Impact of Covid-19 on mental health in Europe revealed

Across Europe, depression and anxiety disorders became more common following the onset of the pandemic, reports a major review of evidence led by UCL researchers.

Later in 2020, depression and anxiety rates reduced again, but fluctuated over the following year.

The systematic review, published in The Lancet Psychiatry, pulls together evidence from 177 studies in 20 European countries to assess how the Covid-19 pandemic affected mental health across the continent for the first two years after lockdowns began.

The researchers, led by a team at the NIHR Mental Health Policy Research Unit at UCL and King’s College London, found that not only did people access mental health services less in the early stages of the pandemic as service provision was disrupted, but that service use in some areas still had not recovered two years later.

Lead author Dr Nafiso Ahmed (UCL Psychiatry) said: “We found that the Covid-19 pandemic had a considerable effect on mental health across Europe, but overall, the impacts were not as substantial as many people had predicted early on, as we did not see a ‘second pandemic’ of mental health problems.

“While there may not have been a major increase in mental health problems at the population level, for many individuals, the pandemic has had devastating consequences for their mental health. It is vital that we continue to improve mental health services as much as we can, and that we work with people with lived experience of mental illness to understand how to meet their needs.”

The researchers identified a modest rise in common mental health problems including depression and anxiety after the onset of the pandemic, which they say could be interpreted as an acute response to a global event that caused widespread disruption, fear, financial hardship, and grief. They found that this increase reverted fairly quickly, but continued to fluctuate throughout the pandemic, which may have corresponded in part to the introductions of further lockdowns.

The study team found that early in the pandemic, there was an initial period of fewer new diagnoses of mental illness, which was likely due to fewer people accessing mental health services, which were disrupted while they transitioned to being delivered remotely. Service use increased later in 2020 and through 2021, although rates of use did not return to pre-pandemic levels for many services. Use in paediatric emergency services (for mental health specifically) and community mental health services for adults of working age did eventually rise above pre-pandemic levels.

Senior author Professor Sonia Johnson (UCL Psychiatry), Director of the Mental Health Policy Research Unit, said: “The disparity we found between increased prevalence of mental health problems and reduced service use suggests that the pre-existing treatment gap in addressing mental health problems may have increased, which could have potential long-term repercussions.

“Globally, provision of mental health services has long lagged behind demand, and in recent years this demand has continued to rise without sufficient increase in service provision; while the pandemic may have played a role in worsening this treatment gap, societal factors may play a greater role in driving rates of mental illness than the pandemic itself.”

The researchers found no clear pattern of improvement or worsening of mental health problems for those with pre-existing conditions, likely due to a large variation between different people with different circumstances, although they did find some evidence of worsening symptoms for children and young people with pre-existing mental health problems.

Suicidal behaviour did not appear to change significantly overall, when pre-pandemic levels were compared to various timepoints in 2020 and 2021.

The researchers caution that while their study was a comprehensive overview of existing evidence, there is still little evidence on a wider range of mental health problems, such as psychosis or bipolar disorder, or for high-risk groups such as people from ethnic minority backgrounds or those who were more directly affected by Covid-19, so the review might have missed trends for certain groups. They say that further research is needed to understand the long-term impact of the pandemic on mental health.