July 2, 2021, by Brigitte Nerlich

Coronavirus and mental health: Risks, protective factors and care

This is a guest post by Dr Rusi Jaspal who is Professor of Psychology at Nottingham Trent University in the UK. E-mail: rusi.jaspal@ntu.ac.uk Twitter: @ProfRJaspal

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For several years, my colleagues and I have studied the effects of major social change on people’s sense of identity and psychological wellbeing. We have done so primarily through the lens of Identity Process Theory which was designed to shed light on how we cope with change and the consequential modifications we make to our sense of identity. In the Identity Change Research Group, we have been particularly focused on how people – from diverse backgrounds – construct, manage and protect their identity when something disruptive occurs.

When we first learned of the outbreak of coronavirus in Wuhan in December 2019, we began to think about what this meant for people’s identities and psychological wellbeing. Given the dearth of data on psychological wellbeing and coronavirus at the time, Professor Brigitte Nerlich and I used knowledge we had generated in other areas (such as responses to social representations of risk, climate change, and uncertainty) to try and predict how people might respond to coronavirus. With colleagues in the UK and Lebanon, I subsequently designed empirical studies of mental health in this context.

We had many questions. Would the necessary prevention measures (such as lockdown and social distancing) accentuate psychological problems we were already aware of, such as social isolation and loneliness? Would this result in poor mental health? If so, what could we do to promote greater self- and other-protection while also reducing insidious effects on mental health? Would some of us be more affected than others? Using a combination of experimental, cross-sectional and interview methods, we have now conducted several empirical studies of mental health during the pandemic. Given that we were dealing with a global pandemic, we were keen to understand not only the UK perspective but also how coronavirus was affecting people in other countries and cultures.

What are the mental health challenges?

Negative affect – in particular, fear of coronavirus – has consistently been high in the various studies we have conducted. Fear has been shown to be an adaptive response in some contexts, but we also found evidence that it was positively related to depression and anxiety in convenience samples in the UK and Lebanon. We also found a distinction between fear, which appeared to be a maladaptive response to the pandemic, and perceived risk of infection, which was more adaptive in that it was associated with pro-active preventive and self-protection behaviours. It was clear that the pandemic and the strategies implemented to control it were threatening people sense of identity, resulting in changes to levels of self-esteem, continuity, distinctiveness and self-efficacy. The uncertainty associated with the pandemic (associated partly with the changing incidence and government guidance) appeared to be accentuating these threats to identity.

In addition to identity threat, depression and anxiety, we also found – early on in the pandemic – that exposure to news about coronavirus appeared to be precipitating symptoms of more severe psychopathology, namely paranoia and hallucinatory experiences, in people with no previous mental health diagnosis. We found evidence that even thinking about coronavirus (something that most of us are doing as we monitor developments in the pandemic) constitutes a psychological ‘stressor’ with the capacity to undermine mental health. Our research suggested that, in order to cope with these ‘stressors’, some people were engaging in behaviours that were detrimental to their health and wellbeing, such as ‘panic buying’, self-harm and sexual risk-taking. Yet, the story was not the same for everyone – some people in some contexts were clearly at disproportionately high risk of negative psychological outcomes.

The risk factors

We wanted to understand the possible risk factors for poor mental health. Just after the lockdown was announced, we conducted a cross-sectional survey of 411 people and found that religious minorities, those with a diagnosed mental health disorder and those with reduced social support exhibited higher fear of coronavirus and were more likely to engage in panic buying behaviours. Moreover, early on in the pandemic it became clear that some ethnic minority groups (i.e., Black, Asian and Minority Ethnic or ‘BAME’ communities) were at greater risk of infection and of poor physical health outcomes. We also began to examine the potential risk factors for poor mental health in these communities due to the pandemic.

