Prevalence and predictors of general psychiatric disorders and loneliness during COVID-19 in the United Kingdom

Prevalence and predictors of general psychiatric disorders and loneliness during COVID-19 in the United Kingdom | Psychiatry Research | Volume 291, September 2020

Despite ample research on the prevalence of specific psychiatric disorders during COVID-19, we know little about the broader psychological impact of the pandemic on a wider population. The study investigates the prevalence and predictors of general psychiatric disorders measured by the 12-item General Health Questionnaire (GHQ-12) and frequency of loneliness during COVID-19 in the United Kingdom, a country heavily hit by the pandemic.

The study found:

  • Over one-fourth of British have general psychiatric disorders during COVID-19.
  • Over one-third of British sometimes or often feel lonely during COVID-19.
  • People with COVID-19 symptoms have more psychiatric disorders and are lonelier.
  • Women and young people are risky for psychiatric disorders and loneliness.
  • Employment and living with a partner reduce psychiatric disorders and loneliness.

Full paper: Prevalence and predictors of general psychiatric disorders and loneliness during COVID-19 in the United Kingdom

The divergence of mental health experiences during the pandemic

via Mental Health Foundation 

This briefing reports findings from the Coronavirus: Mental Health in the Pandemic study as of the fifth wave of data collection carried out between 18th and 22nd June. The study is led by the Mental Health Foundation, in collaboration with the University of Cambridge, Swansea University, the University of Strathclyde and Queen’s University Belfast.

While most people will exit the pandemic with good mental health, the findings of the study clearly suggest that the benefits of exiting the lockdown measures will not be enjoyed equally by all.

Divergence of experience presents a big policy challenge as there are many different groups, areas, impacts and experiences to consider. This huge variety of individual and group identities is difficult to capture in research and it is challenging to produce nuanced policy recommendations that recognise all these different experiences and their effects.  A recovery response needs to take a holistic approach that addresses social, systemic and structural inequalities rather than placing the onus on the individual.

Full detail: Coronavirus: The divergence of mental health experiences during the pandemic

NIHR: Combined drug and psychological therapies may be most effective for depression

NIHR | July 2020 | Combined drug and psychological therapies may be most effective for depression

The most effective treatment for adults with moderate depression is likely to be a combination of antidepressant drugs and psychological interventions. A new summary provides the strongest evidence to date that the combination of treatments work better than either alone.

The most recent advice from National Institute for Health and Care Excellence (NICE) comes in a clinical knowledge summary (March 2020). It suggests low-intensity psychosocial interventions such as self-help, computerised cognitive behavioural therapy (CBT), or group exercise programmes for mild to moderate depression. Routine use of antidepressants is not suggested for this group. The combination of drug and high intensity psychological therapy is reserved for those with severe depression.

Routine use of combination treatment will require increased access to psychological therapies, including computerised and group CBT as well as individual treatment.

What’s the issue?

There is clear evidence that drug-based and psychological therapies are effective treatments for depression. How these therapies compare with each other, alone or in combination, is less clear. Previous studies suggested the combination might be more effective than either alone but were not conclusive.

Combination treatment is likely to be more expensive to deliver than a single treatment. Psychological therapies are more expensive than drug treatments. Commissioners need good evidence if they are to fund psychological therapies and combination treatment. This study was designed to give more precise estimates of how effective each treatment is, to allow treatments to be ranked.

What’s new?

This meta-analysis included 101 trials, with 11,910 participants. The most commonly used psychotherapy was CBT, and the most commonly used group of drugs were the selective serotonin reuptake inhibitors (SSRIs).

The researchers considered that patients had responded to therapy if their symptoms of depression were reduced by half. They found that patients receiving combination psychological and drug therapy were most likely to respond. They were:

  • 27% more likely to respond than those receiving psychotherapy alone
  • 25% more likely to respond than those receiving drug treatment alone

There were no significant differences in response rates between psychotherapy alone and drug treatment.

