The silent pandemic: implications of COVID-19 on mental health in the European Union

The COVID-19 pandemic has indefinitely changed the global reality, forcing countries to implement unprecedented policies in the attempt to withstand the harmful effects of the medical crisis. Some of the consequences involved disconcerting rates of mortality, financial losses, economic downturn and social disruption. These factors, alongside the confinement policies and measures restricting mobility and social interaction, have severely impacted the mental health of the European population. COVID-19 has created a parallel crisis, a silent pandemic of mental ill-health with enduring effects that will outlast these difficult times. To what extent did the pandemic affect the mental health of people and what will be the long-term consequences? How did these effects reflect onto different age and social groups? The outcomes of the research studying the impact of the pandemic on mental well-being draw attention to the need of European states to prioritise the psychosocial interventions meant to combat this issue.

How did the pandemic affect the mental health of Europeans?

The outbreak of the COVID-19 pandemic has produced a series of drastic changes across all areas, affecting the lives of Europeans from their professional activity to personal connections. By March 2021, most European states had lived through a full year of restrictions regarding the economy, physical mobility and social interaction, while multiple countries had experienced national lockdowns. These unprecedented changes have taken a toll on the mental health and well-being of European citizens, faced with a double pressure: the lingering fear caused by the threat of the novel coronavirus and a series of extreme measures imposed by governments in the attempt to alleviate the medical crisis. According to the OECD Forum Network, the pandemic has „caused the risk factors for mental ill-health – financial insecurity, unemployment, fear and anxiety – to increase significantly, while protective factors – social connection, employment and educational engagement, access to exercise, routine, access to health services – have all decreased”. The harmful impact of the COVID-19 crisis on mental health has been called the „silent pandemic”, pointing to the severity of the situation and, at the same time, the urgency to take dedicated measures for this issue.

The World Happiness Report from March 2021 has confirmed a substantial increase in the frequency of mental illnesses among the general population, identifying four mechanisms by which the stress-inducing factors related to the pandemic might negatively impact the mental health of citizens. Therefore, the main factors that have been affecting the mental well-being of people include: health-related anxieties, such as the probability of being infected, the chance of being hospitalised or even dying, the possibility of infecting others and of loved ones contacting the virus or dying; worries resulting from the impact of the pandemic on a person’s financial situation, in both the short and long term; the complications resulting from domestic family arrangements during times of lockdown and, lastly, the effects of the prohibition or restriction of activities caused by the various lockdown policies.

Unfortunately, the state of mental health in the European Union already constituted a cause for concern before the emergence of the coronavirus. The Health at a Glance: Europe report from 2018 has revealed worrisome data: one in six individuals across EU states was suffering from a mental illness in 2016, which accounts for a total of around 84 million people. In the spring of 2020, at the peak of the pandemic and the lockdown measures imposed in most European countries, the rates of stress, anxiety and depression increased significantly from previous years. People are also prone to develop mental illnesses such as obsessive-compulsive disorder as a result of hypervigilance and excessive measures regarding personal hygiene meant to protect oneself from contacting the virus.

National estimates of depression prevalence in 2020 and a year prior
Source: OECD

Data collected from a number of countries illustrate the severe effect of the pandemic on the mental well-being of people. For example, at the beginning of the lockdown in France, anxiety was twice as frequent among citizens, while the level of life satisfaction notably decreased. In Italy, eight in ten individuals stated that they needed psychological support. Meanwhile, in Belgium, the prevalence of anxiety and depression doubled, increasing from an average of 11% (9.5%, respectively) to 23% (20%, respectively) in April 2020. In the same way, in the Netherlands, more than a third of the respondents reported feeling more anxious, stressed and lonely, with around 20% suffering from insomnia.

Throughout 2020 and 2021, the COVID-19 pandemic has seen fluctuations in the number of infected cases, hospitalizations and deaths, as well as in regard to the restrictions dedicated for combatting the spread of the virus. The mental health of the European population has concurrently gone up and down in waves, reaching peaks in mental suffering at the same time with peaks in deaths caused by the coronavirus infection. Additionally, mental distress seemed to be at its highest in periods when anti-COVID measures were most restrictive and decreased in prevalence during the summer season, characterized by a relaxation of the lockdown policies. In general, European countries experienced similar trends in mental health, which proved the correlation with the number of deaths, along with the stringency of restrictive measures, as seen in the example of the Netherlands, measured based on the Oxford University/ Blavatnik Stringency and Policy Index.