The first key observation was that not all ‘BAME’ communities were affected in quite the same way. For instance, in one study, we found that Black British people were at higher risk of fear of coronavirus, depression and anxiety through the mediating variable of discrimination. In other words, the more discrimination one reported, the more fearful one felt of coronavirus, which in turn was associated with these poor mental health outcomes. Protective factors included feeling part of religious/ ethnic communities and stronger sense of Britishness. Yet, some minority groups perceived their religious and ethnic groups to be stigmatised and clearly believed that Britishness was inaccessible to them as ethnic minorities. In another study, we examined how ethnic and sexual minorities (specifically, British Asian gay men) were experiencing the lockdown and found that many felt unsafe about the circumstances that the pandemic had produced – i.e., that they might be discriminated against by significant others (especially family members) during lockdown. All this seemed to reinforce our hypothesis that social connectedness and integration in relevant social groups were protective against poor mental health in relation to coronavirus but that there were clearly disparities.

We were also acutely aware of the global nature of coronavirus in the sense that the negative consequences of the pandemic might be more acutely felt in some societies. My PhD students Dr Ismael Maatouk, Moubadda Assi and I conducted a series of studies in Lebanon and found that political and economic instability, in particular, was accentuating poor mental health. More specifically, we found that decreased political trust in Lebanon was associated with higher rates of self-harm and that lower income was related to increased suicidal ideation. People were clearly concerned about their livelihoods and about the government’s inability to manage the crisis effectively, which appeared to be taking its toll on their mental health.

The protective factors

Our research has repeatedly shown that there are some social psychological factors that appear to be protective against the negative psychological impacts of the pandemic. Professor Dame Glynis Breakwell and I developed the concept of identity resilience, which can be seen as a self-schema akin to a trait. Identity resilience is said to be high when individuals perceive their identity to be characterized by a high overall combined rating of their self-efficacy, self-esteem, continuity and distinctiveness. We found that this was inversely associated with fear of coronavirus and uncertainty about the pandemic – both triggers for identity change. We have also found that trust – in politics and politicians and in science and scientists – is associated with less uncertainty and less fear of coronavirus, suggesting that we need to promote greater trust in the general population. Needless to say, this can be challenging in view of (perceived) government failings, political and economic instability (in some societies) and indeed the misinformation and conspiracy theorizing that have surrounded online debates about coronavirus. Furthermore, feeling socially connected with others (itself challenging during the era of social distancing) is consistently associated with more favourable mental health outcomes.

What can psychology offer us?

The role of psychology in understanding and responding to the pandemic is considerable. Social psychology has much to offer by way of theories, methodological tools and empirical insights that can shape public policy. Promoting greater trust in institutions and making it easier to access social support appear to be especially important. Effective science communication and public participation in science will be valuable means of doing so. Social psychology shows us that the ‘framing’ of coronavirus, that is, whether it is represented as a hazard which can be prevented and managed or fatalistically as a deadly virus, is important. We can choose to represent the virus in ways that will resonate with people and spur action, rather than inaction.

Clinical psychology also has many tools that can be used to manage the mental health crisis associated with the pandemic. Existing resources, including the digitised Computerized Cognitive and Behavioural Therapy (CBT) at Step 2 in the National Health Service (NHS) in the UK, will need to be adapted to the specific stressors that social psychological research is currently revealing. We have argued that tailored digitised CBT, which includes components of mindfulness, could be especially effective. In particular, digitised CBT would do well to focus on the management of stress, worry and fear, as well as distressing thoughts in the context of COVID-19 (e.g., sudden unemployment, social isolation, possible death, etc.). In some contexts, the challenge will be to promote public confidence in mental health services so that people can actually benefit from them.

Our research has shown that any public health or psychotherapeutic intervention must be tailored to COVID-19 as it plays out in specific cultures, communities and countries. There can be no ‘one size fits all’ approach to managing the mental health burden of the pandemic. Social psychology must continue to play a key role.

Further reading

Assi, M., Maatouk, I., & Jaspal, R. (2021). Depressive and anxious symptomatology in a Lebanese sample during the COVID-19 outbreak. International Journal of Health Promotion and Education. https://doi.org/10.1080/14635240.2021.1950561 

Breakwell, G. M., Fino, E., & Jaspal, R. (2021). COVID-19 preventive behaviours in White British and Black, Asian and Minority Ethnic people in the UK. Journal of Health Psychology. https://doi.org/10.1177/13591053211017208

Jaspal, R. & Breakwell, G. M. (2021). Social support, perceived risk and the likelihood of COVID-19 testing and vaccination: Cross-sectional data from the United Kingdom. Current Psychology. https://doi.org/10.1007/s12144-021-01681-z

