The mental health of populations in middle- and high-income countries has deteriorated little or not at all during the COVID-19 pandemic, according to a large meta-analysis led by a team from McGill University. This observation, confirmed by the president of the Association of Psychiatric Physicians of Quebec, contrasts with the catastrophic portrait that has been painted in the major media and by the authors of various studies. Rather, this research reveals the great resilience shown by the majority of the population of these different states, the authors of the study point out.
This meta-analysis, which was conducted by a team of researchers from McGill, McMaster, Toronto and Ottawa universities and King’s College London, is published in the British Medical Journal (BMJ). The researchers only retained for their analysis studies that compared the mental health of a population during the pandemic – more precisely during the first year of the pandemic – with that observed before the health crisis. Of the 94,000 studies reviewed, only 137 met this scientific quality criterion. The selected studies, which covered a total of 134 different cohorts, were carried out in various middle- and high-income countries, including three in Canada.
The studies that were discarded represented “snapshots of a particular situation, in a particular place, at a particular time, and did not include a comparison with the state of the situation before the pandemic”, underlines the main author of study, Brett Thombs, professor in the Department of Psychiatry at McGill University and researcher at the Lady Davis Institute at the Jewish General Hospital.
Women more affected
To the surprise of the researchers, the analysis of these 134 studies revealed no statistically significant change in the general mental health of the populations studied between the pandemic period and the period before it. Only symptoms of depression showed a change, described as “minimal to weak”, among people aged 60 and over, university students and people belonging to a sexual or gender minority. “It means that a few more people in these categories, only a few more, have experienced episodes of depression. But it was obviously not catastrophic,” says Thombs.
In a editorial Carsten Hjorthøj and Trine Madsen from the University of Copenhagen argue that this “minimal” worsening of depression symptoms might well have occurred in the absence of the pandemic.
The study did, however, highlight the definite, albeit “minimal to low” impact of the pandemic on women, whose symptoms of depression, anxiety and general mental health problems increased during the start of the pandemic. “Symptoms affecting the female subgroup have increased a bit. So you can extrapolate that probably more women suffered from mental health issues,” says Thombs.
This disproportionate effect of the pandemic on women can be explained by their often precarious situation which made them more vulnerable during the months of confinement. “Women are more often responsible for single-parent families. They often have more family obligations, especially in raising children, than men. They often have lower incomes. Many of them work in environments that have made them more vulnerable, such as health care establishments, CHSLDs, where it was a disaster. And studies have shown that domestic violence targeting women was more prevalent during the pandemic,” says Thombs.
Psychological distress
All these results come as no surprise to the Dre Claire Gamache, president of the Association of Psychiatrists of Quebec. “It’s been clear to us from the beginning that psychiatric problems, psychiatric diagnoses, have not increased during the pandemic, nor following. We haven’t had more depression, more anxiety disorders, more post-traumatic stress syndromes that have reached diagnostic levels. But in general, it is rather a certain psychological distress which has increased during the pandemic and which is slowly normalizing, ”she says while insisting on this important distinction which is only just beginning to be made.
“If you ask people if they have felt negative emotions during COVID-19, most will answer positively. You have to separate frustration, discomfort and sadness from mental health symptoms, anxiety and depression, which you can’t cope with,” notes Thombs.
Contrary to some public health studies and several media reports that claim that the pandemic has had a devastating effect on the mental health of adolescents and young adults, the data from the meta-analysis of the BMJ showed no increase in symptoms of depression, anxiety and general mental health issues during the pandemic in this age group.
“It’s normal, anxiety [chez les ados]. It is normal in a period of learning to adult life to experience moments of stress. We don’t have to make something pathological out of it. We are in adaptation mechanisms which are completely normal and which have probably been much more stressed during the pandemic, by the fact of homeschooling and losing regular contact with friends a little ”, replies the Dre Gamache.
There is, however, a pathological condition linked to adolescence which has increased during the pandemic and which has not clearly emerged in the study, namely that of eating disorders, she underlines. “There have been significant eating disorder issues due to more isolation, more pressure within the family, more social media among young girls, so more body image comparisons, and perhaps more need to find control over food when you felt a loss of control socially, due to loss of regular school attendance and friends, and you knows that anorexia is often an issue of regaining control over one’s life”, points out the psychiatrist.
Far from the general disaster
For Brett Thombs, one of the main messages of his study is that “even if we detected a slight deterioration in the mental health of women, we clearly did not find a catastrophe, a disaster, a tsunami of mental health problems, so many terms that have been used in the media and by certain authors of studies.
“Although in general we haven’t seen a lot of change, it was certainly catastrophic for some individuals because any mental health issue can be very devastating. But we want to emphasize that in many ways people have been really resilient. People found ways to support each other. They met virtually through Zoom. On the street I live on, a group of women started exercising outside, and three years later they are still continuing. Many people suffered a lot, had terrible experiences, others felt better. Some experienced less work stress, had more time than usual with their children. The pandemic has changed their lives and allowed them to refocus on their values,” he notes.
Although the researchers observed little or no change in the mental health of the population in their study, they nevertheless emphasize the importance of improving access to mental health services. “There is a crisis in Quebec and across Canada because people with mental health issues cannot get the care they need. We definitely need to do better. And for people who have developed mental health issues during the pandemic, it’s regarding making sure they get the care they need when they need it,” says Thombs.
“The pandemic has had a much more nuanced effect than we had been presented with so far,” he adds.
In support of this finding: the results of a large study on suicide that brings together data from 21 countries indicate no increase in suicide during the pandemic, and even show a statistically significant decrease in 12 of these countries or regions .
For help concerning your mental health or that of a loved one, do not hesitate to contact the Info-Social 811 service.
