Policy stringency and mental health during the Covid-19 pandemic

A longitudinal analysis of data from 15 countries

Bibliographic Data

ID23354051
AuthorsLara B Aknin (0000-0003-1712-6542, Simon Fraser University), Bernardo Andretti (0000-0002-9308-8675, Fundação Getulio Vargas), Rafael Goldszmidt (0000-0002-7580-6063, Fundação Getulio Vargas, corresponding author), John F Helliwell (0000-0001-7963-6420, University of British Columbia), Anna Petherick (0000-0001-8678-4456, University of Oxford), Jan‐emmanuel De Neve (0000-0001-5126-5496, University of Oxford), Jan-Emmanuel De Neve, Elizabeth W Dunn (0000-0003-1214-7512, University of British Columbia), Daisy Fancourt (0000-0002-6952-334X, University College London), Elkhonon Goldberg (0000-0002-4249-1907, New York University), Sarah Jones (0000-0002-5379-7231, Imperial College London), Sarah P Jones, Ozge Karadag (Earth Island Institute), Elie Karam, Elie G Karam (0000-0002-4681-8225, Saint George Hospital), Richard Layard (London School of Economics and Political Science), Shekhar Saxena (0000-0001-9385-0212, Harvard University), Emily Thornton (University of Guelph), Ashley V Whillans (0000-0002-1726-6978, Harvard University), Jamil Zaki (0000-0002-0664-2982, Stanford University)
Year2022
Volume7
Issue5
Pagese417-e426
Publication date2022-05-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueThe Lancet Public Health (JOURNAL)
Journal identifiersISSN: 2468-2667 • E-ISSN: 2468-2667
PublisherElsevier BV (PUBLISHER)
DOI10.1016/s2468-2667(22)00060-3
PMID35461592
OpenAlexW4224235823
LanguageEN
Citations received67
References cited22

BACKGROUND: To date, public health policies implemented during the COVID-19 pandemic have been evaluated on the basis of their ability to reduce transmission and minimise economic harm. We aimed to assess the association between COVID-19 policy restrictions and mental health during the COVID-19 pandemic. METHODS: In this longitudinal analysis, we combined daily policy stringency data from the Oxford COVID-19 Government Response Tracker with psychological distress scores and life evaluations captured in the Imperial College London-YouGov COVID-19 Behaviour Tracker Global Survey in fortnightly cross-sections from samples of 15 countries between April 27, 2020, and June 28, 2021. The mental health questions provided a sample size of 432 642 valid responses, with an average of 14 918 responses every 2 weeks. To investigate how policy stringency was associated with mental health, we considered two potential mediators: observed physical distancing and perceptions of the government's handling of the pandemic. Countries were grouped on the basis of their response to the COVID-19 pandemic as those pursuing an elimination strategy (countries that aimed to eliminate community transmission of SARS-CoV-2 within their borders) or those pursuing a mitigation strategy (countries that aimed to control SARS-CoV-2 transmission). Using a combined dataset of country-level and individual-level data, we estimated linear regression models with country-fixed effects (ie, dummy variables representing the countries in our sample) and with individual and contextual covariates. Additionally, we analysed data from a sample of Nordic countries, to compare Sweden (that pursued a mitigation strategy) to other Nordic countries (that adopted a near-elimination strategy). FINDINGS: Controlling for individual and contextual variables, higher policy stringency was associated with higher mean psychological distress scores and lower life evaluations (standardised coefficients β=0·014 [95% CI 0·005 to 0·023] for psychological distress; β=-0·010 [-0·015 to -0·004] for life evaluation). Pandemic intensity (number of deaths per 100 000 inhabitants) was also associated with higher mean psychological distress scores and lower life evaluations (standardised coefficients β=0·016 [0·008 to 0·025] for psychological distress; β=-0·010 [-0·017 to -0·004] for life evaluation). The negative association between policy stringency and mental health was mediated by observed physical distancing and perceptions of the government's handling of the pandemic. We observed that countries pursuing an elimination strategy used different policy timings and intensities compared with countries pursuing a mitigation strategy. The containment policies of countries pursuing elimination strategies were on average less stringent, and fewer deaths were observed. INTERPRETATION: Changes in mental health measures during the first 15 months of the COVID-19 pandemic were small. More stringent COVID-19 policies were associated with poorer mental health. Elimination strategies minimised transmission and deaths, while restricting mental health effects. FUNDING: None.

Coronavirus disease 2019 (COVID-19) · Environmental health · Geography · Government (linguistics) · Longitudinal study · Mental health · Pandemic · Psychiatry · Public health · Sample (material) · Sociology · COVID-19 and Mental Health · COVID-19 epidemiological studies · Demography · Employment and Welfare Studies · Medicine · Psychology