Jaspal, R., & Breakwell, G. M. (2021). Socio-economic inequalities in social network, loneliness and mental health during the COVID-19 pandemic. International Journal of Social Psychiatry. http://doi.org/10.1177/0020764020976694

Jaspal, R., Fino, E., & Breakwell, G. M. (2021). The COVID-19 Own Risk Appraisal Scale (CORAS): Development and validation in two samples from the United Kingdom. Journal of Health Psychology. http://doi.org/10.1177/1359105320967429

Lopes, B., Lopes, P., & Jaspal, R. (2021). The impact of COVID-19 news reporting on state depression in a United Kingdom sample: A preliminary experimental study. Studies in Psychology. https://doi.org/10.1080/02109395.2021.1950461 

Maatouk, I., Assi, M., & Jaspal, R. (2021). Self-harm and suicidal ideation during the COVID-19 outbreak in Lebanon: A preliminary study. Journal of Health Research. https://doi.org/10.1108/JHR-01-2021-0029

Nerlich, B., & Jaspal, R. (2021). Social representations of ‘social distancing’ in response to COVID-19 in the United Kingdom media.Current Sociology. https://doi.org/10.1177/0011392121990030

Breakwell, G. M., Fino, E., & Jaspal, R. (2021). The COVID-19 Preventive Behaviours Index: Development and validation in two samples from the United Kingdom. Evaluation & the Health Professions44(1), 77-86https://doi.org/10.1177/0163278720983416

Breakwell, G. M., & Jaspal, R. (2021). Identity change, uncertainty and mistrust in relation to fear and risk of COVID-19. Journal of Risk Research24(3-4), 335-351https://doi.org/10.1080/13669877.2020.1864011

Jaspal, R. (2021). Identity threat and coping among British South Asian gay men during the COVID-19 lockdown. Sexuality and Culture25(4), 1428-1446https://doi.org/10.1007/s12119-021-09817-w

Jaspal, R. (2021). Panic buying in the community as a coping strategy in response to COVID-19. Health Psychology Update30(2), 3-10. https://shop.bps.org.uk/health-psychology-update-vol-30-no-2-autumn-2021

Jaspal, R., & Lopes, B. (2021). Discrimination and mental health outcomes among British Black and South Asian people during the COVID-19 outbreak in the United Kingdom. Mental Health, Religion & Culture, 24(1), 80-96https://doi.org/10.1080/13674676.2020.1871328

Jaspal, R., Assi, M., & Maatouk, I. (2020). The potential impact of the COVID-19 pandemic on mental health outcomes in societies with economic and political instability: the case of Lebanon. Mental Health Review Journal25(3), 215-219. https://doi.org/10.1108/MHRJ-05-2020-0027

Jaspal, R. Lopes, B., & Lopes, P. (2020). Fear, social isolation and compulsive buying in response to COVID-19 in a religiously diverse sample in the UK. Mental Health, Religion and Culture31(5), 427-442.https://doi.org/10.1080/13674676.2020.1784119

Jaspal, R., Lopes, B., & Lopes, P. (2020). Predicting social distancing and compulsive buying behaviours in response to COVID-19 in a United Kingdom sample. Cogent Psychology, 7(1), 1800924https://doi.org/10.1080/23311908.2020.1800924

Jaspal, R., & Nerlich, B. (2020). Social representations, identity threat and coping amid COVID-19. Psychological Trauma: Theory, Research, Practice and Policy, 2(S1), S249-S251. http://doi.org/10.1037/tra0000773

Lopes, B. Bortolon, C., & Jaspal, R. (2020). Paranoia, hallucinations and compulsive buying during the early phase of the COVID-19 outbreak in the United Kingdom: a preliminary experimental study. Psychiatry Research293, 113455https://doi.org/10.1016/j.psychres.2020.113455

Lopes, B., & Jaspal, R. (2020). Understanding the mental health burden of COVID-19 in the United Kingdom. Psychological Trauma: Theory, Research, Practice and Policy, 12(5), 465–467.http://doi.org/10.1037/tra0000632

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