Treatment acceptability was based on the number of patients who dropped out of studies. The study found that:

  • combined treatment was 23% more acceptable than drug treatment alone
  • psychological therapy alone was 17% more acceptable than drug treatment alone
  • combined treatment and psychological therapy alone were equally as acceptable

Combination treatment was superior overall for both moderate and severe depression. There were too few studies to calculate the effectiveness of these treatments on mild depression.

Why is this important?

This research suggests that, for people with moderate depression, combination treatment should be offered before antidepressants alone. Where a single treatment is chosen, the results suggest that psychological treatment is more acceptable to patients than drug treatment.

The added benefit of combined treatment is greatest for those with the highest chance of responding to either therapy alone. When considering treatment options, patient preferences, individual circumstances, and treatment history also need to be taken into account.

What’s next?

New NICE guidelines on depression in adults are planned. The existing NICE guidelines, published in 2009, recommend a stepped-care model for those with mild to moderate depression. Either psychological therapy or antidepressant drugs were offered only after earlier steps have been exhausted.

The recent NICE clinical knowledge summary (March 2020) recommends low-intensity psychosocial therapies in newly-diagnosed mild-to-moderate depression. Routine use of antidepressants is not recommended for mild-to-moderate depression unless people have a history of the condition, persistent symptoms, or another ongoing physical health problem. Combination therapy with an antidepressant and a high-intensity psychological intervention is reserved for those with severe depression.

Further research needs to focus on long-term results. Most studies included in this meta-analysis lasted eight to 16 weeks, which is not long enough to consider relapse rates. Further analysis could identify the specific groups likely to benefit from one or another treatment approach.

Source: NIHR

The mental health emergency. How has the coronavirus pandemic impacted our mental health?

The mental health emergency. How has the coronavirus pandemic impacted our mental health? | Mind 

A survey of more than 16,000 people during lockdown by the charity Mind has revealed the scale of the impact of the pandemic on people with mental health problems. Two out of three (65 per cent) adults over 25 and three-quarters (75 per cent) of young people aged 13-24 with an existing mental health problem reported worse mental health.

Full report: The mental health emergency

Access to mental health support

Commission for Equality in Mental Health: Briefing 2: Access to mental health support | Centre for Mental Health

The Commission for Equality’s second briefing explores inequalities in access to mental health services, identifying the factors that make services inaccessible, and sharing ideas that could improve access to support for people who experience inequalities.

Ideas for actions that could help to address inequalities in access to mental health support that have been shared with the Commission so far include:

  • Improve access to wider choice of flexible support
  • Prioritise links between statutory services and community organisations
  • Invest in user-led and peer support groups
  • Commission and design services in partnership with the people who need them
  • Adopt trauma-informed approaches
  • Develop a workforce that more closely reflects the local population
  • Include equality measures in mental health service access standards
  • Strengthen the Public Sector Equality Duty

Full report: Commission for Equality in Mental Health: Briefing 2: Access to mental health support

A New Social Contract for a mentally healthier society

A New Social Contract for a mentally healthier society | Centre for Mental Health 

The devastating impact of the Covid-19 pandemic demands an urgent renewal plan for the nation’s mental health to avoid crisis, according to an unprecedented coalition of over 50 voluntary and social sector organisations which has written to the Prime Minister to call for a cross-government approach to put the nation’s mental health at the heart of its Covid-19 recovery plan.

Samaritans, Mental Health UK, Mind, Rethink Mental Illness, Mental Health Foundation, Centre for Mental Health, Young Minds and the Association of Mental Health Providers are among the charities joined by voices from across the voluntary sector who warn that the system will fail to cope with an increase in demand without a comprehensive and fundamentally new approach to mental health, which both prevents and responds to the damage inflicted on the nation’s mental health by Covid-19. The coalition is asking the Prime Minister to convene a cross-governmental group to work with the sector and provide the financial and political backing to develop policy and unlock crucial funding across England.