Population mental distress, excess deaths and confinement measures across 2020
Source: OECD

Which social groups have been most affected?

Although the pandemic has impacted the mental health of the general population to some extent, certain age and social groups have been affected on a deeper level. Frontline healthcare workers have been suffering from mental distress in particular due to the exceptionally challenging, physically and mentally-draining work that they have been performing during this time. According to a research report developed by the WHO Regional Office for Europe in 2021, health professionals are more vulnerable to mental illnesses compared to workers from other fields, experiencing higher levels of anxiety (13%) and depression (12.2%) than other professions (8.5%, respectively 9.5%). More specifically, data collected from eight European countries in April 2021 showed that 43% of frontline professionals reported suffering from anxiety disorder, with a prevalence of 27% in nurses and around 17% in medical doctors.

These results are caused by the constant exposure of medical workers to psychosocial risks such as traumatic stress, burnout, emotional fatigue, social stigma and work-family conflict. Much of the emotional trauma is caused by witnessing frequent deaths, human suffering and isolation. Ultimately, being most exposed to the virus, frontline professionals develop anxiety over the possibility of becoming infected or infecting their close ones. Time pressure and the need to make decisions quickly when faced with complex ethical dilemmas can also lead to moral injury – psychological distress experienced when acting against one’s moral and ethical principles. For instance, especially at the beginning of the pandemic, most countries were faced with an insufficiency of health resources, placing doctors in difficult situations where they were forced to distribute these resources selectively to patients based on criteria such as life expectancy.

Socio-economic status plays a key role in determining the vulnerability and resilience of individuals to mental distress. Hence, people with lower socio-economic status, with less secure employment and fragile financial situation displayed higher rates of mental illness during the pandemic. Employment represents an important factor in this case, as individuals who were able to keep their jobs during the lockdown, including those who switched to remote activity, showed less symptoms of depression and anxiety than those who became unemployed.

On the other hand, remote work poses a series of risks such as extensive working hours, constant availability, blurred boundaries between the professional and personal life, as well as social isolation, with effects that reach the mental well-being of individuals. Several studies confirmed an increase in the weekly working hours of those who worked from home and in supplemental work, which could be paid or unpaid, after the end of the schedule.

Some European countries reported an average working time of 41 to 60 hours per week for teleworkers, such as Greece, Luxembourg and Romania. In consequence, respondents to a Eurofound survey (July 2020 round) showed the effects of working long hours – feeling isolated and emotionally drained. The probability of experiencing such feelings increased with the number of hours spent performing professional tasks: 39% of employees who worked 41-60 hours from home revealed being emotionally exhausted always or most of time, while 20% were overwhelmed with feelings of loneliness and isolation. Overworking affected the work-life balance especially for parents with children of school-age, who reported being too fatigued after work to perform household chores and care for their family, as well as their performance at work because of home distractions.

Research shows that various age groups have been affected at different rates by the pandemic. Despite facing a lower risk of developing severe forms of COVID-19, young people have been suffering from higher rates of mental distress. Children, teenagers and young adults have experienced serious disruptions in their education and daily lives through school closures and remote learning. Furthermore, when embarking on the professional path towards building a career, they were inevitably confronted with a collapse in employment opportunities and weak social connections. In addition, mobility and social restrictions constitute to a certain extent the deprivation from important life experiences in the transition to adulthood.

Respondents’ negative feelings by age and gender
Source: Eurofound

Despite the vulnerability of older people (over fifty years old) to social isolation during the pandemic and increased health risk, this age segment seems to have coped better with the new reality brought by the pandemic, displaying lower rates of mental distress than younger people. In spring 2021, there was an overall increase in negative feelings, such as tension, anxiety, depression and loneliness across most social groups in the EU. However, discrepancies can also be seen regarding gender. Across age and gender groups, the lowest mental well-being in spring 2021 was registered among women aged 18–24 and 35–44, though the most significant increase in mental distress occurred among men aged 18–24.

