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The impact on mental health of SARS-CoV-2 coronavirus infection and the various restrictions implemented to combat the Covid-19 epidemic in 2020 and 2021, including the peak periods of confinement, have been highlighted by several researchers and specialists in the field. A deterioration in mental well-being as well as an increase in depression and anxiety scores have been identified.
The repercussions of confinement were severe for the most vulnerable individuals or when it took place in particularly restrictive conditions. The feeling of constraint depended on several factors, some of which were beyond the person's control, such as the size of the living space, lack of access to outdoor space, and the duration of the confinement.
The feeling of uselessness fostered by idleness and loss of control caused by the complete absence of deadlines increased stress. Conversely, social interactions and physical activity played a beneficial role.
After this period, post-traumatic stress disorders mainly developed in individuals who were directly confronted with the death of a loved one, as well as in healthcare professionals working in intensive care units or nursing homes for dependent elderly people.
Post-traumatic symptoms have also been facilitated by a strictly enforced confinement, which caused acute but brief stress. When the stress was less intense but prolonged, it could contribute to crossing the threshold of anxiety or depressive vulnerability.
Confinement has also altered screen and substance consumption. The longer the measures have lasted and the more significant the constraint imposed on the population, the more severe the consequences on mental health have been. Facing the challenge of reducing contamination, confinement is an effective public health measure, but it should only be considered as a last resort given its deleterious effects.
The following will be about the impact on mental health of the infection caused by the SARS-CoV-2 coronavirus, known as Covid-19, but mainly about the restrictive measures implemented on an unprecedented scale to fight the epidemic. In particular, the focus will be on the consequences of lockdown measures.
In 2020, due to the initial lack of an effective vaccine or antiviral medication, and in early 2021, due to insufficient availability of the vaccines that were gradually being released, only hygiene measures aimed at slowing down contamination could reduce the impact of this viral epidemic.
To contain it, public authorities had to rely on long-standing measures such as social distancing, closure of non-essential public places, border closure, curfew, and, on several occasions, widespread lockdown. The novelty lied in their unprecedented scale of implementation.
Beyond the loss of freedom of movement and the drastic reduction of opportunities for cultural enrichment, all these measures have restricted the exercise of essential functions for human beings, such as interpersonal exchanges and physical activity. Moreover, the mass home confinement imposed for the first time in spring 2020 abruptly disrupted people's daily routines, causing a marked state of stress among the population.
In terms of mental health, it is essential not to only consider the effects of the virus on the nervous system. The fear of getting sick and the restrictive measures implemented to fight the epidemic have also played a very detrimental role.
Indeed, during the spring 2020 lockdown, the fear of insufficient availability of certain health equipment (artificial respirators, protective masks, hand sanitizer, and diagnostic tests) added to the fear of dying from the disease.
This exceptional health context has sometimes led to ethically difficult choices (selection of individuals who can benefit from intensive care measures), generating very negative reactions.
Beyond the lockdown, other prolonged restrictive measures imposed on the population have also been poorly received. For some people, they were more difficult to bear than a strict lockdown because, unlike it, they did not offer them the opportunity to rest.
Among these people, those who were teleworking during the lockdown used the same means of communication for their professional and private exchanges, which led to a confusion of spaces and burnout for some of them.
The pandemic has had an impact on people who have not been infected with the coronavirus. Thus, the mental health of the entire population has potentially been affected during this health disaster. Indeed, beyond the fear caused by the consequences of the viral infection in those who developed it, everyone has suffered the consequences of the imposed restrictions.
In healthcare professionals and other individuals directly confronted with the experience of death, the consequences have been more severe, potentially leading to post-traumatic manifestations.
Numerous studies have focused on the psychological and psychiatric consequences of quarantines on the general population or, more specifically, on healthcare professionals. Aspecific manifestations such as irritability, insomnia, fear, confusion, anger, frustration or a sense of boredom have been reported, as well as acute anxiety states and depression. Stigmatization of people exposed to contamination, which may persist after the quarantine is lifted, has also been frequently highlighted.
Quantitative studies focusing on people who were quarantined during confined epidemics have shown that they frequently report symptoms of distress, emotional expressions of anger, emotional exhaustion, irritability, stress-related symptoms, general psychiatric symptoms, depressive disorders, insomnia, or symptoms of post-traumatic stress. They also pointed to reactions such as confusion, fear, anger, sadness, loss of motivation, anxiety, and insomnia.
These research reports have shown that the longer the quarantine, the worse the mental health outcomes are, particularly in terms of post-traumatic stress, avoidance behaviors, and anger.
Among the stress factors reported in the literature, the duration of confinement, the lack of essential goods, the shortage of medical care and medications, as well as financial losses due to work interruption are the most prominent.