Further detail: “Business as usual is not an option”: Prime Minister urged to create new Mental Health Renewal Plan for England

Full publication: A New Social Contract for a mentally healthier society

Lockdown: Suicide fears soar in LGBT community #covid19rftlks

via BBC News | July 2020 | Lockdown: Suicide fears soar in LGBT community

There has been a significant rise during lockdown in the UK in the number of LGBT people seeking suicide-prevention support.

Support group LGBT Hero reports 11,000 people have accessed its suicide-prevention web pages – up over 44% on the first three months of the year.

And other LGBT charities have service users who have killed themselves.

The government considers LGBT people to be at higher risk of suicide but no national data on LGBT suicides is kept.

Full news story from BBC News

Prevalence of and risk factors associated with mental health symptoms during the Coronavirus disease pandemic

Prevalence of and Risk Factors Associated With Mental Health Symptoms Among the General Population in China During the Coronavirus Disease 2019 Pandemic | JAMA Network | 1st July 2020

Question:  What are the patterns of and factors associated with mental health conditions among the general population during the coronavirus disease 2019 (COVID-19) outbreak in China?

Findings:  In this survey study with 56 679 participants across all 34 province-level regions in China, 27.9% of participants had symptoms of depression, 31.6% had symptoms of anxiety, 29.2% had symptoms of insomnia, and 24.4% had symptoms of acute stress during the outbreak. Factors independently associated with negative mental health outcomes included having confirmed or suspected COVID-19, having a relative with confirmed or suspected COVID-19, having occupational exposure risks, living in Hubei province, and experiencing quarantine and delays in returning to work.

Meaning:  The mental health burden associated with COVID-19 is considerable among the general population of China, suggesting that mental health interventions are in urgent demand during the COVID-19 pandemic, especially for some at-risk populations.

Full detail: Prevalence of and Risk Factors Associated With Mental Health Symptoms Among the General Population in China During the Coronavirus Disease 2019 Pandemic

House of Lords Library: Coronavirus: the impact on mental health

House of Lords Library | June 2020 | Coronavirus: the impact on mental health

The House of Lords Library has produced a briefing on Coronavirus: the impact on mental health.

The coronavirus outbreak has affected mental health in a variety of ways. These include:

  • the impact of lockdown on an individual’s mental health;
  • the impact on individuals with pre-existing mental health conditions prior to the pandemic; and
  • loss of funding and operational capacity for mental health services and charities.

Why is mental health affected by the Covid-19 outbreak?

The lockdown, imposed from 23 March, has significantly limited many activities that have been shown to improve mental wellbeing. These include exercise, contact with the natural world, contact with friends and relatives, and a loss of everyday routine. Generalised fear and anxiety around the Covid-19 pandemic itself may also have an impact on an individual’s mental health.

While research on the mental health impact of the current pandemic is limited, studies of previous epidemics have shown that changes in health behaviour can lead to long lasting damage to mental health. These include:

  • enduring changes in health behaviours, such as insomnia and alcohol abuse;
  • fragmentation of social engagement, such as continued avoidance of public spaces and contact with others; and
  • adverse effects on work and working routines, such as isolation caused by remote working, and stress caused by change in working patterns.

Research into previous outbreaks has also shown that health workers and patients are at increased risk of long-term mental health problems.

Read the full briefing from the House of Lords Library

Neurological and neuropsychiatric complications of COVID-19

Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study | The Lancet Psychiatry | 25th June 2020

Concerns regarding potential neurological complications of COVID-19 are being increasingly reported, primarily in small series. Larger studies have been limited by both geography and specialty. Comprehensive characterisation of clinical syndromes is crucial to allow rational selection and evaluation of potential therapies.

The aim of this study was to investigate the breadth of complications of COVID-19 across the UK that affected the brain.

To our knowledge, this is the first nationwide, cross-specialty surveillance study of acute neurological and psychiatric complications of COVID-19. Altered mental status was the second most common presentation, comprising encephalopathy or encephalitis and primary psychiatric diagnoses, often occurring in younger patients.

This study provides valuable and timely data that are urgently needed by clinicians, researchers, and funders to inform immediate steps in COVID-19 neuroscience research and health policy.

Full article: Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study