Expert Reaction: Mental health impacts of NZ lockdown revealed

The results of this study fit broadly with other evidence about alcohol consumption over lockdown here and internationally. Results suggest a large proportion of Kiwis had stable consumption levels, but that drinking patterns changed for many others. About one in five Kiwis in this study reduced their drinking during lockdown, and this may have been through personal choice to simply not drink as much as usual, or because their usual consumption patterns revolved around drinking with friends (which they couldn’t do during lockdown).

More concerning is the roughly one in five Kiwis who increased their usual drinking habits over lockdown. It would have been great if the authors had been able clarify whether this group differed to the other groups on any of the key study variables. However, if these results align with what we know about heavier drinking around the world, then it is possible that the group that consumed more alcohol over lockdown did so as a means to reduce the stress of lockdown and/or to reduce loneliness, depression, or anxiety.

In February, the Department of Psychological Medicine, King's College London, completed a rapid review of the research examining the impact of quarantine (self-isolation) on wellbeing and mental health. The review strongly indicated that quarantine can have significant and long-lasting impacts on individuals.

It is therefore unsurprising that the University of Otago’s cross-sectional on New Zealanders psychological distress during our level 4 lockdown recorded similar findings. The results demonstrated a significant rise form baseline measurements for psychological distress and anxiety, and a decrease in overall wellbeing.

It is important to remember that whilst this study has recorded important information at a specific point in time, it is snapshot data. Given the ongoing global impact of COVID-19, collection of longitudinal data will enable a richer understanding of the relationship between New Zealanders’ mental health and the health, social and economic impacts of this pandemic.

This study by the University of Otago provides a unique snapshot of the wellbeing of Kiwis during the midst of lockdown. Real-time data is often hard to get as it takes a lot to get research up and running quickly enough to tap into people’s feelings ‘live’ rather than how they remember they were weeks or months ago.

The data confirms in many ways what was expected: that many Kiwis were distressed and anxious in the midst of the lockdown. However, the study also shows a few interesting twists: about a third of New Zealanders reported significant distress, and rates in younger people (18-34 years) were higher than for older people. Interestingly, rates of distress amongst women and men were quite similar, which is unusual as often women report higher levels of distress.

Although the study couldn’t tell us exactly what about the lockdown people found stressful, it is likely that a combination of health anxiety and worry about the potential economic consequences of COVID-19 played a role. Sadly, more people reported feeling suicidal and there were higher rates of family violence during lockdown too.

There were some ‘silver linings’ reported by people in the midst of Alert Level 4: working from home, more family time, and less pollution were seen as positive outcomes by almost two-thirds of people in the study.

Whilst the focus of our response to COVID-19 has now shifted onto the economy and ongoing containment on the virus, this study is a timely reminder that the virus has not only biological, but also psychological consequences. These psychological effects are likely to have a ‘long tail’ and be with us long after the virus has been contained or eliminated. The new Minister of Health will want to pay close attention to studies like this and continue investing in training of mental health professionals to inoculate the country against a future wave of mental health difficulties.

Dr Every-Palmer and her colleagues have used Dynata, a New Zealand commercial survey platform with 300,000 potential participants to survey people about their psychological experience during COVID-19 Alert Level 4. There were 2416 respondents. 

During the early part of the lockdown, 30.3% reported moderate to severe levels of psychological distress, 38% reported low levels of wellbeing, and 15% of the sample were reporting moderate to severe rates of generalized worry.

Psychological distress was higher in young people, with 47.3% of 18 – 24 year olds reporting moderate to severe levels of distress. There was no difference by ethnicity. 6.1% reported suicidal ideation, with 2.1% making active plans, and the same proportion reported having made a suicide attempt. Again, this was more common among young people

One in five stated that their alcohol intake had increased, and the same proportion were drinking less.

The majority of people reported an improvement or no change in their family structure. However, 11.1% reported that they were lonely most of the time, and 9.1% reported some event of family harm, such as sexual assault, physical assault, harassment, or threatening behaviour.

This is about twice the rate of suicidal ideation one would expect in a year from the previous New Zealand Mental Health Survey, Te Rau Hinengaro, which occurred in 2005​, and a much higher rate of family harm than in the New Zealand Crime & Victims Survey, which would give a rate of family harm of around 1.1%

The authors note there are some methodological differences between previous surveys and that most people were recruited from social media, which may stop certain disadvantaged members of society from participating.

This survey took place during Alert Level 4 lockdown, from 15th to 18th April 2020. There was a good distribution of age and gender. About a fifth of the sample were not currently in the workforce: 86% were living with others, and 81% were satisfied with their experience in their ‘bubble.’ About a quarter of the survey had health vulnerabilities. Nineteen per cent were essential workers.

The survey used three well-tested and validated measures of psychological distress, wellbeing and generalized worry. Thirty-six of the respondents believed they had been infected with COVID-19, nine had positive serology for COVID.

The results of the survey present an interesting snapshot of people’s self-reported psychological distress, anxiety and suicidality captured at the ‘peak’ of the early lockdown period.

The timing of the survey is relevant to the results, as data collection occurred just after a period of a sharp increase in COVID-19 case numbers, when public anxiety and distress were likely to be running particularly high. While the epidemiological expectation was that the lockdown would result in plateau followed by eventual decline in case numbers, for the general public, this survey took place at a time where this change in COVID-19 case numbers had not yet occurred.  

As a consequence, this snapshot may have taken place where public anxiety and distress were at a ‘peak’. It would be fascinating to see how the survey results might differ if the survey was to be repeated at this time.

That aside, the study raises a number of other points that are worth discussing. These include:

• The relatively high rates of reported severe psychological distress, anxiety, low well-being, and suicidal ideation.
• The high rates of direct experience of family violence reported by participants.

These results are consistent with international reports of how these problems can escalate and intensify during periods of lockdown, but should not be misconstrued as causal, i.e., the lockdown did not cause the problem, but instead the conditions of lockdown may have intensified pre-existing problems. 

Examples of this can be drawn from the study findings, e.g., the finding that of those who reported suicidal thoughts, over 80% had experienced suicidal ideation in the year prior to the lockdown. Reports of the escalation and intensification of family violence during periods of lockdown are also consistent with international reports.

Implications of these findings are threefold:

• Mental health and family violence response systems need to be resourced to respond to increased need during times of lockdown.
• COVID-19 response and post-crisis recovery plans need to promote women’s economic empowerment and address gender inequalities in employment and social protection systems.
• There needs to be systemic change to address the underlying causes of mental health issues and family violence whether we are in lockdown or not. This means we need to invest in and implement evidence-based prevention strategies to prevent family violence.

Further examples of steps that could be taken are available here.