Since the beginning of 2020, lockdown has been considered as the best way to slow down the exponential transmission of the coronavirus and flatten the epidemic curve. In many countries, all schools and universities were closed during the spring 2020 lockdown, and in some of them, they remained closed until mid-2021. Movements were limited to the strict necessities (food shopping, healthcare, work when teleworking was not possible), and to nearby outings (especially for brief individual sports activities) during the successive lockdown periods. In spring 2020, borders, including those within the Schengen area, were closed, and air travel was nearly brought to a halt.
These unprecedented health measures gradually reduced individual freedoms. The population had to face major changes in their way of life for which they were not at all prepared.
Starting from mid-March 2020, the entire population found itself confined at home, idle and worried about the effects of the virus. The stress generated by this abrupt change in lifestyle plunged many people into a state of mental shock. Subsequently, the cumulative effects of more or less restrictive measures that were successively imposed on the population led to the expression of manifestations of suffering that could be severe.
The various lockdowns have certainly reduced the infection rate, but they have also had a significant impact on social organization and individuals. They have been stressors for populations and have increased manifestations of depression and anxiety.
The stress associated with isolation was compounded, during the first lockdown and to a lesser extent during the second, by a phenomenon of pandemic fear that also had a negative impact on the mental health of populations. The stress was not only related to the lockdown and the fear of getting sick, but also sometimes to the fear of seeing a loved one fall ill. The restriction of contacts was thus the consequence of political decisions, and also sometimes the deliberate choice of people who wished to protect themselves. Fear and self-confinement thus combined their effects with those of the constraints imposed on the population.
The restriction of social interactions and the economic and social consequences of the pandemic have been associated with a climate of uncertainty. The confinement of a major part of the population to their homes for an indefinite period, the successive or simultaneous contradictory instructions given by the authorities, the prolonged uncertainty about the outcome of the crisis, and the succession of periods characterized by constraints of varying severity raised concerns that the ongoing health catastrophe would also extend to the psychological and psychiatric domains. It quickly appeared essential to find strategies aimed at alleviating the mental burden of these measures.
According to the World Health Organization (WHO), health primarily implies a "state of complete physical, mental, and social well-being [...] not merely the absence of disease or infirmity," and mental health is a "state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community."
Being mentally healthy translates to a state of emotional, psychological, and cognitive well-being. Mental health encompasses dimensions such as a sense of purpose, hope, self-confidence, quality of personal experience, as well as many personal, marital, family, social, and occupational factors, as well as the person's own expectations.
As the lockdown not only changes the freedom of movement but also social organization, it seems relevant to study its impact on all aspects of mental well-being.
It is important to note that healthcare professionals have been subjected to specific stress factors due to their exposure to the disease as well as psychological effects resulting from taking care of patients in unfavorable circumstances. Some of these professionals have been forced to cut themselves off from their families for an extended period, either due to quarantine or extended work hours. For these individuals, quarantine has resulted in additional stress due to feelings of guilt caused by the fear of being rejected or the extra workload that their colleagues had to face due to their absence.
The environment in which people were confined had a significant impact on their well-being. The larger the surface area of the accommodation, the better the reported well-being. Living as a couple was also associated with better well-being than living alone.
Being able to go to work or even work from home was favorable to well-being. However, these data also highlight the difficulties that some may have experienced in managing a workload at home while also taking care of young children who were no longer able to attend school.
The modification of environmental constraints has led to a modification of behaviors, as well as a disruption of life rituals, and sometimes the need to increase certain behaviors or habits that provide, at least in the short term, comfort or pleasure.
It had already been experimentally shown in animals that the reduction of social ties led to stress associated with an increase in food intake, weight, and substance consumption.
Overall, the reduction in mental well-being associated with this epidemic has resulted in an increase in all types of consumption. Each type of consumption was linked to certain characteristics of the participants.
The use of screens significantly increased with the lockdown. Social isolation and stress are already known factors for increased screen time, especially among young people living in urban areas. A marked association between not working and internet use was found.
The remote work, induced by the lockdown situation, may also have explained part of the increase in screen usage, but the very significant association with stress factors also shows that screens may have been a refuge or a way of coping with the sudden void of social life imposed by the health situation and the measures put in place at that time.
The consumption of calorie-dense foods increased overall, and this was evident from the beginning of the lockdown. The following facilitating factors can be put forward: boredom, confinement, accessibility to food, major restriction of social contacts, need to seek comfort with food, particularly with snacking food, salty or sweet. Substance use has also increased.
The lockdown had a considerable psychological impact. Its consequences on mental health were even more marked when this measure was long-lasting. Some sociodemographic characteristics (age, gender, socioeconomic status, and economic situation), a history of psychiatric or general medical conditions, as well as living conditions (housing, access to stores, and work arrangements), determined the intensity of these consequences. But it is the duration of the lockdown that was a major source of stress as it was not known in advance.
However, it was still possible to promote one's well-being by choosing to engage in social exchanges and physical activity, but also by limiting screen time and structuring one's activities, diet, and sleep.
Health education interventions promoting behaviors that favor mental well-being are essential. By regaining control over their daily lives, individuals can develop their sense of self-esteem and self-confidence, and nurture their sense of well-being.