Another vulnerable category is represented by people suffering from chronic illnesses, who are more susceptible to developing severe forms of COVID-19. Being part of the high-risk category, they suffer from high levels of anxiety and hypervigilance which puts a strain on their mental well-being and social life. Furthermore, individuals with pre-existing mental illnesses have been affected by the disruption of mental healthcare services, leading to a substantial reduction in access to facility-based services and community-based support. According on the outcomes of a European survey on the initial impact of the pandemic on this social group, carried out between September and December 2020, 51% of respondents admitted their mental health has worsened since the outbreak. While 82% were able to access mental health services when needed, 60% reported a negative change in the manner of receiving these services, which consisted mainly of phone consultations.

Future prospects and long-term effects of the pandemic on mental health

The outbreak of COVID-19 has impacted the European population on a mental level in an unprecedented way, drawing attention to the importance of alleviating the negative effects and fighting against a crisis that will most likely endure in the aftermath of the pandemic. Although the long-term psychological impact of the coronavirus is marked by uncertainty, experts warn that the mental health effects will linger on. Trauma left behind by the tragedy surrounding the past years could continue to manifest itself in ways such as an increased use of substance abuse, for instance. Moreover, researchers consider that a sizable segment of the population could suffer from mental health issues that will outlast the pandemic, including obsessive-compulsive disorder linked to contamination obsessions and cleaning compulsion, as well as general anxiety. Returning to normality will not mean, for some people, the cure for mental issues that have been triggered by the experiences of the pandemic, requiring a longer time to heal and recover. Chronic loneliness resulting from social isolation during the lockdown, among other factors, is considered to be another major concern. At the same time, unemployment or the unstable financial situation caused by the economic implications of the pandemic may affect long-term wellbeing, too. Lastly, there are also speculations surrounding the effects of COVID-19 on the perception of individuals regarding human relationships, one’s place in the society and even personal identity.

These considerations give emphasis to the need of implementing a series of measures that will address the current impacts of the pandemic on mental health and the way in which these effects will reflect onto the population in the future. In order to alleviate the negative consequences on the mental health of European citizens, national decision-makers should:

1. Engage all national stakeholders in promoting and protecting mental health

Inclusion of mental health in the national response of EU states to COVID-19 is an essential measure that improves coping skills of people during the crisis and contributes to accelerating the recovery and rebuilding of communities. To protect people from the adversities brought by the pandemic, measures have to be taken on a social and financial level to alleviate the impact of losing livelihoods and accentuating inequalities. Moreover, interventions to adapt workplace policies could help employers support workers’ fragile mental health. To reduce anxiety in the population, governments and other actors, including media outlets, need to communicate about the pandemic in a way that promotes psychological comfort and social well-being.

2. Ensure widespread availability of mental health services and psychosocial support

Access to mental health services needs to be provided in any given context. Psychosocial support may be remote, through video call, telephone or text. At the same time, support for people suffering from severe mental health conditions and psychosocial disabilities must be available at all times and in-person care should be delivered in extreme cases in a safe manner.

3. Support recovery from COVID-19 effects by building mental health services for the future

As part of the national COVID-19 recovery plan, governments should organize affordable community-based services that can address mental implications of the pandemic. Mental health care should be included in health care benefit packages and insurance schemes to ensure widespread access of the population to essential services. Research also represents a key instrument in providing an understanding of the extent of the mental health consequences the pandemic. Hence, programs addressing mental health problems need to be monitored and evaluated in order to improve their effectiveness and find better solutions for the future.

Conclusions

The COVID-19 pandemic has affected our reality on all levels. Although not the most discussed, the effects of the pandemic on the mental health of people are perhaps the most staggering. The traumatic events experienced during this harsh time and the restrictions that have indefinitely forced people to adapt to a lifestyle that is out of the ordinary have led to an alarming increase in mental distress, depression and anxiety. European states will eventually recover from the economic implications of the pandemic, but repairing the damage that it has caused on a psychosocial level will be a far more complex and long-lasting process. It is essential for governments to include mental health interventions for the current situation and for the uncertain near-future on the list of priorities for addressing the negative impact of COVID-19 on the population.

Analysis conducted by Antonia-Isabella Hapaina, MA graduate of the International Relations and European Integration Department (SNSPA) and member of the SNSPA European Studies Center. Main photo source: News Medical