taking a multidisciplinary approach and looks at a variety of respiratory, as well as renal, cardiac and, of course, mental health outcomes.

The PHOSP-COVID Brain Working Group is investigating the long term effects of COVID-19 on mental, cognitive and neurological health – and will explore how these effects are related to individual patient characteristics and whole body health. Using patient-reported symptoms and brain imaging techniques, the group aims to identify factors and mechanisms involved and to then develop interventions and treatments that improve patient outcomes.

The working group’s core membership and coordination is provided by the NIHR Mental Health Translational Research Collaboration and Dementia Translational Research Collaboration. These collaborations bring in a community of expert researchers who are passionate about driving this research.

Clinical studies such as PHOSP-COVID will allow us to understand more clearly what the long-term effects are, and potentially why they affect some people more than others. Research is progressing well and the first results are already emerging from the study.

The psychological effects of the pandemic

But as well as examining the mental health effect of COVID-19 itself, we also need to consider the effect of the other aspects of the pandemic. Professor Sir Simon Wessely and team wrote a review of the psychological impact of quarantine using existing data and found it to be wide-ranging, substantial and that it can also be long-lasting.

Additionally, there are likely to be different mental health impacts on contrasting populations of people. We already know that COVID-19 targets a disproportionate number of people from BAME backgrounds. But what about the mental health impact on those who live in a tower block and have limited access to green space? Or those with young children at home who have struggled to work? It’s completely different. Hopefully, the recent NIHR and UKRI funding for research on mental health and COVID-19 will help us understand with more nuance how different people are affected.

One thing we clearly need to avoid doing is using alarmist language such as referring to a “tsunami” of mental health problems related to the pandemic. These statements, while great for a soundbite, are not particularly helpful, partly because it’s scaremongering and also because it isn’t true. When threatening things, such as a pandemic, actually happen, society can be surprisingly resilient in some ways. For example, a study which looked at the long-term mental health effects on children and families, found that in the secondary school age group, anxiety actually reduced during the lockdown in those adolescents.

What next?

That the pandemic is having a detrimental effect, both directly and indirectly, on people’s mental health is clear. With a difficult and uncertain winter to come this looks set to get worse before it gets better. But there is hope. The importance of research into COVID-19 is undeniable, and a lot of good work is and will be done by some of the country’s best researchers in the months ahead. We have to ensure that the findings coming from them are utilised in the best way and that the health and mental health of the population is protected.

John Geddes is Professor of Epidemiological Psychiatry at Oxford University and Director of the NIHR Oxford Health Biomedical Research Centre. 

Read more about the NIHR's response to COVID-19

Find out more about Post-hospitalisation COVID 19’ (aka PHOSP-COVID)

Read more about the NIHR Mental Health Translational Research Collaboration

Read more about the NIHR Dementia Translational Research Collaboration

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