A look at the psychological burdens of COVID lockdowns

 A look at the psychological burdens of COVID lockdowns

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Two men cary a bench.

Enlarge / Municipality employees remove the famous blue chairs on the “Promenade des anglais” in Nice, southern France, in order to limit opportunities for people to gather.

With the dramatic rise in infections in the United States, there’s increasing discussion of whether states need to go back to severe social restrictions or even lockdowns, in which only essential workers are allowed to leave their homes. But many people aren’t happy about the idea of re-entering lockdowns because lockdowns exact both an economic and an emotional cost.

While we’re likely to get lots of hard data on economic costs eventually, some researchers in New Zealand decided to look at the emotional toll. They performed a detailed survey at the height of lockdown and found that, as expected, the restrictions had an impact on people trapped in their houses for weeks. But the impact was more pronounced on the young and those who had experienced psychological distress previously.

Lockdown NZ

The public health officials who advocate for lockdowns in response to soaring infection rates recognize that lockdowns exact an emotional toll on people who have to stay in their homes. The trade-off for this toll is the avoidance of death, severe illness, overloading of healthcare systems, etc. And the lockdowns are meant to be temporary; once infection rates drop sufficiently, then less draconian control measures (like social distancing, limiting gatherings, and mask use) can keep the infection rates low.

Understanding how to balance these costs and benefits requires some degree of quantification—we’d like to know both how effective lockdowns are at limiting infections, as well as a sense of their economic and emotional costs. It’s this last bit, the psychological cost of lockdowns, that was the focus of a team of researchers from New Zealand’s University of Otago.

In some ways, New Zealand is the ideal place for that sort of study. Its lockdown was severe: all schools and non-essential businesses were shut, and everyone not deemed an essential worker was required to stay at home for over 30 days. That was the most restrictive approach adopted by any high-income country. Before the COVID-19 pandemic had even started, the country’s public health services had regularly surveyed the population to get a sense of its mental health, providing heaps of data for comparison.

About the only limitation of using New Zealand was that its lockdown and travel restrictions were so successful that very few in the country ended up with direct experience of just how severe the unchecked spread of SARS-CoV-2 could be.

The research team did an extensive survey on days 19 to 223 of the lockdown, reaching a total of over 2,000 residents. While these weren’t perfectly representative of the country’s demographics, there were enough that the researchers could adjust their responses to proportions that were representative.

Many of the questions focused on living situation—how many people shared the home, was there access to personal and outdoor space, and so on. Beyond that, the questions largely used the same measures of mental health that had been used in previous surveys of the New Zealand population: the Kessler Psychological Distress Scale, the Generalised Anxiety Disorder Assessment, and the World Health Organization Well-Being Index.

Not happy

Over 80 percent of the people surveyed described themselves as happy with their living arrangements, and a similar number said that their overall health was good during the lockdown. Twenty percent worked in jobs that were considered essential and so were leaving the house regularly. Roughly a quarter indicated that they had a condition that put them at high risk should they contract COVID-19. So, based on these numbers, there doesn’t seem to be anything especially unusual about the survey population.

Despite being happy with their living arrangements, plenty of those surveyed weren’t especially happy overall. About 30 percent scored above the cutoff that would mark them as having at least moderate psychological distress. This was particularly pronounced among younger participants—just under half of the 18-24 age group reported that level of distress. When it came to anxiety, just over 15 percent scored in the moderate-to-severe category. As with distress, anxiety dropped as people got older. Just under 40 percent reported poor well-being on the WHO scale (with only 9 percent falling in the excellent category).

In pre-pandemic surveys, only about 8 percent of the population reported distress, while only a quarter had reported poor well-being based on the WHO scale. So, it’s clear that the lockdown conditions seemed to be making things more difficult for people. About 20 percent of the population had a previous diagnosis of a mental health condition, but they only accounted for about 10 of the 30 percent who were in distress during lockdown. About half of those who had a previous diagnosis felt like things had gotten worse during the pandemic, while only 15 percent felt that things were better during lockdown.

Six percent of the population had thoughts of suicide during the lockdown, which isn’t good. But over 80 percent of those had had similar thoughts prior to the onset of lockdown, so most of this may have involved triggering an underlying tendency.

Always look on the bright side

Despite all of this, a surprising number of those surveyed saw bright spots in the lockdown. About 45 percent of respondents found some positive aspects for themselves personally, while 38 percent felt that there were positive aspects for society. The positive responses ranged from the chance to spend more time with family to an enjoyment of the lower noise and pollution that resulted from fewer people leaving their houses. A number also enjoyed working from home.

So, the data confirms what everyone has suspected: lockdowns come with a psychological cost. But beyond that, the data offers an abundance of potentially helpful information. This includes identifying people who may be most at risk for problems due to an extended lockdown: younger adults and those with a history of mental health diagnoses. These individuals could potentially be targeted by public health officials in ways that can minimize the impacts of the lockdown. The data also suggests that there are things people might find valuable in the lockdown, which could be emphasized in order to make people more conscious of them.

With more mental health programs in place, it might be possible to minimize the emotional costs of lockdowns and shift the balance of benefits toward more aggressive control of the pandemic. And, given the recent rates of infection, a lot of countries are likely to face a second lockdown in the near future.

PLOS ONE, 2020. DOI: 10.1371/journal.pone.0241658  (About DOIs).