Two years after SARS-COV-2 was declared a public health emergency, global estimates of excess deaths from the Institute for Health Metrics and Evaluation indicate that 18·2 million people died due to the pandemic by Dec 31, 2021—three times higher than official records suggest. 100 million people have been plunged into extreme poverty by the pandemic, according to World Bank estimates. While the true burden of COVID-19 is being unravelled, is a mental health crisis being unmasked? The pandemic has exposed long-standing gaps and a global underinvestment in mental health care and prevention, disproportionately affecting young people and women. According to WHO's Mental Health Atlas, the global median spending on mental health is still hovering at around 2% of government health expenditure. However, cases of anxiety disorders rose by 25·6% and cases of major depressive disorder increased by 27·6% globally in 2020. Immediate action is needed to strengthen mental health services to address this steeply increasing demand and to meet peoples’ needs.
Adverse mental health outcomes and psychiatric morbidity have been documented in patients with COVID-19, and concerns persist regarding the long-term health effects of COVID-19. Post-COVID-19 condition or long COVID and its potentially considerable psychological sequelae is still poorly understood. About 1·7 million people in the UK had self-reported long COVID, as of March 5, 2022, according to the latest figures by the Office for National Statistics. In this issue of The Lancet Public Health, Ingibjörg Magnúsdóttir and colleagues report that acute COVID-19 disease severity (indicated by the number of days bedridden) is associated with long-term impact on mental health. Individuals bedridden for 7 days or longer were 50–60% more likely to experience depression and anxiety symptoms.
Non-pharmaceutical interventions, physical distancing, and lockdown measures have been important public health tools to suppress COVID-19 transmission, but they also disrupted people's daily lives. School closures and confinement affected the wellbeing of children and adolescents, who showed higher levels of stress, anxiety, and depressive symptoms, according to UNICEF. The loss of schooling and the effects that might have on mental health—directly, because the loss of education could be a permanent deficit for human capital, and indirectly, because of the fractured social networks among children and young people—should be a cause of concern.
In an effort to disentangle the impact of lockdowns on mental health from the direct effects of the pandemic, Peter Butterworth and colleagues used a quasi-experimental approach, enabled by the localised lockdown in the state of Victoria, Australia, and found that lockdowns had a small, but independent, effect on population mental health. However, the study also suggested that mental health impacts could be worse for some groups and thus widen existing inequalities.
Countries have used different levels of policy stringency to curb the spread of COVID-19. Lara Aknin and colleagues report, also in this issue, the association between COVID-19 policy restrictions and mental health during the pandemic. More stringent COVID-19 policies were associated with poorer mental health—higher psychological distress and lower life satisfaction. Such findings should be important in informing future pandemic response strategies, and the enhanced support that is needed to balance the potential negative effects of necessary public health measures.
The content in this issue of The Lancet Public Health and research published elsewhere have made a start in documenting the mental health impacts of the COVID-19 pandemic and its associated policy responses, but the full public health implications of the pandemic are broad and much remains to be understood. The pandemic has affected all areas of health and wellbeing and is not only a public health crisis but also a social, economic, and political one. Lessons must be learned to ensure that future public health crises are met with resilience, unity, and equity. We invite submissions (Viewpoints or Essays) to reflect on the public health challenges and opportunities in the post-COVID-19 age. We encourage authors to be critical and visionary. We welcome submissions from early-career researchers, frontline public health workers, academics, and policy makers. The deadline for submission is July 1, 2022.